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European Journal of Heart Failure 2006 8(3):263-269; doi:10.1016/j.ejheart.2005.09.001
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© 2005 European Society of Cardiology

Influence of atrial fibrillation on cardiac brain natriuretic peptide release during haemodynamic stress in heart failure

P.A. Goulda, J. D'Agostinob, H.G. Schneiderb and D.M. Kayea,*

a Baker Heart Research Institute, Wynn Department of Metabolic Cardiology PO Box 6492, St. Kilda Road Central, Melbourne Victoria 8008, Australia
b Biochemistry Department, Alfred Hospital Melbourne, Victoria, Australia

* Corresponding author. Tel.: +61 3 9276 3265; fax: +61 3 9207 1044. E-mail address: david.kaye{at}baker.edu.au. (D.M. Kaye).


  Abstract

Background: The determinants of release of brain natriuretic peptide (BNP) in heart failure (HF) are incompletely understood, particularly, the effect of heart rhythm and haemodynamic stress.

Aims: To investigate the effect of haemodynamic stress on cardiac BNP release in HF and differentiate this response for atrial fibrillation (AF) and sinus rhythm (SR).

Methods: In 18 HF patients (ejection fraction<40%, 9 in AF and 9 in SR) haemodynamics and BNP levels were measured from arterial and coronary sinus samples at baseline, after 10 min of 20° passive head up tilt (HUT) and after 10 min of isometric handgrip (IHG) exercise. From these data, we calculated a transcardiac BNP gradient and compared results between the AF and SR cohort.

Results: During haemodynamic stress in both groups, there were no significance differences in left sided filling pressures. At baseline, there were no differences in BNP measurements between the SR and AF group. The transcardiac BNP gradient increased significantly in the SR (p=0.02) but not the AF cohort, after HUT. During IHG exercise, there was a significant decrease in cardiac BNP release in the AF cohort (p=0.03) but not the SR cohort.

Conclusion: These data imply in HF, cardiac rhythm influences cardiac BNP release in response to haemodynamic stress.

Key Words: Brain natriuretic peptide • Atrial fibrillation • Heart failure

Received April 24, 2005; Revised July 6, 2005; Accepted September 6, 2005


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