natriuretic-peptide--brain and Cerebral-Hemorrhage

Background and Purpose- Current European guidelines for the management of atrial fibrillation suggest using biomarkers to refine the risk stratification process. However, it is unclear whether ≥2 biomarkers incrementally improve risk prediction beyond 1 biomarker alone. We investigated whether the predictive performance of CHA

Topics: Aftercare; Aged; Aged, 80 and over; Atrial Fibrillation; Biomarkers; Cerebral Hemorrhage; Female; Fibrin Fibrinogen Degradation Products; Follow-Up Studies; Humans; Interleukin-6; International Normalized Ratio; Intramolecular Oxidoreductases; Lipocalins; Male; Natriuretic Peptide, Brain; Peptide Fragments; Predictive Value of Tests; Prospective Studies; Risk Factors; Spain; Stroke; Troponin T; von Willebrand Factor

and purpose N-terminal probrain natriuretic peptide, which is mainly produced by the heart, is increased in acute stroke. We aimed to determine if N-terminal probrain natriuretic peptide could be a biomarker for ischemic stroke with a cardioembolic cause.. Consecutive sample of acute stroke patients admitted to a Stroke Unit. Ischemic stroke subtype was classified using the TOAST classification. Blood samples were drawn within 72 h after stroke onset. Serum N-terminal probrain natriuretic peptide concentration was measured using an electrochemiluminescence immunoassay. Mean values of N-terminal probrain natriuretic peptide were compared between patients with hemorrhagic stroke vs. ischemic stroke, cardioembolic stroke vs. noncardioembolic stroke, cardioembolic stroke with atrial fibrillation vs. noncardioembolic stroke using t-test. Receiver operating characteristic curves were used to test the ability of N-terminal probrain natriuretic peptide values to identify cardioembolic stroke and cardioembolic stroke with atrial fibrillation.. Ninety-two patients were included (66 with ischemic stroke) with a mean age of 58·6 years. Twenty-eight (42·4%) ischemic strokes had a cardioembolic cause. Mean N-terminal probrain natriuretic peptide values for cardioembolic stroke were significantly higher (P<0·001) (491·6; 95% confidence interval 283·7-852·0 pg/ml) than for noncardioembolic ischemic stroke (124·7; 86·3-180·2 pg/ml). The area under the receiver operating characteristic curve for N-terminal probrain natriuretic peptide in cardioembolic stroke was 0·77. The cut-off point with the highest sensitivity and specificity was set at 265·5 pg/ml (71·4% and 73·7% respectively). The area under the curve of N-terminal probrain natriuretic peptide for cardioembolic stroke related to atrial fibrillation was 0·92, cut-off was set at 265·5 pg/ml (sensitivity 94·4%, specificity 72·9%).. N-terminal probrain natriuretic peptide is a biomarker with a good accuracy to predict ischemic stroke of cardioembolic cause, namely associated with atrial fibrillation.

Topics: Adult; Aged; Area Under Curve; Atrial Fibrillation; Biomarkers; Brain Ischemia; Cerebral Hemorrhage; Female; Heart Diseases; Humans; Intracranial Embolism; Male; Middle Aged; Natriuretic Peptide, Brain; Peptide Fragments; Risk Factors; ROC Curve; Sensitivity and Specificity; Ultrasonography

In preclinical stroke models, high-dose human albumin confers robust neuroprotection. We investigated the safety and tolerability of this therapy in patients with acute ischemic stroke.. The ALIAS (Albumin in Acute Stroke) Pilot Clinical Trial used a multiple-tier, open-label, dose-escalation design. Subjects with acute ischemic stroke (NIH Stroke Scale [NIHSS] of 6 or above) received a 2-hour infusion of 25% human albumin (ALB) beginning within 16 hours of stroke onset. Six successive ALB dose tiers were assessed ranging from 0.34 to 2.05 g/kg. Neurologic and cardiac function was sequentially monitored. At 3 months, the NIHSS, modified Rankin Scale, and Barthel Index were measured.. Eighty-two subjects (mean age, 65 years) received ALB at 7.8+/-3.4 hours after stroke onset (mean+/-standard deviation). Forty-two patients also received standard-of-care intravenous tissue plasminogen activator (tPA). Vital signs were unaltered by ALB treatment. Dose-related increases in plasma albumin and mild hemodilution were maximal at 4 to 12 hours. Age-related plasma brain natriuretic peptide levels increased at 24 hours after ALB but did not predict cardiac adverse events. The sole ALB-related adverse event was mild or moderate pulmonary edema in 13.4% of subjects, which was readily managed with diuretics. In the tPA-treated subgroup, symptomatic intracranial hemorrhage occurred in only one of 42 subjects.. Twenty-five percent human albumin in doses ranging up to 2.05 g/kg was tolerated by patients with acute ischemic stroke without major dose-limiting complications. tPA therapy did not affect the safety profile of ALB. The companion article presents neurologic outcome data and efficacy analysis in these subjects.

