Usefulness of Natriuretic Peptide Testing for Long-Term Risk Assessment Following Acute Ischemic Stroke

• Published in: The American journal of cardiology Vol. 104; no. 2; pp. 287 - 291
• Main Authors: Jensen, Jesper K., Atar, Dan, Kristensen, Søren R., Mickley, Hans, Januzzi, James L.
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 15.07.2009; Elsevier; Elsevier Limited
• Subjects: Acute Disease; Aged; Area Under Curve; Biological and medical sciences; Brain Ischemia - drug therapy; Brain Ischemia - mortality; Brain Ischemia - physiopathology; Cardiology; Cardiology. Vascular system; Cardiovascular; Cardiovascular disease; Confidence Intervals; Denmark; Female; Health risk assessment; Humans; Male; Medical sciences; Middle Aged; Multivariate Analysis; Natriuretic Peptide, Brain - blood; Neurology; Norway; Peptide Fragments - blood; Peptides; Prognosis; Prospective Studies; Risk Assessment; ROC Curve; Sensitivity and Specificity; Stroke; Stroke - drug therapy; Stroke - mortality; Stroke - physiopathology; Survival analysis; Time Factors; Vascular diseases and vascular malformations of the nervous system; Denmark; Norway; Cerebral infarction; Nervous system diseases; Stroke; Peptides; Acute; Cardiovascular disease; Risk; Long term; Cerebral disorder; Vascular disease; Central nervous system disease; Risk factor; Brain ischemia; Circulatory system; Cardiology; Cerebrovascular disease
• ISSN: 0002-9149; 1879-1913; 1879-1913
• DOI: 10.1016/j.amjcard.2009.03.029

Acute-phase levels of B-type natriuretic peptide (BNP) and the N-terminal fragment of the BNP prohormone (NT–pro-BNP) have been associated with mortality when measured in patients with an acute ischemic stroke; however, data regarding the longer-term value of NT–pro-BNP for long-term prognostication after ischemic stroke are limited. Two hundred sixteen patients (mean age 67 ± 13 years) with acute ischemic stroke were seen 6 months after index admission at which time a structured evaluation including measurement of plasma NT–pro-BNP was performed. Patients were followed for 45 months, with all-cause mortality as the clinical end point. Median NT–pro-BNP concentration for the entire group was 147 pg/ml (10th to 90th percentiles 37 to 869). At follow-up 45 patients (21%) had died. NT–pro-BNP concentrations were significantly higher in decedents (308 pg/ml, 10th to 90th percentiles 74 to 2,279) than in the 171 survivors (132 pg/ml, 10th to 90th percentiles 35 to 570, p <0.001). Patients with NT–pro-BNP ≤147 pg/ml had a significantly improved survival rate on univariate analysis (p <0.001). In multivariate analysis after adjustment for age, stroke severity, heart and renal failures, levels of NT–pro-BNP were an independent predictor of mortality >6 months after stroke (adjusted hazard ratio 1.5, 95% confidence interval 1.1 to 1.9, p = 0.005). In conclusion, NT–pro-BNP concentrations measured during the stable phase after acute ischemic stroke are strongly predictive of long-term mortality.