Biomarkers of Left Atrial Volume

Abstract

Abstract-Left atrial volume (LAV) has recently emerged as a useful biomarker for risk stratification and risk monitoring in patients with end stage renal disease. We investigated the relationship between cardiac natriuretic peptides (atrial natriuretic peptide [ANP] and brain natriuretic peptide [BNP]) and norepinephrine (NE) with LAV and LAV changes over time in 199 end stage renal disease patients. At baseline, LAV was directly related to BNP (rϭ0.60), ANP (rϭ0.59), and NE (rϭ0.28; PϽ0.001), and these relationships held true in multiple-regression models adjusting for potential confounders (PՅ0.003). In the longitudinal study (17Ϯ2 months), LAV increased from 9.8Ϯ4.6 to 10.9Ϯ5.4 mL/m 2.7 (ϩ11%). In a multiple linear regression model, BNP (␤ϭ0.28; Pϭ0.003), ANP (␤ϭ0.22; Pϭ0.03), and NE (␤ϭ0.27; Pϭ0.003) predicted LAV changes. The area under the receiver operating characteristic curve for predicting LAV changes (Ͼ3 mL/m 2.7 per year) of a risk score on the basis of standard risk factors was 0.72. Plasma BNP (ϩ12%; Pϭ0.004), ANP (ϩ8%; Pϭ0.03), NE (ϩ8%; Pϭ0.05) and midwall fraction shortening (ϩ8%; Pϭ0.05) increased the area under the receiver operating characteristic curve to a significant extent, whereas LV mass did not (ϩ5%; Pϭ0.18). Predictive models, including BNP, ANP, and NE, maintained a satisfactory discriminatory power for LAV and LAV changes also when tested by a bootstrap resampling technique. BNP and ANP are strongly related to LAV in the end stage renal disease patients and predict LAV changes over time in these patients. Because an increased LAV underlies diastolic dysfunction and/or volume overload (ie, potentially modifiable risk factors), the measurement of the plasma concentration of these compounds might be useful for risk stratification and for guiding treatment in dialysis patients. , as measured by echocardiography, has emerged recently as a biomarker of potential value for risk stratification 1 and risk monitoring 2 in patients with end stage renal disease (ESRD). Indeed, LAV and LAV changes over time predict death and cardiovascular (CV) outcomes also beyond established echocardiographic markers of high CV risk, like left ventricular (LV) mass (LVM) and LV systolic function. 1,2 Although echocardiography is formally recommended as a fundamental tool for risk stratification in ESRD patients, 3 because of cost and logistic problems, this technique is applied less than needed in many centers. Biomarker research on anatomic and functional alterations of the heart is a growing, promising clinical research area. 4 We have shown previously that atrial natriuretic peptide (ANP), a hormone mainly produced in the atrium, and brain natriuretic peptide (BNP), a hormone secreted by ventricular cardiomyocytes, are reasonably accurate markers of LVM and LV systolic function in ESRD patients. 5,6 The relationship between cardiac natriuretic peptides and LAV and the diagnostic and prognostic values of these peptides for LAV enlargement and for LAV evolution over time have never been tested in well-powered ...

Left Atrial Remodeling is Associated with Left Ventricular Remodeling in Patients with Reperfused Acute Myocardial Infarction

“…Although theoretically BNP levels would normally have some association with LA volume, as both indices are considered surrogates of LV diastolic illing properties, convincing data in the literature are missing. In contrast there are several reports where BNP levels are correlated with LA volume in various other clinical entities and especially patients with heart failure [29][30][31]. We have evidenced a strong positive association between LA remodeling and LV hypertrophy as expressed by LV mass index.…”

Heart Failure in Patients with Chronic Kidney Disease: A Systematic Integrative Review

“…In dialysis patients, plasma natriuretic peptides have shown significant associations with LVH [63], LV systolic and diastolic dysfunction [62, 64–66], and LA dilatation [62, 67]. Furthermore, it has been demonstrated that BNP and NT-pro-BNP can predict the risk of HF in nondialysis CKD [63] and in PD patients [65], respectively.…”

Improving Volume Status by Comprehensive Dietary and Dialytic Sodium Management in Chronic Hemodialysis Patients

“…There is a close relationship between volume overload and hypertension, increased vascular stiffness and cardiac remodeling [1][2][3][4] . Moreover, several studies have shown a relationship between volume control and mortality [5][6][7] .…”