Assessment of factors affecting plasma BNP levels in patients with chronic atrial fibrillation and preserved left ventricular systolic function

Kim, Byung Jin; Hwang, Soon Jae; Sung, Ki Chul; Kim, Bum Soo; Kang, Jin Ho; Lee, Man Ho; Park, Jung Ro

doi:10.1016/j.ijcard.2006.03.088

Cited by 22 publications

(16 citation statements)

References 29 publications

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“…Other independent predictors of high NT-proBNP level were age and presence of persistent or permanent AF. These findings are in accordance with the results of previous studies (11,17,18,23,24). In previous studies, structural heart disease such as hypertension and coronary artery disease were significantly associated with NT-proBNP or BNP (10,11,18,23,24).…”

Section: Discussionsupporting

confidence: 93%

“…In our study, left atrial dilatation was significantly related to high NT-proBNP level as in previous studies (11,(16)(17)(18)(19)(20)(21)(22). Other independent predictors of high NT-proBNP level were age and presence of persistent or permanent AF.…”

Section: Discussionsupporting

confidence: 86%

“…A similar association has been demonstrated in a recent study (17). Furthermore, Tuinenburg et al (25) have reported that persistent AF induced the expression of proBNP in atrial tissue but paroxysmal AF did not.…”

Section: Discussionsupporting

confidence: 84%

“…Previous studies have reported that NT-proBNP levels can be associated with AF in patients with normal LV systolic function (10)(11)(12)(13)(14)(15)(16)(17)(18). These studies included the patients with paroxysmal, persistent or chronic AF.…”

Section: Introductionmentioning

confidence: 99%

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Plasma renin activity and pro-B-type natriuretic peptide levels in different atrial fibrillation types

Doğan¹,

Gedikli²,

Ozaydin³

et al. 2010

Anadolu Kardiyol Derg

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Objective: Renin-angiotensin system may be activated during atrial fibrillation (AF). Our aim was to evaluate plasma renin activity (PRA) and N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels in patients with different AF types who had normal left ventricular (LV) systolic function. Methods: This cross-sectional study included 97 patients with recent (≤7 days), persistent (7 days to 12 months) and permanent AF (>12 months), and age-and sex-matched 30 controls with sinus rhythm. Plasma levels of PRA and NT-pro-BNP were measured and presented as median (25 th -75 th percentiles). Echocardiographic examination was performed in all population. Variance and logistic regression analyses were also used for multiple comparisons and independent predictors, respectively. Results: Median NT-proBNP levels were higher in overall patients with AF than in controls [114 (63-165) vs 50 (38-58) pg/ml, p<0.001), but PRA level was comparable in both groups. Similarly, NT-proBNP levels were also higher in all subtypes of AF compared with controls (p<0.05). In addition, there was a significant difference in NT-proBNP level among recent, persistent and permanent AF subtypes (p=0.001). This difference mainly derived from the recent AF subtypes. Whereas PRA level was similar in all AF subtypes and controls. Age was an independent predictor of PRA level ≥1.9 ng/ml/hour (OR=1.1, 95% CI 1.01-1.23, p=0.03). With NT-proBNP level ≥52 pg/ml, independent predictors were age (OR=1.1, 95% CI 1.01-1.19, p=0.02), presence of persistent and/or permanent AF (OR=6.8, 95% CI 1.03-45.7, p=0.04) and left atrial dimension (OR=1.2, 95% CI 1.03-1.36, p=0.02). Conclusion: Plasma NT-proBNP levels can be associated with AF and its subtypes in patients with normal LV systolic function, whereas there was no association between PRA levels and AF. (Anadolu Kardiyol Derg 2010; 10: 317-22) Key words: Plasma renin activity, B-type natriuretic peptide, atrial fibrillation, logistic regression analysis ÖZET Amaç: Atriyal fibrilasyon (AF) sırasında renin-anjiyotensin sistemi (RAS) aktif olabilir. Amacımız, sol ventrikül sistolik fonksiyonu normal olan farklı AF hastalarında, plazma renin aktivitesi (PRA) ve N-terminal pro-B-tipi natriüretik peptit (NT-proBNP) düzeylerini değerlendirmektir. Yöntemler: Bu kesitsel çalışmaya, yeni (≤7 gün), persistan (7 gün ile 12 ay) ve kalıcı AF'si (>12 ay) olan 97 hasta alındı. Yaş ve cinsiyeti benzer sinüs ritimli 30 sağlıklı birey kontrol grubunu oluşturdu. Plazma PRA ve NT-pro-BNP düzeyleri ölçüldü (mediyan, 25th -75th persantil). Tüm popülasyona ekokardiyografi yapıldı. Standart testlere ek olarak, çoklu karşılaştırmalar için varyans analizi ve bağımsız prediktörler için lojistik regresyon analizi kullanıldı. Bulgular: Tüm AF grubunun ortanca NT-proBNP düzeyi, kontrol grubundan daha yüksekti [114 (63-165)'e 50 (38-58) pg/ml, p<0.001), fakat PRA düzeyi benzerdi. Benzer olarak, kontrol grubuna kıyasla, tüm AF alt-gruplarında da NT-proBNP düzeyleri daha yüksekti (p=0.001). Bu fark, başlıca yeni AF'den kaynaklandı. O...

