Elevated Admission N-Terminal Pro-Brain Natriuretic Peptide as a Predictor of Computed Tomography Perfusion Core Infarct Overestimation in Acute Ischemic Stroke in a Sample of Chinese Patients.

Abstract

Overestimation of computed tomography perfusion (CTP) core infarcts in ischemic stroke is common and may interfere with treatment decisions. We aim to assess the value of admission N-terminal pro-brain natriuretic peptide (NT-pro BNP) in predicting CTP core infarct overestimation. A total of 353 patients with anterior circulation large vessel occlusion stroke who achieved satisfactory recanalization (extended thrombolysis in cerebral infarction ≥ 2c) from a single-center prospective database were enrolled in this study. Core infarct overestimation was considered when the CTP-derived infarct was larger than the final infarct measured on 24- to 48-hour noncontrast CT. Multivariable logistic regression analysis was performed to identify variables associated with overestimation. Fifty-two (14.8%) patients presented with CTP core infarct overestimation. Multivariate analysis, adjusted for covariates, showed that admission NT-pro BNP (adjusted odds ratio [OR] 1.34; 95% confidence interval [CI] 1.13-1.69), poor collaterals (adjusted OR 3.13; 95% CI 1.87-4.87), onset-to-imaging time (adjusted OR 0.23; 95% CI 0.17-0.46), and embolism etiology (adjusted OR 1.15; 95% CI 1.09-1.46) were independently associated with overestimation. Based on the receiver operating characteristic curve, the optimal cut-off value of NT-pro BNP for diagnosing infarct overestimation was 876 pg/ml, which yielded a sensitivity of 76.9%, a positive likelihood ratio of 2.796, a negative likelihood ratio of 0.319, and an area under the curve of 0.813 (95% CI: 0.761-0.864). Elevated admission NT-pro BNP could serve as a predictor of CTP infarct overestimation. CTP results should be interpreted with caution in specific circumstances to ensure that patients who might benefit from thrombectomy are not inadvertently excluded.