Background and Objective: Although brain natriuretic peptide (BNP) is increasingly being used for screening and monitoring of congestive heart failure in AF with structural heart disease, its clinical utility in patients with lone atrial fibrillation (AF) is unclear. The objective of this study was to examine the relationship of BNP and prognosis in patients with lone atrial fibrillation.
Method: We enrolled out-patients with lone atrial fibrillation from January 2003 to June 2006 at Wonju Christian Hospital. Exclusion criteria were the presence of symptomatic heart failure, valvular disease, congenital heart disease, hypertrophic cardiomyopathy, an LV ejection fraction ≤ 45%, a permanent pacemaker, paroxysmal AF, COPD, thyroid dysfunction, renal failure (Cr≥3) and obesity. The samples for BNP of were checked using the Biosite Kit.
Results: The clinical characteristics of 229 subjects are described as below; (116 males and 113 female; age, 70.02 ± 11.23 years), AF duration (1.74 ± 0.87 years), HR (90.8 ± 28.5 beats/min), LV EF (65.1 ± 9.8 %), LA size (5.58 ± 0.86 cm), LA volume index (76.4 ± 40.3 mL). The distribution of risk factors for AF are advanced age (≥65 years, 75.5 %), hypertension (58.6 %), history of coronary heart disease(23.6 %), previous stroke or TIA (29.1 %), and diabetes mellitus (24.1 %), respectively. Initial mean BNP level was 418.7 ±560.3 pg/mL, peak BNP levels 592.5 ± 775.0 pg/mL, final BNP 454.9 ± 743.2 pg/mL. Cardiovascular complication (stroke, MI, angina, coronary heart disease, CHF) happened in 18.8%, cardiac death in 8.1%. In patients with cardiovascular complication, BNP level was higher (494.5 ± 826.1 pg/mL vs. 313.7 ± 262.8 pg/mL, p<0.05). But, BNP was not significant relation to CV complications (p=0.054). In multivariate logistic regression analysis, clinical factor contributing to cardiovascular complication was age (p=0.005).
Conclusions; This study suggests that in lone atrial fibrillation without structural heart disease, BNP was not significant predictor of long term prognosis.
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