Download PDF
Thromb Haemost 2021; 121(11): 1523-1529
DOI: 10.1055/a-1400-6096
Stroke, Systemic or Venous Thromboembolism

The Prognostic Potential of Atrial Natriuretic Peptide on the Development of Postoperative Atrial Fibrillation after Cardiac Surgery

Felix Hofer‡   *
1   Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
,
Andreas Hammer‡   *
1   Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
,
Matthias Steininger
1   Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
,
Niema Kazem
1   Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
,
Lorenz Koller
1   Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
,
Barbara Steinlechner
2   Department of Anesthesiology, Medical University of Vienna, Vienna, Austria
,
Günther Laufer
3   Division of Cardiac Surgery, Department of Surgery, Medical University of Vienna, Vienna, Austria
,
Martin Andreas
3   Division of Cardiac Surgery, Department of Surgery, Medical University of Vienna, Vienna, Austria
,
Rodrig Marculescu
4   Department of Laboratory Medicine, Medical University of Vienna, Vienna, Austria
,
Christian Hengstenberg
1   Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
,
Johann Wojta
1   Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
,
Alexander Niessner
1   Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
,
Patrick Sulzgruber
1   Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
› Author Affiliations Funding The study was supported and received funding for materials by the “Association for the Promotion of Research in Atherosclerosis, Thrombosis and Vascular Biology” (ATVB), Vienna, Austria.
› Further Information
Also available at
    Permissions and Reprints

Abstract

Background Postoperative atrial fibrillation (POAF) represents a common complication after cardiac surgery associated with major adverse events and poor patient outcome. Tools for risk stratification of this arrhythmia remain scarce. Atrial natriuretic peptide (ANP) represents an easily assessable biomarker picturing atrial function and strain; however, its prognostic potential on the development of POAF has not been investigated so far.

Methods Within the present investigation, 314 patients undergoing elective cardiac surgery were prospectively enrolled. Preoperative mid-region proANP (MR-proANP) values were assessed before the surgical intervention. Patients were followed prospectively and continuously screened for the development of arrhythmic events.

Results A total of 138 individuals (43.9%) developed POAF. Median concentrations of MR-proANP were significantly higher within the POAF group (p < 0.001). MR-proANP showed a strong association with the development of POAF with a crude odds ratio (OR) of 1.68 per 1 standard deviation (1-SD; 95% confidence interval [CI]: 1.31–2.15; p < 0.001), which remained stable after comprehensive adjustment for confounders with an adjusted OR of 1.74 per 1-SD (95% CI: 1.17–2.58; p = 0.006). The discriminatory power of MR-proANP for the development of POAF was validated by the category-free net reclassification improvement (0.23 [95% CI: 0.0349–0.4193]; p = 0.022) and integrated discrimination increment (0.02 [95% CI: 0.0046–0.0397], p = 0.013).

Conclusion MR-proANP proved to be a strong and independent predictor of the development of POAF. Considering a personalized diagnostic and prognostic preoperative work-up, a standardized preoperative evaluation of MR-proANP levels might help to identify patients at risk for development of POAF after cardiac surgery.

Keywords

atrial-natriuretic peptide - postoperative atrial fibrillation - cardiac surgery - risk prediction

Author Contributions

A.N., P.S. and, J.W. contributed to the conception or design of the work. F.H., A.H., M.S., N.K., and L.K. contributed to the acquisition, analysis, or interpretation of data for the work. F.H. and A.H. drafted the manuscript. B.S., G.L., M.A., R.M., and C.H. critically revised the manuscript. All gave final approval and agreed to be accountable for all aspects of work ensuring integrity and accuracy.


* Both authors contributed equally in this work.


Supplementary Material



Publication History

Received: 22 December 2020

Accepted: 23 February 2021

Accepted Manuscript online:
25 February 2021

Article published online:
14 April 2021

© 2021. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

Comment to this article:

Atrial Fibrillation after Cardiac Surgery—To Infinity and Beyond!Thromb Haemost 2021; 121(11): 1391-1393
DOI: 10.1055/a-1506-8744

 

