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Circ J. 2018 Mar 23;82(4):1017-1025. doi: 10.1253/circj.CJ-17-1124. Epub 2018 Jan 30.

Ability of B-Type Natriuretic Peptide Testing to Predict Cardioembolic Stroke in the General Population - Comparisons With C-Reactive Protein and Urinary Albumin.

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Department of Internal Medicine, Iwate Medical University.
Department of Neurosurgery, Iwate Medical University.
Department of Hygiene and Preventive Medicine, Iwate Medical University.
Iwate Health Service Association.
The Research Institute of Strategy for Prevention.



The ability of cardiovascular biomarkers to predict the incidence of stroke subtypes remains ill-defined in the general population.Methods and Results:The blood levels of B-type natriuretic peptide (BNP) and high-sensitivity C-reactive protein (hs-CRP) and urinary albumin corrected by urinary creatinine (UACR) were determined in a general population (n=13,575). The ability to predict the incidence of ischemic stroke subtypes (lacunar, atherothrombotic, cardioembolic) for each biomarker was assessed based on the area under the receiver-operating characteristic curve (AUC-ROC) and using Cox proportional hazard modeling. The predictive abilities of UACR and hs-CRP for any subtype of ischemic event were found to be suboptimal. However, the ability of BNP to predict the incidence of cardioembolic stroke was excellent (AUC-ROC=0.81). When BNP was added to established stroke risk factors, the ability to predict cardioembolic stroke in terms of the AUC-ROC significantly improved (4-year follow-up, P=0.018; 8-year follow-up, P=0.009). Furthermore, when BNP was added to the JPHC score, the ability to predict cardioembolic stroke was significantly improved (net reclassification improvement=0.968, P<0.0001: integrated discrimination improvement=0.039, P<0.05).


In the general population, plasma BNP was an excellent biomarker for predicting the incidence of cardioembolic stroke when used alone or in combination with established stroke risk factors.


Albuminuria; C-reactive protein; Ischemic stroke; Natriuretic peptide; Screening

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