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(Circulation. 2007;115:1339-1344.)
© 2007 American Heart Association, Inc.

Arrhythmia/Electrophysiology

Increased Perioperative N-Terminal Pro-B-Type Natriuretic Peptide Levels Predict Atrial Fibrillation After Thoracic Surgery for Lung Cancer

Daniela Cardinale, MD; Alessandro Colombo, MD; Maria T. Sandri, MD; Giuseppina Lamantia, MD; Nicola Colombo, MD; Maurizio Civelli, MD; Michela Salvatici, DSc; Giulia Veronesi, MD; Fabrizio Veglia, PhD; Cesare Fiorentini, MD; Lorenzo Spaggiari, MD, PhD; Carlo M. Cipolla, MD

From the Cardiology Unit (D.C., A.C., G.L., N.C., M.C., C.M.C.), Laboratory Medicine Unit (M.T.S., M.S.), and Division of Thoracic Surgery (G.V., L.S.), European Institute of Oncology, IRCCS, and Centro Cardiologico Monzino (F.V., C.F.), IRCCS, University of Milan, Milan, Italy.

Correspondence to Daniela Cardinale, MD, Cardiology Unit, European Institute of Oncology, Via Ripamonti 435, 20141 Milan, Italy. E-mail daniela.cardinale{at}ieo.it

Received June 23, 2006; accepted January 5, 2007.

Background— Postoperative atrial fibrillation (AF) is a complication of thoracic surgery for lung cancer, with a reported incidence that can run as high as 42%. Recently, it has been observed retrospectively that B-type natriuretic peptide predicts AF after cardiac surgery. We performed a prospective study to evaluate the role of N-terminal pro–B-type natriuretic peptide (NT-proBNP) as a marker for risk stratification of postoperative AF in patients undergoing thoracic surgery for lung cancer.

Methods and Results— We measured NT-proBNP levels in 400 patients (mean age, 62±10 years; 271 men) 24 hours before and 1 hour after surgery. The primary end point of the study was the incidence of postoperative AF. Overall, postoperative AF occurred in 72 patients (18%). Eighty-eight patients (22%) showed an elevated perioperative NT-proBNP value. When patients with either preoperatively or postoperatively elevated NT-proBNP were pooled, a greater incidence of AF was observed compared with patients with normal values (64% versus 5%; P<0.001). At multivariable analysis, adjusted for age, gender, major comorbidities, echocardiography parameters, pneumonectomy, and medications, both preoperative and postoperative NT-proBNP values were independent predictors of AF (relative risk, 27.9; 95% CI, 13.2 to 58.9; P<0.001 for preoperative NT-proBNP elevation; relative risk, 20.1; 95% CI, 5.8 to 69.4; P<0.001 for postoperative NT-proBNP elevation).

Conclusions— Elevation of perioperative NT-proBNP is a strong independent predictor of postoperative AF in patients undergoing thoracic surgery for lung cancer. This finding should facilitate studies of therapies to reduce AF in selected high-risk patients.

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