Discordant Regulation of CRP and NT‐proBNP Plasma Levels After Electrical Cardioversion of Persistent Atrial Fibrillation

Buob, Axel; Jung, Jens; Siaplaouras, Stephanos; Neuberger, Hans‐Ruprecht; Mewis, Christian

doi:10.1111/j.1540-8159.2006.00401.x

Cited by 32 publications

(23 citation statements)

References 28 publications

(43 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…[20][21][22][23][24] Two recently published studies found comparable NT-proBNP values in AF. 13,25 Given the absence of concomitant left ventricular dysfunction and the very low percentage of patients with a diastolic dysfunction in the present study population (5.6%), our results strongly support the thesis of an independent atrial release of BNP. 26 In fact, in the non-heart-failure-setting, BNP is primarily released from the atria.…”

Section: Discussionsupporting

confidence: 79%

NT-ProBNP Predicts Rhythm Stability After Cardioversion of Lone Atrial Fibrillation

Möllmann

Weber

Elsässer

et al. 2008

Circ J

View full text Add to dashboard Cite

trial fibrillation (AF) is the most common arrhythmia diagnosed in daily clinical practice. The prevalence in the general population is estimated to be 0.4% to 1%, and this increases with age to 8% in those older than 80 years. 1,2 The percentage of lone AF ranges from 12% to 30% of these patients. 2,3 It is likely, that the overall incidence of AF will rise further in the next few decades as the elderly population increases in size.AF is associated with an increased long-term risk of stroke, heart failure and all-cause mortality. 4,5 The rate of ischemic stroke among patients with non-valvular AF averages 5% per year, 2 to 7 times that of people without AF. 6 Oral anticoagulation with warfarin or other vitamin-Kantagonists reduces this risk related to AF by about 70%. 7,8 However, oral anticoagulants raise the risk of major bleeding from 0.9% to 2.2% and thus should be only used in a carefully selected cohort. 9 Therefore, in clinical practice, AF remains one of the most difficult arrhythmias to treat and the criteria for selecting different therapeutic options for patients is still a matter of debate. 10 Although several studies Circulation Journal Vol.72, June 2008 propose that a rate-controlling approach might be superior to the rhythm-controlling approach, clinical symptoms of AF such as palpitations, reduced exercise tolerance and impact on quality of life provide obvious reasons for considering early restoration and maintenance of sinus rhythm (SR). 11,12 B-type natriuretic peptide (BNP) is synthesized as preproBNP in response to ventricular stretch and pressure overload. After enzymatic cleavage, it is released into the circulation system in equimolar proportions as the hormonally active BNP and the inactive amino-terminal fragment N-terminal (NT)-proBNP. Recent studies have shown, that BNP and NT-proBNP, respectively, are increased in patients with AF and rapidly fall upon restoration of SR. 13,14 Therefore, the purpose of the present study was to elucidate, whether NT-proBNP can: (1) predict the short-term outcome of an elective direct current cardioversion; and (2) be used to monitor rhythm stability. Methods Study Population and ProtocolFifty-three consecutive patients who were referred to our institution for elective cardioversion of AF and who met the inclusion criteria were enrolled into the present study. Inclusion criteria were: (1) AF at the time of enrollment evidenced through 12-lead ECG; (2) eligibility of a directcurrent cardioversion documented using a sufficient oral anticoagulation over >4 weeks or absence of an atrial thrombus, evidenced by transoesophageal echocardiography; (3) absence of structural heart diseases, that is, known or susCirc J 2008; 72: 921 -925 (Received October 11, 2007; revised manuscript received December 27, 2007; accepted January 7, 2008) Kerckhoff-Klinik Bad Nauheim, Bad Nauheim, *Universitätsklinikum Frankfurt, Frankfurt, Germany **The first two authors contributed equally. Mailing address: Helge Möllmann, MD, Kerckhoff Heart Center, Benekestraße 2-8, 6123...

show abstract

Section: Discussionsupporting

confidence: 79%

NT-ProBNP Predicts Rhythm Stability After Cardioversion of Lone Atrial Fibrillation

Möllmann

Weber

Elsässer

et al. 2008

Circ J

View full text Add to dashboard Cite

show abstract

“…BNP or NT-proBNP have been shown be associated with AF after cardiac pacemaker implantation [7], postoperative AF in patients undergoing cardiac surgery [8], sinus rhythm maintenance after cardioversion [6,9] and AF recurrence in patients with NHYA functional classes I or II [10]. Very high levels of NT-proBNP in patients with AF without concomitant left ventricular dysfunction [32,33] and decrease after restoration of sinus rhythm [34] suggest that BNP is also released by atrial myocardium. Moreover, it has been reported that in the nonheart-failure-setting, BNP is primarily released from the atria [35].…”

Section: Discussionmentioning

confidence: 98%

Factors associated with the development of atrial fibrillation in patients with rheumatic mitral stenosis