  • References

  • 1 Chugh SS, Havmoeller R, Narayanan K. et al. Worldwide epidemiology of atrial fibrillation: a Global Burden of Disease 2010 Study. Circulation 2014; 129 (08) 837-847
    CrossrefPubMedGoogle Scholar
  • 2 Yadava M, Hughey AB, Crawford TC. Postoperative atrial fibrillation: incidence, mechanisms, and clinical correlates. Heart Fail Clin 2016; 12 (02) 299-308
    CrossrefPubMedGoogle Scholar
  • 3 Ehrlich MP, Osorio-Jaramillo E, Aref T. et al. Atrial fibrillation after cardiac surgery: electrophysiological mechanism and outcome. Ann Thorac Surg 2020; 109 (06) 1765-1772
    CrossrefPubMedGoogle Scholar
  • 4 Maesen B, Nijs J, Maessen J, Allessie M, Schotten U. Post-operative atrial fibrillation: a maze of mechanisms. Europace 2012; 14 (02) 159-174
    CrossrefPubMedGoogle Scholar
  • 5 Helgadottir S, Sigurdsson MI, Ingvarsdottir IL, Arnar DO, Gudbjartsson T. Atrial fibrillation following cardiac surgery: risk analysis and long-term survival. J Cardiothorac Surg 2012; 7: 87
    CrossrefPubMedGoogle Scholar
  • 6 Wong PCY, Guo J, Zhang A. The renal and cardiovascular effects of natriuretic peptides. Adv Physiol Educ 2017; 41 (02) 179-185
    CrossrefPubMedGoogle Scholar
  • 7 Yagmur E, Sckaer JH, Koek GH. et al. Elevated MR-proANP plasma concentrations are associated with sepsis and predict mortality in critically ill patients. J Transl Med 2019; 17 (01) 415
    CrossrefPubMedGoogle Scholar
  • 8 Richards M, Di Somma S, Mueller C. et al. Atrial fibrillation impairs the diagnostic performance of cardiac natriuretic peptides in dyspneic patients: results from the BACH Study (Biomarkers in ACute Heart Failure). JACC Heart Fail 2013; 1 (03) 192-199
    CrossrefPubMedGoogle Scholar
  • 9 Kirchhof P, Benussi S, Kotecha D. et al; ESC Scientific Document Group. 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS. Eur Heart J 2016; 37 (38) 2893-2962
    CrossrefPubMedGoogle Scholar
  • 10 Ahmad T, Fiuzat M, Pencina MJ. et al. Charting a roadmap for heart failure biomarker studies. JACC Heart Fail 2014; 2 (05) 477-488
    CrossrefPubMedGoogle Scholar
  • 11 Cook NR. Statistical evaluation of prognostic versus diagnostic models: beyond the ROC curve. Clin Chem 2008; 54 (01) 17-23
    CrossrefPubMedGoogle Scholar
  • 12 Potter LR, Yoder AR, Flora DR, Antos LK, Dickey DM. Natriuretic peptides: their structures, receptors, physiologic functions and therapeutic applications. Handb Exp Pharmacol 2009; (191) 341-366
    CrossrefPubMedGoogle Scholar
  • 13 Forte M, Madonna M, Schiavon S. et al. Cardiovascular pleiotropic effects of natriuretic peptides. Int J Mol Sci 2019; 20 (16) E3874
    CrossrefPubMedGoogle Scholar
  • 14 Seewöster T, Büttner P, Nedios S. et al. Association between cardiovascular magnetic resonance-derived left atrial dimensions, electroanatomical substrate and NT-proANP levels in atrial fibrillation. J Am Heart Assoc 2018; 7 (19) e009427
    CrossrefPubMedGoogle Scholar
  • 15 Hidayet Ş, Yağmur J, Bayramoğlu A, Taşolar MH, Kurtoğlu E, Özyalın F. Prediction of postoperative atrial fibrillation with left atrial mechanical functions and NT-pro ANP levels after coronary artery bypass surgery: a three-dimensional echocardiography study. Echocardiography 2018; 35 (05) 661-666
    CrossrefPubMedGoogle Scholar
  • 16 Berntsson J, Smith JG, Nilsson PM, Hedblad B, Melander O, Engström G. Pro-atrial natriuretic peptide and prediction of atrial fibrillation and stroke: The Malmö Preventive Project. Eur J Prev Cardiol 2017; 24 (08) 788-795
    CrossrefPubMedGoogle Scholar
  • 17 Rolf S, Kircher S, Arya A. et al. Tailored atrial substrate modification based on low-voltage areas in catheter ablation of atrial fibrillation. Circ Arrhythm Electrophysiol 2014; 7 (05) 825-833
    CrossrefPubMedGoogle Scholar
  • 18 Dobrev D, Aguilar M, Heijman J, Guichard J-B, Nattel S. Postoperative atrial fibrillation: mechanisms, manifestations and management. Nat Rev Cardiol 2019; 16 (07) 417-436
    CrossrefPubMedGoogle Scholar
  • 19 Andreas M, Arzl P, Mitterbauer A. et al. Electrical stimulation of the greater auricular nerve to reduce postoperative atrial fibrillation. Circ Arrhythm Electrophysiol 2019; 12 (10) e007711
    CrossrefPubMedGoogle Scholar