Atrial Fibrillation, thromboembolic risk, and the potential role of the natriuretic peptides, a focus on BNP and NT-proBNP – A narrative review

Kerr, B; Brandon, Lisa

doi:10.1016/j.ijcha.2022.101132

Cited by 14 publications

(12 citation statements)

References 101 publications

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“…Previous studies have also considered that atrial and ventricular myocyte stretching, counter regulation of myocardial fibrosis and inflammation response, and downregulation of neutral endonuclease in patients with AF are the main causes of elevated BNP levels. Our study had similar result to previous studies ( Kerr & Brandon, 2022 ).…”

Section: Discussionsupporting

confidence: 93%

Changes of the gut microbiota composition and short chain fatty acid in patients with atrial fibrillation

Chen,

Huang

et al. 2023

PeerJ

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Background With the establishment of the cardiac-gut axis concept, increasing evidence has suggested the involvement and important regulatory role of the gut microbiota (GM) and short chain fatty acid (SCFA) in cardiovascular diseases. However, the relationship between GM and atrial fibrillation (AF) is still poorly understood. Objectives The aim of this study was to investigate whether there were differences in GM and SCFA between AF patients and healthy controls. Methods In this study, we enrolled 30 hospitalized patients with AF and 30 matched patients with sinus rhythm (SR). GM species in fecal samples were evaluated through amplicon sequencing targeting the 16Sribosomal RNA gene. The feces SCFAs were describe step by step the quantitative analysis using gas chromatography-mass spectrometry (GC-MS). GM species richness, diversity, differential abundance of individual taxa between AF and SR were analyzed. Results AF patients showed decreased species richness and α-diversity compared to SR patients, but there was no statistical difference. The phylogenetic diversity was significant decreased in AF group. The β-diversity indexes revealed significant differences in GM community structure between the AF group and the SR group. After investigated the individual taxa, AF group showed altered relative abundance in several taxa compared to the SR group. linear discriminant analysis (LDA) effect size (LEfSe) analysis revealed, a significant decrease in Bifidobacterium and a greater abundance of Lactobacillus, Fusobacterium, Haemophilus in AF group compared with the SR group. The abundance of haemophilus was negative correlated with isovaleric acid and isobutyric acid. Conclusions In AF patients, the GM phylogenetic diversity and β-diversity decreased, the relative abundance altered in several taxa and the bacterial community structure changed as well as the SCFA level. GM and SCFA dysbiosis might play a crucial part in the occurrence and development of AF.

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Section: Discussionsupporting

confidence: 93%

Changes of the gut microbiota composition and short chain fatty acid in patients with atrial fibrillation

Chen,

Huang

et al. 2023

PeerJ

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“…Chronic heart failure with preserved systolic function, which is much more common than chronic pulmonary artery occlusion, may explain elevated concentrations of NT-proBNP in symptomatic patients after PE [17,18]. Survivors with symptoms were also much older and more likely to have fibrillation than asymptomatic patients, which also explains the increased concentration of BNP [19]. Obviously, mean concentrations of BNP were higher in CTEPH/CTEPD but levels above 125 pg/mL were exceeded similarly frequently in symptomatic patients with and without chronic thromboembolism.…”

Section: Discussionmentioning

confidence: 99%

Electrocardiogram, Echocardiogram and NT-proBNP in Screening for Thromboembolism Pulmonary Hypertension in Patients after Pulmonary Embolism

