Plasma Brain Natriuretic Peptide Can be a Biological Marker to Distinguish Cardioembolic Stroke from Other Stroke Types in Acute Ischemic Stroke

Shibazaki, Kensaku; Kimura, Kazumi; Iguchi, Yasuyuki; Okada, Yôko; Inoue, Takeshi

doi:10.2169/internalmedicine.48.1475

Cited by 78 publications

(61 citation statements)

References 26 publications

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“…More patients with a concentration of NT-pro-BNP >1,583.50 pg/mL suffered from AF. Our results suggest that the BNP level in acute ischemic stroke patients without clinical heart failure is frequently elevated, particularly in those with cardioembolic stroke (17). Another factor affecting the NT-pro-BNP level is the difference in the size of infarction.…”

Section: Discussionmentioning

confidence: 70%

The Prognostic Value of Combined NT-pro-BNP Levels and NIHSS Scores in Patients with Acute Ischemic Stroke

Chen

et al. 2012

Intern. Med.

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Objective Determining the prognoses of patients with acute ischemic stroke is difficult. Therefore, the aim of this study was to evaluate whether the combined assessment of plasma N-terminal pro-brain natriuretic peptide (NT-pro-BNP) and the National Institutes of Health Stroke Scale (NIHSS) variables is relevant to the prognosis of patients with acute cerebral ischemic infarction in-hospital. Methods We enrolled 122 patients who were within three days of onset of acute ischemic stroke. We measured the plasma NT-pro-BNP level of each patient within 72 hours and recorded the NIHSS score on admission. The factors associated with death were investigated using a multivariate logistic regression analysis. Results Twenty-three patients (18.85%) died during hospitalization. The frequency of atrial fibrillation (AF), the NIHSS score on admission (8.69±4.87 in the survival group vs. 14.48±2.54 in the deceased group, p<0.001) and the plasma NT-pro-BNP level (median: 926.30 pg/mL in the survival group vs. 3,280 pg/mL in the deceased group, p<0.001; Lg NT-pro-BNP 2.82±0.66 in the survival group vs. 3.46±0.52 in the deceased group, p<0.001) were each significantly higher in the deceased group than in the survival group. The optimal cut-off levels for the NT-pro-BNP level and NIHSS score to distinguish the deceased group from the survival group were 1,583.50 pg/mL and 12.5, respectively. Patients with both elevated NT-pro-BNP levels (>1,583.50 pg/mL) and NIHSS scores on admission (NIHSS >12.5) had a substantially higher mortality rate than those without elevated NT-pro-BNP levels and NIHSS scores (89.47% vs. 9.84%, p<0.001). A multivariate logistic regression analysis demonstrated that a NT-pro-BNP level >1,583.50 pg/mL (OR, 5.001; 95% CI, 1.233 to 20.287, p=0.024) and a NIHSS score >12.5 (OR, 1.465; 95% CI, 1.191 to 1.801, p<0.001) were each independent factors associated with in-hospital death. Conclusion The plasma NT-pro-BNP level and the NIHSS score added independent and incremental contributions to the prognostic stratification of patients with acute ischemic stroke.

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Section: Discussionmentioning

confidence: 70%

The Prognostic Value of Combined NT-pro-BNP Levels and NIHSS Scores in Patients with Acute Ischemic Stroke

Chen

et al. 2012

Intern. Med.

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“…BNP is a well-established marker of left ventricular dysfunction, and is elevated in acute strokes 32 and vascular dementia. 33 Elevated BNP levels are also associated with cognitive decline in vascular disease 34 and the development of AD and vascular dementia (independent of heart failure).…”

