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Olsen FJ, Darkner S, Goetze JP, Chen X, Henningsen K, Pehrson S, Svendsen JH, Biering-Sørensen T. Interplay between natriuretic peptides and left atrial mechanics and the relation to recurrence of atrial fibrillation following catheter ablation. Int J Cardiovasc Imaging 2023; 39:1889-1895. [PMID: 37428246 PMCID: PMC10589158 DOI: 10.1007/s10554-023-02913-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Accepted: 06/30/2023] [Indexed: 07/11/2023]
Abstract
The relationship between natriuretic peptides and atrial distension is not fully understood. We sought to examine their interrelationship and how they relate to atrial fibrillation (AF) recurrence following catheter ablation. We analyzed patients enrolled in the AMIO-CAT trial (amiodarone vs. placebo for reducing AF recurrence). Echocardiography and natriuretic peptides were assessed at baseline. Natriuretic peptides included mid-regional proANP (MR-proANP) and N-terminal proBNP (NT-proBNP). Atrial distension was assessed by left atrial strain measured by echocardiography. The endpoint was AF recurrence within 6 months after a 3-month blanking period. Logistic regression was used to assess the association between log-transformed natriuretic peptides and AF. Multivariable adjustments were made for age, gender, randomization, and left ventricular ejection fraction. Of 99 patients, 44 developed AF recurrence. No differences in natriuretic peptides nor echocardiography were observed between the outcome groups. In unadjusted analyses, neither MR-proANP nor NT-proBNP were significantly associated with AF recurrence [MR-proANP: OR = 1.06 (0.99-1.14), per 10% increase; NT-proBNP: OR = 1.01 (0.98-1.05), per 10% increase]. These findings were consistent after multivariable adjustments. However, atrial strain significantly modified the association between MR-proANP and AF (p for interaction = 0.009) such that MR-proANP was associated with AF in patients with high atrial strain [OR = 1.24 (1.06-1.46), p = 0.008, per 10% increase] but not in patients with low atrial strain. In patients with high atrial strain, an MR-proANP > 116 pmol/L posed a fivefold higher risk of AF recurrence [HR = 5.38 (2.19-13.22)]. Atrial natriuretic peptide predicts AF recurrence in patients with preserved atrial distension. Assessing atrial strain may assist the interpretation of natriuretic peptides.
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Affiliation(s)
- Flemming Javier Olsen
- Department of Cardiology, Copenhagen University Hospital - Herlev and Gentofte, Hellerup, Denmark.
- Cardiovascular Non-Invasive Imaging Research Laboratory, Department of Cardiology, Copenhagen University Hospital - Herlev and Gentofte, Gentofte Hospitalsvej 1, 2900, Hellerup, Denmark.
| | - Stine Darkner
- Department of Cardiology, Copenhagen University Hospital - Herlev and Gentofte, Hellerup, Denmark
| | - Jens Peter Goetze
- Department of Clinical Biochemistry, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Xu Chen
- Department of Cardiology, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Kristoffer Henningsen
- Department of Cardiology, Copenhagen University Hospital - Herlev and Gentofte, Hellerup, Denmark
| | - Steen Pehrson
- Department of Cardiology, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Jesper Hastrup Svendsen
- Department of Cardiology, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Tor Biering-Sørensen
- Department of Cardiology, Copenhagen University Hospital - Herlev and Gentofte, Hellerup, Denmark
- Department of Biomedical Sciences, University of Copenhagen, Copenhagen, Denmark
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Olsen FJ, Johansen ND, Skaarup KG, Lassen MCH, Ravnkilde K, Schnohr P, Jensen GB, Marott JL, Søgaard P, Møgelvang R, Biering-Sørensen T. Changes in left atrial structure and function over a decade in the general population. Eur Heart J Cardiovasc Imaging 2021; 23:124-136. [PMID: 34468711 DOI: 10.1093/ehjci/jeab173] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2021] [Accepted: 08/13/2021] [Indexed: 11/14/2022] Open
Abstract
