B-type natriuretic peptides help in cardioembolic stroke diagnosis: pooled data meta-analysis
Víctor Llombart1, Albert Antolin-Fontes1, Alejandro Bustamante1
1From the Neurovascular Research Laboratory, Institut de Recerca Vall d'Hebron, Neurovascular Unit, Department of Neurology, Universitat Autònoma de Barcelona, Barcelona, Spain (V.L., A.A.-F., A.B., D.G., T.G.-B., J.M.); Acute Stroke Services, Massachusetts General Hospital, J. Philip Kistler Stroke Research Center, Boston (N.S.R.); Department of Neurology, Rhode Island Hospital, Alpert Medical School of Brown University, Providence (K.F.); Department of Stroke Medicine, Kawasaki Medical School, Kurashiki, Okayama, Japan (K.S.); Department of Cardiology, Haydarpaşa Numune Education and Research Hospital, Istanbul, Turkey (M.B.); Department of Neurology, Clinical University, Hospital University of Santiago de Compostela, Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela, Spain (J.C., M.R.-Y.); Department of Neurosciences (Neurology), Hospital de Santa Maria, University of Lisbon, Lisbon, Portugal (A.C.F.); Department of Cardiology, Pulmonology and Nephrology, Yamagata University School of Medicine, Yamagata, Japan (T.W.); Department of Neurology, Stroke Unit, Hospital Universitari Arnau de Vilanova, Grup Neurociències Clíniques IRBLleida, Lleida, Spain (F.P.); Department of Emergency Medicine, Foshan Hospital of Traditional Chinese Medicine, Foshan, Guangdong, China (W.Z.); Department of Neurology, Kliniken Südostbayern-Klinikum Traunstein, Traunstein, Germany; Department of Psychiatry and Psychotherapy, Technische Universität München, München, Germany (T.E.); Department of Clinical Neuroscience and Therapeutics, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan (N.H.); Tehran University of Medical Sciences and Health Services, Tehran, Iran (S.R.J.K.); Stroke and Parkinson's Disease Services, Lincoln County Hospital, University of Nottingham, Nottingham, United Kingdom (J.C.S.); Department of Neurology, University of Ulm, Ulm, Germany (C.K.); Stroke Unit, Department of Neurology, Hospital
Natriuretic peptides, such as B-type natriuretic peptide (BNP) and N-terminal pro-BNP (NT-proBNP), are elevated in cardioembolic stroke. These biomarkers significantly improve stroke cause identification and secondary prevention strategies.
Area of Science:
- Cardiology
- Neurology
- Biomarker Research
Background:
- Identifying stroke causes is crucial for effective secondary prevention.
- Elevated natriuretic peptides (BNP/NT-proBNP) are linked to cardioembolic stroke.
Purpose of the Study:
- To systematically review and meta-analyze the clinical value of BNP/NT-proBNP as pathogenic biomarkers for stroke.
- To evaluate the predictive value of natriuretic peptides in identifying cardioembolic stroke.
Main Methods:
- Systematic literature search of PubMed (until Nov 2013) for studies comparing BNP/NT-proBNP levels across stroke causes.
- Individual participant data meta-analysis of 2834 patients to assess predictive values.
- Logistic regression models incorporating clinical variables and dichotomized peptide levels to evaluate sensitivity, specificity, and added value (AUC, IDI).
Main Results:
- BNP/NT-proBNP levels were significantly elevated in cardioembolic stroke up to 72 hours post-onset.
- Models including BNP/NT-proBNP demonstrated high sensitivity (>90%) and specificity (>80%).
- Biomarkers significantly improved model discrimination (AUC, IDI) compared to clinical factors alone. Validation in 197 patients confirmed findings.
Conclusions:
- Natriuretic peptides are robustly elevated in cardioembolic strokes.
- Further multicenter prospective studies are needed to optimize biomarker selection, timing, and cutoff points for cardioembolic stroke identification.
