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Updated: Feb 24, 2026
Echocardiographic Evaluation of Atrial Communications before Transcatheter Closure
Published on: February 8, 2022
Serial Assessment of Natriuretic Peptides in Patients Undergoing Interventional Closure of the Left Atrial Appendage
Blerim Luani1, Thomas Rauwolf1, Thomas Groscheck1
1Department of Internal Medicine, Division of Cardiology and Angiology, Magdeburg University, Magdeburg, Germany.
Insights
Left atrial appendage closure significantly reduced mid-regional pro A-type natriuretic peptide (MR-proANP) levels in specific patient groups, while N-terminal pro B-type natriuretic peptide (NT-proBNP) remained unchanged.
Area of Science:
- Cardiology
- Biomarker Research
- Medical Devices
Background:
- Left atrial appendage (LAA) closure is an alternative to anticoagulation for preventing cardioembolic events in non-valvular atrial fibrillation.
- The LAA's role in natriuretic peptide production suggests LAA closure may impact these hormone levels and their clinical utility.
Purpose of the Study:
- To prospectively evaluate changes in MR-proANP and NT-proBNP levels after interventional LAA closure using the WATCHMAN device.
- To assess the impact of LAA closure on natriuretic peptide levels at 6 weeks and 6 months post-procedure.
Main Methods:
- Prospective study involving 29 patients undergoing successful WATCHMAN device implantation for LAA closure.
- Measurement of MR-proANP and NT-proBNP levels at baseline, 6 weeks, and 6 months post-procedure.
- Analysis of biomarker changes in relation to baseline levels and left ventricular ejection fraction (LVEF).
Main Results:
- MR-proANP levels showed a trend towards decrease post-LAA closure, with significant reductions observed in patients with elevated baseline MR-proANP or reduced LVEF (<45%).
- NT-proBNP levels, along with other parameters like blood pressure and electrolytes, did not change significantly.
- A significant decrease in MR-proANP was noted at 6 weeks and 6 months in subgroups with elevated baseline MR-proANP or reduced LVEF.
Conclusions:
- Interventional LAA closure leads to a significant decrease in MR-proANP levels in specific patient populations (elevated baseline MR-proANP or reduced LVEF).
- NT-proBNP levels remain stable after LAA closure, indicating a potential alteration in the correlation between MR-proANP and NT-proBNP.
- These findings necessitate consideration when interpreting MR-proANP and NT-proBNP for diagnostic and prognostic purposes in patients who have undergone LAA closure.
Background:
Closure of the left atrial appendage (LAA) to prevent cardioembolic events is an alternative therapy to oral anticoagulation in patients with non-valvular atrial fibrillation. The LAA is an important source of natriuretic peptides and its exclusion from the circulation may alter the blood level of these hormones, thereby influencing their diagnostic value and clinical effects.
Methods:
We aimed to prospectively assess potential changes in mid-regional pro A-type natriuretic peptide (MR-proANP) and N-terminal pro B-type natriuretic peptide (NT-proBNP) levels 6 weeks and 6 months after interventional LAA closure using the WATCHMAN device.
Results:
In 29 consecutive patients with successful LAA closure baseline MR-proANP level was 274±208pmol/l and decreased by -24.5±68 (p=0.07) and -15.0±44pmol/l (p=0.10) after 6 weeks and 6 months, respectively. The drop in the MR-proANP level after 6 weeks and 6 months was significant in patients with elevated (≥214pmol/l) baseline MR-proANP level (n=15: -54.3±78.0, p<0.01 and -31.8±45.4pmol/l, p=0.03, respectively) and those with reduced left ventricular ejection fraction (LVEF<45%, n=7: -87.4±97.3, p=0.02 and -60.3±42.6pmol/l, p=0.01, respectively). Baseline NT-proBNP level (median 1054pg/ml; IQR 621-1977pg/ml), sodium, potassium, mean systolic or diastolic blood pressure did not change significantly in the mentioned patient groups.
Conclusions:
After LAA closure, MR-proANP level decreased significantly in patients with elevated baseline MR-proANP level or reduced LVEF, whereas NT-proBNP level remained unchanged, thereby altering the correlation coefficient between the two biomarkers. Our findings should be considered when using these biomarkers for diagnostic or prognostic evaluation in patients with interventional LAA closure.
