Abstract
Background: Many studies have evaluated the relationship between N-terminal pro-brain natriuretic
peptide (NT-proBNP) and its prognostic value in ischemic stroke. However, a widespread
consensus has not been reached. Therefore, we completed a meta-analysis to evaluate
the prognostic significance of NT-proBNP for mortality and functional outcome in patients
with ischemic stroke. Methods: We performed a systematic search and review using the PubMed and EMBASE databases
to identify literature that reported a correlation between NT-proBNP and mortality
and functional outcome in ischemic stroke patients. Results: Eleven studies inclusive of 10,498 patients met the inclusion criteria. Elevated
plasma NT-proBNP levels were associated with increased risk of mortality in ischemic
stroke patients (all-cause mortality: odds ratio [OR] = 2.43, 95% confidence interval
[CI] 1.62-3.64, P < .001, I2=74.3%; cardiovascular mortality: OR = 2.01, 95% CI 1.55-2.61, P < .001, I2 = 42.6%). In addition, unfavorable functional outcomes were observed in patients
with higher levels of NT-proBNP (OR = 1.68, 95% CI 1.13-2.50, P = .01, I2 = 90.8%) after ischemic stroke. Conclusions: This meta-analysis demonstrates that NT-proBNP could be a predictor of mortality
and functional outcome in ischemic stroke patients.
Key Words
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 accessOne-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 Journal of Stroke and Cerebrovascular DiseasesAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Executive summary: heart disease and stroke statistics-2016 update: a report from the American Heart Association.Circulation. 2016; 133: 447
- Neurogenesis in stroke recovery.Transl Stroke Res. 2017; 8: 3-13
- Ischemic stroke biomarkers in blood.Biomarkers Med. 2013; 7: 37-47
- Blood protein biomarkers as diagnostic tool for ischemic stroke: a systematic review.Biomarkers Med. 2017; 11: 503-512
- Blood biomarkers in ischemic stroke: potential role and challenges in clinical practice and research.Crit Rev Clin Lab Sci. 2018; 55: 294-328
- B-type natriuretic peptide in cardiovascular disease.Lancet (London, England). 2003; 362: 316-322
- In-hospital percentage BNP reduction is highly predictive for adverse events in patients admitted for acute heart failure: the Italian RED Study.Crit Care (London, England). 2010; 14: R116
- B-type natriuretic peptide trumps other prognostic markers in patients assessed for coronary disease.BMC Med. 2019; 17: 72
- Plasma natriuretic peptide levels and the risk of cardiovascular events and death.N Engl J Med. 2004; 350: 655-663
- Updating the role of natriuretic peptide levels in cardiovascular disease.Postgraduate Med. 2011; 123: 102-113
- NT-ProBNP in acute heart failure: correlation with invasively measured hemodynamic parameters during recompensation.J Cardiac Fail. 2005; 11: S38-S41
- Natriuretic peptide-guided heart failure management.Eur Heart J. 2014; 35: 16-24
- The use of biomarkers to predict specific causes of death in patients with atrial fibrillation: insights from the ARISTOTLE Trial.Circulation. 2018;
- Assessment of multiple cardiac biomarkers in non-ST-segment elevation acute coronary syndromes: observations from the MERLIN-TIMI 36 trial.Eur Heart J. 2011; 32: 697-705
- The cardiac consequences of stroke.Neurol Clin. 1992; 10: 167-176
- [Heart-brain interactions: status of knowledge and perspectives of study].Giornale Italiano Cardiol. 1992; 22: 311-322
- Neurology and the heart.J Neurol Neurosurg Psychiatry. 1998; 64: 289-297
- Cardiac troponins and N-terminal pro-brain natriuretic peptide in acute ischemic stroke do not relate to clinical prognosis.Stroke. 2005; 36: 270-275
- Neurocardiology: close interaction between heart and brain.Netherlands Heart J. 2013; 21: 51-52
- Brain-heart axis–Review article.J Med life. 2015; 8: 266-271
- New insights in prevention, diagnosis and treatment of stroke: its relation with atrial fibrillation.Netherlands Heart J. 2012; 20: 141-142
- Association between increased N-terminal pro-brain natriuretic peptide level and poor clinical outcomes after acute ischemic stroke.J Neurol Sci. 2017; 383: 5-10
- The prognostic value of combined NT-pro-BNP levels and NIHSS scores in patients with acute ischemic stroke.Intern Med (Tokyo, Japan). 2012; 51: 2887-2892
- Prognostic value of a single prehospital measurement of N-terminal pro-brain natriuretic peptide and troponin T after acute ischaemic stroke.J Int Med Res. 2012; 40: 768-776
