Usefulness of Natriuretic Peptide Testing for Long-Term Risk Assessment Following Acute Ischemic Stroke

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• 作者：Jesper K. Jensen ; Dan Atar ; Sø ; ren R. Kristensen ; Hans Mickley ; James L. Januzzi Jr.
• 刊名：The American Journal of Cardiology
• 出版年：2009
• 出版时间：15 July 2009
• 年：2009
• 卷：104
• 期：2
• 页码：287-291
• 全文大小：313 K

文摘

Acute-phase levels of B-type natriuretic peptide (BNP) and the N-terminal fragment of the BNP prohormone (NT–pro-BNP) have been associated with mortality when measured in patients with an acute ischemic stroke; however, data regarding the longer-term value of NT–pro-BNP for long-term prognostication after ischemic stroke are limited. Two hundred sixteen patients (mean age 67 ± 13 years) with acute ischemic stroke were seen 6 months after index admission at which time a structured evaluation including measurement of plasma NT–pro-BNP was performed. Patients were followed for 45 months, with all-cause mortality as the clinical end point. Median NT–pro-BNP concentration for the entire group was 147 pg/ml (10th to 90th percentiles 37 to 869). At follow-up 45 patients (21 % ) had died. NT–pro-BNP concentrations were significantly higher in decedents (308 pg/ml, 10th to 90th percentiles 74 to 2,279) than in the 171 survivors (132 pg/ml, 10th to 90th percentiles 35 to 570, p <0.001). Patients with NT–pro-BNP ≤147 pg/ml had a significantly improved survival rate on univariate analysis (p <0.001). In multivariate analysis after adjustment for age, stroke severity, heart and renal failures, levels of NT–pro-BNP were an independent predictor of mortality >6 months after stroke (adjusted hazard ratio 1.5, 95 % confidence interval 1.1 to 1.9, p = 0.005). In conclusion, NT–pro-BNP concentrations measured during the stable phase after acute ischemic stroke are strongly predictive of long-term mortality.