title: Addition of B-Type Natriuretic Peptide to Existing Clinical Risk Scores Enhances Identification of Patients at Risk for Atrial Fibrillation Recurrence After Pulmonary Vein Isolation.
abstract: BACKGROUND
  Predicting which patients will be free from atrial fibrillation (AF) after pulmonary vein isolation (PVI) remains challenging. Clinical risk prediction scores show modest ability to identify patients at risk for AF recurrence after PVI. B-type natriuretic peptide (BNP) is associated with risk for incident and recurrent AF but is not currently included in existing AF risk scores. We sought to evaluate the incremental benefit of adding preoperative BNP to existing risk scores for predicting AF recurrence during the 6 months after PVI.
  
  
  METHODS
  One hundred sixty-one patients with paroxysmal or persistent AF underwent an index PVI procedure between 2010 and 2013; 77 patients (48%) had late AF recurrence after PVI (>3 months post-PVI) over the 6-month follow-up period.
  
  
  RESULTS
  A BNP greater than or equal to 100 pg/dL (P=0.01) and AF recurrence within 3 months after PVI (P<0.001) were associated with late AF recurrence in multivariate analyses. Addition of BNP to existing clinical risk scores significantly improved the areas under the curve for each score, with an integrated discrimination improvement of 0.08 (P=0.001) and a net reclassification improvement of 60% (P=0.001) for all risk scores.
  
  
  CONCLUSIONS
  Circulating BNP levels are independently associated with late AF recurrence after PVI. Inclusion of BNP significantly improves the discriminative ability of CHADS2, CHA2DS2-VASc, R2CHADS2, and the HATCH score in predicting clinically significant, late AF recurrence after PVI and should be incorporated in decision-making algorithms for management of AF. B-R2CHADS2 is the best score model for prediction of late AF recurrence.
authors.affiliation: From the *Department of Medicine, University of Massachusetts Medical School, Worcester, MA; †Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA; ‡Department of Medicine, Rutgers New Jersey Medical School, Newark, NJ; §Division of Cardiology and Electrophysiology, University of Massachusetts Medical School, Worcester, MA; and ¶Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA.
authors.forename: Amir Y
authors.initials: AY
authors.lastname: Shaikh
authors.forename: Nada
authors.initials: N
authors.lastname: Esa
authors.forename: William
authors.initials: W
authors.lastname: Martin-Doyle
authors.forename: Menhel
authors.initials: M
authors.lastname: Kinno
authors.forename: Iryna
authors.initials: I
authors.lastname: Nieto
authors.forename: Kevin C
authors.initials: KC
authors.lastname: Floyd
authors.forename: Clifford
authors.initials: C
authors.lastname: Browning
authors.forename: Cynthia
authors.initials: C
authors.lastname: Ennis
authors.forename: J Kevin
authors.initials: JK
authors.lastname: Donahue
authors.forename: Lawrence S
authors.initials: LS
authors.lastname: Rosenthal
authors.forename: David D
authors.initials: DD
authors.lastname: McManus
mesh_terms: D000328:Adult; D000368:Aged; D001281:Atrial Fibrillation / Q000097:blood / Q000601:surgery*; D017115:Catheter Ablation / Q000379:methods; D015331:Cohort Studies; D003452:Cryosurgery / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D057234:Preoperative Period; D011379:Prognosis; D011667:Pulmonary Veins / Q000601:surgery*; D012008:Recurrence; D018570:Risk Assessment; D016896:Treatment Outcome
chemical_list: D020097:Natriuretic Peptide, Brain