Estimation of atrial fibrillation recency of onset and safety of cardioversion using NTproBNP levels in patients with unknown time of onset

Deftereos, Spyridon; Γιαννόπουλος, Γεώργιος; Kossyvakis, Charalampos; Raisakis, Konstantinos; Kaoukis, Andreas; Aggeli, C.; Toli, Konstantina; Theodorakis, Andreas; Panagopoulou, Vasiliki; Driva, Metaxia; Mantas, Ioannis; Pyrgakis, Vlasios; Rentoukas, Ilias; Stefanadis, Christodoulos

doi:10.1136/hrt.2010.214742

Cited by 24 publications

(30 citation statements)

References 13 publications

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“…BNP secretion is closely correlated with the volume and pressure load of heart chambers (Beck-da-Silva et al, 2004;Date et al, 2006;Wozakowska-Kaplon and Opolski, 2010;Tang et al, 2011;Barassi et al, 2012;Govindan et al, 2012). In the successful ablation group, BNP levels significantly decreased 2 h after surgery (P < 0.01) and declined even further after three months (P < 0.01), which is consistent with the results in the literature (Marsiliani et al, 2010;Deftereos et al, 2011;Freynhofer et al, 2011;Higa et al, 2011;Kawabata et al, 2011;Ruggiero et al, 2011;Psychari et al, 2011). After sinus rhythm was restored, the atrium exhibited effective contractions, its auxiliary pump function recovered, hemodynamic rhythm improved, and poor mechanical and volumetric stimulations to atrial cells decreased or disappeared.…”

Section: Discussionsupporting

confidence: 88%

Clinical significance and levels of blood brain natriuretic peptides in patients with persistent atrial fibrillation before and after catheter ablation

Sy¹,

Hl²,

Ps³

et al. 2015

Genet. Mol. Res.

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ABSTRACT. The aim of this study was to observe levels of blood brain natriuretic peptides (BNPs) in patients with persistent atrial fibrillation (AF) before and after catheter ablation. Thirty-six patients with persistent AF (28 successful surgeries and eight recurrent cases) and 36 healthy controls with normal sinus rhythm were recruited for this study. BNP levels in the AF and control groups were measured before and after catheter ablation. BNP levels before surgery were significantly higher in the persistent AF group than in the control group (P < 0.01). The successful surgery group had distinctly lower BNP levels before ablation than the recurrent group (P < 0.01). In the recurrent group, BNP levels 2 h after ablation were significantly lower than those before ablation (P < 0.01); these levels increased after AF recurrence (P < 0.01) and were comparable with those before ablation (P < 0.01). Logistic regression analysis indicated that the BNP level was an inde-S.Y. Xing et al. 6954©FUNPEC-RP www.funpecrp.com.br Genetics and Molecular Research 14 (2): 6953-6959 (2015) pendent factor for and predictor of AF recurrence (P < 0.01). The BNP level in patients with persistent AF is clinically important in predicting and evaluating AF recurrence after ablation.

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Section: Discussionsupporting

confidence: 88%

Clinical significance and levels of blood brain natriuretic peptides in patients with persistent atrial fibrillation before and after catheter ablation

Sy¹,

Hl²,

Ps³

et al. 2015

Genet. Mol. Res.

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“…High plasma concentrations of the peptide have been associated with the presence of thrombi on TEE, without information regarding the duration of AF (11). Another study observed an association between BNP concentrations and presence of atrial thrombi on TEE in patients presenting with AF of unknown duration and without manifestations of heart failure (12). In the present study, we observed that MR-proANP tended to better discriminate AF ≤48 h in duration than NTproBNP; this is consistent with the site of synthesis and secretion (atrium vs ventricular), and as a consequence, a previous report that suggests that ANP is more influenced by AF than fluid overload As an example, a heart rate of 140 bpm (57 points), in the absence of dyspnea (37 points), and a MR-proANP concentration of 300 pmol/L (35 points) represents a total score of 129 points, corresponding to a 70% probability of AF ≤48 h in duration.…”

Section: Discussionmentioning

confidence: 99%

“…Several studies suggested that natriuretic peptides are increased in AF, and that B-type natriuretic peptide (BNP) and N-terminal probrain natriuretic peptide (NT-proBNP) may even discriminate patients with recent vs older AF (9)(10)(11)(12). Atrial natriuretic peptide (ANP) is another natriuretic peptide but is synthesized and secreted by the atrial myocardium in response to mechanical stretch (13).…”

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confidence: 99%

Score Using Measurements of Plasma Midregional Pro–Atrial Natriuretic Peptide to Estimate the Duration of Atrial Fibrillation

