Changes And Significance Of Plasma Brain Natr-iuretie Peptide Levels In Atrial Fibrillation Patients With Heart Failure

ObjectiveThis study is meant to clarify the relationship between the plasma brain natriuret ie peptide(BNP)and the atrial fibrillation in patients with heart failure by testing the change of BNP level in similar NYHA.To analyse the impact of the type of AF in plasma BNP levels;further to investigate the relationship between serum BNP levels and the size of atrium in patients atrial fibrillaion with heart failure. to further investigate the predictors of plasma BNP levels.lt is to improve the diagnosis and treatment in clinical practice.MethodSingle-center retrospective analysis of hospitalized cased was done in the study to analyze the change of BNP level in artial fibrillation patients with similar NYHA on hospitalized patients with heart failure from Jan.2009to Oct.2012.140subjects are chosen from the inpatients in the Chest Disease Hospital of Tianjin City.94cases are artrial fibrillation patients.46cases are non-artrial fibrila tion patients, whose conditions are similar to those artrial fibrillation patients. Left ventricular function is evaluated by NYHA function class.Left atrium diameter(LAD)is determined by echocardiogram.using spss11.6software to count and analyze data.Results(1)A total of140hospitalized patients were enrolled in the study.The SR group,the persistent atrial fibrillaion group,the paroxysmal atrial fibrillaion group had no statistical difference on sex,age,level of blood lipid,eremimne,urea nitrogen (P>0.05).Besides,the three groups had no statistical difference on prevalence of coronary heart disease, hyperten-sion,diabetes,dilatedcardiomyopathy,valvularheart disease (P>0.05).(2)ANOVA showed that there were statistical significance in the three groups (P<0.05). Then, LSD test was used to compare every two groups and there were statistical significance in any two groups(P<0.05). The persistent atrial fibrillation (AF-2)group had the highest serum BNP,the second was paroxysmal atrial fibril ation (AF-1) group and the last was sinus rhythm(SR) group.In NYHA Ⅱ,the plasma BNP level of AF-2、AF-1and SR groups are(379.88±100.52pg/ml,321.16±98.79pg/ml and210.88±51.83pg/ml,P<0.05); In NYHA Ⅲ,the plasma BNP level of AF-2. AF-1and SR groups are(620.50±102.14pg/ml,438.97±49.77pg/ml and329.30±119.64pg/ml,P<0.05); In NYHA IV,the plasma BNP level of AF-2、AF-1and SR groups are(2380.5±470.97pg/ml,1707.8±124.01pg/ml and631.36±197.80pg/ml,P<0.05).In same type of rhythme group, the levels of plasma BNP increases significantly with NYHA cardiac function classification elevating,there were statistical significance in any two groups(P<0.01).(3)There were significant statistical differenc(P<0.05) of left atrial diameter (LAD),left ventrieular end-diastolic diameter(LVEDd)and left ventricular posterior wall thickness (LVPWT)among three groups,except for the comparison of left ventricular ejection fraction(LVEF) didn’t reached statistical significance (P>0.05). Pearson correlation test showed that there was a positive correlation between plasma BNP and LAD in the atrial fibrillation groups (P<0.05),also between plasma BNP and LVEDd (P<0.05). except for collection of BNP and LVPWT didn’t reached statistical significance (P>0.05).(4)Pearson correlation test showed that there was a positive correlation between plasma BNP and LAD in the atrial fibrillation groups (P<0.01) with similar NYHA class,there was not specific relation in sinus groups(P>0.05).The test also showed that there was a positive correlation between plasma BNP and LVEDd in the atrial fibrillation groups,but only in NYHA IV class, there was only specific relation in atrial fibrillation groups with heart failure(r=0.653, P=0.001).(5)In the same NYHA class,the plasma BNP level of rheumatic atrial fibrillation patients is higher than that of non-rheumatic atrial fibrillation patients,but there are no siginificant difference.(6)The final regression model showed that the presenc of AF,older age,larger LV-EDd, wheather or not combined dilated cardiomyopathy,wheather or not combined valvular disease and diabetes were independently predictive of higher plasma BNP values.(7) Binary Logistic regression analysis showed higher levels of serum BNP、older age and larger LAD were good prediction index for the occurrence of atrial fibrillai-on.(P<0.05).Conclusions(1)The present study showed that serum BNP levels were significantly higher in atrial fibrillaion patients Cardiac atrium secretion of BNP is higher in atrial fibrillaion patients with heart failure and whether with or without heart disease than in those without atrial fibrillaion.This study demonstrated that the presence of atrial fibrillaion affected BNP secretion from myocyte and the type of atrial fibrillaion significantly affect serum BNP levels in patients with heart failure. BNP is an anticipation index on atrial fibrillaion of occurrence.(2)The levels of plasma BNP increases significantly with NYHA cardiac functi-on classification elevating.(3)In the same NYHA class subgroup,there was a positive correlation between plasma BNP and LAD in atrial fibrillaion patients with heart failure. They are causation each oth er.(4)Presence of atrial fibrillaion,older age,larger diameters of left ventricular end-diastolicdia meter, wheather or not combined dilated cardiomyopathy,wheather or not combined valvular disease and diabetes were independently predictive of higher serum BNP valuesl.(5)The results indicate that the levels of plasma BNP、older ageand larger LAD in atrial fibrillaition patients may play an important role in the occurece and sustainn ment of atrial fibrillation.