Prognostic Value of Plasma N-terminal Pro-B-Type Natriuretic Peptide (Nt-proBNP) Levels in Patients Presenting With Cardiac Arrhythmias to the Emergency Department: A Prospective Observational Study From India.

Authors

Shiwangini Jaiswal, Amit Rohila, Ankur Sharma, Mahaveer Singh Rodha, Rahul Choudhary, Bharat Choudhary, Siddhi Chawla

Published in

Cureus. Volume 18. Issue 6. Pages e110665. Epub Jun 11, 2026.

Abstract

N-terminal pro-B-type natriuretic peptide (NT-proBNP), a key marker of cardiac stress, is widely used in heart failure care. However, its role in patients presenting to the Emergency Department (ED) with cardiac arrhythmias remains underexplored.
To evaluate the prognostic significance of plasma NT-proBNP levels in patients presenting to the ED with cardiac arrhythmias and to assess their clinical profile.
A prospective observational study was conducted over 18 months, from September 2023 to December 2024, with data analysis performed from January 2025 to May 2025, in the Department of Trauma and Emergency, All India Institute of Medical Sciences (AIIMS) Jodhpur, India. Patients aged ≥18 years with various arrhythmias were enrolled, excluding those with pre-existing heart failure, renal dysfunction, or structural heart disease. NT-proBNP levels, echocardiographic findings, clinical symptoms, and laboratory parameters were recorded and correlated with immediate outcomes (rhythm reversion versus recurrence). Arrhythmia recurrence was defined as the recurrence of the same or another clinically significant arrhythmia during hospitalization or within a seven-day follow-up period.
In 194 patients with cardiac arrhythmias, 35.6% achieved rhythm reversion, while 64.4% experienced recurrence. NT-proBNP levels were significantly higher in the recurrence group (8545.53 vs. 2555.06 pg/mL, p=0.001), consistent across all left ventricular ejection fraction (LVEF) categories. Elevated NT-proBNP, sepsis, high-sensitivity C-reactive protein (hs-CRP), and low hemoglobin predicted poorer outcomes in univariable analyses, with septic shock showing the strongest adverse prognostic impact (p=0.015).
Elevated NT-proBNP levels were associated with an increased risk of arrhythmia recurrence and adverse short-term outcomes in patients presenting with cardiac arrhythmias. These associations were observed across different LVEF categories, suggesting that NT-proBNP may reflect underlying cardiac stress and overall illness severity. Sepsis and inflammatory states were also associated with poorer outcomes, highlighting the multifactorial nature of risk in this population. NT-proBNP may have utility as a risk stratification marker in the ED; however, larger prospective studies with multivariable adjustment are required to validate these findings and determine its independent prognostic value.

PMID:
42437209
Bibliographic data and abstract were imported from PubMed on 12 Jul 2026.

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