Brain Natriuretic Peptide (Bnp): Biomarker for Risk Stratification and Functional Recovery Prediction in Ischemic Stroke

Abstract

Functional outcome after cardiovascular and cerebrovascular events is traditionally predicted using demographic and clinical variables like age, gender, blood pressure, cholesterol levels, diabetes status, smoking habits or pre-existing morbidity. Identification of new variables will improve the risk stratification of specific categories of patients. Numerous blood-based biomarkers associated with increased cardiovascular risk have been identified; some of them even predict cardiovascular events. Investigators have tried to produce prediction models by incorporating traditional risk factors and biomarkers. (1). Widely-available, rapidly processed and less expensive biomarkers could be used in the future to guide management of complex cerebrovascular patients in order to maximize their recovery (2) Recently, studies have demonstrated that biomarkers can predict not only the risk for a specific clinical event, but also the risk of death of vascular cause and the functional outcome after cardiovascular or cerebrovascular events.Early prediction of fatal outcome after stroke may improve therapeutic strategies (such as the use of more aggressive treatments or inclusion of patients in clinical trials) and guide decision-making processes in order to maximize patient's chances for survival and recovery. (3) Long term functional outcome after stroke is one of the most difficult variables to predict. Elevated serum levels of brain natriuretic peptide (BNP) are powerful predictor of outcomes in patients with cardiovascular disease (heart failure, atrial fibrillation). Potential role of BNP in predicting atrial fibrillation occurrence, cardio-embolic stroke and post-stroke mortality have been proved in many studies. However, data concerning the potential role of BNP in predicting short term and long term functional outcomes after stroke remain controversial.

The evolution of disability after ischemic stroke depending on the circadian variation of stroke onset

“…The first evaluates an individual's ability to perform daily activities required for personal needs (6 items with a maximum score of 6 points: dressing, personal hygiene, toileting, continence, walking/transfers, feeding) and the second measures the degree of independence within the community, including more complex activities (financial management, telephone use, house cleaning, meal preparation, public transportation use, shopping, laundry, selfmedication). Changes occurring in IADL suggest mild cognitive decline, while ADL changes suggest moderate/advanced cognitive decline, along with other neurological deficits that create disability as a consequence of cerebrovascular pathology [6][7][8][9]. The impact of the circadian variation of ischemic stroke onset on basic (ADL) and instrumental (IADL) functional status and, moreover, its dynamics have been less studied [10][11][12].…”

Predictors for early motor improvement in patients with ischemic stroke

“…The biomarkers that have been studied in stroke rehabilitation are S100 calcium binding protein B, Creactive protein (CRP), matrix metalloproteinases (MMPs), N-terminal pro-brain natriuretic peptide (NT-pro-BNP), interleukin-6 (IL-6) (15,16). Levels of NT-pro-BNP are correlated with NIHSS score values and are usefull in predicting prognosis in patients with acute ischemic stroke, but have no value in predicting motor recovery (17,18). Also, IL-6 did not shown to have predictive value in stroke outcome (47).…”

Seasonal variation of stroke occurrence: a hospital based-study

“…The winter period is also marked by an increase in BP values by about 5 mmHg, through the increase in arterial wall tone during the process of adaptation to cold consecutive to sympathetic activity, along with an enhancement of blood viscosity (through the increase in the number and volume of red blood cells and platelets), as well as an elevation of the serum level of coagulation factor VIII, favoring thrombotic processes [10]. In addition, during the winter months, there is an increased frequency of seasonal infections (Influenza, Chlamydia pneumonia, Helicobacter pylori) and the occurrence of other inflammatory episodes is favored [10], while the plasma levels of fibrinogen and C reactive protein, considered to be independent risk factors for cardiovascular and cerebrovascular diseases, increase [10,11,12]. The aim of our study was to investigate a possible seasonal variation in the occurrence of stroke during 2012 and the differences between the types of stroke in the Cluj-Napoca area.…”