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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...

BNPs are associated with poststroke mortality independent of NIH Stroke Scale score, age, and sex. However, their translation to clinical practice seems difficult because BNP/NT-proBNP add only minor predictive value to clinical information.

The studied biomarkers were not sufficient for an accurate differential diagnosis of stroke in the hyperacute setting. Additional discovery of new biomarkers and improvement on laboratory techniques seem necessary for achieving a molecular diagnosis of stroke.

Gender differences have been identified on the risk factors profile and diagnostic and therapeutic management of patients with ischemic stroke. Active measures should thus be taken to avoid bias in clinical practice.

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J. Neurochem. (2012) 122, 233–243. Abstract Protective effects of statins have been well documented for stroke therapy. Here, we used a systematic review and meta‐analysis to assess these evidences. We identified 190 studies using statin treatment in stroke animal models by electronic searching. From those, only studies describing ischemic occlusive stroke and reporting data on infarct volume and/or neurological outcome were included in the analysis (41 publications, 1882 animals). The global estimate effect was assessed by Weighted Mean Difference meta‐analysis. Statins reduced infarct volume by 25.12% (20.66%–29.58%, P < 0.001) and consistently, induced an improvement on neurological outcome (20.36% (14.17%–26.56%), P < 0.001). Stratified analysis showed that simvastatin had the greatest effect on infarct volume reduction (38.18%) and neurological improvement (22.94%), whereas bigger infarct reduction was observed giving the statin as a pre‐treatment (33.5%) compared with post‐treatment (16.02%). The use of pentobarbital sodium, the timing of statin administration, the statement of conflict of interest and the type of statin studied were found to be independent factors in the meta‐regression, indicating their influence on the results of studies examining statin treatment. In conclusion, this meta‐analysis provides further evidences of the efficacy of statins, supporting their potential use for human stroke therapy.