N-terminal proANF in acute atrial fibrillation: A biochemical marker of atrial pressures but not a predictor for conversion to sinus rhythm☆,☆☆,★
Section snippets
Methods
The patients in this study are a subsample from the Digitalis in Acute Atrial Fibrillation Trial.30 This trial was performed in 13 Swedish hospitals and was a randomized double-blind comparison of intravenously administered digoxin and placebo in patients with acute atrial fibrillation. The primary end point was conversion to sinus rhythm within 16 hours after randomization. Patients older than 18 years of age presenting with atrial fibrillation with a maximal duration of 7 days were eligible.
Baseline characteristics
Between February 1993 and June 1994, 239 patients were included in the Digitalis in Acute Atrial Fibrillation Trial. In 216 patients samples for N-terminal proANF analysis were available. Of these, 98 were women. The mean age was 65.9 ± 13.3 years (range 21 to 89 years), and the mean body weight was 78.4 ± 15.0 kg (range 45 to 160 kg). In 116 patients this was the first episode of atrial fibrillation, whereas in 100 it was a recurrent arrhythmia. The results concerning conversion to sinus
Discussion
Our study shows that N-terminal proANF is markedly increased in patients with acute atrial fibrillation and that the plasma levels decrease substantially after conversion to sinus rhythm. The plasma level of N-terminal proANF at baseline does not predict conversion to sinus rhythm within 16 hours of observation. Furthermore a correlation between relative changes in heart rate and N-terminal proANF was found in patients remaining in atrial fibrillation.
On hemodynamic evaluation atrial
Acknowledgements
We thank Gunilla Norman, RN, and Eva Alfvegren, RN, Department of Internal Medicine, Division of Cardiology, Östra University Hospital, Göteborg for excellent support in coordinating the study. We also thank Lars Frison, PhD, Astra Hässle, AB, Mölndal for invaluable help with statistical methods and interpretation.
References (48)
- et al.
Molecular forms of atrial natriuretic peptides in mammalian tissues and plasma
Biochem Biophys Res Commun
(1985) - et al.
A rapid and potent natriuretic response to intravenous injection of atrial myocardial extracts in rats
Life Sci
(1981) - et al.
The aminoacid sequence of an atrial peptide with potent diuretic and natriuretic properties
Biochem Biophys Res Commun
(1983) - et al.
NH2-terminal fragment of rat pro-atrial natriuretic factor in the circulation: identification, radioimmunoassay and half-life
Peptides
(1988) - et al.
Plasma atrial natriuretic peptide response to direct current cardioversion of atrial fibrillation in patients with mitral stenosis
J Am Coll Cardiol
(1993) - et al.
Atrial natriuretic factor during atrial fibrillation and supraventricular tachycardia
J Am Coll Cardiol
(1987) - et al.
Prognostic importance of atrial natriuretic peptide in patients with chronic heart failure
J Am Coll Cardiol
(1989) - et al.
Atrial natriuretic peptide response to cardioversion of atrial flutter and fibrillation and role of associated heart failure
Am J Cardiol
(1991) - et al.
Prohormone atrial natriuretic peptides 1-30, 31-67 and 99-126 increase in proportion to right ventricular pacing rate
Am Heart J
(1989) - et al.
Plasma prohormone atrial natriuretic peptides 1-98 and 31-67 increase with supraventricular and ventricular arrhythmias
Am J Med Sci
(1990)
The hemodynamic consequences of cardiac arrhythmias: evaluation of the relative roles of abnormal atrioventricular sequencing, irregularity of ventricular rhythm and atrial fibrillation in a canine model
Am Heart J
The propeptide Asn 1-Tyr 126 is the storage form of rat natriuretic factor
Biochem J
Identification and plasma concentrations of the N-terminal fragment of proatrial natriuretic factor in man
J Clin Endocrinol Metab
Gamma-atrial natriuretic polypeptide (gammaANP) -derived peptides in human plasma: cosecretion of N-terminal gammaANP fragment and alfaANP
J Clin Endocrinol Metab
Atrial natriuretic peptide
Studies in cardiac surgical patients with acute renal failure or myocardial ischemia
Atriopeptin turnover: quantitative relationship between in vivo changes in plasma level and atrial content
J Pharm Exp Ther
The N-terminus and a 4000-MW peptide from the midportion of the N-terminus of the atrial natriuretic prohormone each circulate in humans and increase in congestive heart failure
Circulation
Release of natriuretic factor from rat heart-lung preparation by atrial distension
Am J Physiol
Release of ANF, proANF 1-98 and proANF 31-67 from isolated rat atria by atrial distension
Am J Physiol
Plasma atrial natriuretic factor and cyclic GMP in mitral stenosis treated by balloon valvulotomi. Effect of atrial fibrillation
Circulation
Atrial natriuretic peptide in spontaneous tachycardias
Br Heart J
Comparative study of atrial peptides ANF(1-98) and ANF(99-126) as diagnostic markers of atrial distension in patients with cardiac disease
Scand J Lab Invest
Hormones regulating cardiovascular function in patients with severe congestive heart failure and their relation to mortality
Circulation
The plasma concentration of N-terminal proatrial natriuretic factor ANF(1-98) is related to prognosis in severe heart failure
Clin Cardiol
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2015, Journal of Veterinary CardiologyCitation Excerpt :Sympathetic stimulation, angiotensin II, and vasopressin can directly stimulate ANP release45,48,51,52 and might have influenced the CpANP in this study. Also, acute AF and atrial tachycardia can cause an increase in CpANP.53,54 Conversely, in long standing chronic AF, depletion of ANP in atrial myocytes has been described.55,56
Left atrial size and function after spontaneous cardioversion of atrial fibrillation and their relation to N-terminal atrial natriuretic peptide
2003, American Journal of CardiologyNatriuretic peptide levels in atrial fibrillation
2000, Journal of the American College of CardiologyCitation Excerpt :In CHF and ischemic heart disease, higher N-ANP levels are associated with worse outcome (6,7). Although the N-ANP level in A-Fib is not acutely predictive of return to sinus rhythm (23), its large individual variation suggests a potential role as a prognostic indicator that should be evaluated in large long-term studies. Another important clinical issue is the use of natriuretic peptides as diagnostic markers for LV dysfunction.
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From the Departments of aInternal Medicine and Cardiology of Östra University Hospital (Göteborg), cVarberg, dMölndal, e Uddevalla, and fLidköping; and the bInstitute for Surgical Research, Oslo.
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Reprint requests: Björn Hornestam, MD, Division of Cardiology, Department of Internal Medicine, Sahlgrenska University Hospital, S- 413 45 Göteborg, Sweden.
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