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Nogami, Makoto; Shiga, Junji; Takatsu, Akihiro; Endo, Noriko; Ishiyama, Ikuo

doi:10.1023/a:1017996113871

Cited by 43 publications

(10 citation statements)

References 9 publications

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“…[1011] Our study showed that BNP in patients was significantly higher than in controls ( P < 0.001) which is in agreement with studies in the past. [1213] One of the reasons postulated for raised BNP levels in stroke patients is cardiac dysfunction.…”

Section: Discussionsupporting

confidence: 91%

Role of brain natriuretic peptide as a novel prognostic biomarker in acute ischemic stroke

Menon¹,

Ramalingam²,

Conjeevaram³

et al. 2016

Ann Indian Acad Neurol

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Aim:We investigated to study the prognostic importance of brain natriuretic peptide (BNP) in ischemic stroke.Materials and Methods:We prospectively enrolled 100 patients with acute ischemic stroke and measured plasma BNP levels and compared with age- and sex-matched healthy controls. Risk factors, biochemical parameters, lipid profile, carotid and vertebral Doppler, imaging, and cardiac evaluation were done. Stroke severity was assessed by the National Institutes of Health Stroke Scale (NIHSS) score on admission and functional disability by Barthel Index (BI) at 3 months. Ischemic stroke subtype was classified according to the Oxfordshire Community Stroke Project (OCSP). Data were entered in MS Excel, and appropriate statistical analysis was done using the SPSS software version 21.0. A P = 0.05 was considered as significant.Results:Mean age of patients was 55.17 ± 11.37 years with a male:female ratio 3:1. OCSP showed total anterior circulation infarct (TACI) 35, partial anterior circulation infarct 9, lacunar infarct 12, and posterior circulation infarct 44. NIHSS on admission was average 10 ± 7 and BI was 57 ± 30. BNP in patients (435 ng/ml) was very high as compared to controls (<60 ng/ml) (P < 0.001). There was a positive correlation between age and BNP (R2 = 0.34; P < 0.00); NIHSS and BNP (R2 = 0.255; P < 0.01), negative correlation between BI and BNP (R2 = −0.064; P < 0.01). Mean BNP levels across the OCSP showed higher values in TACI (F = 4.609 P = 0.005). Regression analysis showed that BNP can predict BI which was statistically significant.Conclusion:Plasma BNP levels was significantly elevated in patients with ischemic stroke. Our study concludes that high BNP levels are seen in large anterior circulation stroke and is a predictor for the poor functional outcome at 3 months. Determination of BNP levels as a biomarker could be helpful in predicting the outcome in stroke patients.

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Section: Discussionsupporting

confidence: 91%

Role of brain natriuretic peptide as a novel prognostic biomarker in acute ischemic stroke

Menon¹,

Ramalingam²,

Conjeevaram³

et al. 2016

Ann Indian Acad Neurol

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“…Natriuretic peptides have been shown to be elevated in patients with SAH and have been found to be associated with a decreased level of consciousness [17,18]. Data from experimental studies suggest that cerebral ischemia induces ANP release [6,7]. In patients with ICH, higher levels of brain natriuretic peptide, another member of the natriuretic peptide family, have been reported to be associated with functional neurological outcome [19].…”

Section: Discussionmentioning

confidence: 99%

“…Accounting for about 98% of all circulating natriuretic peptides, ANP is released from intracellular granules in atrial myocytes upon atrial dilation, with myocyte stretching through volume and blood pressure challenge being the most potential stimulators [5]. ANP-immunoreactive glial cells have been found in ischemic brain tissue, suggesting regulation of cerebral blood flow through ANP [6]. Moreover, release of ANP from brain tissue has also been reported during cerebral ischemia [6,7].…”

Section: Introductionmentioning

confidence: 99%

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The Prognostic Value of Midregional Proatrial Natriuretic Peptide in Patients with Hemorrhagic Stroke

