Presentation Number:
ASA P12
Publishing Title:
Brain Natriuretic Polypeptide is a Marker Associated with Cardiac Thrombus in Stroke Patients
with Atrial Fibrillation
Author Block:
Yoko Okada
, Ehime hospital, Toon, Japan; Kensaku Shibazaki, Kazumi Kimura, Noriko Matsumoto, Yasuyuki
Iguchi, Kawasaki Medical Sch, Kurashiki, Japan
Abstract Body:
Background and purpose
Brain natriuretic peptide (BNP) is used as a biological marker of heart diseases. 8-10% of acute stroke patients
with atrial fibrillation (AF) have cardiac thrombus (CTh), which is considered as a high risk of stroke recurrence.
We investigated whether high BNP levels could be a biological marker of CTh in acute stroke patients with AF.
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Methods
Between November 2006 and June 2008, acute ischemic stroke patients with AF within 7 days of stroke onset
who underwent transesophageal echocardiography (TEE) were enrolled. We measured BNP using rapidly assay
(SHIONOSPOT® BNP) on TEE examination. Patients were divided into two groups according to the absence and
presence of CTh (Negative and Positive groups). We compared clinical characteristics including age, gender,
previous ischemic stroke, vascular risk factors, National Institutes of Health Stroke Scale (NIHSS) score on
admission, and BNP level between the two groups. Moreover, the factors associated with CTh were investigated
by multivariate logistic regression model.
Results
67 patients (male 40; mean age, 76.5±11.1 years) were enrolled. 17 (25.4%) patients had CTh. Hypertension
(88.2% vs. 58.0%, p= 0.037) was higher in the Positive group than in the Negative group. There were no
significant differences between the Positive group and Negative group in age (76.5±9.5 vs. 76.4±11.7, p=0.730),
female (58.8% vs. 34.0%, p=0.072), previous ischemic stroke (23.5% vs. 30.0%, p=0.760), diabetes mellitus
(35.3% vs. 20.0%, p=0.201), hyperlipidemia (17.6% vs. 14.0%, p=0.706), smoking (41.2% vs. 52.0%, p=0.441),
and NIHSS score on admission (9.8±8.3 vs. 7.0±7.8, p=0.237). The mean±SD BNP level was significantly higher
in the Positive group than in the Negative group (307.3±270.6 vs. 146.5±119.0 pg/ml, p=0.024). The optimal cutoff
level, sensitivity, and specificity of BNP levels to distinguish the Positive group from the Negative group were
145.0 pg/ml, 70.6% and 64.0%, respectively. Multivariate logistic regression analysis demonstrated that plasma
BNP level of >145.0 pg/ml (odds ratio, 4.61; 95%CI, 1.29 to 16.51, p=0.019) was independent factor associated
with CTh.
Conclusions
BNP is a marker associated with CTh in stroke patients with AF.
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