title: Discordant regulation of CRP and NT-proBNP plasma levels after electrical cardioversion of persistent atrial fibrillation.
abstract: BACKGROUND
  B-type natriuretic peptide (BNP) and C-reactive protein (CRP) have been suggested to be prognostically relevant markers in patients with cardiovascular disease. Additionally, BNP and CRP plasma levels seem to be independently elevated in patients with atrial fibrillation (AF). However, there are only sparse data about the significance and temporal course of these plasma markers after restoration of sinus rhythm (SR).
  
  
  METHODS
  We performed a prospective study in consecutive patients with symptomatic atrial fibrillation. NT-proBNP and CRP plasma levels were measured before and one month after electrical cardioversion (CV). Patients with infections, an acute coronary syndrome, or surgery 4 weeks prior to CV, were excluded.
  
  
  RESULTS
  Twenty-five patients (men 84%, age 66 +/- 8 years, duration of AF 90 +/- 75 days, left ventricular ejection fraction 0.57 +/- 0.11) were analyzed. At follow-up (33 +/- 6 days after CV) 14 patients (56%) were in SR and 11 patients (44%) in AF. In patients with SR there was a significant reduction of NT-proBNP levels (baseline 1647 +/- 1272 pg/mL, follow-up 772 +/- 866 pg/mL, P < 0.05), even in a subgroup of patients (n = 10) with normal left ventricular ejection fraction (1262 +/- 538 vs 413 +/- 344 pg/mL, P < 0.001). CRP levels in patients with SR were similar at baseline and at follow-up (3.5 +/- 3.6 vs 3.2 +/- 2.5 mg/L, P = 0.8).
  
  
  CONCLUSIONS
  We conclude that even in patients with normal left ventricular ejection fraction restoration of sinus rhythm leads to a significant reduction of NT-proBNP plasma levels. In contrast, CRP plasma levels seem not to be influenced during the first 4 weeks after electrical cardioversion.
authors.affiliation: Innere Medizin III, (Kardiologie, Angiologie, und Internistische Intensivmedizin), Universitätsklinikum des Saarlandes, Homburg/Saar, Germany. buob@med-in.uni-saarland.de
authors.forename: Axel
authors.initials: A
authors.lastname: Buob
authors.forename: Jens
authors.initials: J
authors.lastname: Jung
authors.forename: Stephanos
authors.initials: S
authors.lastname: Siaplaouras
authors.forename: Hans-Ruprecht
authors.initials: HR
authors.lastname: Neuberger
authors.forename: Christian
authors.initials: C
authors.lastname: Mewis
mesh_terms: D000368:Aged; D001281:Atrial Fibrillation / Q000097:blood* / Q000628:therapy*; D002097:C-Reactive Protein / Q000032:analysis*; D004554:Electric Countershock; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D010446:Peptide Fragments / Q000097:blood*; D011446:Prospective Studies; D011498:Protein Precursors / Q000097:blood*; D017211:Treatment Failure
chemical_list: D010446:Peptide Fragments; D011498:Protein Precursors; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain; D002097:C-Reactive Protein