title: Impact of Atrial Natriuretic Peptide Value for Predicting Paroxysmal Atrial Fibrillation in Ischemic Stroke Patients.
abstract: BACKGROUND
  The impact of atrial natriuretic peptide (ANP) value for predicting paroxysmal atrial fibrillation (pAF) in ischemic stroke patients remains uncertain.
  
  
  METHODS
  The consecutive 222 ischemic stroke patients (median 77 [IQR 68-83] years old, 93 females) within 48 hours after onset were retrospectively studied. Plasma ANP and brain natriuretic peptide (BNP) levels were simultaneously measured at admission. Of all, 158 patients had no evidence of atrial fibrillation (AF) (sinus rhythm [SR] group), 25 patients had pAF (pAF group), and the other 39 patients had chronic AF (cAF group). We investigated predicting factors for pAF, with focus on ANP, BNP, and ANP/BNP ratio.
  
  
  RESULTS
  ANP value was significantly higher in the pAF than in the SR group (97 [50-157] mg/dL versus 42 [26-72] mg/dL, P < .05) and further increased in the cAF group (228 [120-392], P < .05 versus pAF and SR groups). Similarly, the BNP value was higher in the pAF than in the SR group (116 [70-238] mg/dL versus 34 [14-72] mg/dL, P < .05) and further increased in the cAF group (269 [199-423], P < .05 versus pAF and SR groups). ANP/BNP ratio was lower in the pAF and cAF groups than in the SR group (.6 [.5-1.2] and .7 [.5-1.0] versus 1.3 [.8-2.4], both P < .05]. Multivariate analysis in the SR and pAF groups (n = 183) demonstrated that age, congestive heart failure, ANP, and BNP, but not ANP/BNP ratio, were independent predictors for detecting pAF. Receiver operating characteristic curve analysis further showed that area under the curve was similar between ANP and BNP (.76 and .80).
  
  
  CONCLUSIONS
  ANPmay be clinically useful for detecting pAF in ischemic stroke patients as well as BNP.
authors.affiliation: Hirosaki Stroke and Rehabilitation Center, Hirosaki 036-8104, Japan.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Shiroto
authors.affiliation: Department of Cardiology, Hirosaki University Graduate School of Medicine, Hirosaki 036-8562, Japan; Department of Hypertension and Stroke Medicine, Hirosaki University Graduate School of Medicine, Hirosaki 036-8562, Japan. Electronic address: tomitah@hirosaki-u.ac.jp.
authors.forename: Hirofumi
authors.initials: H
authors.lastname: Tomita
authors.affiliation: Hirosaki Stroke and Rehabilitation Center, Hirosaki 036-8104, Japan.
authors.forename: Joji
authors.initials: J
authors.lastname: Hagii
authors.affiliation: Hirosaki Stroke and Rehabilitation Center, Hirosaki 036-8104, Japan.
authors.forename: Norifumi
authors.initials: N
authors.lastname: Metoki
authors.affiliation: Hirosaki Stroke and Rehabilitation Center, Hirosaki 036-8104, Japan.
authors.forename: Ayaka
authors.initials: A
authors.lastname: Fujita
authors.affiliation: Hirosaki Stroke and Rehabilitation Center, Hirosaki 036-8104, Japan.
authors.forename: Takaatsu
authors.initials: T
authors.lastname: Kamada
authors.affiliation: Hirosaki Stroke and Rehabilitation Center, Hirosaki 036-8104, Japan.
authors.forename: Koki
authors.initials: K
authors.lastname: Takahashi
authors.affiliation: Hirosaki Stroke and Rehabilitation Center, Hirosaki 036-8104, Japan.
authors.forename: Shin
authors.initials: S
authors.lastname: Saito
authors.affiliation: Hirosaki Stroke and Rehabilitation Center, Hirosaki 036-8104, Japan.
authors.forename: Satoko
authors.initials: S
authors.lastname: Sasaki
authors.affiliation: Hirosaki Stroke and Rehabilitation Center, Hirosaki 036-8104, Japan.
authors.forename: Hiroyasu
authors.initials: H
authors.lastname: Hitomi
authors.affiliation: Hirosaki Stroke and Rehabilitation Center, Hirosaki 036-8104, Japan.
authors.forename: Satoshi
authors.initials: S
authors.lastname: Seino
authors.affiliation: Hirosaki Stroke and Rehabilitation Center, Hirosaki 036-8104, Japan.
authors.forename: Yoshiko
authors.initials: Y
authors.lastname: Baba
authors.affiliation: Hirosaki Stroke and Rehabilitation Center, Hirosaki 036-8104, Japan.
authors.forename: Takamitsu
authors.initials: T
authors.lastname: Uchizawa
authors.affiliation: Hirosaki Stroke and Rehabilitation Center, Hirosaki 036-8104, Japan.
authors.forename: Manabu
authors.initials: M
authors.lastname: Iwata
authors.affiliation: Hirosaki Stroke and Rehabilitation Center, Hirosaki 036-8104, Japan.
authors.forename: Shigeo
authors.initials: S
authors.lastname: Matsumoto
authors.affiliation: Hirosaki Stroke and Rehabilitation Center, Hirosaki 036-8104, Japan.
authors.forename: Minoru
authors.initials: M
authors.lastname: Yasujima
authors.affiliation: Division of Cardiology, Saiseikai Kumamoto Hospital, Kumamoto 861-4193, Japan.
authors.forename: Ken
authors.initials: K
authors.lastname: Okumura
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001281:Atrial Fibrillation / Q000097:blood / Q000175:diagnosis / Q000209:etiology; D009320:Atrial Natriuretic Factor / Q000097:blood*; D002545:Brain Ischemia / Q000150:complications; D005260:Female; D006801:Humans; D008297:Male; D015999:Multivariate Analysis; D011237:Predictive Value of Tests; D012372:ROC Curve; D012189:Retrospective Studies; D012720:Severity of Illness Index; D020521:Stroke / Q000150:complications* / Q000209:etiology
chemical_list: D009320:Atrial Natriuretic Factor
keywords: Cardioembolic stroke; atrial natriuretic peptide; brain natriuretic peptide; paroxysmal atrial fibrillation