Low atrial natriuretic peptide to brain natriuretic peptide ratio is associated with left atrial remodeling

Abstract

Aims Atrial natriuretic peptide (ANP) deficiency is thought to be one of the causes of heart failure induced by atrial fibrillation (AF). Although ANP deficiency is thought to occur as a result of atrial remodeling, data to explain this mechanism are limited. The purpose of this study was to investigate the association between ANP and left atrial remodeling or prognosis of heart failure in patients with AF ablation. Methods In total, 373 consecutive patients who underwent initial ablation for persistent AF [age, 67 ± 10 years; female, 97 (26%)] were retrospectively enrolled. ANP and brain natriuretic peptide (BNP) were measured before the procedure and the ANP/BNP ratio was calculated. Left atrial volume index, left atrial appendage emptying velocity, and left atrial low-voltage areas (LVAs) were used as left atrial-remodeling parameters. The primary outcome of heart failure was defined as the composite of all-cause death or hospitalization due to worsening heart failure. Results The median ANP level was 116 (71–178) pg/ml and the median ANP/BNP ratio was 0.65 (0.46–1.00). The ANP/BNP ratio decreased with increasing left atrial volume index or LVAs and with decreasing left atrial appendage emptying velocity. During the 5-year follow-up, freedom from the primary outcome was significantly lower in patients with ANP/BNP ratio ≤0.65 than in those with ANP/BNP ratio >0.65 (84.6% versus 95.6%, P < 0.01). Conclusion Secretion of ANP relative to BNP decreased with progression of left atrial remodeling in patients with AF ablation. Furthermore, prognosis of heart failure was poor in patients with a low ANP/BNP ratio.

Unraveling the Complexity: From Molecular Subtypes to Therapeutic Strategies in Heart Failure with Preserved Ejection Fraction and Atrial Fibrillation

“…Natriuretic Peptides Response: Atrial stretch and pressure overload in atrial fibrillation (AF) lead to the release of atrial natriuretic peptide (ANP) and brain natriuretic peptide (BNP) [65,66]. Initially, these peptides are released to counteract the effects of volume overload.…”

“…ANP deficiency is thought to occur as a result of atrial remodeling in patients with AF ablation [67,68]. Additionally, the ANP-to-BNP ratio is significantly higher in patients with LA reverse remodeling [65]. In patients with sustained volume-dependent primary hypertension, those with uncontrolled systolic blood pressure (SBP) have an attenuated relationship between ANP and indexes of volume overload, suggesting impaired vascular effects of ANP [66].…”