Natriuretic Peptides and Mortality After Stroke

Abstract

Background and Purpose-Measurement of natriuretic peptides provides prognostic information in various patient populations. The prognostic value of natriuretic peptides among patients with acute stroke is not known, although elevated peptide levels have been observed. Methods-A series of 51 patients (mean age, 68Ϯ11years) with first-ever ischemic stroke underwent a comprehensive clinical examination and measurements of plasma atrial natriuretic peptides (N-ANP) and brain natriuretic peptides (N-BNP) in the acute phase of stroke. The patients were followed-up for 44Ϯ21 months. Risk factors for all-cause mortality were assessed. Control populations, matched for gender and age, consisted of 51 patients with acute myocardial infarction (AMI) and 25 healthy subjects. Results-Plasma concentrations of N-ANP (meanϮSD, 988Ϯ993 pmol/L) and N-BNP (751Ϯ1608 pmol/L) in the stroke patients were at the same level as those in the AMI patients (NS for both), but significantly higher than those of the healthy subjects (358Ϯ103 pmol/L, PϽ0.001 and 54Ϯ26 pmol/L, PϽ0.01, respectively). Elevated levels of N-ANP and N-BNP predicted mortality after stroke (risk ratio [RR] 4.3, PϽ0.01 and RR 3.9, PϽ0.01, respectively) and after AMI (PϽ0.05), and remained independent predictors of death after stroke even after adjustment for age, diabetes, coronary artery disease, and medication (RR 3.9, PϽ0.05 and RR 3.7, PϽ0.05, respectively). Conclusion-Plasma levels of natriuretic peptides are elevated in the acute phase of stroke and predict poststroke mortality.

Etiologic Diagnosis of Ischemic Stroke Subtypes With Plasma Biomarkers

“…17,18 However, although in our study BNP also showed a slight correlation with the NIHSS score, it remained an independent predictor of cardioembolic etiology after correcting for stroke severity and extent. Moreover, BNP is also an independent predictor of cardioembolic TIA, thus supporting the concept that infarct size is not the cause of excessive BNP production.…”

“…Plasma levels of BNP have previously been described as elevated in the acute phase of stroke, 16,17 and some authors have suggested that BNP levels are correlated with neurologic deficits. 17,18 However, although in our study BNP also showed a slight correlation with the NIHSS score, it remained an independent predictor of cardioembolic etiology after correcting for stroke severity and extent.…”

The Prognostic Value of Combined NT-pro-BNP Levels and NIHSS Scores in Patients with Acute Ischemic Stroke

“…Recently, acute-phase levels of NT-pro-BNP have been reported to be associated with mortality in patients with acute ischemic stroke (9,16). It has been well established that acute stroke is associated with a higher prevalence of associated acute cardiovascular effects, including left ventricular dysfunction, and is strongly associated with prevalent AF, which is expected to increase the NT-pro-BNP level in a prognostically meaningful manner (9).…”

“…Therefore, our data further highlight the importance of the NT-pro-BNP level in patients with acute ischemic stroke. So far, substantial research has demonstrated that not only does the NT-pro-BNP level predict the likelihood of ischemic stroke (18,19) and the potential for early hazards after acute ischemic stroke (11,12), it also serves as a useful tool for predicting the prognosis distant from the index event (16). There exists a strong association between the NT-pro-BNP level and patient outcomes.…”

Plasma Brain Natriuretic Peptide Can be a Biological Marker to Distinguish Cardioembolic Stroke from Other Stroke Types in Acute Ischemic Stroke

“…In addition, plasma BNP levels have been shown to be elevated in patients with acute ischemic stroke, in particular with atrial fibrillation (AF) (3,4 T a b l e 1 . B a s e l i n e Ch a r a c t e r i s t i c T a b l e 2 .…”