Özaydın

Türker

Varol

et al. 2010

Int J Cardiovasc Imaging

View full text Add to dashboard Cite

The aim of this study was to evaluate the factors associated with the development of atrial fibrillation (AF) in patients with rheumatic mitral stenosis (MS). A total of 146 consecutive patients with rheumatic MS were screened. They were accepted to be in AF group and sinus rhythm group according to their rhythm in the baseline ECG. After screening, 38 patients were excluded due to hyperthyroidism (n = 13), chronic obstructive pulmonary disease (n = 22), malignancy (n = 2) and rheumatoid arthritis (n = 1). Therefore, remaining 108 patients, 74 of whom in sinus rhythm (MS-SR) and 34 of whom in AF (MS-AF) constituted study population. Fourty age- and gender-matched patients constituted control group. Factors associated with development of AF in multivariable analysis included High sensitivity C reactive protein (P = 0.005; odds ratio, 3.44; 95% confidence interval, 1.44-8.22), N-terminal of brain natriuretic peptide precursor (P < 0.0001; odds ratio, 1.03; 95% confidence interval, 1.02-1.06) and left atrial diameter (P < 0.0001; odds ratio, 1.68; 95% confidence interval, 1.32-2.14). Present study suggests that High sensitivity C reactive protein, N-terminal of brain natriuretic peptide precursor and left atrial diameter are associated with development AF in patients with MS.

show abstract

“…Cosgrave et al [21] and Buob et al [22] found that there was no significant decrease in hs-CRP levels after CV. This result may be explained by the lack of serial hs-CRP measurements.…”

Section: Discussionmentioning

confidence: 99%

The Effect of Sinus Rhythm Restoration on High-Sensitivity C-Reactive Protein Levels and Their Association with Long-Term Atrial Fibrillation Recurrence after Electrical Cardioversion

Çelebi¹,

Celebi²,

Canbay³

et al. 2011

Cardiology

View full text Add to dashboard Cite

Objective: Recent studies have shown that high-sensitivity C-reactive protein (hs-CRP) measured before cardioversion (CV) plays a significant role in predicting atrial fibrillation (AF) relapse. The time course of changes in hs-CRP after successful electrical CV remains controversial. The aim of the present study was to assess the prognostic value of pre- and post-CV hs-CRP levels in predicting the long-term risk of AF. Additionally, we evaluated changes in hs-CRP levels over time following a successful CV. Methods: This prospective study comprised 216 patients with persistent AF who underwent CV (mean age 51.94 ± 8.07 years; 55.6% men). hs-CRP levels were examined in all patients, and blood samples were taken prior to and 1, 2, 7 and 30 days after CV. AF relapse was determined by 24-hour ambulatory electrocardiogram (ECG) monitoring and 12-lead standard ECG during 12 months of follow-up. We further divided the study population into two groups according to their rhythm at the end of the follow-up period (group A: patients with AF at the end of follow-up; group B: patients with sinus rhythm at the end of the follow-up period). Results: The AF recurrence rate was 42.2% throughout the 12-month follow-up period. The basal hs-CRP levels were higher in patients with an AF relapse than in those without (1.68 ± 0.57 vs. 1.12 ± 0.53 mg/dl; p < 0.01). The hs-CRP levels were significantly decreased at 30 days in group B, whereas there was no significant decrease in group A (from 1.12 ± 0.53 to 0.69 ± 0.33 mg/dl, p < 0.01, and from 1.68 ± 0.57 to 1.69 ± 0.76 mg/dl, p > 0.05, respectively). By multivariate Cox analysis, the independent predictors of AF relapse time points were the basal and day-2 hs-CRP levels. Receiver operating characteristic curve analysis showed that the cutoff value of hs-CRP on the 2nd day for predicting AF relapse was 1.85 mg/dl, with a sensitivity of 62%, a specificity of 82%, a positive predictive value of 85.7% and a negative predictive value of 81.6%. Conclusion: The hs-CRP levels both prior to and after CV predict the long-term risk of AF relapse. In the present study, hs-CRP levels were significantly decreased in patients who remained in sinus rhythm at the end of the study. In contrast, hs-CRP levels remained high throughout the follow-up in patients with an AF relapse.

show abstract

Discordant Regulation of CRP and NT‐proBNP Plasma Levels After Electrical Cardioversion of Persistent Atrial Fibrillation

Abstract: We conclude that even in patients with normal left ventricular ejection fraction restoration of sinus rhythm leads to a significant reduction of NT-proBNP plasma levels. In contrast, CRP plasma levels seem not to be influenced during the first 4 weeks after electrical cardioversion.

Cited by 32 publications

References 28 publications

NT-ProBNP Predicts Rhythm Stability After Cardioversion of Lone Atrial Fibrillation

NT-ProBNP Predicts Rhythm Stability After Cardioversion of Lone Atrial Fibrillation

Factors associated with the development of atrial fibrillation in patients with rheumatic mitral stenosis

The Effect of Sinus Rhythm Restoration on High-Sensitivity C-Reactive Protein Levels and Their Association with Long-Term Atrial Fibrillation Recurrence after Electrical Cardioversion

Contact Info

Product

Resources

About