B-type natriuretic peptide is associated with post-discharge stroke in hospitalized patients with heart failure

Abstract

Aims: Recently, B-type natriuretic peptide (BNP) has been attracting attention as a predictor of stroke in patients with atrial fibrillation or those with prior stroke experience. However, the association between BNP and stroke has not been examined in patients with chronic heart failure (CHF). In the current study, we assessed whether BNP is associated with future occurrence of stroke in patients with CHF.

Methods and results: We prospectively studied 1803 consecutive patients who were admitted for decompensated HF and assessed the predictive value of circulating BNP levels for occurrence of post-discharge stroke. A total of 69 (3.8%) patients experienced a stroke (the stroke group) during the post-discharge follow-up period of a median of 1150 days. The stroke group showed a higher CHADS₂ score. With respect to past medical history, the stroke group had a higher prevalence of arterial hypertension, atrial fibrillation, prior stroke, and chronic kidney disease. Echocardiographic parameters showed no significant differences between the two groups. In contrast, BNP levels were significantly higher in the stroke group than in the non-stroke group (452.1 vs. 222.7 pg/mL, P < 0.001). Multivariate Cox proportional hazard analysis indicated that BNP levels were independently associated with post-discharge stroke (hazard ratio 2.636, 95% confidence interval 1.595-4.357, P < 0.001). The survival classification and regression tree analysis revealed that the accurate cut-off point of BNP in predicting post-discharge stroke was 187.7 pg/mL. We added high BNP level (BNP ≥ 180 pg/mL) as one point to CHADS₂ score. The BNP-added CHADS₂ score was compared with CHADS₂ score alone by using c-statistics. The areas under the curve of CHADS₂ score, BNP, and BNP-added CHADS₂ score were 0.698, 0.616, and 0.723, respectively. The predictive value of BNP-added CHADS₂ score was higher compared with those of CHADS₂ score (P = 0.026).

Conclusions: The assessment of BNP may predict the occurrence of stroke in CHF patients used alone or in combination with established CHADS₂ score.

Keywords: B-type natriuretic peptide; CHADS2 score; Heart failure; Stroke.