Plasma Brain Natriuretic Peptide Levels Indicating Thromboembolism in Very Elderly Patients With Non-Valvular Atrial Fibrillation

Abstract

trial fibrillation (AF) is a sustained arrhythmia that is most commonly found among persons in their 60 s, and its incidence is reported to be 2-4% of this generation. In people >75 years old, the incidence of AF has been reported to increase to 11.6%. [1][2][3] Thromboembolism is an important complication of AF that causes deterioration in the quality of life, 4,5 but the most appropriate candidates for anticoagulant therapy among patients with AF remain a matter of debate.Transesophageal echocardiography (TEE) is a useful clinical tool for identifying actual thrombi and for visualizing spontaneous echo contrast (SEC), a change which might predispose patients to develop atrial thrombosis. [6][7][8][9][10][11][12] The left atrial appendage (LAA) flow velocity measured by TEE has been used as a parameter of LAA function. 6,7,12,13 Several investigators have reported that AF patients with a low LAA blood flow velocity (reflecting impaired left atrial (LA) function) have a higher risk of thromboembolism than patients with an appendage flow >20 cm/s. 8,[12][13][14][15][16] In addition, the thrombin level is increased and platelet activation occurs in patients with either valvular or non-valvular AF. 17,18 Abnormal values of these markers might not appear however, until thrombin activation has commenced, and more importantly, such abnormal values might not necessarily reflect changes of cardiac origin.The level of brain natriuretic polypeptide (BNP) is increased in patients with various heart diseases, such as congestive heart failure, 19,20 dilated cardiomyopathy, 21 hypertrophic cardiomyopathy, hypertensive heart disease, 22 and lone AF. 23,24 Contrary to earlier theories that BNP is mainly secreted by the ventricular myocardium, 21,25,26 it was reported recently that the left atrium (not the left ventricle) is the main source of BNP in patients with AF. 23 The major findings of that study were : (1) patients with AF have significantly higher plasma BNP levels than control subjects; (2) a significant increase of BNP occurs between the coronary sinus (reflecting ventricular secretion) and the anterior interventricular vein (reflecting atrial secretion); and (3) there is a significant decrease of both plasma BNP and atrial BNP production after cardioversion of AF to sinus rhythm. 23,24 In the present study, we examined whether plasma BNP levels are higher in very elderly patients with clinical evidence of thromboembolism than in very elderly patients without this complication, and whether plasma BNP levels are correlated with LA function as represented by LAA flow. Methods PatientsWe studied 74 patients (38 men and 36 women aged, 75-96 years; mean, 82 years) with ECG-documented AF who were referred to our department for examination of cerebral vascular diseases. All patients underwent transthoracic and TEE, and then were classified into 2 groups.Circ J 2007; 71: 1446 -1451 (Received February 6, 2007 revised manuscript received May 22, 2007; accepted May 23, 2007 Background Assessment of left atrial (LA) function b...

Relation of hs-CRP and BNP levels with the atrial spontaneous echo contrast and thrombi in permanent atrial fibrillation patients with different etiologies

“…Contrary to earlier theories that BNP was secreted mainly from the ventricular myocardium, recent studies suggest that the left atrium, not the left ventricle, is the main source of BNP in patients with AF [3,5,13]. …”

“…Transesophageal echocardiography (TEE) is a useful diagnostic method for both detection of thrombus and visualization of SEC in the left and right atrial appendages (LAA and RAA), which may develop thrombi [3]. Previous studies have pointed out that patients with AF who have a low appendage blood flow velocity (reflecting impaired LAA) measured by TEE pulsed-wave (PW) Doppler have a higher risk of thromboembolism than patients with an appendage flow >20 cm/s [3,5]. …”

“…In previous studies, it has been found that hs-CRP (or CRP) and BNP (or N-terminal proBNP) are associated with the development and recurrence of AF and can be used to detect vulnerable AF patients at high risk for thromboembolism [5,14–17]. However, possible effects of atrial dysfunction on BNP and hs-CRP levels and association between intra-atrial thrombi and BNP and hs-CRP in various AF etiologies are still the subjects of debate.…”

Letter by Sata et al Regarding Article,"Plasma Brain Natriuretic Peptide Levels Indicating Thromboembolism in Very Elderly Patients With Non-Valvular Atrial Fibrillation"

“…1 We also previously reported the effect of paroxymal atrial fibrillation on coagulation factors, 2 which they cited. We are interested in the connection with atrial fibrillation and coagulation factor, natriuretic peptide family.…”

Reply to Letter Regarding Article,"Plasma Brain Natriuretic Peptide Levels Indicating Thromboembolism in Very Elderly Patients With Non-Valvular Atrial Fibrillation"

“…1 We regret that the references were wrongly numbered and that readers were a little confused. As scientists, we think much of the importance of the thinking process, which is often the key to further study in the field.…”