natriuretic-peptide--brain and Cerebral-Infarction

Cardioembolic stroke is approximately 30% of brain infarction, and most of the embolus sources are atrial fibrillation (AF). Brain infarction with AF was associated with an elderly woman, main brain arterial occlusion, and large infarcts. Therefore, patient outcome is so sever, and mortality is very high compared with other stroke types. Use of the anticoagulant before stroke onset is only 32%, and less than 1.6 of PT-INR was 58.4%. The hospitalized recurrence was 7.5%, which was not higher than stroke patients without AF. For detection of the intracardiac tthrombus, transesophageal cardiac-echogram detected thrombus in 16.4%. Within five years after discharge, mortality rate was higher in stroke patients with AF than those without AF. Brain infarction with AF should be knock-out stroke.

Topics: Anticoagulants; Atrial Fibrillation; Biomarkers; Cerebral Infarction; Coronary Thrombosis; Echocardiography, Transesophageal; Female; Humans; Male; Natriuretic Peptide, Brain; Prognosis; Recurrence; Sex Factors

Previous studies demonstrated that elevated brain natriuretic peptide (BNP) level is associated with adverse clinical outcomes of acute cerebral infarction (ACI). Researchers hypothesized that BNP might be a potential neuroprotective factor against cerebral ischemia because of the antagonistic effect of the natriuretic peptide system on the renin-angiotensin system and regulation of cardiovascular homeostasis. However, whether decreasing the BNP level can improve the prognosis of ACI has not been studied yet. The main effect of sacubitril/valsartan is to enhance the natriuretic peptide system. We investigated whether the intervention of plasma BNP levels with sacubitril/valsartan could improve the prognosis of patients with ACI.. In a randomized, controlled, parallel-group trial of patients with ACI within 48 hours of symptom onset and need for antihypertensive therapy, patients have randomized within 24 hours to sacubitril/valsartan 200mg once daily (the intervention group) or to conventional medical medication (the control group). The primary outcome was a change in plasma BNP levels before and after sacubitril/valsartan administration. The secondary outcomes included plasma levels of brain-derived neurotrophic factor (BDNF), Corin and neprilysin (NEP) before and after medication, the modified Rankin scale, and the National Institutes of Health Stroke Scale (at onset, at discharge, 30 days, and 90 days after discharge).. We evaluated 80 eligible patients admitted to the Stroke Center of Lianyungang Second People's Hospital between 1st May, 2021 and 31st June, 2022. Except for 28 patients excluded before randomization and 14 patients who did not meet the criteria or dropped out or lost to follow-up during the trial, the remaining 38 patients (intervention group: 17, control group: 21) had well-balanced baseline features. In this trial, we found that plasma BNP levels (P = 0.003) decreased and NEP levels (P = 0.006) increased in enrolled patients after treatment with sacubitril/valsartan. There were no differences in plasma BDNF and Corin levels between the two groups. Furthermore, no difference in functional prognosis was observed between the two groups (all P values>0.05).. Sacubitril/valsartan reduced endogenous plasma BNP levels in patients with ACI and did not affect their short-term prognosis.

Topics: Acute Disease; Brain Ischemia; Brain-Derived Neurotrophic Factor; Cerebral Infarction; Humans; Natriuretic Peptide, Brain; Prognosis; Stroke; United States

