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Impact of BNP level and peak VO2 on future heart failure events: comparison between sinus rhythm and atrial fibrillation

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Abstract

This study aimed to examine the discrete impacts of peak oxygen consumption (VO2) and brain natriuretic peptide (BNP) levels on future heart failure (HF) events in sinus rhythm (SR) and atrial fibrillation (AF). A total of 1447 patients who underwent symptom-limited cardiopulmonary exercise testing and whose BNP values were determined simultaneously were analysed (SR, N = 1151 and AF, N = 296). HF events were defined as HF hospitalization or HF death. Over a mean follow-up period of 1472 days, 140 HF events were observed. A high BNP value (dichotomized by median value) was independently associated with HF events in SR (HR 8.08; 95 % CI 4.02–16.26; p < 0.0001), but not in AF patients (HR 1.97; 95 % CI 0.91–4.28; p = 0.087) with a significant interaction between the rhythms. By contrast, low-peak VO2 was independently associated with HF events in both rhythms (AF; HR 5.81; 95 % CI 1.75–19.30; p = 0.004, SR; HR 2.04; 95 % CI 1.19–3.49; p = 0.009), with a marginal interaction between them. In bivariate Cox models, low-peak VO2 had much stronger predictive power for HF events than high-BNP in AF, whereas high-BNP was more powerful than low-peak VO2 in SR. The prognostic value of BNP and peak VO2 for future HF events seemed to be different between SR and AF.

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References

  1. Miyasaka Y, Barnes ME, Bailey KR, Cha SS, Gersh BJ, Seward JB, Tsang TS (2007) Mortality trends in patients diagnosed with first atrial fibrillation: a 21-year community-based study. J Am Coll Cardiol 49:986–992

    Article  PubMed  Google Scholar 

  2. Marijon E, Le Heuzey JY, Connolly S, Yang S, Pogue J, Brueckmann M, Eikelboom J, Themeles E, Ezekowitz M, Wallentin L, Yusuf S, Investigators R-L (2013) Causes of death and influencing factors in patients with atrial fibrillation: a competing-risk analysis from the randomized evaluation of long-term anticoagulant therapy study. Circulation 128:2192–2201

    Article  CAS  PubMed  Google Scholar 

  3. Wang TJ, Larson MG, Levy D, Vasan RS, Leip EP, Wolf PA, D’Agostino RB, Murabito JM, Kannel WB, Benjamin EJ (2003) Temporal relations of atrial fibrillation and congestive heart failure and their joint influence on mortality: the Framingham Heart Study. Circulation 107:2920–2925

    Article  PubMed  Google Scholar 

  4. Suzuki S, Sagara K, Otsuka T, Matsuno S, Funada R, Uejima T, Oikawa Y, Yajima J, Koike A, Nagashima K, Kirigaya H, Sawada H, Aizawa T, Yamashita T (2012) A new scoring system for evaluating the risk of heart failure events in Japanese patients with atrial fibrillation. Am J Cardiol 110:678–682

    Article  PubMed  Google Scholar 

  5. de Groote P, Dagorn J, Soudan B, Lamblin N, McFadden E, Bauters C (2004) B-type natriuretic peptide and peak exercise oxygen consumption provide independent information for risk stratification in patients with stable congestive heart failure. J Am Coll Cardiol 43:1584–1589

    Article  PubMed  Google Scholar 

  6. Mancini DM, Eisen H, Kussmaul W, Mull R, Edmunds LH Jr, Wilson JR (1991) Value of peak exercise oxygen consumption for optimal timing of cardiac transplantation in ambulatory patients with heart failure. Circulation 83:778–786

    Article  CAS  PubMed  Google Scholar 

  7. Kubozono T, Itoh H, Oikawa K, Tajima A, Maeda T, Aizawa T, Iinuma H, Tokuda Y, Ohashi Y, Fu LT (2008) Peak VO(2) is more potent than B-type natriuretic peptide as a prognostic parameter in cardiac patients. Circ J 72:575–581

