Utility of brain natriuretic peptide as a predictor of atrial fibrillation after cardiac operations.
BACKGROUND
Atrial fibrillation (AF) occurs frequently after coronary bypass grafting and valve operations. Brain natriuretic peptide (BNP) has been shown to predict recurrence of AF in congestive heart failure. It is a potential biomarker for preoperative risk stratification for development of AF in at-risk patients.


METHODS
A total of 398 consecutive patients were prospectively evaluated for new-onset AF after heart operations. Patients with a history of AF and presence of permanent pacemaker were excluded. BNP levels were measured before and immediately after the operation.


RESULTS
AF occurred in 20%. AF was more likely to develop in patients who were older, who underwent valve operations, had a lower ejection fraction, and a larger left atrial size. Preoperative exposure to statins (62% vs 43%, p < 0.01) and angiotensin inhibitors (60% vs 45%, p = 0.02) was more common in patients without AF. BNP values were insignificantly higher preoperatively (361 vs 302 mg/dL, p = 0.3) and postoperatively (312 vs. 229 mg/dL, p = 0.15) in patients with AF. Multivariate logistic analysis showed that older age (odds ratio [OR], 3.1, 95% confidence interval [CI], 1.7 to 5.6), lower ejection fraction (OR, 2.0; 95% CI, 1.2 to 3.3), larger left atrial size (OR, 3.1; 95% CI, 1.9 to 4.9), and nonuse of angiotensin inhibitors (OR, 2.3; 95% CI, 1.1 to 4.8) were independently associated with AF.


CONCLUSIONS
This study does not support use of BNP for prediction of AF. Age, low ejection fraction, large left atrial size, and nonuse of angiotensin blocking agents were found to be significant predictors of AF development.
Tavakol
Morteza
M
Division of Cardiology, Department of Medicine, New York Methodist Hospital, Brooklyn, New York 11215, USA. motavakol@yahoo.com
Hassan
Kashif Z
KZ
Abdula
Raushan K
RK
Briggs
William
W
Oribabor
Charles E
CE
Tortolani
Anthony J
AJ
Sacchi
Terrence J
TJ
Lee
Leonard Y
LY
Heitner
John F
JF
D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D001281:Atrial Fibrillation / Q000097:blood* / Q000175:diagnosis; D002303:Cardiac Output, Low / Q000097:blood / Q000150:complications; D015897:Comorbidity; D001026:Coronary Artery Bypass; D003327:Coronary Disease / Q000097:blood / Q000601:surgery*; D005260:Female; D019918:Heart Valve Prosthesis Implantation; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D016017:Odds Ratio; D011183:Postoperative Complications / Q000097:blood* / Q000175:diagnosis; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors
D000806:Angiotensin-Converting Enzyme Inhibitors; D020097:Natriuretic Peptide, Brain