BNP but Not s-cTnln is associated with cardioembolic aetiology and predicts short and long term prognosis after cerebrovascular events

Nicole Nigro; Karin Wildi; Christian Mueller; Philipp Schuetz; Beat Mueller; Felix Fluri; Mirjam Christ-Crain; Mira Katan

doi:10.1371/journal.pone.0102704

BNP but Not s-cTnln is associated with cardioembolic aetiology and predicts short and long term prognosis after cerebrovascular events

PLoS One. 2014 Jul 29;9(7):e102704. doi: 10.1371/journal.pone.0102704. eCollection 2014.

Authors

Nicole Nigro¹, Karin Wildi², Christian Mueller², Philipp Schuetz³, Beat Mueller³, Felix Fluri⁴, Mirjam Christ-Crain¹, Mira Katan⁵

Affiliations

¹ Department of Endocrinology, University Hospital Basel, Basel, Switzerland; Department of Clinical Research, University Hospital Basel, Basel, Switzerland.
² Department of Cardiology, University Hospital Basel, Basel, Switzerland; Department of Clinical Research, University Hospital Basel, Basel, Switzerland.
³ Medical University Clinic and Division of Endocrinology, Diabetology and Metabolism, Kantonsspital Aarau, Aarau, Switzerland; Department of Clinical Research, University Hospital Basel, Basel, Switzerland.
⁴ Department of Neurology, University Hospital Basel, Basel, Switzerland; Department of Clinical Research, University Hospital Basel, Basel, Switzerland.
⁵ Department of Endocrinology, University Hospital Basel, Basel, Switzerland; Department of Neurology, University Hospital Zurich, Zurich, Switzerland; Department of Clinical Research, University Hospital Basel, Basel, Switzerland.

Abstract

Background: We analyzed the prognostic value of b-type natriuretic peptide (BNP) and sensitive cardiac Troponin (s-cTnI) in patients with ischemic stroke or transient ischemic attack (TIA) and their significance in predicting stroke aetiology.

Methods: In a prospectively enrolled cohort we measured BNP and s-cTnI levels upon admission. Primary endpoints were mortality, unfavorable functional outcome and stroke recurrence after 90 days and after 12 months. Secondary endpoint was cardioembolic aetiology.

Results: In 441 patients BNP but not s-cTnI remained an independent predictor for death with an adjusted HR of 1.2 (95% CI 1.1-1.4) after 90 days and 1.2 (95% CI 1.0-1.3) after one year. The comparison of the Area under Receiver Operating Characteristic (AUROC) of model A (age, NIHSS) and model B (age, NIHSS, BNP) showed an improvement in the prediction of mortality (0.85 (95% CI 0.79-0.90) vs. 0.86 (95% CI 0.81-0.92), Log Rank p = 0.004). Furthermore the category free net reclassification improvement (cfNRI) when adding BNP to the multivariate model was 57.5%, p<0.0001. For the prediction of functional outcome or stroke recurrence both markers provided no incremental value. Adding BNP to a model including age, atrial fibrillation and heart failure lead to a higher discriminatory accuracy for identification of cardioembolic stroke than the model without BNP (AUC 0.75 (95% CI 0.70-0.80) vs. AUC 0.79, (95% CI 0.75-0.84), p = 0.008).

Conclusion: BNP is an independent prognostic maker for overall mortality in patients with ischemic stroke or TIA and may improve the diagnostic accuracy to identify cardioembolic aetiology.

Trial registration: ClinicalTrials.gov NCT00390962.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Aged
Aged, 80 and over
Biomarkers / blood
Female
Humans
Ischemic Attack, Transient / blood*
Ischemic Attack, Transient / diagnosis
Ischemic Attack, Transient / etiology*
Ischemic Attack, Transient / mortality
Male
Middle Aged
Natriuretic Peptide, Brain / blood*
Prognosis
Recurrence
Stroke / blood*
Stroke / diagnosis
Stroke / etiology*
Stroke / mortality
Time Factors
Troponin I / blood*

Substances

Biomarkers
Troponin I
Natriuretic Peptide, Brain

Associated data

ClinicalTrials.gov/NCT00390962

Grants and funding

This study was supported by an unrestricted research grant from Abbott. However Abbott was not involved in data collection, management, analysis and interpretation of the data. As well as grants from the Department of Endocrinology and Metabolism from the University Hospital of Basel. MCC was supported by a grant from the Swiss National Science Foundation (PP00P3_123346). MK was supported by a transatlantic career development award from the foundation Leduqc and a grant from the Swiss National Science Foundation (PZ00P3_142422). All supporting funders had no role in study design, data collection, management, analysis, interpretation of the data, the preparation or approval of the manuscript.