title: High plasma human atrial natriuretic peptide and reduced transthoracic left atrial appendage wall-motion velocity are noninvasive surrogate markers for assessing thrombogenesis in patients with paroxysmal atrial fibrillation.
abstract: BACKGROUND
  The clinical relevance of examining human atrial natriuretic peptide (HANP) or left atrial appendage (LAA) wall-motion velocity during sinus rhythm in paroxysmal atrial fibrillation (AF) patients has not been clearly elucidated.
  
  
  METHODS
  The subjects were 38 patients with paroxysmal AF who underwent transesophageal and transthoracic echocardiography during sinus rhythm. The presence of spontaneous echocontrast (SEC) was examined with transesophageal echocardiography and LAA wall-motion velocity (LAAWV) was measured with transthoracic tissue Doppler echocardiography. Plasma HANP was measured within 3 hours after echocardiography.
  
  
  RESULTS
  Human atrial natriuretic peptide ranged from 12 to 106 pg/mL with an average of 43 ± 24 pg/mL and had a significant correlation with LAAWV (r = -0.57) or LAA flow velocity (r = -0.41). HANP was significantly higher in patients with SEC than in patients without SEC (64 ± 29 vs. 34 ± 15 pg/mL, P = 0.008) and LAAWV was significantly lower in patients with SEC than in patients without SEC (13 ± 5 vs. 20 ± 5 cm/sec, P = 0.002). HANP >44 pg/mL had a sensitivity of 73% and specificity of 89% for diagnosing SEC. SEC was more frequently observed (73%) in patients with HANP >44 pg/mL and/or LAAWV <10 cm/sec as compared with patients (11%) with normal HANP and LAA wall-motion velocity (P < 0.0001).
  
  
  CONCLUSIONS
  Higher plasma HANP and lower LAA wall-motion velocity may be noninvasive surrogate markers for assessing left atrial thrombogenesis during sinus rhythm in paroxysmal AF patients.
authors.affiliation: Echocardiography Division, Department of Laboratory Medicine, Hiroshima Prefectural Hospital, Hiroshima, Japan.
authors.forename: Naoyasu
authors.initials: N
authors.lastname: Yoshida
authors.forename: Mitsunori
authors.initials: M
authors.lastname: Okamoto
authors.forename: Hidekazu
authors.initials: H
authors.lastname: Hirao
authors.forename: Kazuyoshi
authors.initials: K
authors.lastname: Suenari
authors.forename: Kiyomi
authors.initials: K
authors.lastname: Nanba
authors.forename: Mio
authors.initials: M
authors.lastname: Uchida
authors.forename: Ryo
authors.initials: R
authors.lastname: Yamazato
authors.forename: Yuichiro
authors.initials: Y
authors.lastname: Watari
authors.forename: Yukihiro
authors.initials: Y
authors.lastname: Fukuda
authors.forename: Hironori
authors.initials: H
authors.lastname: Ueda
mesh_terms: D000368:Aged; D020517:Atrial Appendage / Q000000981:diagnostic imaging*; D001281:Atrial Fibrillation / Q000097:blood* / Q000150:complications / Q000000981:diagnostic imaging*; D009320:Atrial Natriuretic Factor / Q000097:blood*; D015415:Biomarkers / Q000097:blood; D004452:Echocardiography / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D011379:Prognosis; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D013927:Thrombosis / Q000097:blood* / Q000175:diagnosis* / Q000209:etiology
chemical_list: D015415:Biomarkers; D009320:Atrial Natriuretic Factor
keywords: human atrial natriuretic peptide; left atrial thrombosis; paroxysmal atria fibrillation; transthoracic echocardiography