Brain Natriuretic Peptide and Particular Left Ventricle Segment Asynergy Associated with Cardioembolic Stroke from Old Myocardial Infarction

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• 作者：Naohisa Hosomi ; MD ; PhD ; FAHA^* ; ^{nhosomi@hiroshima-u.ac.jp" class="auth_mail" title="E-mail the corresponding author} ; Takeshi Yoshimoto ; MD^&dagger ; ; Yuhei Kanaya ; MD^&dagger ; ; Shuichiro Neshige ; MD^&dagger ; ; Naoyuki Hara ; MD^&dagger ; ; Takahiro Himeno ; MD^&dagger ; ; Ryuhei Kono ; MD^&dagger ; ; Shinichi Takeshima ; MD^&dagger ; ; Kazuhiro Takamatsu ; MD^&dagger ; ; Tomoko Ota ; MD^&Dagger ; ; Yoshinori Miyamoto ; MD ; PhD^&Dagger ; ; Kotaro Yasuda ; MD^&Dagger ; ; Yutaka Shimoe ; MD ; PhD^&dagger ; ; Taisei Ota ; MD^&dagger ; ; Masaru Kuriyama ; MD ; PhD^&dagger ; ; Masayasu Matsumoto ; MD ; PhD^*
• 关键词：Ischemic stroke ; stroke subtypes ; cardioembolism ; myocardial infarction ; brain natriuretic peptide ; sonography
• 刊名：Journal of Stroke and Cerebrovascular Diseases
• 出版年：2016
• 出版时间：May 2016
• 年：2016
• 卷：25
• 期：5
• 页码：1165-1171
• 全文大小：326 K

文摘

It is important to determine the usage of anticoagulants by defining the actual risk of cardioembolic stroke in patients with old myocardial infarction. In the present study, we aimed to more precisely evaluate the risks of each segment associated with cardioembolic stroke using a 16-segment model. The usage of the plasma brain natriuretic peptide (BNP) associated with cardioembolic stroke was also evaluated in comparison with a left ventricle ejection fraction less than 40%.

Methods

There were a total of 190 ischemic stroke patients who had premorbid myocardial infarction. The study included a total of 143 ischemic stroke patients with old myocardial infarction who were available for evaluation and excluded patients with atrial fibrillation or acute myocardial infarction. Their left ventricle wall motion abnormality and the level of plasma BNP at their admission were analyzed.

Results

Hypertension and a plasma BNP level of 206.9 pg/mL or higher, determined from the receiver operating characteristic curve, were independently associated with cardioembolic stroke (χ² = 35.6, R² = .30, P < .001). Adjusting for these factors, statistically independent high risk was observed at the basal–inferior, basal–inferolateral, mid-anterior, mid-anteroseptal, apical–anterior, and apical–septal left ventricles.

Conclusion

High plasma BNP levels and left ventricular wall motion abnormalities in the segments perfused with left anterior descending coronary artery or right coronary artery show a high risk for cardioembolic stroke in patients with old myocardial infarction. Considering these factors, it could be possible to more precisely define the risk of cardioembolic stroke and to perform appropriate antithrombotic treatments in old myocardial infarction patients.