Ability of B-Type Natriuretic Peptide Testing to Predict Cardioembolic Stroke in the General Population　― Comparisons With C-Reactive Protein and Urinary Albumin ―

Nakamura, Motoyuki; Ishibashi, Yutaka; Tanaka, Fumitaka; Omama, Shinichi; Onoda, Toshiyuki; Takahashi, Tomohiro; Takahashi, Shuko; Tanno, Kozo; Ohsawa, Masaki; Sakata, Kiyomi; Koshiyama, Makoto; Ogasawara, Kuniaki; Okayama, Akira

doi:10.1253/circj.cj-17-1124

Cited by 13 publications

(21 citation statements)

References 30 publications

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“…BNP was reported to be a biomarker for predicting the incidence of cardioembolic stroke in the general population, although the detail of the general population such as comorbidities has not yet been fully examined. 13 A previous prospective observational study of AH patients showed that plasma BNP level (≥143 pg/mL) is a predictor for lacunar infarcts and ischaemic cerebral small vessel disease, which accounts for approximately 20% of all stroke cases. 31 BNP levels are affected by the presence of AH and/or stroke, and the simultaneous presence of AH and stroke results in a more significant increase in BNP levels, than the presence of either stroke or AH alone.…”

Section: Discussionmentioning

confidence: 99%

“…8 Previous studies have identified BNP as a predictor of stroke in patients with AF or those with prior stroke experience. [11][12][13] However, the association between the levels of BNP and stroke has not been investigated in patients with CHF. Thus, in the current study, we assessed whether BNP is associated with future occurrence of stroke in patients with CHF.…”

Section: Introductionmentioning

confidence: 99%

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B‐type natriuretic peptide is associated with post‐discharge stroke in hospitalized patients with heart failure

et al. 2020

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Aims Recently, B-type natriuretic peptide (BNP) has been attracting attention as a predictor of stroke in patients with atrial fibrillation or those with prior stroke experience. However, the association between BNP and stroke has not been examined in patients with chronic heart failure (CHF). In the current study, we assessed whether BNP is associated with future occurrence of stroke in patients with CHF. Methods and results We prospectively studied 1803 consecutive patients who were admitted for decompensated HF and assessed the predictive value of circulating BNP levels for occurrence of post-discharge stroke. A total of 69 (3.8%) patients experienced a stroke (the stroke group) during the post-discharge follow-up period of a median of 1150 days. The stroke group showed a higher CHADS 2 score. With respect to past medical history, the stroke group had a higher prevalence of arterial hypertension, atrial fibrillation, prior stroke, and chronic kidney disease. Echocardiographic parameters showed no significant differences between the two groups. In contrast, BNP levels were significantly higher in the stroke group than in the non-stroke group (452.1 vs. 222.7 pg/mL, P < 0.001). Multivariate Cox proportional hazard analysis indicated that BNP levels were independently associated with post-discharge stroke (hazard ratio 2.636, 95% confidence interval 1.595-4.357, P < 0.001). The survival classification and regression tree analysis revealed that the accurate cutoff point of BNP in predicting post-discharge stroke was 187.7 pg/mL. We added high BNP level (BNP ≥ 180 pg/mL) as one point to CHADS 2 score. The BNP-added CHADS 2 score was compared with CHADS 2 score alone by using c-statistics. The areas under the curve of CHADS 2 score, BNP, and BNP-added CHADS 2 score were 0.698, 0.616, and 0.723, respectively. The predictive value of BNP-added CHADS 2 score was higher compared with those of CHADS 2 score (P = 0.026). Conclusions The assessment of BNP may predict the occurrence of stroke in CHF patients used alone or in combination with established CHADS 2 score.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

B‐type natriuretic peptide is associated with post‐discharge stroke in hospitalized patients with heart failure

et al. 2020

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“…Therefore, over the past years, different biomarkers have been examined for use in ischemic stroke etiology classification [ 49 ]. Several recent studies concluded that BNP and NT-proBNP elevated serum levels show a correlation with cardioembolic stroke [ 118 , 119 , 120 , 121 , 122 , 123 , 124 , 125 , 126 , 127 , 128 , 129 , 130 , 131 , 132 , 133 , 134 , 135 , 136 , 137 , 138 , 139 , 140 ]. In addition, BNP and NT-proBNP showed correlation with an atrial fibrillation (AF) condition, abnormal heart rhythm (arrhythmia), that was found to be associated with cardioembolic stroke.…”

Section: B-type Natriuretic Peptide Expression In Stroke Pathologymentioning

confidence: 99%

“…NT-proBNP showed a summary sensitivity of 0.55 (95% CI: 0.52–0.59) and a summary specificity of 0.93 (95% CI: 0.91–0.94). Nakamura M. et al [ 135 ] reported that the ability of BNP to predict the incidence of cardioembolic stroke was excellent (area under the curve (AUC)-receiver operating characteristic (ROC) = 0.81). Also, when BNP was added to other well-known risk factors, the ability to predict cardioembolic stroke significantly improved: 4-year follow-up, p = 0.018; 8-year follow-up, p = 0.009; net reclassification improvement = 0.968, p < 0.0001: integrated discrimination improvement = 0.039, p < 0.05.…”