Topics: Aged; Albumins; Brain Ischemia; Cerebral Hemorrhage; Diuretics; Dose-Response Relationship, Drug; Drug Therapy, Combination; Female; Fibrinolytic Agents; Humans; Injections, Intravenous; Male; Middle Aged; Natriuretic Peptide, Brain; Neuroprotective Agents; Pilot Projects; Pulmonary Edema; Serum Albumin; Stroke; Tissue Plasminogen Activator; Treatment Outcome

Intracerebral haemorrhage (ICH) is a devastating condition, with more than half of patients dying or becoming dependent after such an event. Natriuretic peptides, frequently used in the management of heart failure, have been shown to correlate with disease severity and prognosis in brain disorders. The aim of this study was to test the hypothesis that NT-pro-BNP correlates with disease severity and is an independent prognostic marker for non-traumatic ICH patients.. A consecutive sample of 201 non-traumatic ICH patients, who were non-comatose on admission and medically treated in a stroke unit, were evaluated for in-hospital mortality and three-month functional dependency (modified Rankin Scale >2). NT-pro-BNP measurement was performed after admission. Independent predictors of the outcomes in study were assessed using logistic regression and the incremental value of NT-pro-BNP on three previously validated severity scores was evaluated using the variation in C-statistic (Δc). Values of p < .05 were considered significant.. In-hospital mortality rate was 8.0%, and 40.3% of patients achieved good functional outcome. NT-pro-BNP correlated with hematoma volume (r = 0.186) and amount of intraventricular blood (r = 0.240). Higher levels of NT-pro-BNP were independently associated with death (Expß = 1.650) and functional dependency (Expß = 1.449). NT-pro-BNP increased the discrimination of the ICH-GS for mortality prediction (Δc = 0.043) and of FUNC and ICH scores for functional outcome prediction (Δc = 0.060 and 0.055 respectively). Admission NT-pro-BNP levels were independently associated with hematoma size.. NT-pro-BNP is an independent prognostic factor for low-risk non-traumatic ICH patients and a valid marker of disease severity in this patient population.

Topics: Aged; Aged, 80 and over; Biomarkers; Cerebral Hemorrhage; Female; Hospital Mortality; Humans; Male; Middle Aged; Natriuretic Peptide, Brain; Peptide Fragments; Prognosis; Prospective Studies; Severity of Illness Index; Survival Rate

To investigate the relationships of the changes of serum N-terminal pro-B-type natriuretic peptide (NT-proBNP) level with the severity of the disease (infarct size, amount of bleeding, National Institutes of Health Stroke Scale [NIHSS] Score and Glasgow Coma Scale [GCS] Score) and prognosis in acute cerebral stroke patients.. Acute cerebral stroke patients admitted to our hospital from August 2015 to August 2017 were enrolled in this study. The NT-proBNP level, infarct size, amount of bleeding, NIHSS Score, GCS Score and Modified Rankin Scale (MRS) Score at 3 months after onset in patients in cerebral infarction group and cerebral hemorrhage group were observed at 24 h, (5±2) d and (12±2) d. The correlations of NT-proBNP level with the severity of the disease and MRS Score at 3 months after onset were also analyzed.. The serum NT-proBNP levels in patients in infarction group and hemorrhage group were significantly higher than those in control group at 24 h and (5±2) d after onset (P<0.01). The serum NT-proBNP level at 24 h after onset in hemorrhage group had statistically significant difference from that at (5±2) d in the same group, and those at 24 h and (5±2) d after onset in infarction group and hemorrhage group had statistically significant difference from those at (12±2) d in the same group (P<0.01). There were significant differences in NT-proBNP levels among subgroups with different NIHSS scores (P<0.01). GCS Score was significantly correlated with NT-proBNP level (P<0.01). The higher the level of serum NT-proBNP, the higher the patient's MRS Score at 3 months after onset was.. Serum NT-proBNP level can be used as a serum biological indicator to evaluate the severity and prognosis of cerebral stroke patients.

