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Niveles de péptido natriurético N-terminal pro-B y trombosis de la orejuela auricular izquierda en pacientes con fibrilación auricular persistente
Resumen
Introducción: En pacientes hospitalizados, la fibrilación auricular es la arritmia más común y causa principal de ictus cardioembólico.
Objetivo: Evaluar la asociación entre el péptido natriurético NT proBNP y el trombo en la orejuela auricular izquierda en pacientes con fibrilación auricular persistente.
Métodos: Se reclutaron prospectivamente 139 pacientes con fibrilación auricular no valvular persistente. Se realizaron ecocardiografÃas transtorácicas y transesofágicas en todos los pacientes.
Resultados: Edad media, 70,5±10,6 años; 80,6 % hombres. En pacientes con LAAT, NT-proBNP correlacionó positivamente con el diámetro telediastólico del ventrÃculo izquierdo (DDVI) (r=0,345), diámetro sistólico final del ventrÃculo izquierdo (DSVI) (r=0,449), E/e' (r=0,445) y contraste de eco espontáneo auricular izquierdo (LA SEC) (r=0,478), y negativamente con la fracción de eyección del ventrÃculo izquierdo (FEVI) (r=-0,473), tensión auricular izquierda (r=-0,301), tasa de tensión (r=0,283) y e' (r=-0,458). En pacientes sin LAAT, NT-proBNP correlacionó positivamente con LVEDD (r= 0,333), LVESD (r=0,358), E (r=0,318), E/e' (r=0,411), Ãndice de volumen auricular izquierdo (LAVI) (r=0,421), y negativamente con FEVI (r=-0,307). NT-proBNP plasmático (>1279 pg/mL) podrÃa usarse para predecir LAAT (AUC=0,639; Se=67,7 %, Sp=60,2 %). En pacientes con fracción de eyección >50 %; valor de corte de NT-proBNP para predecir LAAT fue 1325 pg/mL (AUC=0,572; Se=57,9 %, Sp=78,3 %). Según regresión logÃstica múltiple, el accidente cerebrovascular previo, el Ãndice E/e' y NT-proBNP se correlacionaron con LAAT (r=0,887; p<0,001; r=0,092, p=0,035 y 0,022; p=0,004, respectivamente).
Conclusiones: Los niveles plasmáticos de NT-proBNP y el Ãndice E/e' se asocian con el OAI en pacientes con FA persistente.
Palabras clave
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