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B-type natriuretic peptide is associated with post-discharge stroke in hospitalized patients with heart failure
Yu Hotsuki1, Yu Sato1, Akiomi Yoshihisa1,2
1Department of Cardiovascular Medicine, Fukushima Medical University, Fukushima, Japan.
Insights
B-type natriuretic peptide (BNP) levels can predict stroke in patients with chronic heart failure (CHF). Higher BNP levels, alone or combined with the CHADS₂ score, improve stroke risk prediction in CHF patients.
Area of Science:
- Cardiology
- Neurology
- Biomarkers
Background:
- B-type natriuretic peptide (BNP) is a known stroke predictor in atrial fibrillation.
- Its role in chronic heart failure (CHF) stroke prediction is less understood.
Purpose of the Study:
- To investigate the association between BNP levels and future stroke occurrence in CHF patients.
- To evaluate BNP's predictive value, alone and with the CHADS₂ score.
Main Methods:
- Prospective study of 1803 decompensated heart failure patients.
- Assessed BNP levels and CHADS₂ scores for post-discharge stroke prediction.
- Used Cox proportional hazard analysis and classification and regression tree analysis.
Main Results:
- 69 patients (3.8%) experienced stroke post-discharge.
- Stroke group had higher CHADS₂ scores and prevalence of hypertension, atrial fibrillation, prior stroke, and CKD.
- BNP levels were significantly higher in the stroke group (452.1 vs. 222.7 pg/mL).
- BNP was an independent predictor of post-discharge stroke (HR 2.636).
- Optimal BNP cut-off was 187.7 pg/mL.
- BNP-added CHADS₂ score improved predictive value over CHADS₂ alone (AUC 0.723 vs. 0.698).
Conclusions:
- BNP assessment can predict stroke in CHF patients.
- BNP improves stroke risk stratification when added to the CHADS₂ score.
Aims:
Recently, B-type natriuretic peptide (BNP) has been attracting attention as a predictor of stroke in patients with atrial fibrillation or those with prior stroke experience. However, the association between BNP and stroke has not been examined in patients with chronic heart failure (CHF). In the current study, we assessed whether BNP is associated with future occurrence of stroke in patients with CHF.
Methods And Results:
We prospectively studied 1803 consecutive patients who were admitted for decompensated HF and assessed the predictive value of circulating BNP levels for occurrence of post-discharge stroke. A total of 69 (3.8%) patients experienced a stroke (the stroke group) during the post-discharge follow-up period of a median of 1150 days. The stroke group showed a higher CHADS2 score. With respect to past medical history, the stroke group had a higher prevalence of arterial hypertension, atrial fibrillation, prior stroke, and chronic kidney disease. Echocardiographic parameters showed no significant differences between the two groups. In contrast, BNP levels were significantly higher in the stroke group than in the non-stroke group (452.1 vs. 222.7 pg/mL, P < 0.001). Multivariate Cox proportional hazard analysis indicated that BNP levels were independently associated with post-discharge stroke (hazard ratio 2.636, 95% confidence interval 1.595-4.357, P < 0.001). The survival classification and regression tree analysis revealed that the accurate cut-off point of BNP in predicting post-discharge stroke was 187.7 pg/mL. We added high BNP level (BNP ≥ 180 pg/mL) as one point to CHADS2 score. The BNP-added CHADS2 score was compared with CHADS2 score alone by using c-statistics. The areas under the curve of CHADS2 score, BNP, and BNP-added CHADS2 score were 0.698, 0.616, and 0.723, respectively. The predictive value of BNP-added CHADS2 score was higher compared with those of CHADS2 score (P = 0.026).
Conclusions:
The assessment of BNP may predict the occurrence of stroke in CHF patients used alone or in combination with established CHADS2 score.
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