Relationship Between Human Atrial Natriuretic Peptide and Tricuspid Valve Annular Dilatation in Patients With Atrial Fibrillation

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.