Brain natriuretic peptide (BNP) and troponin have a close relationship with cardiogenic cerebral embolism (CCE), but their relationship with noncardiogenic patients with anterior circulation ischemia (ACI) and posterior circulation ischemia (PCI) is not clear.. To explore the predictive value of serum initial BNP and troponin on the functional prognosis of patients with noncardiogenic ACI and PCI.. Consecutive patients with first-episode cerebral infarction within 12 hours of symptom onset were enrolled in the present 1-year prospective cohort study. Serum levels of BNP and troponin were collected within 12 hours of onset. Infarction location was classified as ACI and PCI by magnetic resonance imaging (MRI). According to the modified Rankin Scale (mRS) score at 90 days after onset, ACI and PCI cases were respectively divided into a good prognosis group (mRS score between 0 and 2) and a poor prognosis group (mRS score between 3 and 6). The general state of health and results of laboratory examinations and other auxiliary examinations of all patients were recorded. Single-factor analysis and multivariate logistic regression analysis were used to assess the relationship between serum levels of BNP, troponin, and functional outcome.. The multivariate logistic regression found that higher levels of initial BNP (odds ratio [OR] = 1.024; 95% confidence interval [CI]: 1.006-1.041;. The levels of initial BNP and CRP were related to poor functional outcomes in noncardiogenic PCI patients at 3 months, independent of troponin..  O peptídeo natriurético cerebral (BNP, na sigla em inglês) e a troponina estão intimamente relacionados com a embolia cerebral cardiogênica (CCE, na sigla em inglês), mas a relação com pacientes não cardioembólicos com isquemia de circulação anterior (ICA) e isquemia de circulação posterior (ICP) não é clara..  Investigar o valor preditivo dos níveis séricos iniciais do BNP e da troponina no prognóstico de pacientes com AVC isquêmico não cardiogênico. MéTODOS:  Os níveis séricos de BNP e de troponina foram recolhidos de pacientes com primeiro episódio de acidente vascular cerebral (AVC) isquêmico dentro de 12 horas após o início dos sintomas, com localização classificada como ICA e ICP de acordo com exame de ressonância magnética (RM). De acordo com a pontuação modificada da escala de Rankin (mRS), aos 90 dias após o início dos sintomas, ICA e ICP foram divididas respectivamente em um grupo de bom prognóstico (mRS entre 0 e2) e em um grupo de mau prognóstico (mRS entre 3 e 6). Foram registrados exames laboratoriais e outros exames complementares de todos os pacientes. Foram utilizadas análise fatorial única e análise de regressão logística multivariada para investigar a relação entre os níveis séricos de BNP e de troponina e o resultado funcional..  A regressão logística multivariada evidenciou que os níveis mais altos de BNP inicial (odds ratio [OR] = 1,024, intervalo de confiança [IC] de 95%: 1,006–1,041;

Topics: Biomarkers; C-Reactive Protein; Cerebral Infarction; Humans; Natriuretic Peptide, Brain; Prognosis; Prospective Studies; Troponin

The objective was to study the relationship of serum uric acid, C-reactive protein, and N-terminal pro-B-type natriuretic peptide levels with acute cerebral infarction.. A total of 96 acute cerebral infarction patients were divided into small, middle, and large infarct size groups based on the size of infarct focus and mild, moderate, and severe infarction groups based on the evaluation criteria of nerve defect degree. In addition, 75 healthy people were selected as the control group. The serum uric acid, C-reactive protein, and N-terminal pro-B-type natriuretic peptide levels of all subjects were detected.. The serum uric acid, C-reactive protein, and N-terminal pro-B-type natriuretic peptide levels in the acute cerebral infarction group were significantly higher than the control group (p<0.05). Compared with the small infarct size group, each index in middle and large infarct size groups was significantly increased (p<0.05). Compared with the middle infarct size group, each index in the large infarct size group was significantly increased (p<0.05). The serum uric acid, C-reactive protein, and N-terminal pro-B-type natriuretic peptide levels in moderate and severe infarction groups were significantly higher than the mild infarction group (p<0.05). Compared with the moderate infarction group, each index in the severe infarction group was significantly increased (p<0.05). The serum uric acid, C-reactive protein, and N-terminal pro-B-type natriuretic peptide levels were positively correlated with the infarct size and nerve defect degree (p<0.05).. The serum uric acid, C-reactive protein, and N-terminal pro-B-type natriuretic peptide levels are closely correlated with the occurrence and development of acute cerebral infarction. The detection of these indexes has significance for understanding the severity of acute cerebral infarction, guiding the individual treatment scheme, and evaluating the prognosis.

