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. 2024 Sep 18:15:1436062.
doi: 10.3389/fneur.2024.1436062. eCollection 2024.

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

Takuya Moriyama  1   2 , Kenichi Todo  1 , Hiroshi Yamagami  2   3 , Yoko Kimura  2 , Shiro Yamamoto  2 , Keiko Nagano  2 , Ryosuke Doijiri  4 , Hidekazu Yamazaki  5 , Kazutaka Sonoda  6 , Junpei Koge  7 , Taira Nakayama  8 , Tomonori Iwata  8 , Yuji Ueno  9 , Yasufumi Gon  1 , Shuhei Okazaki  1   2 , Tsutomu Sasaki  1 , Hideki Mochizuki  1
Affiliations

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

Takuya Moriyama et al. Front Neurol. .

Abstract

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: B-type natriuretic peptide; CRYPTON-ICM registry; atrial fibrillation; cryptogenic stroke; insertable cardiac monitor.

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Conflict of interest statement

KT reports lecture fees from Pfizer, Bristol-Myers Squibb, Daiichi-Sankyo, Bayer, Stryker, Medtronic, AstraZeneca, Otsuka Pharmaceutical, Kyowa Kirin, Takeda Pharmaceutical and Amgen. HirY reports lecturer fees from Medtronic, Abbott, Daiichi Sankyo, Bristol-Myers Squibb, and Bayer, and grant support from Bristol-Myers Squibb. RD reports lecture fees from Medtronic, Abbott, Biotronic, Stryker, CERENOVUS, Daiichi Sankyo, Bristol-Myers Squibb, and Bayer. HidY reports lecture fees from Medtronic, Abbott, CERENOVUS, Daiichi Sankyo, Bristol-Myers Squibb, and Bayer. KS reports lecture fees from Medtronic, Stryker, Abbott, and Daiichi-Sankyo, and grants support from JSPS KAKENHI. JK reports lecture fees from Medtronic. TI reports lecture fees from Daiichi-Sankyo, Medtronic, Eisai, Takeda Pharmaceutical, and Nestle Health Sciences. YU reports OHARA Pharmaceutical’s lecture fees and Bristol-Myers Squibb’s research funds. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Flowchart for exclusion criteria used in the study and the division of BNP groups. Patients whose BNP levels were measured within 30 days of index stroke onset were included in this study. BNP, B-type natriuretic peptide.
Figure 2
Figure 2
Kaplan–Meier curve estimates from the onset of index stroke to AF detection according to BNP tertile levels. Cumulative AF detection rate was significantly higher in high-BNP group than low-BNP and mid-BNP groups (log-rank p < 0.01). AF, atrial fibrillation; BNP, B-type natriuretic peptide.
Figure 3
Figure 3
Receiver operating characteristic curve analysis. The optimal cutoff level of BNP, and sensitivity and specificity required to discriminate AF detection was BNP 43.4 pg/mL, 60.0 and 74.0%, respectively. The area under curve using BNP to predict AF detection was 0.69. AF, atrial fibrillation; BNP, B-type natriuretic peptide.
See this image and copyright information in PMC

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