Wozakowska-Kapłon Beata, Opolski Grzegorz
1st Department of Cardiology, Centre of Cardiology, Kielce, Poland.
Kardiol Pol. 2009 Mar;67(3):254-61.
Assessment of endocrine profile in patients with cardiovascular diseases has become increasingly important during the last decade. Plasma brain natriuretic peptide (BNP) levels have been used as a marker of left ventricular dysfunction. However, the role of BNP in patients with atrial fibrillation (AF) and normal left ventricular function has not yet been determined.
To examine changes in the secretion of natriuretic peptides (atrial natriuretic peptide - ANP and BNP) during exercise in patients with persistent or permanent AF.
The study group consisted of 42 patients with permanent AF and 77 patients with persistent AF. There were no significant differences in baseline clinical (except AF duration), echocardiographic and haemodynamic data between the groups. The control group comprised 20 patients. All had normal sinus rhytm without a history of AF and were compatible in age, gender and concomitant diseases with the examined groups. The ANP and BNP samples were obtained at rest and at the peak of the exercise testing. Duration of exercise testing was 10 min.
The multiple regression analysis showed an association between ANP levels and left atrial volume (p = 0.0001), maximal heart rate (p = 0.0036) and NYHA class (p < 0.0001). There was a trend toward a significant relation between AF duration and ANP levels. There was a significant correlation between BNP levels and heart failure class according to NYHA (p < 0.0001). A significant and strong positive correlation of ANP and BNP concentrations at rest was observed in all groups of AF. Significant variation of natriuretic peptide release in response to exercise (ANPex and BNPex) was observed. The highest increase of ANP level and the lowest increase of BNP level were noted in the control group, and no significant differences were found in ANP and BNP secretion between the groups with persistent and permanent AF.
Neurohormonal response to exercise differs between patients with AF and those in sinus rhythm. Exercise testing may be used to assess the ability of cardiac myocytes to increase peptide secretion.
在过去十年中，评估心血管疾病患者的内分泌状况变得越来越重要。血浆脑钠肽（BNP）水平已被用作左心室功能障碍的标志物。然而，BNP在心房颤动（AF）且左心室功能正常的患者中的作用尚未确定。
研究持续性或永久性房颤患者运动期间利钠肽（心房利钠肽 - ANP和BNP）分泌的变化。
研究组包括42例永久性房颤患者和77例持续性房颤患者。两组之间的基线临床（除房颤持续时间外）、超声心动图和血流动力学数据无显著差异。对照组包括20例患者。所有患者均为正常窦性心律，无房颤病史，在年龄、性别和伴随疾病方面与研究组匹配。在静息状态和运动试验峰值时采集ANP和BNP样本。运动试验持续时间为10分钟。
多元回归分析显示ANP水平与左心房容积（p = 0.0001）、最大心率（p = 0.0036）和纽约心脏协会（NYHA）分级（p < 0.0001）之间存在关联。房颤持续时间与ANP水平之间存在显著关系的趋势。根据NYHA分级，BNP水平与心力衰竭分级之间存在显著相关性（p < 0.0001）。在所有房颤组中，静息时ANP和BNP浓度之间存在显著且强烈的正相关。观察到利钠肽释放对运动的显著变化（ANPex和BNPex）。对照组中ANP水平升高最高，BNP水平升高最低，持续性房颤组和永久性房颤组之间的ANP和BNP分泌无显著差异。
房颤患者与窦性心律患者对运动的神经激素反应不同。运动试验可用于评估心肌细胞增加肽分泌的能力。
