ArticleJournal of the Saudi Heart Association2025
Left Atrial Remodeling Parameters and Brain Natriuretic Peptide Levels in Nonvalvular Atrial Fibrillation.
Article in Journal of the Saudi Heart Association, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Objectives: Left atrium (LA) remodeling, categorized by functional and structural variations, is predominant in heart failure with preserved ejection fraction (HFpEF) and atrial fibrillation (AF). Brain natriuretic peptide (BNP) levels, implying atrial strain, may lead management by indicating LA remodeling severity. This study was instructed to correlate BNP levels with LA volume index (LAVI) in HFpEF patients with nonvalvular AF against sinus rhythm (SR), to evaluate diagnostic implications. Methods: This two-center, observational, cross-sectional study (April 2023-October 2024) registered 340 patients with de novo HFpEF (140 AF, 200 SR). Patients with left ventricular ejection fraction (LVEF) less than 50 %, valvular disease, or acute conditions were excluded. BNP was measured using enzyme-linked immunosorbent assay and categorized as low (≤200 pg/mL), moderate-high (>200-400 pg/mL), or high (≥400 pg/mL). LAVI was calculated via echocardiography per American Society of Echocardiography (ASE) guidelines, categorized as normal (16-34 mL/m Results: AF patients had higher BNP (470 ± 280 vs. 400 ± 211 pg/mL, P = 0.013) and LAVI (60.4 ± 19.0 vs. 54.8 ± 22.0 mL/m Conclusion: In HFpEF, low BNP levels in AF patients are paradoxically associated with severe LA remodeling and worse symptoms, unlike in SR. BNP interpretation should integrate clinical, echocardiographic, and strain data, particularly in AF, high BMI, or kidney disease, to optimize management.
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