血浆去甲肾上腺素水平升高与孤立性心房颤动患者的病态窦房结综合征。

Elevated plasma norepinephrine level and sick sinus syndrome in patients with lone atrial fibrillation.

机构信息

Division of Cardiovascular Medicine, Ibaraki Prefectural Central Hospital, Kasama, Japan Cardiovascular Division, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan.

Cardiovascular Division, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan.

出版信息

Heart. 2015 Jul;101(14):1133-8. doi: 10.1136/heartjnl-2014-307334. Epub 2015 May 12.

DOI:10.1136/heartjnl-2014-307334

PMID:25968056

Abstract

OBJECTIVE

Plasma norepinephrine (NE) level can be a guide to mortality in patients with heart failure. This study aimed to evaluate the significance of plasma NE level compared with plasma natriuretic peptides (atrial natriuretic peptide (ANP) and brain natriuretic peptide (BNP)) levels in patients with atrial fibrillation (AF).

METHODS

Included in this study were 137 consecutive patients referred for catheter ablation of lone AF (paroxysmal in 90 and persistent in 47 patients). Blood samples for measurements of ANP, BNP and NE were drawn in the supine position before the procedure.

RESULTS

ANP, BNP and NE levels were greater in patients with persistent AF than in patients with paroxysmal AF (median (25th-75th centile)=28 (18-49) vs 69 (36-106), p<0.0001; 28 (15-50) vs 94 (39-156), p<0.0001; and 315 (223-502) vs 382 (299-517) pg/mL, p=0.04, respectively). NE level correlated weakly with ANP and BNP levels (r=0.28 and r=0.23, respectively, p<0.01 for both). BNP and NE levels differed between patients with and without recurrence of AF (55 (26-135) vs 35 (18-64), p=0.005 and 431 (323-560) vs 302 (225-436) pg/mL, p<0.001, respectively). Of note, only NE level was significantly greater in patients with symptomatic sick sinus syndrome (SSS) (n=21) than in those without SSS (560 (466-632) vs 321 (242-437) pg/mL, p<0.0001). Logistic regression analysis showed NE level to be the only independent discriminator for SSS (OR 1.006, 95% CI 1.002 to 1.010, p=0.001).

CONCLUSIONS

An increase in plasma NE level was observed in patients with AF and SSS. Although this implies a pathophysiological link between clinical manifestation of SSS and the autonomic nervous dysfunction, further studies are needed to clarify the mechanisms for this novel finding.

摘要

目的

血浆去甲肾上腺素（NE）水平可作为心力衰竭患者死亡率的指导。本研究旨在评估血浆 NE 水平与血浆利钠肽（心房利钠肽（ANP）和脑利钠肽（BNP））水平在心房颤动（AF）患者中的意义。

方法

本研究纳入了 137 例因孤立性 AF（阵发性 90 例，持续性 47 例）而行导管消融术的连续患者。在手术前取仰卧位时抽取血液样本测量 ANP、BNP 和 NE 水平。

结果

持续性 AF 患者的 ANP、BNP 和 NE 水平高于阵发性 AF 患者（中位数（25-75 百分位数）=28（18-49）比 69（36-106），p<0.0001；28（15-50）比 94（39-156），p<0.0001；315（223-502）比 382（299-517）pg/mL，p=0.04，分别）。NE 水平与 ANP 和 BNP 水平呈弱相关（r=0.28 和 r=0.23，p<0.01 均）。AF 复发患者与无复发患者的 BNP 和 NE 水平不同（55（26-135）比 35（18-64），p=0.005 和 431（323-560）比 302（225-436）pg/mL，p<0.001，分别）。值得注意的是，只有伴有症状性窦性心动过缓综合征（SSS）的患者（n=21）的 NE 水平明显高于无 SSS 的患者（560（466-632）比 321（242-437）pg/mL，p<0.0001）。Logistic 回归分析显示，NE 水平是 SSS 的唯一独立鉴别因素（OR 1.006，95%CI 1.002 至 1.010，p=0.001）。