| 김재희, 채성철, 이장훈, 권용섭, 류현민, 배명환, 양동헌, 박헌식, 조용근, 전재은, 박의현 |
BACKGROUND AND OBJECTIVES: It has been known that atrial fibrillation (AF) may affect plasma levels of N-terminal pro-brain natriuretic peptide (NT-proBNP) in patients with chronic congestive heart failure. However, little is known about the influence of AF on plasma level of NT-proBNP in patients with acute congestive heart failure (CHF). We evaluated the association between the presence of AF and plasma level of NT-proBNP in patients with acute CHF. METHODS: In this retrospective study, 309 patients (161 males and 148 females; mean age=67.0 ± 12.9 year-old) with acute CHF admitted to the emergency room were included. Patients with end-stage renal disease were excluded. RESULTS: Of 309 patients, 121 (39%) had AF at presentation. NT-proBNP levels were significantly lower in patients with AF compared with those with sinus rhythm (4631.7 pg/mL vs. 7434.3 pg/mL, p=0.001). Patients were divided into 2 groups according to the left ventricular (LV) systolic function. In patients with preserved LV systolic function (LV ejection fraction (EF) ≥40%), NT-proBNP levels were significantly lower in patients with AF compared with sinus rhythm (3756.4 pg/mL vs. 5798.4 pg/mL, p=0.039). In patients with decreased LV systolic function (LVEF <40%), there was no significant difference in NT-proBNP levels between patients with AF and sinus rhythm (6698.5 pg/mL vs. 8904.9 pg/mL, p=0.206). Among echocardiographic parameters, LV end-diastolic and systolic dimension, LV end-diastolic and systolic volume, E’, E/E’ ratio, and LV mass index (LVMI) were significantly higher in patients with sinus rhythm, whereas LVEF and LA size were significantly higher in patients with AF. NT-proBNP levels were positively correlated with right ventricular systolic pressure (RVSP), E/E’ ratio, and LVMI. The LVEF was negatively correlated with NT-proBNP levels. In stepwise multivariate linear regression analysis showed LVMI (p=0.003) and RVSP (p=0.011) were independent determinants of NT-proBNP level. AF was not an independent determinant of NT-proBNP levels. CONCLUSIONS: NT-proBNP levels were significantly lower in patients of acute CHF with AF, particularly in those with preserved LV systolic function.
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