Thromb Haemost 2021; 121(11): 1523-1529
DOI: 10.1055/a-1400-6096
Stroke, Systemic or Venous Thromboembolism

The Prognostic Potential of Atrial Natriuretic Peptide on the Development of Postoperative Atrial Fibrillation after Cardiac Surgery

Felix Hofer*
1  Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
,
Andreas Hammer*
1  Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
,
Matthias Steininger
1  Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
,
Niema Kazem
1  Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
,
Lorenz Koller
1  Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
,
Barbara Steinlechner
2  Department of Anesthesiology, Medical University of Vienna, Vienna, Austria
,
Günther Laufer
3  Division of Cardiac Surgery, Department of Surgery, Medical University of Vienna, Vienna, Austria
,
Martin Andreas
3  Division of Cardiac Surgery, Department of Surgery, Medical University of Vienna, Vienna, Austria
,
Rodrig Marculescu
4  Department of Laboratory Medicine, Medical University of Vienna, Vienna, Austria
,
Christian Hengstenberg
1  Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
,
Johann Wojta
1  Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
,
Alexander Niessner
1  Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
,
Patrick Sulzgruber
1  Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
› Author Affiliations
Funding The study was supported and received funding for materials by the “Association for the Promotion of Research in Atherosclerosis, Thrombosis and Vascular Biology” (ATVB), Vienna, Austria.

Abstract

Background Postoperative atrial fibrillation (POAF) represents a common complication after cardiac surgery associated with major adverse events and poor patient outcome. Tools for risk stratification of this arrhythmia remain scarce. Atrial natriuretic peptide (ANP) represents an easily assessable biomarker picturing atrial function and strain; however, its prognostic potential on the development of POAF has not been investigated so far.

Methods Within the present investigation, 314 patients undergoing elective cardiac surgery were prospectively enrolled. Preoperative mid-region proANP (MR-proANP) values were assessed before the surgical intervention. Patients were followed prospectively and continuously screened for the development of arrhythmic events.

Results A total of 138 individuals (43.9%) developed POAF. Median concentrations of MR-proANP were significantly higher within the POAF group (p < 0.001). MR-proANP showed a strong association with the development of POAF with a crude odds ratio (OR) of 1.68 per 1 standard deviation (1-SD; 95% confidence interval [CI]: 1.31–2.15; p < 0.001), which remained stable after comprehensive adjustment for confounders with an adjusted OR of 1.74 per 1-SD (95% CI: 1.17–2.58; p = 0.006). The discriminatory power of MR-proANP for the development of POAF was validated by the category-free net reclassification improvement (0.23 [95% CI: 0.0349–0.4193]; p = 0.022) and integrated discrimination increment (0.02 [95% CI: 0.0046–0.0397], p = 0.013).

Conclusion MR-proANP proved to be a strong and independent predictor of the development of POAF. Considering a personalized diagnostic and prognostic preoperative work-up, a standardized preoperative evaluation of MR-proANP levels might help to identify patients at risk for development of POAF after cardiac surgery.

Author Contributions

A.N., P.S. and, J.W. contributed to the conception or design of the work. F.H., A.H., M.S., N.K., and L.K. contributed to the acquisition, analysis, or interpretation of data for the work. F.H. and A.H. drafted the manuscript. B.S., G.L., M.A., R.M., and C.H. critically revised the manuscript. All gave final approval and agreed to be accountable for all aspects of work ensuring integrity and accuracy.


* Both authors contributed equally in this work.


Supplementary Material



Publication History

Received: 22 December 2020

Accepted: 23 February 2021

Publication Date:
25 February 2021 (online)

© 2021. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany