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Brain Natriuretic Peptide and Particular Left Ventricle Segment Asynergy Associated with Cardioembolic Stroke from
Naohisa Hosomi1, Takeshi Yoshimoto2, Yuhei Kanaya2
1Department of Clinical Neuroscience and Therapeutics, Hiroshima University Graduate School of Biomedical & Health Sciences, Hiroshima, Japan.
Insights
High plasma BNP levels and specific left ventricular wall motion abnormalities indicate a higher risk of cardioembolic stroke in patients with prior myocardial infarction. This helps in precise risk stratification and targeted antithrombotic therapy.
Area of Science:
- Cardiology
- Neurology
- Internal Medicine
Background:
- Determining cardioembolic stroke risk in myocardial infarction (MI) patients is crucial for anticoagulant use.
- A 16-segment model can refine risk assessment in post-MI patients.
- Evaluating plasma brain natriuretic peptide (BNP) in relation to left ventricle ejection fraction (LVEF < 40%) is important.
Purpose of the Study:
- To precisely evaluate cardioembolic stroke risks associated with specific left ventricular segments in patients with old MI.
- To assess the association of plasma BNP levels with cardioembolic stroke risk in this population.
Main Methods:
- Analyzed 143 ischemic stroke patients with prior MI, excluding those with atrial fibrillation or acute MI.
- Assessed left ventricle wall motion abnormalities and plasma BNP levels upon admission.
Main Results:
- Hypertension and plasma BNP ≥ 206.9 pg/mL were independently associated with cardioembolic stroke.
- High risk was identified in basal-inferior, basal-inferolateral, mid-anterior, mid-anteroseptal, apical-anterior, and apical-septal segments, independent of other factors.
Conclusions:
- Elevated plasma BNP and left ventricular wall motion abnormalities in LAD or RCA territories indicate high cardioembolic stroke risk in old MI patients.
- These findings allow for more precise cardioembolic stroke risk definition and tailored antithrombotic treatment strategies.
Background:
It is important to determine the usage of anticoagulants by defining the actual risk of cardioembolic stroke in patients with old myocardial infarction. In the present study, we aimed to more precisely evaluate the risks of each segment associated with cardioembolic stroke using a 16-segment model. The usage of the plasma brain natriuretic peptide (BNP) associated with cardioembolic stroke was also evaluated in comparison with a left ventricle ejection fraction less than 40%.
Methods:
There were a total of 190 ischemic stroke patients who had premorbid myocardial infarction. The study included a total of 143 ischemic stroke patients with old myocardial infarction who were available for evaluation and excluded patients with atrial fibrillation or acute myocardial infarction. Their left ventricle wall motion abnormality and the level of plasma BNP at their admission were analyzed.
Results:
Hypertension and a plasma BNP level of 206.9 pg/mL or higher, determined from the receiver operating characteristic curve, were independently associated with cardioembolic stroke (χ(2) = 35.6, R(2) = .30, P < .001). Adjusting for these factors, statistically independent high risk was observed at the basal-inferior, basal-inferolateral, mid-anterior, mid-anteroseptal, apical-anterior, and apical-septal left ventricles.
Conclusion:
High plasma BNP levels and left ventricular wall motion abnormalities in the segments perfused with left anterior descending coronary artery or right coronary artery show a high risk for cardioembolic stroke in patients with old myocardial infarction. Considering these factors, it could be possible to more precisely define the risk of cardioembolic stroke and to perform appropriate antithrombotic treatments in old myocardial infarction patients.
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