Predicting cardioembolic stroke with the B-type natriuretic peptide test: a systematic review and meta-analysis.

Abstract

BACKGROUND:

We performed a systematic review and meta-analysis to evaluate the value of B-type natriuretic peptide (BNP) in differentiating cardioembolic (CE) stroke from other subtypes of ischemic stroke.

METHODS:

We searched the EMBASE, MEDLINE, and Cochrane databases and reference lists of relevant articles published in April 2013. We selected original studies reporting the performance of BNP or N-terminal probrain natriuretic peptide (NT-proBNP) in diagnosing CE stroke and summarized test performance characteristics using forest plots, hierarchical summary receiver operating characteristic curves, and bivariate random-effect models.

RESULTS:

Data from 2958 patients with ischemic stroke were retrieved from 16 studies. Of these, 1024 (34.6%) patients had a final diagnosis of CE stroke. Overall, the mean diagnostic odds ratio (DOR) of BNP for CE stroke was 15.8 (95% confidence interval [CI]: 9.92-25.20). Even after adjustment for multiple clinical predictors, serum natriuretic peptide levels showed a strong association with CE stroke (pooled adjusted DOR, 12.7; 95% CI: 7.32-22.0). The sensitivity and specificity of BNP for CE stroke were .78 (95% CI: .71-.87) and .83 (95% CI: .77-.87), respectively. A single BNP-negative result may be sufficient to exclude a diagnosis of CE stroke in low-prevalence (<20%) settings. Subgroup analysis showed that NT-proBNP had a slightly higher specificity (.87; 95% CI: .77-.93) and better capability for exclusion diagnosis. There was a lack of homogeneity in the timing of measurement and BNP assay method.

CONCLUSIONS:

BNP has reasonable accuracy in the diagnosis of CE stroke and may be a useful marker for the early detection in patients who may benefit from preventive anticoagulation therapy.

• Authors: Hong-Ling Yang, Yong-Ping Lin, Yan Long, Qing-Ling Ma, Cheng Zhou
• Journal: Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association (J Stroke Cerebrovasc Dis) Vol. 23 Issue 7 Pg. 1882-9 (Aug 2014) ISSN: 1532-8511 [Electronic] United States
• PMID: 24795095 (Publication Type: Journal Article, Meta-Analysis, Review, Systematic Review)
• Copyright: Copyright © 2014 National Stroke Association. Published by Elsevier Inc. All rights reserved.

Chemical References

• Natriuretic Peptide, Brain

Topics

• Aged
• Coronary Thrombosis (blood, complications, diagnosis)
• Female
• Humans
• Male
• Middle Aged
• Natriuretic Peptide, Brain (blood)
• Stroke (blood, diagnosis, etiology)