Abstract
The objective of this work was to assess the predictive value of pre-procedural N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels in patients undergoing atrial fibrillation (AF) ablation. Seventy-three consecutive patients with AF (paroxysmal n = 49, persistent n = 24) and preserved left ventricular (LV) systolic function (LV ejection fraction > 45%) were prospectively enrolled in this study. All of the enrolled patients underwent catheter ablation after a measurement of their plasma NT-proBNP levels, and an echocardiographic examination with assessment of their LV diastolic function and left atrial(LA) volume. Patients with AF recurrence at 3 months had more persistent AF (P = 0.001), a higher LA volume index (P = 0.002), lesser decelerating times (DT) of mitral inflow (P = 0.014), and higher NT-proBNP levels (P < 0.001), when compared with patients with sinus rhythm restoration. The baseline log NT-proBNP correlated significantly with age (r = 0.26, P = 0.025), LA volume index (r = 0.41, P = 0.001), E/E’ (r = 0.34, P = 0.007), DT (r = −0.34, P = 0.007), and E (r = 0.25, P = 0.04). The log NT-proBNP (HR 7.76, 95% CI 2.95–20.39, P < 0.001) was an independent predictor of AF recurrence. The measurement of NT-proBNP added incremental predictive value to standard indexes of LA size or diastolic function, including LA volume index and DT (P = 0.02). This study suggests the clinical utility of the level of NT-proBNP as an integrating marker of various risk factors, and as an incremental predictive marker for AF catheter ablation.
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References
Anand IS, Fisher LD, Chiang YT, Latini R et al (2003) Changes in brain natriuretic peptide and norepinephrine over time and mortality and morbidity in the Valsartan Heart Failure Trial (Val-HeFT). Circulation 107:1278–1283
Berruezo A, Tamborero D, Mont L et al (2007) Pre-procedural predictors of atrial fibrillation recurrence after circumferential pulmonary vein ablation. Eur Heart J 28:836–841
Date T, Yamane T, Inada K et al (2006) Plasma brain natriuretic peptide concentrations in patients undergoing pulmonary vein isolation. Heart (Br Cardiac Soc) 92:1623–1627
Ellinor PT, Low AF, Patton KK et al (2005) Discordant atrial natriuretic peptide and brain natriuretic peptide levels in lone atrial fibrillation. JACC 45:82–86
Enriquez-Sarano M, Bailey KR, Seward JB et al (1993) Quantitative Doppler assessment of valvular regurgitation. Circulation 87:841–848
Hense HW, Gneiting B, Muscholl M et al (1998) The associations of body size and body composition with left ventricular mass: impacts for indexation in adults. JACC 32:451–457
Inoue S, Murakami Y, Sano K et al (2000) Atrium as a source of brain natriuretic polypeptide in patients with atrial fibrillation. J Cardiac Fail 6:92–96
Iwanaga Y, Nishi I, Furuichi S et al (2006) B-type natriuretic peptide strongly reflects diastolic wall stress in patients with chronic heart failure: comparison between systolic and diastolic heart failure. JACC 47:742–748
Lang RM, Bierig M, Devereux RB et al (2005) Recommendations for chamber quantification: a report from the American Society of Echocardiography’s guidelines and standards committee and the chamber quantification writing group, developed in conjunction with the European Association of echocardiography, a branch of the European Society of Cardiology. J Am Soc Echocardiogr 18:1440–1463
Lee SH, Jung JH, Choi SH et al (2006) Determinants of brain natriuretic peptide levels in patients with lone atrial fibrillation. Circ J 70:100–104
Oral H, Knight BP, Tada H et al (2002) Pulmonary vein isolation for paroxysmal and persistent atrial fibrillation. Circulation 105:1077–1081
Quinones MA, Waggoner AD, Reduto LA (1981) A new, simplified and accurate method for determining ejection fraction with two-dimensional echocardiography. Circulation 64:744–753
Reant P, Lafitte S, Jais P et al (2005) Reverse remodeling of the left cardiac chambers after catheter ablation after 1 year in a series of patients with isolated atrial fibrillation. Circulation 112:2896–2903
Shin DI, Jaekel K, Schley P et al (2005) Plasma levels of NT-pro-BNP in patients with atrial fibrillation before and after electrical cardioversion. Zeitschrift fur Kardiologie 94:795–800
Silvet H, Young-Xu Y, Walleigh D et al (2003) Brain natriuretic peptide is elevated in outpatients with atrial fibrillation. Am J Cardiol 92:1124–1127
Tada H, Kurosaki K, Ito S et al (2005) Left atrial and pulmonary vein ostial ablation as a new treatment for curing persistent atrial fibrillation. Circ J 69:1057–1063
Troughton RW, Prior DL, Pereira JJ et al (2004) Plasma b-type natriuretic peptide levels in systolic heart failure: importance of left ventricular diastolic function and right ventricular systolic function. JACC 43:416–422
Tsang TS, Gersh BJ, Appleton CP et al (2002) Left ventricular diastolic dysfunction as a predictor of the first diagnosed nonvalvular atrial fibrillation in 840 elderly men and women. JACC 40:1636–1644
Tsuchida K, Tanabe K (2004) Influence of paroxysmal atrial fibrillation attack on brain natriuretic peptide secretion. J Cardiol 44:1–11
Yamada T, Murakami Y, Okada T et al (2006) Plasma atrial natriuretic peptide and brain natriuretic peptide levels after radiofrequency catheter ablation of atrial fibrillation. Am J Cardiol 97:1741–1744
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Dr. Hwang and Dr. Son contributed equally to this work.
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Hwang, H.J., Son, J.W., Nam, BH. et al. Incremental predictive value of pre-procedural N-terminal pro-B-type natriuretic peptide for short-term recurrence in atrial fibrillation ablation. Clin Res Cardiol 98, 213–218 (2009). https://doi.org/10.1007/s00392-009-0744-3
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DOI: https://doi.org/10.1007/s00392-009-0744-3