Detection of cardioembolic stroke with B-type natriuretic peptide or N-terminal pro-BNP: a comparative diagnostic meta-analysis

Background: B-type natriuretic peptides (BNPs) have shown promise in detecting cardioembolic stroke. However, there has been little investigation comparing the diagnostic efficacy of BNP and its cleavage by-product N-terminal peptide (NT-proBNP) in cardioembolic stroke patients. Therefore, the aim of this meta-analysis will be to comparatively assess the diagnostic efficacy of BNP versus NT-proBNP in distinguishing cardioembolic stroke from non-cardioembolic stroke in adult ischemic stroke patients. Methods: We conducted a literature search of several databases for prospective studies assessing the use of BNP or NT-proBNP to detect cardioembolic stroke in adult acute ischemic stroke patients. Only clinical studies reporting the diagnostic performance of BNP or NT-proBNP in predicting cardioembolic stroke in adult ischemic stroke patients were included. Diagnostic performance outcomes were summarized using forest plots and summary receiver operating characteristic (SROC) curves. Results: Ten BNP prospective cohort studies and six NT-proBNP prospective cohort studies were finally included in the meta-analysis. BNP showed a summary sensitivity of 0.65 (95% confidence interval (CI): 0.63-0.68), a summary specificity of 0.85 (95% CI: 0.83-0.87), and an area under the SROC curve of 0.8718 (standard error (SE): 0.0248). NT-proBNP showed a summary sensitivity of 0.55 (95% CI: 0.52-0.59), a summary specificity of 0.93 (95% CI: 0.91-0.94), and an AUC of 0.8746 (SE: 0.0280). Discussion: BNP and NT-proBNP display closely equivalent overall diagnostic accuracies in distinguishing cardioembolic stroke from non-cardioembolic stroke in adult ischemic stroke patients, with BNP showing a superior sensitivity and NT-proBNP showing a superior specificity.