Abstract P594: Cardiac Natriuretic Peptides for Diagnosis of Covert AtrialFibrillation After Acute Ischemic Stroke: A Meta-Analysis of Diagnostic Accuracy Studies

Background and purpose: Detection of atrial fibrillation (AF) after acute ischemic stroke is pivotal for the timely initiation of anticoagulation to prevent recurrence. Besides heart rhythm monitoring, various blood biomarkers have been suggested as complimentary diagnostic tools for AF. We aimed to summarize data on the performance of cardiac natriuretic peptides for the diagnosis of covert AF after acute ischemic stroke and to assess their potential clinical utility. Methods: We searched PubMed and Embase for prospective studies reporting the performance of B-type natriuretic peptide (BNP) or N-terminal pro-B-type natriuretic peptide (NT-proBNP) for the diagnosis of covert AF after acute ischemic stroke. Summary diagnostic performance measures were pooled using bivariate meta-analysis with random-effects model. Results: We included six studies focusing on BNP (n = 1930) and three studies focusing on NT-proBNP (n = 623). BNP had a sensitivity of 0.83 (95% CI: 0.64-0.93), a specificity of 0.74 (0.67-0.81), a positive likelihood ratio of 3.2 (2.6-4.0), and a negative likelihood ratio of 0.23 (0.11-0.49). NT-proBNP had a sensitivity of 0.91 (0.65-0.98), a specificity of 0.77 (0.52-0.91), a positive likelihood ratio of 3.9 (1.8-8.7), and a negative likelihood ratio of 0.12 (0.03-0.48). Considering a pre-test probability of 20%, BNP and NT-proBNP had post-test probabilities of 45% and 50%. Conclusions: NT-proBNP has a better performance than BNP for the diagnosis of covert AF after acute ischemic stroke. Both biomarkers have low post-test probabilities and may not be used as a stand-alone decision-making tool for the diagnosis of covert AF in patients with acute ischemic stroke. However, they may be useful for a screening strategy aiming to select patients for long-term monitoring of the heart rhythm.

Cardiac natriuretic peptides for diagnosis of covert atrial fibrillation after acute ischaemic stroke: a meta-analysis of diagnostic accuracy studies

Background and purposeDetection of atrial fibrillation (AF) after acute ischaemic stroke is pivotal for the timely initiation of anticoagulation to prevent recurrence. Besides heart rhythm monitoring, various blood biomarkers have been suggested as complimentary diagnostic tools for AF. We aimed to summarise data on the performance of cardiac natriuretic peptides for the diagnosis of covert AF after acute ischaemic stroke and to assess their potential clinical utility.MethodsWe searched PubMed and Embase for prospective studies reporting the performance of B-type natriuretic peptide (BNP) or N-terminal pro-BNP (NT-proBNP) for the diagnosis of covert AF after acute ischaemic stroke. Summary diagnostic performance measures were pooled using bivariate meta-analysis with a random-effect model.ResultsWe included six studies focusing on BNP (n=1930) and three studies focusing on NT-proBNP (n=623). BNP had a sensitivity of 0.83 (95% CI 0.64 to 0.93), a specificity of 0.74 (0.67 to 0.81), a positive likelihood ratio of 3.2 (2.6 to 4.0) and a negative likelihood ratio of 0.23 (0.11 to 0.49). NT-proBNP had a sensitivity of 0.91 (0.65 to 0.98), a specificity of 0.77 (0.52 to 0.91), a positive likelihood ratio of 3.9 (1.8 to 8.7) and a negative likelihood ratio of 0.12 (0.03 to 0.48). Considering a pretest probability of 20%, BNP and NT-proBNP had post-test probabilities of 45% and 50%.ConclusionsNT-proBNP has a better performance than BNP for the diagnosis of covert AF after acute ischaemic stroke. Both biomarkers have low post-test probabilities and may not be used as a stand-alone decision-making tool for the diagnosis of covert AF in patients with acute ischaemic stroke. However, they may be useful for a screening strategy aiming to select patients for long-term monitoring of the heart rhythm.

Association Between Cardiac Natriuretic Peptides and Lipid Profile: a Systematic Review and Meta-Analysis

Cardiac natriuretic peptides (NPs) play a fundamental role in maintaining cardiovascular (CV) and renal homeostasis. Moreover, they also affect glucose and lipid metabolism. We performed a systematic review and meta-analysis of studies investigating the association of NPs with serum lipid profile. A PubMed and Scopus search (2005–2018) revealed 48 studies reporting the association between NPs and components of lipid profile [total cholesterol (TC), low-density lipoprotein cholesterol (LDLc), high-density lipoprotein cholesterol (HDLc) and triglycerides (TG)]. Despite high inconsistency across studies, NPs levels were inversely associated with TC [k = 32; pooled r = −0.09; I2 = 90.26%], LDLc [k = 31; pooled r = −0.09; I2 = 82.38%] and TG [k = 46; pooled r = −0.11; I2 = 94.14%], while they were directly associated with HDLc [k = 41; pooled r = 0.06; I2 = 87.94%]. The relationship with LDLc, HDLc and TG lost significance if only studies on special populations (works including subjects with relevant acute or chronic conditions that could have significantly affected the circulating levels of NPs or lipid profile) or low-quality studies were taken into account. The present study highlights an association between higher NP levels and a favorable lipid profile. This confirms and extends our understanding of the metabolic properties of cardiac NPs and their potential in CV prevention.

Estimating prognosis: biomarkers

Risk stratification informs the management of heart failure (HF). A range of clinical variables are associated with outcome in HF and have been incorporated into risk calculators which perform adequately at a population level, especially for those with more severe or recently decompensated HF. Their performance in predicting individual patient outcomes among the ambulant community-based populations with chronic HF is less assured. Risk score performance is enhanced by incorporation of selected circulating biomarkers. The cardiac natriuretic peptides, particularly B-type natriuretic peptide (BNP) and N-terminal proBNP (NT-proBNP), are independently predictive of mortality in both acute and chronic HF. Risk at a given level of BNP is similar regardless of left ventricular ejection fraction. The prognostic performance of NT-proBNP and BNP enriches therapeutic trials for clinical events. Trials of marker-guided therapy in HF consistently indicate that lowering plasma NT-proBNP (preferably to <1000 pg/mL) is associated with improved outcomes. The cardiac natriuretic peptides may be combined with other markers including mid-regional pro-adrenomedullin, ST2, growth/differentiation factor 15, and cardiac troponin to refine risk stratification. There is a need for an improved, independently validated, risk score calculator derived from a large well-annotated HF population incorporating both key clinical predictors and one or more circulating biomarkers.