Natriuretic Peptide Applications in Ischemic Stroke Management

Natriuretic peptides, principally B-type natriuretic peptide (BNP) and its N-terminal fragment (NT-proBNP), have emerged as versatile tools in the management of acute ischemic stroke. Synthesised in response to intracardiac pressure and volume overload, these peptides serve not only as indicators of underlying cardiac dysfunction but also as biomarkers reflective of cerebrovascular risk, clot composition and neurovascular injury. Elevated circulating NT-proBNP levels facilitate early recognition of cardioembolic stroke and enable rapid stratification of patients for tailored reperfusion therapies. Beyond diagnosis, natriuretic peptides correlate with infarct core volume and predict functional outcomes at 90 days, guiding post-acute care planning. Histological studies reveal BNP and NT-proBNP within thrombi, where they co-localise with platelets and inflammatory cells, implicating them in thrombo-inflammatory pathways. Ongoing efforts aim to integrate bedside assays into hyperacute workflows and to explore therapeutic modulation of natriuretic peptide signalling as a means to attenuate blood–brain barrier disruption and promote neurovascular repair. This multifaceted application underscores the global significance of natriuretic peptides as both biomarkers and potential targets in ischaemic stroke management.

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Natriuretic Peptide Applications in Ischemic Stroke Management publication trend

The graph below shows the total number of articles in natriuretic peptide applications in ischemic stroke management across all publications each year (not limited to Nature Index journals).

Technical terms

B-type natriuretic peptide (BNP): A cardiac hormone released in response to ventricular stretch, used as a biomarker of cardiac stress.

N-terminal pro-BNP (NT-proBNP): The inactive fragment cleaved from proBNP, circulating in plasma and serving as a stable stroke biomarker.

Cardioembolic stroke: An ischaemic stroke subtype arising from emboli originating in the heart, often linked to atrial fibrillation.

Infarct core and penumbra: Regions of irreversibly damaged brain tissue (core) and surrounding at-risk but salvageable tissue (penumbra) identified by perfusion imaging.

Thrombo-inflammation: The interplay between thrombosis and inflammatory responses within the vascular and perivascular milieu.

Mendelian randomisation: A genetic epidemiology method that uses inherited genetic variants as proxies for modifiable exposures to infer causality.

References

1. Investigating the Role of Brain Natriuretic Peptide (BNP) and N-Terminal-proBNP in Thrombosis and Acute Ischemic Stroke Etiology. International Journal of Molecular Sciences (2024).
2. Blood-Based Biomarkers Are Associated with Different Ischemic Stroke Mechanisms and Enable Rapid Classification between Cardioembolic and Atherosclerosis Etiologies. Diagnostics (2020).
3. B-Type Natriuretic Peptide as a Significant Brain Biomarker for Stroke Triaging Using a Bedside Point-of-Care Monitoring Biosensor. Biosensors (2020).
4. Circulating N-Terminal Probrain Natriuretic Peptide Levels in Relation to Ischemic Stroke and Its Subtypes: A Mendelian Randomization Study. Frontiers in Genetics (2022).
5. Elevated NT-proBNP levels are associated with CTP ischemic volume and 90-day functional outcomes in acute ischemic stroke: a retrospective cohort study. BMC Cardiovascular Disorders (2022).