Top

Published in:

01-02-2019 | Original Paper

Independent effect of atrial fibrillation on natriuretic peptide release

Authors: Marek Sramko, Dan Wichterle, Vojtech Melenovsky, Janka Franekova, Marcell Clemens, Masato Fukunaga, Josef Kautzner

Published in: Clinical Research in Cardiology | Issue 2/2019

Abstract

Background

We investigated whether the increase of plasma natriuretic peptides (NPs) in atrial fibrillation (AF) is independent of the effect of AF on the left atrial (LA) hemodynamics.

Methods

Hemodynamically stable patients scheduled for AF ablation underwent assessment of B-type natriuretic peptide (BNP) and mid-regional pro-atrial natriuretic peptide (MR-proANP), echocardiography, and direct measurement of left atrial (LA) pressure. Concentrations of the NPs were compared between patients in AF (n = 31) and controls in sinus rhythm (SR; n = 31) who were matched for age, gender, heart rate, left ventricular ejection fraction, LA volume index, and directly measured mean LA pressure. Eighteen patients underwent serial measurement of NPs and LA pressure during native SR and after 20 min of pacing-induced AF.

Results

Compared to the patients in SR, the patients in AF had 2.6 times higher unadjusted BNP [median (inter-quartile range), 101 (63, 129) vs. 38 (26, 79) ng/L] and two times higher unadjusted MR-proANP [183 (140, 230) vs. 91 (67, 135) pmol/L; both p < 0.001]. Concentrations of both NPs correlated with mean LA pressure in the patients in SR (r = 0.75 for BNP and 0.62 for MR-proANP, both p < 0.001) but not in the patients in AF (r = 0.18 and 0.04, respectively, both p > 0.3). Both NPs increased significantly during induced AF [adjusted median (IQR) relative change, BNP: 27 (22; 40)%, MR-proANP: 75 (64; 99)%, both p < 0.001] without a significant change in the LA pressure.

Conclusions

The increase of NPs in AF was independent of its effect on the LA hemodynamics.

Kotecha D, Lam CS, Van Veldhuisen DJ, Van Gelder IC, Voors AA, Rienstra M (2016) Heart failure with preserved ejection fraction and atrial fibrillation: vicious twins. J Am Coll Cardiol 68(20):2217–2228. https://doi.org/10.1016/j.jacc.2016.08.048 CrossRefPubMed

Bai M, Yang J, Li Y (2009) Serum N-terminal-pro-brain natriuretic peptide level and its clinical implications in patients with atrial fibrillation. Clin Cardiol 32(12):E1–E5. https://doi.org/10.1002/clc.20478 CrossRefPubMed

Bakowski D, Wozakowska-Kaplon B, Opolski G (2009) The influence of left ventricle diastolic function on natriuretic peptides levels in patients with atrial fibrillation. Pacing Clin Electrophysiol 32(6):745–752. https://doi.org/10.1111/j.1540-8159.2009.02360.x CrossRefPubMed

Corell P, Gustafsson F, Kistorp C, Madsen LH, Schou M, Hildebrandt P (2007) Effect of atrial fibrillation on plasma NT-proBNP in chronic heart failure. Int J Cardiol 117(3):395–402. https://doi.org/10.1016/j.ijcard.2006.03.084 CrossRefPubMed

Lee SH, Jung JH, Choi SH, Lee N, Park WJ, Oh DJ, Rhim CY, Lee KH (2006) Determinants of brain natriuretic peptide levels in patients with lone atrial fibrillation. Circ J 70(1):100–104CrossRef

Letsas KP, Filippatos GS, Pappas LK, Mihas CC, Markou V, Alexanian IP, Efremidis M, Sideris A, Maisel AS, Kardaras F (2009) Determinants of plasma NT-pro-BNP levels in patients with atrial fibrillation and preserved left ventricular ejection fraction. Clin Res Cardiol 98(2):101–106. https://doi.org/10.1007/s00392-008-0728-8 CrossRefPubMed

