Time course of NT-proBNP levels after acute ischemic stroke

Fonseca, Ana Catarina; Matias, Joaquim Sampaio; Melo, Teresa Pinho e; Pires, Christine; Geraldes, Ruth; Canhão, Patrı́cia; Brito, Dulce; Ferro, José M.

doi:10.1111/ane.12112

Cited by 15 publications

(12 citation statements)

References 22 publications

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“…Because of unavailability of the requested data or lack of response from authors, we finally selected 23 articles (Figure 1). [16][17][18][19][20][21][22][23][30][31][32][33][34][35][36][37][38][39][40][41][42][43][44] The median quality score was 9 (minimum=5 and maximum=11; data not shown). These 23 included articles corresponded to 18 different cohorts of patients, 16 of which had data from patients with a defined cause (cardioembolic, LAA, or SVD) and 2 cohorts containing data of undetermined patients only.…”

Section: Resultsmentioning

confidence: 93%

B-Type Natriuretic Peptides Help in Cardioembolic Stroke Diagnosis

Llombart

Antolin-Fontes

Bustamante

et al. 2015

Stroke

142

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Background and Purpose-Determining the underlying cause of stroke is important to optimize secondary prevention treatment. Increased blood levels of natriuretic peptides (B-type natriuretic peptide/N-terminal pro-BNP [BNP/ NT-proBNP]) have been repeatedly associated with cardioembolic stroke. Here, we evaluate their clinical value as pathogenic biomarkers for stroke through a literature systematic review and individual participants' data meta-analysis. Methods-We searched publications in PubMed database until November 2013 that compared BNP and NT-proBNP circulating levels among stroke causes. Standardized individual participants' data were collected to estimate predictive values of BNP/NT-proBNP for cardioembolic stroke. Dichotomized BNP/NT-proBNP levels were included in logistic regression models together with clinical variables to assess the sensitivity and specificity to identify cardioembolic strokes and the additional value of biomarkers using area under the curve and integrated discrimination improvement index. Results-From 23 selected articles, we collected information of 2834 patients with a defined cause. BNP/NT-proBNP levels were significantly elevated in cardioembolic stroke until 72 hours from symptoms onset. Predictive models showed a sensitivity >90% and specificity >80% when BNP/NT-proBNP were added considering the lowest and the highest quartile, respectively. Both peptides also increased significantly the area under the curve and integrated discrimination improvement index compared with clinical models. Sensitivity, specificity, and precision of the models were validated in 197 patients with initially undetermined stroke with final pathogenic diagnosis after ancillary follow-up. Conclusions-Natriuretic peptides are strongly increased in cardioembolic strokes. Future multicentre prospective studies comparing BNP and NT-proBNP might aid in finding the optimal biomarker, the best time point, and the optimal cutoff points for cardioembolic stroke identification. 2 Patients with cardioembolic stroke are treated with anticoagulant drugs, whereas antiplatelet agents are the treatment of choice for patients with large artery atherosclerosis (LAA) stroke and small vessel disease (SVD).3 Cardioembolic strokes are generally more severe and more prone to recurrence than LAA or SVD and account for approximately one fifth of ischemic strokes. 4 However, in spite of the importance of an accurate etiopathogenic classification, the cause of ≈35% of patients remains undetermined, even after complete evaluation.5 This group of patients presents a rate of recurrence of ≈30% during the first year after the event, partly explained by an inappropriate secondary prevention treatment.6 Stroke of undetermined cause is an heterogeneous group that includes patients with 2 or more potential causes of stroke, patients with <50% of stenosis and patients with a negative diagnostic workup.7 From the latter, a negative diagnostic might be caused by a transitory or reversible condition which is difficult to detect, such as a...

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Section: Resultsmentioning

confidence: 93%

B-Type Natriuretic Peptides Help in Cardioembolic Stroke Diagnosis

Llombart

Antolin-Fontes

Bustamante

et al. 2015

Stroke

142

View full text Add to dashboard Cite

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“…Finally, an alternative explanation would be a higher influence of stroke on NT‐proBNP concentration in comparison to BNP. Both biomarkers are increased after stroke [24,25] and the infarcted area in the brain may be a potential source of their expression [26]. As NT‐proBNP has a longer half‐life, the confounding effects of stroke may last longer, even until 72 h after stroke onset [24].…”

Section: Discussionmentioning

confidence: 99%

B‐type natriuretic peptide over N‐terminal pro‐brain natriuretic peptide to predict incident atrial fibrillation after cryptogenic stroke

Palà

Pagola

Juega

et al. 2020

Euro J of Neurology

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Background and purposeB‐type natriuretic peptide (BNP) and N‐terminal pro‐brain natriuretic peptide (NT‐proBNP) are well‐known surrogates of atrial fibrillation (AF) detection but studies usually present data on either BNP or NT‐proBNP. The aim was to determine and directly compare the validity of the two biomarkers as a tool to predict AF and guide prolonged cardiac monitoring in cryptogenic stroke patients.MethodsNon‐lacunar acute ischaemic stroke (<72 h) patients over 55 years of age with cryptogenic stroke after standard evaluation were included in the Crypto‐AF study and blood was collected. BNP and NT‐proBNP levels were determined by automated immunoassays. AF was assessed by 28 days’ monitoring. Highest (optimizing specificity) and lowest (optimizing sensitivity) quartiles were used as biomarker cut‐offs to build predictive models adjusted by sex and age. The integrated discrimination improvement index (IDI) and DeLong test were used to compare the performance of the two biomarkers.ResultsFrom 320 patients evaluated, 218 were included in the analysis. AF was detected in 50 patients (22.9%). NT‐proBNP (P < 0.001) and BNP (P < 0.001) levels were higher in subjects with AF and their levels correlated (r = 0.495, P < 0.001). BNP showed an increased area under the curve (0.720 vs. 0.669; P = 0.0218) and a better predictive capacity (IDI = 3.63%, 95% confidence interval 1.36%–5.91%) compared to NT‐proBNP. BNP performed better than NT‐proBNP in a specific model (IDI = 3.7%, 95% confidence interval 0.87%–6.5%), whilst both biomarkers performed similarly in the case of a sensitive model.ConclusionsBoth BNP and NT‐proBNP were increased in cryptogenic stroke patients with AF detection. Interestingly, BNP outperforms NT‐proBNP, especially in terms of specificity.

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“…Although the great majority of the samples were obtained in the first 24 h after the TIA, in some cases they were not extracted until 48 or 72 h after the event. In any case, previous studies indicate that the highest values of serum NT-pro-BNP are found during the first 3 days after the stroke and that the usefulness of the determinations is similar within that time interval [34].…”

Section: Limitationsmentioning

confidence: 71%