Dzikowska-Diduch

Kurnicka

Lichodziejewska

et al. 2022

JCM

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Background: The annual mortality of patients with untreated chronic thromboembolism pulmonary hypertension (CTEPH) is approximately 50% unless a timely diagnosis is followed by adequate treatment. In pulmonary embolism (PE) survivors with functional limitation, the diagnostic work-up starts with echocardiography. It is followed by lung scintigraphy and right heart catheterization. However, noninvasive tests providing diagnostic clues to CTEPH, or ascertaining this diagnosis as very unlikely, would be extremely useful since the majority of post PE functional limitations are caused by deconditioning. Methods: Patients after acute PE underwent a structured clinical evaluation with electrocardiogram, routine laboratory tests including NT-proBNP and echocardiography. The aim of this study was to verify whether the parameters from echocardiographic or perhaps electrocardiographic examination and NT-proBNP concentration best determine the risk of CTEPH. Results: Out of the total number of patients (n = 261, male n = 123) after PE who were included in the study, in the group of 155 patients (59.4%) with reported functional impairment, 13 patients (8.4%) had CTEPH and 7 PE survivors had chronic thromboembolic pulmonary disease (CTEPD) (4.5%). Echo parameters differed significantly between CTEPH/CTEPD cases and other symptomatic PE survivors. Patients with CTEPH/CTEPD also had higher levels of NT-proBNP (p = 0.022) but concentration of NT-proBNP above 125 pg/mL did not differentiate patients with CTEPH/CTEPD (p > 0.05). Additionally, the proportion of patients with right bundle brunch block registered in ECG was higher in the CTEPH/CTED group (23.5% vs. 5.8%, p = 0.034) but there were no differences between the other ECG characteristics of right ventricle overload. Conclusions: Screening for CTEPH/CTEPD should be performed in patients with reduced exercise tolerance compared to the pre PE period. It is not effective in asymptomatic PE survivors. Patients with CTEPH/CTED predominantly had abnormalities indicating chronic thromboembolism in the echocardiographic assessment. NT-proBNP and electrocardiographic characteristics of right ventricle overload proved to be insufficient in predicting CTEPH/CTEPD development.

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“…One possible reason for this is that increased pressure on atrial myocytes can lead to increased BNP secretion, thus reflecting atrial dysfunction [ 10 ]. Natriuretic peptides (NPs) have been shown to be elevated in AF, with higher levels of BNP and NT-proBNP being predictive of incidental AF [ 11 ]. Although no significant difference between NT-proBNP and BNP for HF has been identified in terms of diagnostic efficacy, prognostic evaluation, or outcome time [ 12 ], the association between the AF progression phenotype and NT-proBNP is related to the type of AF.…”

Section: Introductionmentioning

confidence: 99%

Relationship between Brain Natriuretic Peptide and Thromboembolic Events in Elderly Patients with Nonvalvular Atrial Fibrillation

Wang,

Huang,

et al. 2024

Cardiology Research and Practice

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Objective. To investigate the relationship between brain natriuretic peptide (BNP) and thromboembolic events in elderly patients with nonvalvular atrial fibrillation (NVAF). Methods. This is a prospective cohort study, and based on the inclusion and exclusion criteria, 180 elderly patients with NVAF were included. The patients received follow-up appointments in the clinic or by telephone every 6 months after the beginning of the study. The primary follow-up endpoints were thromboembolic and atherosclerotic events, including ischaemic stroke, myocardial infarction, and systemic embolism. The secondary endpoints were adverse events, including cardiovascular death, all-cause death, and hospitalisation for heart failure. Patients were divided into three groups according to their BNP level at admission: group A (BNP ≤334.5 pg/mL), group B (BNP = 334.5–1,288 pg/mL), and group C (BNP ≥1,288 pg/mL). Results. A total of 180 patients were enrolled in this study, with 50 patients in group A, 68 in group B, and 62 in group C. Compared with groups A and B, group C had a higher CHA2DS2-VASc score (Z = 15.142; P=0.001) and a lower ejection fraction (EF) value (Z = 119.893; P=0.001). The left atrium (LA) and left ventricular end-diastolic diameter (LVEDD) were larger (Z = 105.031; P=0.001 and Z = 74.430; P=0.001), respectively, suggesting that patients with significantly increased BNP had a higher risk of thromboembolism and atherosclerosis, lower EF, larger LA and LVEDD, and worse cardiac function. After 1 year of follow-up, the incidence of primary endpoint events (χ2 = 9.556; P=0.008) and secondary endpoint events (χ2 = 59.485; P=0.001) in group C were higher than those in groups A and B. Conclusion. Higher BNP levels may be an independent risk factor for thromboembolic and atherosclerotic events in elderly patients with NVAF. The higher the BNP level, the greater the risk of thromboembolic and atherosclerotic events.

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Atrial Fibrillation, thromboembolic risk, and the potential role of the natriuretic peptides, a focus on BNP and NT-proBNP – A narrative review

Cited by 14 publications

References 101 publications

Changes of the gut microbiota composition and short chain fatty acid in patients with atrial fibrillation

Changes of the gut microbiota composition and short chain fatty acid in patients with atrial fibrillation

Electrocardiogram, Echocardiogram and NT-proBNP in Screening for Thromboembolism Pulmonary Hypertension in Patients after Pulmonary Embolism

Relationship between Brain Natriuretic Peptide and Thromboembolic Events in Elderly Patients with Nonvalvular Atrial Fibrillation

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