Imamura Teruhiko, Kataoka Naoya, Tanaka Shuhei, Ueno Hiroshi, Kinugawa Koichiro, Nakashima Masaki, Yamamoto Masanori, Sago Mitsuru, Chatani Ryuki, Asami Masahiko, Hachinohe Daisuke, Naganuma Toru, Ohno Yohei, Tani Tomoyuki, Okamatsu Hideharu, Mizutani Kazuki, Watanabe Yusuke, Izumo Masaki, Saji Mike, Mizuno Shingo, Kubo Shunsuke, Shirai Shinichi, Hayashida Kentaro
Second Department of Internal Medicine, University of Toyama, Toyama 930-0194, Japan.
Department of Cardiology, Sendai Kousei Hospital, Sendai 980-0873, Japan.
J Clin Med. 2024 Oct 18;13(20):6232. doi: 10.3390/jcm13206232.
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. 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. 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, = 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, = 0.004). 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.
经皮左心耳封堵术（LAAC）可降低非瓣膜性心房颤动、卒中高危且持续抗凝治疗存在禁忌证患者的卒中/出血事件发生率。其中，心力衰竭患者在LAAC术后可能仍处于这些事件的高风险状态。纳入多中心前瞻性收集的OCEAN-LAAC注册研究中的LAAC患者符合条件。其中，排除无基线血浆B型利钠肽（BNP）水平的个体以及依赖血液透析的个体。评估基线血浆BNP水平对LAAC术后死亡或卒中/出血事件发生率的预后影响。共纳入937例患者（中位年龄78岁，男性596例）。934例（98%）患者成功植入LAAC装置。在LAAC术后的366（251，436）天内，148例患者发生主要结局。基线血浆BNP的常用对数与主要结局独立相关，调整后风险比为1.46（95%置信区间1.06 - 2.18，P = 0.043）。计算得出的截断值2.12（相当于血浆BNP水平133 pg/mL）显著分层了主要结局的累积发生率（2年时分别为29%和21%，P = 0.004）。利用前瞻性收集的大规模多中心日本注册研究数据，我们证明基线血浆BNP水平较高与LAAC术后卒中/出血事件及死亡率较高独立相关。有必要进一步开展研究以了解基线血浆BNP水平升高的LAAC候选患者的最佳治疗策略。
