Advertisement

Brain Natriuretic Peptide Levels as a Predictor for New Atrial Fibrillation During Hospitalization in Patients With Acute Ischemic Stroke

Published:February 17, 2012DOI:https://doi.org/10.1016/j.amjcard.2011.12.022
      The aim of this study was to investigate the relation between brain natriuretic peptide (BNP) levels and the detection rate of new documented atrial fibrillation (AF) after ischemic stroke. Consecutive patients with ischemic stroke prospectively enrolled within 24 hours of onset. Patients with AF on admission electrocardiography or with histories of AF were excluded. The plasma BNP level was measured on admission, and the factors associated with new documented AF were investigated by multivariate logistic regression analysis. Furthermore, the detection rates of AF according to BNP level were evaluated. A total of 584 patients were enrolled. AF was detected in 40 patients (new AF group; 6.8%). The median BNP level of the new AF group was significantly higher than for the non-AF group (186.6 pg/ml [interquartile range 68.7 to 386.3] vs 35.2 pg/ml [interquartile range 15.9 to 80.1], p <0.0001). The cut-off level, sensitivity, and specificity of BNP levels to distinguish the new AF group from the non-AF group were 65.0 pg/ml, 80%, and 70%, respectively. Multivariate logistic regression analysis demonstrated that National Institutes of Health Stroke Scale score >7 (odds ratio 3.4, 95% confidence interval 1.685 to 7.006, p = 0.0007) and a plasma BNP level >65.0 pg/ml (odds ratio 6.8, 95% confidence interval 2.975 to 15.359, p <0.0001) were independently associated with new AF. The detection rates of AF according to BNP level were as follows: 2% of patients with <50 pg/ml, 4% of those with 50 to <100 pg/ml, 12% of those with 100 to <200 pg/ml, 26% of those with 200 to <400 pg/ml, and 38% of those with ≥400 pg/ml. In conclusion, BNP levels can predict new AF in patients with acute ischemic stroke. Elevated BNP levels result in an increase in the frequency of detection of new AF.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to American Journal of Cardiology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Tsutamoto T.
        • Wada A.
        • Maeda K.
        • Hisanaga T.
        • Maeda Y.
        • Fukai D.
        • Ohnishi M.
        • Sugimoto Y.
        • Kinoshita M.
        Attenuation of compensation of endogenous cardiac natriuretic peptide system in chronic heart failure: prognostic role of plasma brain natriuretic peptide concentration in patients with chronic symptomatic left ventricular dysfunction.
        Circulation. 1997; 96: 509-516
        • Sudoh T.
        • Kangawa K.
        • Minamino N.
        • Matsuo H.
        A new natriuretic peptide in porcine brain.
        Nature. 1988; 332: 78-81
        • Nakagawa K.
        • Yamaguchi T.
        • Seida M.
        • Yamada S.
        • Imae S.
        • Tanaka Y.
        • Yamamoto K.
        • Ohno K.
        Plasma concentrations of brain natriuretic peptide in patients with acute ischemic stroke.
        Cerebrovasc Dis. 2005; 19: 157-164
        • Makikallio A.M.
        • Makikallio T.H.
        • Korpelainen J.T.
        • Vuolteenaho O.
        • Tapanainen J.M.
        • Ylitalo K.
        • Sotaniemi K.A.
        • Huikuri H.V.
        • Myllyla V.V.
        Natriuretic peptides and mortality after stroke.
        Stroke. 2005; 36: 1016-1020
        • Di Angelantonio E.
        • De Castro S.
        • Toni D.
        • Sacchetti M.L.
        • Biraschi F.
        • Prencipe M.
        • Fiorelli M.
        Determinants of plasma levels of brain natriuretic peptide after acute ischemic stroke or TIA.
        J Neurol Sci. 2007; 260: 139-142
        • Montaner J.
        • Perea-Gainza M.
        • Delgado P.
        • Ribo M.
        • Chacon P.
        • Rosell A.
        • Quintana M.
        • Palacios M.E.
        • Molina C.A.
        • Alvarez-Sabin J.
        Etiologic diagnosis of ischemic stroke subtypes with plasma biomarkers.
        Stroke. 2008; 39: 2280-2287
        • Naya T.
        • Yukiiri K.
        • Hosomi N.
        • Takahashi T.
        • Ohkita H.
        • Mukai M.
        • Koziol J.A.
        • Kohno M.
        Brain natriuretic peptide as a surrogate marker for cardioembolic stroke with paroxysmal atrial fibrillation.
        Cerebrovasc Dis. 2008; 26: 434-440
        • Shibazaki K.
        • Kimura K.
        • Iguchi Y.
        • Okada Y.
        • Inoue T.
