Key result
Higher Log10MR-proANP levels in acute ischemic stroke patients were strongly associated with newly diagnosed atrial fibrillation (OR 35.3; 95% CI 17.58-71.03) and MACE (HR 2.02; 95% CI 1.32-3.08).
Why the study?
MR-proANP is a promising biomarker to differentiate AIS etiology, but its role in classifying cardioembolic stroke, identifying newly diagnosed AF, and assessing MACE risk required determination.
Does MR-proANP measurement predict cardioembolic stroke etiology, newly diagnosed atrial fibrillation, and MACE in patients with acute ischemic stroke?
Cohort (n=1,759)
Yes
Does MR-proANP measurement predict cardioembolic stroke etiology, newly diagnosed atrial fibrillation, and MACE in patients with acute ischemic stroke?
MR-proANP measured within 24 hours of acute ischemic stroke is a strong predictor of newly diagnosed atrial fibrillation and 1-year MACE, offering a potential decision tool to identify patients for prolonged cardiac monitoring.
Answers are grounded in this paper and cite their sources.
MR-proANP may aid CE stroke classification and NDAF detection in AIS; leaves open prospective validation for MACE risk stratification.
Midregional pro-atrial natriuretic peptide (MR-proANP) is a promising biomarker to differentiate the underlying etiology of acute ischemic stroke (AIS). This study aimed to determine the role of MR-proANP for classification as cardioembolic (CE) stroke, identification of newly diagnosed atrial fibrillation (NDAF), and risk assessment for major adverse cardiovascular events (MACE). This study measured MR-proANP prospectively collected within 24 hours after symptom-onset in patients with AIS from the multicenter BIOSIGNAL (Biomarker Signature of Stroke Aetiology) cohort study. Primary outcomes were CE stroke etiology and NDAF after prolonged cardiac monitoring, as well as a composite outcome of MACE (recurrent cerebrovascular events, myocardial infarction, or cardiovascular death) within 1 year. Logistic/Poisson and subproportional hazard regression were applied to evaluate the association between MR-proANP levels and outcomes. Additionally, a model for prediction of NDAF was derived and validated as a decision tool for immediate clinical application. Between October 1, 2014, and October 31, 2017, this study recruited 1,759 patients. Log10MR-proANP levels were associated with CE stroke (OR: 7.96; 95% CI: 4.82-13.14; risk ratio: 3.12; 95% CI: 2.23-4.37), as well as NDAF (OR: 35.3; 95% CI: 17.58-71.03; risk ratio: 11.47; 95% CI: 6.74-19.53), and MACE (subdistributional HR: 2.02; 95% CI: 1.32-3.08) during follow-up. The model to predict NDAF including only age and MR-proANP levels had a good discriminatory capacity with an area under the curve of 0.81 (95% CI: 0.76-0.86), was well calibrated (calibration in the large: −0.086; calibration slope 1.053), and yielded higher net-benefit compared with validated scores to predict NDAF (AS5F score, CHA2DS2-VASc [Congestive Heart Failure, Hypertension, Age ≥65 or ≥75, Diabetes, Prior Cardioembolic Event, (female) Sex, or Vascular Disease] score). MR-proANP is a valid biomarker to determine risk of NDAF and MACE in patients with AIS and can be used as a decision tool to identify patients for prolonged cardiac monitoring. (Biomarker Signature of Stroke Aetiology Study: The BIOSIGNAL study [BIOSIGNAL]; NCT02274727)
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Schweizer et al. (2022) conducted a cohort in acute ischemic stroke (AIS) (n=1,759). Midregional pro-atrial natriuretic peptide (MR-proANP) was evaluated on newly diagnosed atrial fibrillation (NDAF) (OR 35.3, 95% CI 17.58-71.03). Higher Log10MR-proANP levels in acute ischemic stroke patients were strongly associated with newly diagnosed atrial fibrillation (OR 35.3; 95% CI 17.58-71.03) and MACE (HR 2.02; 95% CI 1.32-3.08).
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