Doukky Rami, Gage Heather, Nagarajan Vijaiganesh, Demopoulos Anna, Cena Marek, Garcia-Sayan Enrique, Karam George J, Kazlauskaite Rasa
Section of Cardiology, Rush University Medical Center, Chicago, Illinois; Department of Medicine, John H. Stroger, Jr., Hospital of Cook County, Chicago, Illinois.
Echocardiography. 2013 Sep;30(8):889-95. doi: 10.1111/echo.12169. Epub 2013 Mar 15.
To investigate whether plasma B-type Natriuretic peptide (BNP), a surrogate of left ventricular filling pressure (LVFP), is predictive of left atrial appendage thrombus (LAAT) in patients with nonvalvular atrial fibrillation (AF) independent of known clinical risk predictors.
We conducted a retrospective cohort study of 297 consecutive subjects with AF who underwent a clinically indicated transesophageal echocardiogram (TEE) to evaluate for LAAT and spontaneous echo contrast (SEC). Among those, 136 had a clinically indicated BNP level. Using multivariate logistic regression analysis models, we determined factors independently predictive of the primary endpoint of LAAT and the secondary endpoint of either LAAT or SEC.
Nineteen subjects (6.4%) had LAAT and they were found to have a higher mean CHADS2 score (2.53 vs 1.76, P = 0.01) and mean BNP level [1949 vs. 819 pg/mL, P = 0.001] than those without LAAT. None of the patients with a BNP level ≤500 pg/mL had LAAT. Multivariate logistic regression analysis demonstrated that BNP was predictive of LAAT and the composite of LAAT/SEC independent of the CHADS2 score and warfarin therapy [OR = 1.23 and 1.6 per 500 pg/mL increment in BNP, P-values = 0.03 and 0.001; respectively]. Moreover, adding BNP to the predictive model negated the influence of the CHADS2 score.
These data indicate that BNP is an independent predictor of LAAT in AF and may complement the role of the CHADS2 score in predicting stroke risk.
研究作为左心室充盈压（LVFP）替代指标的血浆B型利钠肽（BNP）是否能独立于已知临床风险预测因素，预测非瓣膜性心房颤动（AF）患者的左心耳血栓（LAAT）。
我们对297例连续的AF患者进行了一项回顾性队列研究，这些患者接受了临床指示的经食管超声心动图（TEE）检查，以评估LAAT和自发回声增强（SEC）。其中，136例患者有临床指示的BNP水平。使用多变量逻辑回归分析模型，我们确定了独立预测LAAT主要终点以及LAAT或SEC次要终点的因素。
19例患者（6.4%）有LAAT，发现他们的平均CHADS2评分（2.53对1.76，P = 0.01）和平均BNP水平[1949对819 pg/mL，P = 0.001]高于无LAAT的患者。BNP水平≤500 pg/mL的患者均无LAAT。多变量逻辑回归分析表明，BNP可独立于CHADS2评分和华法林治疗预测LAAT以及LAAT/SEC的复合终点[BNP每增加500 pg/mL，OR分别为1.23和1.6，P值分别为0.03和0.001]。此外，将BNP添加到预测模型中可消除CHADS2评分的影响。
这些数据表明，BNP是AF患者LAAT的独立预测因素，可能补充CHADS2评分在预测中风风险中的作用。