Section: B-type Natriuretic Peptide Expression In Stroke Pathologymentioning

confidence: 99%

B-Type Natriuretic Peptide as a Significant Brain Biomarker for Stroke Triaging Using a Bedside Point-of-Care Monitoring Biosensor

et al. 2020

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Stroke is a widespread condition that causes 7 million deaths globally. Survivors suffer from a range of disabilities that affect their everyday life. It is a complex condition and there is a need to monitor the different signals that are associated with it. Stroke patients need to be rapidly diagnosed in the emergency department in order to allow the admission of the time-limited treatment of tissue plasminogen activator (tPA). Stroke diagnostics show the use of sophisticated technologies; however, they still contain limitations. The hidden information and technological advancements behind the utilization of biomarkers for stroke triaging are significant. Stroke biomarkers can revolutionize the way stroke patients are diagnosed, monitored, and how they recover. Different biomarkers indicate different cascades and exhibit unique expression patterns which are connected to certain pathologies in the human body. Over the past decades, B-type natriuretic peptide (BNP) and its derivative N-terminal fragment (NT-proBNP) have been increasingly investigated and highlighted as significant cardiovascular biomarkers. This work reviews the recent studies that have reported on the usefulness of BNP and NT-proBNP for stroke triaging. Their classification association is also presented, with increased mortality in stroke, correlation with cardioembolic stroke, and an indication of a second stroke recurrence. Moreover, recent scientific efforts conducted for the technological advancement of a bedside point-of-care (POC) device for BNP and NT-proBNP measurements are discussed. The conclusions presented in this review may hopefully assist in the major efforts that are currently being conducted in order to improve the care of stroke patients.

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“…For instance, screening BNP concentrations can establish risk for patients bearing symptoms that imply HF. Additionally, various trials have established the use of BNP measurements for other diagnoses and treatments including dyspnea, cardiogenic brain embolism, and general medical wellness [4] [5]. Therefore, clinical guidelines recommend measuring BNP to aid in the diagnosis of HF and other diseases and to monitor disease progression [6] [7].…”

Section: Introductionmentioning

confidence: 99%

A Mixture of Glycosylated proBNP and BNP-32 Is a Suitable Calibrator for BNP Immunoassays

Masuta¹,

Funatsuki²,

Inoue³

et al. 2019

OJCD

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Aim: Measurement of B-type natriuretic peptide (BNP) is widely used as a diagnostic and risk assessment tool for cardiovascular disease. Recent studies have demonstrated that BNP-32 and its precursor proBNP circulate in the blood stream, and that most commercial BNP immunoassays measure both forms. However, recombinant or synthetic BNP-32 is used as the standard for those BNP immunoassays. This gap between clinical samples and the standard might be a potential source of variation in BNP measurements among assays. The purpose of this study is to validate a more suitable calibrator for BNP immunoassays. Methods: External BNP calibrators containing both BNP-32 and glycosylated proBNP were prepared at two concentration levels. Target BNP concentrations of the low and high levels were 40 and 160 pg/mL, respectively. And to reflect clinical samples, the molar ratios of BNP-32 to glycosylated proBNP in these concentration levels were adjusted to 50:50 and 25:75, respectively. BNP concentrations of plasma samples along with the external BNP calibrators were measured at two commercial labs and using an automated analyzer MI02 Shionogi® BNP (MI02). These samples and the calibrators were also measured using an immunoradiometric assay (IRMA) as a standard assay procedure. Concentrations of the plasma samples measured at the labs or using the MI02 were adjusted according to a comparison of the measured concentrations of the external BNP calibrators with the IRMA. Results: After measured concentrations of the plasma samples were adjusted using the external BNP calibrators, the correlation between each measurement and the IRMA was improved. The range of the slopes according to Passing-Bablok regression analysis narrowed from 0.

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Ability of B-Type Natriuretic Peptide Testing to Predict Cardioembolic Stroke in the General Population　― Comparisons With C-Reactive Protein and Urinary Albumin ―

Abstract: In the general population, plasma BNP was an excellent biomarker for predicting the incidence of cardioembolic stroke when used alone or in combination with established stroke risk factors.

Cited by 13 publications

References 30 publications

B‐type natriuretic peptide is associated with post‐discharge stroke in hospitalized patients with heart failure

B‐type natriuretic peptide is associated with post‐discharge stroke in hospitalized patients with heart failure

B-Type Natriuretic Peptide as a Significant Brain Biomarker for Stroke Triaging Using a Bedside Point-of-Care Monitoring Biosensor

A Mixture of Glycosylated proBNP and BNP-32 Is a Suitable Calibrator for BNP Immunoassays

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Ability of B-Type Natriuretic Peptide Testing to Predict Cardioembolic Stroke in the General Population ― Comparisons With C-Reactive Protein and Urinary Albumin ―

Abstract: In the general population, plasma BNP was an excellent biomarker for predicting the incidence of cardioembolic stroke when used alone or in combination with established stroke risk factors.

Cited by 13 publications

References 30 publications

B‐type natriuretic peptide is associated with post‐discharge stroke in hospitalized patients with heart failure

B‐type natriuretic peptide is associated with post‐discharge stroke in hospitalized patients with heart failure

B-Type Natriuretic Peptide as a Significant Brain Biomarker for Stroke Triaging Using a Bedside Point-of-Care Monitoring Biosensor

A Mixture of Glycosylated proBNP and BNP-32 Is a Suitable Calibrator for BNP Immunoassays

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Ability of B-Type Natriuretic Peptide Testing to Predict Cardioembolic Stroke in the General Population　― Comparisons With C-Reactive Protein and Urinary Albumin ―