Elevated plasma brain natriuretic peptide levels predict left atrial appendage dysfunction in patients with acute ischemic stroke

Tamura, H.; Watanabe, Tetsu; Nishiyama, Satoshi; Sasaki, Satoshi; Wanezaki, Masahiro; Arimoto, Takanori; Takahashi, Hiroki; Shishido, Tetsuro; Miyashita, Takehiko; Miyamoto, Takuya; Hirono, Osamu; Kayama, Takamasa; Kubota, Isao

doi:10.1016/j.jjcc.2012.02.010

Cited by 31 publications

(19 citation statements)

References 30 publications

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“…In a previous study by Tamura et al, the association between BNP and LAA function in patients with acute ischemic stroke was reported. 24 They showed that plasma BNP levels significantly correlated with LAAFV regardless of SR or AF rhythm, which was similar to the result in our study. BNP is secreted into the plasma mainly in response to mechanical stretching of the LV, LA and LAA myocardium.…”

Section: Patient Populationsupporting

confidence: 91%

Does Left Atrial Appendage Morphology Influence Left Atrial Appendage Flow Velocity?

Kishima

Mine

Ashida

et al. 2015

Circ J

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Background:The shape of the left atrial appendage (LAA) might affect thrombus formation. The chicken wing-type LAA (CW) has been reported as unlikely to influence stroke events in atrial fibrillation (AF) patients, so we investigated whether LAA shapes could influence LAA function. Methods and Results:We studied 102 patients (64 men, age 65±9 years) who underwent transthoracic echocardiography, transesophageal echocardiography (TEE), and cardiac computed tomography prior to catheter ablation (CA) for AF. LAA morphology were classified into 2 types: (1) CW: LAA with a bend in its shape and (2) non-CW type (NCW): LAA without any bends. All patients were classified into these groups using a cutoff value of LAA flow velocity (LAAFV). Patients with LAAFV <35 cm/s were classified as the low LAAFV group (Low FV, n=37). The patients with LAAFV >35 cm/s were classified as normal LAAFV group (Normal FV, n=65). The NCW type was detected in 25/102 patients (25%). In multivariate analysis, the patients with Low FV were associated with NCW type (P=0.0429, odds ratio [OR] 9.664, 95% confidence interval [CI] 1.075-86.900) and higher B-type natriuretic peptide (BNP) (P=0.0350, OR 1.012 for each 1 pg/ml increase in BNP, 95% CI 1.001-1.022). Conclusions:The NCW-type LAA and higher BNP were associated with lower LAAFV. One reason for the frequent cardiogenic stroke in patients with the NCW-type LAA may be the lower LAAFV. (Circ J 2015; 79: 1706 -1711

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Section: Patient Populationsupporting

confidence: 91%

Does Left Atrial Appendage Morphology Influence Left Atrial Appendage Flow Velocity?

Kishima

Mine

Ashida

et al. 2015

Circ J

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“…The peak early (E') mitral annular velocity was measured, and the ratio of the E-wave to E' (E/E') was calculated, as previously described. 13 All echocardiographic measurements were calculated as the mean of 5 consecutive cardiac cycles. 14 LAA thrombus was diagnosed when a fixed or mobile echogenic mass could be clearly differentiated from the wall of the LA or LAA.…”

Section: Echocardiographymentioning

confidence: 99%

“…14 LAA thrombus was diagnosed when a fixed or mobile echogenic mass could be clearly differentiated from the wall of the LA or LAA. 13 The severity of spontaneous echocardiographic contrast (SEC) was graded from 0 to 4+ by 2 independent observers who were unaware of the blood data: 0=none; 1+=mild; 2+=mild to moderate; 3+=moderate; and 4+=severe. 15…”

Section: Echocardiographymentioning

confidence: 99%

Predictors of Left Atrial Coagulation Activity Among Paroxysmal Atrial Fibrillation Patients

