Relation of hs-CRP and BNP levels with the atrial spontaneous echo contrast and thrombi in permanent atrial fibrillation patients with different etiologies
Tayfun Sahin, Eser Acar, Umut Celikyurt, Teoman Kılıc, Guliz Kozdag, Aysen Agacdiken, Dilek Ural
Med Sci Monit 2012; 18(2): CR78-87
Available online: 2012-02-01
Background: Thromboembolic risk in permanent atrial fibrillation (AF) is strongly associated with the underlying etiology, and inflammatory parameters may contribute. The present study aimed to investigate the relationship of hs-CRP and BNP levels with left and right atrial appendage (LAA and RAA) function, presence of spontaneous echo contrast (SEC) and thrombus.
Material/Methods: Eighty-four permanent AF patients with different etiologies (20 mitral stenosis, 44 hypertension and 20 hyperthyroidism) and 23 patients with sinus rhythm were included. LAA and RAA flow velocities were measured by pulsed-wave Doppler and wall motion velocities with tissue Doppler imaging (TDI) in transesophageal echocardiography.
Results: Hs-CRP and BNP levels significantly differed among the 3 AF groups: levels were highest in mitral stenosis patients (8.6±5.3 mg/L and 98.0±125.7 pg/mL, respectively), the lowest hs-CRP was in hyperthyroidism patients (4.3±3.8 mg/L), and the lowest BNP was in hypertensive patients (64.8±44.3 pg/mL). There were also significant differences between the AF group and controls regarding hs-CRP and BNP levels. In the correlation analysis, BNP level was not significantly correlated with LAA and RAA functions, whereas hs-CRP level was significantly correlated with some LAA and RAA functions. On the other hand, hs-CRP level was significantly related to the presence of mild-moderate SEC and thrombi, mainly in mitral stenosis patients. Moreover, hs-CRP was the most important determinant of RAA thrombus formation, followed by RAA ejection fraction. In contrast, no positive or negative correlation was found between BNP levels and RAA and LAA thrombi.
Conclusions: Higher hs-CRP levels in AF patients may be a predictor for the presence of SEC and thrombi in the atria.
Keywords: Heart Atria - ultrasonography, Echocardiography, Transesophageal, Case-Control Studies, C-Reactive Protein - metabolism, Atrial Fibrillation - ultrasonography, Adult, Natriuretic Peptide, Brain - metabolism, Thrombosis - ultrasonography