In patients evaluated for suspected newly detected atrial fibrillation, NT-proBNP was most strongly associated with AF while spirometric indices showed a weaker but directionally consistent signal, suggesting an integrated cardiopulmonary profile may serve as a hypothesis-generating additive signal supporting longer rhythm monitoring in selected patients.
Key Findings
Results
NT-proBNP was markedly higher in patients with newly detected AF compared to those without AF.
NT-proBNP levels were 684.5 pg/mL in the AF group versus 62.3 pg/mL in the non-AF group (p = 0.001).
This represented 'by far the largest between-group difference among the biomarkers assessed.'
The difference persisted even when accounting for confounders such as age, chronic kidney disease (CKD), and chronic pulmonary disease (CPD).
Formal discrimination statistics such as ROC/AUC were not computed.
The study does not support NT-proBNP as a stand-alone diagnostic tool for AF.
Results
Exploratory inflammatory markers showed only modest, non-significant differences between AF and non-AF groups.
The inflammatory markers assessed included high-sensitivity C-reactive protein (hs-CRP), neutrophil/lymphocyte ratio, and homocysteine.
Differences in these markers between groups were described as 'only modest, non-significant differences.'
No specific p-values or effect sizes were reported for these markers in the abstract.
Results
Conventional echocardiographic parameters did not differ significantly between the AF and non-AF groups.
Conventional left atrial structural and functional variables were used for echocardiographic assessment.
No statistically significant between-group differences were found for these parameters.
The study included 48 patients with newly detected AF and 116 without AF in the main comparison.
Results
In the strict complete-case comparison, spirometric indices did not reach statistical significance, though preliminary analysis showed lower values in AF patients.
The main respiratory parameters assessed were forced vital capacity (FVC), forced expiratory volume in 1 second (FEV1), and peak expiratory flow (PEF).
Preliminary project-level analysis showed lower FVC, FEV1, and PEF in AF patients, but without supporting a COPD diagnosis.
Exploratory correlations suggested a relationship between spirometric performance and left atrial function.
The respiratory signal was described as 'weaker but directionally consistent with a broader cardiopulmonary phenotype.'
Methods
The study population consisted of 164 patients retained from 536 records of patients without previously known AF who underwent 24-hour 12-lead Holter ECG monitoring.
Patients were referred for Holter monitoring due to palpitations and/or chest pain.
None of the included patients had a previously documented diagnosis of atrial fibrillation before Holter monitoring.
48 patients had newly detected AF and 116 did not have AF.
No ECG changes suggestive of myocardial ischemia were detected during Holter monitoring.
AF documented for the first time during recording was termed 'newly detected AF' rather than 'paroxysmal AF' because a single 24-hour recording cannot establish spontaneous termination or long-term temporal pattern with certainty.
Conclusions
Elevated NT-proBNP with concordant spirometric impairment was proposed as a hypothesis-generating additive signal to support longer or repeated rhythm monitoring in selected patients with suspected AF.
The authors state these findings 'do not support spirometry or NT-proBNP as stand-alone diagnostic tools for AF.'
The additive value of this combined signal 'was not formally tested against clinical models alone and requires prospective confirmation.'
The signal was considered relevant 'when interpreted alongside traditional AF risk factors and symptoms.'
The authors suggest this profile may support longer monitoring 'beyond 24 h in selected patients with suspected AF.'
What This Means
This research suggests that patients who are found to have atrial fibrillation (AF) — an irregular heart rhythm — for the first time during a 24-hour heart monitoring test show a distinct pattern involving both heart and lung measurements. The study looked at 164 adults who wore a heart monitor because of palpitations or chest pain, comparing 48 who were found to have AF to 116 who were not. The clearest finding was that a blood marker called NT-proBNP, which signals heart stress, was about 11 times higher in the AF group. Meanwhile, standard echocardiogram (heart ultrasound) measurements surprisingly did not show significant differences between the two groups. Lung function measurements (how much and how fast air can be breathed out) tended to be lower in the AF group, but this difference was not strong enough to be statistically conclusive in the most rigorous analysis.
This research suggests that looking at the combination of elevated NT-proBNP and reduced lung function together — what the authors call an 'integrated cardiopulmonary profile' — might help identify patients whose AF is being missed by a standard 24-hour heart monitor. Because AF can come and go unpredictably, a single day of monitoring sometimes fails to catch it. The authors propose that when a patient has this combined pattern of elevated NT-proBNP and slightly impaired lung function, it could be a signal worth noting, potentially justifying longer or repeated heart monitoring to catch intermittent AF episodes.
However, the study has important limitations: it was retrospective (looking back at existing records), conducted at a single center, and the lung function findings were not statistically significant in the primary analysis. The authors emphasize that neither NT-proBNP nor lung function tests should be used alone to diagnose AF, and that these results need to be confirmed in future prospective studies before any clinical practice changes could be considered.
Kundnani N, Sharma A, Rosca C, Velimirovici M, Nicoras A, Velimirovici D, et al.. (2026). Integrated Cardiopulmonary Profile as an Additive Signal in Patients Evaluated for Suspected Newly Detected Atrial Fibrillation.. Medical sciences (Basel, Switzerland). https://doi.org/10.3390/medsci14040507