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.
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.
Yoshihara
Fumiki
F
National Cardiovascular Center Research Institute, Suita, Japan.
Nishikimi
Toshio
T
Sasako
Yoshikado
Y
Hino
Jun
J
Kobayashi
Junjiro
J
Minatoya
Kenji
K
Bando
Ko
K
Kosakai
Yoshio
Y
Horio
Takeshi
T
Suga
Shin-ichi
S
Kawano
Yuhei
Y
Matsuoka
Hiroaki
H
Yutani
Chikao
C
Matsuo
Hisayuki
H
Kitamura
Soichiro
S
Ohe
Tohru
T
Kangawa
Kenji
K
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
D015415:Biomarkers; D009320:Atrial Natriuretic Factor; D003094:Collagen