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Published in: Journal of Echocardiography 2/2018

01-06-2018 | Original Investigation

Correlation between plasma brain natriuretic peptide levels and left atrial appendage flow velocity in patients with non-valvular atrial fibrillation and normal left ventricular systolic function

Authors: Masahiko Harada, Satoshi Tabako, Yuichiro Fujii, Yuichi Takarada, Kyoko Hayashi, Hiroshi Ohara, Fumihiko Hara, Takanori Ikeda

Published in: Journal of Echocardiography | Issue 2/2018

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Abstract

Background

The left atrial appendage (LAA) flow velocity is an important factor for thrombus formation in patients with non-valvular atrial fibrillation (NV-AF). Recently, the relation of plasma brain natriuretic peptide (BNP) levels and thromboembolism has been reported in patients with NV-AF. The aim of this study was to determine whether the plasma BNP is predictive of lower LAA flow velocity in patients with NV-AF and normal left ventricular (LV) systolic function.

Methods and results

A total of 184 patients with NV-AF (132 men; 65 ± 12 years, LV ejection fraction; 65 ± 10%) underwent transthoracic echocardiography, transesophageal echocardiography (TEE), and measurement of plasma BNP. The LAA flow velocity was obtained by pulsed Doppler TEE. Multivariate logistic regression analysis demonstrated that plasma BNP levels, left atrial volume index (LAVI), LV mass index (LVMI), and the CHADS2 score were independent predictors of lower LAA flow velocity (< 20 cm/s). Plasma BNP levels (r = − 0.58, p < 0.001) were correlated with LAA flow velocity. The area under the curve (AUC) for BNP (AUC 0.803) was larger than that for the CHADS2 score (AUC 0.712), LAVI (AUC 0.664) and LVMI (AUC 0.608) with an optimal BNP cut-off value of 164 pg/ml (sensitivity 75.7%, specificity 71.1%).

