B-type natriuretic peptide over N-terminal pro-brain natriuretic peptide to predict incident atrial fibrillation after cryptogenic stroke
E. Palà
Neurovascular Research Laboratory, Vall d'Hebron Institute of Research (VHIR), Hospital Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
E Palà and J. Pagola contributed equally to this work.
Contribution: Data curation (equal), Formal analysis (lead), Investigation (equal), Methodology (equal), Visualization (equal), Writing - original draft (lead), Writing - review & editing (equal)
Search for more papers by this authorJ. Pagola
Stroke Unit, Medicine Department, Vall d'Hebrón Hospital and Autonomous University of Barcelona, Barcelona, Spain
E Palà and J. Pagola contributed equally to this work.
Contribution: Conceptualization (equal), Data curation (equal), Funding acquisition (equal), Methodology (equal), Project administration (equal), Resources (equal), Supervision (equal), Validation (equal), Writing - review & editing (equal)
Search for more papers by this authorJ. Juega
Stroke Unit, Medicine Department, Vall d'Hebrón Hospital and Autonomous University of Barcelona, Barcelona, Spain
Contribution: Conceptualization (equal), Data curation (equal), Methodology (equal), Project administration (equal), Resources (equal), Writing - review & editing (equal)
Search for more papers by this authorJ. Francisco-Pascual
Arrhythmia Unit—Cardiology Department, Vall d'Hebrón Hospital, Barcelona, Spain
Contribution: Data curation (equal), Investigation (equal), Writing - review & editing (supporting)
Search for more papers by this authorA. Bustamante
Neurovascular Research Laboratory, Vall d'Hebron Institute of Research (VHIR), Hospital Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
Contribution: Conceptualization (equal), Supervision (equal), Writing - review & editing (equal)
Search for more papers by this authorA. Penalba
Neurovascular Research Laboratory, Vall d'Hebron Institute of Research (VHIR), Hospital Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
Contribution: Investigation (equal), Supervision (equal), Writing - review & editing (supporting)
Search for more papers by this authorI. Comas
Clinical Biochemestry Service, Clinical Laboratories, Vall d'Hebrón Hospital, Barcelona, Spain
Contribution: Investigation (equal), Writing - review & editing (supporting)
Search for more papers by this authorM. Rodriguez
Stroke Unit, Medicine Department, Vall d'Hebrón Hospital and Autonomous University of Barcelona, Barcelona, Spain
Contribution: Investigation (equal), Writing - review & editing (supporting)
Search for more papers by this authorM. De Lera Alfonso
Stroke Unit, University Hospital of Valladolid, Valladolid, Spain
Contribution: Investigation (equal), Writing - review & editing (supporting)
Search for more papers by this authorJ. F. Arenillas
Stroke Unit, University Hospital of Valladolid, Valladolid, Spain
Contribution: Investigation (equal), Writing - review & editing (supporting)
Search for more papers by this authorR. de Torres
Stroke Unit, University Hospital Virgen del Rocio, Seville, Spain
Contribution: Investigation (equal), Writing - review & editing (supporting)
Search for more papers by this authorS. Pérez-Sánchez
Stroke Unit, University Hospital Virgen del Rocio, Seville, Spain
Contribution: Investigation (equal), Writing - review & editing (supporting)
Search for more papers by this authorJ. A. Cabezas
Stroke Unit, University Hospital Virgen del Rocio, Seville, Spain
Contribution: Investigation (equal), Writing - review & editing (supporting)
Search for more papers by this authorF. Moniche
Stroke Unit, University Hospital Virgen del Rocio, Seville, Spain
Contribution: Investigation (equal), Writing - review & editing (equal)
Search for more papers by this authorT. González-Alujas
Echocardiography Lab Cardiology Department, Vall d'Hebrón Hospital, Barcelona, Spain
Contribution: Investigation (equal), Writing - review & editing (equal)
Search for more papers by this authorC. A. Molina
Stroke Unit, Medicine Department, Vall d'Hebrón Hospital and Autonomous University of Barcelona, Barcelona, Spain
Contribution: Conceptualization (equal), Funding acquisition (equal), Resources (equal), Writing - review & editing (equal)
Search for more papers by this authorCorresponding Author
J. Montaner
Neurovascular Research Laboratory, Vall d'Hebron Institute of Research (VHIR), Hospital Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
Correspondence: J. Montaner, Neurovascular Research Laboratory, Vall d'Hebron Institute of Research (VHIR), Hospital Vall d'Hebron, Pg. Vall d'Hebron 119–129, 08035, Barcelona, Spain (tel.: +34 93 489 4029; fax: 34-93-489-4015; e-mail: [email protected]).