et al. 2014

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Background: Atrial natriuretic peptide (ANP) is a well-known prognostic marker of outcome and mortality in patients with cardiovascular disease. Midregional proatrial natriuretic peptide (MR-proANP) is a stable fragment of the ANP precursor hormone. As a prognostic marker after ischemic stroke, it reliably predicts poststroke mortality and functional outcome. This study aimed to analyze the prognostic value of MR-proANP in patients with hemorrhagic stroke, i.e. subarachnoid (SAH) and intracerebral hemorrhage (ICH). Methods: MR-proANP was analyzed in patients with spontaneous SAH or spontaneous ICH. All patients were prospectively randomized into two treatment arms: (1) a prophylactic normothermia group with a target core temperature 36.5°C using endovascular cooling, and (2) a control group with conventional stepwise predefined fever management using antipyretic medication and surface cooling. Blood samples were obtained on admission and on days 4 and 7. Measurement of MR-proANP was performed in serum using sandwich immunoassay. The primary endpoint was functional outcome [assessed by the Glasgow Outcome Score (GOS)] and the secondary endpoints were mortality within 180 days after hemorrhagic stroke and influence of temperature on MR-proANP. A favorable outcome was defined as GOS 4-5, and the patients were considered to have a poor outcome with a 180-day GOS score between 1 and 3. Results: Analysis of MR-proANP was performed in 24 patients with spontaneous SAH and 22 patients with spontaneous ICH. MR-proANP was elevated on days 4 and 7 as compared to baseline levels (p < 0.05 and p < 0.001, respectively). High MR-proANP levels (>120 pmol/l) were associated with increased mortality and poor outcome (after 180 days; p < 0.05, respectively). There was no significant difference regarding MR-proANP serum concentrations between the endovascular and the control groups. Conclusions: Increased levels of MR-proANP are independently associated with poor functional outcome and increased mortality after 180 days in patients with hemorrhagic stroke. Endovascular temperature control had no significant influence on MR-proANP levels.

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“…BNP increase has been associated with the intensity of brain ischemia reflecting the magnitude of brain injury [4,7]. On the other hand, an acute blood pressure elevation has been well documented during the acute phase of stroke and it might indeed increase BNP released from the heart, as BNP plays a role in the hemodynamic regulation during this period [8].…”

Section: Discussionmentioning

confidence: 99%

Brain Natriuretic Peptide Is Associated with Worsening and Mortality in Acute Stroke Patients but Adds No Prognostic Value to Clinical Predictors of Outcome

Montaner¹,

García‐Berrocoso²,

Mendioroz³

et al. 2012

Cerebrovasc Dis

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Background: At the present time, the determination of the outcome of stroke patients is based on the analysis of clinical and neuroimaging data. The use of prognostic blood biomarkers could aid in decision-making processes, e.g. admitting patients to specialized stroke units. Although the prognostic role of natriuretic peptides has been studied in heart failure and coronary diseases, the value of brain natriuretic peptide (BNP) is less known within the field of strokes. Objective: We aimed to study the relationship between plasma levels of BNP and acute neurological worsening or mortality after stroke in a large cohort of patients (investigating both ischemic and hemorrhagic disease). Methods: Consecutive stroke patients (ischemic and hemorrhagic) admitted to the Stroke Unit of our University Hospital within 24 h of the onset of symptoms were included. Stroke severity was assessed according to the National Institutes of Health Stroke Scale (NIHSS) at admission and at discharge. Neurological worsening was defined as an increase of 4 or more points in the NIHSS score or death during the patient’s stay at the Stroke Unit. Blood samples were drawn upon admission to measure plasma levels of BNP (Biosite Inc., San Diego, Calif., USA). Statistical analysis was performed using SPSS 15.0 and R software. Results: Altogether, 896 patients were included in the study. BNP plasma levels were higher among patients who deteriorated the most over time (n = 112; 90.5 vs. 61.2 ng/l; p = 0.006) or died (n = 83; 118.2 vs. 60.9 ng/l; p < 0.001). Multivariate logistic regression analysis indicated that plasma BNP level was an independent predictor of neurological worsening [BNP >56.7 ng/l; odds ratio (OR) = 1.64; p = 0.04] and death after stroke (BNP >65.3 ng/l; OR = 1.97; p = 0.034). Adding BNP level to other well-known clinical predictors of bad outcome did not significantly increase the predictive value. Conclusions: Plasma levels of BNP measured during the acute phase of stroke are associated both with early neurological worsening and mortality. However, this biological information does not supply prognostic information which would add to clinical variables, which limits its use as a biomarker. Further investigation and systematic reviews are needed to clarify the role of natriuretic peptides in stroke outcome.

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Untitled

Cited by 43 publications

References 9 publications

Role of brain natriuretic peptide as a novel prognostic biomarker in acute ischemic stroke

Role of brain natriuretic peptide as a novel prognostic biomarker in acute ischemic stroke

The Prognostic Value of Midregional Proatrial Natriuretic Peptide in Patients with Hemorrhagic Stroke

Brain Natriuretic Peptide Is Associated with Worsening and Mortality in Acute Stroke Patients but Adds No Prognostic Value to Clinical Predictors of Outcome

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