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- Title
Impact of B-type natriuretic peptide level on the risk of left atrial appendage thrombus in patients with nonvalvular atrial fibrillation: a prospective study.
- Authors
Pant, Rojina; Patel, Mita; Garcia-Sayan, Enrique; Wassouf, Marwan; D'Silva, Oliver; Kehoe, Richard F.; Doukky, Rami
- Abstract
<bold>Background: </bold>The 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.<bold>Methods: </bold>In two academic medical centers, we obtained BNP levels immediately prior to transesophageal echocardiogram performed to exclude LAA thrombus in patients with NVAF.<bold>Results: </bold>Among 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).<bold>Conclusions: </bold>BNP is predictive of SEC. However, it does not provide significant incremental value in the prediction of LAA thrombus.
- Subjects
ILLINOIS; NATRIURETIC peptides; THROMBOSIS; ATRIAL fibrillation; LONGITUDINAL method; LOGISTIC regression analysis; ODDS ratio; UNIVARIATE analysis; MULTIVARIATE analysis; ATRIAL fibrillation diagnosis; THROMBOSIS diagnosis; COMPARATIVE studies; ECHOCARDIOGRAPHY; HEART atrium; RESEARCH methodology; MEDICAL cooperation; PEPTIDE hormones; RESEARCH; RESEARCH evaluation; COMORBIDITY; EVALUATION research; DISEASE prevalence; STROKE volume (Cardiac output)
- Publication
Cardiovascular Ultrasound, 2016, p1
- ISSN
1476-7120
- Publication type
journal article
- DOI
10.1186/s12947-016-0047-6