Elevated NT-proBNP predicts worse clinical outcome in patients after acute ischemic stroke
Authors: Mihalovic M , Mikulenka P , Linkova H , Neuberg M , Peisker T , Stetkarova I , Tousek P 
Published: November 2023

Abstract

Background/introduction
Elevated levels of NT-proBNP in ischemic stroke patients may indicate increased cardiac stress, which can be associated with poor outcome. However, clinical utility and cut offs are not completely known.

Purpose
We aimed to describe relation between NT-proBNP elevation with stroke severity and poor clinical outcome in patients after acute ischemic stroke (AIS).

Methods
Patients after AIS were enrolled in our study. Blood samples were obtained from patients at the time of admission, 24 and 48 hours later to determine the plasma levels of NT-proBNP. Twelve-lead ECGs were obtained at the time of admission, 24 and 48 h later. Standard echocardiographic examination was performed within the first 7 days of hospitalization if patients were eligible. Demographic characteristics, clinical data, functional outcome, and all-cause mortality were compared between groups according to NT-proBNP levels (NT-proBNP ≤ 125 pg/ml; &gt;125 and ≤450 pg/ml; &gt;450 pg/ml). National Institutes of Health Stroke Scale (NIHSS) at the time of admission and the modified Rankin Scale (mRS) 90 days following the patient’s discharge from the hospital were used to assess stroke severity and clinical outcome. All analyses were performed with SPSS 29.0 (SPSS Inc).

Results
Between August 2020 and August 2022, 177 patients after AIS were enrolled. Elevated NT-proBNP &gt;125pg/ml was observed in 82 patients (46,3%), 34 patients (19,2%) presented with NT-proBNP &gt;450pg/ml. Most common comorbidities included arterial hypertension, dyslipidemia, type 2 DM and atrial fibrillation. In analysis, we observed a connection between elevated NT-proBNP with unfavorable outcome evaluated by mRS at 90 days (p&lt;0.001) and with all-cause death at 30 days (P=0.001) and 90 days (P&lt;0.001). Kaplan-Meier survival curve showed that all-cause mortality was significantly higher in patients with elevated NT-proBNP (P&lt;0.001), however with no difference between elevation &gt;125pg/ml and &gt;450pg/ml (p=0.14). In survival analysis, there was close to significant association between patients who presented with elevated NT-proBNP&gt;125pg/ml and &gt;20% change in value comparing to those with elevated NT-proBNP without subsequent change &gt;20%. Moreover, we observed a connection with stroke severity evaluated by NIHSS (p=0.005). In ECG analysis, we showed higher occurrence of T wave inversion (P&lt;0.001), ST segment depression (P&lt; 0.001) and QTc prolongation (P=0.003) in patients with elevated NT-proBNP. In multivariate regression analysis elevated NT-proBNP was associated with atrial fibrillation, high-sensitive troponin I elevation and age≥75 years.

Conclusion
The results show that elevated NT-proBNP is associated with stroke severity, unfavorable functional outcome, and short-term mortality in patients after acute ischemic stroke. Moreover, we described connection between NT-proBNP elevation and ECG changes.Kaplan Meier survival analysisAssociation worse outcome and severity