Topics: Acute Disease; Biomarkers; Case-Control Studies; Cerebral Hemorrhage; Hemorrhage; Humans; Magnetic Resonance Imaging; Natriuretic Peptide, Brain; Peptide Fragments; Prognosis; Quality of Life; Severity of Illness Index; Stroke; Time Factors; Tomography, X-Ray Computed

Stroke diagnosis could be challenging in the acute phase. We aimed to develop a blood-based diagnostic tool to differentiate between real strokes and stroke mimics and between ischemic and hemorrhagic strokes in the hyperacute phase.. The Stroke-Chip was a prospective, observational, multicenter study, conducted at 6 Stroke Centers in Catalonia. Consecutive patients with suspected stroke were enrolled within the first 6 hours after symptom onset, and blood samples were drawn immediately after admission. A 21-biomarker panel selected among previous results and from the literature was measured by immunoassays. Outcomes were differentiation between real strokes and stroke mimics and between ischemic and hemorrhagic strokes. Predictive models were developed by combining biomarkers and clinical variables in logistic regression models. Accuracy was evaluated with receiver operating characteristic curves.. From August 2012 to December 2013, 1308 patients were included (71.9% ischemic, 14.8% stroke mimics, and 13.3% hemorrhagic). For stroke versus stroke mimics comparison, no biomarker resulted included in the logistic regression model, but it was only integrated by clinical variables, with a predictive accuracy of 80.8%. For ischemic versus hemorrhagic strokes comparison, NT-proBNP (N-Terminal Pro-B-Type Natriuretic Peptide) >4.9 (odds ratio, 2.40; 95% confidence interval, 1.55-3.71;. The studied biomarkers were not sufficient for an accurate differential diagnosis of stroke in the hyperacute setting. Additional discovery of new biomarkers and improvement on laboratory techniques seem necessary for achieving a molecular diagnosis of stroke.

Topics: Aged; Aged, 80 and over; Amine Oxidase (Copper-Containing); Apolipoprotein C-III; Biomarkers; Brain Ischemia; Case-Control Studies; Caspase 3; Cell Adhesion Molecules; Cerebral Hemorrhage; Chemokine CXCL1; Endostatins; Fas Ligand Protein; Female; Fibrin Fibrinogen Degradation Products; Fibronectins; HSC70 Heat-Shock Proteins; Humans; Insulin-Like Growth Factor Binding Protein 3; Interleukin Receptor Common gamma Subunit; Interleukin-17; Interleukin-6; Logistic Models; Male; Matrix Metalloproteinase 9; Middle Aged; Natriuretic Peptide, Brain; Nerve Growth Factor; Neural Cell Adhesion Molecules; Odds Ratio; Peptide Fragments; Phosphopyruvate Hydratase; Prospective Studies; Receptors, Tumor Necrosis Factor, Type I; ROC Curve; S100 Calcium Binding Protein beta Subunit; Stroke; von Willebrand Factor

The aim of this study was to assess the differences in the mortality and in-hospital outcomes of preterm infants with < 28 weeks of gestation who received ibuprofen treatment according to the presence of clinical symptoms (any of oliguria, hypotension, or moderate to severe respiratory difficulty) attributable to hemodynamically-significant patent ductus arteriosus (hsPDA) at the time of first ibuprofen treatment. In total, 91 infants born from April 2010 to March 2015 were included. Fourteen infants (15.4%) received ibuprofen treatment when there were clinical symptoms due to hsPDA (clinical symptoms group). In clinical symptoms group, infants were younger (25 [23-27] vs. 26 [23-27] weeks; P = 0.012) and lighter (655 [500-930] vs. 880 [370-1,780] grams; P < 0.001). Also, the clinical risk index for babies (CRIB)-II scores were higher and more infants received invasive ventilator care ≤ 2 postnatal days. More infants received multiple courses of ibuprofen in clinical symptoms group. Although the frequency of secondary patent ductus arteriosus (PDA) ligation and the incidence of bronchopulmonary dysplasia (BPD) was higher in the clinical symptoms group in the univariate analysis, after multivariate logistic regression analysis adjusting for the CRIB-II score, birthweight, birth year, and the invasive ventilator care ≤ 2 postnatal days, there were no significant differences in mortality, frequency of secondary ligation and in-hospital outcomes including necrotizing enterocolitis (NEC), intraventricular hemorrhage (IVH), BPD or death. Our data suggest that we can hold off on PDA treatment until the clinical symptoms become prominent.

