Plasma B-type Natriuretic Peptide Level in Patients with Acute Cerebral Infarction according to Infarction Subtype and Infarction Volume

Abstract

Background: Plasma B-type natriuretic peptide (BNP) is used as a diagnostic marker of cardiovascular diseases. BNP is secreted mainly from the myocardium and has been detected by immunoreactivity in brain and cerebral arteries. The aim of our study was to investigate plasma BNP in patients with acute cerebral infarction according to infarction subtype and infarction volume.Methods: We studied 141 patients with acute cerebral infarction, classified as large artery atherosclerosis (LAA), cardioembolism (CE), or small vessel disease (SA) according to the Trial of Org 10172 in Acute Stroke Treatment classification. Plasma BNP level was measured in patients and 61 healthy controls. We analyzed various clinical and laboratory variables of patients according to plasma BNP level.Results: Compared to controls, the patients had higher plasma BNP (11.9 ± 11.7 pg/mL versus 124.6 ± 228.8 pg/mL, p <0.01). The highest quartile BNP group was associated with advanced age, female gender, current non-smoker, atrial fibrillation, heart failure, CE group, increased white blood cell counts, increased high sensitivity C-reactive protein, increased left atrium size, decreased left ventricular ejection fraction, increased initial National Institute of Health Stroke Scale, and increased infarction volume. According to multiple regression analysis, CE group, female gender, and infarction volume were independently associated with plasma BNP. Plasma BNP level showed statistically significant differences among LAA (n = 71), CE (n = 50), and SA (n = 20) groups (p <0.001), and the expression decreased in order of CE (253.8 ± 337.1 pg/mL), LAA (61.6 ± 78.8 pg/mL), and SA (25.3 ± 24.8 pg/mL). Increased plasma BNP correlated with increased infarction volume (r = 0.42, p <0.001).Conclusions: Plasma BNP may be helpful for prediction of etiologic classification of acute cerebral infarction and infarction volume.

Association of Plasma Brain Natriuretic Peptide Levels in Acute Ischemic Stroke Subtypes and Outcome

“…The prevalence of elevated BNP levels was low in other stroke subtypes (20%), a finding consistent with the previously published studies. 19,21,26 Almost three fourths of cardioembolic stroke patients in our study had high BNP, which is comparable to the study by Yukiiri et al 21 among Japanese cardioembolic stroke patients and Montaner et al 27 in Spanish patients. We did not find any association between elevated BNP and noncardioembolic strokes; our findings advocated other studies.…”

“…Even at 90 days, mean NIHSS score was lesser in patients with normal BNP levels. Similar observations have been reported previously Kim et al 19 and Tomita et al 44 Furthermore, Sviri et al 22 showed that high concentrations of BNP was associated with cerebral ischemia and neurologic deficit. Good outcome (mRS #2) was significantly higher in stroke patients with normal BNP (91.8%) compared with elevated BNP levels (66.3 %).…”

“…11,19,20 Yukiiri et al 21 reported elevated BNP values (.77 pg/mL) in three fourths of their stroke patients. Furthermore, a strong association has been described between high plasma BNP levels and the risk of development of cerebral ischemia as well as its severity.…”

“…39 However, this relationship remains controversial. 19,40 The discrepancy may be because of the varied regulation of the natriuretic factors by sex hormones, estrogen having stimulatory, and androgen having inhibitory effects. 33,41 …”

Levels of brain natriuretic peptide as a marker for the diagnosis and prognosis of acute ischemic stroke

“…Moreover, Kim et al stated that plasma BNP levels are elevated in cardioembolic stroke, large vessel atherosclerosis, and small vessel stroke (types of stroke are listed in order of decreasing associated plasma BNP levels) [26]. In our study, there was no significant difference between plasma BNP levels and stroke subgroups according to the TOAST classification.…”