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

Abstract

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...

The Prognostic Value of Combined NT-pro-BNP Levels and NIHSS Scores in Patients with Acute Ischemic Stroke

“…The reasons for this disparity include many factors. To our knowledge, conditions such as left ventricular dysfunction (20,21), AF (3,15), heart failure (22-24), older age (25) and renal dysfunction (26) are known causes of increased natriuretic peptides. In addition, race is a potential factor.…”

“…Stroke subtypes were classified according to the TOAST as cardiac embolism, other or unknown cause of stroke. The subjects were divided into groups according to the size of infarction observed on CT (referent to Pullicino (13)): large infarction group (>10 cm 3 ), middle infarction group (4.1-10 cm 3 ) and small infarction group (! 4 cm 3 ).…”

NT-proBNP as predictive factor for the conversion of paroxysmal atrial fibrillation of heart to sinus rhythm in non-diabetic and diabetic populations

“…However, they also point to another published study in which the NT-proBNP levels were comparable in all of the above-mentioned forms of arrhythmia. 15,16 Only patients with a paroxysmal form of AF with a known duration of 24 hours were included in our group, with NT-proBNP levels reaching a relatively large numerical range (1 698.1 ± 2 029.3 ng/l), which is related to laboratory variation of values of this parameter in the range of several thousand ng/l (max. measurable value is 35 000 ng/l in laboratory conditions), but without signifi cant impact on the clinical manifestations of the patient.…”