B-type natriuretic peptides and mortality after stroke

García‐Berrocoso, Teresa; Giralt, Dolors; Bustamante, Alejandro; Etgen, Thorleif; Jensen, Jesper K.; Sharma, Jagdish C.; Shibazaki, Kensaku; Sarıtaş, Ayhan; Chen, Xingyong; Whiteley, William; Montaner, Joan

doi:10.1212/01.wnl.0000436937.32410.32

Cited by 88 publications

(71 citation statements)

References 43 publications

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“…Variability in biomarker measurement, particularly between sites, has been identified. For example, in a meta-analysis of IL-6 in stroke and another meta-analysis of BNP in ischemic stroke, >1000 fold difference in mean protein concentration was observed between sites 40, 41 . Reducing such variability will be essential to replicate promising biomarkers and biomarker panels in stroke.…”

Section: Molecules To Include In Biomarker Panels and Their Measurementmentioning

confidence: 99%

Biomarker Panels in Ischemic Stroke

Jickling¹,

Sharp²

2015

Stroke

116

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Section: Molecules To Include In Biomarker Panels and Their Measurementmentioning

confidence: 99%

Biomarker Panels in Ischemic Stroke

Jickling¹,

Sharp²

2015

Stroke

116

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“…Predicting stroke mortality is important in the management of patients with stroke and setting goals of care. A recent meta-analysis of 16 studies (3498 participants) evaluated the association of B-type natriuretic peptide (BNP) with stroke mortality and assessed whether adding this blood biomarker could improve clinical prediction of stroke mortality [3]. BNP or the inactive N-terminal fragment of BNP (NT-proBNP) was measured in ischemic and hemorrhagic strokes.…”

Section: Highlights From the Latest Articles In Biomarkers In Medicinementioning

confidence: 99%

Research Highlights: Highlights from the Latest Articles in Biomarkers in Medicine

Jickling

2014

Biomarkers Med.

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Predicting the risk of future stroke is important to identify those in need of stroke prevention therapy. In a cohort of 9771 healthy males aged 50-59 years, several plasma proteins were found to be predictive of stroke risk [1]. Study participants were followed for 10 years, during which time 95 ischemic strokes occurred. When these 95 strokes were compared with 190 matched controls, subjects who had a stroke were found to have higher baseline fibrinogen (odds ratio [OR]: 1.5; 95% CI: 1.0-2.3), E-selectin (OR :1.8, 95% CI: 1.1-2.9), IFN-γ-inducible protein-10 (OR: 1.7; 95% CI: 1.1-2.8), resistin (OR: 2.9; 95% CI: 1.3-6.3) and total adiponectin (OR: 1.8; 95% CI: 1.0-3.2). When E-selectin and resistin were added to a traditional risk factor model to predict ischemic stroke, the c-statistic improved from 0.68 (95% CI: 0.61-0.75) to 0.79 (95% CI: 0.79-0.89; p < 0.001) and resulted in a net reclassification improvement of 41.4% (p < 0.001).Resistin is released from adipose tissue and can increase macrophage uptake of oxidized low-density lipoprotein, promote thrombus formation, bind TLR4 and upregulate several proinflammatory molecules (ICAM-1, VCAM-1, IL-6, TNF-α, IL1B and NF-κB). E-selectin is an adhesion involved in leukocyte adhesion to endothelial cells and has previously been associated with carotid atherosclerosis and coronary heart disease. The study focused on males in a narrow age range. Further evaluation is required to determine whether these markers can predict stroke risk in females and in persons outside the 50-59-year range. Although resistin and E-selectin incrementally improved stroke risk stratification beyond that achieved by traditional vascular stroke risk factors, combining them with other factors such as MRI patterns may further improve the prediction of stroke risk. Resistin or E-selectin may also represent novel targets to reduce stroke risk. Of interest, statins and folate can reduce resistin levels. Stroke risk predicted by patterns on MRI brainEvaluation of: Weinstein G, Beiser AS, Decarli C, Au R, Wolf PA, Seshadri S. Brain imaging and cognitive predictors of stroke and Alzheimer disease in the Framingham Heart Study. Stroke 44(10), 2787-2794 (2013).Over time, vascular risk factors can have harmful effects on the brain. These include loss of brain volume and development of white matter hyperintensities. A recent study sought to determine whether features on baseline brain MRI are predictive of future stroke [2]. These MRI features were measured in 1679 patients from the Framingham Heart Study and patients were followed for 10 years for the development of stroke (n = 45) or Alzheimer's disease (n = 28). Participants with low total brain volume and marked cerebral white matter hyperintensities were found to have an increased risk of stroke (hazard ratio: 1.97; 95% CI: 1.03-3.77 and hazard ratio: 2.74; 95% CI: 1.51-5.00, respectively). The risk of stroke increased stepwise with increasing severity of brain volume loss and white matter hyperintensities.

