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ORIGINAL RESEARCH article

Front. Neurol.
Sec. Stroke
Volume 15 - 2024 | doi: 10.3389/fneur.2024.1436062

Relationship between initial B-type natriuretic peptide levels and detection of atrial fibrillation with an insertable cardiac monitor in cryptogenic stroke: CRYPTON-ICM registry

Provisionally accepted
Takuya Moriyama Takuya Moriyama 1,2Kenichi Todo Kenichi Todo 1Hiroshi Yamagami Hiroshi Yamagami 2,3*Yoko Kimura Yoko Kimura 2*Shiro Yamamoto Shiro Yamamoto 2Keiko Nagano Keiko Nagano 2*Ryosuke Doijiri Ryosuke Doijiri 4Hidekazu Yamazaki Hidekazu Yamazaki 5Kazutaka Sonoda Kazutaka Sonoda 6*Junpei Koge Junpei Koge 7Taira Nakayama Taira Nakayama 8*Tomonori Iwata Tomonori Iwata 8Yuji Ueno Yuji Ueno 9Gon Yasufumi Gon Yasufumi 1*Shuhei Okazaki Shuhei Okazaki 1,2Tsutomu Sasaki Tsutomu Sasaki 1Hideki Mochizuki Hideki Mochizuki 1
  • 1 Department of Neurology, Graduate School of Medicine, Osaka University, Suita, Ōsaka, Japan
  • 2 Department of Neurology, Osaka National Hospital (NHO), Osaka, Japan
  • 3 Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
  • 4 Department of Neurology, Iwate Prefectural Central Hospital, Morioka-shi, Iwate, Japan
  • 5 Yokohamashintoshi Neurosurgical Hospital, Yokohama, Kanagawa, Japan
  • 6 Department of Neurology, Saiseikai Fukuoka General Hospital, Fukuoka, Fukuoka, Japan
  • 7 Department of Cerebrovascular Medicine and Neurology, National Cerebral and Cardiovascular Center, Osaka, Japan
  • 8 Department of Neurology, Tokai University School of Medicine, Isehara, Kanagawa, Japan
  • 9 Department of Neurology, School of Medicine, Juntendo University, Bunkyo, Japan

The final, formatted version of the article will be published soon.

    High B-type natriuretic peptide (BNP) levels are associated with new atrial fibrillation (AF). This study investigated the distribution of AF detection rates according to BNP levels in patients with cryptogenic stroke (CS) using an insertable cardiac monitor (ICM). We enrolled consecutive patients with CS who underwent ICM implantation between October 2016 and September 2020 at eight stroke centers in Japan. Those with BNP levels were divided into three groups by tertiles. We evaluated the association of BNP levels with AF detection. Youden's index was calculated to identify the optimal cutoff for BNP. Of 417 patients, we analyzed 266 patients with BNP data. The tertile range of BNP level was 19.0 to 48.5 pg/mL. AF detection rate was 13.3 %/year, 12.8 %/year, and 53.7 %/year in the low-BNP (≤ 19.0), mid-BNP (19.1-48.4), and high-BNP (≥ 48.5) groups, respectively (log-rank trend P < 0.01). Compared with low-BNP group, the adjusted hazard ratios for AF detection in mid-and high-BNP groups were 0.91 (95% confidence interval [CI] 0.46-1.78) and 2.17 (95% CI 1.14-4.13), respectively.Receiver operating characteristic curve analysis showed the optimal cutoff value was 43.4 pg/mL. The area under curve using BNP to predict AF detection was 0.69. The BNP level was associated with AF detection in patients with CS. This relationship changed around the BNP levels of 40-50 pg/mL.

    Keywords: Atrial Fibrillation, B-type natriuretic peptide, cryptogenic stroke, insertable cardiac monitor, CRYPTON-ICM registry

    Received: 21 May 2024; Accepted: 06 Sep 2024.

    Copyright: © 2024 Moriyama, Todo, Yamagami, Kimura, Yamamoto, Nagano, Doijiri, Yamazaki, Sonoda, Koge, Nakayama, Iwata, Ueno, Yasufumi, Okazaki, Sasaki and Mochizuki. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

    * Correspondence:
    Hiroshi Yamagami, Department of Neurology, Osaka National Hospital (NHO), Osaka, Japan
    Yoko Kimura, Department of Neurology, Osaka National Hospital (NHO), Osaka, Japan
    Keiko Nagano, Department of Neurology, Osaka National Hospital (NHO), Osaka, Japan
    Kazutaka Sonoda, Department of Neurology, Saiseikai Fukuoka General Hospital, Fukuoka, Fukuoka, Japan
    Taira Nakayama, Department of Neurology, Tokai University School of Medicine, Isehara, 259-1193, Kanagawa, Japan
    Gon Yasufumi, Department of Neurology, Graduate School of Medicine, Osaka University, Suita, 565-0871, Ōsaka, Japan

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