Is Brain Natriuretic Peptide specific for the left atrial
appendage?
Erdi Babayiğit, MD1, Andaç Karadeniz,
MD2, Prof. Bülent Görenek, MD, FACC,
FESC1
1.Eskişehir Osmangazi University, School of Medicine, Department of
Cardiology, Eskişehir, Turkey
2. Erzurum State Hospital, Department of Internal Medicine, Erzurum,
Turkey
Corresponding Author:
Erdi Babayiğit, MD
Department of Cardiology,
Eskisehir Osmangazi University School of Medicine,
Eskisehir, Turkey
Tel: +90 535 740 9486
e-mail: erdibabayigit@gmail.com
Dear Editor,
We read with great interest the article recently published in Journal of
Cardiovascular Electrophysiology, “Left atrial appendage dimension
predicts elevated brain natriuretic peptide in nonvalvular atrial
fibrillation” by Cook JA. et al.1 The authors have
studied the relation between Brain natriuretic peptide (BNP) elevations
and left atrial appendage measurements in patients who referred for left
atrial appendage (LAA) occlusion in patients with nonvalvular atrial
fibrillation (AF).
BNP release is largely from the ventricles and it is also dynamically
dependent on myocardial stretch and fluid volume status. However, it
seems difficult to prove that BNP levels are directly related to the LAA
measurements. Correlating BNP elevation only with left atrial or LAA
measurements means ignoring left ventricular strain. Considering that
these patients were referred for LAA occlusion and had a high
CHA2DS2-VASc score, and not taking heart
failure with preserved ejection fraction into account may lead to errors
in interpreting the results. Moreover, it should be evaluated that the
left atrial appendage may undergo remodeling or enlargement as a result
of the left ventricular end-diastolic pressure increase. In this case,
although the study is valuable, remains a cross-sectional study and a
snapshot of the correlation of BNP and LAA.
Second, it should be disclosed whether patients have paroxysmal or
chronic AF and how long the patient has had AF. A relationship was
established between LAA dimensions and BNP in the study, it is essential
that the duration of AF should be considered and subgroup analyses
should be evaluated if possible, since AF has a significant effect on
BNP release.
We appreciate this study and believe that a more detailed evaluation
including left ventricular evaluation and prospectively monitored LAA
and BNP would yield more realistic results. In addition, we think that
it would be useful to evaluate midregional pro-A-type natriuretic
(MR-proANP) in LAA studies, which is specific to the left atrial
enlargement and similar physiology to BNP.2
Cook JA, Lancaster MC, Kanagasundram AN, et al. Left atrial appendage
dimension predicts elevated brain natriuretic peptide in nonvalvular
atrial fibrillation. J Cardiovasc Electrophysiol .
2023;34(1):135-141. doi:10.1111/jce.15719
Behnes M, Sartorius B, Wenke A, et al. Percutaneous Closure of Left
Atrial Appendage affects Mid-Term Release of MR-proANP. Sci
Rep . 2017;7(1):9028. Published 2017 Aug 22.
doi:10.1038/s41598-017-08999-4