The association between tenascin-c and nt-probnp levels and arrhythmia prevalence in heart failure

Aim: Tenascin-C (TN-C) and the amino terminal fragment of B-type natriuretic peptide (NT-proBNP) are important determinants for prognosis in patients with heart failure (HF). In HF, NT-proBNP is secreted from the ventricles largely in response to the increase in ventricular pressure and stretch. In cardiac pathologies, TN-C is associated with prolonged macrophage infiltration and inflammatory foci. In this study, we aimed to investigate the relationship between arrhythmia prevalence and TN-C and NT-proBNP levels in patients with HF. Materials and methods: In our study, 107 HF patients with EF< 45% were enrolled. In the Holter analysis, the patients were classified into malignant arrhythmia group (n = 29) that observed Lown class 4a and 4b and benign arrhythmia group (n = 78) that observed Lown class 0-3b arrhythmia. Holter recordings were also analyzed in terms of paroxysmal atrial fibrillation (PAF). Patients were also categorized into two groups according presence of PAF. The groups were compared in terms of TN-C and NT-proBNP levels. The relationships between the levels of NT-proBNP and TN-C, and ventricular premature complexes (VPCs), supraventricular premature complexes (SVPCs) and heart rate variability (HRV) were also examined. Results: In the malignant arrhythmia group, NT-proBNP (5042.1 ± 1626 versus 1417.1 ± 1711.6 pg/ml) and TN-C (1089 ± 348.6 versus 758.5 ± 423.9 ng/ml) levels were significantly higher than benign arrhythmia group (p<0,001). Between the patients with and without PAF, only TN-C was found to be significantly different (for NT-proBNP: 2903,6±2440,8 versus 2164,8±2261,1 pg/ml, p=0,128), (for TN-C: 1089 ± 419.9 versus 735.9 ± 388 ng/ml, p<0.001). There was significant strong positive correlation between NT-proBNP levels and the number of VPCs (r=0.741, p<0,001), significant positive correlation between NT-proBNP levels and the number SVPCs (r = 0.559, p<0,001). There was significant weak positive correlation between TN-C levels and the number of VPCs and SVPCs (r=0.347, p<0,001 and r=0.464, p<0,001, respectively). A significant correlation was found between SDNN, SDANN and NT-proBNP levels (r=-0.535, p<0,001 and r=-0.562, p<0,001, respectively). There was no correlation between RMSSD, pNN50 and NT-proBNP levels. There was significant weak negative correlation between frequency domain parameters and NT-proBNP levels. There was no correlation between TN-C levels and any heart rate variability. Conclusion: In patients with HF, NT-proBNP and TN-C measurements are useful in determining arrhythmia prevalence. While there was a relationship between NT-proBNP levels and autonomic function, this relationship was not established for TN-C levels. TN-C was found to be related to PAF in HF patients. Key Words: Arrhythmia, aminoterminal fragment of B-type natriuretic peptide, tenascin-C.