Legallois

Sorbets

Chenevier‐Gobeaux

et al. 2017

The Journal of Applied Laboratory Medicine

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Background An accurate estimate of the duration of atrial fibrillation (AF) is critical for its safe and successful management. We examined the ability of midregional pro–atrial natriuretic peptide (MR-proANP) to identify patients presenting with AF of ≤48 vs >48 h in duration. Methods We prospectively studied 106 patients presenting with AF of known duration. We examined the predictive values of MR-proANP and N-terminal pro–brain natriuretic peptide (NT-proBNP) in the detection of recent-onset AF, in addition to other factors identified by multiple variable analyses. Results In patients presenting with AF of ≤48 vs >48 h in duration, the median MR-proANP plasma concentration was 147.7 [95.3–197.4] pmol/L vs 220.4 [154.0–303.1] pmol/L (P <0.001). MR-proANP and NT-proBNP were correlated (r = 0.5, P <10−7), but MR-proANP tended to better discriminate AF of ≤48 h in duration than NT-proBNP (P = 0.09). A score including heart rate, dyspnea, and MR-proANP concentration accurately detected AF of ≤48 h in duration (area under the curve = 0.890; 95% CI, 0.828–0.952). A score of 98 points was an optimal cutoff that excluded AF of ≤48 h in duration with a sensitivity of 95%, while a score of 132.5 points was an optimal cutoff that confirmed AF of ≤48 h in duration with a sensitivity of 95%. Overall, a score ≤98 or ≥132.5 identified AF of ≤48 h in duration in 56% of patients. Conclusions A score based on a model including heart rate, dyspnea, and plasma MR-proANP concentration was helpful in identifying AF of ≤48 h in duration.

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“…Other biomarkers like NTproBNP [20], cardiac troponin I [21], and C reactive protein [22] have shown a strong association to the presence of markers of left atrial stasis like LAAT [20,21,22], DSEC [20,21,22], LFV [21], and LA ABN [21] and have inclusively shown additive prognostic power when added to the CHADS 2 [21,22] and CHA 2 DS 2 VASc classifications [20,21]. Transthoracic echocardiographic parameters like left atrial size and LVEF have also been shown to be associated with markers of left atrial stasis and able to refine the currently available clinical risk schemes [23].…”

Section: Discussionmentioning

confidence: 99%

Decreased Glomerular Filtration Rate and Markers of Left Atrial Stasis in Patients with Nonvalvular Atrial Fibrillation

Providência¹,

Fernandes²,

Paiva³

et al. 2012

Cardiology

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Background: It is currently unknown if the increased risk of stroke in subjects with chronic kidney disease and atrial fibrillation (AF) is due to the presence of left atrial stasis or to any other vascular or systemic conditions. Methods: This was a retrospective study of 372 subjects undergoing evaluation during an AF episode. The following markers of left atrial stasis were sought on transesophageal echocardiogram: left atrial or left atrial appendage thrombus (LAAT), dense spontaneous echocardiographic contrast (DSEC), and low flow velocities (LFV) in the left atrial appendage. Subgroup comparisons were performed according to the level of estimated glomerular filtration rate (eGFR) using the Chronic Kidney Disease Epidemiology Collaboration equation as follows: ≥90, 45–89.9, and <45 ml/min/1.73 m². Results: LAAT was found in 11.6%, DSEC in 29.0%, and LFV in 14.9% of cases. A significant increase in the prevalence of DSEC was observed in the lower categories of eGFR: 37.8% in eGFR <45 ml/min, 30.7% in eGFR 45–89.9 ml/min, and 17.0% in eGFR ≥90 ml/min (p = 0.009; γ for trend = 0.297, p = 0.002). The same was observed when assessing left atrial abnormality, i.e. the presence of at least one of the former transesophageal echocardiogram changes. On multivariate analysis, clinical parameters from CHADS₂ (congestive heart failure, hypertension, age ≥75, diabetes mellitus and stroke) and CHA₂DS₂-VASc (age 65–74, history of vascular disease, and female gender along with the clinical variables from CHADS₂) were predictors of transesophageal echocardiogram changes and an additive predictive value was found for eGFR. Conclusions: Our results suggest an association between compromised renal function as assessed through eGFR and markers of left atrial stasis in patients with AF. The increased risk of stroke in this population may be due to thromboembolism.

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Estimation of atrial fibrillation recency of onset and safety of cardioversion using NTproBNP levels in patients with unknown time of onset

Cited by 24 publications

References 13 publications

Clinical significance and levels of blood brain natriuretic peptides in patients with persistent atrial fibrillation before and after catheter ablation

Clinical significance and levels of blood brain natriuretic peptides in patients with persistent atrial fibrillation before and after catheter ablation

Score Using Measurements of Plasma Midregional Pro–Atrial Natriuretic Peptide to Estimate the Duration of Atrial Fibrillation

Decreased Glomerular Filtration Rate and Markers of Left Atrial Stasis in Patients with Nonvalvular Atrial Fibrillation

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