Atrial Natriuretic Peptide Predicts Impaired Atrial Remodeling and Occurrence of Late Postoperative Atrial Fibrillation after Surgery for Symptomatic Aortic Stenosis

Abstract

Background: Aortic stenosis (AS) and atrial fibrillation (AF) are commonly encountered in clinical practice. Natriuretic peptides (NP) are endogenous cardiac hormones, which have been shown to increase in patients with heart failure, and valvular or congenital heart disease. We aimed to determine the association between atrial NP (ANP) and late postoperative AF after surgery for AS along with temporal changes in plasma ANP levels and left atrial (LA) volumes. Methods: 22 patients (16 males/6 females, mean age: 61 years) with symptomatic AS and 8 healthy volunteers (5 males/3 females) were enrolled into our study. All the patients studied underwent transthoracic echocardiography, which was repeated during the follow-up. N-terminal ANP (N-ANP) was studied initially and at the 2-month follow-up. Postoperatively, the patients were followed up for 12 months for AF attacks. Results: Patients with AS had significantly higher levels of N-ANP, left ventricular (LV) end-diastolic pressure, E/A ratio, LV mass and LA volumes compared to the controls. Patients with postoperative AF attacks were significantly older, had higher N-ANP levels and LV end-diastolic pressure in addition to higher LA volumes and longer symptom duration compared to patients without AF. Age at the time of operation (p = 0.011) and N-ANP at the 2nd month (p = 0.047) were found to be independent predictors for late AF attacks during follow-up in regression analysis. Besides, N-ANP (p < 0.001) at the 2-month follow-up independently predicted impaired LA remodeling. Conclusion: ANP might be an important factor to identify AS patients at risk for late postoperative AF attacks.

EHRA/HRS/APHRS/SOLAECE expert consensus on atrial cardiomyopathies: definition, characterization, and clinical implication

“…230 Plasma natriuretic peptide (ANP) levels are higher in symptomatic than asymptomatic patients with AS 231 and N-ANP levels predict atrial remodelling and late (2 month) post-operative AF after surgery for AS. 232 Taken together, these data support the notion that substrate-based AF is a consequence of the abnormal haemodynamics and atrial remodelling that accompany valvular heart disease. In this instance, atrial remodelling is the consequence of multiple biological processes that create structural and ultrastructural abnormalities and a change in conduction (as opposed to refractoriness) that favours the development and maintenance of AF.…”

Evidence for Natriuretic Peptides a and B as Non-Invasive Markers in Congenital and Valvular Heart Disease

“…The present results confirm the findings of other studies showing significantly elevated levels of natriuretic peptides in various types of congenital and valvular heart diseases [3][4][5] . Other studies have shown a relationship between concentrations of natriuretic peptides and severity of heart failure [6][7][8][9][10][11][12] .…”

EHRA/HRS/APHRS/SOLAECE expert consensus on atrial cardiomyopathies: Definition, characterization, and clinical implication

“…230 Plasma natriuretic peptide (ANP) levels are higher in symptomatic than asymptomatic patients with AS 231 and N-ANP levels predict atrial remodelling and late (2 month) post-operative AF after surgery for AS. 232 …”