Ventricular Irregularity, But Not Ventricular Rate, Is Important for Determination of NT-ProBNP Levels in Chronic Atrial Fibrillation: Evidence for Lenient Rate Control in Atrial Fibrillation

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Background: Role of ventricular rate (VR) and its irregularity in AF have not been well studied with respect to the elevation of NT-proBNP. Methods and Results: In 66 patients with AF (71±9 years, 32 men), NT-proBNP, indices of VR irregularity (mean VR, standard deviation (SD) of VR, SD of successive differences and SD of 5-minute averages (SDAVR)) derived from 24-hour Holter and transthoracic echocardiographic parameters (early mitral inflow velocity (e)/mitral annular velocity (e′), left atrial volume index and left ventricular ejection fraction (LVEF)) were measured. Mean VR, LVEF, e/e′, SDVR and SDAVR were significant univariate predictors of NT-proBNP. e/e′ and SDAVR remained as significant predictors after multivariate adjustment (standardized β=0.306, P=0.007, and β=−0.362, P=0.002, respectively), but mean VR did not. By partial correlation, e/e′ was found to be independently correlated with NT-proBNP (r=0.283, P=0.031), but mean VR was not (r=0.032, P=0.811). When the patients were stratified with the 33rd and 67th percentile values of e/e′ (11.8 and 15.4, respectively), a significant positive correlation between mean VR and NT-proBNP was present only in patients with the upper tertile value. Conclusions: VR is not as important as LV diastolic function and VR irregularity in the elevation of NT-proBNP in AF. VR control may be needed in patients with severe LV diastolic dysfunction. Our results support the findings of RACE II trial.

Ventricular Irregularity, But Not Ventricular Rate, Is Important for Determination of NT-ProBNP Levels in Chronic Atrial Fibrillation: Evidence for Lenient Rate Control in Atrial Fibrillation

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