Usefulness of natriuretic peptide testing for long-term risk assessment following acute ischemic stroke

TY - JOUR

T1 - Usefulness of natriuretic peptide testing for long-term risk assessment following acute ischemic stroke

AU - Jensen, Jesper K

AU - Atar, Dan

AU - Kristensen, Søren R

AU - Mickley, Hans

AU - Januzzi, James L

PY - 2009

Y1 - 2009

N2 - 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 < or =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.

AB - 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 < or =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.

KW - Acute Disease

KW - Aged

KW - Area Under Curve

KW - Brain Ischemia

KW - Confidence Intervals

KW - Denmark

KW - Female

KW - Humans

KW - Male

KW - Middle Aged

KW - Multivariate Analysis

KW - Natriuretic Peptide, Brain

KW - Norway

KW - Peptide Fragments

KW - Prognosis

KW - Prospective Studies

KW - ROC Curve

KW - Risk Assessment

KW - Sensitivity and Specificity

KW - Stroke

KW - Time Factors

U2 - 10.1016/j.amjcard.2009.03.029

DO - 10.1016/j.amjcard.2009.03.029

M3 - Journal article

C2 - 19576362

SN - 1879-1913

VL - 104

SP - 287

EP - 291

JO - The American Journal of Cardiology

JF - The American Journal of Cardiology

IS - 2

ER -