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Plasma levels of NT-pro-BNP in patients with atrial fibrillation before and after electrical cardioversion

NT-pro-BNP Plasmaspiegel bei Vorhofflimmern vor und nach elektrischer Kardioversion

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Zusammenfassung

Hintergrund

In mehreren Studien wurden natriuretische Peptide (ANP, BNP) bei Patienten mit persistierendem Vorhofflimmern vor und nach elektrischer Kardioversion ermittelt. Häufig bestand bei den untersuchten untersuchten Patienten jedoch additiv eine Herzinsuffizienz, welche die Interpretation der natriuretischen Peptide hinsichtlich des Vorhofflimmerns erschwert. Ziel dieser Studie war es, die Serumkonzentrationen von NT-pro-BNP, welches das stabilere Abspaltungsprodukt von pro-BNP darstellt, bei Patienten mit persistierendem Vorhofflimmern, aber normaler linksventrikulärer Ejektionsfraktion, vor und nach elektrischer Kardioversion zu bestimmen.

Patienten und Methoden

Es wurden NT-pro-BNP-Plasmaspiegel von 34 konsekutiven Patienten vor, wenige Minuten nach und 11 Tage nach elektrischer Kardioversion bestimmt. Alle Patienten wiesen nach echokardiographischen oder lävokardiographischen Kriterien eine normale linksventrikuläre Ejektionsfraktion auf.

Ergebnisse

Im Vergleich zu einem gesunden Kontrollkollektiv zeigte sich das NT-pro-BNP mit einem Medianwert von 1086 pg/ml vs. 66,9 pg/ml signifikant erhöht (p<0,001). Nach einer mittleren Beobachtungszeit von 11 Tagen wiesen Patienten mit anhaltendem Sinusrhythmus einen Abfall des NT-pro-BNP von 1071 pg/ml zu 300 pg/ml auf (p<0,001). Im Gegensatz dazu wiesen Patienten mit einem Vorhofflimmern Rezidiv eine Erhöhung der NT-pro-BNP-Plasmaspiegel von 1570,5 pg/ml zu 1991 pg/ml auf (n.s. p=0,13). Die NT-pro-BNP-Spiegel vor elektrischer Kardioversion zeigten bei Patienten mit oder ohne Rezidiv keinen signifikanten Unterschied (p=0,23).

Zusammenfassung

Patienten mit Vorhofflimmern und normaler linksventrikuärer Ejektionsfraktion zeigten im Vergleich zu einer gesunden Kontrollgruppe ein signifikant erhöhtes NT-pro-BNP. Nach elektrischer Kardioversion war bei Patienten mit Sinusrhythmus ein signifikanter Abfall des NT-pro-BNP nachweisbar, während bei Patienten mit Rezidiv eines Vorhofflimmerns ein erhöhtes (n.s.) NT-pro-BNP messbar war. Da Patienten mit Sinusrhythmus oder Rezidiv eines Vorhofflimmerns vor Kardioversion kein signifikant unterschiedliches NT-pro-BNP aufwiesen, scheint NT-pro-BNP keinen prädiktiven Wert für das Auftreten eines Rezidivs zu besitzen.

Summary

Objective

Plasma levels of brain natriuretic peptide (BNP) have been examined in studies on patients with persistent atrial fibrillation, both before and after electrical cardioversion. Studied patients often showed a comorbidity with congestive heart failure, which complicates interpretation of measured BNP values as a natriuretic peptide. The aim of this study was to examine plasma levels of N-terminal fragment pro-brain natriuretic peptide (NT-pro-BNP), which is the more stable but inactive cleavage product of pro-BNP in patients with atrial fibrillation, but normal left ventricular ejection fraction, before and after electrical cardioversion.

Patients and methods

NT-pro-BNP plasma levels of 34 consecutive patients were measured before, shortly after and 11 days after electrical cardioversion. All patients showed a normal ejection fraction after echocardiographic or laevocardiographic criteria.

Results

At baseline, all patients showed elevated NT-pro-BNP compared to a healthy control group (1086 vs. 66.9 pg/ml, p<0.001). After a mean follow-up time of 11 days in patients with persistent restored sinusrhythm, NT-pro-BNP decreased from 1071 pg/ml at baseline to 300 pg/ml (p<0.001). In contrast, patients with recurrence of atrial fibrillation showed increased levels from 1570.5 pg/ml at baseline to 1991 pg/ml (p=0.13; n.s.). Recurrence of atrial fibrillation was independent from height of NT-pro-BNP levels at baseline (p=0.23).

Conclusions

Atrial fibrillation in patients with a normal left ventricular ejection fraction is associated with elevated NT-pro-BNP plasma levels, which decrease when a persistent sinus-rhythm can be restored by electrical cardioversion. On the other hand, NT-pro-BNP seems to increase (n.s.) when recurrence of atrial fibrillation occurs. Finally, NT-pro-BNP is no valid predictor for long-term success of sinus-rhythm restoration by electrical cardioversion.

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Authors and Affiliations

  1. HELIOS-Klinikum Wuppertal, Universitätsklinikum der Universität Witten-Herdecke, Herzzentrum Kardiologie, Medizinische Klinik III, Arrenberger Str. 20, 42117, Wuppertal, Germany

    D.-I. Shin, Ph. Schley, A. Sause, M. Müller, R. Fueth, H. Guelker & M. Horlitz

  2. Institut für Herz-Kreislaufforschung, Universität Witten-Herdecke, Arrenberger Str. 20, 42117, Wuppertal, Germany

    K. Jaekel & T. Scheffold

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  1. D.-I. Shin
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  2. K. Jaekel
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  3. Ph. Schley
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  4. A. Sause
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  5. M. Müller
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  6. R. Fueth
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  7. T. Scheffold
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  8. H. Guelker
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  9. M. Horlitz
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Correspondence to D.-I. Shin.

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Shin, DI., Jaekel, K., Schley, P. et al. Plasma levels of NT-pro-BNP in patients with atrial fibrillation before and after electrical cardioversion. ZS Kardiologie 94, 795–800 (2005). https://doi.org/10.1007/s00392-005-0301-7

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  • DOI: https://doi.org/10.1007/s00392-005-0301-7

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