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      Serum B-type natriuretic peptide level and timing of its measurement as a predictor of acute ischemic stroke outcome

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          Abstract

          An increased B-type natriuretic peptide (BNP) level is associated with cardioembolic stroke because of atrial fibrillation. However, data associating the measurement time of BNP and clinical influence of BNP are limited. Herein, we examined the utility of BNP level for prediction of stroke severity when accounting for measurement time. We retrospectively registered 327 patients admitted within 7 days from onset of ischemic stroke. We collected information on patients' background, stroke risk factors, subtype and severity, and outcome at discharge. Measurement of BNP was performed by chemiluminescent enzyme immunoassay. Patients were divided into 3 groups according to the time of BNP measurement from disease onset. Multivariate analyses were performed to evaluate the association of BNP value with outcome after patients were grouped according to BNP measurement time. Of the 327 patients, the numbers of patients whose BNP was measured within 24 h of symptom onset, between 24 and 48 h of symptom onset, and after 48 h of symptom onset were 102, 92, and 133, respectively. Favourable outcome at discharge was negatively correlated with BNP value in patients with a BNP level measured within 24 h of stroke onset. BNP value may be useful for prediction of stroke outcome if measured within 24 h after stroke onset.

          Highlights

          • We investigated the association between earlier BNP value and stroke severity.

          • We registered 327 patients admitted to our neurological center within 7 days.

          • BNP value was inversely correlated with the outcome when measured within 24 h.

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          Most cited references17

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          Rapid measurement of B-type natriuretic peptide in the emergency diagnosis of heart failure.

          B-type natriuretic peptide is released from the cardiac ventricles in response to increased wall tension. We conducted a prospective study of 1586 patients who came to the emergency department with acute dyspnea and whose B-type natriuretic peptide was measured with a bedside assay. The clinical diagnosis of congestive heart failure was adjudicated by two independent cardiologists, who were blinded to the results of the B-type natriuretic peptide assay. The final diagnosis was dyspnea due to congestive heart failure in 744 patients (47 percent), dyspnea due to noncardiac causes in 72 patients with a history of left ventricular dysfunction (5 percent), and no finding of congestive heart failure in 770 patients (49 percent). B-type natriuretic peptide levels by themselves were more accurate than any historical or physical findings or laboratory values in identifying congestive heart failure as the cause of dyspnea. The diagnostic accuracy of B-type natriuretic peptide at a cutoff of 100 pg per milliliter was 83.4 percent. The negative predictive value of B-type natriuretic peptide at levels of less than 50 pg per milliliter was 96 percent. In multiple logistic-regression analysis, measurements of B-type natriuretic peptide added significant independent predictive power to other clinical variables in models predicting which patients had congestive heart failure. Used in conjunction with other clinical information, rapid measurement of B-type natriuretic peptide is useful in establishing or excluding the diagnosis of congestive heart failure in patients with acute dyspnea. Copyright 2002 Massachusetts Medical Society.
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            Relations of biomarkers of distinct pathophysiological pathways and atrial fibrillation incidence in the community.

            Biomarkers of multiple pathophysiological pathways have been related to incident atrial fibrillation (AF), but their predictive ability remains controversial. In 3120 Framingham cohort participants (mean age 58.4+/-9.7 years, 54% women), we related 10 biomarkers that represented inflammation (C-reactive protein and fibrinogen), neurohormonal activation (B-type natriuretic peptide [BNP] and N-terminal proatrial natriuretic peptide), oxidative stress (homocysteine), the renin-angiotensin-aldosterone system (renin and aldosterone), thrombosis and endothelial function (D-dimer and plasminogen activator inhibitor type 1), and microvascular damage (urinary albumin excretion; n=2673) to incident AF (n=209, 40% women) over a median follow-up of 9.7 years (range 0.05 to 12.8 years). In multivariable-adjusted analyses, the biomarker panel was associated with incident AF (P<0.0001). In stepwise-selection models (P<0.01 for entry and retention), log-transformed BNP (hazard ratio per SD 1.62, 95% confidence interval 1.41 to 1.85, P<0.0001) and C-reactive protein (hazard ratio 1.25, 95% confidence interval 1.07 to 1.45, P=0.004) were chosen. The addition of BNP to variables recently combined in a risk score for AF increased the C-statistic from 0.78 (95% confidence interval 0.75 to 0.81) to 0.80 (95% confidence interval 0.78 to 0.83) and showed an integrated discrimination improvement of 0.03 (95% confidence interval 0.02 to 0.04, P<0.0001), with 34.9% relative improvement in reclassification analysis. The combined analysis of BNP and C-reactive protein did not appreciably improve risk prediction over the model that incorporated BNP in addition to the risk factors. BNP is a predictor of incident AF and improves risk stratification based on well-established clinical risk factors. Whether knowledge of BNP concentrations may be used to target individuals at risk of AF for more intensive monitoring or primary prevention requires further investigation.
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              Etiologic diagnosis of ischemic stroke subtypes with plasma biomarkers.

              Because there is no biologic marker offering precise information about stroke etiology, many patients receive a diagnosis of undetermined stroke even after all available diagnostic tests are done, precluding correct treatment. To examine the diagnostic value of a panel of biochemical markers to differentiate stroke etiologies, consecutive acute stroke patients were prospectively evaluated. Brain computed tomography, ultrasonography, cardiac evaluations, and other tests were done to identify an etiologic diagnosis according to TOAST classification. Blood samples were drawn on Emergency Department arrival ( 76 pg/mL 2.3 (1.4-3.7, P=0.001); and D-dimer >0.96 microg/mL 2.2 (1.4-3.7, P=0.001). Even among patients with transient symptoms (n=155), a high BNP level identified cardioembolic etiology (6.7, 2.4-18.9; P<0.001). A model combining clinical and biochemical data had a sensitivity of 66.5% and a specificity of 91.3% for predicting cardioembolism. Using a combination of biomarkers may be a feasible strategy to improve the diagnosis of cardioembolic stroke in the acute phase, thus rapidly guiding other diagnostic tests and accelerating the start of optimal secondary prevention.
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                Author and article information

                Contributors
                Journal
                eNeurologicalSci
                eNeurologicalSci
                eNeurologicalSci
                Elsevier
                2405-6502
                02 December 2019
                March 2020
                02 December 2019
                : 18
                : 100217
                Affiliations
                Department of Neurology, Faculty of Medicine, Fukuoka University, Japan
                Author notes
                [* ]Corresponding author at: Department of Neurology, Fukuoka University, 7-45-1 Nanakuma, Jonan-ku, Fukuoka 814-0180, Japan. tsuboi@ 123456cis.fukuoka-u.ac.jp
                Article
                S2405-6502(19)30041-3 100217
                10.1016/j.ensci.2019.100217
                6926319
                31890906
                fd434afc-70d3-465d-a86d-9069d4fb2c91
                © 2019 Published by Elsevier B.V.

                This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

                History
                : 29 April 2019
                : 30 November 2019
                : 2 December 2019
                Categories
                Original Article

                b-type natriuretic peptide (bnp),ischemic stroke,measurement time,outcome

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