    Article  CAS  PubMed  Google Scholar 

  8. Magri D, Agostoni P, Corra U, Passino C, Scrutinio D, Perrone-Filardi P, Correale M, Cattadori G, Metra M, Girola D, Piepoli MF, Iorio A, Emdin M, Raimondo R, Re F, Cicoira M, Belardinelli R, Guazzi M, Limongelli G, Clemenza F, Parati G, Frigerio M, Casenghi M, Scardovi AB, Ferraironi A, Di Lenarda A, Bussotti M, Apostolo A, Paolillo S, La Gioia R, Gargiulo P, Palermo P, Mina C, Farina S, Battaia E, Maruotti A, Pacileo G, Contini M, Oliva F, Ricci R, Sinagra G, Metabolic Exercise test data combined with C, Kidney Indexes Score Research G (2015) Deceptive meaning of oxygen uptake measured at the anaerobic threshold in patients with systolic heart failure and atrial fibrillation. Eur J Prev Cardiol 22:1046–1055

    Article  PubMed  Google Scholar 

  9. Kato Y, Suzuki S, Kano H, Semba H, Matsuno S, Takai H, Otsuka T, Uejima T, Oikawa Y, Nagashima K, Kirigaya H, Sagara K, Kunihara T, Yajima J, Sawada H, Aizawa T, Yamashita T (2015) Prognostic significance of exercise capacity and resting heart rate: comparison between atrial fibrillation and sinus rhythm. Int J Cardiol 203:561–563

    Article  PubMed  Google Scholar 

  10. Suzuki S, Yamashita T, Ohtsuka T, Sagara K, Uejima T, Oikawa Y, Yajima J, Koike A, Nagashima K, Kirigaya H, Ogasawara K, Sawada H, Aizawa T (2008) Prevalence and prognosis of patients with atrial fibrillation in Japan: a prospective cohort of Shinken Database 2004. Circ J 72:914–920

    Article  PubMed  Google Scholar 

  11. Japnese Society of Nephrology (2013) Evidence-based clinical practice guideline for CKD (Japanese). Tokyo Igaku, Tokyo, Japan

    Google Scholar 

  12. Nakamura M, Koeda Y, Tanaka F, Onoda T, Itai K, Ohsawa M, Tanno K, Sakata K, Omama S, Ishibashi Y, Makita S, Ohta M, Ogasawara K, Komatsu T, Okayama A (2013) Plasma B-type natriuretic peptide as a predictor of cardiovascular events in subjects with atrial fibrillation: a community-based study. PLoS One 8:e81243

    Article  PubMed  PubMed Central  Google Scholar 

  13. Silvet H, Young-Xu Y, Walleigh D, Ravid S (2003) Brain natriuretic peptide is elevated in outpatients with atrial fibrillation. Am J Cardiol 92:1124–1127

    Article  CAS  PubMed  Google Scholar 

  14. Don-Wauchope AC, McKelvie RS (2015) Evidence based application of BNP/NT-proBNP testing in heart failure. Clin Biochem 48:236–246

    Article  CAS  PubMed  Google Scholar 

  15. Hijazi Z, Oldgren J, Andersson U, Connolly SJ, Ezekowitz MD, Hohnloser SH, Reilly PA, Vinereanu D, Siegbahn A, Yusuf S, Wallentin L (2012) Cardiac biomarkers are associated with an increased risk of stroke and death in patients with atrial fibrillation: a randomized evaluation of long-term anticoagulation therapy (RE-LY) substudy. Circulation 125:1605–1616

    Article  CAS  PubMed  Google Scholar 

  16. Hijazi Z, Wallentin L, Siegbahn A, Andersson U, Christersson C, Ezekowitz J, Gersh BJ, Hanna M, Hohnloser S, Horowitz J, Huber K, Hylek EM, Lopes RD, McMurray JJ, Granger CB (2013) N-terminal pro-B-type natriuretic peptide for risk assessment in patients with atrial fibrillation: insights from the ARISTOTLE Trial (Apixaban for the Prevention of Stroke in Subjects With Atrial Fibrillation). J Am Coll Cardiol 61:2274–2284

