title: BNP but Not s-cTnln is associated with cardioembolic aetiology and predicts short and long term prognosis after cerebrovascular events.
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).
  
  
  CONCLUSIONS
  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.
  
  
  BACKGROUND
  ClinicalTrials.gov NCT00390962.
authors: Department of Endocrinology, University Hospital Basel, Basel, Switzerland; Department of Clinical Research, University Hospital Basel, Basel, Switzerland.
authors: Nicole
authors: N
authors: Nigro
authors: Department of Cardiology, University Hospital Basel, Basel, Switzerland; Department of Clinical Research, University Hospital Basel, Basel, Switzerland.
authors: Karin
authors: K
authors: Wildi
authors: Department of Cardiology, University Hospital Basel, Basel, Switzerland; Department of Clinical Research, University Hospital Basel, Basel, Switzerland.
authors: Christian
authors: C
authors: Mueller
authors: Medical University Clinic and Division of Endocrinology, Diabetology and Metabolism, Kantonsspital Aarau, Aarau, Switzerland; Department of Clinical Research, University Hospital Basel, Basel, Switzerland.
authors: Philipp
authors: P
authors: Schuetz
authors: Medical University Clinic and Division of Endocrinology, Diabetology and Metabolism, Kantonsspital Aarau, Aarau, Switzerland; Department of Clinical Research, University Hospital Basel, Basel, Switzerland.
authors: Beat
authors: B
authors: Mueller
authors: Department of Neurology, University Hospital Basel, Basel, Switzerland; Department of Clinical Research, University Hospital Basel, Basel, Switzerland.
authors: Felix
authors: F
authors: Fluri
authors: Department of Endocrinology, University Hospital Basel, Basel, Switzerland; Department of Clinical Research, University Hospital Basel, Basel, Switzerland.
authors: Mirjam
authors: M
authors: Christ-Crain
authors: 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.
authors: Mira
authors: M
authors: Katan
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood; D005260:Female; D006801:Humans; D002546:Ischemic Attack, Transient / Q000097:blood* / Q000175:diagnosis / Q000209:etiology* / Q000401:mortality; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D011379:Prognosis; D012008:Recurrence; D020521:Stroke / Q000097:blood* / Q000175:diagnosis / Q000209:etiology* / Q000401:mortality; D013997:Time Factors; D019210:Troponin I / Q000097:blood*
chemical_list: D015415:Biomarkers; D019210:Troponin I; D020097:Natriuretic Peptide, Brain