Topics: Biomarkers; C-Reactive Protein; Cerebral Infarction; Humans; Natriuretic Peptide, Brain; Peptide Fragments; Prognosis; Receptors, Immunologic; Uric Acid

Previous studies reported that the plasma d-dimer level reflects the activity of thrombus formation in the left atrium of patients with acute cerebral infarction and acute aortic dissection (AAD). Brain natriuretic peptide (BNP) is considered to be a marker of chronic heart failure. The differential diagnosis in the emergency room between stroke due to cardioembolism and AAD is difficult but important for early treatment especially in patients requiring intravenous thrombolysis with a recombinant tissue-type plasminogen activator. We aimed to investigate the association between the plasma d-dimer and BNP levels in patients with cerebral infarction and AAD.. We identified 115 consecutive patients with ischemic stroke who were admitted within 72 h of symptom onset and 15 consecutive patients with AAD and measured the level of plasma d-dimer and BNP and the d-dimer:BNP ratio.. In patients with AAD the d-dimer level was significantly higher than that in patients with any other stroke subtypes and their BNP level was significantly lower than that in patients with cardioembolic stroke. The d-dimer:BNP ratio was significantly higher in patients with AAD than in those with any other stroke subtype. Compared to patients with a cardioembolic stroke subtype they manifested significantly higher d-dimer levels and d-dimer:BNP ratios suggesting that this ratio may help to diagnose cerebral infarction due to AAD (sensitivity 80%, specificity 93.5%, cut-off 0.074). When the population was limited to patients within 6h of onset, the ratio had higher sensitivity and specificity at the same cut-off value (sensitivity 81.8%, specificity 96.4%).. We found that the d-dimer:BNP ratio may be helpful in distinguishing between cerebral infarction with and without AAD.

Topics: Aged; Aged, 80 and over; Aortic Diseases; Cerebral Infarction; Female; Fibrin Fibrinogen Degradation Products; Humans; Male; Middle Aged; Natriuretic Peptide, Brain; Retrospective Studies; ROC Curve

The analytical performances of the NT-proBNP and BNP assays on the Cobas E601 and ADVIA Centaur were thoroughly evaluated. In addition, the values of BNP and NT-proBNP, which are heart failure markers, were compared in the diagnosis of HF patients with or without acute cerebral infarction since they could also be elevated in ischemic stroke.. Clinical and Laboratory Standards Institute (CLSI) documents were employed in the analytical evaluation of NT-proBNP and BNP assays on the Cobas E601 and ADVIA Centaur. Then 100 heart failure patients and 103 cerebral infarction complicated with heart failure patients, who had been diagnosed by clinical doctors blinded to NT-proBNP and BNP concentrations, were chosen to compare their values in the diagnosis of heart failure with or without acute cerebral infarction.. The NT-proBNP and BNP methods are precise and accurate (total CV < 2.9%, deviation < 3.6%), have wide dynamic measuring ranges (8 pg/mL to 35 126 pg/mL and 2.0 pg/mL to 5094 pg/mL, respectively) with maximum dilutability of 1:2, and are free of common interferences. The most suitable sample types for NT-proBNP and BNP are serum and EDTA plasma, respectively, and both methods correlate well in simple-HF patients. Unlike BNP, the level of NT-proBNP is much higher in HF patients with acute cerebral infarction (p < 0.001). The Cobas E601 and ADVIA Centaur systems have good analytical performances.. In HF patients with acute cerebral infarction, the NT-proBNP and BNP levels did not correlate and thus had implications for clinical diagnosis.

Topics: Adult; Aged; Aged, 80 and over; Biomarkers; Cerebral Infarction; Female; Heart Failure; Humans; Limit of Detection; Male; Middle Aged; Natriuretic Peptide, Brain; Peptide Fragments; Reproducibility of Results; Sensitivity and Specificity

Plasma B-type natriuretic peptide (BNP) is used as a diagnostic marker of cardiovascular diseases. BNP is secreted mainly from the myocardium and has been detected by immunoreactivity in brain and cerebral arteries. The aim of our study was to investigate plasma BNP in patients with acute cerebral infarction according to infarction subtype and infarction volume.. We studied 141 patients with acute cerebral infarction, classified as large artery atherosclerosis (LAA), cardioembolism (CE), or small vessel disease (SA) according to the Trial of Org 10172 in Acute Stroke Treatment classification. Plasma BNP level was measured in patients and 61 healthy controls. We analyzed various clinical and laboratory variables of patients according to plasma BNP level.. Compared to controls, the patients had higher plasma BNP (11.9 ± 11.7 pg/mL versus 124.6 ± 228.8 pg/mL, p <0.01). The highest quartile BNP group was associated with advanced age, female gender, current non-smoker, atrial fibrillation, heart failure, CE group, increased white blood cell counts, increased high sensitivity C-reactive protein, increased left atrium size, decreased left ventricular ejection fraction, increased initial National Institute of Health Stroke Scale, and increased infarction volume. According to multiple regression analysis, CE group, female gender, and infarction volume were independently associated with plasma BNP. Plasma BNP level showed statistically significant differences among LAA (n = 71), CE (n = 50), and SA (n = 20) groups (p <0.001), and the expression decreased in order of CE (253.8 ± 337.1 pg/mL), LAA (61.6 ± 78.8 pg/mL), and SA (25.3 ± 24.8 pg/mL). Increased plasma BNP correlated with increased infarction volume (r = 0.42, p <0.001).. Plasma BNP may be helpful for prediction of etiologic classification of acute cerebral infarction and infarction volume.