Rossi A, Enriquez-Sarano M, Burnett JC Jr, Lerman A, Abel MD, Seward JB (2000) Natriuretic peptide levels in atrial fibrillation: a prospective hormonal and Doppler-echocardiographic study. J Am Coll Cardiol 35(5):1256–1262CrossRef

Silvet H, Young-Xu Y, Walleigh D, Ravid S (2003) Brain natriuretic peptide is elevated in outpatients with atrial fibrillation. Am J Cardiol 92(9):1124–1127CrossRef

Ulimoen SR, Enger S, Tveit A (2009) Impact of atrial fibrillation on NT-proBNP levels in a 75-year-old population. Scand J Clin Lab Invest 69(5):579–584. https://doi.org/10.1080/00365510902853305 CrossRefPubMed

10.

Lam CS, Rienstra M, Tay WT, Liu LC, Hummel YM, van der Meer P, de Boer RA, Van Gelder IC, van Veldhuisen DJ, Voors AA, Hoendermis ES (2017) Atrial fibrillation in heart failure with preserved ejection fraction: association with exercise capacity, left ventricular filling pressures, natriuretic peptides, and left atrial volume. JACC Heart Fail 5(2):92–98. https://doi.org/10.1016/j.jchf.2016.10.005 CrossRefPubMed

11.

Melenovsky V, Hwang SJ, Redfield MM, Zakeri R, Lin G, Borlaug BA (2015) Left atrial remodeling and function in advanced heart failure with preserved or reduced ejection fraction. Circ Heart Fail 8(2):295–303. https://doi.org/10.1161/CIRCHEARTFAILURE.114.001667 CrossRefPubMed

12.

Degiovanni A, Boggio E, Prenna E, Sartori C, De Vecchi F, Marino PN, From the Novara Atrial Fibrillation Study G (2018) Association between left atrial phasic conduit function and early atrial fibrillation recurrence in patients undergoing electrical cardioversion. Clin Res Cardiol 107(4):329–337. https://doi.org/10.1007/s00392-017-1188-9 CrossRefPubMed

13.

Sramko M, Wichterle D, Melenovsky V, Clemens M, Fukunaga M, Peichl P, Aldhoon B, Cihak R, Kautzner J (2017) Resting and exercise-induced left atrial hypertension in patients with atrial fibrillation: the causes and implications for catheter ablation. J Am Coll Cardiol EP. https://doi.org/10.1016/j.jacep.2016.12.010 CrossRef

14.

Ponikowski P, Voors AA, Anker SD, Bueno H, Cleland JG, Coats AJ, Falk V, Gonzalez-Juanatey JR, Harjola VP, Jankowska EA, Jessup M, Linde C, Nihoyannopoulos P, Parissis JT, Pieske B, Riley JP, Rosano GM, Ruilope LM, Ruschitzka F, Rutten FH, van der Meer P (2016) 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: the Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC)Developed with the special contribution of the Heart Failure Association (HFA) of the ESC. Eur Heart J 37(27):2129–2200. https://doi.org/10.1093/eurheartj/ehw128 CrossRefPubMed

15.

Tzikas S, Keller T, Wild PS, Schulz A, Zwiener I, Zeller T, Schnabel RB, Sinning C, Lubos E, Kunde J, Munzel T, Lackner KJ, Blankenberg S (2013) Midregional pro-atrial natriuretic peptide in the general population/Insights from the Gutenberg Health Study. Clin Chem Lab Med 51(5):1125–1133. https://doi.org/10.1515/cclm-2012-0541 CrossRefPubMed

16.

Ballo P, Betti I, Barchielli A, Balzi D, Castelli G, De Luca L, Gheorghiade M, Zuppiroli A (2016) Prognostic role of N-terminal pro-brain natriuretic peptide in asymptomatic hypertensive and diabetic patients in primary care: impact of age and gender: results from the PROBE-HF study. Clin Res Cardiol 105(5):421–431. https://doi.org/10.1007/s00392-015-0937-x CrossRefPubMed

17.