Conclusions

This study showed that a higher plasma BNP was associated with a lower LAA flow velocity in patients with NV-AF and normal LV systolic function. The plasma BNP may complement the role of the CHADS2 score in predicting lower LAA flow velocity.
Literature
1.
go back to reference Archer SL, James KE, Kvernen LR, et al. Role of transesophageal echocardiography in the detection of left atrial thrombus in patients with chronic nonrheumatic atrial fibrillation. Am Heart J. 1995;130:287–95.CrossRefPubMed Archer SL, James KE, Kvernen LR, et al. Role of transesophageal echocardiography in the detection of left atrial thrombus in patients with chronic nonrheumatic atrial fibrillation. Am Heart J. 1995;130:287–95.CrossRefPubMed
2.
go back to reference Handke M, Harloff A, Hetzel A, et al. Left atrial appendage flow velocity as a quantitative surrogate parameter for thromboembolic risk: determinants and relationship to spontaneous echocontrast and thrombus formation—a transesophageal echocardiographic study in 500 patients with cerebral ischemia. J Am Soc Echocardiogr. 2005;18:1366–72.CrossRefPubMed Handke M, Harloff A, Hetzel A, et al. Left atrial appendage flow velocity as a quantitative surrogate parameter for thromboembolic risk: determinants and relationship to spontaneous echocontrast and thrombus formation—a transesophageal echocardiographic study in 500 patients with cerebral ischemia. J Am Soc Echocardiogr. 2005;18:1366–72.CrossRefPubMed
3.
go back to reference Igarashi Y, Kashimura K, Makiyama Y, et al. Left atrial appendage dysfunction in chronic nonvalvular atrial fibrillation in significantly associated with an elevated level of brain natriuretic peptide and a prothrombotic state. Jpn Circ J. 2001;65:788–92.CrossRefPubMed Igarashi Y, Kashimura K, Makiyama Y, et al. Left atrial appendage dysfunction in chronic nonvalvular atrial fibrillation in significantly associated with an elevated level of brain natriuretic peptide and a prothrombotic state. Jpn Circ J. 2001;65:788–92.CrossRefPubMed
4.
go back to reference Shimizu H, Murakami Y, Inoue S, et al. High plasma brain natriuretic polypeptide level as a marker of risk for thromboembolism in patients with nonvalvular atrial fibrillation. Stroke. 2002;33:1005–10.CrossRefPubMed Shimizu H, Murakami Y, Inoue S, et al. High plasma brain natriuretic polypeptide level as a marker of risk for thromboembolism in patients with nonvalvular atrial fibrillation. Stroke. 2002;33:1005–10.CrossRefPubMed
5.
go back to reference Watanabe D, Shizuka K, Koyama S, et al. Plasma brain natriuretic levels indicating thromboembolism in very elderly patients with non-valvular atrial fibrillation. Circ J. 2007;71:1446–51.CrossRefPubMed Watanabe D, Shizuka K, Koyama S, et al. Plasma brain natriuretic levels indicating thromboembolism in very elderly patients with non-valvular atrial fibrillation. Circ J. 2007;71:1446–51.CrossRefPubMed
6.
go back to reference Tamura H, Watanabe T, Nishiyama S, et al. Elevated plasma brain natriuretic peptide levels predict left atrial appendage dysfunction in patients with acute ischemic stroke. J Cardiol. 2012;60:126–32.CrossRefPubMed Tamura H, Watanabe T, Nishiyama S, et al. Elevated plasma brain natriuretic peptide levels predict left atrial appendage dysfunction in patients with acute ischemic stroke. J Cardiol. 2012;60:126–32.CrossRefPubMed
7.
go back to reference Doukky R, Gage H, Nagarajan V, et al. B-type natriuretic peptide predicts left atrial appendage thrombus in patients with nonvalvular atrial fibrillation. Echocardiography. 2013;30:889–95.CrossRefPubMed Doukky R, Gage H, Nagarajan V, et al. B-type natriuretic peptide predicts left atrial appendage thrombus in patients with nonvalvular atrial fibrillation. Echocardiography. 2013;30:889–95.CrossRefPubMed
8.
