Plasma B-type natriuretic peptide levels predict postoperative atrial fibrillation in patients undergoing cardiac surgery.
BACKGROUND
Postoperative (postop) atrial fibrillation (AF) occurs in up to 60% of patients after cardiac surgery, leading to longer hospital stays and increased healthcare costs. Recently, B-type natriuretic peptide (BNP) has been reported to predict occurrence of nonpostoperative AF. This study evaluates whether elevated preoperative (preop) plasma BNP levels predict the occurrence of postop AF.


RESULTS
One hundred eighty-seven patients with no history of atrial arrhythmia who had a preoperative BNP level and had undergone cardiac surgery were identified. Their records were reviewed, and postoperative ECG and telemetry strips were analyzed for AF until the time of discharge. Postop AF was documented in 80 patients (42.8%). AF patients were older (68+/-11 versus 64+/-14 years, P=0.04), but there was no difference in sex distribution, hypertension, left ventricular (LV) function, LV hypertrophy (LVH), left atrial size, history of coronary artery disease (CAD), or beta-blocker use. Preop plasma BNP levels were higher in the postop AF patients (615 versus 444 pg/mL, P=0.005). After adjustment for age, sex, type of surgery, hypertension, LV function, LVH, left atrial size, CAD, and beta-blocker use, the odds ratios of postop AF according to increasing quartiles, compared with patients with lowest quartile, were 1.8, 2.5, and 3.7 (P(trend)=0.03).


CONCLUSIONS
An elevated preop plasma BNP level is a strong and independent predictor of postop AF. This finding has important implications for identifying patients at higher risk of postop AF who could be considered for prophylactic antiarrhythmic or beta-blocker therapy.
Wazni
Oussama M
OM
Center for Atrial Fibrillation, The Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA.
Martin
David O
DO
Marrouche
Nassir F
NF
Latif
Ahmed Abdel
AA
Ziada
Khaled
K
Shaaraoui
Mustaphasahim
M
Almahameed
Soufian
S
Schweikert
Robert A
RA
Saliba
Walid I
WI
Gillinov
A Marc
AM
Tang
W H Wilson
WH
Mills
Roger M
RM
Francis
Gary S
GS
Young
James B
JB
Natale
Andrea
A
D000368:Aged; D001281:Atrial Fibrillation / Q000097:blood*; D015415:Biomarkers; D006348:Cardiac Surgical Procedures; D004562:Electrocardiography; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D011183:Postoperative Complications / Q000097:blood*; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D013686:Telemetry
D015415:Biomarkers; D020097:Natriuretic Peptide, Brain