Ho D, Imai K, King G, Stuart EA (2011) MatchIt: Nonparametric preprocessing for parametric causal inference. J Stat Softw. https://doi.org/10.18637/jss.v042.i08 CrossRef

18.

Francis GS, Felker GM, Tang WH (2016) A test in context: critical evaluation of natriuretic peptide testing in heart failure. J Am Coll Cardiol 67(3):330–337. https://doi.org/10.1016/j.jacc.2015.10.073 CrossRefPubMedPubMedCentral

19.

Miro O, Gil VI, Martin-Sanchez FJ, Jacob J, Herrero P, Alquezar A, Llauger L, Aguilo S, Martinez G, Rios J, Dominguez-Rodriguez A, Harjola VP, Muller C, Parissis J, Peacock WF, Llorens P, Research Group on Acute Heart Failure of the Spanish Society of Emergency Medicine R (2018) Short-term outcomes of heart failure patients with reduced and preserved ejection fraction after acute decompensation according to the final destination after emergency department care. Clin Res Cardiol. https://doi.org/10.1007/s00392-018-1237-z CrossRefPubMed

20.

Riedel O, Ohlmeier C, Enders D, Elsasser A, Vizcaya D, Michel A, Eberhard S, Schlothauer N, Berg J, Garbe E (2018) The contribution of comorbidities to mortality in hospitalized patients with heart failure. Clin Res Cardiol 107(6):487–497. https://doi.org/10.1007/s00392-018-1210-x CrossRefPubMed

21.

Tschope C, Birner C, Bohm M, Bruder O, Frantz S, Luchner A, Maier L, Stork S, Kherad B, Laufs U (2018) Heart failure with preserved ejection fraction: current management and future strategies: expert opinion on the behalf of the Nucleus of the “Heart Failure Working Group” of the German Society of Cardiology (DKG). Clin Res Cardiol 107(1):1–19. https://doi.org/10.1007/s00392-017-1170-6 CrossRefPubMed

22.

Morbach C, Buck T, Rost C, Peter S, Gunther S, Stork S, Prettin C, Erbel R, Ertl G, Angermann CE, Handheld BNPRN (2018) Point-of-care B-type natriuretic peptide and portable echocardiography for assessment of patients with suspected heart failure in primary care: rationale and design of the three-part handheld-BNP program and results of the training study. Clin Res Cardiol 107(2):95–107. https://doi.org/10.1007/s00392-017-1181-3 CrossRefPubMed

23.

Greene SJ, Fonarow GC, Solomon SD, Subacius HP, Ambrosy AP, Vaduganathan M, Maggioni AP, Bohm M, Lewis EF, Zannad F, Butler J, Gheorghiade M (2016) Influence of atrial fibrillation on post-discharge natriuretic peptide trajectory and clinical outcomes among patients hospitalized for heart failure: insights from the ASTRONAUT trial. Eur J Heart Fail. https://doi.org/10.1002/ejhf.674 CrossRefPubMedPubMedCentral

24.

Wozakowska-Kaplon B (2010) Changes in plasma natriuretic peptide levels in patients with atrial fibrillation after cardioversion. Int J Cardiol 144(3):436–437. https://doi.org/10.1016/j.ijcard.2009.03.085 CrossRefPubMed

25.

Charitakis E, Walfridsson H, Alehagen U (2016) Short-term influence of radiofrequency ablation on NT-proBNP, MR-proANP, copeptin, and MR-proADM in patients with atrial fibrillation: data from the observational SMURF Study. J Am Heart Assoc. https://doi.org/10.1161/JAHA.116.003557 CrossRefPubMedPubMedCentral

26.

Vinch CS, Rashkin J, Logsetty G, Tighe DA, Hill JC, Meyer TE, Rosenthal LS, Aurigemma GP (2004) Brain natriuretic peptide levels fall rapidly after cardioversion of atrial fibrillation to sinus rhythm. Cardiology 102(4):188–193. https://doi.org/10.1159/00008100981009 CrossRefPubMed

27.

