Brain Natriuretic Peptide Is a Powerful Predictor of Outcome in Stroke Patients with Atrial Fibrillation

• Published in: Cerebrovascular diseases extra 2017-01, Vol.7 (1), p.35-43
• Main Authors: Maruyama, Kenji, Uchiyama, Shinichiro, Shiga, Tsuyoshi, Iijima, Mutsumi, Ishizuka, Kentaro, Hoshino, Takao, Kitagawa, Kazuo
• Format: Article
• Language: English
• Subjects: Aged; Aged, 80 and over; Angina pectoris; Anticoagulants; Atrial Fibrillation - complications; Atrial Fibrillation - diagnosis; Biomarkers - blood; Blood clots; Brain natriuretic peptide; Cardiac arrhythmia; Cardiomyopathy; Cardiovascular disease; Chi-Square Distribution; Disability Evaluation; Female; Humans; Logistic Models; Male; Modified Rankin Scale score; Multivariate Analysis; National Institutes of Health Stroke Scale; Natriuretic Peptide, Brain - blood; Neurology; NMR; Nonvalvular atrial fibrillation; Nuclear magnetic resonance; Odds Ratio; Original Paper; Outcome; Peptides; Predictive Value of Tests; Prognosis; Retrospective Studies; Risk Factors; Stroke; Stroke - blood; Stroke - diagnosis; Stroke - etiology; Systolic blood pressure; Time Factors
• ISSN: 1664-5456; 1664-5456
• DOI: 10.1159/000457808

Background: Since stroke patients with nonvalvular atrial fibrillation (NVAF) have poor outcomes in general, the prediction of outcomes following discharge is of utmost concern for these patients. We previously reported that brain natriuretic peptide (BNP) levels were significantly higher in NVAF patients with larger infarcts, higher modified Rankin Scale (mRS) score, and higher CHADS 2 score. In the present study, we evaluated an array of variables, including BNP, in order to determine significant predictors for functional outcome in patients with NVAF after acute ischemic stroke (AIS). Methods: A total of 615 consecutive patients with AIS within 48 h of symptom onset, admitted to our hospital between April 2010 and October 2015, were retrospectively searched. Among these patients, we enrolled consecutive patients with NVAF. We evaluated the mRS score 3 months after onset of stroke and investigated associations between mRS score and the following clinical and echocardiographic variables. Categorical variables included male sex, current smoking, alcohol intake, hypertension, diabetes mellitus, dyslipidemia, coronary artery disease, peripheral artery disease, use of antiplatelet drugs, anticoagulants, or tissue plasminogen activator (tPA), and infarct size. Continuous variables included age, systolic blood pressure (SBP), diastolic blood pressure, hemoglobin, creatinine, D-dimer, brain natriuretic peptide (BNP), left atrial diameter, left ventricular ejection fraction (EF), and early mitral inflow velocity/diastolic mitral annular velocity (E/e’). We also analyzed the association of prestroke CHADS 2 , CHA 2 DS 2 -VASc, and R 2 CHADS 2 scores, and National Institutes of Health Stroke Scale (NIHSS) score on admission with mRS score 3 months after the onset of stroke. Patients were classified into 2 groups according to mRS score: an mRS score ≤2 was defined as good outcome, an mRS score ≥3 was defined as poor outcome. To clarify the correlations between categorical or continuous variables and mRS score, uni- and multivariate logistic regression models using the stepwise variable selection method were applied. Results: Among 157 patients with NVAF after AIS, 63.7% were male and the mean age was 75.9 years. In univariate regression analysis, poor outcome (mRS score ≥3) was associated with use of tPA, infarct size, age, SBP, BNP, EF, and NIHSS score. In multivariate regression analysis, BNP levels (odds ratio [OR] 6.40; 95% confidence interval [CI] 1.26–32.43; p