Affiliations: Clinical Neuroscience Research Laboratory, Department
of Neurology, Hospital Clínico Universitario, University of Santiago de
Compostela, Santiago de Compostela, Spain | Department of Neurosciences, Hospital Germans Trias i
Pujol, Universitat Autònoma de Barcelona, Spain
Note: [] Corresponding author: Prof. José Castillo, Department of
Neurology, Hospital Clínico Universitario, Travesa da Choupana s/n,
15706 Santiago de Compostela, Spain. E-mail: jose.castillo@usc.es
Abstract: Background: Stroke subtype diagnosis leads to specific therapies to
reduce recurrences. Because nearly one third of patients remain with unknown
etiology after a complete screening workup, we aim to investigate whether
molecular markers of myocardial damage were associated with cardioembolic
stroke and if they were useful to reclassify strokes of undetermined etiology. Methods: We included 262 patients with first ischemic stroke within the
first 12 hours. Stroke subtype was evaluated by TOAST criteria. Stroke of
undetermined origin were reclassified into likely atherothrombotic or likely
cardioembolic according to a predefined non-validated algorithm. Blood samples
were obtained on admission to determine serum levels of molecular markers
(pro-BNP, pro-ANP and CK-MB) of myocardial damage. Results: Patients with
cardioembolic infarct showed higher levels of pro-BNP, pro-ANP and CK-MB.
Pro-BNP > 360 pg/mL was independently associated with cardioembolic stroke
(OR: 28.51, CI95%: 5.90–136.75, p< 0.0001). Stroke etiology was
undetermined in 82 patients (31%); 34 were reclassified as likely
cardioembolic, 22 as likely atherothrombotic, and 26 remained as undetermined.
Pro-BNP > 360 pg/mL was the only factor independently associated with
likely cardioembolic stroke. Conclusions: Pro-BNP levels higher than
360 pg/mL are associated with cardioembolic stroke and may be useful to
reclassify undetermined strokes as of cardioembolic origin.
