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Relationship Between Human Atrial Natriuretic Peptide and Tricuspid Valve Annular Dilatation in Patients With Atrial
Kanako Izumi1, Hiroto Utsunomiya1, Kiyotaka Tohgi1
1Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan.
Background:
Atrial fibrillation (AF) may cause right-sided heart remodeling such as tricuspid valve annular (TVA) dilatation, leading to atrial functional tricuspid regurgitation with prognostic impact. Not all AF patients develop TVA dilatation; therefore, predicting its occurrence is challenging. This study aimed to investigate human atrial natriuretic peptide (hANP) as a potential diagnostic marker of TVA dilatation in AF patients.
Methods:
A total of 346 patients with lone AF (222 paroxysmal AF [paroxAF], 124 persistent AF [persAF]) who underwent 2-dimensional (2D) transthoracic and 3-dimensional (3D) transesophageal echocardiography (TEE) were retrospectively reviewed. This cohort was considered to have normal tricuspid valve geometry screening by 3D-TEE and having no left-side heart disease, pulmonary hypertension, and right ventricular dysfunction. We evaluated the association of plasma hANP concentration with AF-related right-sided heart remodeling including right atrial (RA) dilatation and TVA dilatation.
Results:
Plasma hANP levels showed a correlation with RA area index in the paroAF group (r = 0.27, p < 0.001) but not in the persAF group. In contrast, as for association with 3D TVA area, plasma hANP levels demonstrated an inverse correlation with 3D TVA area (r = -0.25, p = 0.005) in the persAF group, especially with TVA diameter in the anterior-posterior direction, but not in the paroAF group. Multivariate analysis revealed that reduced hANP levels were independently associated with TVA dilatation (per 1 increase in Log10hANP, β: -0.17 [95% CI: -306.7 to -7.59]; p = 0.04).
Conclusion:
Declining plasma hANP levels may serve as a marker for diagnosing TVA dilatation in persAF patients, highlighting its potential role in assessing AF-related structural changes.
