title: Brain Natriuretic Peptide and Particular Left Ventricle Segment Asynergy Associated with Cardioembolic Stroke from Old Myocardial Infarction.
abstract: BACKGROUND
  It is important to determine the usage of anticoagulants by defining the actual risk of cardioembolic stroke in patients with old myocardial infarction. In the present study, we aimed to more precisely evaluate the risks of each segment associated with cardioembolic stroke using a 16-segment model. The usage of the plasma brain natriuretic peptide (BNP) associated with cardioembolic stroke was also evaluated in comparison with a left ventricle ejection fraction less than 40%.
  
  
  METHODS
  There were a total of 190 ischemic stroke patients who had premorbid myocardial infarction. The study included a total of 143 ischemic stroke patients with old myocardial infarction who were available for evaluation and excluded patients with atrial fibrillation or acute myocardial infarction. Their left ventricle wall motion abnormality and the level of plasma BNP at their admission were analyzed.
  
  
  RESULTS
  Hypertension and a plasma BNP level of 206.9 pg/mL or higher, determined from the receiver operating characteristic curve, were independently associated with cardioembolic stroke (χ(2) = 35.6, R(2) = .30, P < .001). Adjusting for these factors, statistically independent high risk was observed at the basal-inferior, basal-inferolateral, mid-anterior, mid-anteroseptal, apical-anterior, and apical-septal left ventricles.
  
  
  CONCLUSIONS
  High plasma BNP levels and left ventricular wall motion abnormalities in the segments perfused with left anterior descending coronary artery or right coronary artery show a high risk for cardioembolic stroke in patients with old myocardial infarction. Considering these factors, it could be possible to more precisely define the risk of cardioembolic stroke and to perform appropriate antithrombotic treatments in old myocardial infarction patients.
authors.affiliation: Department of Clinical Neuroscience and Therapeutics, Hiroshima University Graduate School of Biomedical & Health Sciences, Hiroshima, Japan. Electronic address: nhosomi@hiroshima-u.ac.jp.
authors.forename: Naohisa
authors.initials: N
authors.lastname: Hosomi
authors.affiliation: Department of Neurology, Brain Attack Center Ota Memorial Hospital, Fukuyama, Japan.
authors.forename: Takeshi
authors.initials: T
authors.lastname: Yoshimoto
authors.affiliation: Department of Neurology, Brain Attack Center Ota Memorial Hospital, Fukuyama, Japan.
authors.forename: Yuhei
authors.initials: Y
authors.lastname: Kanaya
authors.affiliation: Department of Neurology, Brain Attack Center Ota Memorial Hospital, Fukuyama, Japan.
authors.forename: Shuichiro
authors.initials: S
authors.lastname: Neshige
authors.affiliation: Department of Neurology, Brain Attack Center Ota Memorial Hospital, Fukuyama, Japan.
authors.forename: Naoyuki
authors.initials: N
authors.lastname: Hara
authors.affiliation: Department of Neurology, Brain Attack Center Ota Memorial Hospital, Fukuyama, Japan.
authors.forename: Takahiro
authors.initials: T
authors.lastname: Himeno
authors.affiliation: Department of Neurology, Brain Attack Center Ota Memorial Hospital, Fukuyama, Japan.
authors.forename: Ryuhei
authors.initials: R
authors.lastname: Kono
authors.affiliation: Department of Neurology, Brain Attack Center Ota Memorial Hospital, Fukuyama, Japan.
authors.forename: Shinichi
authors.initials: S
authors.lastname: Takeshima
authors.affiliation: Department of Neurology, Brain Attack Center Ota Memorial Hospital, Fukuyama, Japan.
authors.forename: Kazuhiro
authors.initials: K
authors.lastname: Takamatsu
authors.affiliation: Department of Cardiology, Brain Attack Center Ota Memorial Hospital, Fukuyama, Japan.
authors.forename: Tomoko
authors.initials: T
authors.lastname: Ota
authors.affiliation: Department of Cardiology, Brain Attack Center Ota Memorial Hospital, Fukuyama, Japan.
authors.forename: Yoshinori
authors.initials: Y
authors.lastname: Miyamoto
authors.affiliation: Department of Cardiology, Brain Attack Center Ota Memorial Hospital, Fukuyama, Japan.
authors.forename: Kotaro
authors.initials: K
authors.lastname: Yasuda
authors.affiliation: Department of Neurology, Brain Attack Center Ota Memorial Hospital, Fukuyama, Japan.
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Shimoe
authors.affiliation: Department of Neurology, Brain Attack Center Ota Memorial Hospital, Fukuyama, Japan.
authors.forename: Taisei
authors.initials: T
authors.lastname: Ota
authors.affiliation: Department of Neurology, Brain Attack Center Ota Memorial Hospital, Fukuyama, Japan.
authors.forename: Masaru
authors.initials: M
authors.lastname: Kuriyama
authors.affiliation: Department of Clinical Neuroscience and Therapeutics, Hiroshima University Graduate School of Biomedical & Health Sciences, Hiroshima, Japan.
authors.forename: Masayasu
authors.initials: M
authors.lastname: Matsumoto
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D019540:Area Under Curve; D015415:Biomarkers / Q000097:blood; D001696:Biomechanical Phenomena; D016009:Chi-Square Distribution; D003430:Cross-Sectional Studies; D003661:Decision Support Techniques; D004452:Echocardiography; D005260:Female; D006801:Humans; D006973:Hypertension / Q000150:complications; D020766:Intracranial Embolism / Q000175:diagnosis / Q000209:etiology*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000097:blood / Q000150:complications* / Q000000981:diagnostic imaging / Q000503:physiopathology; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D016017:Odds Ratio; D011237:Predictive Value of Tests; D011379:Prognosis; D012372:ROC Curve; D018570:Risk Assessment; D012307:Risk Factors; D020521:Stroke / Q000175:diagnosis / Q000209:etiology*; D013318:Stroke Volume; D015854:Up-Regulation; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging / Q000209:etiology* / Q000503:physiopathology; D016277:Ventricular Function, Left
chemical_list: D015415:Biomarkers; D020097:Natriuretic Peptide, Brain
keywords: Ischemic stroke; brain natriuretic peptide; cardioembolism; myocardial infarction; sonography; stroke subtypes