Abstract
BackgroundWe analyzed the prognostic value of b-type natriuretic peptide (BNP) and sensitive cardiac Troponin (s-cTnI) in patients with ischemic stroke or transient ischemic attack (TIA) and their significance in predicting stroke aetiology.MethodsIn a prospectively enrolled cohort we measured BNP and s-cTnI levels upon admission. Primary endpoints were mortality, unfavorable functional outcome and stroke recurrence after 90 days and after 12 months. Secondary endpoint was cardioembolic aetiology.ResultsIn 441 patients BNP but not s-cTnI remained an independent predictor for death with an adjusted HR of 1.2 (95% CI 1.1–1.4) after 90 days and 1.2 (95% CI 1.0–1.3) after one year. The comparison of the Area under Receiver Operating Characteristic (AUROC) of model A (age, NIHSS) and model B (age, NIHSS, BNP) showed an improvement in the prediction of mortality (0.85 (95% CI 0.79–0.90) vs. 0.86 (95% CI 0.81–0.92), Log Rank p = 0.004). Furthermore the category free net reclassification improvement (cfNRI) when adding BNP to the multivariate model was 57.5%, p<0.0001. For the prediction of functional outcome or stroke recurrence both markers provided no incremental value. Adding BNP to a model including age, atrial fibrillation and heart failure lead to a higher discriminatory accuracy for identification of cardioembolic stroke than the model without BNP (AUC 0.75 (95% CI 0.70–0.80) vs. AUC 0.79, (95% CI 0.75–0.84), p = 0.008).ConclusionBNP is an independent prognostic maker for overall mortality in patients with ischemic stroke or TIA and may improve the diagnostic accuracy to identify cardioembolic aetiology.Trial RegistrationClinicalTrials.gov NCT00390962
Highlights
Several prognostic [1] and some aetiological biomarkers have been evaluated in ischemic stroke but so far most failed to show incremental information
b-type natriuretic peptide (BNP) levels were associated with cardioembolic stroke aetiology [8,9]
New published data show that BNP levels are associated with transient ischemic attack (TIA) recurrence after a TIA [14]
Summary
Several prognostic [1] and some aetiological biomarkers have been evaluated in ischemic stroke but so far most failed to show incremental information. BNP levels were associated with cardioembolic stroke aetiology [8,9]. New published data show that BNP levels are associated with TIA recurrence after a TIA [14] These data base on a small group of patients and need to be verified in a larger cohort. The incremental prognostic value concerning overall mortality, was limited The authors of this metaanalysis concluded with the remark that further well designed cohort studies are needed to assess the predictive value of BNP in stroke patients [15]. We analyzed the prognostic value of b-type natriuretic peptide (BNP) and sensitive cardiac Troponin (s-cTnI) in patients with ischemic stroke or transient ischemic attack (TIA) and their significance in predicting stroke aetiology
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