Journal
INTERNATIONAL JOURNAL OF STROKE
Volume 9, Issue 4, Pages 419-425Publisher
SAGE PUBLICATIONS LTD
DOI: 10.1111/ijs.12126
Keywords
atrial fibrillation; diagnosis; stroke; NT-proBNP; cryptogenic; biomarker
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Funding
- Fundacao para a Ciencia e Tecnologia [HMSP-ICJ/0003/2010]
- Fundação para a Ciência e a Tecnologia [HMSP-ICJ/0003/2010] Funding Source: FCT
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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 center dot 91 (95% confidence interval 0 center dot 87-0 center dot 95). The cutoff point of 265 center dot 5 pg/ml had a sensitivity of 100% and specificity of 70 center dot 5% for the diagnosis of atrial fibrillation. The cutoff point of 912 pg/ml had a sensitivity of 81 center dot 8% and a specificity of 87 center dot 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 center dot 83. The cutoff point of 265 center dot 5 had a sensitivity of 88 center dot 2% and a specificity of 61 center dot 9%. The cutoff point of 912 pg/ml had a sensitivity of 47 center dot 1% and a specificity of 88 center dot 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.
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