Key result
Admission BNP combined with imaging mismatch ratio accurately identifies cardioembolic stroke.
Why the study?
To identify the potential roles of BNP and multimodal CT imaging markers in distinguishing cardioembolic from non-cardioembolic stroke to help individualize endovascular treatment planning.
Does BNP on admission combined with multimodal CT imaging markers predict the risk of cardioembolic stroke in patients with acute ischemic stroke?
Observational (n=160)
No
Does BNP on admission combined with multimodal CT imaging markers predict the risk of cardioembolic stroke in patients with acute ischemic stroke?
BNP and imaging mismatch ratio serve as valuable independent and combined biomarkers to distinguish cardioembolic stroke from other subtypes in acute ischemic stroke.
BNP plus mismatch ratio may aid early CE stroke differentiation in acute LVO; hypothesis-generating and requires prospective validation before any practice change.
Background. The aim of the study was to find the potential roles of B-type natriuretic peptide (BNP) and imaging markers on distinguishing cardioembolic (CE) stroke from non-CE stroke, so as to provide useful information for making individualized endovascular treatment (EVT) plan for the patients with acute ischemic stroke (AIS). Methods. The patients with unilateral anterior circulation large vessel occlusion who underwent EVT between March 2016 and December 2021 were analyzed in this study, retrospectively. The risk factors, laboratory test indicators, imaging parameters, and other factors were compared between the CE group and non-CE group. Logistic regression was used to analyze the risk factors of CE stroke. ROC curves were used to assess the values of different parameters on distinguishing CE stroke from non-CE stroke. The relationships between BNP and imaging parameters were assessed using the Spearman correlation analysis. Results. 160 patients were enrolled in the study and divided into the CE group ( <a:math xmlns:a="http://www.w3.org/1998/Math/MathML" id="M1"> <a:mi>n</a:mi> <a:mo>=</a:mo> <a:mn>66</a:mn> </a:math> ) and non-CE group ( <c:math xmlns:c="http://www.w3.org/1998/Math/MathML" id="M2"> <c:mi>n</c:mi> <c:mo>=</c:mo> <c:mn>94</c:mn> </c:math> ). BNP (odds ratio <e:math xmlns:e="http://www.w3.org/1998/Math/MathML" id="M3"> <e:mfenced open="(" close=")"> <e:mrow> <e:mtext>OR</e:mtext> </e:mrow> </e:mfenced> <e:mo>=</e:mo> <e:mn>1.004</e:mn> </e:math> ; 95% CI, 1.001-1.009; <i:math xmlns:i="http://www.w3.org/1998/Math/MathML" id="M4"> <i:mi>p</i:mi> <i:mo>=</i:mo> <i:mn>0.038</i:mn> </i:math> ), MMR ( <k:math xmlns:k="http://www.w3.org/1998/Math/MathML" id="M5"> <k:mtext>OR</k:mtext> <k:mo>=</k:mo> <k:mn>0.736</k:mn> </k:math> ; 95% CI, 0.573-0.945; <m:math xmlns:m="http://www.w3.org/1998/Math/MathML" id="M6"> <m:mi>p</m:mi> <m:mo>=</m:mo> <m:mn>0.016</m:mn> </m:math> ), NIHSS ( <o:math xmlns:o="http://www.w3.org/1998/Math/MathML" id="M7"> <o:mtext>OR</o:mtext> <o:mo>=</o:mo> <o:mn>1.150</o:mn> </o:math> ; 95% CI, 1.022-1.294; <q:math xmlns:q="http://www.w3.org/1998/Math/MathML" id="M8"> <q:mi>p</q:mi> <q:mo>=</q:mo> <q:mn>0.020</q:mn> </q:math> ), and AF ( <s:math xmlns:s="http://www.w3.org/1998/Math/MathML" id="M9"> <s:mtext>OR</s:mtext> <s:mo>=</s:mo> <s:mn>556.968</s:mn> </s:math> ; 95% CI, 51.739-5995.765; <u:math xmlns:u="http://www.w3.org/1998/Math/MathML" id="M10"> <u:mi>p</u:mi> <u:mo><</u:mo> <u:mn>0.001</u:mn> </u:math> ) were the independent predictive factors of CE stroke. The area under the curve (AUC) of BNP and mismatch ratio (MMR) were 0.846 (95% CI (0.780-0.898), <w:math xmlns:w="http://www.w3.org/1998/Math/MathML" id="M11"> <w:mi>p</w:mi> <w:mo><</w:mo> <w:mn>0.001</w:mn> </w:math> ) and 0.636 (95% CI (0.633-0.779), <y:math xmlns:y="http://www.w3.org/1998/Math/MathML" id="M12"> <y:mi>p</y:mi> <y:mo><</y:mo> <y:mn>0.001</y:mn> </y:math> ), respectively. The cut-off value of BNP was 249.23 pg/mL with the sensitivity of 74.24% and the specificity of 82.98%. BNP combined with MMR improved the predictive value for CE stroke. The AUC of the combination was 0.858 with the sensitivity of 84.85% and the specificity of 73.40%. BNP was correlated with 4D CTA collateral score, MMR, clot burden score, final infarct volume, infarct core volume, and ischemic penumbra volume (all, <ab:math xmlns:ab="http://www.w3.org/1998/Math/MathML" id="M13"> <ab:mi>p</ab:mi> <ab:mo><</ab:mo> <ab:mn>0.05</ab:mn> </ab:math> ). Conclusion. BNP on admission combined with MMR is valuable for the risk prediction of CE stroke, which will promote the further screening of the high-risk patients with CE stroke and provide more diagnostic information for clinicians.
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Cao et al. (2022) conducted an observational in Acute ischemic stroke with unilateral anterior circulation large vessel occlusion undergoing endovascular treatment (n=160). B-type natriuretic peptide (BNP) and Mismatch ratio (MMR) was evaluated on Cardioembolic stroke diagnosis prediction by BNP (OR 1.004, 95% CI 1.001-1.009, p=0.038). Elevated B-type natriuretic peptide on admission independently predicted cardioembolic stroke (OR 1.004), and combining it with the imaging mismatch ratio achieved high diagnostic accuracy (AUC 0.858).
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