Correlations Between Plasma BNP Level and Risk of Thrombotic-Hemorrhagic Events After Left Atrial Appendage Closure

<b>Background:</b> Percutaneous left atrial appendage closure (LAAC) reduces the incidence of stroke/bleeding events in patients with non-valvular atrial fibrillation, high risk of stroke, and contraindication in continuing anticoagulation therapy. Of them, patients with heart failure may remain at high risk of these events after LAAC. <b>Method:</b> Patients who underwent LAAC and were listed for the multi-center, prospectively collected OCEAN-LAAC registry, were eligible. Of them, individuals without baseline plasma B-type natriuretic peptide (BNP) levels and those dependent on hemodialysis were excluded. The prognostic impact of baseline plasma BNP levels on the incidence of death or stroke/bleeding events after LAAC was evaluated. <b>Results:</b> A total of 937 patients (median 78 years, 596 men) were included. The LAAC device was successfully implanted in 934 (98%) patients. Over the 366 (251, 436) days after the LAAC, 148 patients encountered a primary outcome. The common logarithm of baseline plasma BNP was independently associated with the primary outcome with an adjusted hazard ratio of 1.46 (95% confidence interval 1.06-2.18, <i>p</i> = 0.043). A calculated cutoff of 2.12 (equivalent to 133 pg/mL of plasma BNP level) significantly stratified the cumulative incidence of the primary outcome (29% vs. 21% for 2 years, <i>p</i> = 0.004). <b>Conclusions:</b> Using prospectively collected large-scale multi-center Japanese registry data, we demonstrated that a baseline higher plasma BNP level was independently associated with a higher incidence of stroke/bleeding events and mortality after LAAC. Further studies are warranted to understand the optimal therapeutic strategy for LAAC candidates with elevated baseline plasma BNP levels.

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Journal
Journal of Clinical Medicine
Published
2024-10-18
DOI
https://doi.org/10.3390/jcm13206232
Citations
6
Primary Topic
Atrial Fibrillation Management and Outcomes
Type
article
Field-Weighted Citation Impact
2.41
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article

Correlations Between Plasma BNP Level and Risk of Thrombotic-Hemorrhagic Events After Left Atrial Appendage Closure

Mike Saji, Hiroshi Ueno, Teruhiko Imamura, Masahiko Asami et al.
6 citations
Journal of Clinical Medicine
Atrial Fibrillation Management and Outcomes
2.41
article

Correlations Between Plasma BNP Level and Risk of Thrombotic-Hemorrhagic Events After Left Atrial Appendage Closure

Mike Saji, Hiroshi Ueno, Teruhiko Imamura, Masahiko Asami, Mitsuru Sago, Yohei Ohno, Ryuki Chatani, Naoya Kataoka, Yusuke Watanabe, Tomoyuki Tani, Masanori Yamamoto, Koichiro Kinugawa, Kentaro Hayashida, Masaki Nakashima, Kazuki Mizutani, Hideharu Okamatsu, Daisuke Hachinohe, Masaki Izumo, Toru Naganuma, Shuhei Tanaka, Shunsuke Kubo, Shinichi Shirai, Shingo Mizuno
article en
6 citations

Abstract

<b>Background:</b> Percutaneous left atrial appendage closure (LAAC) reduces the incidence of stroke/bleeding events in patients with non-valvular atrial fibrillation, high risk of stroke, and contraindication in continuing anticoagulation therapy. Of them, patients with heart failure may remain at high risk of these events after LAAC. <b>Method:</b> Patients who underwent LAAC and were listed for the multi-center, prospectively collected OCEAN-LAAC registry, were eligible. Of them, individuals without baseline plasma B-type natriuretic peptide (BNP) levels and those dependent on hemodialysis were excluded. The prognostic impact of baseline plasma BNP levels on the incidence of death or stroke/bleeding events after LAAC was evaluated. <b>Results:</b> A total of 937 patients (median 78 years, 596 men) were included. The LAAC device was successfully implanted in 934 (98%) patients. Over the 366 (251, 436) days after the LAAC, 148 patients encountered a primary outcome. The common logarithm of baseline plasma BNP was independently associated with the primary outcome with an adjusted hazard ratio of 1.46 (95% confidence interval 1.06-2.18, <i>p</i> = 0.043). A calculated cutoff of 2.12 (equivalent to 133 pg/mL of plasma BNP level) significantly stratified the cumulative incidence of the primary outcome (29% vs. 21% for 2 years, <i>p</i> = 0.004). <b>Conclusions:</b> Using prospectively collected large-scale multi-center Japanese registry data, we demonstrated that a baseline higher plasma BNP level was independently associated with a higher incidence of stroke/bleeding events and mortality after LAAC. Further studies are warranted to understand the optimal therapeutic strategy for LAAC candidates with elevated baseline plasma BNP levels.

Journal of Clinical MedicineVol. 13(20)
Tokai University (JP), St. Marianna University School of Medicine (JP), Keio University (JP), Kurashiki Central Hospital (JP), Sapporo Higashi Tokushukai Hospital (JP), New Tokyo Hospital (JP), Saiseikai Kumamoto Hospital (JP), Sapporo Science Center (JP), Toyohashi Heart Center (JP), Sakakibara Hospital (JP), Mitsui Memorial Hospital (JP), Nagoya Heart Center (JP), Shonan Kamakura General Hospital (JP), Gifu Heart Center (JP), Kokura Memorial Hospital (JP), Sendai Kousei Hospital (JP), University of Toyama (JP), Teikyo University (JP), Kindai University (JP), Kumamoto University (JP)
Openalex Percentile: Top 10%
Atrial Fibrillation Management and Outcomes
2.41
DOIOpen Access PDFOpenAlex
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