Acute heart failure symptoms and brain natriuretic peptide levels variation after left atrial appendage occlusion

• Published in: Archives of Cardiovascular Diseases Supplements Vol. 10; no. 1; p. 44
• Main Authors: Robert, R., Bernard, F., Porot, G., Buffet, P., Fichot, M., Stamboul, K., Maillot, N., Guenancia, C., Cottin, Y., Lorgis, L.
• Format: Journal Article
• Language: English
• Published: Elsevier Masson SAS 01.01.2018
• ISSN: 1878-6480
• DOI: 10.1016/j.acvdsp.2017.11.092

Few data are available about clinical consequences of BNP variation after left appendage occlusion (LAAO) technique. In all consecutive patients successfully implanted with a LAAO device, blood samples were obtained before, 48h after device implantation and at the first visit after discharge (30–45 days) for BNP measurement. Clinical and echocardiography parameters were gathered. Patients diagnosed with symptoms of heart failure according to the ESC guidelines were classified as HF group. Among the 58 patients implanted, 6 (10%) complain with new HF symptoms, mainly breathlessness, and were classified in NYHA class II or III during the FU visit. Symptomatic patients were older, however procedural success and echo parameters after the device implantation were similar between groups. Despite no difference in NTproBNP levels on admission and after 48h, median NTproBNP levels was increased by about 20% at time of FU in HF patients when compared with asymptomatic patients. To avoid potential confounders, each HF case was matched with 2 controls on age, LVEF and creatinine levels. After matching, the median NTproBNP levels was significantly increased in the HF group vs. control (1048 vs. 521pg/mL, respectively, P<0.001). Interestingly, in the asymptomatic group, a non significant decrease in NTproBNP levels was observed during the FU compared to baseline measurements (593pgmL vs. 521pgmL, P=0.078). Our prospective study showed for the first time that LAAO modifies BNP levels and that trends of variation can have clinical impact during FU. The pathophysiological mechanisms of these findings need to be further investigated.