title: Plasma atrial natriuretic peptide concentration inversely correlates with left atrial collagen volume fraction in patients with atrial fibrillation: plasma ANP as a possible biochemical marker to predict the outcome of the maze procedure.
abstract: OBJECTIVE
  We hypothesized that the plasma atrial natriuretic peptide (ANP) level reflects atrial degenerative change and may predict the outcome of the maze procedure.
  
  
  BACKGROUND
  Although a larger preoperative left atrial dimension and longer duration of atrial fibrillation (AF) have been reported in patients with persistent AF than in those with sinus rhythm (SR), these individual factors were not enough to predict the outcome of the maze procedure.
  
  
  METHODS
  Preoperative plasma ANP levels were measured in consecutive 62 patients who underwent the Kosakai's modified maze procedure. Moreover, we performed histological and molecular biological examinations in the resected left atrial tissues.
  
  
  RESULTS
  The preoperative plasma ANP was lower in the AF group (n = 13) than it was in the SR group (n = 49) (p < 0.001). Multiple logistic regression analysis revealed that duration of AF and plasma ANP were independently associated with postoperative cardiac rhythm. Among 41 patients with a higher plasma ANP or shorter duration of AF than the median value, SR was restored in 95% of patients. In contrast, in 21 patients with a lower plasma ANP and a longer duration of AF than the median value, SR was restored only in 48% of patients. Histological examination revealed that the collagen volume in the left atrial tissue was higher in AF than it was in SR and inversely correlated with plasma ANP. In addition, the messenger RNA expressions of ANP, collagen type I and type III were lower in AF than they were in SR.
  
  
  CONCLUSIONS
  These results suggest that a combination of plasma ANP and/or duration of AF may predict the success rate for the maze operation. Advanced atrial degenerative change may result in a decrease of atrial ANP secretion.
authors.affiliation: National Cardiovascular Center Research Institute, Suita, Japan.
authors.forename: Fumiki
authors.initials: F
authors.lastname: Yoshihara
authors.forename: Toshio
authors.initials: T
authors.lastname: Nishikimi
authors.forename: Yoshikado
authors.initials: Y
authors.lastname: Sasako
authors.forename: Jun
authors.initials: J
authors.lastname: Hino
authors.forename: Junjiro
authors.initials: J
authors.lastname: Kobayashi
authors.forename: Kenji
authors.initials: K
authors.lastname: Minatoya
authors.forename: Ko
authors.initials: K
authors.lastname: Bando
authors.forename: Yoshio
authors.initials: Y
authors.lastname: Kosakai
authors.forename: Takeshi
authors.initials: T
authors.lastname: Horio
authors.forename: Shin-ichi
authors.initials: S
authors.lastname: Suga
authors.forename: Yuhei
authors.initials: Y
authors.lastname: Kawano
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Matsuoka
authors.forename: Chikao
authors.initials: C
authors.lastname: Yutani
authors.forename: Hisayuki
authors.initials: H
authors.lastname: Matsuo
authors.forename: Soichiro
authors.initials: S
authors.lastname: Kitamura
authors.forename: Tohru
authors.initials: T
authors.lastname: Ohe
authors.forename: Kenji
authors.initials: K
authors.lastname: Kangawa
mesh_terms: D000368:Aged; D001281:Atrial Fibrillation / Q000097:blood* / Q000601:surgery; D009320:Atrial Natriuretic Factor / Q000097:blood*; D015415:Biomarkers; D015152:Blotting, Northern; D003094:Collagen / Q000032:analysis*; D005260:Female; D006325:Heart Atria / Q000737:chemistry*; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D012680:Sensitivity and Specificity
chemical_list: D015415:Biomarkers; D009320:Atrial Natriuretic Factor; D003094:Collagen