go back to reference Mügge A, Kühn H, Nikutta P, et al. Assessment of left atrial appendage function by biplane transesophageal echocardiography in patients with nonrheumatic atrial fibrillation: identification of a subgroup of patients at increased embolic risk. J Am Coll Cardiol. 1994;23:599–607.CrossRefPubMed Mügge A, Kühn H, Nikutta P, et al. Assessment of left atrial appendage function by biplane transesophageal echocardiography in patients with nonrheumatic atrial fibrillation: identification of a subgroup of patients at increased embolic risk. J Am Coll Cardiol. 1994;23:599–607.CrossRefPubMed
9.
go back to reference Rietbrock S, Heeley E, Plumb J, et al. Chronic atrial fibrillation: incidence, prevalence, and prediction of stroke using the congestive heart failure, hypertension, age > 75, diabetes mellitus, and prior stroke or transient ischemic attack (CHADS2) risk stratification scheme. Am Heart J. 2008;156:57–64.CrossRefPubMed Rietbrock S, Heeley E, Plumb J, et al. Chronic atrial fibrillation: incidence, prevalence, and prediction of stroke using the congestive heart failure, hypertension, age > 75, diabetes mellitus, and prior stroke or transient ischemic attack (CHADS2) risk stratification scheme. Am Heart J. 2008;156:57–64.CrossRefPubMed
10.
go back to reference Gage BF, Waterman AD, Shannon W, et al. Validation of clinical classification schemes for predicting stroke: results from the National Registry of Atrial Fibrillation. JAMA. 2001;285:2864–70.CrossRefPubMed Gage BF, Waterman AD, Shannon W, et al. Validation of clinical classification schemes for predicting stroke: results from the National Registry of Atrial Fibrillation. JAMA. 2001;285:2864–70.CrossRefPubMed
11.
go back to reference Lester SJ, Ryan EW, Schiller NB, et al. Best method in clinical practice and in research studies to determine left atrial size. Am J Cardiol. 1999;84:829–32.CrossRefPubMed Lester SJ, Ryan EW, Schiller NB, et al. Best method in clinical practice and in research studies to determine left atrial size. Am J Cardiol. 1999;84:829–32.CrossRefPubMed
12.
go back to reference Devereux RB, Reicheck N. Echocardiographic determination of left ventricular mass in man: anatomic validation of the method. Circulation. 1977;55:613–8.CrossRefPubMed Devereux RB, Reicheck N. Echocardiographic determination of left ventricular mass in man: anatomic validation of the method. Circulation. 1977;55:613–8.CrossRefPubMed
13.
go back to reference Fatkin D, Herbert E, Feneley MP. Hematologic correlates of spontaneous echo contrast in patients with atrial fibrillation and implications for thromboembolic risk. Am J Cardiol. 1994;73:672–6.CrossRefPubMed Fatkin D, Herbert E, Feneley MP. Hematologic correlates of spontaneous echo contrast in patients with atrial fibrillation and implications for thromboembolic risk. Am J Cardiol. 1994;73:672–6.CrossRefPubMed
14.
go back to reference The Stroke Prevention in Atrial Fibrillation Investigators Committee on Echocardiography. Transesophageal echocardiographic correlates of thromboembolism in high-risk patients with nonvalvular atrial fibrillation. Ann Intern Med. 1998;128:639–47.CrossRef The Stroke Prevention in Atrial Fibrillation Investigators Committee on Echocardiography. Transesophageal echocardiographic correlates of thromboembolism in high-risk patients with nonvalvular atrial fibrillation. Ann Intern Med. 1998;128:639–47.CrossRef
15.
go back to reference García-Fernández MA, Torrecilla EG, San Román D, et al. Left atrial appendage Doppler flow patterns: implications on thrombus formation. Am Heart J. 1992;124:955–61.CrossRefPubMed García-Fernández MA, Torrecilla EG, San Román D, et al. Left atrial appendage Doppler flow patterns: implications on thrombus formation. Am Heart J. 1992;124:955–61.CrossRefPubMed
16.