    Article  CAS  PubMed  Google Scholar 

  17. Sadanaga T, Kohsaka S, Mitamura H, Ogawa S (2011) Elevated B-type natriuretic peptide level as a marker of subsequent thromboembolic events in patients with atrial fibrillation. Heart Vessels 26:530–535

    Article  PubMed  Google Scholar 

  18. Richards M, Di Somma S, Mueller C, Nowak R, Peacock WF, Ponikowski P, Mockel M, Hogan C, Wu AH, Clopton P, Filippatos GS, Anand I, Ng L, Daniels LB, Neath SX, Shah K, Christenson R, Hartmann O, Anker SD, Maisel A (2013) 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 1:192–199

    Article  PubMed  Google Scholar 

  19. Sitar Taut AV, Pop D, Zdrenghea DT (2015) NT-proBNP values in elderly heart failure patients with atrial fibrillation and diabetes. J Diabetes Complications 29:1119–1123

    Article  PubMed  Google Scholar 

  20. Edwards BS, Zimmerman RS, Schwab TR, Heublein DM, Burnett JC Jr (1988) Atrial stretch, not pressure, is the principal determinant controlling the acute release of atrial natriuretic factor. Circ Res 62:191–195

    Article  CAS  PubMed  Google Scholar 

  21. Frustaci A, Chimenti C, Bellocci F, Morgante E, Russo MA, Maseri A (1997) Histological substrate of atrial biopsies in patients with lone atrial fibrillation. Circulation 96:1180–1184

    Article  CAS  PubMed  Google Scholar 

  22. Wozakowska-Kaplon B (2004) Effect of sinus rhythm restoration on plasma brain natriuretic peptide in patients with atrial fibrillation. Am J Cardiol 93:1555–1558

    Article  CAS  PubMed  Google Scholar 

  23. Vinch CS, Rashkin J, Logsetty G, Tighe DA, Hill JC, Meyer TE, Rosenthal LS, Aurigemma GP (2004) Brain natriuretic peptide levels fall rapidly after cardioversion of atrial fibrillation to sinus rhythm. Cardiology 102:188–193

    Article  CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Cardiovascular Medicine, The Cardiovascular Institute, Nishiazabu 3-2-19, Minato-ku, Tokyo, 106-0031, Japan

    Yuko Kato, Shinya Suzuki, Tokuhisa Uejima, Hiroaki Semba, Hiroto Kano, Shunsuke Matsuno, Takayuki Otsuka, Yuji Oikawa, Kazuyuki Nagashima, Hajime Kirigaya, Koichi Sagara, Junji Yajima, Hitoshi Sawada, Tadanori Aizawa & Takeshi Yamashita

  2. Department of Cardiovascular Surgery, The Cardiovascular Institute, Tokyo, Japan

    Hideaki Takai & Takashi Kunihara

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  1. Yuko Kato
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  2. Shinya Suzuki
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  3. Tokuhisa Uejima
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  5. Hiroto Kano
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  15. Hitoshi Sawada
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  16. Tadanori Aizawa
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  17. Takeshi Yamashita
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Correspondence to Yuko Kato.

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Conflict of interest

T. Yamashita has received honoraria from Daiichi Sankyo, Boehringer Ingelheim, Bayer Healthcare, Pfizer, Bristol-Myers Squibb, Eisai, Tanabe-Mitsubishi, and Ono Pharmaceutical; and has received grants from Daiichi Sankyo, Boehringer Ingelheim, and Tanabe-Mitsubishi.

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Kato, Y., Suzuki, S., Uejima, T. et al. Impact of BNP level and peak VO2 on future heart failure events: comparison between sinus rhythm and atrial fibrillation. Heart Vessels 32, 428–435 (2017). https://doi.org/10.1007/s00380-016-0887-x

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  • DOI: https://doi.org/10.1007/s00380-016-0887-x

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