Document Detail

Longstanding atrial fibrillation causes depletion of atrial natriuretic peptide in patients with advanced congestive heart failure.
MedLine Citation:
PMID:  12034149     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Congestive heart failure (CHF) is characterized by neurohormonal activation, including increased plasma concentrations of atrial natriuretic peptide (ANP) and N-terminal ANP (N-ANP). Onset of atrial fibrillation (AF) further increases these peptides, but it may be hypothesized that concentrations decrease during longstanding AF due to inherent atrial degeneration.
AIM: We sought to investigate the relation between neurohormonal activation in patients with CHF and the duration of concomitant AF.
METHODS: The study group comprised 60 patients (age 70 +/- 8 years) with advanced CHF due to left ventricular systolic dysfunction (left ventricular ejection fraction (LVEF) < 0.35) and chronic AF (duration 21 (1-340) months). Plasma neurohormone concentrations were measured, and multiple regression analysis was performed to identify their clinical predictors.
RESULTS: Median plasma neurohormone concentrations were: ANP 113 pmol/l, N-ANP 1187 pmol/l, norepinephrine 496 pg/ml, renin 127 micro units/l, aldosterone 128 pg/ml and endothelin 8.1 pg/ml. Norepinephrine, renin, aldosterone and endothelin were not significantly related to the duration of AF. In contrast, ANP decreased along with the duration of AF (P = 0.03), while the same trend was observed for N-ANP (P = 0.10). However, for these peptides a first order interaction with LVEF was present, which was not observed in the other neurohormones. In patients with LVEF > 0.25 ANP and N-ANP increased along with the duration of AF, whereas in patients with LVEF < or = 0.25 an inverse relation between ANP (P = 0.02) and N-ANP (P = 0.04) and the duration of AF was present, longer-standing AF being associated with lower concentrations.
CONCLUSION: In patients with advanced CHF with low LVEF plasma ANP and N-ANP concentrations decrease during longstanding AF. This finding agrees with the concept that longstanding AF leads to impaired ability of the atria to produce these neurohormones due to inherent degenerative changes.
Maarten P van den Berg; Geert Tjeerdsma; Pieter Jan de Kam; Frans Boomsma; Harry J G M Crijns; Dirk J van Veldhuisen
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Publication Detail:
Type:  Clinical Trial; Journal Article; Randomized Controlled Trial    
Journal Detail:
Title:  European journal of heart failure     Volume:  4     ISSN:  1388-9842     ISO Abbreviation:  Eur. J. Heart Fail.     Publication Date:  2002 Jun 
Date Detail:
Created Date:  2002-05-29     Completed Date:  2002-10-16     Revised Date:  2011-06-08    
Medline Journal Info:
Nlm Unique ID:  100887595     Medline TA:  Eur J Heart Fail     Country:  Netherlands    
Other Details:
Languages:  eng     Pagination:  255-62     Citation Subset:  IM    
Department of Cardiology, Thorax Center, University Hospital Groningen, P.O. Box 30.001, 9700 RB Groningen, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands.
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MeSH Terms
Aldosterone / blood
Analysis of Variance
Atrial Fibrillation / blood*,  physiopathology
Atrial Natriuretic Factor / biosynthesis*,  blood
Heart Failure / blood*,  physiopathology
Norepinephrine / blood
Protein Precursors / blood
Renin / blood
Stroke Volume / physiology
Time Factors
Ventricular Dysfunction, Left / physiopathology
Reg. No./Substance:
0/N-terminal proatrial natriuretic peptide; 0/Protein Precursors; 51-41-2/Norepinephrine; 52-39-1/Aldosterone; 85637-73-6/Atrial Natriuretic Factor; EC

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