Poster ini telah dipresentasikan di 7th International Peptide Symposium di Singapore

1. 7th International
Peptide
Symposium
Literature Review: B-type Natriuretic
Peptide as Biomarker Screening of Atrial
Fibrilation to Prevent Ischemic Stoke
Ryan Rachmad Nugraha, Amila Hanifan Muslimah, Arnova Reswari
Universitas Padjadjaran, Hasan Sadikin University Hospital Bandung
Indonesia
B-type natriuretic peptide (BNP) is one of natriuretic peptides which has function as a defense mechanism to maintain cardiovascular homeostasis. In normal heart, BNP are synthesized
and should be reserved at the atrial granules. BNP is secreted by ventricular myocytes and it is subjected to hemodynamic stress, including atrial fibrillation. Atrial fibrillation is the most
common arrhythmia in medical practice which characterized by irregularly irregular rapid atrial activation. Its clinical manifestation is ranging from asymptomatic to various symptoms, thus
making it difficult to diagnose early. This condition can lead to subsequent thromboembolic events and become risk factor of ischemic stroke. Early diagnosis of AF is important and needs
to be defined in acute clinical settings. Several studies have proved that BNP level is elevated in patient in any type of atrial fibrillation, including lone, acute, paroxysmal, persistent,
permanent, and recurrent AF. This literature review intends to describe the B-type Natriuretic Peptide which is useful as a screening biomarker for atrial fibrillation in order to prevent
ischemic stroke.
Abstract
B-type Natriuretic Peptide
Atrial fibrillation
Thromboembolic events
Ischemic stroke
Early detection
needed
One of natriuretic peptide contains 32 amino acid
peptide.
BNP level in young and healthy adult is < 25pg/ml.
Increase with age and in women.
In normal heart, BNP are synthesized
and should be reserved at the atrial
granules. BNP is produced and
secreted by ventricular myocytes is
subjected to hemodynamic stress.
Natriuretic peptides (NP),
group of related
hormone to maintain
cardiovascular
homeostasis.
BNP physiological levels are very low, coming to prominence when
compensatory responses are required to address pathological challenges,
include atrial fibrillation.
Introduction
Atrial Fibrilation
Most common arrhythmia, increasing as the age has increased, 0.5%
(50-59 years old) - 8.8% (80-89 years old).
Characterized by irregularly irregular rapid atrial activation
Clinical manifestation is various and sometime is asymptomatic it
difficult to accurately assess the frequency and duration of AF on the
basis of clinical manifestation.
B-type Natriuretic Peptide as Biomarrker Screening of Atrial FibrilationB-type Natriuretic Peptide as Biomarker Screening of Atrial Fibrilation
Classification :
BNP significantly increase in several type
of AF. It may be useful as a biomarker to
screen early AF to further prevent
ischemic stroke.
BNP has high sensitivity, but not specific
biomarker for AF.
Further study need to explain the
pathomechanism of increased BNP in AF.
Conclusion
BNP Various Cardiovascular Event Atrial Fibrilation : Lone, Acute, Paroxysmal, Persistent, Permanent, Recurrent
Cohort study by Knudsen et al proves that paroxysmal and permanent AF
is correlated with the elevation of BNP that taken at admission (p = 0.001).
Study by Tsuchida and Tanabe shows that outpatient with paroxysmal AF,
the BNP levels during attack (median 102 pg/ml) was increased by 66
(median) pg/ml (2.4 fold) compared during sinus rhythm (median 39
pg/ml).
Seegers et al cohort study, BNP levels are also elevated in patients with
silent AF as compared with sinus rhythm.
Study by Lewicka et al, shows that BNP level of 700 fmol/ml or higher 7
days after cardioversion is an independent predictor of AF recurrence
during 12 months after cardioversion.
Baret et al study use BNP as predictor criteria of Atrial fibrillation .
Gold Standard Diagnosis :
ECG recordings by trained clinician
Time consuming to be practical
Not feasible to screen the whole population
another screening strategy is needed
Lone Atrial
Fibrilation
Acute Atrial
Fibrilation
Paroxysmal
Atrial
Fibrilation
Persistent
Atrial
Fibrilation
Permanent
Atrial
Fibrilation
Recurrent
Atrial
Fibrilation
6 X risk
BNP
Nt-pro
BNP
Nt pro-
ANP
Atrial Fibrilation
Prospective observational trial studied by
Watcher et al :
(NT-proBNP, BNP, and NT-proANP) measured on
admission, 6, and 24 hours later. 28 patient
become AF by 7 days Holter recording.
In multivariate analysis, BNP was the only
biomarker to be independently predictive for
paroxysmal atrial fibrillation. BNP cut-offs with
highest sensitivity (96%) is 86 pg/ml.
Useful marker
• associated with change of
left ventricular function
• clear mechanism of isolated
BNP elevation still remains
uncleardifference in the source of
secretion, interaction between
the each peptide with endocrine,
paracrine, and autocrine system
that gives variation response.
Ischemic
StrokeLeft atrial appendage thrombus (LAAT) is the most frequent source of embolic
stroke (ES) in AF patients. Mean BNP levels were significantly higher in LAAT(+)
than LAAT(-) subjects. Higher BNP levels can identify left atrial appendage
thrombus that lead to stroke. Cutoff value for BNP (≤ 450 pg/dl) below which
LAAT formation and ES are highly unlikely
Study by Lewicke et al shows same
result The BNP level is increased in
patients with persistent AF with
preserved LV systolic function.
Heart
Failure
Pulmonary
Diseases
Advance
Age
Female
Gender
Renal
Failure
high level of
BNP has low
specificity for AF
Its high level also found in
several condition
high level of
BNP useful strategyhas high sensitivity for
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Reference :
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