Topics: Bronchopulmonary Dysplasia; Cerebral Hemorrhage; Ductus Arteriosus, Patent; Echocardiography; Enterocolitis, Necrotizing; Female; Gestational Age; Hemodynamics; Hospital Mortality; Humans; Ibuprofen; Incidence; Infant, Low Birth Weight; Infant, Newborn; Infant, Premature; Logistic Models; Male; Multivariate Analysis; Natriuretic Peptide, Brain; Retrospective Studies; Risk

Previous reports have shown that plasma brain natriuretic peptide (BNP) levels are increased in patients with subarachnoid hemorrhage and ischemic stroke. We examined BNP in patients with intracerebral hemorrhage (ICH). Between June 2006 and February 2010, we prospectively enrolled consecutive patients with acute ICH within 24 hours of onset. The plasma BNP level was measured twice, on admission and 4 weeks after onset or at discharge. We investigated whether plasma BNP was elevated in the acute phase of ICH and associated factors. The mean ± standard deviation (SD) plasma BNP level of all patients was 71.1 ± 104.1 pg/mL. The log BNP level positively correlated with the cardio-thoracic ratio (r=0.240, p=0.0001). Moreover, BNP was significantly associated with intraventricular extension (p=0.0039) and hydrocephalus (p=0.0046). The mean ± SD BNP level of patients with cerebellar hemorrhage was the highest (130.2 ± 152.0 pg/mL), followed by brainstem (84.5 ± 170.6 pg/mL), lobar (72.4 ± 148.1 pg/mL), thalamus (64.8 ± 72.1 pg/mL), and putamen (59.9 ± 62.6 pg/mL) hemorrhages. In 185 patients, BNP was measured in the subacute phase of ICH. The BNP level in the acute phase of ICH was significantly higher than that in the subacute phase of ICH (69.3 ± 108.1 versus 21.7 ± 23.5 pg/mL, p<0.0001). In conclusion, plasma BNP appears to be elevated in the acute phase of ICH, particularly in those with cerebellar lesions.

Topics: Aged; Brain Stem; Cerebellar Diseases; Cerebral Cortex; Cerebral Hemorrhage; Female; Humans; Hydrocephalus; Male; Natriuretic Peptide, Brain; Prospective Studies; Putaminal Hemorrhage; Thalamic Diseases; Time Factors; Treatment Outcome

The purpose of the present study was to test the hypothesis that plasma brain natriuretic peptide (BNP) is associated with short-term mortality after intracerebral hemorrhage (ICH).. We prospectively enrolled 271 patients (median age 72 years; 109 females) who were admitted within 24 h of ICH onset between April 2007 and July 2011 and in whom plasma BNP levels were measured upon admission. The patients were assigned to two groups according to survival within 1 month of ICH. Factors associated with mortality were determined by multivariate logistic regression analysis.. Within 1 month of ICH, 48 (17.7%) of the 271 enrolled patients died. The median (interquartile range) level of plasma BNP was significantly higher in the group of non-survivors than in the group of survivors [102.5 (48.7-205.0) vs. 32.4 (17.3-85.0) pg/ml; p < 0.001]. A cutoff BNP level of 60.0 pg/ml could predict death within 1 month of ICH. Multivariate logistic regression analysis showed that a plasma BNP of >60.0 pg/ml (OR 4.7; 95% CI 1.43-15.63; p = 0.011) was independently associated with mortality within 1 month after ICH.. A high BNP level upon admission is associated with mortality within 1 month after ICH.

Topics: Aged; Biomarkers; Cerebral Hemorrhage; Enzyme-Linked Immunosorbent Assay; Female; Humans; Male; Middle Aged; Natriuretic Peptide, Brain; Prognosis

To evaluate the correlation between the dimensions of ischemic and hemorrhagic lesions detected by diffusion MRI and the changes in lesion dimensions with serum NT-proBNP levels in mild and moderate head trauma.. 30 patients were assessed in our study. A control group of 10 individuals with no trauma history was formed in order to establish normal serum NT-proBNP values. Patients underwent brain diffusion MRI 24 and 48 hours following admittance. Their plasma NT-proBNP levels were checked at the same stages.. The correlation between the values of 24th and 48th hour Intra-axial hemorrhage (IAHEM) and Intra-axial ischemia (IAISC) and the values of 24th and 48th hour NT-proBNP was established as statistically significant.. It was observed that the serum NT-proBNP values could be higher in patients with wide intra-axial lesion following head trauma than patients with smaller intra-axial lesions. In addition, the fact that it has been established that the serum NT-proBNP values of patients with increasing cerebral parenchymal lesion dimensions on the advancing hours after the trauma increase suggests that serum NTproBNP values may be significant in the follow-up of the dimensions of cerebral parenchymal damage.

