title: Impact of BNP on cryptogenic stroke without potential embolic sources on transesophageal echocardiography.
abstract: BACKGROUND
  Clinical characteristics are important for determining the etiologies of embolic stroke, including patent foramen ovale and complex aortic plaques demonstrated on transesophageal echocardiography (TEE). This study sought to analyze the clinical signs of cryptogenic stroke (CS) without such embolic etiologies and to examine the association between CS and brain natriuretic peptide (BNP), which is currently unknown.
  
  
  METHODS
  Patients with CS after routine examinations who underwent TEE were included in this single-center observational study. Patients were classified into the potential embolic sources (PES) group (patients having PES on TEE) and the no potential embolic source (NPES) group. Patients were also categorized according to the tertile of BNP.
  
  
  RESULTS
  A total of 158 patients (age, 64.0 ± 13.9 years; 119 males) with CS were enrolled. The PES group had 108 (68%) patients, and the NPES group had 50 (32%). Hypertension was more common, and glucose, D-dimer, and BNP were higher in the NPES than in the PES group (p<0.05). NPES was independently associated with high-BNP tertile (OR: 5.61; 95% CI: 1.91 to 16.44; p=0.002).
  
  
  CONCLUSIONS
  BNP, an indicator of cardioembolism, was closely associated with NPES. Cardiogenic mechanisms may be implicated in the etiology of CS without potential embolic etiologies on TEE.
authors.affiliation: Department of Neurology, Juntendo University, School of Medicine, Japan. Electronic address: yuji-u@juntendo.ac.jp.
authors.forename: Yuji
authors.initials: Y
authors.lastname: Ueno
authors.affiliation: Department of Neurology, Juntendo University, School of Medicine, Japan.
authors.forename: Ryota
authors.initials: R
authors.lastname: Tanaka
authors.affiliation: Department of Neurology, Juntendo University, School of Medicine, Japan.
authors.forename: Kazuo
authors.initials: K
authors.lastname: Yamashiro
authors.affiliation: Department of Neurology, Juntendo University, School of Medicine, Japan.
authors.forename: Yoshiaki
authors.initials: Y
authors.lastname: Shimada
authors.affiliation: Department of Neurology, Juntendo University, School of Medicine, Japan.
authors.forename: Takuma
authors.initials: T
authors.lastname: Kuroki
authors.affiliation: Department of Neurology, Juntendo University, School of Medicine, Japan.
authors.forename: Kenichiro
authors.initials: K
authors.lastname: Hira
authors.affiliation: Department of Neurology, Juntendo University, School of Medicine, Japan; Department of Neurology, Juntendo University, Urayasu Hospital, Japan.
authors.forename: Takao
authors.initials: T
authors.lastname: Urabe
authors.affiliation: Department of Neurology, Juntendo University, School of Medicine, Japan.
authors.forename: Nobutaka
authors.initials: N
authors.lastname: Hattori
mesh_terms: D000368:Aged; D017548:Echocardiography, Transesophageal; D004617:Embolism / Q000209:etiology*; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D012307:Risk Factors; D018709:Statistics, Nonparametric; D020521:Stroke / Q000097:blood* / Q000000981:diagnostic imaging*
chemical_list: D020097:Natriuretic Peptide, Brain
keywords: Brain natriuretic peptide; Cryptogenic stroke; Stroke; TOAST classification; Transesophageal echocardiography