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Direct comparison of prognostic ability of cardiac biomarkers for cardiogenic stroke and clinical outcome in patients with stroke

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Abstract

Despite many recent advances in medicine, cardiogenic stroke is still a health problem with a high mortality rate. Cardiac biomarkers have been reported to be useful indicators for cardiogenic stroke and subsequent cerebrovascular events. However, there are no data directly comparing the cardiac biomarkers in stroke patients. We measured atrial natriuretic peptide (ANP), brain natriuretic peptide (BNP), N-terminal pro-brain natriuretic peptide (NT-proBNP), and high-sensitivity troponin T (hsTnT) levels and performed transthoracic and transesophageal echocardiography in 282 stroke patients. There were 108 cases of cardiogenic stroke and 47 cases of major adverse cardiovascular and cerebrovascular events (MACCE) during the follow-up period. Association with left atrial function and left atrial appendage function appeared somewhat stronger for BNP and NT-proBNP than ANP and hsTnT. Multivariate logistic analysis demonstrated that cardiac biomarkers excluding ANP were significantly associated with cardiogenic stroke in stroke patients, multivariate Cox’s proportional hazards regression analysis demonstrated that all biomarkers were significantly associated with MACCE after adjustment for confounding risk factors. Receiver operating characteristic curve analysis showed that the C indices of BNP and NT-proBNP for cardiogenic stroke and MACCE were almost equal, but significantly greater than those of ANP and hsTnT. Both BNP and NT-proBNP levels are useful predictors of cardiogenic stroke and subsequent MACCE superior to ANP and hsTnT in stroke patients.

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Authors and Affiliations

  1. Department of Cardiology, Pulmonology, and Nephrology, Yamagata University School of Medicine, 2-2-2 Iida-Nishi, Yamagata, 990-9585, Japan

    Yoichiro Otaki, Tetsu Watanabe, Hayato Tsuchiya, Masahiro Wanezaki, Harutoshi Tamura, Satoshi Nishiyama, Takanori Arimoto, Hiroki Takahashi, Tetsuro Shishido & Masafumi Watanabe

  2. Division of Clinical Laboratory, Yamagata University Hospital, Yamagata, Japan

    Naohito Sato & Toru Shirata

  3. Division of Clinical Laboratory and Infection Control, Yamagata University Hospital, Yamagata, Japan

    Keita Morikane

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  1. Yoichiro Otaki
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380_2019_1345_MOESM1_ESM.pdf

Supplemental figure 1. Associations of BNP/NT-proBNP with LAEF (A) and LAA area (B). LAEF, left atrial ejection fraction; LAA area, left atrial appendage area. Supplemental figure 2. Associations between BNP and NT-proBNP (PDF 317 kb)

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Otaki, Y., Watanabe, T., Sato, N. et al. Direct comparison of prognostic ability of cardiac biomarkers for cardiogenic stroke and clinical outcome in patients with stroke. Heart Vessels 34, 1178–1186 (2019). https://doi.org/10.1007/s00380-019-01345-w

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  • DOI: https://doi.org/10.1007/s00380-019-01345-w

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