Topics: Adult; Cerebral Hemorrhage; Craniocerebral Trauma; Diffusion Magnetic Resonance Imaging; Female; Humans; Ischemia; Male; Middle Aged; Natriuretic Peptide, Brain; Peptide Fragments; Young Adult

A 94-year-old woman was admitted to our hospital because of altered mental status and cerebellar ataxia of left upper and lower extremities. A brain CT scan revealed a right cerebellar hemorrhage approximately 15 cc. Plasma brain natriuretic peptide (BNP) value on admission was 1,064.6 pg/ml. Twelve-lead ECG revealed negative T-wave in V3-V5. Transthoracic echocardiology confirmed an ejection fraction of 35%, and left ventricular apical akinesia and basal hyperkinesis were seen. Plasma BNP value was dramatically declined in the subacute phase of cerebellar hemorrhage. On the 14th day, echocardiography showed completely improvement of the left ventricular wall abnormalities. Therefore, we diagnosed having as a Tako-tsubo cardiomyopathy. Tako-tsubo cardiomyopathy is a rare complication of acute intracerebral hemorrhage. In the present case, plasma BNP was effective as a screening marker of Tako-tsubo cardiomyopathy and serial measurement of BNP was made helpful to know cardiac status.

Topics: Aged, 80 and over; Biomarkers; Cerebral Hemorrhage; Echocardiography; Electrocardiography; Female; Humans; Natriuretic Peptide, Brain; Takotsubo Cardiomyopathy; Tomography, X-Ray Computed

Because of the known correlation between the brain natriuretic peptide (BNP) level and the severity of cardiac failure, cardiac function assessment often involves measuring BNP levels. In addition, BNP is produced in the hypothalamus; high BNP levels are reported in patients with subarachnoid hemorrhage (SAH), although the details of this mechanism remain to be clarified. Furthermore, there are unconfirmed reports of high BNP levels during follow up in cases of post-SAH cerebral vasospasm (CVS). In the present study, we retrospectively investigated the correlation between plasma BNP levels and severity of SAH at onset and the utility of the BNP level as a predictor for CVS. Of 149 SAH cases treated as inpatients at our institution between November 2008 and March 2010, our subjects comprised 28 SAH cases in which the plasma BNP level was measured at the time of hospitalization (≦48 hours after SAH onset). There was no significant correlation between BNP levels and SAH severity at the onset, but BNP levels tended to be high in cases accompanied by intracerebral hematoma, particularly in patients with an anterior communicating aneurysm rupture. This is thought to be the result of direct damage to the hypothalamus. The cases with normal BNP levels at the onset of SAH were apt to have favorable outcomes. The incidence of delayed ischemic neurological deficit (DIND) was investigated in 15 cases in which the BNP level was measured multiple times during follow up. The ratio of BNP at SAH onset compared to at days 3 to 7 of the illness was not significant; however, BNP levels tended to be high in cases with DIND complications. BNP levels may constitute a useful early marker for CVS, despite BNP susceptibility to surgical invasion and perioperative management.

Topics: Adult; Aged; Aged, 80 and over; Biomarkers; Cerebral Hemorrhage; Female; Humans; Intracranial Aneurysm; Male; Middle Aged; Natriuretic Peptide, Brain; Retrospective Studies; Subarachnoid Hemorrhage; Vasospasm, Intracranial

There is emerging evidence to suggest that brain natriuretic peptide (BNP) is elevated after acute brain injury, and that it may play an adaptive role in recovery through augmentation of cerebral blood flow (CBF). Through a series of experiments, we tested the hypothesis that the administration of BNP after different acute mechanisms of central nervous system (CNS) injury could improve functional recovery by improving CBF. C57 wild-type mice were exposed to either pneumatic-induced closed traumatic brain injury (TBI) or collagenase-induced intracerebral hemorrhage (ICH). After injury, either nesiritide (hBNP) (8 microg/kg) or normal saline were administered via tail vein injection at 30 min and 4 h. The mice then underwent functional neurological testing via rotorod latency over the following 5 days and neurocognitive testing via Morris water maze testing on days 24-28. Cerebral blood flow (CBF) was assessed by laser Doppler from 25 to 90 min after injury. After ICH, mRNA polymerase chain reaction (PCR) and histochemical staining were performed during the acute injury phase (<24 h) to determine the effects on inflammation. Following TBI and ICH, administration of hBNP was associated with improved functional performance as assessed by rotorod and Morris water maze latencies (p < 0.01). CBF was increased (p < 0.05), and inflammatory markers (TNF-alpha and IL-6; p < 0.05), activated microglial (F4/80; p < 0.05), and neuronal degeneration (Fluoro-Jade B; p < 0.05) were reduced in mice receiving hBNP. hBNP improves neurological function in murine models of TBI and ICH, and was associated with enhanced CBF and downregulation of neuroinflammatory responses. hBNP may represent a novel therapeutic strategy after acute CNS injury.

