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Arch Hellen Med, 29(3), May-June 2012, 362-368


The levels of NT-pro-BNP as a predictor of recurrence of paroxysmal atrial fibrillation

Ι. Mavrodimitrakis,1 A. Moutsios -Rentzos,2 M. Piagkou,3 N. Kouvelas,1 T. Iliopoulos1
1Department of Cardiology, 251 General Air Force Hospital, Athens,
2Department of Pre-School Education and Educational Design, School of Humanities, University of the Egean, Rhodes,
3Department of Anatomy, Medical School, National and Kapodistrian University of Athens, Athens, Greece

OBJECTIVE Left ventricular (LV) dysfunction has been linked with increased recurrence of atrial fibrillation (AF). The role of natriuretic peptides as a prognostic indicator of AF has not been fully clarified. This study investigated whether or not the level of NT-pro-BNP may be used as a satisfactory predictor of 6-month recurrence of paroxysmal AF in patients with preserved LV ejection fraction. In addition, the prognostic value of NT-pro-BNP levels in such cases was compared with that of the left atrial size.

METHOD The study included 31 patients (54.8% male, mean age: 61.61±3.51 years), all of whom had preserved LV ejection fraction and were hospitalized because of a new episode of paroxysmal AF. These patients were followed for a period of 6 months after cardioversion to sinus rhythm. The study population was classified into 2 groups: Group A (n=15) consisted of patients that relapsed back to AF within 6 months, and Group B (n=16) patients that preserved sinus rhythm. Measurement was made of the levels of NT-pro-BNP and of the left atrial size (by transthoracic echocardiography), before and after the reversion.

RESULTS Logistic regression analysis showed that NT-pro-BNP levels predicted the 6-month recurrence of AF (total prognostic value 87.1%, Nagelkerke's R2=0.664, Wald criterion: p<0.05, 95% CI: 0.990−0.999) more efficiently than the left atrial size (total prognostic value 71.1%, Nagelkerke's R2=0.364, Wald criterion: p<0.01, 95% CI: 0.004−0.0427). ROC analysis revealed that the NT-pro-BNP values above 324 pg/mL can predict the 6-month recurrence of AF with 93.3% sensitivity and 75% specificity.

CONCLUSIONS The levels of NT-pro-BNP appear to be a satisfactory prognostic indicator of recurrence of paroxysmal atrial fibrillation within 6 months for patients with preserved LV ejection fraction.

Key words: Atrial fibrillation, Natriuretic peptides, Recurrence.

© Archives of Hellenic Medicine