Natriuretic peptide response to dynamic exercise in patients with atrial fibrillation

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Abstract

Background

In patients with atrial fibrillation (AF) information regarding exercise release of atrial natriuretic peptide (ANP) is sparse and data on plasma brain natriuretic peptide (BNP) response to exercise is lacking. The aim of this study was to investigate plasma ANP and BNP response to exercise in patients with permanent AF and to assess if the response was different from the response in healthy age- and sex-matched control subjects.

Methods

Plasma venous concentrations of ANP and BNP were determined at rest, at peak exercise and 30 min from the end of exercise in 38 patients with permanent AF and in 43 age- and sex-matched healthy control subjects.

Results

Plasma concentrations of ANP and BNP were significantly higher in AF patients compared with the healthy control group at rest, peak exercise and after 30 min of recovery (p<0.0001). ANP and BNP increased significantly during exercise in both patients with AF and in the healthy control subjects (p<0.05). The increase in plasma concentration of ANP and BNP during exercise was significantly higher in AF patients compared with healthy controls (p=0.0002 for ANP; p<0.0001 for BNP). In the recovery period plasma BNP decreased significantly (p<0.0001) where as the decrease in plasma ANP was insignificant (p=0.4).

Conclusions

Patients with permanent AF have elevated levels of ANP and BNP at rest and exhibit much higher exercise release compared to healthy control subjects. This enhanced secretion of potent vasodilating and natriuretic agents may represent an important compensatory mechanism to improve exercise capacity in patients with AF.

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.

Section snippets

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.

References (59)

  • T. Kinugawa et al.

    Interleukin-6 and tumor necrosis factor-[alpha] levels increase in response to maximal exercise in patients with chronic heart failure

    Int J Cardiol

    (2003)
  • A. Matsumoto et al.

    Effects of exercise on plasma level of brain natriuretic peptide in congestive heart failure with and without left ventricular dysfunction

    Am Heart J

    (1995)
  • R. Kazanegra et al.

    A rapid test for B-type natriuretic peptide correlates with falling wedge pressures in patients treated for decompensated heart failure: a pilot study

    J Card Fail

    (2001)
  • G. Barletta et al.

    Effects of exercise on natriuretic peptides and cardiac function in man

    Int J Cardiol

    (1998)
  • S. Kruger et al.

    Brain natriuretic peptide kinetics during dynamic exercise in patients with chronic heart failure

    Int J Cardiol

    (2004)
  • M.R. Cowie et al.

    BNP and congestive heart failure

    Prog Cardiovasc Dis

    (2002)
  • H. Bentzen et al.

    Effect of exercise on natriuretic peptides in plasma and urine in chronic heart failure

    Int J Cardiol

    (2004)
  • P.Y. Marie et al.

    Exercise release of cardiac natriuretic peptides is markedly enhanced when patients with coronary artery disease are treated medically by beta-blockers

    J Am Coll Cardiol

    (2004)
  • A.U. Khand et al.

    Carvedilol alone or in combination with digoxin for the management of atrial fibrillation in patients with heart failure?

    J Am Coll Cardiol

    (2003)
  • K. Maeda et al.

    High levels of plasma brain natriuretic peptide and interleukin-6 after optimized treatment for heart failure are independent risk factors for morbidity and mortality in patients with congestive heart failure

    J Am Coll Cardiol

    (2000)
  • B. Stanek et al.

    Prognostic evaluation of neurohumoral plasma levels before and during beta-blocker therapy in advanced left ventricular dysfunction

    J Am Coll Cardiol

    (2001)
  • L. Frost et al.

    Decrease in mortality in patients with a hospital diagnosis of atrial fibrillation in Denmark during the period 1980–1993

    Eur Heart J

    (1999)
  • S. Stewart et al.

    Trends in hospital activity, morbidity and case fatality related to atrial fibrillation in Scotland, 1986–1996

    Eur Heart J

    (2001)
  • B.M. Brenner et al.

    Diverse biological actions of atrial natriuretic peptide

    Physiol Rev

    (1990)
  • C.C. Lang et al.

    Atrial and brain natriuretic peptides: a dual natriuretic peptide system potentially involved in circulatory homeostasis

    Clin Sci

    (1992)
  • E.R. Levin et al.

    Natriuretic Peptides

    N Engl J Med

    (1998)
  • R.S. Gardner et al.

    N-terminal pro-brain natriuretic peptide. A new gold standard in predicting mortality in patients with advanced heart failure

    Eur Heart J

    (2003)
  • G.N. Theodorakis et al.

    Clinical, adrenergic and heart endocrine measures in chronic atrial fibrillation as predictors of conversion and maintenance of sinus rhythm after direct current cardioversion

    Eur Heart J

    (1996)
  • B. Wozakowska-Kaplon et al.

    An increase in plasma atrial natriuretic peptide concentration during exercise predicts a successful cardioversion and maintenance of sinus rhythm in patients with chronic atrial fibrillation

    Pacing Clin Electrophysiol

    (2000)
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