B-type natriuretic peptide as a marker for heart failure in patients with acute stroke

Matthew A. Koenig, Hans Adrian Puttgen, Vivek Prabhakaran, Daniel Reich, Robert David Stevens

Research output: Contribution to journalArticle

Abstract

Objective: To determine whether serum N-terminal pro-B-type natriuretic peptide (N-BNP), a biomarker of myocardial wall stress, is specific to acute heart failure (HF) in patients hospitalized with stroke. Design: Case-control study. Setting: Tertiary hospital, Neurosciences Critical Care Unit and Stroke Unit. Patients: Consecutive patients with acute ischemic or hemorrhagic stroke who were evaluated for HF. Intervention: None. Measurements and results: Cases and controls were classified, respectively, as patients with or without HF, defined according to modified Framingham criteria. Seventy-two patients were evaluated, 39 with ischemic stroke, 22 with aneurysmal subarachnoid hemorrhage (SAH), and 11 with intracerebral hemorrhage (ICH). Thirty-four patients (47%) met criteria for HF, and 47 patients (65%) had systolic or diastolic left ventricular (LV) dysfunction on echocardiogram. Serum N-BNP was measured a median of 48 h following the onset of stroke and was increased (> 900 pg/ml) in 56 patients (78%), with higher levels in non-survivors (11898 ± 12741 vs 4073 ± 5691; p = 0.001). In a multiple regression model, N-BNP elevation was not independently associated with HF (OR 5.4, 95% CI 0.8-36.0, p = 0.084). At a cut-off of 900 pg/ml, the sensitivity of N-BNP for HF was 94%, specificity 37%, positive predictive value (PPV) 57%, and negative predictive value (NPV) 88%. For systolic or diastolic LV dysfunction, the sensitivity of N-BNP was 89%, specificity 44%, PPV 75%, and NPV 69%. Conclusions: These results demonstrate that N-BNP elevation is not specific to HF or LV dysfunction in patients with acute ischemic stroke, SAH, and ICH.

Original languageEnglish (US)
Pages (from-to)1587-1593
Number of pages7
JournalIntensive Care Medicine
Volume33
Issue number9
DOIs
StatePublished - Sep 2007

Fingerprint

Brain Natriuretic Peptide
Heart Failure
Stroke
Left Ventricular Dysfunction
Cerebral Hemorrhage
Subarachnoid Hemorrhage
Critical Care
Neurosciences
Serum
Tertiary Care Centers
Case-Control Studies
Biomarkers

Keywords

  • B-type natriuretic peptide
  • Heart failure
  • Intracerebral hemorrhage
  • Stroke
  • Subarachnoid hemorrhage

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine

Cite this

B-type natriuretic peptide as a marker for heart failure in patients with acute stroke. / Koenig, Matthew A.; Puttgen, Hans Adrian; Prabhakaran, Vivek; Reich, Daniel; Stevens, Robert David.

In: Intensive Care Medicine, Vol. 33, No. 9, 09.2007, p. 1587-1593.

Research output: Contribution to journalArticle

Koenig, Matthew A. ; Puttgen, Hans Adrian ; Prabhakaran, Vivek ; Reich, Daniel ; Stevens, Robert David. / B-type natriuretic peptide as a marker for heart failure in patients with acute stroke. In: Intensive Care Medicine. 2007 ; Vol. 33, No. 9. pp. 1587-1593.
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abstract = "Objective: To determine whether serum N-terminal pro-B-type natriuretic peptide (N-BNP), a biomarker of myocardial wall stress, is specific to acute heart failure (HF) in patients hospitalized with stroke. Design: Case-control study. Setting: Tertiary hospital, Neurosciences Critical Care Unit and Stroke Unit. Patients: Consecutive patients with acute ischemic or hemorrhagic stroke who were evaluated for HF. Intervention: None. Measurements and results: Cases and controls were classified, respectively, as patients with or without HF, defined according to modified Framingham criteria. Seventy-two patients were evaluated, 39 with ischemic stroke, 22 with aneurysmal subarachnoid hemorrhage (SAH), and 11 with intracerebral hemorrhage (ICH). Thirty-four patients (47{\%}) met criteria for HF, and 47 patients (65{\%}) had systolic or diastolic left ventricular (LV) dysfunction on echocardiogram. Serum N-BNP was measured a median of 48 h following the onset of stroke and was increased (> 900 pg/ml) in 56 patients (78{\%}), with higher levels in non-survivors (11898 ± 12741 vs 4073 ± 5691; p = 0.001). In a multiple regression model, N-BNP elevation was not independently associated with HF (OR 5.4, 95{\%} CI 0.8-36.0, p = 0.084). At a cut-off of 900 pg/ml, the sensitivity of N-BNP for HF was 94{\%}, specificity 37{\%}, positive predictive value (PPV) 57{\%}, and negative predictive value (NPV) 88{\%}. For systolic or diastolic LV dysfunction, the sensitivity of N-BNP was 89{\%}, specificity 44{\%}, PPV 75{\%}, and NPV 69{\%}. Conclusions: These results demonstrate that N-BNP elevation is not specific to HF or LV dysfunction in patients with acute ischemic stroke, SAH, and ICH.",
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AU - Prabhakaran, Vivek

AU - Reich, Daniel

AU - Stevens, Robert David

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KW - Intracerebral hemorrhage

KW - Stroke

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