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Cardiac natriuretic peptides for diagnosis of covert atrial fibrillation after acute ischaemic stroke: a meta-analysis of diagnostic accuracy studies
  1. Kejia Zhang1,
  2. Joseph Kamtchum-Tatuene2,
  3. Mingxi Li3,
  4. Glen C. Jickling1
  1. 1 Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
  2. 2 Neuroscience and Mental Health Institute, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
  3. 3 Department of Neurology, Jilin University First Hospital, Changchun, Jilin, China
  1. Correspondence to Professor Glen C. Jickling; glenj{at}ualberta.ca

Abstract

Background and purpose Detection of atrial fibrillation (AF) after acute ischaemic stroke is pivotal for the timely initiation of anticoagulation to prevent recurrence. Besides heart rhythm monitoring, various blood biomarkers have been suggested as complimentary diagnostic tools for AF. We aimed to summarise data on the performance of cardiac natriuretic peptides for the diagnosis of covert AF after acute ischaemic stroke and to assess their potential clinical utility.

Methods We searched PubMed and Embase for prospective studies reporting the performance of B-type natriuretic peptide (BNP) or N-terminal pro-BNP (NT-proBNP) for the diagnosis of covert AF after acute ischaemic stroke. Summary diagnostic performance measures were pooled using bivariate meta-analysis with a random-effect model.

Results We included six studies focusing on BNP (n=1930) and three studies focusing on NT-proBNP (n=623). BNP had a sensitivity of 0.83 (95% CI 0.64 to 0.93), a specificity of 0.74 (0.67 to 0.81), a positive likelihood ratio of 3.2 (2.6 to 4.0) and a negative likelihood ratio of 0.23 (0.11 to 0.49). NT-proBNP had a sensitivity of 0.91 (0.65 to 0.98), a specificity of 0.77 (0.52 to 0.91), a positive likelihood ratio of 3.9 (1.8 to 8.7) and a negative likelihood ratio of 0.12 (0.03 to 0.48). Considering a pretest probability of 20%, BNP and NT-proBNP had post-test probabilities of 45% and 50%.

Conclusions NT-proBNP has a better performance than BNP for the diagnosis of covert AF after acute ischaemic stroke. Both biomarkers have low post-test probabilities and may not be used as a stand-alone decision-making tool for the diagnosis of covert AF in patients with acute ischaemic stroke. However, they may be useful for a screening strategy aiming to select patients for long-term monitoring of the heart rhythm.

  • stroke
  • statistics
  • embolic
http://creativecommons.org/licenses/by-nc/4.0/

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

https://doi.org/10.1136/svn-2020-000440

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    Footnotes

    • Twitter @JTatuene

    • KZ and JK-T contributed equally.

    • Contributors KZ, JK-T, ML, and GCJ conceived the study. KZ, JK-T and ML searched the literature and selected studies. KZ, JK-T and ML extracted, analysed and interpreted the data. KZ and JK-T drafted the manuscript. ML and GCJ contributed to data interpretation and critically revised the manuscript. All authors approved the final version. JK-T is the guarantor of the review.

    • Funding KZ is supported by the China Scholarship Council. JK-T is supported by graduate excellence scholarships from the Alberta Government and the Banque of Montreal Financial Group.

    • Competing interests GCJ receives research support from Canadian Institutes of Health Research, the National Institutes of Health, The Heart and Stroke Foundation, the Canada Foundation for Innovation and the Alberta University Hospital Foundation.

    • Patient consent for publication Not required.

    • Provenance and peer review Not commissioned; externally peer reviewed.