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Brain natriuretic peptide as a surrogate marker for cardioembolic stroke with paroxysmal atrial fibrillation
Takayuki Naya1, Kazushi Yukiiri, Naohisa Hosomi
1Department of Cardiorenal and Cerebrovascular Medicine, Division of Stroke, Kagawa University School of Medicine, Kagawa, Japan.
Insights
Plasma brain natriuretic peptide and left atrial appendage flow measurements can help differentiate cardioembolic stroke from noncardioembolic stroke. These markers are crucial for identifying stroke type, especially in patients with atrial fibrillation.
Area of Science:
- Cardiology
- Neurology
- Biomarkers
Background:
- Cardioembolic stroke often leads to more severe disability due to larger ischemic areas.
- Differentiating cardioembolic from noncardioembolic stroke is challenging in patients with sinus rhythm upon presentation.
Purpose of the Study:
- To evaluate plasma brain natriuretic peptide levels in acute ischemic stroke patients.
- To assess the utility of these levels in differentiating cardioembolic stroke (especially due to paroxysmal atrial fibrillation) from noncardioembolic stroke.
Main Methods:
- Analyzed plasma brain natriuretic peptide, E/A ratio, left atrial diameter, and left atrial appendage flow.
- Included 76 acute cerebral infarction patients (excluding those with specific cardiac or renal conditions).
Main Results:
- Cardioembolic stroke patients with atrial fibrillation showed significantly increased plasma brain natriuretic peptide and left atrial diameter.
- Significantly decreased left atrial appendage flow was observed in cardioembolic stroke patients.
- Plasma brain natriuretic peptide and left atrial appendage flow accurately predicted cardioembolic stroke with >95% accuracy.
Conclusions:
- First-day brain natriuretic peptide and left atrial appendage flow measurements aid in differentiating cardioembolic stroke with atrial fibrillation from noncardioembolic stroke.
- These findings are valuable for clinical decision-making in stroke management.
Background:
Cardioembolic stroke generally results in severer disability, since it typically has a larger ischemic area than the other types of ischemic stroke. However, it is difficult to differentiate cardioembolic from noncardioembolic stroke (atherothrombotic and lacunar stroke), whenever ischemic stroke patients have sinus rhythm at the time of presentation.
Methods:
In this study, we evaluated the levels of plasma brain natriuretic peptide in acute ischemic stroke patients with cardioembolic or noncardioembolic stroke and assessed whether this could provide a basis for differentiating cardioembolic stroke (especially due to paroxysmal atrial fibrillation) from noncardioembolic stroke. Our patient cohort consisted of 99 consecutive patients with acute cerebral infarction who were admitted to Kagawa University School of Medicine Hospital from January 1, 2005, to December 31, 2006. We excluded 23 patients with valve disease, heart failure, myocardial infarction or chronic renal failure. The mean age of the remaining 76 patients (51 males, 25 females) was 70.0 +/- 10.1 years.
Results:
Thirty-six patients had cardioembolic stroke with atrial fibrillation (including permanent and paroxysmal atrial fibrillation); the remaining 40 had noncardioembolic stroke. The plasma brain natriuretic peptide was evaluated on the first morning after admission in all patients. In cardioembolic stroke with atrial fibrillation (permanent and paroxysmal atrial fibrillation), the plasma brain natriuretic peptide, ratio of peak early filling velocity to peak atrial systolic velocity (E/A) and left atrial diameter were significantly increased (p < 0.001), and the left atrial appendage flow was significantly decreased (p < 0.001), compared with noncardioembolic stroke. Analyzed in those 4 factors, cardioembolic stroke was strongly predicted with >95% accuracy assessed by plasma brain natriuretic peptide and left atrial appendage flow.
Conclusion:
From our results, it was suggested that the first-day brain natriuretic peptide and left atrial appendage flow measurements would be helpful in differentiating cardioembolic stroke with atrial fibrillation from noncardioembolic stroke.
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