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“…Usually BNP is measured by this N-terminal fragment (NT-proBNP), since the Nterminal part seems to be more stable than BNP itself. Serum concentrations of NTproBNP are usually almost 10 fold higher than BNP concentrations; this is caused by differences in metabolism: the inactive fragment having a longer half-live (3).…”

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“…Elevated plasma levels of NT-proBNB and of troponin T are markers of future major cardiac events, but also are correlated with multiple other vascular conditions and risk factors, even with mortality from noncardiovascular causes (7) In neurovascular conditions, elevated plasma levels of BNP and NTproBNP predicts the risk for an incident ischemic stroke, predicts the risk for cardio-embolic etiology of a stroke, the risk of having a new onset AF episode in the setting of an ischemic stroke, the risk of death in the acute phase and the risk of poor functional recovery at 3 and 6 months after stroke. Generally, both BNP peptides have been associated with unfavorable clinical outcome and mortality in stroke patients (3) In a prospective epidemiological study (7) was shown that increased levels of natriuretic peptides were associated positively with stroke risk factors and with increase in total stroke incidence : the combination of both elevated troponin T and NT-proBNP tripled the risk of ischemic stroke. BNP predicts a high-risk vascular profile in general population, risk factors for stroke were prevalent in individuals with high BNP values (7).…”

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confidence: 99%

Brain Natriuretic Peptide (Bnp): Biomarker for Risk Stratification and Functional Recovery Prediction in Ischemic Stroke

Stănescu¹,

Dogaru²

2015

BALNEO

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Functional outcome after cardiovascular and cerebrovascular events is traditionally predicted using demographic and clinical variables like age, gender, blood pressure, cholesterol levels, diabetes status, smoking habits or pre-existing morbidity. Identification of new variables will improve the risk stratification of specific categories of patients. Numerous blood-based biomarkers associated with increased cardiovascular risk have been identified; some of them even predict cardiovascular events. Investigators have tried to produce prediction models by incorporating traditional risk factors and biomarkers. (1). Widely-available, rapidly processed and less expensive biomarkers could be used in the future to guide management of complex cerebrovascular patients in order to maximize their recovery (2) Recently, studies have demonstrated that biomarkers can predict not only the risk for a specific clinical event, but also the risk of death of vascular cause and the functional outcome after cardiovascular or cerebrovascular events.Early prediction of fatal outcome after stroke may improve therapeutic strategies (such as the use of more aggressive treatments or inclusion of patients in clinical trials) and guide decision-making processes in order to maximize patient's chances for survival and recovery. (3) Long term functional outcome after stroke is one of the most difficult variables to predict. Elevated serum levels of brain natriuretic peptide (BNP) are powerful predictor of outcomes in patients with cardiovascular disease (heart failure, atrial fibrillation). Potential role of BNP in predicting atrial fibrillation occurrence, cardio-embolic stroke and post-stroke mortality have been proved in many studies. However, data concerning the potential role of BNP in predicting short term and long term functional outcomes after stroke remain controversial.

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B-type natriuretic peptides and mortality after stroke

Abstract: BNPs are associated with poststroke mortality independent of NIH Stroke Scale score, age, and sex. However, their translation to clinical practice seems difficult because BNP/NT-proBNP add only minor predictive value to clinical information.

Cited by 88 publications

References 43 publications

Biomarker Panels in Ischemic Stroke

Biomarker Panels in Ischemic Stroke

Research Highlights: Highlights from the Latest Articles in Biomarkers in Medicine

Brain Natriuretic Peptide (Bnp): Biomarker for Risk Stratification and Functional Recovery Prediction in Ischemic Stroke

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