NT-proBNP and Cardioembolic Stroke

A recent paper published by scientists in Turkey shows that NT-proBNP may be able to predict cardioembolic stroke and help with its prognosis. Stroke is one of the leading causes of morbidity and mortality. In ischemic stroke, it is essential to detect risk factors rapidly, to establish appropriate treatment and follow-up protocols by examining the etiologic aspects and to take measures. Natriuretic peptides are known to be used as a diagnostic marker for cardiovascular diseases. Also, recent studies have shown that elevated natriuretic peptides are associated with acute ischemic stroke (AIS) but the exact mechanism of elevated N-terminal-probrain-type natriuretic peptide level (NT-proBNP) in acute ischemic stroke is unknown. Researchers in Turkey aimed to assess NT-proBNP levels to see if it can be useful as a diagnostic or prognostic biomarker in subgroups of AIS and identify the factors associated with increased NT-proBNP levels in patients with AIS.

In their study, 107 patients with AIS were evaluated prospectively. Of all, 56 patients had no evidence of atrial fibrillation (AF) (sinus rhythm [SR] group) (52.3%), 24 patients had paroxysmal AF (pAF group) (22.4%), and the other 27 patients had chronic AF (cAF group) (25.3%). According to the TOAST (Trial of Org 10172 in Acute Stroke Treatment) and OCSP (Oxfordshire Community Stroke Project) study, ischemic stroke subtyping was performed. Serum NT-proBNP levels were estimated in 107 stroke patients and 24 age- and sex-matched control subjects. Venous blood samples were obtained for serum NT-proBNP measurement within the first 48 hours of the patient group.

They found that NT-proBNP levels were higher in noncardioembolic SR group compared to control group, but these differences were not statistically significant. These results support the association of the increase of BNP in AIS with cardiac causes and shows that independently of cardiac causes, BNP levels in AIS need to be examined in larger and homogeneous groups. In our study, NT-proBNP was found to be higher in patients with cAF and pAF than in the SR group. The NT-proBNP value checked in acute period might be a guide for the clinician in terms of priority patient selection and ECG Holter monitoring time for pAF research. NT-proBNP was higher in CE stroke group than in LAA and SVD group. High levels of NT-proBNP in cryptogenic strokes may help to prescribe a cardioembolic cause that has not yet been diagnosed and with the drug selection in secondary prophylaxis.

NT-proBNP values were significantly higher in the pAF and cAF group than SR groups. Non-cardioembolic SR group (n = 49) had higher plasma NT-proBNP levels than the controls but the difference was not statistically significant. NT-proBNP values were significantly higher in CE than in the LAA and SVD groups. Compared to the controls, LAA and SVD groups had higher plasma NT-proBNP levels but the difference was not statistically significant. There was a positive correlation between NT-proBNP levels and 3-month mRS scores in CE group. Serum NT-proBNP levels were positively correlated with age, LAD, CHA2DS2-VASc score, NIHSS and mRS score on admission. A negative correlation was detected with serum Cr, LDL, TG levels and smoking status. No correlation between sex, hypertension, diabetes mellitus, dyslipidemia, previous stroke/TIA, serum HbA1c, high-density lipoprotein cholesterol levels, size of infarction and NT-proBNP levels were found.

The results of their study support the association of NT-proBNP increase with cardiac causes in AIS. The authors suggest larger multicentric studies are required to understand the mechanism of elevated NT-proBNP levels in AIS and compare the sensitivity and specificity of NT-proBNP with other types of BNP.

Reference

• Assessment of Relationship between Serum NT-proBNP Levels with Clinical Features and Prognosis in Acute Ischemic Stroke Patients
• Beyza Muhsine Arslan, Murat Cabalar, Nilgün Isiksacan, Vildan Yayla
• Neurology India
• DOI: 10.4103/0028-3886.364072