Topics: Aged; C-Reactive Protein; Cerebral Infarction; Female; Humans; Male; Middle Aged; Natriuretic Peptide, Brain; Stroke Volume

Elevated levels of B-type natriuretic peptide (BNP) have been associated with cardiac dysfunction and adverse neurological outcomes after subarachnoid hemorrhage (SAH). We sought to determine whether elevated levels of BNP are independently associated with radiographic cerebral infarction after SAH.. Plasma BNP levels were measured after admission, a mean of 5.5 ± 3.0 days after SAH onset. Cerebral infarction was determined by retrospective review of computerized tomography (CT) scans. Cerebral vasospasm was confirmed by the presence of vascular narrowing on cerebral angiogram. The association between BNP and cerebral infarction was quantified using multivariable logistic regression and reverse stepwise elimination of clinical covariates. A stratified analysis was performed to quantify the association between BNP levels and infarction in patients with and without angiographic vasospasm.. BNP levels were measured from 119 subjects. The median BNP level was 105 pg/ml (interquartile range 37-275 pg/ml). In our multivariable model, the top quartile of BNP levels (≥ 276 pg/ml) were associated with an increased odds of cerebral infarction (OR 4.2, P = 0.009). The stratified analysis showed that the association between BNP and infarction was strongest in patients without angiographic vasospasm (OR 7.8, P = 0.006).. Elevated levels of BNP are strongly and independently associated with cerebral infarction, and the association is most pronounced in patients without angiographic vasospasm. These results provide further evidence that other mechanisms can contribute to infarction, and BNP may be a useful biomarker in detecting patients at risk for adverse outcomes without large vessel vasospasm.

Topics: Adult; Aged; Biomarkers; Cerebral Infarction; Cohort Studies; Female; Humans; Male; Middle Aged; Natriuretic Peptide, Brain; Subarachnoid Hemorrhage; Tomography, X-Ray Computed; Vasospasm, Intracranial

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

Acute coronary syndrome is an inflammatory disease, during which the complement cascade is activated. We assessed the complement C3 and C4 concentration ratio (C3/C4 ratio) in serum as a potential measurement to predict cardiovascular attacks. Patients with acute coronary syndrome (n=148) were followed after an initial attack for subsequent ischemic cardiovascular events (composite end point of death, myocardial infarction, recurrent unstable angina, or stroke). During the follow-up period (average 555 days), 44 patients met an end point. Blood samples were taken at hospitalization, 1 week, 3 months, and 1 year after hospital admission. Serum complement C3 and C4 concentrations and the C3/C4 ratio were analyzed. Patients with an end point had, throughout the follow-up period, a higher C3/C4 ratio than patients without these end points (repeated measures analysis of variance, p=0.007). When all traditional cardiovascular risk factors and other potential confounding factors were included in a Cox multivariate logistic regression survival analysis, the C3/C4 ratio emerged as the novel risk factor for any new cardiovascular event (odds ratio 1.33, 95% confidence interval 1.08 to 1.63, p=0.007). When the C3/C4 ratio was divided into 4 quartiles, 24% in quartiles 1 and 2 (lowest) and 48% in quartile 4 (highest) had end points during follow-up (odds ratio 3.04, 95% confidence interval 1.27 to 7.29, p=0.01). In conclusion, increased serum C3/C4 ratio is a readily available and novel marker for recurrent cardiovascular events in acute coronary syndrome. The relative increase in serum C3 protein and decrease in C4 protein could explain changes in the C3/C4 ratio.

