MR-proANP levels in Acute ischemic stroke and clinical outcomes: a systematic review and meta-analysis.

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.

Duke Scholars

Author Brian C. Mac Grory Neurology, Stroke and Vascular Neurology