title: Elevated plasma brain natriuretic peptide levels predict left atrial appendage dysfunction in patients with acute ischemic stroke.
abstract: BACKGROUND
  It is well known that left atrial appendage (LAA) dysfunction plays an important role in the occurrence of cardioembolic stroke. The atrium is the main source of brain natriuretic peptide (BNP) in patients with atrial fibrillation (AF). We hypothesized that the plasma BNP level would be a sensitive predictor of LAA dysfunction in patients with acute ischemic stroke.
  
  
  RESULTS
  Transesophageal echocardiography was performed and plasma BNP levels were measured in 223 patients (145 males, age 69 ± 14 years), within 7 days after the onset of acute ischemic stroke. None of the patients had a history of congestive heart failure. LAA thrombus was detected in 23 of 77 (30%) patients with AF. Plasma BNP levels were markedly higher in patients with cardioembolic stroke compared to those without (144 pg/ml vs. 35 pg/ml, p<0.05). Plasma BNP levels were significantly correlated with LAA emptying flow velocity regardless of sinus rhythm (R=-0.352) or AF (R=-0.436). Furthermore, among patients with cardioembolic stroke, plasma BNP levels were markedly higher in patients with cardiogenic stroke, as diagnosed by transesophageal echocardiography, than in those with cryptogenic stroke (193 pg/ml vs. 14 pg/ml, p<0.05). Multivariate logistic regression analysis showed that a BNP concentration >90 pg/ml was an independent predictor of cardiogenic stroke (odds ratio 41.39, 95% confidence interval 1.28-138; p=0.0358).
  
  
  CONCLUSIONS
  Elevated plasma BNP concentrations may be a reliable surrogate marker for the prediction of LAA dysfunction and cardiogenic stroke in patients with acute ischemic stroke.
authors.affiliation: Department of Cardiology, Pulmonology, and Nephrology, Yamagata University School of Medicine, Japan.
authors.forename: Harutoshi
authors.initials: H
authors.lastname: Tamura
authors.forename: Tetsu
authors.initials: T
authors.lastname: Watanabe
authors.forename: Satoshi
authors.initials: S
authors.lastname: Nishiyama
authors.forename: Shintaro
authors.initials: S
authors.lastname: Sasaki
authors.forename: Masahiro
authors.initials: M
authors.lastname: Wanezaki
authors.forename: Takanori
authors.initials: T
authors.lastname: Arimoto
authors.forename: Hiroki
authors.initials: H
authors.lastname: Takahashi
authors.forename: Tetsuro
authors.initials: T
authors.lastname: Shishido
authors.forename: Takehiko
authors.initials: T
authors.lastname: Miyashita
authors.forename: Takuya
authors.initials: T
authors.lastname: Miyamoto
authors.forename: Osamu
authors.initials: O
authors.lastname: Hirono
authors.forename: Takamasa
authors.initials: T
authors.lastname: Kayama
authors.forename: Isao
authors.initials: I
authors.lastname: Kubota
mesh_terms: D000368:Aged; D020517:Atrial Appendage / Q000503:physiopathology*; D001281:Atrial Fibrillation / Q000150:complications; D015415:Biomarkers / Q000097:blood; D017548:Echocardiography, Transesophageal; D005260:Female; D006801:Humans; D008297:Male; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D013923:Thromboembolism / Q000175:diagnosis* / Q000209:etiology
chemical_list: D015415:Biomarkers; D020097:Natriuretic Peptide, Brain