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Table of Contents
LETTER TO THE EDITOR
Year : 2014  |  Volume : 17  |  Issue : 2  |  Page : 243-244
 

Experiences and the use of BNP POCT platform on suspected stroke patients by a Chinese emergency department


1 Department of Internal Medicine, Foshan Hospital of Traditional Chinese Medicine, Foshan, China
2 Department of Emergency , Foshan Hospital of Traditional Chinese Medicine, Foshan, China
3 Department of Neurology, Sun Yat-Sen Memorial Hospital, Sun Yat-sen University, Guangdong Province, China

Date of Web Publication17-May-2014

Correspondence Address:
Wu Zhixin
Department of Emergency, Foshan Hospital of Traditional Chinese Medicine, 6#Qinren Road, 528 000, Foshan City, Guangdong Province
China
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0972-2327.132670

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How to cite this article:
Qihong G, Zhixin W, Mingfeng H, Lianhong Y, Wenchong X. Experiences and the use of BNP POCT platform on suspected stroke patients by a Chinese emergency department. Ann Indian Acad Neurol 2014;17:243-4

How to cite this URL:
Qihong G, Zhixin W, Mingfeng H, Lianhong Y, Wenchong X. Experiences and the use of BNP POCT platform on suspected stroke patients by a Chinese emergency department. Ann Indian Acad Neurol [serial online] 2014 [cited 2019 Dec 8];17:243-4. Available from: http://www.annalsofian.org/text.asp?2014/17/2/243/132670


Sir,

We have recently published an article about the opinions of the use of brain natriuretic peptide (BNP) among acute ischemic stroke patients in Annals of Indian Academy of Neurology. [1] In this field, several studies have reported that the plasma BNP level in cardioembolic stroke is significantly higher than that in other the trial of ORG 10172 in acute stroke treatment criteria (TOAST) subtypes and associated with functional outcome at 6 months after ischemic stroke. Also, plasma BNP level has been shown to be an independent predictor of the mortality and myocardial infarction in stroke patients. [2],[3],[4],[5] We also notice that a few studies were accomplished in the emergency department (ED) setting and wish to make some points about our experience.

According to the new stroke guidelines and recommendations published by the American Heart Association (AHA) and American Stroke Association (ASA), health providers' focus on the initial out-of-hospital and ED assessment, and management of the patient with acute stroke as depicted in the algorithm Goals for Management of Patients with Suspected Stroke. [6] Based on the related guidelines, we set up a clinical study about the use of BNP among acute stroke patients in our ED. [7] We suggest to add plasma BNP test at bedside to the third step of the AHA and ASA stroke guidelines in the ED. The suspected stroke patients could be obtained intravenous (IV) access and performed laboratory assessments within 10 min of arrival at the ED. The plasma BNP concentration is measured immediately at bedside, while other blood samples are sent to the department of laboratory medicine for necessary tests. Then, the patients get the emergent brain computed tomography (CT) or magnetic resonance imaging (MRI) scans. The 12-lead electrocardiogram (ECG) is recommended to perform at the ED. [7]

Our algorithm of diagnostic stroke subtypes using BNP is very efficient and different from our Japanese colleagues. In their study, they collected patients' blood samples twice and performed the BNP test on ischemic stroke patients after the emergent brain CT or MRI scan. And the 12-lead ECG was performed in hospitalization. [2]

In our opinion, we had better collected the blood samples together to test according to the related guidelines at the ED and save more time. The common target is to recognize the patients with cardioembolic stroke as soon as possible, due to high risks and poor long-term outcome, including death. [2],[3],[4],[5],[6],[7] Based on a lot of published studies, the BNP testing at bedside on admission, could be suggested to add into early stroke management guidelines as a strategy for improving stroke subtype classification, predict the development of atrial fibrillation after admission, and risk stratification. Thus, rapidly guiding other diagnostic tests and accelerating the start of optimal secondary prevention (e.g., control of risk factors, interventional approaches for atherosclerotic disease, antithrombotic treatments for cardioembolism, and the use of antiplatelet agents for noncardioembolic stroke), further diagnostic examination, intensive rehabilitative intervention, and ultimately better patient outcomes. It is sensitive, specific, easy, rapidly processed, inexpensive, and widely available; suggesting that the plasma BNP could be a potential and good stroke biomarker for emergency physicians' use. [2],[3],[4],[5],[6],[7],[8]

 
   References Top

1.Wu Z, He M, Gao S, Yang L. Opinions about the use of brain natriuretic peptide among acute ischemic stroke patients. Ann Indian Acad Neurol 2013;16:726.  Back to cited text no. 1
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2.Sakai K, Shibazaki K, Kimura K, Aoki J, Kobayashi K, Fujii S, et al. Brain natriuretic Peptide as a predictor of cardioembolism in acute ischemic stroke patients: Brain natriuretic Peptide stroke prospective study. Eur Neurol 2013;69:246-51.  Back to cited text no. 2
    
3.Mäkikallio AM, Mäkikallio TH, Korpelainen JT, Vuolteenaho O, TapanainenJM, Ylitalo K, et al. Natriuretic peptides and mortality after stroke. Stroke 2005;36:1016-20.  Back to cited text no. 3
    
4.Shibazaki K, Kimura K, Okada Y, Iguchi Y, Uemura J, Terasawa Y, et al. Plasma brain natriuretic peptide as an independent predictor of in-hospital mortality after acute ischemic stroke. Intern Med 2009;48:1601-6.  Back to cited text no. 4
    
5.Jensen JK, Atar D, Kristensen SR, Mickley H, Januzzi JL Jr. Usefulness of natriuretic peptide testing for long-term risk assessment following acute ischemic stroke. Am J Cardiol 2009;104:287-91.  Back to cited text no. 5
    
6.Jauch EC, Cucchiara B, Adeoye O, Meurer W, Brice J, Chan YY, et al. Part 11: Adult stroke: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation 2010;122:S818-28.  Back to cited text no. 6
    
7.Zhixin W, Lianhong Y, Wei H, Lianda L, Longyuan J, Yingjian Z, et al. The value of the use of plasma B-type natriuretic peptide among acute ischemic stroke patients in a Chinese emergency department. Clin Neurol Neurosurg 2013;115:1671-6.  Back to cited text no. 7
    
8.Furie KL, Kasner SE, Adams RJ, Albers GW, Bush RL, Fagan SC, et al. American Heart Association Stroke Council, Council on Cardiovascular Nursing, Council on Clinical Cardiology, and Interdisciplinary Council on Quality of Care and Outcomes Research. Guidelines for the prevention of stroke in patients with stroke or transient ischemic attack: A guideline for healthcare professionals from the American heart association/American stroke association. Stroke 2011;42:227-76.  Back to cited text no. 8
    




 

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