Natriuretic peptides in patients with atrial fibrillation and advanced chronic heart failure: determinants and prognostic value of (NT-)ANP and (NT-pro)BNP

Aims To study the determinants of natriuretic peptides in advanced chronic heart failure (CHF) patients with and without atrial fibrillation (AF) and to evaluate the prognostic value of natriuretic peptides in AF compared with sinus rhythm patients with advanced CHF, Methods and results The study group comprised 354 advanced CHIF patients (all New York Heart Association (NYHA) III/IV], including 76 AF patients. AF patients were older (70 +/- 7 vs. 67 +/- 8; P = 0.01), and non-ischaemic CHF was more common (42 vs. 19%; P = 0.002) than in sinus rhythm patients, but left-ventricular ejection fraction was comparable (0.23 +/- 0.08 vs. 0.24 +/- 0.07; P = ns). At baseline, (NT-)ANP and NT-proBNP levels were significantly higher in AF patients, compared with those in sinus rhythm. By multivariate regression analysis, AF was identified as independent determinant of (NT-)ANP, but not of (NT-pro)BNP levels. After a mean follow-up of 3.2 +/- 0.9 (range 0.4 +/- 5.4) years, cardiovascular mortality was comparable (55 vs. 47%; P = ns). In both groups, AF and sinus rhythm, NT-proBNP [AF: adjusted HR 5.8 (1.3 - 25.4), P = 0.02; sinus rhythm: adjusted HR 3.1 (1.7 - 5.7), P < 0.001] was an independent risk indicator of cardiovascular mortality. Conclusion In advanced CHF patients, AF affects (NT-)ANP levels, but not (NT-pro)BNP levels. NT-proBNP is an independent determinant of prognosis in advanced CHF, irrespective of the rhythm, AF or sinus rhythm.