go back to reference Santiago D, Warshofsky M, Li Mandri G, et al. Left atrial appendage function and thrombus formation in atrial fibrillation-flutter: a transesophageal echocardiographic study. J Am Coll Cardiol. 1994;24:159–64.CrossRefPubMed Santiago D, Warshofsky M, Li Mandri G, et al. Left atrial appendage function and thrombus formation in atrial fibrillation-flutter: a transesophageal echocardiographic study. J Am Coll Cardiol. 1994;24:159–64.CrossRefPubMed
17.
go back to reference Li YH, Lai LP, Shyu KG, et al. Clinical implications of left atrial appendage flow patterns in nonrheumatic atrial fibrillation. Chest. 1994;105:748–52.CrossRefPubMed Li YH, Lai LP, Shyu KG, et al. Clinical implications of left atrial appendage flow patterns in nonrheumatic atrial fibrillation. Chest. 1994;105:748–52.CrossRefPubMed
18.
go back to reference Donal E, Yamada H. The left atrial appendage, a small, blind-ended structure. A review of its echocardiographic evaluation and its clinical role. Chest. 2005;128:1853–62.CrossRefPubMed Donal E, Yamada H. The left atrial appendage, a small, blind-ended structure. A review of its echocardiographic evaluation and its clinical role. Chest. 2005;128:1853–62.CrossRefPubMed
19.
go back to reference Noda T, Arakawa M, Miwa H, et al. Effects of heart rate on flow velocity of the left atrial appendage in patients with nonvalvular atrial fibrillation. Clin Cardiol. 1996;19:295–300.CrossRefPubMed Noda T, Arakawa M, Miwa H, et al. Effects of heart rate on flow velocity of the left atrial appendage in patients with nonvalvular atrial fibrillation. Clin Cardiol. 1996;19:295–300.CrossRefPubMed
20.
go back to reference Iwama M, Kawasaki M, Tanaka R, et al. Left atrial appendage emptying fraction assessed by a feature-tracking echocardiographic method is a determinant of thrombus in patients with nonvalvular atrial fibrillation. J Cardiol. 2012;59:329–36.CrossRefPubMed Iwama M, Kawasaki M, Tanaka R, et al. Left atrial appendage emptying fraction assessed by a feature-tracking echocardiographic method is a determinant of thrombus in patients with nonvalvular atrial fibrillation. J Cardiol. 2012;59:329–36.CrossRefPubMed
22.
go back to reference Panagiotopoulos K, Toumanidis S, Saridakis N, et al. Left atrial and left atrial appendage functional abnormalities in patients with cardioembolic stroke in sinus rhythm and idiopathic atrial fibrillation. J Am Soc Echocardiogr. 1998;11:711–9.CrossRefPubMed Panagiotopoulos K, Toumanidis S, Saridakis N, et al. Left atrial and left atrial appendage functional abnormalities in patients with cardioembolic stroke in sinus rhythm and idiopathic atrial fibrillation. J Am Soc Echocardiogr. 1998;11:711–9.CrossRefPubMed
24.
go back to reference Falk RH. Etiology and complications of atrial fibrillation: insights from pathology studies. Am J Cardiol. 1998;82:10N–7N.CrossRefPubMed Falk RH. Etiology and complications of atrial fibrillation: insights from pathology studies. Am J Cardiol. 1998;82:10N–7N.CrossRefPubMed
25.
go back to reference Agmon Y, Khandheria BK, Meissner I, et al. Are left atrial appendage flow velocities adequate surrogates of global left atrial function? A population-based transthoracic and transesophageal echocardiographic study. J Am Soc Echocardiogr. 2002;15:433–40.CrossRefPubMed Agmon Y, Khandheria BK, Meissner I, et al. Are left atrial appendage flow velocities adequate surrogates of global left atrial function? A population-based transthoracic and transesophageal echocardiographic study. J Am Soc Echocardiogr. 2002;15:433–40.CrossRefPubMed
26.
go back to reference Beigel R, Wunderlich NC, Ho SY, et al. The left atrial appendage: anatomy, function, and noninvasive evaluation. J Am Coll Cardiol Imaging. 2014;7:1251–65.CrossRef Beigel R, Wunderlich NC, Ho SY, et al. The left atrial appendage: anatomy, function, and noninvasive evaluation. J Am Coll Cardiol Imaging. 2014;7:1251–65.CrossRef
27.
