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CLINICAL STUDY: ELECTROPHYSIOLOGY

Plasma atrial natriuretic peptide concentration inversely correlates with left atrial collagen volume fraction in patients with atrial fibrillation

Plasma ANP as a possible biochemical marker to predict the outcome of the maze procedure

Fumiki Yoshihara, MD^*, Toshio Nishikimi, MD^*,,*, Yoshikado Sasako, MD, Jun Hino, PhD^*, Junjiro Kobayashi, MD, Kenji Minatoya, MD, Ko Bando, MD, Yoshio Kosakai, MD^,, Takeshi Horio, MD, Shin-ichi Suga, MD^*, Yuhei Kawano, MD, Hiroaki Matsuoka, MD, Chikao Yutani, MD^||, Hisayuki Matsuo, PhD^*, Soichiro Kitamura, MD, Tohru Ohe, MD^¶ and Kenji Kangawa, PhD^*

^* National Cardiovascular Center Research Institute, Suita, Japan
Department of Hypertension and Cardiorenal Medicine, Dokkyo University School of Medicine, Mibu, Japan
Division of Cardiovascular Surgery and Hypertension, National Cardiovascular Center, Suita, Japan
Division of Cardiovascular Surgery, Takarazuka Citizen’s Hospital, Takarazuka, Japan
^|| Division of Pathology, National Cardiovascular Center, Suita, Japan
^¶ Department of Cardiovascular Medicine, Okayama University Medical School, Okayama, Japan

Manuscript received April 17, 2001; revised manuscript received September 25, 2001, accepted October 24, 2001.

^* Reprint requests and correspondence: Dr. Toshio Nishikimi, Department of Hypertension and Cardiorenal Medicine, Dokkyo University School of Medicine, Mibu, Tochigi 321-0293, Japan.
nishikim{at}dokkyomed.ac.jp

OBJECTIVES: We hypothesized that the plasma atrial natriuretic peptide (ANP) level reflects atrial degenerative change and may predict the outcome of the maze procedure.

BACKGROUND: Although a larger preoperative left atrial dimension and longer duration of atrial fibrillation (AF) have been reported in patients with persistent AF than in those with sinus rhythm (SR), these individual factors were not enough to predict the outcome of the maze procedure.

METHODS: Preoperative plasma ANP levels were measured in consecutive 62 patients who underwent the Kosakai’s modified maze procedure. Moreover, we performed histological and molecular biological examinations in the resected left atrial tissues.

RESULTS: The preoperative plasma ANP was lower in the AF group (n = 13) than it was in the SR group (n = 49) (p < 0.001). Multiple logistic regression analysis revealed that duration of AF and plasma ANP were independently associated with postoperative cardiac rhythm. Among 41 patients with a higher plasma ANP or shorter duration of AF than the median value, SR was restored in 95% of patients. In contrast, in 21 patients with a lower plasma ANP and a longer duration of AF than the median value, SR was restored only in 48% of patients. Histological examination revealed that the collagen volume in the left atrial tissue was higher in AF than it was in SR and inversely correlated with plasma ANP. In addition, the messenger RNA expressions of ANP, collagen type I and type III were lower in AF than they were in SR.

CONCLUSIONS: These results suggest that a combination of plasma ANP and/or duration of AF may predict the success rate for the maze operation. Advanced atrial degenerative change may result in a decrease of atrial ANP secretion.

Abbreviations and Acronyms   AF   atrial fibrillation   ANP   atrial natriuretic peptide   cDNA   complementary DNA   CTR   cardiothoracic ratio   LAD   left atrial dimension   mRNA   messenger RNA   SR   sinus rhythm

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