Raised Plasma Aldosterone and Natriuretic Peptides in Atrial Fibrillation

Abstract

Background and Aims: During atrial fibrillation (AF), the renin-angiotensin-aldosterone system (RAAS) may be activated.In this study, our aim was to evaluate at a long-term follow-up visit the levels of plasma aldosterone and natriuretic peptides as markers of neurohormonal remodeling in patients with earlier, documented AF in relation to present heart rhythm, clinical data, and the left ventricular ejection fraction (LVEF). We hypothesized that increased levels of aldosterone and natriuretic peptides were significantly associated with present AF as markers of RAAS activation during the arrhythmia. Methods: We studied 158 patients with earlier ECG-documented AF followed by restored sinus rhythm (SR) attending a follow-up visit 2.6 years (mean) after primary inclusion. Results: At follow-up, 93 patients had SR. Heart rhythm at follow-up visit (SR/AF), plasma aldosterone, plasma N-terminal pro Brain Natriuretic Peptide (Nt- proBNP), plasma N-terminal pro Atrial Natriuretic Peptide (Nt-proANP), LVEF, medication, and clinical characteristics were recorded. Standard linear multiple regression analysis including age, sex, weight, hypertension, congestive heart failure, ischemic heart disease, present AF at follow-up, total duration of AF disease, ongoing medication, and the LVEF as explanatory variables showed that only ongoing treatment with diuretics was significantly associated (likelihood ratio test, p = 0.0057) with a raised log-transformed plasma aldosterone, although present AF at follow-up was related to a high aldosterone level (p = 0.09). For the natriuretic peptides, present AF at follow-up (p < 0.0001), age (p < 0.0001), female gender (p = 0.0047), ischemic heart disease (p = 0.0154), and ongoing treatment with sotalol (p = 0.0003) were all independently associated with high log-transformed plasma Nt-proANP. Likewise, present AF at follow-up (p = 0.0008) as well as age (p < 0.0001) were associated with high log-transformed plasma Nt-proBNP. Conclusions: In patients with earlier AF, AF at long-term follow-up visit was independently associated with raised levels of Nt-proANP and Nt-proBNP and to some extent with plasma aldosterone indicating neurohormonal activation during arrhythmia.

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

“…Other independent predictors of high NT-proBNP level were age and presence of persistent or permanent AF. These findings are in accordance with the results of previous studies (11,17,18,23,24). In previous studies, structural heart disease such as hypertension and coronary artery disease were significantly associated with NT-proBNP or BNP (10,11,18,23,24).…”

Neuroendocrine and haemodynamic changes in single-lead atrial pacing and dual-chamber pacing modes

“…[3][4][5] The choice of AAI or DDD pacing mode influences not only the mechanical systolic sequence, but also components of the neuroendocrine system such as the renin-angiotensin-aldosterone system (RAAS), the endothelin system and atrial natriuretic peptide (ANP), which are markers of clinical heart failure 6,7 and atrial fibrillation. 8,9 Although some related observations have been reported, 10 our group is the first to investigate all these factors together in the field of pacemaker. Classically, activation of the RAAS starts with renin production and culminates in the formation of angiotension II (a peptide that acts as a vasoconstrictor and also as a stimulator of aldosterone secretion).…”

Effects of spironolactone on atrial structural remodelling in a canine model of atrial fibrillation produced by prolonged atrial pacing

“…Patients with primary hyperaldosteronism show a 12-fold greater AF risk compared with controls (Milliez et al, 2005b). A chronic increase in the plasma concentration of aldosterone has also been shown to contribute to the pathophysiology of AF (Dixen et al, 2007). As an endproduct of RAAS, aldosterone is one element of neurohormonal activation associated with both chronic heart failure (CHF) and AF.…”