Time Course and Prognostic Value of Plasma Levels of N-Terminal Pro-Brain Natriuretic Peptide in Patients After Ischemic Stroke

• Published in: Circulation Journal Vol. 70; no. 4; pp. 447 - 452
• Main Authors: Sun, Cheuk-Kwan, Chen, Mien-Cheng, Yip, Hon-Kan, Chang, Li-Teh, Liou, Chia-Wei
• Format: Journal Article
• Language: English
• Published: Japan The Japanese Circulation Society 2006
• Subjects: Acute Disease; Aged; Biomarkers - blood; Brain Ischemia - blood; Case-Control Studies; Female; Humans; Ischemia; Male; Middle Aged; Multivariate Analysis; N-terminal pro-brain natriuretic peptide; Natriuretic Peptide, Brain - blood; Peptide Fragments - blood; Prognosis; Stroke; Stroke - blood; Time Factors; Treatment Outcome
• ISSN: 1346-9843; 1347-4820; 1347-4820
• DOI: 10.1253/circj.70.447

Background The association between plasma levels of N-terminal pro-brain natriuretic peptide (NT-proBNP) and prognostic outcomes in patients after ischemic stroke remains unknown. The present study tested the hypothesis that NT-proBNP level is noticeably increased after ischemic stroke and that elevated NT-proBNP is associated with unfavorable clinical outcomes (UFCO). Methods and Results Blood samples for NT-proBNP levels were collected serially and examined with sandwich immunoassay after acute ischemic stroke in 86 consecutive patients. The NT-proBNP levels were also measured in 30 healthy control volunteers and 30 at-risk control subjects. The NT-proBNP levels were significantly higher at 4 intervals after ischemic stroke than in healthy and at-risk control subjects (all p<0.001). The NT-proBNP decreased to a significantly lower level on day 21 and to a substantially lower level on day 90. Additionally, the NT-proBNP level at any of the 4 intervals was significantly higher in patients with than in patients without UFCO (defined as combined congestive heart failure ≥ class 3, acute myocardial infarction, recurrent stroke or any cause of death) (all p<0.01). Multivariate analysis demonstrated that age and NIH Stroke Scale were the 2 strongest independent predictors of increased NT-proBNP levels (all p<0.01). Furthermore, increased NT-proBNP (≥150 pg/ml) was the strongest independent predictor of long-term (mean follow-up: 24 months) UFCO (26 patients) (all p<0.05). Conclusions The NT-proBNP level was markedly elevated after acute ischemic stroke and declined substantially thereafter. An increased NT-proBNP level was strongly and independently correlated with UFCO in patients after ischemic stroke. (Circ J 2006; 70: 447 - 452)