Higher BNP Peptide Levels Predict Stroke and Bleeding Risk After Heart Procedure in 937 Patients

What the researchers found

Among 937 patients who underwent LAAC (98% successful implantation rate), the common logarithm of baseline plasma BNP was independently associated with the composite primary outcome (death or stroke/bleeding events) with an adjusted hazard ratio of 1.46 (95% CI: 1.06-2.18, p = 0.043). A calculated BNP cutoff of 133 pg/mL significantly stratified outcomes: 29% vs 21% cumulative incidence of the primary outcome at 2 years (p = 0.004). Over a median follow-up of 366 days, 148 patients experienced a primary outcome event.

Why it matters

LAAC is performed to prevent stroke in atrial fibrillation patients who can't take blood thinners. But some patients remain at high risk even after the procedure. This study shows that the natriuretic peptide BNP — a simple, widely available blood test — can identify which patients are at highest risk, enabling more personalized post-procedure monitoring and management.

How the study worked

Multi-center prospective registry study (OCEAN-LAAC registry) in Japan. 937 patients with non-valvular atrial fibrillation who underwent percutaneous left atrial appendage closure were included. Patients without baseline BNP levels or on hemodialysis were excluded. Cox regression assessed the prognostic impact of baseline BNP on death or stroke/bleeding events. ROC analysis determined the optimal BNP cutoff.

What this study cannot tell us

Observational registry data cannot establish causation. The study was conducted exclusively in Japanese patients, which may limit generalizability to other populations. BNP was measured only at baseline — changes over time were not assessed. The study could not determine whether BNP-guided management would improve outcomes. The 133 pg/mL cutoff needs external validation.

How to read the evidence

This is a large multicenter prospective registry study (n=937) with adequate follow-up. While not a randomized trial, the prospective design, large sample, and independent association in adjusted models provide moderately strong evidence for BNP's prognostic value in this context.

When this study was published

Published in 2024, this is recent evidence supporting BNP-based risk stratification in the growing field of left atrial appendage closure procedures.

The bigger picture

This study adds to the growing evidence that natriuretic peptides — BNP and NT-proBNP — are versatile cardiac biomarkers useful beyond heart failure diagnosis. Their ability to predict outcomes after cardiac procedures like LAAC demonstrates the broad clinical utility of these peptide biomarkers for risk stratification across different cardiac conditions and interventions.

Questions still open

• Should baseline BNP testing become standard before LAAC procedures to guide risk stratification?
• Would BNP-guided post-LAAC management (such as continued anticoagulation in high-BNP patients) improve outcomes?
• Do patients with high baseline BNP benefit less from LAAC, or do they simply have more comorbidities that drive adverse events?

Common questions

Read the original research

Correlations Between Plasma BNP Level and Risk of Thrombotic-Hemorrhagic Events After Left Atrial Appendage Closure.

Journal of clinical medicine, 13(20)

Citation

Imamura, Teruhiko; Kataoka, Naoya; Tanaka, Shuhei; Ueno, Hiroshi; Kinugawa, Koichiro; Nakashima, Masaki; Yamamoto, Masanori; Sago, Mitsuru; Chatani, Ryuki; Asami, Masahiko; Hachinohe, Daisuke; Naganuma, Toru; Ohno, Yohei; Tani, Tomoyuki; Okamatsu, Hideharu; Mizutani, Kazuki; Watanabe, Yusuke; Izumo, Masaki; Saji, Mike; Mizuno, Shingo; Kubo, Shunsuke; Shirai, Shinichi; Hayashida, Kentaro. (2024). Correlations Between Plasma BNP Level and Risk of Thrombotic-Hemorrhagic Events After Left Atrial Appendage Closure.. Journal of clinical medicine, 13(20). https://doi.org/10.3390/jcm13206232