        Plasma brain natriuretic peptide can be a biological marker to distinguish cardioembolic stroke from other stroke subtypes in acute ischemic stroke.
        Intern Med. 2009; 48: 259-264
        • Shibazaki K.
        • Kimura K.
        • Okada Y.
        • Iguchi Y.
        • Uemura J.
        • Terasawa Y.
        • Aoki J.
        Plasma brain natriuretic peptide as an independent predictor of in-hospital mortality after acute ischemic stroke.
        Intern Med. 2009; 48: 1601-1606
        • Shibazaki K.
        • Kimura K.
        • Okada Y.
        • Iguchi Y.
        • Terasawa Y.
        • Aoki J.
        Heart failure may be associated with the onset of ischemic stroke with atrial fibrillation: a brain natriuretic peptide study.
        J Neurol Sci. 2009; 281: 55-57
        • Okada Y.
        • Shibazaki K.
        • Kimura K.
        • Iguchi Y.
        • Miki T.
        Brain natriuretic peptide as a predictor of delayed atrial fibrillation after ischaemic stroke and transient ischaemic attack.
        Eur J Neurol. 2010; 17: 326-331
        • Kimura K.
        • Shibazaki K.
        • Iguchi Y.
        • Aoki J.
        • Sakai K.
        • Sakamoto Y.
        • Kobayashi K.
        The combination of elevated BNP and AF as a predictor of no early recanalization after IV-t-PA in acute ischemic stroke.
        J Neurol Sci. 2010; 290: 37-40
        • Shibazaki K.
        • Kimura K.
        • Iguchi Y.
        • Aoki J.
        • Sakai K.
        • Kobayashi K.
        Plasma brain natriuretic peptide predicts death during hospitalization in acute ischaemic stroke and transient ischaemic attack patients with atrial fibrillation.
        Eur J Neurol. 2011; 18: 165-169
        • Buckley M.G.
        • Sethi D.
        • Markandu N.D.
        • Sagnella G.A.
        • Singer D.R.
        • MacGregor G.A.
        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 (Lond). 1992; 83: 437-444
        • Lyden P.
        • Brott T.
        • Tilley B.
        • Welch K.M.
        • Mascha E.J.
        • Levine S.
        • Haley E.C.
        • Grotta J.
        • Marler J.
        • NINDS TPA Stroke Study Group
        Improved reliability of the NIH Stroke Scale using video training.
        Stroke. 1994; 25: 2220-2226
        • Adams Jr, H.P.
        • Bendixen B.H.
        • Kappelle L.J.
        • Biller J.
        • Love B.B.
        • Gordon D.L.
        • Marsh III, E.E.
        Classification of subtype of acute ischemic stroke.
        Stroke. 1993; 24: 35-41
        • Maisel A.S.
        The diagnosis of acute congestive heart failure: role of BNP measurement.
        Heart Fail Rev. 2003; 8: 327-334
        • Benjamin E.J.
        • Levy D.
        • Vaziri S.M.
        • D'Agostino R.B.
        • Belanger A.J.
        • Wolf P.A.
        Independent risk factors for atrial fibrillation in a population-based cohort.
        Jama. 1994; 271: 840-844
        • Tsang T.S.
        • Gersh B.J.
        • Appleton C.P.
        • Tajik A.J.
        • Barnes M.E.
        • Bailey K.R.
        • Oh J.K.
        • Leibson C.
        • Montgomery S.C.
        • Seward J.B.
        Left ventricular diastolic dysfunction as a predictor of the first diagnosed nonvalvular atrial fibrillation in 840 elderly men and women.
        J Am Coll Cardiol. 2002; 40: 1636-1644
        • Liao J.
        • Khalid Z.
        • Scallan C.
        • Morillo C.
        • O'Donnell M.
        Noninvasive cardiac monitoring for detecting paroxysmal atrial fibrillation or flutter after acute ischemic stroke: a systematic review.
        Stroke. 2007; 38: 2935-2940
        • Douen A.G.
        • Pageau N.
        • Medic S.
        Serial electrocardiographic assessments significantly improve detection of atrial fibrillation 2.6-fold in patients with acute stroke.
        Stroke. 2008; 39: 480-482
        • Rizos T.
        • Rasch C.
        • Janetzky E.
        • Hametner C.
        • Kathoefer S.
        • Reinhardt R.
        • Hepp T.
        • Hacke W.
        • Veltkamp R.
        Detection of paroxysmal atrial fibrillation in acute stroke patients.
        Cerebrovasc Dis. 2010; 30: 410-417
        • Suissa L.
        • Bertora D.
        • Lachaud S.
        • Mahagne M.H.
        Score for the targeting of atrial fibrillation (STAF): a new approach to the detection of atrial fibrillation in the secondary prevention of ischemic stroke.
        Stroke. 2009; 40: 2866-2868