Early diagnostic utility of BNP and NT-proBNP for cardioembolic stroke: A head-to-head comparison in the hyperacute and early acute phase

IF 1.8 4区医学 Q3 CLINICAL NEUROLOGY

Journal of Clinical Neuroscience Pub Date : 2025-08-30 DOI:10.1016/j.jocn.2025.111595

Eunhee Han , Hyejeong Kim , Minseok Kwon , Ae-Ran Choi , Jeong-Joong Lee , Eun-Jee Oh , Hyojin Chae

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引用次数: 0

Abstract

Background

Cardioembolic (CE) stroke is a common and often severe subtype of ischemic stroke, but early and accurate differentiation from other stroke types remains challenging. Brain natriuretic peptide (BNP) and N-terminal pro-BNP (NT-proBNP) have emerged as promising biomarkers, yet direct comparative studies evaluating their diagnostic utility in the hyperacute and early acute phase are limited.

Methods

This prospective study included 165 patients who presented with acute stroke symptoms within twenty-four hours of onset at a single tertiary center. Plasma BNP and NT-proBNP levels were measured upon admission and analyzed in relation to stroke subtype, with classification based on TOAST criteria. Diagnostic performance for identifying CE stroke was evaluated using receiver operating characteristic (ROC) curve analysis.

Results

Among 121 patients diagnosed with ischemic stroke, 32 (26.4 %) had CE stroke. Both BNP and NT-proBNP levels were significantly higher in CE stroke compared to other subtypes. ROC analysis showed that BNP (AUC = 0.845) and NT-proBNP (AUC = 0.861) demonstrated similar diagnostic accuracies. A BNP cutoff of 49.8 pg/mL achieved a sensitivity of 87.5 % and specificity of 79.0 %, while an NT-proBNP cutoff of 350 pg/mL yielded a sensitivity of 90.6 % and specificity of 75.2 %.

Conclusion

Our results demonstrate that BNP and NT-proBNP provide similar diagnostic accuracy for distinguishing CE stroke in the hyperacute and early acute setting. Their high sensitivity in hyperacute and early acute phase highlights the potential of both biomarkers to improve diagnostic accuracy, especially in setting with limited healthcare resources.

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BNP和NT-proBNP对心脏栓塞性卒中的早期诊断效用：超急性期和早期急性期的正面比较

心脏栓塞性（CE）中风是缺血性中风的一种常见且严重的亚型，但与其他类型中风的早期和准确区分仍然具有挑战性。脑钠肽（BNP）和n端前BNP （NT-proBNP）已成为有前景的生物标志物，但评估其在超急性期和早期急性期诊断效用的直接比较研究有限。方法本前瞻性研究纳入了165例在单一三级中心24小时内出现急性卒中症状的患者。入院时测量血浆BNP和NT-proBNP水平，并根据TOAST标准进行分类，分析其与卒中亚型的关系。采用受试者工作特征（ROC）曲线分析评估诊断CE脑卒中的效能。结果121例缺血性脑卒中患者中，32例（26.4%）为CE脑卒中。与其他亚型相比，脑卒中患者的BNP和NT-proBNP水平均显著升高。ROC分析显示BNP （AUC = 0.845）和NT-proBNP （AUC = 0.861）的诊断准确性相似。49.8 pg/mL的BNP临界值的敏感性为87.5%，特异性为79.0%，而350 pg/mL的NT-proBNP临界值的敏感性为90.6%，特异性为75.2%。结论：BNP和NT-proBNP在区分超急性期和早期急性期CE卒中方面具有相似的诊断准确性。它们在超急性期和早期急性期的高敏感性突出了这两种生物标志物提高诊断准确性的潜力，特别是在医疗资源有限的情况下。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Clinical Neuroscience 医学-临床神经学

CiteScore

4.50

自引率

0.00%

发文量

402

审稿时长

40 days

期刊介绍： This International journal, Journal of Clinical Neuroscience, publishes articles on clinical neurosurgery and neurology and the related neurosciences such as neuro-pathology, neuro-radiology, neuro-ophthalmology and neuro-physiology. The journal has a broad International perspective, and emphasises the advances occurring in Asia, the Pacific Rim region, Europe and North America. The Journal acts as a focus for publication of major clinical and laboratory research, as well as publishing solicited manuscripts on specific subjects from experts, case reports and other information of interest to clinicians working in the clinical neurosciences.