Study On The Level Of BNP And Its Correlation In Patients With Chronic Heart Failure Complicated With Atrial Fibrillation

Objective:By comparing the leves of B-type natriuretic peptide(BNP)in patients with chronic heart failure(CHF)and atrial fibrillation(AF)with different left ventricular ejection fraction(LVEF),to explore the level of BNP and its related factors in patients with chronic heart failure and atrial fibrillation,so as to provide important theoretical basis for guiding clinical work.Methods:From January 2017 to April 2020,308 CHF patients aged≥18 years old in the department of geriatric cardiology of the first Affiliated Hospital of kunming Medical University were selected as the case group,aged from 20 to 91 years old.According to the left ventricular ejection fraction(LVEF),the patients were divided into three groups:121cases of heart failure with reduced ejection fraction(HFrEF),64 cases of heart failure with mid-range ejection fraction(HFmrEF)and 123 cases of heart failure with preserved ejection fraction(HFmrEF).According to whether they were complicated with persistent atrial fibrillation,they were divided into 6 subgroups:HFrEF sinus rhythm group(n=87);HFrEF atrial fibrillation group(n=34);HFmrEF sinus rhythm group(n=32);HFmrEF atrial fibrillation group(n=32);HFpEF sinus rhythm group(n=46)and HFpEF atrial fibrillation group(n=77).In addition,77 patients with organic heart disease but no symptoms and/or signs of heart failure and LVEF≥ 50%were selected as the control group,aged from 44 to 87 years old,including 47 cases in the control sinus rhythm group and 30 cases in the control group of atrial fibrillation.The data of age,sex,height,weight,smoking history,drinking history,plasma BNP,red blood cell count,hemoglobin,liver and kidney function,24-hour ambulatory electrocardiogram+blood pressure and cardiac ultrasound were collected and statistically analyzed.Results:1.A total of 385 subjects were included,including 308 cases in the case group,with an average age of 67.82 ± 12.35 years old.There were 77 cases in the control group,with an average age of 65.23±10.85 years old.There was no significant difference in sex,age,smoking history,drinking history and body mass index(BMI)among the all groups.2.There was no significant difference in the level of BNP between HFrEF and HFmrEF atrial fibrillation group and sinus rhythm group(all P>0.05);In HFpEF and control group,the level of BNP in atrial fibrillation group was higher than that in sinus rhythm group(all P<0.05).In the classification of heart failure in the three groups,the 24-hour average heart(ventricular)rate in the atria]fibrillation group was higher than that in the sinus rhythm group(P<0.01).3.In heart failure sinus rhythm group,the level of BNP in HFrEF group was higher than that in HFpEF group(P<0.05).There was no significant difference in BNP level between HFrEF group and HFmrEF group,and between HFmrEF group and HFpEF group(P>0.05).In heart failure and atrial fibrillation group,the level of BNP in HFrEF group and HFmrEF group was higher than that in HFpEF group,respectively(all P<0.05).With the decrease of LVEF,the level of BNP increased,but there was no significant difference in BNP level between HFrEF and HFmrEF groups(P>0.05).4.In case group and control group,left atrial diameter(LAD)and right atrial diameter(RAD)in AF group were higher than those in sinus rhythm group(all P<0.01).In the case group,LVEF in HFrEF AF group was higher than that in sinus rhythm group,while Left ventricular end diastolic diameter(LVEDD),end diastolic velocity(EDV)and stroke volume(SV)in AF group were lower than those in sinus rhythm group(all P<0.01).Pulmonary arterial systolic pressure(PASP)in HFmrEF AF group was higher than that in sinus rhythm group,while LVEDD,EDV,interventricular septal thickness(IVST)and SV were lower than those in sinus rhythm group(all P<0.05).PASP in HFpEF atrial fibrillation group was higher than that in sinus rhythm group(P<0.05).There was no significant difference in right ventricular diameter(RVD)and left ventricular posterior wall thickness(LVPWT)among the three groups of heart failure-atrial fibrillation group and sinus rhythm group.5.In the heart failure sinus rhythm group,the level of BNP was negatively correlated with BMI(r=-0.18,P=0.02),serum creatinine(r=-0.17,P<0.05),LVEF(r=-0.44,p<0.01),IVST(r=-0.18,P<0.05)and LVPWT(r=-0.15,P<0.05),and 24-hour average heart rate(r=0.29,P<0.05),echocardiographic parameters(LAD,RAD,LVEDD,RVD,PASP,EVD)were positively correlated(all P<0.05).6.In patients with heart failure and atrial fibrillation,the results of correlation analysis showed that tthe level of BNP was negatively correlated with BMI(r=-0.38,P<0.01)and LVEF(r=-0.32,P<0.01),and positively correlated with 24-hour average ventricular rate(r=0.34,P<0.01)and RVD(r=0.19,P<0.01).It was positively correlated with 24-hour average ventricular rate(r=0.34,P<0.01)and RVD(r=0.19,P<0.01).7.Multiple linear regression analysis showed that atrial fibrillation,NYHA cardiac function classification,estimated glomerular filtration rate(eGFR)and echocardiographic parameters(LVEF,LAD,RAD,LVEDD)were independent predictors of the increase of BNP in patients with heart failure,while the plasma BNP level decreased with the increase of body mass index((BMI)).Multiple regression analysis showed that only RAD was an independent predictor of the increase of plasma BNP level in heart failure sinus rhythm group.Multiple linear regression analysis showed that eGFR,LAD and NYHA cardiac function grade were independent predictors of the increase of plasma BNP level in patients with heart failure and atrial fibrillation.8.Logistic regression analysis showed that the changes of age,BNP,eGFR,LVEDD,24-hour mean ventricular rate,LAD and RAD would affect the occurrence of atrial fibrillation,in which the increase of BNP(OR=0.999)and eGFR(OR=0.975)would reduce the risk of atrial fibrillation,while the increase of age(OR=1.043),24-hour mean heart rate(OR=1.101),LAD(OR=1.207)and RAD(OR=1.265)would increase the risk of atrial fibrillation.Conclusion:1.In this study,the level of BNP in patients with CHF with or without atrial fibrillation increased with the decrease of LVEF score,and high BNP level could reflect the severity of heart failure.2.When diagnosing and evaluating the severity of HFrEF and HFmrEF,the level of BNP may not be affected by atrial fibrillation,while when diagnosing and evaluating the severity of HFpEF,atrial fibrillation may affect the level of BNP.3.In patients with CHF complicated with atrial fibrillation,the 24-hour average ventricular rate and RVD were positively correlated with BNP,while BMI,LVEF and BNP were negatively correlated.4.NYHA cardiac function grade,LAD,BMI and eGFR are independent influencing factors of BNP level in patients with CHF complicated with atrial fibrillation.5.Aging,left and right atrial enlargement and 24-hour average heart rate increase are the risk factors of atrial fibrillation in patients with CHF.