Cardiac natriuretic peptides for diagnosis of covert atrial fibrillation after acute ischaemic stroke: a meta-analysis of diagnostic accuracy studies

Abstract

Background and purposeDetection of atrial fibrillation (AF) after acute ischaemic stroke is pivotal for the timely initiation of anticoagulation to prevent recurrence. Besides heart rhythm monitoring, various blood biomarkers have been suggested as complimentary diagnostic tools for AF. We aimed to summarise data on the performance of cardiac natriuretic peptides for the diagnosis of covert AF after acute ischaemic stroke and to assess their potential clinical utility.MethodsWe searched PubMed and Embase for prospective studies reporting the performance of B-type natriuretic peptide (BNP) or N-terminal pro-BNP (NT-proBNP) for the diagnosis of covert AF after acute ischaemic stroke. Summary diagnostic performance measures were pooled using bivariate meta-analysis with a random-effect model.ResultsWe included six studies focusing on BNP (n=1930) and three studies focusing on NT-proBNP (n=623). BNP had a sensitivity of 0.83 (95% CI 0.64 to 0.93), a specificity of 0.74 (0.67 to 0.81), a positive likelihood ratio of 3.2 (2.6 to 4.0) and a negative likelihood ratio of 0.23 (0.11 to 0.49). NT-proBNP had a sensitivity of 0.91 (0.65 to 0.98), a specificity of 0.77 (0.52 to 0.91), a positive likelihood ratio of 3.9 (1.8 to 8.7) and a negative likelihood ratio of 0.12 (0.03 to 0.48). Considering a pretest probability of 20%, BNP and NT-proBNP had post-test probabilities of 45% and 50%.ConclusionsNT-proBNP has a better performance than BNP for the diagnosis of covert AF after acute ischaemic stroke. Both biomarkers have low post-test probabilities and may not be used as a stand-alone decision-making tool for the diagnosis of covert AF in patients with acute ischaemic stroke. However, they may be useful for a screening strategy aiming to select patients for long-term monitoring of the heart rhythm.

N-Terminal Pro-brain Natriuretic Peptide Is Associated With Hemorrhagic Transformation and Poor Outcomes in Patients With Stroke Treated With Intravenous Thrombolysis

“…The association between NT-proBNP levels and poor stroke outcomes could also be explained as concomitant cardiac dysfunction, which is reflected by elevated NT-proBNP levels. Previous studies have reported that NT-proBNP levels are strongly associated with cardioembolic stroke and AF ( Llombart et al, 2015 ; Zhang K. et al, 2021 ). Cardioembolic stroke tends to be much more severe with a higher risk of mortality and recurrence ( Ferro, 2003 ).…”

“…Our findings demonstrate that NT-proBNP levels are independently associated with hemorrhagic transformation in patients with stroke who have undergone intravenous thrombolysis. Elevated NT-proBNP levels are closely correlated with cardioembolic stroke or cardiac etiology ( Llombart et al, 2015 ; Zhang K. et al, 2021 ). Patients with cardioembolic stroke or AF-related stroke had a higher risk of hemorrhagic transformation and poor outcomes ( Saposnik et al, 2013 ; Vaclavik et al, 2018 ).…”

“…N-terminal pro-brain natriuretic peptide (NT-proBNP) is an inactive fragment derived from the cleavage of BNP, which is released by the ventricular myocardium in response to stretching ( Daniels and Maisel, 2007 ). NT-proBNP is associated with cardioembolic stroke, stroke-related atrial fibrillation (AF), and atrial cardiopathy ( Llombart et al, 2015 ; Kamel et al, 2018 ; Zhang K. et al, 2021 ) and is also associated with poor outcomes in patients with stroke. Previous studies have reported that NT-proBNP levels are associated with mortality, poor functional outcomes, and stroke-associated complications ( Garcia-Berrocoso et al, 2013 ; Zhao et al, 2020 ; Faura et al, 2021 ).…”

Atrial Fibrillation Detected After Stroke and Transient Ischemic Attack: A Novel Clinical Concept Challenging Current Views

“…Identifying patients more likely to be diagnosed with AFDAS on PCM is crucial for the efficient use of resources and for ensuring that high-risk patients receive and adhere to PCM. The biomarkers most consistently associated with the diagnosis of AFDAS are age, 33 left atrial enlargement, 34 increased cardiac natriuretic peptides, 33 and premature atrial complexes. 35 Measuring cardiac troponin is recommended in stroke prevention guidelines and is done as part of the regular workup in most stroke centers.…”

Difficult issues in the management of patients with atrial fibrillation: a neurologist's point of view

“…Пролонгированный мониторинг у пациентов с маркерами предсердной кардиопатии более эффективен: 12-месячное наблюдение позволяет выявить ФП у 33% пациентов [71]. В рутинной практике наиболее удобными биомаркерами предсердной кардиопатии представляются структурные и функциональные характеристики левого предсердия по данным трансторакальной эхокардиографии: диаметр, индекс объема (LAVI), фракция выброса (LAEF) [72], а также сывороточная концентрация натрийуретических пептидов, особенно NT-proBNP [73][74][75]. Данные маркеры целесообразно использовать для отбора пациентов на пролонгированный мониторинг.…”