NT-proBNP Levels and Collateral Circulation Status in Patients with Acute Ischemic Stroke

Abstract

Background and Objectives. Strokes resulting from atrial fibrillation (AF) increase with age. The relationship between N-terminal- (NT-) prohormone brain natriuretic peptide (NT-proBNP) level and National Institutes of Health Stroke Scale (NIHSS) score is not well established. Also, the collateral circulation plays an important role in NHISS scores. In this study, the effects of NT-proBNP on collateralization were assessed in patients with and without AF. Methods. In this study, 326 hospitalized patients with acute anterior circulation ischemic stroke (AACIS) were included. A comparison of the clinical characteristics of those with and without AF was conducted. The Spearman rank correlation was used for the correlation analysis of plasma NT-proBNP level, regional leptomeningeal collateral (rLMC) score, and computed tomography perfusion (CTP) status in the AF and non-AF groups. An analysis of multivariate linear regression was used to determine how plasma NT-proBNP level, rLMC score, and CTP status influenced the score on the NIHSS. Results. There was a greater plasma NT-proBNP level in the AF group compared with the non-AF group, an increased CTP volume (including CTP ischemic volume, CTP infarct core volume, and CTP ischemic penumbra volume ( P = 0.002 )), higher NIHSS score on admission, and lower rLMC score ( P < 0.001 for the remaining parameters). A negative correlation exists between plasma NT-proBNP level and rLMC score ( r = − 0.156 , P = 0.022 ), but a positive correlation exists between plasma NT-proBNP level and both CTP ischemic volume and CTP infarct core volume ( r = 0.148 , P = 0.003 ) in the AF group, but not in the non-AF group. Multivariate linear regression analysis demonstrated that NT-proBNP, CTP ischemic penumbra volume, and rLMC score were associated with NIHSS score, and NT-proBNP was positively associated with NIHSS scores (95% confidence interval (CI), 0.000-0.002; P = 0.004 ) in the AF group, whatever in the unadjusted model or adjusted models, but not in the nonlarge artery atherosclerosis (LAA) group. Conclusion. In AACIS patients with AF, NT-proBNP level negatively correlated with collateral status, positively with CTP ischemic volume, and positively with NIHSS score.

Calculated plasma volume status is associated with poor outcomes in acute ischemic stroke treated with endovascular treatment

“…The mechanisms between PVS and poor outcomes in patients with failed recanalization, large artery atherosclerosis, and poor collateral status can be explained in the following way: intravascular volume is an important component in blood pressure and volume overload, and systemic congestion may be associated with progressive edema in ischemic brain tissues, which could lead to increased interstitial pressures and reduced collateral flow to the penumbra and eventually cause collateral failure and hemorrhagic transformation in patients with failed recanalization (37). Volume overload and systemic congestion are also associated with atrial disturbing inflammatory bodies and lead to larger infarct volumes and extra intense hemorrhagic transformation through the activation of atrial traumatic inflammation in patients with poor collateral status (38). Large artery atherosclerosis is the pathological formation of in situ thrombosis owing to chronic vascular stenosis and plaque rupture in the culprit artery.…”