AIMS Assessing left atrial (LA) size and function is an important part of the echocardiographic examination. We sought to assess how LA size and function develop over time, and which clinical characteristics promote atrial remodelling. METHODS AND RESULTS We examined longitudinal changes of the LA between two visits in the Copenhagen City Heart Study (n = 1065). The median time between the examinations was 10.4 years. LA measurements included: maximal LA volume (LAVmax), minimal LA volume (LAVmin), and LA emptying fraction (LAEF). Clinical and echocardiographic accelerators were determined from linear regression. The value of LA remodelling for predicting incident atrial fibrillation (AF) and heart failure (HF) was examined by Cox proportional hazards regressions. During follow-up, LAVmax and LAVmin significantly increased by 8.3 and 3.5 mL/m2, respectively. LAEF did not change. Age and AF were the most impactful clinical accelerators of LA remodelling with standardized beta-coefficients of 0.17 and 0.28 for changes in LAVmax, and 0.18 and 0.38 for changes in LAVmin, respectively. Left ventricular (LV) systolic function, diameter, and mass were also significant accelerators of LA remodelling. Changes in both LAVmax and LAVmin were significantly associated with incident AF [n = 46, ΔLAVmax: HR = 1.06 (1.03-1.09), P < 0.001 and ΔLAVmin: HR = 1.14 (1.10-1.18), P < 0.001, per 1 mL/m2 increase] and HF [n = 27, ΔLAVmax: HR = 1.08 (1.04-1.12), P < 0.001 and ΔLAVmin: HR = 1.13 (1.09-1.18), P < 0.001, per 1 mL/m2 increase]. CONCLUSION Both maximal and minimal LA volume increase over time. Clinical accelerators included age and AF. LV structure and systolic function also accelerate LA remodelling. LA remodelling poses an increased risk of clinical outcomes.
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Affiliation(s)
- Flemming Javier Olsen
- The Copenhagen City Heart Study, Bispebjerg and Frederiksberg Hospital, Frederiksberg, Denmark.,Department of Cardiology, Herlev and Gentofte Hospital, Niels Andersens Vej 65, 2900 Hellerup, Denmark
| | - Niklas Dyrby Johansen
- The Copenhagen City Heart Study, Bispebjerg and Frederiksberg Hospital, Frederiksberg, Denmark.,Department of Cardiology, Herlev and Gentofte Hospital, Niels Andersens Vej 65, 2900 Hellerup, Denmark
| | - Kristoffer Grundtvig Skaarup
- The Copenhagen City Heart Study, Bispebjerg and Frederiksberg Hospital, Frederiksberg, Denmark.,Department of Cardiology, Herlev and Gentofte Hospital, Niels Andersens Vej 65, 2900 Hellerup, Denmark
| | - Mats Christian Højbjerg Lassen
- The Copenhagen City Heart Study, Bispebjerg and Frederiksberg Hospital, Frederiksberg, Denmark.,Department of Cardiology, Herlev and Gentofte Hospital, Niels Andersens Vej 65, 2900 Hellerup, Denmark
| | - Kirstine Ravnkilde
- The Copenhagen City Heart Study, Bispebjerg and Frederiksberg Hospital, Frederiksberg, Denmark.,Department of Cardiology, Herlev and Gentofte Hospital, Niels Andersens Vej 65, 2900 Hellerup, Denmark
| | - Peter Schnohr
- The Copenhagen City Heart Study, Bispebjerg and Frederiksberg Hospital, Frederiksberg, Denmark
| | - Gorm Boje Jensen
- The Copenhagen City Heart Study, Bispebjerg and Frederiksberg Hospital, Frederiksberg, Denmark
| | - Jacob Louis Marott
- The Copenhagen City Heart Study, Bispebjerg and Frederiksberg Hospital, Frederiksberg, Denmark
| | - Peter Søgaard
- The Copenhagen City Heart Study, Bispebjerg and Frederiksberg Hospital, Frederiksberg, Denmark.,Department of Cardiology, North Zealand Hospital, University of Copenhagen, Hillerød, Denmark
| | - Rasmus Møgelvang
- The Copenhagen City Heart Study, Bispebjerg and Frederiksberg Hospital, Frederiksberg, Denmark.,Department of Cardiology, Rigshospitalet, Copenhagen, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.,Department of Clinical Research, Faculty of Health and Medical Sciences, University of Southern, Svendborg, Denmark
| | - Tor Biering-Sørensen
- The Copenhagen City Heart Study, Bispebjerg and Frederiksberg Hospital, Frederiksberg, Denmark.,Department of Cardiology, Herlev and Gentofte Hospital, Niels Andersens Vej 65, 2900 Hellerup, Denmark.,Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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