Impact of B-type natriuretic peptide level on the risk of left atrial appendage thrombus in patients with nonvalvular atrial fibrillation: a prospective study

Cardiovascular Ultrasound

Research

Oliver D’Silva¹  Richard F. Kehoe¹  Rojina Pant¹  Marwan Wassouf²  Rami Doukky³  Mita Patel⁴  Enrique Garcia-Sayan⁵ 

[1] Division of Cardiology, Advocate Illinois Masonic Medical Center, Chicago, IL, USA;Division of Cardiology, Rush University Medical Center, Chicago, IL, USA;Department of Medicine, Fairview Hospital, Cleveland, OH, USA;Division of Cardiology, Rush University Medical Center, Chicago, IL, USA;Division of Adult Cardiology, John H. Stroger, Jr. Hospital of Cook County, 1901 W. Harrison St, 60612, Chicago, IL, USA;Division of Cardiology, Rush University Medical Center, Chicago, IL, USA;Division of Cardiology, Medical College of Wisconsin, Milwaukee, WI, USA;Division of Cardiology, Rush University Medical Center, Chicago, IL, USA;Division of Cardiology, Mount Sinai Hospital, Chicago, IL, USA;

关键词: Atrial fibrillation;    B-type natriuretic peptide;    Left atrial appendage thrombus;    Spontaneous echo contrast;   

DOI  :  10.1186/s12947-016-0047-6

 received in 2015-12-27, accepted in 2016-01-12,  发布年份 2016

来源: Springer

【 摘 要 】

BackgroundThe impact of B-type natriuretic peptide (BNP) level on the risk of left atrial appendage (LAA) thrombus in patients with nonvalvular atrial fibrillation (NVAF) has not been prospectively studied.MethodsIn two academic medical centers, we obtained BNP levels immediately prior to transesophageal echocardiogram performed to exclude LAA thrombus in patients with NVAF.ResultsAmong 261 subjects (mean age 65 ± 12 years; 30 % women) with NVAF, 17 (6.5 %) had LAA thrombus and 85 (32.6 %) had at least mild spontaneous echo contrast (SEC). Mean BNP level was significantly higher in patients with LAA thrombus [775 ± 678 vs. 384 ± 537, P = 0.001]. Receiver operator characteristics analysis demonstrated that BNP has a good discriminatory capacity for LAA thrombus (area under the curve, 0.74; 95 % confidence interval [CI], 0.63–0.85; P = 0.001); BNP ≥ 67 pg/mL was 100 % sensitive and 20 % specific for LAA thrombus. Multivariate logistic regression analysis demonstrated that BNP was not independently associated with LAA thrombus (odds-ratio, 1.05 per 100 pg/mL increment; CI, 0.99–1.12; P = 0.127) after adjusting for CHA2DS2-VASc score; while the latter was independently associated with LAA thrombus after adjusting for BNP level (odds-ratio, 1.46 per CHA2DS2-VASc point; CI, 1.09–1.96; P = 0.011). Nonetheless, BNP was associated with SEC in univariate and multivariate analysis, after adjusting for the CHA2DS2-VASc score, (odds-ratio, 1.08; CI, 1.02–1.14; P = 0.005).ConclusionsBNP is predictive of SEC. However, it does not provide significant incremental value in the prediction of LAA thrombus.

【 授权许可】

CC BY   
© Pant et al. 2016