Natriuretic peptides and mortality after stroke

Background and Purpose - Measurement of natriuretic peptides provides prognostic information in various patient populations. The prognostic value of natriuretic peptides among patients with acute stroke is not known, although elevated peptide levels have been observed. Methods - A series of 51 patients ( mean age, 68 +/- 11 years) with first-ever ischemic stroke underwent a comprehensive clinical examination and measurements of plasma atrial natriuretic peptides (N-ANP) and brain natriuretic peptides (N-BNP) in the acute phase of stroke. The patients were followed-up for 44 +/- 21 months. Risk factors for all-cause mortality were assessed. Control populations, matched for gender and age, consisted of 51 patients with acute myocardial infarction ( AMI) and 25 healthy subjects. Results - Plasma concentrations of N-ANP ( mean +/- SD, 988 +/- 993 pmol/L) and N-BNP ( 751 +/- 1608 pmol/L) in the stroke patients were at the same level as those in the AMI patients (NS for both), but significantly higher than those of the healthy subjects ( 358 +/- 103 pmol/L, P < 0.001 and 54 +/- 26 pmol/L, P < 0.01, respectively). Elevated levels of N-ANP and N-BNP predicted mortality after stroke ( risk ratio [RR] 4.3, P < 0.01 and RR 3.9, P < 0.01, respectively) and after AMI ( P < 0.05), and remained independent predictors of death after stroke even after adjustment for age, diabetes, coronary artery disease, and medication ( RR 3.9, P < 0.05 and RR 3.7, P < 0.05, respectively). Conclusion - Plasma levels of natriuretic peptides are elevated in the acute phase of stroke and predict poststroke mortality.