title: Association between the N-terminal plasma brain natriuretic peptide levels or elevated left ventricular filling pressure and thromboembolic risk in patients with non-valvular atrial fibrillation.
abstract: We aimed to investigate the role of brain natriuretic peptide (BNP) levels and left ventricular (LV) filling pressures in thromboembolic risk in patients with non-valvular atrial fibrillation (AF).
  
  
  
  Among 327 patients with non-valvular AF, the ratio of peak early filling velocity to mitral annulus velocity (E/Ea) and N-terminal proBNP (NT-proBNP) was compared according to the presence of left atrial appendage (LAA) dysfunction [presence of spontaneous echo contrast (SEC)≥grade 3 and/or reduced LAA emptying flow velocity <20cm/s].
  
  
  
  Compared to patients without LAA dysfunction, patients with LAA dysfunction presented with significantly higher CHADS2 scores (1.24±1.14 vs. 1.68±1.31, p=0.005), high-sensitivity C-reactive protein (0.36±1.18mg/dl vs. 0.66±1.32mg/dl, p=0.043), and NT-proBNP (765.3±2534.8pg/ml vs. 2266.9±6117.4pg/ml, p=0.002). Furthermore, patients with LAA dysfunction showed significantly higher left atrial volume index (LAVI, 25.1±10.9 vs. 43.1±22.1, p<0.001) and E/Ea (10.8±7.27 vs. 7.97±2.50mg/dl, p<0.001). Plasma logNT-proBNP levels were significantly correlated with the presence of SEC (r=0.276, p<0.001), LAA emptying flow velocity (r=-0.492, p<0.001), LAVI (r=0.405, p<0.001), and E/Ea (r=0.353, p<0.001). Binary logistic regression analysis showed that high NT-proBNP level >249.7pg/ml (odds ratio, OR 6.79, 95% confidence interval, CI 3.16-15.55, p<0.001) and E/Ea >10 (OR 4.41, 95% CI 2.39-8.15, p<0.001) were independent predictors of LAA dysfunction after adjustment of known thromboembolic risk factors.
  
  
  
  Elevated plasma NT-proBNP concentrations and LV filling pressures represented by LAA dysfunction may be reliable surrogate markers for predicting thromboembolic risk in patients with AF.
authors.affiliation: Division of Cardiology, Department of Internal Medicine, Kosin University College of Medicine, Busan, Republic of Korea.
authors.forename: Ga-In
authors.initials: GI
authors.lastname: Yu
authors.affiliation: Division of Cardiology, Department of Internal Medicine, Kosin University College of Medicine, Busan, Republic of Korea. Electronic address: kyoungim74@gmail.com.
authors.forename: Kyoung-Im
authors.initials: KI
authors.lastname: Cho
authors.affiliation: Division of Cardiology, Department of Internal Medicine, Kosin University College of Medicine, Busan, Republic of Korea.
authors.forename: Hyun-Su
authors.initials: HS
authors.lastname: Kim
authors.affiliation: Division of Cardiology, Department of Internal Medicine, Kosin University College of Medicine, Busan, Republic of Korea.
authors.forename: Jung-Ho
authors.initials: JH
authors.lastname: Heo
authors.affiliation: Division of Cardiology, Department of Internal Medicine, Kosin University College of Medicine, Busan, Republic of Korea.
authors.forename: Tae-Joon
authors.initials: TJ
authors.lastname: Cha
mesh_terms: D000368:Aged; D020517:Atrial Appendage / Q000503:physiopathology; D001281:Atrial Fibrillation / Q000097:blood* / Q000150:complications / Q000503:physiopathology*; D015415:Biomarkers / Q000097:blood; D001783:Blood Flow Velocity; D002097:C-Reactive Protein / Q000032:analysis; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000503:physiopathology; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D016017:Odds Ratio; D010446:Peptide Fragments / Q000097:blood*; D012307:Risk Factors; D012720:Severity of Illness Index; D013318:Stroke Volume; D013923:Thromboembolism / Q000209:etiology*
chemical_list: D015415:Biomarkers; D010446:Peptide Fragments; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain; D002097:C-Reactive Protein
keywords: Atrial fibrillation; Brain natriuretic peptide; Heart failure; Left atrial appendage dysfunction