By Matthew E. Fink, MD

Professor and Chairman, Department of Neurology, Weill Cornell Medical College, Neurologist-in-Chief, New York Presbyterian Hospital

Dr. Fink reports no financial relationships relevant to this field of study.

Source: Llombart V, et al. B-type natriuretic peptides help in cardioembolic stroke diagnosis: Pooled data meta-analysis. Stroke 2015;46:1187-1195.

The accurate diagnosis of cardioembolic stroke is extremely important since secondary prevention for this disorder, with antithrombotic therapy, is different than for other patients who might be treated with antiplatelet therapy. However, this remains a difficult diagnosis to make if there are no underlying cardiac abnormalities, such as valvular heart disease or atrial fibrillation. B-type natriuretic peptide (BNP) is a cardiac hormone that plays an important role during stretch or overload of the left atrium, when there is inapparent heart disease. Both BNP and proBNP are released from the myocyte and have been identified as biomarkers for underlying heart disease.

Investigators of this study searched a PubMed database through November 2013 to identify all articles that measured BNP and proBNP in patients with ischemic stroke to determine the sensitivity and specificity of these measurements in cardioembolic stroke. From 23 selected articles, they collected information regarding 2834 patients who were diagnosed with a defined cause for stroke. They noted that BNP and proBNP levels were significantly elevated until 72 hours from symptom onset in patients with cardioembolic stroke, with sensitivity > 90% and specificity > 80%, when measurements of BNP and proBNP were added and compared to the lowest and highest quartiles. Both peptides increased significantly in patients with cardiopulmonary cardioembolic stroke, and the investigators feel that measurements of these peptides may be an important biomarker in the diagnosis of cardioembolic stroke. However, multicenter prospective studies need to be designed and carried out to determine the optimal biomarker, the best time point, and the best cutoff values to improve discrimination between the various stroke types.