NT-proBNP levels and QT changes in acute ischemic stroke

Background: In literature, electrocardiographic (ECG) changes and the increase in the levels of the natriuretic peptide are shown to occur in patients having acute ischemic stroke. We aimed to investigate the association between ECG alterations and NT pro B-type natriuretic peptide (NT-proBNP) values in patients having acute ischemic stroke with no known cardiac pathology. Methods: The patients who admitted to the emergency service with acute ischemic stroke were enrolled in the study. Their ECGs were recorded and serum samples were obtained as soon as they arrived into the emergency service. The plasma NT-proBNP levels were measured by electrochemiluminescence method. Maximum QT interval, QT dispersion (QTd), corrected QT and corrected QTd (cQT and cQTd) was calculated, for each ECG. The patients were evaluated according to the Glasgow Coma Scale (GCS) and National Institutes of Health Stroke Scale (NIHSS). Results: A total of 50 consecutive patients were evaluated. QT intervals for 4 patients (8%) and cQT intervals for 29 patients (58%) were above 440 ms and 11 patients (22%) had QTd values above 50ms and 17 (34%) had cQTd values above 50 ms. The NTproBNP levels had a negative correlation with the GCS (p=0.001, r= -0.461) and a positive correlation with the NIHSS, cQT, QTd and cQTd (p=0.001, r=0.444, p=0.000, r=0.494, p=0.016, r=0.338 p=0.011, r=0.355, respectively). Conclusions: The NT-proBNP levels in the ischemic stroke patients with no known cardiac pathology were markedly increased, and this increase was found to be associated with the GCS, NIHSS, cQT, QTd and the cQTd interval. Neurology Asia 2013; 18(1) : 1 – 8 Address correspondence to: Salim Satar, M.D., Adana Numune Education and Research Hospital, Department of Emergency Medicine, Adana, Turkey. E-Mail: [email protected] INTRODUCTION Stroke is an important health problem that may lead to serious disabilities or even to death. The prevalence of stroke in our country is around 175/100,000 and an average of 120,000 new cases per annum is being admitted to the emergency services. Ischemic strokes form 85% of all the strokes and are well known to be closely associated with cardiac thromboembolic events and atherosclerosis. Electrocardiographic (ECG) changes including ST segment and T alterations, prolongation of the QT interval and formation of pathological Q waves are known to occur in patients having acute ischemic stroke. It is known that cardiac disorders such as atrial fi brillation and acute myocardial infarction may be associated with ischemic strokes. In addition, ischemic strokes may cause the ECG alterations and/or myocardial damage by using non-ischemic mechanism in patients without cardiac pathology. And, it is well known that these changes in the ECG are associated with early mortalities. The increase in the levels of the natriuretic peptide during the acute phase of the stroke and its association with early mortality has been reported. However, information about the NT pro B-type natriuretic peptide (NT-proBNP) during the cerebrovascular events is limited. In this study, we aimed to investigate the association between ORIGINAL ARTICLES Neurology Asia March 2013 2 QT changes in ECG and NT-proBNP values in patients having acute ischemic stroke with no known cardiac pathology.