Clinical Investigation
Imaging and Diagnostic Testing
Elevated plasma N-terminal pro–brain natriuretic peptide levels in acute ischemic stroke

https://doi.org/10.1016/j.ahj.2005.05.022Get rights and content

Background

B-type natriuretic peptide (BNP) is a neurohormone secreted mainly in the cardiac ventricles in response to volume expansion and pressure overload. The aim of this study was to assess plasma N-terminal proBNP (NT-proBNP) changes in acute ischemic stroke (AIS).

Methods

The study group consisted of 57 (37 women aged 64 ± 12 years) patients who had their first AIS and no history or signs of cardiovascular disease. An age-matched control group was also included (n = 57, 36 women aged 61 ± 6 years). NT-proBNP, troponin I (TnI), and creatine kinase–MB were evaluated. A thorough cardiovascular and neurological investigation, including imaging techniques and lesion size determination, was also performed.

Results

The log NT-proBNP peak levels, TnI, and creatine kinase–MB levels were significantly higher in AIS compared with controls (7.25 ± 1.77 vs 3.48 ± 0.76 pg/mL, P < .0001; 0.76 ± 0.54 vs 0.5 ± 0.0 ng/mL, P < .001; 57 ± 37 vs 13 ± 4 U/L, P < .001, respectively). The log NT-proBNP correlated positively with TnI (r = 0.29, P = .03) and heart rate (r = 0.41, P = .002), and negatively with left ventricular ejection fraction (r = −0.67, P < .0001). Patients with signs of marked myocardial ischemia and patients with insular cortex involvement had even higher NT-proBNP levels. After adjustment for relevant factors, the relation between the log NT-proBNP and AIS as well as insular cortex involvement was observed to be insignificant (P > .05 for both).

Conclusions

Our results show that NT-proBNP plasma levels are significantly elevated in AIS and might be of clinical importance as a supplementary tool for the assessment of cardiovascular function in patients with AIS.

Section snippets

Methods

A total of 57 consecutive patients who were admitted to our neurological intensive care unit between October 2003 and May 2004 within the first 24 hours of an AIS were included as the study group. The diagnosis of AIS was established both clinically and radiologically (computed tomography [CT] or magnetic resonance imaging [MRI]). A total of 57 age- and gender-matched healthy individuals were included as controls. Focal or global loss of brain functions lasting for >24 hours and causing

Patient characteristics

There were 37 female and 20 male AIS patients in the study, with a mean age of 64.5 ± 11.3 years (range 35-85). Control group consisted of 36 female and 21 male patients, with a similar mean age of 61.3 ± 6.09 years (range 36-71) (P > .05). Forty-three patients (75%) with AIS had hypertension, and 11 (19%) had diabetes mellitus. Thirteen patients (23%) were active smokers. Twenty-three patients (40%) had insular cortex involvement in CT or MR images, and the diameter of the infarct was >3 cm in

Discussion

To our knowledge, our study is the first to report a significant increase in NT-proBNP levels in patients with AIS. This increase is at the highest level on the first day of AIS and declines significantly on the following days. Importantly, some patients had elevated NT-proBNP levels even if their LVEF was preserved. This observation suggests that increase in NT-proBNP is not limited to primary cardiac conditions, and they may also be elevated in AIS, as they may in pulmonary embolism,12 cor

References (38)

  • S. Sen et al.

    Cardiac disorders and stroke

    Curr Opin Neurol

    (1998)
  • A. Kolin et al.

    Myocardial damage from acute cerebral lesions

    Stroke

    (1984)
  • S.L. Tokgozoglu et al.

    Effects of stroke localization on cardiac autonomic balance and sudden death

    Stroke

    (1999)
  • G.C. Fonarow et al.

    Combining natriuretic peptides and necrosis markers in determining prognosis in heart failure

    Rev Cardiovasc Med

    (2003)
  • P.A. McCullough et al.

    B-type natriuretic peptides: a diagnostic breakthrough for clinicians

    Rev Cardiovasc Med

    (2003)
  • A. Maisel

    B-type natriuretic peptide levels: diagnostic and prognostic in congestive heart failure: what's next?

    Circulation

    (2002)
  • M.G. Buckley et al.

    Plasma concentrations and comparisons of brain natriuretic peptide and atrial natriuretic peptide in normal subjects, cardiac transplant recipients and patients with dialysis-independent or dialysis dependent chronic renal failure

    Clin Sci

    (1992)
  • G.A. Sagnella

    Measurement and significance of circulating natriuretic peptides in cardiovascular disease

    Clin Sci

    (1998)
  • W.J. Remme et al.

    Task Force for the Diagnosis and Treatment of Chronic Heart Failure, European Society of Cardiology. Guidelines for the diagnosis and treatment of chronic heart failure

    Eur Heart J

    (2001)
  • Cited by (84)

    • Atrial Fibrillation, thromboembolic risk, and the potential role of the natriuretic peptides, a focus on BNP and NT-proBNP – A narrative review

      2022, IJC Heart and Vasculature
      Citation Excerpt :

      Baseline natriuretic peptide(NP)s have been shown to predict stroke, with N-Terminal Pro Brain Natriuretic Peptide (NT-proBNP) levels correlating to the degree of arteriosclerosis[33] and carotid plaque burden[34], both of which are associated with ischaemic stroke[35,36]. They are also frequently and significantly increased after an acute ischemic stroke[37,38], even when adjusted for age and sex[39]. Similarly, mid regional pro-atrial natriuretic peptide (MR-proANP) has been identified as a biomarker of CE(cardioembolic) stroke but not small vessel cerebral disease, with at least similar associations to both NT-proBNP and Brain Natriuretic Peptide (BNP)[40].

    • Elevated Troponin Levels in Acute Stroke Patients Predict Long-term Mortality

      2015, Journal of Stroke and Cerebrovascular Diseases
      Citation Excerpt :

      Thus, we cannot disregard the possibility that silent myocardial infarctions could have contributed to the poor prognosis of these patients and that troponin may be a marker of unstable atherosclerotic disease. Indeed, ST segment deviations, suggestive of myocardial ischemia, were significantly more common in patients with elevated cTnI, which is in line with previous studies.1,11,22-25 A substantial amount of stroke patients (26%) have been shown to have asymptomatic coronary artery stenosis more than 50%, indicating CAD7 and pre-existing CAD in stroke patients may result in a higher vulnerability to myocardial injury.

    View all citing articles on Scopus
    View full text