急性期脳梗塞における非弁膜症性心房細動とbrain natriuretic peptide(BNP)の関係

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BACKGROUND AND PURPOSE: Elevated serum levels of brain natriuretic peptide (BNP) have been associated with cardioembolic stroke (CES). In this study, we investigated the factors associated with increased BNP levels in CES due to non-valvular atrial fibrillation (NVAF). METHODS: We measured BNP in consecutive acute ischemic stroke patients aged ?18 years who were admitted to our department between 2010 and 2012. Stroke subtypes were assigned using the Trial of ORG 10172 in Acute Stroke Treatment criteria. Categorical variables included sex, cigarette smoking, alcohol consumption, hypertension, diabetes mellitus, dyslipidemia, coronary artery disease, AF, antiplatelet therapy, and anticoagulant therapy. Continuous variables included age and hemoglobin and creatinine (Cr) levels. We investigated the relationships between serum BNP and left ventricular ejection fraction (LVEF), National Institutes of Health Stroke Scale score on admission, and modified Rankin Scale (mRS) score at discharge. We also calculated the CHADS2 (congestive heart failure, hypertension, age ≧75 years, diabetes, prior stroke) score in the NVAF patients. RESULTS: Of 102 patients with CES, 63.7% were men, and the mean age was 75.9 ± 9.6 years. Serum BNP levels were significantly correlated with age, hypertension, Cr, LVEF, CHADS2 score, and mRS score in univariate regression analysis. Higher BNP levels were associated with higher CHADS2 scores in patients with NVAF (p for trend <0.04). The addition of BNP to multivariate models increased their predictive abilities for functional outcomes (p=0.03). CONCLUSIONS: Serum BNP levels are significantly associated with functional outcomes following CES in addition to CHADS2 scores in patients with NVAF.
2014-01-31

急性期脳梗塞における非弁膜症性心房細動とbrain natriuretic peptide(BNP)の関係

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