Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association · 2025
Brain natriuretic peptide changes as a potential biomarker for paroxysmal atrial fibrillation in acute ischemic stroke cases.
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Kitamura Akihiro, Ogawa Nobuhiro, Nakamura Ryutaro, Sugiyama Seiji, Tamura Ryota, Tsukamoto Takahito, Yabata Hiroyuki, Kobashi Shuhei, Tamaki Yoshitaka, Shitara Satoshi, Yamakawa Isamu, Terashima Tomoya, Yoshida Kazumichi, Urushitani Makoto
Аннотация
BACKGROUND AND PURPOSE: Identifying reliable predictors for paroxysmal atrial fibrillation (PAF) in acute ischemic stroke (AIS) remains a critical clinical challenge. Since conversion from AF to sinus rhythm reduces plasma brain natriuretic peptide (BNP) levels, we hypothesized that BNP reduction could serve as a biomarker for detecting PAF in AIS cases.
METHODS: We performed a retrospective analysis of consecutive AIS cases admitted to our institution from 2022 to 2025, measuring BNP twice: upon admission and within 48 hours. Changes in BNP levels (ΔBNP) and logarithmically transformed BNP values (ΔLog BNP), and multiple stroke-associated covariates were compared across three groups: cardioembolic stroke due to PAF (CES-PAF), other CES etiologies (CES), and non-CES. The diagnostic performance of ΔLog BNP for CES-PAF was evaluated and compared with established PAF predictors.
RESULTS: Among 400 consecutive AIS cases, 220 were eligible. Median ΔBNP (pg/mL) was -19.6 in the CES-PAF group (n = 30), +82.1 in the CES group (n = 67), and +25.5 in the non-CES group (n = 123). ΔLog BNP was significantly lower in the CES-PAF group (vs. CES: p < 0.001, vs. non-CES: p < 0.001). This association remained significant following multivariate adjustment for stroke-associated covariates (vs. CES: p < 0.001, vs. non-CES: p < 0.001). ΔLog BNP demonstrated superior predictive performance compared with established PAF predictors, with an area under the ROC curve of 0.91 (95 % CI: 0.84-0.98). Composite scores incorporating ΔLog BNP further enhanced diagnostic performance.
CONCLUSIONS: These findings suggest that ΔBNP could be a promising practical clinical biomarker for identifying PAF in patients with causally related AIS, warranting validation in larger prospective cohorts.
METHODS: We performed a retrospective analysis of consecutive AIS cases admitted to our institution from 2022 to 2025, measuring BNP twice: upon admission and within 48 hours. Changes in BNP levels (ΔBNP) and logarithmically transformed BNP values (ΔLog BNP), and multiple stroke-associated covariates were compared across three groups: cardioembolic stroke due to PAF (CES-PAF), other CES etiologies (CES), and non-CES. The diagnostic performance of ΔLog BNP for CES-PAF was evaluated and compared with established PAF predictors.
RESULTS: Among 400 consecutive AIS cases, 220 were eligible. Median ΔBNP (pg/mL) was -19.6 in the CES-PAF group (n = 30), +82.1 in the CES group (n = 67), and +25.5 in the non-CES group (n = 123). ΔLog BNP was significantly lower in the CES-PAF group (vs. CES: p < 0.001, vs. non-CES: p < 0.001). This association remained significant following multivariate adjustment for stroke-associated covariates (vs. CES: p < 0.001, vs. non-CES: p < 0.001). ΔLog BNP demonstrated superior predictive performance compared with established PAF predictors, with an area under the ROC curve of 0.91 (95 % CI: 0.84-0.98). Composite scores incorporating ΔLog BNP further enhanced diagnostic performance.
CONCLUSIONS: These findings suggest that ΔBNP could be a promising practical clinical biomarker for identifying PAF in patients with causally related AIS, warranting validation in larger prospective cohorts.