Background: Stroke subtype diagnosis leads to specific therapies to reduce recurrences. Because nearly one third of patients remain with unknown etiology after a complete screening workup, we aim to investigate whether molecular markers of myocardial damage were associated with cardioembolic stroke and if they were useful to reclassify strokes of undetermined etiology.Methods: We included 262 patients with first ischemic stroke within the first 12 hours. Stroke subtype was evaluated by TOAST criteria. Stroke of undetermined origin were reclassified into likely atherothrombotic or likely cardioembolic according to a predefined non-validated algorithm. Blood samples were obtained on admission to determine serum levels of molecular markers (pro-BNP, pro-ANP and CK-MB) of myocardial damage.Results: Patients with cardioembolic infarct showed higher levels of pro-BNP, pro-ANP and CK-MB. Pro-BNP > 360 pg/mL was independently associated with cardioembolic stroke (OR: 28.51, CI95%: 5.90–136.75, p < 0.0001). Stroke etiology was undetermined in 82 patients (31%); 34 were reclassified as likely cardioembolic, 22 as likely atherothrombotic, and 26 remained as undetermined. Pro-BNP > 360 pg/mL was the only factor independently associated with likely cardioembolic stroke.Conclusions: Pro-BNP levels higher than 360 pg/mL are associated with cardioembolic stroke and may be useful to reclassify undetermined strokes as of cardioembolic origin.

中文翻译：

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脑钠肽前体 (pro BNP) 的高血清水平可识别未确定中风的心源性栓塞起源。

背景：中风亚型诊断导致特定疗法以减少复发。由于近三分之一的患者在完整的筛查检查后仍存在病因不明，我们的目标是调查心肌损伤的分子标志物是否与心源性卒中相关，以及它们是否有助于重新分类病因不明的卒中。方法：我们纳入了 262 名在前 12 小时内首次发生缺血性卒中的患者。卒中亚型通过 TOAST 标准进行评估。根据预定义的非验证算法，不确定起源的中风被重新分类为可能的动脉粥样硬化血栓形成或可能的心源性栓塞。入院时采集血样以确定心肌损伤的分子标志物（pro-BNP、pro-ANP 和 CK-MB）的血清水平。结果：心源性梗塞患者表现出更高水平的 pro-BNP、pro-ANP 和 CK-MB。Pro-BNP > 360 pg/mL 与心源性卒中独立相关（OR：28.51，CI95%：5.90–136.75，p < 0.0001）。82 名患者 (31%) 中风病因未明确；34 人被重新归类为可能是心源性栓塞，22 人被归类为可能是动脉粥样硬化，26 人仍为未确定。Pro-BNP > 360 pg/mL 是与可能的心源性卒中独立相关的唯一因素。结论：Pro-BNP 水平高于 360 pg/mL 与心源性卒中相关，可能有助于将未确定的卒中重新归类为心源性卒中。