go back to reference Tsang TSM, Gersh BJ, Appleton CP, et al. Left ventricular diastolic dysfunction as a predictor of the first diagnosed nonvalvular atrial fibrillation in 840 elderly men and women. J Am Coll Cardiol. 2002;40:1636–44.CrossRefPubMed Tsang TSM, Gersh BJ, Appleton CP, et al. Left ventricular diastolic dysfunction as a predictor of the first diagnosed nonvalvular atrial fibrillation in 840 elderly men and women. J Am Coll Cardiol. 2002;40:1636–44.CrossRefPubMed
28.
go back to reference Tabata T, Oki T, Fukuda N, et al. Influence of left atrial pressure on left atrial appendage flow velocity patterns in patients in sinus rhythm. J Am Soc Echocardiogr. 1996;9:857–64.CrossRefPubMed Tabata T, Oki T, Fukuda N, et al. Influence of left atrial pressure on left atrial appendage flow velocity patterns in patients in sinus rhythm. J Am Soc Echocardiogr. 1996;9:857–64.CrossRefPubMed
29.
go back to reference Lin JM, Hsu KL, Hwang JJ, et al. Influence of left ventricular diastole on left atrial appendage blood flow in patients with nonrheumatic atrial fibrillation. Cardiology. 1997;88:563–8.CrossRefPubMed Lin JM, Hsu KL, Hwang JJ, et al. Influence of left ventricular diastole on left atrial appendage blood flow in patients with nonrheumatic atrial fibrillation. Cardiology. 1997;88:563–8.CrossRefPubMed
30.
go back to reference Moon J, Rim SJ, Cho IJ, et al. Left ventricular hypertrophy determines the severity of diastolic dysfunction in patients with nonvalvular atrial fibrillation and preserved left ventricular systolic function. Clin Exp Hypertens. 2010;32:540–6.CrossRefPubMed Moon J, Rim SJ, Cho IJ, et al. Left ventricular hypertrophy determines the severity of diastolic dysfunction in patients with nonvalvular atrial fibrillation and preserved left ventricular systolic function. Clin Exp Hypertens. 2010;32:540–6.CrossRefPubMed
31.
go back to reference Silvet H, Young-Xu Y, Walleigh D, et al. Brain natriuretic peptide is elevated in outpatients with atrial fibrillation. Am J Cardiol. 2003;92:1124–7.CrossRefPubMed Silvet H, Young-Xu Y, Walleigh D, et al. Brain natriuretic peptide is elevated in outpatients with atrial fibrillation. Am J Cardiol. 2003;92:1124–7.CrossRefPubMed
32.
go back to reference Inoue S, Murakami Y, Sano K, et al. Atrium as a source of brain natriuretic polypeptide in patients with atrial fibrillation. J Card Fail. 2000;6:92–6.CrossRefPubMed Inoue S, Murakami Y, Sano K, et al. Atrium as a source of brain natriuretic polypeptide in patients with atrial fibrillation. J Card Fail. 2000;6:92–6.CrossRefPubMed
33.
go back to reference Ohta Y, Shimada T, Yoshitomi H, et al. Drop on plasma brain natriuretic peptide levels after successful direct current cardioversion in chronic atrial fibrillation. Can J Cardiol. 2001;17:415–20.PubMed Ohta Y, Shimada T, Yoshitomi H, et al. Drop on plasma brain natriuretic peptide levels after successful direct current cardioversion in chronic atrial fibrillation. Can J Cardiol. 2001;17:415–20.PubMed
34.
go back to reference Lee SH, Jung JH, Choi SH, et al. Determinants of brain natriuretic peptide levels in patients with lone atrial fibrillation. Circ J. 2006;70:100–4.CrossRefPubMed Lee SH, Jung JH, Choi SH, et al. Determinants of brain natriuretic peptide levels in patients with lone atrial fibrillation. Circ J. 2006;70:100–4.CrossRefPubMed
35.
go back to reference Sadanaga T, Kohsaka S, Mitamura H, et al. Elevated B-type natriuretic peptide level as a marker of subsequent thromboembolic events in patients with atrial fibrillation. Heart Vessels. 2011;26:530–5.CrossRefPubMed Sadanaga T, Kohsaka S, Mitamura H, et al. Elevated B-type natriuretic peptide level as a marker of subsequent thromboembolic events in patients with atrial fibrillation. Heart Vessels. 2011;26:530–5.CrossRefPubMed
36.
go back to reference Sakai K, Shibazaki K, Kimura K, et al. Brain natriuretic peptide as a predictor of cardioembolism in acute ischemic stroke patients: brain natriuretic peptide stroke prospective study. Eur Neurol. 2013;69:246–51.CrossRefPubMed Sakai K, Shibazaki K, Kimura K, et al. Brain natriuretic peptide as a predictor of cardioembolism in acute ischemic stroke patients: brain natriuretic peptide stroke prospective study. Eur Neurol. 2013;69:246–51.CrossRefPubMed