Topics: Aged; Alleles; Analysis of Variance; Angina, Unstable; Biomarkers; Cerebral Infarction; Complement C3; Complement C4; Coronary Disease; Female; Finland; Follow-Up Studies; Humans; Inflammation Mediators; Kaplan-Meier Estimate; Logistic Models; Male; Middle Aged; Myocardial Infarction; Natriuretic Peptide, Brain; Proportional Hazards Models; Randomized Controlled Trials as Topic; Recurrence; Risk Factors; Sensitivity and Specificity; Survival Analysis; Syndrome

Greater change of postural blood pressure (BP) is often seen in elderly hypertensives and is recognized as a risk factor for cognitive decline and poorer cerebrovascular outcome, but its clinical significance still remains to be clarified. We performed a head-up tilting test, ambulatory BP monitoring, and brain MRI in 59 hypertensives and 27 normotensive subjects. We measured plasma atrial natriuretic peptide (ANP) and brain natriuretic peptide (BNP) levels at rest to assess cardiac burden. The 59 hypertensive patients were classified into 3 groups: an orthostatic hypertension (OHT) group with orthostatic increase in systolic BP (SBP) > or = 10 mmHg (n=16); an orthostatic hypotension (OHYPO) group with orthostatic SBP decrease < or = -10 mmHg (n=18); and an orthostatic normotension (ONT) group with neither of these two patterns (n=25). A group of 27 normotensive subjects (NT) was also included as a control. Plasma BNP (72 +/- 92 vs. 29 +/- 24 pg/ml, p < 0.05) and BNP/ANP ratio (4.6 +/- 3.3 vs. 2.4 +/- 1.5, p < 0.05) were significantly higher in the OHYPO than in the NT group. The BNP/ANP ratio was also higher in the OHT than in the NT group (5.1 +/- 3.9 vs. 2.4 +/- 1.5, p < 0.01). The number of silent cerebral infarct (SCI), prevalence of SCI and number of multiple SCIs was the highest in the OHT group, followed in order by the OHYPO, ONT and NT groups. Blood pressure and left ventricular mass index were not significantly different among the 3 hypertensive groups. In conclusion, hypertensive patients with greater change of postural BP (OHT and OHYPO) were shown to have increased risk of advanced silent brain lesions and greater cardiac burden.

Topics: Aged; Aged, 80 and over; Atrial Natriuretic Factor; Blood Pressure; Cerebral Infarction; Female; Humans; Hypertension; Hypertrophy, Left Ventricular; Hypotension, Orthostatic; Magnetic Resonance Imaging; Male; Middle Aged; Natriuretic Peptide, Brain; Stroke Volume; Ventricular Dysfunction, Left

To determine the potential role of atrial natriuretic peptide (ANP) and brain natriuretic peptide (BNP) in the pathogenesis of cerebral salt wasting.. Clinical case report.. Regional pediatric intensive care unit.. A 3-yr-old boy with a cerebral infarct secondary to traumatic carotid artery dissection who developed hyponatremia associated with weight loss and excessive renal sodium excretion on the sixth day after hospitalization.. Plasma concentrations of ANP, BNP, antidiuretic hormone, and renin were determined serially and compared with concentrations measured in a group of eight healthy children undergoing elective surgical procedures. Compared with controls, ANP and BNP plasma concentrations on the eighth day after hospitalization were increased 1.9-fold and 7.7-fold, respectively. Thereafter, the course of ANP and BNP paralleled that of sodium and H2O excretion and remained elevated until the 14th (BNP) and 16th (ANP) days after hospitalization. Serum antidiuretic hormone and renin concentrations were within normal ranges during the entire observation period.. Cerebral salt wasting is associated with elevated plasma concentrations of ANP and BNP. Natriuretic peptides may play a role in the pathogenesis of this syndrome.

Topics: Atrial Natriuretic Factor; Carotid Artery, Internal, Dissection; Cerebral Infarction; Child; Child, Preschool; Humans; Hyperpituitarism; Hyponatremia; Male; Natriuretic Peptide, Brain; Renin; Vasopressins