- Copeptin and NT-proBNP for prediction of all-cause and cardiovascular death in ischemic stroke.Neurology. 2017; 88: 1899-1905
- Prognostic value of inflammatory and cardiovascular biomarkers for prediction of 90-day all-cause mortality after acute ischemic stroke-results from the Linz Stroke Unit Study.Clin Chem. 2017; 63: 1101-1109
- Blood biomarkers in stroke: research and clinical practice.Int J Stroke. 2012; 7: 435-439
- Biomarkers and mortality after transient ischemic attack and minor ischemic stroke: population-based study.Stroke. 2015; 46: 659-666
- Highly sensitive troponin T in patients with acute ischemic stroke.Eur Neurol. 2012; 68: 287-293
- Prognostic value of plasma neuroendocrine biomarkers in patients with acute ischaemic stroke.J Neuroendocrinol. 2013; 25: 771-778
- Trim and fill: a simple funnel-plot-based method of testing and adjusting for publication bias in meta-analysis.Biometrics. 2000; 56: 455-463
- N-terminal probrain natriuretic peptide levels as a predictor of functional outcomes in patients with ischemic stroke.Neuroreport. 2014; 25: 985-990
- N-terminal pro-brain natriuretic peptide predicts short-term functional outcome in acute ischemic stroke.Stroke. 2015; 46(Suppl 1) (Conference Abstract): ATP152
- Difference in the prognostic significance of N-terminal pro-B-type natriuretic peptide between cardioembolic and noncardioembolic ischemic strokes.Dis Markers. 2015; 2015597570
- Relationship between n-terminal pro brain natriuretic peptide (NT-ProBNP) and HbA1c with outcome in acute ischemic stroke patients.J Neurol Sci. 2017; 381 (Conference Abstract): 991-992
- Time course and prognostic value of plasma levels of N-terminal pro-brain natriuretic peptide in patients after ischemic stroke.Circ J. 2006; 70: 447-452
- Serial measurements of N-terminal pro-brain natriuretic peptide after acute ischemic stroke.Cerebrovasc Dis (Basel, Switzerland). 2006; 22: 439-444
- The insular cortex and cardiac response to stroke.Neurology. 2006; 66: 1296-1297
- Neuroanatomic correlates of stroke-related myocardial injury.Neurology. 2006; 66: 1325-1329
- Impact of cardiac complications on outcome after aneurysmal subarachnoid hemorrhage: a meta-analysis.Neurology. 2009; 72: 635-642
- Brain-heart interaction: cardiac complications after stroke.Circ Res. 2017; 121: 451-468
- Pattern of activation of the hypothalamic-pituitary-adrenal axis in acute stroke. Relation to acute confusional state, extent of brain damage, and clinical outcome.Stroke. 1994; 25: 1105-1108
- Contribution of catecholamine reactive intermediates and oxidative stress to the pathologic features of heart diseases.Curr Med Chem. 2011; 18: 2272-2314
- Pathophysiological mechanisms of catecholamine and cocaine-mediated cardiotoxicity.Heart Fail Rev. 2014; 19: 815-824
- Cardiac complications in acute ischemic stroke.Western J Emerg Med. 2011; 12: 414-420
- N-terminal pro-brain natriuretic protein levels in takotsubo cardiomyopathy.Am J Cardiol. 2011; 108: 1316-1321
- Transcription of brain natriuretic peptide and atrial natriuretic peptide genes in human tissues.J Clin Endocrinol Metab. 1994; 78: 1307-1311
- Characteristics and early and long-term outcome in patients with acute ischemic stroke and low ejection fraction.Int J Cardiol. 2013; 168: 1082-1087
- Nationwide frequency and association of heart failure on stroke outcomes in the United States.J Cardiac Fail. 2009; 15: 11-16
- Heart failure in acute ischemic stroke.J Neurol. 2008; 255: 385-389
- Electrocardiographic changes in patients with acute stroke: a systematic review.Cerebrovasc Dis (Basel, Switzerland). 2002; 14: 67-76
- Stroke and cardiac arrhythmias.J Stroke Cerebrovasc Dis. 2002; 11: 28-33
- Electrocardiographic findings and prognosis in ischemic stroke.Neurol India. 2003; 51: 500-502
- Cerebrogenic tachyarrhythmia in acute stroke.J Neurosci Rural Pract. 2012; 3: 204-206
- Clinical applications of biomarkers in atrial fibrillation.Am J Med. 2017; 130: 1351-1357
- State of the art of immunoassay methods for B-type natriuretic peptides: an update.Crit Rev Clin Lab Sci. 2015; 52: 56-69
Article info
Publication history
Published online: February 14, 2020
Accepted:
January 10,
2020
Received in revised form:
January 6,
2020
Received:
November 27,
2019
Footnotes
Financial disclosures: This research was supported by grants from the Hubei Province Natural Science Foundation (2017CFA028).
Identification
DOI: https://doi.org/10.1016/j.jstrokecerebrovasdis.2020.104659
Copyright
© 2020 Elsevier Inc. All rights reserved.