Contribution: Conceptualization (equal), Funding acquisition (equal), Methodology (equal), Resources (equal), Supervision (lead), Writing - review & editing (equal)
Search for more papers by this authorE. Palà
Neurovascular Research Laboratory, Vall d'Hebron Institute of Research (VHIR), Hospital Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
E Palà and J. Pagola contributed equally to this work.
Contribution: Data curation (equal), Formal analysis (lead), Investigation (equal), Methodology (equal), Visualization (equal), Writing - original draft (lead), Writing - review & editing (equal)
Search for more papers by this authorJ. Pagola
Stroke Unit, Medicine Department, Vall d'Hebrón Hospital and Autonomous University of Barcelona, Barcelona, Spain
E Palà and J. Pagola contributed equally to this work.
Contribution: Conceptualization (equal), Data curation (equal), Funding acquisition (equal), Methodology (equal), Project administration (equal), Resources (equal), Supervision (equal), Validation (equal), Writing - review & editing (equal)
Search for more papers by this authorJ. Juega
Stroke Unit, Medicine Department, Vall d'Hebrón Hospital and Autonomous University of Barcelona, Barcelona, Spain
Contribution: Conceptualization (equal), Data curation (equal), Methodology (equal), Project administration (equal), Resources (equal), Writing - review & editing (equal)
Search for more papers by this authorJ. Francisco-Pascual
Arrhythmia Unit—Cardiology Department, Vall d'Hebrón Hospital, Barcelona, Spain
Contribution: Data curation (equal), Investigation (equal), Writing - review & editing (supporting)
Search for more papers by this authorA. Bustamante
Neurovascular Research Laboratory, Vall d'Hebron Institute of Research (VHIR), Hospital Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
Contribution: Conceptualization (equal), Supervision (equal), Writing - review & editing (equal)
Search for more papers by this authorA. Penalba
Neurovascular Research Laboratory, Vall d'Hebron Institute of Research (VHIR), Hospital Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
Contribution: Investigation (equal), Supervision (equal), Writing - review & editing (supporting)
Search for more papers by this authorI. Comas
Clinical Biochemestry Service, Clinical Laboratories, Vall d'Hebrón Hospital, Barcelona, Spain
Contribution: Investigation (equal), Writing - review & editing (supporting)
Search for more papers by this authorM. Rodriguez
Stroke Unit, Medicine Department, Vall d'Hebrón Hospital and Autonomous University of Barcelona, Barcelona, Spain
Contribution: Investigation (equal), Writing - review & editing (supporting)
Search for more papers by this authorM. De Lera Alfonso
Stroke Unit, University Hospital of Valladolid, Valladolid, Spain
Contribution: Investigation (equal), Writing - review & editing (supporting)
Search for more papers by this authorJ. F. Arenillas
Stroke Unit, University Hospital of Valladolid, Valladolid, Spain
Contribution: Investigation (equal), Writing - review & editing (supporting)
Search for more papers by this authorR. de Torres
Stroke Unit, University Hospital Virgen del Rocio, Seville, Spain
Contribution: Investigation (equal), Writing - review & editing (supporting)
Search for more papers by this authorS. Pérez-Sánchez
Stroke Unit, University Hospital Virgen del Rocio, Seville, Spain
Contribution: Investigation (equal), Writing - review & editing (supporting)
Search for more papers by this authorJ. A. Cabezas
Stroke Unit, University Hospital Virgen del Rocio, Seville, Spain
Contribution: Investigation (equal), Writing - review & editing (supporting)
Search for more papers by this authorF. Moniche
Stroke Unit, University Hospital Virgen del Rocio, Seville, Spain
Contribution: Investigation (equal), Writing - review & editing (equal)
Search for more papers by this authorT. González-Alujas
Echocardiography Lab Cardiology Department, Vall d'Hebrón Hospital, Barcelona, Spain
Contribution: Investigation (equal), Writing - review & editing (equal)
Search for more papers by this authorC. A. Molina
Stroke Unit, Medicine Department, Vall d'Hebrón Hospital and Autonomous University of Barcelona, Barcelona, Spain
Contribution: Conceptualization (equal), Funding acquisition (equal), Resources (equal), Writing - review & editing (equal)
Search for more papers by this authorCorresponding Author
J. Montaner
Neurovascular Research Laboratory, Vall d'Hebron Institute of Research (VHIR), Hospital Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
Correspondence: J. Montaner, Neurovascular Research Laboratory, Vall d'Hebron Institute of Research (VHIR), Hospital Vall d'Hebron, Pg. Vall d'Hebron 119–129, 08035, Barcelona, Spain (tel.: +34 93 489 4029; fax: 34-93-489-4015; e-mail: [email protected]).
