Department of Neurosurgery and Neurology, Duke University Hospital, Durham, NC, USA.
Department of Neurosurgery, Thomas Jefferson University Hospital, Philadelphia, USA.
Neurosurg Rev. 2024 Nov 5;47(1):835. doi: 10.1007/s10143-024-03073-w.
In patients with acute ischemic stroke, midregional proatrial natriuretic peptide (MR-proANP) has shown promise in preliminary studies for risk stratification. The objective of this study is to evaluate the prognostic utility of MR-proANP in AIS, focusing on its ability to predict 90-day functional outcomes, mortality rates, and the presence of atrial fibrillation (Afib). A comprehensive literature search was conducted using PubMed, Web of Science, and Scopus, following PRISMA guidelines. The search strategy employed a combination of keywords and index terms including "Acute Ischemic Stroke," "AIS," "Cerebral Infarction," "Atrial Fibrillation," "AFib," "stroke," "MR-proANP," "Mid-regional pro-atrial natriuretic peptide," and "proatrial natriuretic peptide." Inclusion criteria encompassed any study focusing on MR-proANP and ischemic stroke, published up to October 15, 2023. Primary end points were newly diagnosed Afib, 90-day Modified Rankin Scale (mRS) score, and 90-day mortality. Studies were described in narrative and tabular form. Risk of bias was assessed using the ROBINS-I tool. Pooled estimates for our key end points were generated using a random effects model where appropriate. MR-proANP levels were significantly elevated in newly diagnosed Afib patients compared to no Afib patients (mean difference (MD): 134.4 pmol/l; 95% confidence interval (CI): 119.45 to 149.35, P < 0.0001). Unfavorable functional outcomes, as measured by mRS scores of ≥ 3 at 90 days, were associated with higher levels of MR-proANP (MD: 93.87 pmol/; 95% CI: 76.66 to 111.09, P < 0.0001). Elevated MR-proANP levels were also strongly correlated with increased 90-day mortality rates (MD: 164.43 pmol/; CI: 95.94 to 232.92, P < 0.0001). MR-proANP was significantly associated with functional outcomes, 90-day mortality, and the newly diagnosed AF. The limited number of studies included calls for further large-scale research to confirm these findings and explore the potential for expedited diagnostic procedures and targeted interventions like anticoagulant therapy.
在急性缺血性脑卒中患者中，中段 pro 心房利钠肽（MR-proANP）在初步研究中显示出用于风险分层的潜力。本研究的目的是评估 MR-proANP 在 AIS 中的预后效用，重点关注其预测 90 天功能结局、死亡率和心房颤动（Afib）的能力。根据 PRISMA 指南，使用 PubMed、Web of Science 和 Scopus 进行了全面的文献检索。搜索策略采用了关键词和索引术语的组合，包括“急性缺血性脑卒中”、“AIS”、“脑梗死”、“心房颤动”、“Afib”、“中风”、“MR-proANP”、“中段 pro-心房利钠肽”和“pro 心房利钠肽”。纳入标准包括任何专注于 MR-proANP 和缺血性脑卒中的研究，发表时间截至 2023 年 10 月 15 日。主要终点是新诊断的 Afib、90 天改良 Rankin 量表（mRS）评分和 90 天死亡率。研究以叙述和表格形式描述。使用 ROBINS-I 工具评估偏倚风险。在适当的情况下，使用随机效应模型生成我们主要终点的汇总估计值。与无 Afib 患者相比，新诊断的 Afib 患者的 MR-proANP 水平显著升高（平均差异（MD）：134.4 pmol/l；95%置信区间（CI）：119.45 至 149.35，P < 0.0001）。90 天 mRS 评分≥3 的不良功能结局与较高的 MR-proANP 水平相关（MD：93.87 pmol/；95% CI：76.66 至 111.09，P < 0.0001）。升高的 MR-proANP 水平也与 90 天死亡率的增加密切相关（MD：164.43 pmol/；CI：95.94 至 232.92，P < 0.0001）。MR-proANP 与功能结局、90 天死亡率和新诊断的 AF 显著相关。纳入的研究数量有限，需要进一步的大规模研究来证实这些发现，并探讨加快诊断程序和靶向干预（如抗凝治疗）的潜力。
