Darkner Stine, Goetze Jens Peter, Chen Xu, Henningsen Kristoffer, Pehrson Steen, Svendsen Jesper Hastrup
Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.
Department of Clinical Biochemistry, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.
Am J Cardiol. 2017 Oct 15;120(8):1309-1315. doi: 10.1016/j.amjcard.2017.07.018. Epub 2017 Jul 24.
Natriuretic peptides are established plasma markers of systolic heart failure, but their usefulness for the evaluation of atrial fibrillation (AF) is unknown. We examined mid-regional pro-atrial natriuretic peptide (MR-proANP) and N-terminal pro-brain natriuretic peptide (NT-proBNP) in patients undergoing ablation for AF. A subpopulation of 102 patients (median age 60 [52;65], 82% male) from the AMIO-CAT trial (Recurrence of arrhythmia following short-term oral AMIOdarone after CATheter ablation for atrial fibrillation: a double-blind, randomized, placebo-controlled study) undergoing ablation for paroxysmal (n = 55) or persistent (n = 47) AF was studied. MR-proANP and NT-proBNP were measured before ablation and at 1, 3, and 6 months' follow-up. Three-day Holter monitoring was performed before ablation, and 6 to 8 weeks and 6 months after ablation. Plasma MR-proANP and NT-proBNP concentrations were higher during AF than during sinus rhythm before ablation (188 pmol/L [131;260] vs 94 pmol/L [64;125], p <0.001; 78 pmol/L [43;121] vs 10.3 pmol/L [5.9;121], p <0.001) and at 1, 3, and 6 months' follow-up. Categories of AF burden on 3-day Holter monitoring (0%, 0% to 99%, and 99% to 100%) were associated with plasma concentrations of both MR-proANP (94 pmol/L [55;127] vs 117 pmol/L [88;185] vs 192 pmol/L [127;261], p <0.001) and NT-proBNP (10 pmol/L [5.9;22] vs 22 pmol/L [8.9;53] vs 81 pmol/L [45;116], p <0.001). In a multivariate regression analysis, however, there was no significant association between baseline propeptide concentrations and recurrence of AF at 6 months' follow-up. In conclusion, AF was associated with higher plasma concentrations of MR-proANP and NT-proBNP than sinus rhythm. Moreover, AF burden was associated with subsequent concentrations of both MR-proANP and NT-proBNP. The results suggest that natriuretic propeptide measurement reflects functional cardiac dysfunction during AF, and that AF burden should be included in biochemical assessment of left ventricular dysfunction.
利钠肽是收缩性心力衰竭公认的血浆标志物，但其对心房颤动（AF）评估的有用性尚不清楚。我们对接受AF消融术的患者的中段心房利钠肽原（MR-proANP）和N末端脑钠肽原（NT-proBNP）进行了检测。来自AMIO-CAT试验（房颤导管消融术后短期口服胺碘酮后心律失常复发：一项双盲、随机、安慰剂对照研究）的102例患者（中位年龄60[52；65]岁，82%为男性）亚组接受了阵发性（n = 55）或持续性（n = 47）AF消融术。在消融术前以及随访1、3和6个月时测量MR-proANP和NT-proBNP。在消融术前、消融术后6至8周以及6个月时进行为期三天的动态心电图监测。AF期间血浆MR-proANP和NT-proBNP浓度高于消融术前窦性心律期间（188 pmol/L[131；260]对94 pmol/L[64；125]，p<0.001；78 pmol/L[43；121]对10.3 pmol/L[5.9；121]，p<0.001）以及随访1、3和6个月时。为期三天的动态心电图监测的AF负荷类别（0%、0%至99%以及99%至100%）与MR-proANP（94 pmol/L[55；127]对117 pmol/L[88；185]对192 pmol/L[127；261]，p<0.001）和NT-proBNP（10 pmol/L[5.9；22]对22 pmol/L[8.9；53]对81 pmol/L[45；116]，p<0.001）的血浆浓度均相关。然而，在多变量回归分析中，基线前体肽浓度与随访6个月时AF复发之间无显著关联。总之，与窦性心律相比，AF与更高的MR-proANP和NT-proBNP血浆浓度相关。此外，AF负荷与随后的MR-proANP和NT-proBNP浓度均相关。结果表明，利钠肽原测量反映了AF期间的功能性心脏功能障碍，并且AF负荷应纳入左心室功能障碍的生化评估中。
