Background
We performed a systematic review and meta-analysis to evaluate the value of B-type
natriuretic peptide (BNP) in differentiating cardioembolic (CE) stroke from other
subtypes of ischemic stroke.
Methods
We searched the EMBASE, MEDLINE, and Cochrane databases and reference lists of relevant
articles published in April 2013. We selected original studies reporting the performance
of BNP or N-terminal probrain natriuretic peptide (NT-proBNP) in diagnosing CE stroke
and summarized test performance characteristics using forest plots, hierarchical summary
receiver operating characteristic curves, and bivariate random-effect models.
Results
Data from 2958 patients with ischemic stroke were retrieved from 16 studies. Of these,
1024 (34.6%) patients had a final diagnosis of CE stroke. Overall, the mean diagnostic
odds ratio (DOR) of BNP for CE stroke was 15.8 (95% confidence interval [CI]: 9.92-25.20).
Even after adjustment for multiple clinical predictors, serum natriuretic peptide
levels showed a strong association with CE stroke (pooled adjusted DOR, 12.7; 95%
CI: 7.32-22.0). The sensitivity and specificity of BNP for CE stroke were .78 (95%
CI: .71-.87) and .83 (95% CI: .77-.87), respectively. A single BNP-negative result
may be sufficient to exclude a diagnosis of CE stroke in low-prevalence (<20%) settings.
Subgroup analysis showed that NT-proBNP had a slightly higher specificity (.87; 95%
CI: .77-.93) and better capability for exclusion diagnosis. There was a lack of homogeneity
in the timing of measurement and BNP assay method.
Conclusions
BNP has reasonable accuracy in the diagnosis of CE stroke and may be a useful marker
for the early detection in patients who may benefit from preventive anticoagulation
therapy.
Key Words
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Article info
Publication history
Published online: May 01, 2014
Accepted:
February 21,
2014
Received:
February 11,
2014
Footnotes
The authors declare no conflicts of interest.
Identification
DOI: https://doi.org/10.1016/j.jstrokecerebrovasdis.2014.02.014
Copyright
© 2014 National Stroke Association. Published by Elsevier Inc. All rights reserved.
