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Updated: Jun 9, 2025
Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation
Published on: February 26, 2013
Correlations Between Plasma BNP Level and Risk of Thrombotic-Hemorrhagic Events After Left Atrial Appendage Closure
Teruhiko Imamura1, Naoya Kataoka1, Shuhei Tanaka1
1Second Department of Internal Medicine, University of Toyama, Toyama 930-0194, Japan.
Insights
Higher baseline B-type natriuretic peptide (BNP) levels in patients undergoing left atrial appendage closure (LAAC) are linked to increased risks of stroke, bleeding, and death. This finding highlights BNP as a key prognostic marker post-LAAC.
Area of Science:
- Cardiology
- Interventional Cardiology
- Biomarkers in Cardiovascular Disease
Background:
- Percutaneous left atrial appendage closure (LAAC) is used for patients with non-valvular atrial fibrillation at high stroke risk and contraindications to anticoagulation.
- Patients with heart failure undergoing LAAC may still face significant risks of stroke and bleeding events.
- Baseline plasma B-type natriuretic peptide (BNP) levels may offer prognostic insights in this patient population.
Purpose of the Study:
- To evaluate the prognostic impact of baseline plasma B-type natriuretic peptide (BNP) levels on the incidence of death or stroke/bleeding events after LAAC.
- To identify if elevated BNP levels can stratify risk in patients who have undergone LAAC.
Main Methods:
- Analysis of patients from the prospective, multi-center OCEAN-LAAC registry who underwent LAAC.
- Exclusion of patients without baseline plasma BNP levels or those dependent on hemodialysis.
- Statistical evaluation of the association between baseline plasma BNP and the primary outcome (death or stroke/bleeding events).
Main Results:
- A total of 937 patients were included; LAAC was successful in 98%.
- Over a median follow-up of 366 days, 148 patients experienced the primary outcome.
- The common logarithm of baseline plasma BNP was independently associated with the primary outcome (aHR 1.46, p=0.043). A BNP cutoff of 133 pg/mL significantly stratified risk (29% vs. 21% at 2 years, p=0.004).
Conclusions:
- Higher baseline plasma BNP levels are independently associated with an increased incidence of stroke/bleeding events and mortality after LAAC.
- Baseline plasma BNP serves as a significant independent predictor of adverse outcomes post-LAAC.
- Further research is needed to determine optimal therapeutic strategies for LAAC candidates with elevated baseline BNP.
Abstract:
Background: 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. Method: 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. Results: 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, p = 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, p = 0.004). Conclusions: 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.
