title: Association of plasma brain natriuretic peptide levels in acute ischemic stroke subtypes and outcome.
abstract: BACKGROUND
  Brain natriuretic peptide (BNP) is believed to be a diagnostic marker for cardiovascular diseases, including atrial fibrillation (AF). Recent studies have incriminated BNP as a marker of cardioembolic stroke. We aimed at investigating association of plasma BNP levels in acute ischemic stroke subtypes and their outcome in Indian patients.
  
  
  METHODS
  We recruited 270 acute ischemic stroke patients within 48 hours of symptom onset and compared with 110 age- and sex-matched control subjects. This study was carried out at Yashoda Hospital, Hyderabad, India between April 2011 and March 2013. Serum BNP levels were estimated in stroke patients and control subjects. Good functional outcome at 3 months was defined as modified Rankin score (mRS) 2 or less.
  
  
  RESULTS
  Elevated BNP levels was significantly more in patients with acute ischemic stroke patients 119 (44%) compared with controls 4 (3.6%; P < .0001). Among stroke subtypes, elevated BNP levels were observed in 75% of cardioembolic strokes, 45.8% of small artery disease, 43.1% of larger artery atherosclerosis, and 34.5% of stroke of undetermined etiology. On multiple logistic regression analysis, elevated BNP levels were significantly associated with acute ischemic stroke (odds ratio [OR], 13.0; 95% confidence interval [CI], 8.1-15.4). Among stroke subtypes, significant association was seen with cardioembolic stroke (OR, 3.5; 95% CI, 2.2-7.2). Elevated BNP levels were independently associated with poor outcome (OR, 3.4; 95% CI, 1.2-13.7; P < .0001) and higher mortality (OR, 3.4; 95% CI, 1.2-13.7; P < .0001).
  
  
  CONCLUSIONS
  Elevated BNP level is an independent marker for cardioembolic stroke and poor outcome at 90 days follow-up. No significant association was seen with other stroke subtypes.
authors.affiliation: Department of Neurology, Yashoda Hospital Hyderabad, India.
authors.forename: Jaydip Ray
authors.initials: JR
authors.lastname: Chaudhuri
authors.affiliation: Department of Neurology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
authors.forename: Vijay Kumar
authors.initials: VK
authors.lastname: Sharma
authors.affiliation: Department of Neurology, Nizams's Institute of Medical Sciences Hyderabad, India.
authors.forename: Kandadai Rukmini
authors.initials: KR
authors.lastname: Mridula
authors.affiliation: Department of Medicine, Yashoda Hospital, Hyderabad, India.
authors.forename: Banda
authors.initials: B
authors.lastname: Balaraju
authors.affiliation: Department of Neurology, Yashoda Hospital Hyderabad, India; Department of Research, Yashoda Hospital Hyderabad, India. Electronic address: rsbhandaru@gmail.com.
authors.forename: Venkata Chandra Sekher Srinivasarao
authors.initials: VC
authors.lastname: Bandaru
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood; D001794:Blood Pressure; D002545:Brain Ischemia / Q000097:blood* / Q000145:classification / Q000401:mortality; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007194:India; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D011379:Prognosis; D012307:Risk Factors; D020521:Stroke / Q000097:blood* / Q000145:classification / Q000401:mortality; D055815:Young Adult
chemical_list: D015415:Biomarkers; D020097:Natriuretic Peptide, Brain
keywords: Acute ischemic stroke; BNP; Indian patients; cardioembolic stroke