ArticleFrontiers in cardiovascular medicine2026
Integrated biomarkers and cardiac phenotypes associated with atrial fibrillation: evidence from real-world hospital data.
Article in Frontiers in cardiovascular medicine, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: This study aimed to investigate the association between the B-type natriuretic peptide (BNP)/ left ventricular ejection fraction (LVEF) and atrial fibrillation (AF) and to evaluate its discriminative performance in a real-world hospitalized population. Methods: We conducted a hospital-based observational study that included 270 consecutive patients hospitalized at the Second Affiliated Hospital of Wannan Medical University between August 2023 and December 2025. BNP/LVEF was calculated by dividing plasma BNP levels by LVEF measured by transthoracic echocardiography. AF was diagnosed based on cardiac rhythm recordings during hospitalization or physician diagnosis. We used a multivariate logistic regression model to analyze the association between BNP/LVEF and atrial fibrillation. Restricted cubic spline analysis was used to explore potential non-linear relationships. Receiver operating characteristic (ROC) curves were used to assess discriminatory performance, and pre-specified subgroup analyses were performed to evaluate effect modification. Results: Among 270 patients, 123 (45.6%) had atrial fibrillation. In all adjusted models, higher BNP/LVEF values were independently associated with an increased risk of atrial fibrillation in fully adjusted model (OR, 1.02; 95% CI, 1.01-1.04). Restricted cubic spline analysis revealed a significant non-linear association (P-nonlinear 0.001), with a sharp increase in the risk of atrial fibrillation at lower BNP/LVEF levels, followed by a plateau. BNP/LVEF demonstrated good discriminatory ability for atrial fibrillation (AUC = 0.84) in the full unadjusted model. Subgroup analysis showed significant heterogeneity across sex, smoking, alcohol consumption, and coronary heart disease status. Conclusion: BNP/LVEF is independently and nonlinearly associated with atrial fibrillation and demonstrates good discriminative performance. This integrative marker may provide clinically useful information for AF risk stratification in hospitalized patients.
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