37.
go back to reference Okada Y, Shibazaki K, Kimura K, et al. Brain natriuretic peptide is a marker associated with thrombus in stroke patients with atrial fibrillation. J Neurol Sci. 2011;301:86–9.CrossRefPubMed Okada Y, Shibazaki K, Kimura K, et al. Brain natriuretic peptide is a marker associated with thrombus in stroke patients with atrial fibrillation. J Neurol Sci. 2011;301:86–9.CrossRefPubMed
38.
go back to reference Ayirala S, Kumar S, O’Sullivan DM, et al. Echocardiographic predictors of left atrial appendage thrombus formation. J Am Soc Echocardiogr. 2011;24:499–505.CrossRefPubMed Ayirala S, Kumar S, O’Sullivan DM, et al. Echocardiographic predictors of left atrial appendage thrombus formation. J Am Soc Echocardiogr. 2011;24:499–505.CrossRefPubMed
39.
go back to reference Kim MN, Kim SA, Choi JI, et al. Improvement of predictive value for thromboembolic risk by Incorporating left atrial functional parameters in the CHADS2 and CHA2DS2-VAScs scores. Int Heart J. 2015;56:286–92.CrossRefPubMed Kim MN, Kim SA, Choi JI, et al. Improvement of predictive value for thromboembolic risk by Incorporating left atrial functional parameters in the CHADS2 and CHA2DS2-VAScs scores. Int Heart J. 2015;56:286–92.CrossRefPubMed
40.
go back to reference Veinot JP, Harrity PJ, Gentile F, et al. Anatomy of the normal left atrial appendage: a quantitative study of age-related changes in 500 autopsy hearts—implications for echocardiographic examination. Circulation. 1997;96:3112–5.CrossRefPubMed Veinot JP, Harrity PJ, Gentile F, et al. Anatomy of the normal left atrial appendage: a quantitative study of age-related changes in 500 autopsy hearts—implications for echocardiographic examination. Circulation. 1997;96:3112–5.CrossRefPubMed
41.
go back to reference Bilge M, Guler N, Eryonucu B, et al. Does acute-phase beta blockade reduce left atrial appendage function in patients with chronic nonvalvular atrial fibrillation? J Am Soc Echocardiogr. 2001;14:194–9.CrossRefPubMed Bilge M, Guler N, Eryonucu B, et al. Does acute-phase beta blockade reduce left atrial appendage function in patients with chronic nonvalvular atrial fibrillation? J Am Soc Echocardiogr. 2001;14:194–9.CrossRefPubMed
42.
go back to reference Daoud EG, Marcovitz P, Knight BP, et al. Short-term effect of atrial fibrillation on atrial contractile function in humans. Circulation. 1999;99:3024–7.CrossRefPubMed Daoud EG, Marcovitz P, Knight BP, et al. Short-term effect of atrial fibrillation on atrial contractile function in humans. Circulation. 1999;99:3024–7.CrossRefPubMed
43.
go back to reference Tsai LM, Chen JH, Lin LJ, et al. Natural history of left atrial spontaneous echo contrast in nonrheumatic atrial fibrillation. Am J Cardiol. 1997;80:897–900.CrossRefPubMed Tsai LM, Chen JH, Lin LJ, et al. Natural history of left atrial spontaneous echo contrast in nonrheumatic atrial fibrillation. Am J Cardiol. 1997;80:897–900.CrossRefPubMed
44.
go back to reference Ansari A, Maron BJ. Spontaneous echo contrast and thromboembolism. Hosp Pract. 1997;32:109–11.CrossRef Ansari A, Maron BJ. Spontaneous echo contrast and thromboembolism. Hosp Pract. 1997;32:109–11.CrossRef
Metadata
Title
Correlation between plasma brain natriuretic peptide levels and left atrial appendage flow velocity in patients with non-valvular atrial fibrillation and normal left ventricular systolic function
Authors
Masahiko Harada
Satoshi Tabako
Yuichiro Fujii
Yuichi Takarada
Kyoko Hayashi
Hiroshi Ohara
Fumihiko Hara
Takanori Ikeda
Publication date
01-06-2018
Publisher
Springer Japan
Published in
Journal of Echocardiography / Issue 2/2018
Print ISSN: 1349-0222
Electronic ISSN: 1880-344X
DOI
https://doi.org/10.1007/s12574-017-0362-4

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