Contribution: Conceptualization (equal), Funding acquisition (equal), Methodology (equal), Resources (equal), Supervision (lead), Writing - review & editing (equal)
Search for more papers by this authorAbstract
Background and purpose
B-type natriuretic peptide (BNP) and N-terminal pro-brain natriuretic peptide (NT-proBNP) are well-known surrogates of atrial fibrillation (AF) detection but studies usually present data on either BNP or NT-proBNP. The aim was to determine and directly compare the validity of the two biomarkers as a tool to predict AF and guide prolonged cardiac monitoring in cryptogenic stroke patients.
Methods
Non-lacunar acute ischaemic stroke (<72 h) patients over 55 years of age with cryptogenic stroke after standard evaluation were included in the Crypto-AF study and blood was collected. BNP and NT-proBNP levels were determined by automated immunoassays. AF was assessed by 28 days’ monitoring. Highest (optimizing specificity) and lowest (optimizing sensitivity) quartiles were used as biomarker cut-offs to build predictive models adjusted by sex and age. The integrated discrimination improvement index (IDI) and DeLong test were used to compare the performance of the two biomarkers.
Results
From 320 patients evaluated, 218 were included in the analysis. AF was detected in 50 patients (22.9%). NT-proBNP (P < 0.001) and BNP (P < 0.001) levels were higher in subjects with AF and their levels correlated (r = 0.495, P < 0.001). BNP showed an increased area under the curve (0.720 vs. 0.669; P = 0.0218) and a better predictive capacity (IDI = 3.63%, 95% confidence interval 1.36%–5.91%) compared to NT-proBNP. BNP performed better than NT-proBNP in a specific model (IDI = 3.7%, 95% confidence interval 0.87%–6.5%), whilst both biomarkers performed similarly in the case of a sensitive model.
Conclusions
Both BNP and NT-proBNP were increased in cryptogenic stroke patients with AF detection. Interestingly, BNP outperforms NT-proBNP, especially in terms of specificity.
Disclosure of conflicts of interest
The authors declare no financial or other conflicts of interest.
Open Research
Data availability statement
The data that support the findings of this study are available from the corresponding author upon reasonable request.
Supporting Information
| Filename | Description |
|---|---|
| ene14579-sup-0001-AppendixS1.docxWord document, 139.8 KB |
Figure S1. Flow chart of the Crypto-AF study. *Patients who started the monitoring (initially modified Rankin Scale score < 3) but got worse and were posteriorly excluded. Figure S2. (A) Discriminatory ability of NT-proBNP in comparison to BNP when added as continuous variables. (B) Discriminatory ability of NT-proBNP in comparison to BNP when added as categorized variables with the highest quartiles as cut-offs. Dots indicate the probabilities for each patient to be diagnosed with AF according to the different models. Red dots indicate patients diagnosed with AF after 28 days of monitoring whilst black dots are patients without AF. Figure S3. Kaplan–Meier curves of BNP and NT-proBNP for AF diagnosis. Table S1. Comparison between clinical predictive model (age, sex, heart failure and renal failure) and clinical predictive models adding log2BNP or log2NT-proBNP as continuous variables for AF diagnosis. Table S2. Comparison between clinical predictive model (age, sex, heart failure and renal failure) and clinical predictive models adding BNP or NT-proBNP with selected cut-offs (lowest and highest quartiles) for AF diagnosis. |
Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.
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