Plasma brain natriuretic peptide is a biomarker for screening ischemic cerebral small vessel disease in patients with hypertension

Abstract

Plasma brain natriuretic peptide (BNP), a diagnostic marker of cardiovascular diseases, has been previously linked to cerebrovascular diseases. Our goal was to determine whether plasma BNP level is helpful for identifying high-risk individuals who are likely to present with the 3 main subtypes of cerebral small vessel diseases (CSVDs), namely, white matter lesions, lacunar infarcts, and cerebral microbleeds, on magnetic resonance imaging (MRI) in patients with hypertension.Three hundred forty-six consecutive hypertensive patients presenting at our cardiology or neurology clinic were investigated. Plasma BNP level was measured by chemiluminescent microparticle immunoassay. The presence of CSVD was assessed by 1.5-T brain MRI. Multivariate linear regression was used to determine whether individual or combined MRI-defined CSVD subtypes were associated with BNP level, after adjustment for several covariates.The mean age of patients was 69.1 ± 9.8 years, and 44.2% were female. The highest quartile BNP group was positively associated with advanced age, female sex, clinically manifesting cardiac diseases, and ischemic CSVD (white matter lesions and lacunar infarcts) and no association with cerebral microbleeds. According to multivariate linear regression, white matter lesions [β = 0.722; 95% confidence interval (95% CI), 0.624-0.819] and lacunar infarcts (β = 0.635; 95% CI, 0.508-0.762) were independently associated with BNP level, even after controlling for vascular risk factors and clinically manifesting cardiac diseases. Combined white matter lesions and lacunar infarcts were more strongly associated with BNP level than each subtype alone. With the cutoff value of 106.4 pg/mL, BNP level had a sensitivity, a specificity, and an area under the curve of 95.2%, 64.9%, and 0.799, respectively, for white matter lesions, whereas the values were 143.0 pg/mL, 81.6%, 73.5%, and 0.848, respectively, for lacunar infarcts.Plasma BNP level, which is independently correlated with individual or combined white matter lesions and lacunar infarcts, is a useful molecular marker for identifying ischemic CSVD in patients with hypertension.

The Correlation between Severity of Neurological Impairment and Left Ventricular Function in Patients after Acute Ischemic Stroke

“…Additionally, clinical observation study has previously revealed that 25% to 30% of the brain death patients had left ventricular (LV) dysfunction [13]. Furthermore, previous studies [14,15,16] have shown that the level of brain natriuretic peptide (BNP) or N-terminal pro-BNP (NT-proBNP) can be used for detection of cardioembolic stroke and is strongly related to severity of stroke. Data from our previous study [17] has also demonstrated that the NT-proBNP, a useful biomarker for predictive of acute decompensated heart failure, is not only significantly increased in patients after AIS but also an independent predictor for unfavorable neurological outcomes.…”

“…Data from our previous study [17] has also demonstrated that the NT-proBNP, a useful biomarker for predictive of acute decompensated heart failure, is not only significantly increased in patients after AIS but also an independent predictor for unfavorable neurological outcomes. These findings [13,14,15,16] raise the hypothesis that there may be a strongly negative correlation between the neurological functional status and the left ventricular ejection fraction (LVEF) in patients after AIS. However, relevant data to address this issue has been regrettably rarely reported [17].…”

“…On the other hand, it is well recognized that the crucial contributors to short-term and long-term moralities after AIS are the non-cerebrovascular complications such as severe infection, sepsis, myocardial infarction or other major organ (heart, lung or kidney) dysfunction, rather than cerebrovascular event per se. This issue may highlight the concept that “to improve neurological prognosis after AIS, the integrity of LV systolic function must be as early evaluated and preserved as possible.” With this concept in mind and the aforementioned issues [10,11,12,13,14,15,16,17], we, therefore, conducted a clinical study to investigate the correlation of LV ejection fraction (LVEF) with the stroke severity scores.…”

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

“…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. 32 Additionally, a prospective study of patients with non-valvular AF showed that high plasma BNP levels (≥170 pg/mL) were associated with thromboembolic events, and BNP may be a useful biomarker, which can either be used alone or in combination with scoring systems for stroke such as CHADS 2 score.…”

“…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 32 .…”