Predicting cardioembolic stroke with the B-type natriuretic peptide test: a systematic review and meta-analysis

We performed a systematic review and meta-analysis to evaluate the value of B-type natriuretic peptide (BNP) in differentiating cardioembolic (CE) stroke from other subtypes of ischemic stroke.

We searched the EMBASE, MEDLINE, and Cochrane databases and reference lists of relevant articles published in April 2013. We selected original studies reporting the performance of BNP or N-terminal probrain natriuretic peptide (NT-proBNP) in diagnosing CE stroke and summarized test performance characteristics using forest plots, hierarchical summary receiver operating characteristic curves, and bivariate random-effect models.

Data from 2958 patients with ischemic stroke were retrieved from 16 studies. Of these, 1024 (34.6%) patients had a final diagnosis of CE stroke. Overall, the mean diagnostic odds ratio (DOR) of BNP for CE stroke was 15.8 (95% confidence interval [CI]: 9.92-25.20). Even after adjustment for multiple clinical predictors, serum natriuretic peptide levels showed a strong association with CE stroke (pooled adjusted DOR, 12.7; 95% CI: 7.32-22.0). The sensitivity and specificity of BNP for CE stroke were .78 (95% CI: .71-.87) and .83 (95% CI: .77-.87), respectively. A single BNP-negative result may be sufficient to exclude a diagnosis of CE stroke in low-prevalence (<20%) settings. Subgroup analysis showed that NT-proBNP had a slightly higher specificity (.87; 95% CI: .77-.93) and better capability for exclusion diagnosis. There was a lack of homogeneity in the timing of measurement and BNP assay method.

BNP has reasonable accuracy in the diagnosis of CE stroke and may be a useful marker for the early detection in patients who may benefit from preventive anticoagulation therapy.