Abstract 11612: The Different Impact of Disproportionately Low B-Type Natriuretic Peptide Levels on Outcome in Patients of Acute Decompensated Heart Failure Between Sinus Rhythm and Atrial Fibrillation

Abstract

Introduction: B-type natriuretic peptide (BNP) has been widely used for the diagnosis of heart failure. Previous data suggest a lower diagnostic accuracy of BNP in HF patients with atrial fibrillation (AF). However, little is known about disproportionately low BNP levels in AF patients even during acute heart failure conditions. Hypothesis: The factors related to disproportionately low BNP might be different between AF and sinus rhythm (SR) in patients with acute decompensated heart failure (ADHF). Methods: Among 424 patients hospitalized for ADHF between January 2015 and December 2017, we divided into two groups based on the rhythm at hospital admission (AF group, n=201 and SR group, n=223) and subdivided them into four groups (Q1-Q4) according to each quartile of BNP levels at hospital admission (BNP lowest quartile (Q1) group (LB): < 320 pg/mL in SR; Q1 < 240 pg/mL in AF). Results: The proportion of patients with unexpectedly low BNP (BNP < 200 pg/mL) was higher in AF group (19.9%) than in SR group (12.1%, p=0.03). BNP was correlated with left ventricular end-diastolic volume index (LVEDVi), left ventricular ejection fraction (LVEF) in both groups (AF: r=0.28, p<0.01; r=-0.43, p<0.01, SR: r=0.41, p<0.01; r=-0.39, p<0.01, respectively) . On the other hand, BNP was positively correlated with left atrial diameter in SR group but negatively correlated in AF group (r=0.14, p=0.039 vs. r=-0.21, p<0.01, respectively, Figure). Furthermore, survival rates significantly increased along BNP tertiles in SR group. On the contrary, in AF group, Q1 (LB) did not show the highest survival rates (p=0.02, Figure). Conclusions: A higher proportion of ADHF with disproportionately low BNP was seen in AF than in SR group. In ADHF patients with AF, LB may be reflected by LA structural remodeling. Furthermore, LB was related to good prognosis in SR group, but not in AF group.