Topics: Acute Disease; Animals; Brain; Brain Injuries; Cerebral Hemorrhage; Cerebrovascular Circulation; Cognition Disorders; Cytokines; Disease Models, Animal; Fluoresceins; Male; Maze Learning; Mice; Mice, Inbred C57BL; Natriuretic Agents; Natriuretic Peptide, Brain; Nerve Degeneration; Nerve Regeneration; Neuroprotective Agents; Organic Chemicals; Recovery of Function; RNA, Messenger; Time Factors; Treatment Outcome

One of the significant limitations in the evaluation and management of patients with suspected acute cerebral ischemia is the absence of a widely available, rapid, and sensitive diagnostic test. The objective of the current study was to assess whether a test using a panel of biomarkers might provide useful diagnostic information in the early evaluation of stroke by differentiating patients with cerebral ischemia from other causes of acute neurological deficit.. A total of 1146 patients presenting with neurological symptoms consistent with possible stroke were prospectively enrolled at 17 different sites. Timed blood samples were assayed for matrix metalloproteinase 9, brain natriuretic factor, d-dimer, and protein S100beta. A separate cohort of 343 patients was independently enrolled to validate the multiple biomarker model approach.. A diagnostic tool incorporating the values of matrix metalloproteinase 9, brain natriuretic factor, d-dimer, and S-100beta into a composite score was sensitive for acute cerebral ischemia. The multivariate model demonstrated modest discriminative capabilities with an area under the receiver operating characteristic curve of 0.76 for hemorrhagic stroke and 0.69 for all stroke (likelihood test P<0.001). When the threshold for the logistic model was set at the first quartile, this resulted in a sensitivity of 86% for detecting all stroke and a sensitivity of 94% for detecting hemorrhagic stroke. Moreover, results were reproducible in a separate cohort tested on a point-of-care platform.. These results suggest that a biomarker panel may add valuable and time-sensitive diagnostic information in the early evaluation of stroke. Such an approach is feasible on a point-of-care platform. The rapid identification of patients with suspected stroke would expand the availability of time-limited treatment strategies. Although the diagnostic accuracy of the current panel is clearly imperfect, this study demonstrates the feasibility of incorporating a biomarker based point-of-care algorithm with readily available clinical data to aid in the early evaluation and management of patients at high risk for cerebral ischemia.

Topics: Acute Disease; Adult; Aged; Aged, 80 and over; Biomarkers; Brain Ischemia; Cerebral Hemorrhage; Cohort Studies; Female; Humans; Male; Matrix Metalloproteinase 9; Middle Aged; Natriuretic Peptide, Brain; Nerve Growth Factors; Predictive Value of Tests; Prospective Studies; Reproducibility of Results; S100 Calcium Binding Protein beta Subunit; S100 Proteins; Stroke; Time Factors; Young Adult

To determine the predictive value of S100b and brain natriuretic peptide (BNP) in order to determine accurately and quickly a discharge prognosis after primary supratentorial intracerebral haemorrhage (ICH).. After IRB approval and informed consent, blood samples were obtained and analysed from 28 adult patients consecutively admitted to the neuroscience intensive care unit with computed tomography-proven supratentorial ICH from June 2003 and December 2004 within the first 24 h after symptom onset for S100b and BNP. Functional outcomes on discharge were dichotomized to favourable (mRS < 3) or unfavourable.. BNP (a neurohormone) and S100b (a marker of glial activation) were found to be independently highly predictive of functional neurological outcome at the time of discharge as measured by the modified Rankin Score (BNP: p < 0.01, r = 0.46; S100b: p < 0.01, r = 0.42) and the Barthel Index (BNP: p < 0.01, r = 0.54; s100b: p < 0.01, r = 0.50). Although inclusion of either biomarker produced additive value when included with traditional clinical prognostic variables, such as the ICH score (Barthel index: p < 0.01, r = 0.66; mRS: p < 0.01, r = 0.96), little predictive power is added with inclusion of both biomarkers in a regression model for neurological outcome.. Serum S100b and BNP levels in the first 24 h after injury accurately predict neurological function at discharge after supratentorial ICH.

Topics: Aged; Biomarkers; Cerebral Hemorrhage; Diagnostic Techniques, Neurological; Female; Hospitalization; Humans; Male; Middle Aged; Natriuretic Peptide, Brain; Predictive Value of Tests; Prognosis; S100 Proteins; Tomography, X-Ray Computed

