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

Background Few data are available about clinical consequences of BNP variation after left appendage occlusion (LAAO) technique. Methods In all consecutive patients successfully implanted with a LAAO device, blood samples were obtained before, 48 h 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. Results 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 48 h, 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. 521 pg/mL, respectively, P  P  = 0.078). Conclusion 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.