Background and Purpose-Assessment of left atrial appendage (LAA) function with transesophageal echocardiography is useful for detecting patients at high risk for thromboembolism as a result of atrial fibrillation (AF). A recent study reported that the atrium is the main source of brain natriuretic polypeptide (BNP) in AF patients without overt heart failure. The purpose of this study was to assess a possible relationship between LAA function and plasma BNP levels in nonvalvular AF. Methods-Thirty-four consecutive patients with chronic nonvalvular AF (age, 69Ϯ9 years) underwent transesophageal echocardiography and plasma BNP measurement. Thirteen patients with a history of thromboembolism or echocardiographic evidence of thrombus (E ϩ group) were compared with 21 AF patients without complications (EϪ group). Results-The Eϩ group patients demonstrated greater impairment of LAA velocity and higher plasma BNP levels than the EϪ group patients (LAA velocity: 12Ϯ6 versus 31Ϯ17 cm/s, PϽ0.05; plasma BNP: 126Ϯ53 versus 86Ϯ45 ng/L, PϽ0.05). Overall analysis of the continuous variables with multiple logistic regression analysis revealed that BNP was a significant predictor of thromboembolism. There was a weak but significant negative correlation between plasma BNP levels and LAA flow velocity (rϭ0.38, PϽ0.05). No intergroup difference in plasma atrial natriuretic polypeptide levels was found. Conclusions-The present data suggest the usefulness of measuring plasma BNP levels, which may reflect augmented atrial secretion of BNP from the impaired atrial myocardium, in detecting patients at high risk for thromboembolic complications in nonvalvular AF.
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