Natriuretic peptide levels in atrial fibrillation - A prospective hormonal and Doppler-echocardiographic study
Natriuretic peptide levels in atrial fibrillation - A prospective hormonal and Doppler-echocardiographic study
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DOI：
10.1016/s0735-1097(00)00515-5
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发表时间：
2000-04-01
影响因子：
24
通讯作者：
Seward, JB
中科院分区：
文献类型：
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作者：
Rossi, A;Enriquez-Sarano, M;Seward, JB
目的：目的是确定心房颤动（A-Fib）和利钠肽激活之间的独立关联。心房纤颤与n端心房和脑利钠肽（分别为N-ANPs和BNPs）激活的关系尚不确定，但对利钠肽的诊断应用具有重要意义。这种不确定性与缺乏适当的控制有关，左室（LV）和心房负荷与心房纤颤相似。方法：我们前瞻性地测量了100名患者和14名按年龄和性别分组的对照组的n端心房、BNPs和内皮素-1水平。将32例房颤患者与68例窦性心律相似的左室和心房负荷（二尖瓣反流或左室功能障碍）患者进行比较，同时用综合多普勒超声心动图测量激素水平。与窦性心律患者相比，心房纤颤患者具有相似的症状、合合症、心脏活性药物、肺动脉压、左房容积、左室射血分数和充血特征，但即使在对潜在心脏病进行调整后，也表现出更高的N-ANP水平（2,613 +/- 1,681 vs 1,654 +/- 1,323 pg/ml, p = 0.007）。相反，两组的BNP水平相似（165 +/- 163 vs 160 +/- 269 pg/ml, p = 0.9）。在多因素分析中，较高的N-ANP水平与a - fib （p = 0.0003）、症状类别（p < 0.0001）和内皮素-1水平（p = 0.032）相关，与左房容积和左室射血分数无关。相反，BNP与左室射血分数无独立关联，而与左室射血分数相关性最强（p < 0.0001）。结论：心房颤动是N-ANP水平升高的独立决定因素，模糊了其与左室功能障碍的关联。相反，BNP与心房纤颤并不独立相关，而是由左室功能障碍强烈决定的。n独立标记。[J] journal of Cardiology; 2000;35:1256-62) (C) 2000。
OBJECTIVES objective was to determine the independent association between atrial fibrillation (A-Fib) and activation of natriuretic peptides.BACKGROUND The association of A-Fib with activation of N-terminal atrial and brain natriuretic: peptides (N-ANPs and BNPs, respectively) is uncertain but of great importance for the diagnostic utilization of natriuretic peptides. This uncertainty is related to the lack of appropriate controls, with left ventricular (LV) and atrial overload similar to A-Fib.METHODS We prospectively measured N-terminal atrial and BNPs and endothelin-1 levels in 100 patients and 14 age- and gender-marched control subjects. The 32 patients with A-Fib were compared with 68 patients in sinus rhythm and similar LV and atrial overload (due to mitral regurgitation or LV dysfunction) measured simultaneously with hormonal levels with comprehensive Doppler echocardiography. Patients with A-Fib compared with those in sinus rhythm had similar symptoms, comorbid conditions, cardioactive medications, pulmonary pressure, left atrial volume, and LV ejection fraction and filling characteristics bur demonstrated higher N-ANP levels (2,613 +/- 1,681 vs. 1,654 +/- 1,323 pg/ml, p = 0.007) even after adjustment for the underlying cardiac disease (p < 0.0001). Conversely, BNP levels were similar in both groups (165 +/- 163 vs. 160 +/- 269 pg/ml, p = 0.9). In multivariate analysis, a higher N-ANP level was associated with A-Fib (p = 0.0003), symptom class (p < 0.0001) and endothelin-1 level(p = 0.032) independently of left atrial volume and LV ejection fraction. Conversely, BNP showed no independent association with and was most strongly associated with LV ejection fraction (p < 0.0001).CONCLUSIONS Atrial fibrillation is an independent determinant of higher N-ANP levels and blurs its association with LV dysfunction. Conversely, the BNP is not independently associated with A-Fib and is strongly determined by LV dysfunction, for which it is;tn independent marker. (J Am Coil Cardiol 2000;35:1256-62) (C) 2000 by the American College of Cardiology.