Left ventricular (LV) hypertrophy and dysfunction due to hypertension have been established as risk markers for stroke in hypertensive patients. The purpose of this study was to examine the differences in LV hypertrophy and dysfunction between patients with cerebral hemorrhage and those with cerebral infarction. The study enrolled 23 hypertensive patients with cerebral infarction, 25 hypertensive patients with cerebral hemorrhage, and 24 normotensive controls (controls). Standard echocardiography was performed; LV mass index was measured to evaluate LV hypertrophy, and conventional diastolic transmitral flow velocities were measured to assess LV diastolic function, which was also evaluated by measuring mitral annular velocities using tissue Doppler echocardiography. The Tei index, which reflects both the diastolic and systolic function of LV, was also calculated. The LV mass index and Tei index were significantly higher in cerebral hemorrhage (116 +/- 38 g/m(2) and 0.57 +/- 0.13) than those in controls (92 +/- 20 g/m(2) and 0.46 +/- 0.10) (p < 0.05). In contrast, the LV mass index and Tei index in cerebral infarction (100 +/- 27 g/m(2) and 0.46 +/- 0.12) were not different from those in controls. Thus, the Tei index was significantly worse in the patients with cerebral hemorrhage than in those with cerebral infarction (p < 0.05). On the other hand, the parameters, which reflect diastolic function, showed no significant differences between cerebral hemorrhage and cerebral infarction. These results indicate that LV hypertrophy and dysfunction due to hypertension are more apparent in patients with cerebral hemorrhage than in those with cerebral infarction.

Topics: Aged; Blood Pressure; Case-Control Studies; Cerebral Hemorrhage; Cerebral Infarction; Diastole; Echocardiography, Doppler, Pulsed; Female; Humans; Hypertension; Hypertrophy, Left Ventricular; Male; Middle Aged; Natriuretic Peptide, Brain; Ventricular Dysfunction, Left

We tested the hypothesis that plasma brain natriuretic peptide (BNP) levels are elevated in patients with acute cerebrovascular diseases (CVD) independent of heart disease, and reflect CVD severity. After careful evaluations for heart disease, the study included 79 consecutive patients with CVD without any evidence of heart disease admitted within 48 h after onset (71+/-10 years), and 26 control subjects without CVD (CT, 67+/-12 years). Ischemic stroke subtypes were defined by the TOAST classification. Large-artery atherosclerosis (LAA, n=27), small-artery occlusion (SAO, n=27), and intracerebral hemorrhage (ICH, n=25) were included. The plasma BNP levels were measured at admission and 1 month later. Stroke severity and brain infarct volume were evaluated. There were no significant differences in the clinical profiles including echocardiographic parameters among the groups. The plasma BNP level (pg/mL) upon admission was higher in LAA (70.6+/-53.9) than in SAO (38.2+/-28.4) and CT (28.5+/-19.9) (both p<0.05). The level in ICH (47.3+/-28.6) was not significantly different from that in CT. The BNP level in ischemic stroke was positively correlated with the NIH Stroke Scale (NIHSS) (rho=0.42, p<0.05) and infarct volume (r=0.34, p<0.05). Brain infarct volume and NIHSS were independent contributors to the plasma BNP level in ischemic stroke. One month later, the BNP level was significantly decreased and was similar in all CVD groups. The plasma BNP level transiently increased in patients with LAA independently of heart disease, and reflected infarct volume and the severity of acute ischemic stroke.

Topics: Acute Disease; Aged; Aged, 80 and over; Brain Ischemia; Cerebral Hemorrhage; Cerebral Infarction; Echocardiography; Female; Heart Diseases; Humans; Intracranial Arteriosclerosis; Male; Middle Aged; Natriuretic Peptide, Brain; Severity of Illness Index; Stroke

A patent ductus arteriosus (PDA) in preterm infants is associated with increased risk of intraventricular haemorrhage (IVH) and death. Cardiac troponin T (cTnT) and N-terminal-pro-B type natriuretic peptide (NTpBNP) are markers of cardiac function and can predict poor outcome in adults.. To determine whether echocardiography and cTnT/NTpBNP levels at 48 h predict death before discharge or severe IVH in preterm infants with a PDA.. Infants born <32 weeks' gestation or <1500 g underwent echocardiographic and cTnT/NTpBNP measurements at 12 and 48 h of life. Infants were divided according to their status at discharge: a closed PDA at 48 h, infants with a PDA at 48 h and IVH III/IV and/or death, and infants with a PDA at 48 h without IVH III/IV or death.. Eighty infants with a median gestation of 28 weeks (IQR 26.1-29.5) and birth weight 1.06 kg (0.8-1.21) were included. At 48 h, infants with a PDA and IVH III/IV and/or death had significantly higher median cTnT/NTpBNP levels compared to infants with a PDA without IVH III/IV and/or death and those with spontaneous PDA closure (NTpBNP 9282, 5121 and 740 pmol/l, respectively, p = 0.008, and cTnT 0.66, 0.25 and 0.13 microg/l, respectively, p = 0.027). There were no differences in echocardiographic parameters of PDA size, left atrial to aortic ratio (LA:Ao), left and right ventricular outputs between the PDA groups.. NTpBNP and cTnT in conjunction with echocardiography may provide a basis for trials of targeted medical treatment in infants with a PDA.