Section: Discussionmentioning

confidence: 99%

Plasma multianalyte profiling in mild cognitive impairment and Alzheimer disease

Wilkins¹

2012

Neurology

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Objectives: While plasma biomarkers have been proposed to aid in the clinical diagnosis of Alzheimer disease (AD), few biomarkers have been validated in independent patient cohorts. Here we aim to determine plasma biomarkers associated with AD in 2 independent cohorts and validate the findings in the multicenter Alzheimer's Disease Neuroimaging Initiative (ADNI).Methods: Using a targeted proteomic approach, we measured levels of 190 plasma proteins and peptides in 600 participants from 2 independent centers (University of Pennsylvania, Philadelphia; Washington University, St. Louis, MO), and identified 17 analytes associated with the diagnosis of very mild dementia/mild cognitive impairment (MCI) or AD. Four analytes (apoE, B-type natriuretic peptide, C-reactive protein, pancreatic polypeptide) were also found to be altered in clinical MCI/AD in the ADNI cohort (n ϭ 566). Regression analysis showed CSF A␤42 levels and t-tau/A␤42 ratios to correlate with the number of APOE4 alleles and plasma levels of B-type natriuretic peptide and pancreatic polypeptide. Conclusion:Four plasma analytes were consistently associated with the diagnosis of very mild dementia/MCI/AD in 3 independent clinical cohorts. These plasma biomarkers may predict underlying AD through their association with CSF AD biomarkers, and the association between plasma and CSF amyloid biomarkers needs to be confirmed in a prospective study. Neurology The clinical diagnosis of mild cognitive impairment (MCI) and probable Alzheimer disease (AD) is increasingly aided by biomarkers predictive of underlying pathology.1,2 These include CSF biomarkers reflecting the plaque and tangle pathology underlying AD such as ␤-amyloid 1-42 (A␤42), total tau (t-tau), and tau phosphorylated at threonine 181 (p-tau 181 ) 3 ; substratespecific brain imaging such as 11 C and 18 F PET imaging 4,5 ; and structural MRI findings such as hippocampal volume.6 Each modality has a different sensitivity-specificity profile, and additional technical barriers and patient preferences may dictate the successful implementation of any biomarker into clinical practice, including aversion to having a lumbar puncture for CSF biomarkers and cost for advanced imaging. Thus, a blood-based test is an appealing alternative because of its simplicity and cost-effectiveness for widespread clinical use as well as in specialty centers.7,8 A multi-analyte profiling approach to plasma proteins and peptides can also yield †Deceased.

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“…B-type natriuretic peptide (BNP) elevation had risen to >76 at stroke admission and had an odds ratio of 2.3 times that being associated with cardioembolic stroke compared to other types (confidence interval [CI], 1.4-3.7; p=0.001) [31], and BNP elevation was highest in cardioembolic stroke (as high as 410 pg/ml) among all stroke subtypes [32].…”

Section: Evaluation Of Patients At Risk For Cardioembolic Strokementioning

confidence: 99%

Prevention of Cardioembolic Stroke

Freeman

Aguilar

2011

Neurotherapeutics

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Cardiac causes of ischemic stroke lead to severe neurological deficits from large intracranial artery occlusion compared to small vessel ischemic stroke. The most common cause of cardioembolic stroke is atrial fibrillation (AF), which has an increasing incidence with age. AF stroke trials demonstrate that anti-coagulation is superior to anti-platelet therapy in terms of ischemic stroke prevention. Recently, warfarin was compared with dabigatran, an oral, direct thrombin inhibitor, and was found to be at least equally effective in reducing ischemic stroke with less intracranial bleeding risk. Future research is investigating other direct thrombin inhibitors as potential alternatives to warfarin, which has a narrow therapeutic index, requires frequent blood monitoring, has multiple drug interactions, and a higher rate of intracranial bleeding. Other causes of cardioembolic stroke include myocardial infarction, left ventricular thrombus, reduced ejection fraction, valvular abnormalities, and endocarditis. Patent foramen ovale is a common finding on echocardiograms in patients with and without stroke (up to 20% of the population), and it is a controversial source of cryptogenic stroke. The best way to prevent cardioembolic stroke remains early detection and treatment of AF, and treating the underlying stroke mechanism. Cardiac magnetic resonance imaging is an emerging technology and reveals some sources of cardiac embolism missed by echocardiography, and might provide an additional diagnostic tool in investigating cardioembolic stroke.

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Plasma Brain Natriuretic Peptide Can be a Biological Marker to Distinguish Cardioembolic Stroke from Other Stroke Types in Acute Ischemic Stroke

Abstract: Background Plasma brain natriuretic peptide (BNP) is used as a marker of congestive heart failure. Moreover, plasma BNP levels

Cited by 78 publications

References 26 publications

The Prognostic Value of Combined NT-pro-BNP Levels and NIHSS Scores in Patients with Acute Ischemic Stroke

The Prognostic Value of Combined NT-pro-BNP Levels and NIHSS Scores in Patients with Acute Ischemic Stroke

Plasma multianalyte profiling in mild cognitive impairment and Alzheimer disease

Prevention of Cardioembolic Stroke

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