Ability of B-Type Natriuretic Peptide Testing to Predict Cardioembolic Stroke in the General Population - Comparisons With C-Reactive Protein and Urinary Albumin

Circ J. 2018 Mar 23;82(4):1017-1025. doi: 10.1253/circj.CJ-17-1124. Epub 2018 Jan 30.


Background: The ability of cardiovascular biomarkers to predict the incidence of stroke subtypes remains ill-defined in the general population.Methods and Results:The blood levels of B-type natriuretic peptide (BNP) and high-sensitivity C-reactive protein (hs-CRP) and urinary albumin corrected by urinary creatinine (UACR) were determined in a general population (n=13,575). The ability to predict the incidence of ischemic stroke subtypes (lacunar, atherothrombotic, cardioembolic) for each biomarker was assessed based on the area under the receiver-operating characteristic curve (AUC-ROC) and using Cox proportional hazard modeling. The predictive abilities of UACR and hs-CRP for any subtype of ischemic event were found to be suboptimal. However, the ability of BNP to predict the incidence of cardioembolic stroke was excellent (AUC-ROC=0.81). When BNP was added to established stroke risk factors, the ability to predict cardioembolic stroke in terms of the AUC-ROC significantly improved (4-year follow-up, P=0.018; 8-year follow-up, P=0.009). Furthermore, when BNP was added to the JPHC score, the ability to predict cardioembolic stroke was significantly improved (net reclassification improvement=0.968, P<0.0001: integrated discrimination improvement=0.039, P<0.05).

Conclusions: In the general population, plasma BNP was an excellent biomarker for predicting the incidence of cardioembolic stroke when used alone or in combination with established stroke risk factors.

Keywords: Albuminuria; C-reactive protein; Ischemic stroke; Natriuretic peptide; Screening.

Publication types

  • Comparative Study

MeSH terms

  • Aged
  • Albumins / analysis*
  • Albuminuria
  • Area Under Curve
  • Biomarkers / analysis
  • C-Reactive Protein / analysis*
  • Embolism / diagnosis*
  • Embolism / epidemiology
  • Female
  • Humans
  • Incidence
  • Male
  • Middle Aged
  • Myocardial Infarction / diagnosis*
  • Myocardial Infarction / epidemiology
  • Natriuretic Peptide, Brain / blood*
  • Predictive Value of Tests
  • Proportional Hazards Models
  • ROC Curve
  • Risk Factors
  • Stroke


  • Albumins
  • Biomarkers
  • Natriuretic Peptide, Brain
  • C-Reactive Protein