Elevated B-type natriuretic peptide level as a marker of subsequent thromboembolic events in patients with atrial fibrillation

Abstract

The aim of the present study was to assess whether elevated B-type natriuretic peptide (BNP) levels, as an objective marker of heart failure, is a predictor of subsequent thromboembolic events in patients with atrial fibrillation (AF) during oral anticoagulant therapy. This was a post hoc analysis of a single-center, prospective, observational study. Consecutive patients with AF (261 patients, 74 ± 9 years old, 153 paroxysmal AF) treated with warfarin were included for the analysis. BNP level at baseline examination was measured to assess the relationship of this parameter with subsequent thromboembolic events. BNP levels at the time of entry were 161 ± 188 (5-1,500, median 105) pg/ml. During an average follow-up time of 762 ± 220 (median 742) days, nine (1.8%/year) thromboembolic events occurred. Receiver operating characteristic curve showed that an optimal cut-off value for BNP to predict thromboembolic events was 218 pg/ml. There were six thromboembolic events observed among patients with a baseline BNP levels ≥200 pg/ml (n = 73) as compared to three such events in those with baseline BNP levels <200 pg/ml (n = 188). Kaplan-Meier curves for BNP level showed that elevated BNP level (≥200 pg/ml) was significantly associated with thromboembolic events (p < 0.01). Cox-proportional hazard analysis also revealed that a high BNP level (≥200 pg/ml) was a significant predictor of subsequent thromboembolic events (hazard ratio 5.32, p = 0.018). Elevated BNP levels (≥200 pg/ml) could be a useful marker of subsequent thromboembolic events in patients with AF during oral anticoagulant therapy. However, the number of patients and events in this study was small and drawing a definite conclusion was not possible with this small sample size. Therefore, further larger-scale, multicenter studies are needed to confirm these findings.

Cardiac BNP gene delivery prolongs survival in aged spontaneously hypertensive rats with overt hypertensive heart disease

“…In contrast to normally circulating forms of NPs, a mutant form of ANP has been associated with familiar AF [34]. Although the causal relationship between BNP and thrombogenesis remains unknown, studies have reported that high levels of circulating immuno-reactive BNP is associated with increased risk of thromboembolic events [35, 36]. Further studies are needed to investigate whether the observed atrial thrombosis was induced by BNP overexpression or it was primarily related to aging.…”

D-dimer levels positively correlate with B-type natriuretic peptide levels in patients with atrial fibrillation

“…On the other hand, D-dimer, which originates from the formation and lysis of cross-linked fibrin and indicates activation of coagulation and fibrinolysis, can be used as a coagulation marker in patients with AF. We reported that D-dimer levels predicted subsequent thromboembolic events in AF patients and that BNP levels (≥200 pg/ml) could be a useful marker for predicting subsequent thromboembolic events in patients with AF during anticoagulant therapy [4,5]. The aims of the present study are to evaluate the association between BNP levels and D-dimer levels and to elucidate the usefulness of measuring BNP levels to provide more information for risk-stratification of AF patients not taking anticoagulant therapy.…”

Stroke and Bleeding Risk Assessments in Patients With Atrial Fibrillation: Concepts and Controversies

“…Their value in a variety of cardiovascular diseases such as myocardial infarction and heart failure have previously been established (80,81). Further studies have also consistently demonstrated that levels of these biomarkers may be used to improve predictions of stroke risk in AF (57,62,(65)(66)(67)71). A RE-LY sub-study found that elevations in troponin I and N-terminal pro-B-type natriuretic peptide (NT-proBNP) were common among AF patients (66).…”