Key result
Exercise-induced ΔANP below 55 pg/mL accurately predicts left atrial low-voltage areas.
Why the study?
Does exercise-induced atrial natriuretic peptide secretion predict the presence of left atrial low-voltage areas in patients with persistent atrial fibrillation?
Observational (n=72)
Does exercise-induced atrial natriuretic peptide secretion predict the presence of left atrial low-voltage areas in patients with persistent atrial fibrillation?
Effect estimate: AUC 0.78 (95% CI 0.57-0.87)
p-value: p=<0.01
Exercise-induced changes in ANP levels can serve as a non-invasive predictor for left atrial low-voltage areas in patients with persistent atrial fibrillation prior to ablation.
Low exercise ΔANP may non-invasively flag LA-LVAs in persistent AF; hypothesis-generating and requires prospective validation before clinical use.
Objectives Left atrial (LA) low-voltage areas (LVAs) are a strong predictor of atrial fibrillation (AF) recurrence after pulmonary vein isolation (PVI). However, a non-invasive method for evaluating LA-LAVs has not been established yet. The objective of our study was to assess the predictive value of the plasma atrial natriuretic peptide (ANP) level for the presence of LA-LVAs in patients with persistent AF (PeAF). Methods Seventy-two PeAF patients underwent an exercise stress test preprocedurally. LA voltage maps were created after PVI. Demographic, clinical and echocardiographic data were recorded. Plasma levels of ANP at baseline (ANP0) and increase induced by exercise (ΔANP) were also measured. Results Compared with patients without LA-LVAs, patients with LA-LVAs had a longer history of AF, higher CHADS2 score and higher ANP0 and lower ΔANP. LA-LVAs extent correlated with duration of AF history, CHADS2 score and ΔANP (R = -0.76, P < 0.01). Only ΔANP independently predicted the presence of LA-LVAs (OR =1.63, P = 0.02). Derived from the ROC curve, ΔANP <55 pg/mL predicted the presence of LA-LVAs with high accuracy (AUC =0.78; 95% CI =0.57-0.87, P < 0.01). Conclusions Exercise-induced secretion of ANP may be used to predict the presence of LA-LVAs in patients with PeAF before catheter ablation.
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Yin et al. (2017) conducted an observational in Persistent atrial fibrillation (n=72). Exercise-induced atrial natriuretic peptide (ANP) secretion was evaluated on Presence of left atrial low-voltage areas (LA-LVAs) (AUC 0.78, 95% CI 0.57-0.87, p=<0.01). An exercise-induced increase in atrial natriuretic peptide (ΔANP) <55 pg/mL predicted the presence of left atrial low-voltage areas with high accuracy (AUC 0.78; 95% CI 0.57-0.87, P<0.01).
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