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High pro-BNP levels predict the occurrence of atrial fibrillation after cryptogenic stroke
Manuel Rodríguez-Yáñez1, Susana Arias-Rivas, María Santamaría-Cadavid
1Clinical Neuroscience Research Laboratory, Department of Neurology, Hospital Clínico Universitario, Health Research Institute of Santiago de Compostela-IDIS, University of Santiago de Compostela, Santiago de Compostela, Spain.
Insights
Elevated pro-brain natriuretic peptide (BNP) levels in patients with cryptogenic stroke may predict the development of atrial fibrillation (AF). A pro-BNP level of 360 pg/mL or higher increases the risk of detecting AF by fivefold.
Area of Science:
- Cardiology
- Neurology
- Biomarkers
Background:
- Secondary prevention of stroke often involves antiplatelets.
- Undetected cardioembolic sources in cryptogenic stroke can impact treatment strategies.
- High pro-brain natriuretic peptide (BNP) levels are linked to cardioembolic stroke.
Purpose of the Study:
- To investigate if acute-phase pro-BNP levels predict atrial fibrillation (AF) development in cryptogenic stroke patients.
- To assess the utility of pro-BNP as a predictive biomarker for AF in this population.
Main Methods:
- Prospective study of patients with cryptogenic stroke.
- Pro-BNP levels measured within 24 hours of stroke onset.
- Follow-up for up to 2 years to detect AF development.
Main Results:
- Among 264 patients with cryptogenic stroke, 15 (5.6%) developed AF.
- Patients who developed AF were older, had more hypertension, and higher pro-BNP levels.
- Pro-BNP ≥360 pg/mL was independently associated with AF development (OR 5.70, p=0.037).
Conclusions:
- A pro-BNP level of 360 pg/mL or higher significantly increases the likelihood of detecting AF in cryptogenic stroke patients.
- Pro-BNP serves as a valuable predictor for AF in the secondary prevention of cryptogenic stroke.
Objective:
Antiplatelets are recommended for secondary prevention in patients with cryptogenic stroke; however, some patients may present with a cardioembolic source that has not been detected, which may modify the treatment. Because high pro-brain natriuretic peptide (BNP) levels are associated with cardioembolic stroke, our objective was to determine whether pro-BNP levels in the acute phase of stroke predict the development of atrial fibrillation (AF) in patients with cryptogenic stroke.
Methods:
A prospective study including patients with cryptogenic stroke was conducted. Demographic data, medical history, and stroke characteristics were assessed at admission. A blood sample was obtained within the first 24 hours from stroke onset to determine pro-BNP levels. Patients were followed by a neurologist at 3 and 6 months and later by a primary care physician for 2 years to evaluate the development of AF.
Results:
One thousand fifty patients with ischemic stroke were evaluated. Three hundred seventy-two patients (35%) had cryptogenic stroke. One hundred eight patients were excluded from the study, so 264 patients were valid for the analysis. AF was detected in 15 patients (5.6%) during the follow-up. Patients who developed AF were older, had hypertension more frequently, and showed higher levels of pro-BNP. In the logistic regression model, we found that pro-BNP ≥360 pg/mL was the only variable independently associated with the risk of developing AF (odds ratio 5.70, 95% confidence interval 1.11-29.29, p = 0.037).
Conclusions:
Pro-BNP ≥360 pg/mL increases by 5-fold the possibility of detecting AF during follow-up in patients with cryptogenic stroke.
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