Topics: Biomarkers; Birth Weight; Cerebral Hemorrhage; Ductus Arteriosus, Patent; Epidemiologic Methods; Female; Gestational Age; Humans; Infant, Newborn; Infant, Premature; Infant, Premature, Diseases; Male; Natriuretic Peptide, Brain; Peptide Fragments; Prognosis; Troponin T; Ultrasonography

To determine whether serum N-terminal pro-B-type natriuretic peptide (N-BNP), a biomarker of myocardial wall stress, is specific to acute heart failure (HF) in patients hospitalized with stroke.. Case-control study.. Tertiary hospital, Neurosciences Critical Care Unit and Stroke Unit.. Consecutive patients with acute ischemic or hemorrhagic stroke who were evaluated for HF.. None.. Cases and controls were classified, respectively, as patients with or without HF, defined according to modified Framingham criteria. Seventy-two patients were evaluated, 39 with ischemic stroke, 22 with aneurysmal subarachnoid hemorrhage (SAH), and 11 with intracerebral hemorrhage (ICH). Thirty-four patients (47%) met criteria for HF, and 47 patients (65%) had systolic or diastolic left ventricular (LV) dysfunction on echocardiogram. Serum N-BNP was measured a median of 48 h following the onset of stroke and was increased (> 900 pg/ml) in 56 patients (78%), with higher levels in non-survivors (11898 +/- 12741 vs 4073 +/-5691; p = 0.001). In a multiple regression model, N-BNP elevation was not independently associated with HF (OR 5.4, 95% CI 0.8-36.0, p = 0.084). At a cut-off of 900 pg/ml, the sensitivity of N-BNP for HF was 94%, specificity 37%, positive predictive value (PPV) 57%, and negative predictive value (NPV) 88%. For systolic or diastolic LV dysfunction, the sensitivity of N-BNP was 89%, specificity 44%, PPV 75%, and NPV 69%.. These results demonstrate that N-BNP elevation is not specific to HF or LV dysfunction in patients with acute ischemic stroke, SAH, and ICH.

Topics: Biomarkers; Case-Control Studies; Cerebral Hemorrhage; Female; Heart Failure; Humans; Male; Middle Aged; Natriuretic Peptide, Brain; Peptide Fragments; Predictive Value of Tests; ROC Curve; Sensitivity and Specificity; Stroke; Subarachnoid Hemorrhage; Ultrasonography; Ventricular Dysfunction, Left

Cultured vascular endothelial and smooth muscle cells actively produce adrenomedullin, a novel vasodilator peptide discovered in human pheochromocytoma tissue. This present study was designed to determine whether the plasma level of adrenomedullin is a useful indicator for estimating the degree of endothelial injury in patients with atherosclerotic disease.. We used a radioimmunoassay to measure plasma adrenomedullin concentrations in 51 patients with chronic cerebrovascular disease (34 infarctions and 17 haemorrhages) and in 10 subjects without symptomatic cerebrovascular disease. We also measured the plasma concentrations of thrombomodulin and endothelin as markers of endothelial injury. The patients were divided into three groups (A, B, and C) on the basis of the number of risk factors for atherosclerosis: hypertension, hyperlipidemia, smoking, low HDL-cholesterol, diabetes mellitus, and hyperuricaemia. Group A (68.7+/-2.7 years) consisted of patients with 0 or 1 risk factors; B (68.3+/-4.2 years) those with 2 risk factors; and C (69.2+/-3.6 years) those with 3 or more risk factors.. The plasma concentration of adrenomedullin in these patients showed a significant positive correlation with age (r=0.33, p<0.05), as well as with the plasma concentrations of thrombomodulin (r=0.54, p<0.001) and endothelin (r=0.53, p<0.001). Moreover, the plasma concentrations of adrenomedullin and thrombomodulin (p<0.005 and p<0.02, respectively) tended to be higher in Group B and to be significantly higher in Group C as compared to Group A. Plasma adrenomedullin concentrations did not, however, significantly differ between the infarction and haemorrhage patients.. These findings suggest that the plasma adrenomedullin concentrations reflect the degree of endothelial injury in patients with atherosclerotic disease.

Topics: Adrenomedullin; Aged; Atrial Natriuretic Factor; Biomarkers; Blood Urea Nitrogen; Brain Ischemia; Cerebral Angiography; Cerebral Hemorrhage; Cholesterol; Chronic Disease; Endothelins; Female; Humans; Intracranial Arteriosclerosis; Magnetic Resonance Imaging; Male; Natriuretic Peptide, Brain; Nerve Tissue Proteins; Peptides; Risk Factors; Thrombomodulin; Tomography, X-Ray Computed; Vasodilator Agents