BACKGROUND: Diagnosing paroxysmal atrial fibrillation in patients with stroke can be difficult. We aimed to determine if N-terminal pro-brain natriuretic peptide can help identify paroxysmal atrial fibrillation in cryptogenic stroke. METHODS AND RESULTS: Among 264 ischemic stroke patients, serum levels of N-terminal pro-brain natriuretic peptide were measured within 72 h of stroke onset. In cryptogenic stroke patients, 24-h Holter monitoring was used to look for paroxysmal atrial fibrillation within the first week and also three- and six-months after admission. First, patients with a defined etiology were used to construct a receiver operating characteristic curve for the diagnosis of atrial fibrillation. From this curve, the sensitivity and specificity of preestablished cutoff points for the diagnosis of atrial fibrillation were calculated. A logistic regression was performed to assess the independent relationship of the logarithm of N-terminal pro-brain natriuretic peptide levels with atrial fibrillation. The cutoff points were then evaluated in patients with cryptogenic stroke. RESULTS: One hundred eighty-four patients had a specific stroke etiology. Fifty-five patients had atrial fibrillation. Using multivariate analysis, the logarithm of N-terminal pro-brain natriuretic peptide levels was independently associated with atrial fibrillation. The area under the receiver operating characteristic curve of N-terminal pro-brain natriuretic peptide for the diagnosis of atrial fibrillation was 0.91 (95% confidence interval 0.87-0.95). The cutoff point of 265.5 pg/ml had a sensitivity of 100% and specificity of 70.5% for the diagnosis of atrial fibrillation. The cutoff point of 912 pg/ml had a sensitivity of 81.8% and a specificity of 87.5%. Eighty patients had a cryptogenic stroke. In 17, paroxysmal atrial fibrillation was found during follow-up. In these patients, the area under the curve for the diagnosis of paroxysmal atrial fibrillation was 0.83. The cutoff point of 265.5 had a sensitivity of 88.2% and a specificity of 61.9%. The cutoff point of 912 pg/ml had a sensitivity of 47.1% and a specificity of 88.9%. CONCLUSION: N-terminal pro-brain natriuretic peptide has good accuracy in predicting the presence of paroxysmal atrial fibrillation in patients with cryptogenic stroke and can help to identify these patients.
BACKGROUND: Diagnosing paroxysmal atrial fibrillation in patients with stroke can be difficult. We aimed to determine if N-terminal pro-brain natriuretic peptide can help identify paroxysmal atrial fibrillation in cryptogenic stroke. METHODS AND RESULTS: Among 264 ischemicstrokepatients, serum levels of N-terminal pro-brain natriuretic peptide were measured within 72 h of stroke onset. In cryptogenic strokepatients, 24-h Holter monitoring was used to look for paroxysmal atrial fibrillation within the first week and also three- and six-months after admission. First, patients with a defined etiology were used to construct a receiver operating characteristic curve for the diagnosis of atrial fibrillation. From this curve, the sensitivity and specificity of preestablished cutoff points for the diagnosis of atrial fibrillation were calculated. A logistic regression was performed to assess the independent relationship of the logarithm of N-terminal pro-brain natriuretic peptide levels with atrial fibrillation. The cutoff points were then evaluated in patients with cryptogenic stroke. RESULTS: One hundred eighty-four patients had a specific stroke etiology. Fifty-five patients had atrial fibrillation. Using multivariate analysis, the logarithm of N-terminal pro-brain natriuretic peptide levels was independently associated with atrial fibrillation. The area under the receiver operating characteristic curve of N-terminal pro-brain natriuretic peptide for the diagnosis of atrial fibrillation was 0.91 (95% confidence interval 0.87-0.95). The cutoff point of 265.5 pg/ml had a sensitivity of 100% and specificity of 70.5% for the diagnosis of atrial fibrillation. The cutoff point of 912 pg/ml had a sensitivity of 81.8% and a specificity of 87.5%. Eighty patients had a cryptogenic stroke. In 17, paroxysmal atrial fibrillation was found during follow-up. In these patients, the area under the curve for the diagnosis of paroxysmal atrial fibrillation was 0.83. The cutoff point of 265.5 had a sensitivity of 88.2% and a specificity of 61.9%. The cutoff point of 912 pg/ml had a sensitivity of 47.1% and a specificity of 88.9%. CONCLUSION: N-terminal pro-brain natriuretic peptide has good accuracy in predicting the presence of paroxysmal atrial fibrillation in patients with cryptogenic stroke and can help to identify these patients.
Authors: Marta Rubiera; Ana Aires; Kateryna Antonenko; Sabrina Lémeret; Christian H Nolte; Jukka Putaala; Renate B Schnabel; Anil M Tuladhar; David J Werring; Dena Zeraatkar; Maurizio Paciaroni Journal: Eur Stroke J Date: 2022-06-03
Authors: Markus Kneihsl; Egbert Bisping; Daniel Scherr; Harald Mangge; Simon Fandler-Höfler; Isabella Colonna; Melanie Haidegger; Sebastian Eppinger; Edith Hofer; Franz Fazekas; Christian Enzinger; Thomas Gattringer Journal: Eur J Neurol Date: 2021-09-23 Impact factor: 6.288
Authors: Barbara Ratajczak-Tretel; Anna Tancin Lambert; Henriette Johansen; Bente Halvorsen; Vigdis Bjerkeli; David Russell; Else Charlotte Sandset; Hege Ihle-Hansen; Erik Eriksen; Halvor Næss; Vojtech Novotny; Andrej Netland Khanevski; Thomas C Truelsen; Titto Idicula; Karen L Ægidius; Håkon Tobro; Siv B Krogseth; Håkon Ihle-Hansen; Guri Hagberg; Christina Kruuse; Kathrine Arntzen; Grete K Bakkejord; Maja Villseth; Ingvild Nakstad; Guttorm Eldøen; Raheel Shafiq; Anne Gulsvik; Martin Kurz; Mehdi Rezai; Jesper Sømark; Stein-Helge Tingvoll; Christine Jonassen; Susanne Ingebrigtsen; Linn Hofsøy Steffensen; Christine Kremer; Dan Atar; Anne Hege Aamodt Journal: Eur Stroke J Date: 2019-03-19
Authors: Satish Ramkumar; Nitesh Nerlekar; Daniel D'Souza; Derek J Pol; Jonathan M Kalman; Thomas H Marwick Journal: BMJ Open Date: 2018-09-17 Impact factor: 2.692