Yashiro

Arimoto

Hashimoto

et al. 2014

Circ J

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Background:The difference between left atrial (LA) and systemic coagulation activity in paroxysmal atrial fibrillation (PAF) is unclear. Methods and Results:We enrolled 100 patients with PAF who underwent AF ablation. Warfarin was stopped 1 day before the procedure. LA volume index and LA emptying fraction were measured by 64-slice multidetector computed tomography. Immediately after transseptal puncture, blood samples were simultaneously collected from the LA and systemic circulation (SC). In addition, to evaluate the effect of warfarin on D-dimer levels we recruited an additional 27 PAF patients on continuous warfarin. Even in patients with low CHADS2 scores (mean 0.59±0.68) and during sinus rhythm, the prevalence of positive LA-D-dimer (≥0.5 µg/ml) was greater than that of SC-D-dimer (23% vs. 10%, P<0.01). The LA-D-dimer-positive patients had a larger mean LA volume index and reduced LA emptying fraction than the LA-D-dimer-negative patients. Multiple logistic regression analysis revealed that LA volume index was independently correlated with positive LA-D-dimer (odds ratio 2.245, 95% confidence interval 1.194−4.626, P=0.0112). The prevalence of positive LA-D-dimer was significantly lower in patients taking continuous warfarin, than in those on discontinuous warfarin (3.7% vs. 23%, P=0.025). Conclusions

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“…39 Therefore, it is believed that in a patient with AF, BNP is primarily produced in the atria, whereas in a patient with heart failure, natriuretic peptide is mainly released by ventricles. 40,41 Elevated levels of BNP have been correlated with left atrial appendage dysfunction, 42,43 which itself is associated with increased risk for thromboembolic events in AF patients. 14 The prevalence of elevated biomarkers and their association with cardiovascular events in AF patients receiving chronic anticoagulation were studied independently in two clinical trials: Apixaban for the Prevention of Stroke in Subjects with Atrial Fibrillation (ARISTOTLE) and Randomized Evaluation of Long-Term Anticoagulation Therapy (RE-LY).…”

Section: Brain Natriuretic Peptidementioning

confidence: 99%

Who will benefit from anticoagulant therapy? Use of the CHADS2 score and its variants

Singla¹,

Mittal²,

Flaker³

2014

RRCC

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Stroke prevention is a crucial step in the management of atrial fibrillation (AF). The assessment of stroke risk associated with AF varies, depending on the presence of various clinical risk factors (older age, congestive heart failure, diabetes mellitus, hypertension, history of stroke or transient ischemic attack, female sex, or peripheral vascular disease) incorporated in risk stratification models such as CHADS 2 and CHA 2 DS 2 -VASc. Although these models have modest predictive ability in individual patients, current guidelines advocate the use of a CHA 2 DS 2 -VASc risk score to identify very low risk patients who can avoid antithrombotic therapy, as well as all others who can benefit from such therapy. More recently biomarkers and imaging has improved our knowledge of pathophysiology of AF and may further improve risk stratification for thromboprophylaxis in AF patients. These new markers combined with clinical risk scores may enable the development of novel tools to improve clinical risk assessment in AF. In this article, we summarize the recent developments in risk stratification for stroke prevention in AF, including the various schemes and new biomarkers that may lead to improved patient outcomes.

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Elevated plasma brain natriuretic peptide levels predict left atrial appendage dysfunction in patients with acute ischemic stroke

Abstract: Elevated plasma BNP concentrations may be a reliable surrogate marker for the prediction of LAA dysfunction and cardiogenic stroke in patients with acute ischemic stroke.

Cited by 31 publications

References 30 publications

Does Left Atrial Appendage Morphology Influence Left Atrial Appendage Flow Velocity?

Does Left Atrial Appendage Morphology Influence Left Atrial Appendage Flow Velocity?

Predictors of Left Atrial Coagulation Activity Among Paroxysmal Atrial Fibrillation Patients

Who will benefit from anticoagulant therapy? Use of the CHADS2 score and its variants

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