Plasma B-type Natriuretic Peptide Level in Patients with Acute Cerebral Infarction according to Infarction Subtype and Infarction Volume

Background: Plasma B-type natriuretic peptide (BNP) is used as a diagnostic marker of cardiovascular diseases. BNP is secreted mainly from the myocardium and has been detected by immunoreactivity in brain and cerebral arteries. The aim of our study was to investigate plasma BNP in patients with acute cerebral infarction according to infarction subtype and infarction volume. Methods: We studied 141 patients with acute cerebral infarction, classified as large artery atherosclerosis (LAA), cardioembolism (CE), or small vessel disease (SA) according to the Trial of Org 10172 in Acute Stroke Treatment classification. Plasma BNP level was measured in patients and 61 healthy controls. We analyzed various clinical and laboratory variables of patients according to plasma BNP level. Results: Compared to controls, the patients had higher plasma BNP (11.9 +/- 11.7 pg/mL versus 124.6 +/- 228.8 pg/mL, p <0.01). The highest quartile BNP group was associated with advanced age, female gender, current non-smoker, atrial fibrillation, heart failure, CE group, increased white blood cell counts, increased high sensitivity C-reactive protein, increased left atrium size, decreased left ventricular ejection fraction, increased initial National Institute of Health Stroke Scale, and increased infarction volume. According to multiple regression analysis, CE group, female gender, and infarction volume were independently associated with plasma BNP. Plasma BNP level showed statistically significant differences among LAA (n = 71), CE (n = 50), and SA (n = 20) groups (p <0.001), and the expression decreased in order of CE (253.8 +/- 337.1 pg/mL), LAA (61.6 +/- 78.8 pg/mL), and SA (25.3 +/- 24.8 pg/mL). Increased plasma BNP correlated with increased infarction volume (r = 0.42, p <0.001). Conclusions: Plasma BNP may be helpful for prediction of etiologic classification of acute cerebral infarction and infarction volume.