Schotten U, Verheule S, Kirchhof P, Goette A (2011) Pathophysiological mechanisms of atrial fibrillation: a translational appraisal. Physiol Rev 91(1):265–325. https://doi.org/10.1152/physrev.00031.2009 CrossRefPubMed

28.

Heijman J, Voigt N, Nattel S, Dobrev D (2014) Cellular and molecular electrophysiology of atrial fibrillation initiation, maintenance, and progression. Circ Res 114(9):1483–1499. https://doi.org/10.1161/CIRCRESAHA.114.302226 CrossRef

29.

Zhang YH, Youm JB, Earm YE (2008) Stretch-activated non-selective cation channel: a causal link between mechanical stretch and atrial natriuretic peptide secretion. Prog Biophys Mol Biol 98(1):1–9. https://doi.org/10.1016/j.pbiomolbio.2008.05.005 CrossRefPubMed

30.

De Jong AM, Maass AH, Oberdorf-Maass SU, Van Veldhuisen DJ, Van Gilst WH, Van Gelder IC (2011) Mechanisms of atrial structural changes caused by stretch occurring before and during early atrial fibrillation. Cardiovasc Res 89(4):754–765. https://doi.org/10.1093/cvr/cvq357 CrossRefPubMed

31.

Edwards BS, Zimmerman RS, Schwab TR, Heublein DM, Burnett JC Jr (1988) Atrial stretch, not pressure, is the principal determinant controlling the acute release of atrial natriuretic factor. Circ Res 62(2):191–195CrossRef

32.

Fiala M, Wichterle D, Chovancik J, Bulkova V, Wojnarova D, Nevralova R, Januska J (2010) Left atrial voltage during atrial fibrillation in paroxysmal and persistent atrial fibrillation patients. Pacing Clin Electrophysiol 33(5):541–548. https://doi.org/10.1111/j.1540-8159.2009.02646.x CrossRefPubMed

Title: Independent effect of atrial fibrillation on natriuretic peptide release
Authors: Marek Sramko
Dan Wichterle
Vojtech Melenovsky
Janka Franekova
Marcell Clemens
Masato Fukunaga
Josef Kautzner
Publication date: 01-02-2019
Publisher: Springer Berlin Heidelberg
Published in: Clinical Research in Cardiology / Issue 2/2019
Print ISSN: 1861-0684
Electronic ISSN: 1861-0692
DOI: https://doi.org/10.1007/s00392-018-1332-1

ACC 2024 Congress Coverage

Year in Review: Heart failure and cardiomyopathies

Heart Failure Video

Watch this official video from ACC.24. Dr. Biykem Bozkurt discusses last year's major advances in heart failure and cardiomyopathies.

Watch now

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Independent effect of atrial fibrillation on natriuretic peptide release

Abstract

Background

Methods

Results

Conclusions

ACC 2024 Congress Coverage

Year in Review: Heart failure and cardiomyopathies

Semaglutide benefits people with type 2 diabetes and obesity-related heart failure

Incentivised to exercise

New intervention for STEMI-related cardiogenic shock

» View more highlights on the ACC 2024 congress hub page

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 2/2019

Cardiology and cardiovascular research in Germany: 5 years of gender demographics

Electrocardiogram features predictive of takotsubo syndrome

Body mass index and all-cause mortality in heart failure patients with normal and reduced ventricular ejection fraction: a dose–response meta-analysis

The impact of heart failure and chronic obstructive pulmonary disease on mortality in patients presenting with breathlessness

Atypical angina pectoris: the compressed graft

Echocardiographic calcification score in patients with low/intermediate cardiovascular risk

ACC 2024 Congress Coverage

Year in Review: Heart failure and cardiomyopathies

Semaglutide benefits people with type 2 diabetes and obesity-related heart failure

Incentivised to exercise

New intervention for STEMI-related cardiogenic shock

» View more highlights on the ACC 2024 congress hub page