ARTICLE
Natriuretic peptide levels in atrial fibrillation
A prospective hormonal and Doppler-echocardiographic study
Andrea Rossi, MD*,
Maurice Enriquez-Sarano, MD, FACC*,
John C. Burnett, Jr., MD*,
Amir Lerman, MD*,
Martin D. Abel, MD and
James B. Seward, MD, FACC*
* Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic and Mayo Foundation, Rochester, Minnesota, USA
Division of Cardiovascular/Thoracic Anesthesia, Mayo Clinic and Mayo Foundation, Rochester, Minnesota, USA
Manuscript received July 29, 1999;
revised manuscript received November 5, 1999,
accepted December 15, 1999.
Reprint requests and correspondence: Dr. Maurice Enriquez-Sarano, Mayo Clinic, 200 First St. SW, Rochester, Minnesota 55905
OBJECTIVES
The objective was to determine the independent association between atrial fibrillation (A-Fib) and activation of natriuretic peptides.
BACKGROUND
The association of A-Fib with activation of N-terminal atrial and brain natriuretic peptides (N-ANPs and BNPs, respectively) is uncertain but of great importance for the diagnostic utilization of natriuretic peptides. This uncertainty is related to the lack of appropriate controls, with left ventricular (LV) and atrial overload similar to A-Fib.
METHODS
We prospectively measured N-terminal atrial and BNPs and endothelin-1 levels in 100 patients and 14 age- and gender-matched control subjects. The 32 patients with A-Fib were compared with 68 patients in sinus rhythm and similar LV and atrial overload (due to mitral regurgitation or LV dysfunction) measured simultaneously with hormonal levels with comprehensive Doppler echocardiography.
RESULTS
Patients with A-Fib compared with those in sinus rhythm had similar symptoms, comorbid conditions, cardioactive medications, pulmonary pressure, left atrial volume, and LV ejection fraction and filling characteristics but demonstrated higher N-ANP levels (2,613 ± 1,681 vs. 1,654 ± 1,323 pg/ml, p = 0.007) even after adjustment for the underlying cardiac disease (p < 0.0001). Conversely, BNP levels were similar in both groups (165 ± 163 vs. 160 ± 269 pg/ml, p = 0.9). In multivariate analysis, a higher N-ANP level was associated with A-Fib (p = 0.0003), symptom class (p < 0.0001) and endothelin-1 level (p = 0.032) independently of left atrial volume and LV ejection fraction. Conversely, BNP showed no independent association with and was most strongly associated with LV ejection fraction (p < 0.0001).
CONCLUSIONS
Atrial fibrillation is an independent determinant of higher N-ANP levels and blurs its association with LV dysfunction. Conversely, the BNP is not independently associated with A-Fib and is strongly determined by LV dysfunction, for which it is an independent marker.
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Abbreviations and Acronyms
| | A-Fib | = atrial fibrillation | | ANOVA | = analysis of variance | | ANP | = atrial natriuretic peptide | | BNP | = brain natriuretic peptide | | CHF | = congestive heart failure | | EF | = ejection fraction | | LA | = left atrium, left atrial | | LV | = left ventricle, left ventricular | | N-ANP | = N-terminal ANP | | NYHA | = New York Heart Association |
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|
|
|
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|
|
|
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|
|
|
|
|
|
|
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|
|
|
|
|
|
|
P.A. Gould, J. D'Agostino, H.G. Schneider, and D.M. Kaye
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|
|
|
|
|
|
|
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|
|
|
|
|
|
|
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January 2, 2006;
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|
|
|
|
|
|
|
C. W. Knudsen, T. Omland, P. Clopton, A. Westheim, A. H.B. Wu, P. Duc, J. McCord, R. M. Nowak, J. E. Hollander, A. B. Storrow, et al.
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J. Am. Coll. Cardiol.,
September 6, 2005;
46(5):
838 - 844.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
P. M. McKie and J. C. Burnett Jr
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August 1, 2005;
80(8):
1029 - 1036.
