Open AccessUsefulness of brain natriuretic peptide for predicting left atrial appendage thrombus in patients with unanticoagulated nonvalvular persistent atrial fibrillation
Author(s) -
Ochiumi Yusuke,
Kagawa Eisuke,
Kato Masaya,
Sasaki Shota,
Nakano Yoshinori,
Itakura Kiho,
Takiguchi Yu,
Ikeda Shuntaro,
Dote Keigo
Publication year - 2015
Publication title -
journal of arrhythmia
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.463
H-Index - 21
eISSN - 1883-2148
pISSN - 1880-4276
DOI - 10.1016/j.joa.2015.04.002
Subject(s) - medicine , cardiology , atrial fibrillation , thrombus , odds ratio , brain natriuretic peptide , heart failure , cardioversion , confidence interval , natriuretic peptide , stroke (engine) , mechanical engineering , engineering
Background The CHADS 2 scoring system is simple and widely accepted for predicting thromboembolism in patients with nonvalvular atrial fibrillation (NVAF). Although congestive heart failure (CHF) is a component of the CHADS 2 score, the definition of CHF remains unclear. We previously reported that the presence of CHF was a strong predictor of left atrial appendage (LAA) thrombus. Therefore, the present study aimed to elucidate the relationship between LAA thrombus and the brain natriuretic peptide (BNP) level in patients with unanticoagulated NVAF. Methods The study included 524 consecutive patients with NVAF who had undergone transesophageal echocardiography to detect intracardiac thrombus before cardioversion between January 2006 and December 2008, at Hiroshima City Asa Hospital. The exclusion criteria were as follows: paroxysmal atrial fibrillation, unknown BNP levels, prothrombin time international normalized ratio ≥2.0, and hospitalization for systemic thromboembolism. Results Receiver operating characteristic analysis yielded optimal plasma BNP cut‐off levels of 157.1 pg/mL (area under the curve, 0.91; p <0.01) and 251.2 pg/mL (area under the curve, 0.70; p <0.01) for identifying CHF and detecting LAA thrombus, respectively. Multivariate analyses demonstrated that a BNP level >251.2 pg/mL was an independent predictor of LAA thrombus (odds ratio, 3.51; 95% confidence interval, 1.08–10.7; p =0.046). Conclusions In patients with unanticoagulated NVAF, a BNP level >251.2 pg/mL may be helpful for predicting the incidence of LAA thrombus and may be used as a surrogate marker of CHF. The BNP level is clinically useful for the risk stratification of systemic thromboembolism in patients with unanticoagulated NVAF.