Natriuretic peptide response to dynamic exercise in patients with atrial fibrillation
Introduction
Atrial fibrillation (AF) is the most common sustained arrhythmia seen in clinical practice, and its incidence is still increasing [1], [2]. AF is associated with adverse haemodynamic effects. In particular, absence of synchronized atrial and ventricular activation with loss of atrial systole has detrimental effects. In order to restore and maintain cardiovascular homeostasis the heart synthesizes peptide hormones with diuretic, natriuretic, and vasodilatory properties, namely the atrial and the brain natriuretic peptides [3], [4]. Atrial natriuretic peptide and its N-terminal prohormone (ANP) are produced in the atria, whereas brain natriuretic peptide and its N-terminal prohormone (BNP) originate mainly from the ventricles. Natriuretic peptides are secreted in response to increased wall tension in the atria and ventricles and consequently plasma levels of these peptides are increased in patients with congestive heart failure (CHF) [5]. Considerable attention has focused on the potential utility of these peptides in establishing a diagnosis of CHF and the natriuretic peptides are strong predictors for the prognosis of CHF patients [6].
In AF data regarding ANP and BNP is limited. Most attention has focused on ANP as a possible predictor of successful cardioversion [7], [8], [9] and recurrence AF [10]. However, data on resting plasma levels of ANP and BNP in AF patients are inconsistent and no information is available about the excretion of plasma BNP during exercise in AF patients. The aim of this study was to investigate plasma ANP and BNP response to exercise in AF patients and to assess if the response was different from the response in healthy age- and sex-matched control subjects.
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Patients
Thirty-eight patients with permanent AF and 43 age- and sex-matched normal control subjects were studied. Patients were hospital out-patients with confirmed atrial fibrillation for at least the preceding 6 months. Rhythms were documented by review of chart, history and electrocardiograms. We excluded all patients with a history of valve disease, sick sinus syndrome, atrioventricular conduction disturbances, pacemaker, stroke, or coronary revascularization; debilitating comorbid illness,
Patient characteristics
Baseline characteristics of the patients and controls included in the study are listed in Table 1. All AF patients had a controlled ventricular rate, with a mean resting heart rate of approximately 89 beats/min, a controlled blood pressure and were fully anticoagulated. Main medications in patients with AF included digoxin 31(82%), beta-blockers 9(24%), diuretics 18(47%), angiotensin-converting enzymes/angiotensin II receptor blockers 13(34%), calcium cannel antagonists 15(40%), and nitrates
Discussion
The current study demonstrates the following: 1) ANP and BNP plasma response to exercise is augmented in patients with AF; 2) resting levels of ANP and BNP is significantly elevated in patients with AF; 3) AF is an independent predictor of elevated levels of ANP and BNP.
Conflict of interest statement
No conflict of interest.
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