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Section: Discussionsupporting

confidence: 93%

Section: Discussionsupporting

confidence: 86%

Section: Discussionsupporting

confidence: 84%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Plasma renin activity and pro-B-type natriuretic peptide levels in different atrial fibrillation types

Doğan¹,

Gedikli²,

Ozaydin³

et al. 2010

Anadolu Kardiyol Derg

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“…6 In addition, Kim et al showed that the duration of AF is an independent predictor of plasma BNP levels in patients with chronic AF and preserved LV systolic function, due to the influence on the LAA peak flow velocity. 7 In conclusion, LV dysfunction is a determinant of LAA function and therefore increases BNP levels. 6 In addition to LV dysfunction, increased plasma BNP levels could be related to rapid progression of LAA dysfunction in patients with AF.…”

mentioning

confidence: 87%

Response to Reduced Diurnal Variation of Heart Rate Is Associated With Increased Plasma B‐Type Natriuretic Peptide Level in Patients With Atrial Fibrillation

Yalcinkaya

Çelik

Yıldırım

et al. 2013

Clinical Cardiology

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The authors aimed to show the association between the plasma B-type natriuretic peptide (BNP) level and heart rate variation in patients with atrial fibrillation (AF). Multiple linear regression analysis revealed that the heart rate variation was an independent factor related to the BNP level in patients with AF. In this context, the authors concluded that the reduced diurnal variation of heart rate was significantly associated with increased BNP, which is linked to left ventricular (LV) diastolic dysfunction in patients with AF. The current study is well designed and gives detailed information, but we have some comments about the article.It is reported that the tissue of the left atrial appendage (LAA) in patients with valvular AF showed significant pathological changes, which are well known to enhance BNP production in the ventricular myocardium.2,3 Contrary to earlier theories that LV myocardium is the main source of BNP, it has recently been shown that BNP is mainly secreted from the left atrium in patients with AF. 4 LAA seems to be a source for BNP, as it represents an overload sensor of the heart. 5 Furthermore, the plasma BNP concentration is an independent negative predictor for the LAA peak flow velocity and serves as a determinant of LAA function in nonvalvular AF. 6 In addition, Kim et al showed that the duration of AF is an independent predictor of plasma BNP levels in patients with chronic AF and preserved LV systolic function, due to the influence on the LAA peak flow velocity. 7 In conclusion, LV dysfunction is a determinant of LAA function and therefore increases BNP levels. 6 In addition to LV dysfunction, increased plasma BNP levels could be related to rapid progression of LAA dysfunction in patients with AF.6 Transesophageal echocardiography can be used to identify relationships between LAA peak flow velocities, duration of AF, and plasma BNP levels. 8,9 If relationships between LAA peak flow velocities, duration of AF, and plasma BNP levels were identified, potential mechanisms in the relationship of heart rate variation and LV dysfunction to BNP levels could have been evaluated more precisely.

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Elevated B-type natriuretic peptide level as a marker of subsequent thromboembolic events in patients with atrial fibrillation

Sadanaga¹,

Kohsaka

Mitamura

et al. 2010

Heart Vessels

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The aim of the present study was to assess whether elevated B-type natriuretic peptide (BNP) levels, as an objective marker of heart failure, is a predictor of subsequent thromboembolic events in patients with atrial fibrillation (AF) during oral anticoagulant therapy. This was a post hoc analysis of a single-center, prospective, observational study. Consecutive patients with AF (261 patients, 74 ± 9 years old, 153 paroxysmal AF) treated with warfarin were included for the analysis. BNP level at baseline examination was measured to assess the relationship of this parameter with subsequent thromboembolic events. BNP levels at the time of entry were 161 ± 188 (5-1,500, median 105) pg/ml. During an average follow-up time of 762 ± 220 (median 742) days, nine (1.8%/year) thromboembolic events occurred. Receiver operating characteristic curve showed that an optimal cut-off value for BNP to predict thromboembolic events was 218 pg/ml. There were six thromboembolic events observed among patients with a baseline BNP levels ≥200 pg/ml (n = 73) as compared to three such events in those with baseline BNP levels <200 pg/ml (n = 188). Kaplan-Meier curves for BNP level showed that elevated BNP level (≥200 pg/ml) was significantly associated with thromboembolic events (p < 0.01). Cox-proportional hazard analysis also revealed that a high BNP level (≥200 pg/ml) was a significant predictor of subsequent thromboembolic events (hazard ratio 5.32, p = 0.018). Elevated BNP levels (≥200 pg/ml) could be a useful marker of subsequent thromboembolic events in patients with AF during oral anticoagulant therapy. However, the number of patients and events in this study was small and drawing a definite conclusion was not possible with this small sample size. Therefore, further larger-scale, multicenter studies are needed to confirm these findings.

show abstract

Assessment of factors affecting plasma BNP levels in patients with chronic atrial fibrillation and preserved left ventricular systolic function

Cited by 22 publications

References 29 publications

Plasma renin activity and pro-B-type natriuretic peptide levels in different atrial fibrillation types

Plasma renin activity and pro-B-type natriuretic peptide levels in different atrial fibrillation types

Response to Reduced Diurnal Variation of Heart Rate Is Associated With Increased Plasma B‐Type Natriuretic Peptide Level in Patients With Atrial Fibrillation

Elevated B-type natriuretic peptide level as a marker of subsequent thromboembolic events in patients with atrial fibrillation

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