| Backgound and Purpose:Stroke is a major kind of cerebrovasculr dieases with high-frenquent morbidity,motality,disability and recurrence.National guidlines recommended aucte ischemic stroke to be classified into five subtypes according to TOAST criteria as large-artery atherosclerosis(LAA),cardioembolic(CE),small-artery occlusion Lacunar(SAO),stroke of other determined etiology(SOE)and storke of other undertermined etiology(SUE),thus rapidly guiding other diagnostic tests and accelerating the start of optimal secondary prevention,further diagnostic examination,intensive rehabilitative intervention and,ultimately,better patient outcomes.Patients with CE subtype should be focused because of more severe neurologic deificit and worse outcomes.However,parts of them are difficult to be diagnosed.Stroke biomarkers may help preliminary recognition of CE patients rapidly and guide optimal treatment as early as possible.The research of Brain natriuretic peptide(BNP)and NT-proBNP(N-terminal pro-B-type natriuretic peptide)in the field of stroke biomakers is currently a hot topic but still in controversy.Hence,we conducted a prospective and multiple-center study to evalute whether plasma BNP/NT-proBNP can be used as a reference index in recognition of cardioembolic stroke patients.We set up a new algorithm of suspected stroke patient management in the the Emergency Department(ED)and share our experiences of implementing BNP/NT-proBNP point-of-care testing(POCT)platform on suspected ischemic stroke patients.MethodsA prospective and mutilple-center study was conducted in Foshan Hospital of TCM(FSTCM),Guangdong General hospital,the People's Hospital of Zhongshan City,the People's Hospital of Qingyuan City,Chancheng Distrit Hi-tech Hospital and Sanshui TCM Hospital which are both affiated to FSTCM from July 2015 to July 2016.In the EDs,emergency physicians prospectively assessed consecutive adult patients with acute phase of ischemic stroke and measured plasma BNP/NT-proBNP by POCT platform on admission,then followed up.Stroke neurologists evaluated patients' functional outcome at hospital discharge and also made discharge diagnosis and stroke etiologic subtypes according to the TOAST criteria.ResultsIn this study,548 acute ischemic stroke patients met the study criteria[mean age 68.43±11.93 years;289(52.7%)female,mean age 70.61±11.13 years;259(47.3%)male,mean age 66.00±112.35 years].Of the enrolled patients,28.3%were diagnosed with LAA at discharge,17.9%with CE,41.2%with SAO,12.6%with SOE or SUE.Age,previous cardiac disease,atrial fibrillation,the length of hospital stays,SSS score on admission?<25 and mRS>3 or death at discharge were all significantly higher in the CE patients compared to other subtypes(P<0.01).And the mean BNP/NT-proBNP concentration was significantly higher in the.CE group than in other three subtypes(P<0.001).Even after adjustment for multiple clinical predictors like gender,age,coronary artery disease,atrial fibrillation and renal function,BNP/NT-proBNP showed a strong association with CE[BNP OR:1.044(95%CI 1.025,1.064),P<0.001;NT-proBNP OR:1.005(95%Cl:1.002,1.008),P<0.001].The optimal cut-off concentration,diagnostic accuracy,sensitivity and specificity of plasma BNP/NT-proBNP concentration suitable to distinguish CE from non-CE were 62.50 pg/ml,80.7%,80.8%and 80.7%for BNP;501.17 pg/ml,80.6%,82.6%,80.2%for NT-proBNP,respectively.ConclusionThrough this new algorithm in the EDs,BNP and NT-proBNP have good corresponding diagnostic performce in prelimilary recognition of CE patients.And the implementation of BNP/NT-proBNP POCT platform on suspected stroke patients is able to provide provide more important clinical information for neurologist to start the optimal secondary prevention rapidly,and recognize the potential patient with high-risk in-hospital mortality.However,the single BNP/NT-proBNP biomarker panel cannot be used to confidently identify CE subtype as a diagnosis and must be taken in context with clinical assessment and judgment before making management decisions. |
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