Atrial Natriuretic Peptides as a Bridge between Atrial Fibrillation, Heart Failure, and Amyloidosis of the Atria

Abstract

ANP is mainly synthesized by the atria, and upon excretion, it serves two primary purposes: vasodilation and increasing the renal excretion of sodium and water. The understanding of ANP’s role in cardiac systems has improved considerably in recent decades. This review focuses on several studies demonstrating the importance of analyzing the regulations between the endocrine and mechanical function of the heart and emphasizes the effect of ANP, as the primary hormone of the atria, on atrial fibrillation (AF) and related diseases. The review first discusses the available data on the diagnostic and therapeutic applications of ANP and then explains effect of ANP on heart failure (HF) and atrial fibrillation (AF) and vice versa, where tracking ANP levels could lead to understanding the pathophysiological mechanisms operating in these diseases. Second, it focuses on conventional treatments for AF, such as cardioversion and catheter ablation, and their effects on cardiac endocrine and mechanical function. Finally, it provides a point of view about the delayed recovery of cardiac mechanical and endocrine function after cardioversion, which can contribute to the occurrence of acute heart failure, and the potential impact of restoration of the sinus rhythm by extensive ablation or surgery in losing ANP-producing sites. Overall, ANP plays a key role in heart failure through its effects on vasodilation and natriuresis, leading to a decrease in the activity of the renin-angiotensin-aldosterone system, but it is crucial to understand the intimate role of ANP in HF and AF to improve their diagnosis and personalizing the patients’ treatment.

The impact of COVID-19 on BNP, NT-proBNP and ANP in heart failure

“…Natriuretic peptides are reliable quantitative biomarkers used to assess cardiac stress and are valuable in the diagnosis and management of HF (17,18). In HF patients, these peptides are released either from the ventricles (BNP and NT-proBNP) or the atrium (ANP) in response to increased pressure on the respective cardiac chambers (18,19). While COVID-19 is a relatively new infection and limited research has explored its impact on heart conditions, various mechanisms have been suggested to be involved.…”

Embolic Stroke of Undetermined Source

“…The MOSES trial uses MR-proANP for patient selection, a biomarker that is specifically released by the atrium, implicated in the pathophysiology of AF development, and associated with AF and major adverse cardiovascular events after stroke. [37][38][39] Furthermore, the biomarker cutoff has been validated in several previous stroke populations to be highly associated with AF diagnosed after stroke using Holter ECG (i.e., probably high burden of AF) as well as with major adverse cardiovascular events within 1 year after stroke. [14][15][16]40 The design of the study differs from ARCADIA and ATTICUS further by the fact that the selection is not restricted to the ESUS population because an underlying high-risk cardiac source might also be present in patients with strokes of other etiologies, such as large artery atherosclerosis or small vessel disease (Figure 1).…”

Molecular Mechanisms of Cardiac Development and Disease

“…ANP causes a reduction in expanded extracellular fluid volume by increasing renal sodium excretion. The authors review the diagnostic and therapeutic relevance of ANP in cardiovascular disease, especially atrial fibrillation and heart failure and discuss possible repercussions of cardioversion procedures and cardiac chirurgical interventions on ANP levels [18]. In his review for this Special Issue, Ivan Melnikov and co-authors analyze the knowledge about the impact of the NLRP3 inflammasome, especially the different C-reactive protein (CRP) isoforms, on atherosclerotic cardiovascular disease.…”