High pro-BNP levels predict the occurrence of atrial fibrillation after cryptogenic stroke

Rodríguez‐Yáñez, Manuel; Arias-Rivas, Susana; Santamaría-Cadavid, María; Sobrino, Tomás; Castillo, José; Blanco, Miguel

doi:10.1212/wnl.0b013e31829d8773

Cited by 76 publications

(62 citation statements)

References 26 publications

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“…32,38,41,43 In addition, blood biomarkers, such as high pro-brain natriuretic peptide levels, may be predictors for incident AF in patients with cryptogenic stroke. [71][72][73] Aortogenic Embolic Source Evaluation TCD microembolism study showed that AAA has embolic potential, 74 and DWI patterns are characterized by multiple small scattered lesions in multiple vascular territories that are mainly located in cortical and borderzone regions. 75 These are in line with an autopsy study of cases with cerebral atheromatous embolism, which showed that atheromatous emboli containing mostly cholesterol crystals are associated with borderzone infarct, whereas large emboli containing fibrin are associated with large territory infarcts.…”

Section: Advanced Monitoring For Af Detectionmentioning

confidence: 99%

Evaluation of Cryptogenic Stroke With Advanced Diagnostic Techniques

Bang

Ovbiagele

Kim

2014

Stroke

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Section: Advanced Monitoring For Af Detectionmentioning

confidence: 99%

Evaluation of Cryptogenic Stroke With Advanced Diagnostic Techniques

Bang

Ovbiagele

Kim

2014

Stroke

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“…Additional predictors of paroxysmal AF in patients with cryptogenic stroke may include the NIH Stroke Scale score, 25 radiologic evidence of new cortical or cerebellar infarcts, 26 and cardiac biomarkers such as B-type natriuretic peptide, 27,28 highly sensitive cardiac troponin T, 29 and others. 30 However, in the CRYSTAL AF trial, we did not observe any correlation between infarction pattern and AF detection 31 and biomarker data were not collected.…”

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confidence: 99%

Predictors for atrial fibrillation detection after cryptogenic stroke

et al. 2016

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Objective: We assessed predictors of atrial fibrillation (AF) in cryptogenic stroke (CS) or transient ischemic attack (TIA) patients who received an insertable cardiac monitor (ICM). Methods:We studied patients with CS/TIA who were randomized to ICM within the CRYSTAL AF study. We assessed whether age, sex, race, body mass index, type and severity of index ischemic event, CHADS 2 score, PR interval, and presence of diabetes, hypertension, congestive heart failure, or patent foramen ovale and premature atrial contractions predicted AF development within the initial 12 and 36 months of follow-up using Cox proportional hazards models.Results: Among 221 patients randomized to ICM (age 61.6 6 11.4 years, 64% male), AF episodes were detected in 29 patients within 12 months and 42 patients at 36 months. Significant univariate predictors of AF at 12 months included age (hazard ratio [ Conclusion:Increasing age and a prolonged PR interval at enrollment were independently associated with an increased AF incidence in CS patients. However, they offered only moderate predictive ability in determining which CS patients had AF detected by the ICM. The CRYSTAL AF trial showed that the rate of atrial fibrillation (AF) detection among patients with cryptogenic stroke (CS) or transient ischemic attack (TIA) was 30% within 3 years after insertion of an insertable cardiac monitor (ICM). 1Numerous genetic, clinical, electrocardiographic, and echocardiographic features have been proposed as risk markers for developing AF.2-12 Within the Framingham Heart Study, a risk score for development of AF within 10 years was created, which included age, sex, body mass index, systolic blood pressure, treatment for hypertension, PR interval, clinically significant cardiac murmur, and heart failure.13 Echocardiographic measures did not improve risk prediction substantially.AF episodes are frequently asymptomatic and intermittent. Most CS/TIA patients monitored by ICM for AF detection have already undergone short-term Holter monitoring or telemetry in addition to cardiac and vascular imaging before device insertion.

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“…Experimental evidences have also described the protective effect of NPs in cerebral injury18, 19, 20, 21; however, although the study of NPs (mainly BNP) has been focused as a biomarker of heart failure3, 26 and biomarker of cardioembolic stroke,5, 6, 7, 8, 9, 10 a clinical analysis about the protective effect of BNP in stroke that confirms the beneficial effect of these molecules has not been performed so far.…”

Section: Discussionmentioning

confidence: 99%

“…Cohort I included a total of 262 patients, already described in a previous study from our group 7. Briefly, from January to June 2006, 372 patients were included within the first 12 hours from stroke onset.…”

Section: Methodsmentioning

confidence: 99%

“…In addition, proBNP has been described as a biomarker in some types of cerebrovascular diseases. Indeed, high levels of proBNP are associated with cardioembolic strokes mainly because of atrial fibrillation (AF),5, 6 and can be used to predict the development of atrial fibrillation after first cryptogenic stroke7 and can act as an independent predictor of mortality after stroke 8, 9, 10…”

Section: Introductionmentioning

confidence: 99%

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Heads and Tails of Natriuretic Peptides: Neuroprotective Role of Brain Natriuretic Peptide

Fernández-Susavila

Rodríguez‐Yáñez

Dopico-López

et al. 2017

JAHA

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BackgroundBesides the relevant role of brain‐type natriuretic peptide (BNP) as biomarker of cardioembolic strokes, new experimental evidences suggest that this peptide may mediate neuroprotective effects. In this study, we have evaluated for the first time the clinical association between BNP (by means of proBNP) and good outcome in ischemic stroke patients, and analyzed the effect of blood BNP increase in an ischemic animal model.Methods and ResultsA retrospective study with 2 different cohorts (262 patients in cohort I and 610 in cohort II) from the same prospective stroke registry was performed. proBNP concentration was analyzed within the first 12 hours from stroke onset. The primary predictor variable was functional outcome evaluated by modified Rankin Scale at 3 months. For the experimental study, BNP pretreatment was tested in an ischemic animal model subjected to a transient occlusion of the cerebral artery, and the infarct volume and sensorimotor deficit were evaluated for 14 days. Cardioembolic strokes presented a positive correlation between proBNP concentration and modified Rankin Scale at 3 months; however, noncardioembolic strokes presented a negative correlation. In the logistic regression analysis, noncardioembolic strokes with concentrations of proBNP ≥340 pg/mL were associated with a good outcome. In line with these clinical findings, the experimental study revealed that those BNP pretreated animals presented a reduction on infarct volumes at 24 hours and functional recovery at days 7 and 14 compared with the control groups.ConclusionsThese clinical and experimental evidences support the potential role of BNP as a protective factor against cerebral ischemia.

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High pro-BNP levels predict the occurrence of atrial fibrillation after cryptogenic stroke

Abstract: Pro-BNP ≥360 pg/mL increases by 5-fold the possibility of detecting AF during follow-up in patients with cryptogenic stroke.

Cited by 76 publications

References 26 publications

Evaluation of Cryptogenic Stroke With Advanced Diagnostic Techniques

Evaluation of Cryptogenic Stroke With Advanced Diagnostic Techniques

Predictors for atrial fibrillation detection after cryptogenic stroke

Heads and Tails of Natriuretic Peptides: Neuroprotective Role of Brain Natriuretic Peptide

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