[Abstract]
[PDF]
|
|
|
|
|
|
|
D. Detaint, D. Messika-Zeitoun, J.-F. Avierinos, C. Scott, H. Chen, J. C. Burnett Jr, and M. Enriquez-Sarano
B-Type Natriuretic Peptide in Organic Mitral Regurgitation: Determinants and Impact on Outcome
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May 10, 2005;
111(18):
2391 - 2397.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
P. T. Ellinor, A. F. Low, K. K. Patton, M. A. Shea, and C. A. MacRae
Discordant atrial natriuretic peptide and brain natriuretic peptide levels in lone atrial fibrillation
J. Am. Coll. Cardiol.,
January 4, 2005;
45(1):
82 - 86.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
E. Deroubaix, T. Folliguet, C. Rucker-Martin, S. Dinanian, C. Boixel, P. Validire, P. Daniel, A. Capderou, and S. N. Hatem
Moderate and chronic hemodynamic overload of sheep atria induces reversible cellular electrophysiologic abnormalities and atrial vulnerability
J. Am. Coll. Cardiol.,
November 2, 2004;
44(9):
1918 - 1926.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
G. Lonardo, E. Cerbai, S. Casini, G. Giunti, M. Bonacchi, F. Battaglia, B. Fiorani, P. L. Stefano, G. Sani, and A. Mugelli
Atrial natriuretic peptide modulates the hyperpolarization-activated current (If) in human atrial myocytes
Cardiovasc Res,
August 15, 2004;
63(3):
528 - 536.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
T. J. Wang, M. G. Larson, D. Levy, E. J. Benjamin, E. P. Leip, T. Omland, P. A. Wolf, and R. S. Vasan
Plasma Natriuretic Peptide Levels and the Risk of Cardiovascular Events and Death
N. Engl. J. Med.,
February 12, 2004;
350(7):
655 - 663.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
S. P. Wright, R. N. Doughty, A. Pearl, G. D. Gamble, G. A. Whalley, H. J. Walsh, G. Gordon, W. Bagg, H. Oxenham, T. Yandle, et al.
Plasma amino-terminal pro-brain natriuretic peptide and accuracy of heart-failure diagnosis in primary care: A randomized, controlled trial
J. Am. Coll. Cardiol.,
November 19, 2003;
42(10):
1793 - 1800.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
A. Albage, G. Kenneback, J. van der Linden, and H. Berglund
Improved neurohormonal markers of ventricular function after restoring sinus rhythm by the Maze procedure
Ann. Thorac. Surg.,
March 1, 2003;
75(3):
790 - 795.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
A. Rossi, M. Cicoira, L. Zanolla, R. Sandrini, G. Golia, P. Zardini, and M. Enriquez-Sarano
Determinants and prognostic value of left atrial volume in patients with dilated cardiomyopathy
J. Am. Coll. Cardiol.,
October 16, 2002;
40(8):
1425 - 1430.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
C. Rocken, B. Peters, G. Juenemann, W. Saeger, H. U. Klein, C. Huth, A. Roessner, and A. Goette
Atrial Amyloidosis: An Arrhythmogenic Substrate for Persistent Atrial Fibrillation
Circulation,
October 15, 2002;
106(16):
2091 - 2097.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
M. P. van den Berg, G. Tjeerdsma, P. J. de Kam, F. Boomsma, H. J.G.M. Crijns, and D. J. van Veldhuisen
Longstanding atrial fibrillation causes depletion of atrial natriuretic peptide in patients with advanced congestive heart failure
Eur J Heart Fail,
June 1, 2002;
4(3):
255 - 262.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
P. Jourdain, M. Bellorini, F. Funck, Y. Fulla, N. Guillard, J. Loiret, B. Thebault, N. Sadeg, and M. Desnos
Short-term effects of sinus rhythm restoration in patients with lone atrial fibrillation: a hormonal study
Eur J Heart Fail,
June 1, 2002;
4(3):
263 - 267.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
M Nakamura, H Endo, M Nasu, N Arakawa, T Segawa, and K Hiramori
Value of plasma B type natriuretic peptide measurement for heart disease screening in a Japanese population
Heart,
February 1, 2002;
87(2):
131 - 135.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
