NEW YORK (Reuters Health) Apr 03 - Elevated B-type natriuretic peptide (BNP) levels are a sign of potentially reversible myocardial ischemia in stroke survivors without chest pain, past MI, or left ventricular systolic impairment, a study shows.

For the patient who survives the first six months following a stroke, the most common cause of death in later years is cardiac-related, Dr. Kenneth Y. K. Wong and colleagues point out in the April issue of Heart. "Stroke survivors with a high BNP deserve further investigations to rule out significant reversible myocardial ischemia, in order to reduce their risk of cardiac death," they conclude.

Dr. Wong's group studied the value of BNP concentrations in 56 stroke patients who "made a good recovery" and were at least 1 month from a recently documented stroke or transient ischemic attack.

"The key finding of the study," Dr. Wong told Reuters Health, was that BNP correlated significantly with the degree of reversible myocardial ischaemia demonstrated on stress myocardial perfusion scanning in subjects who did not have chest pain or a history of MI or evidence of left ventricular systolic dysfunction.

"Thus, BNP might be used to risk stratify stroke survivors for myocardial perfusion scanning to look for evidence of reversible ischaemia," he said.

In the large number of stroke survivors who are not candidates for revascularization, an abnormal BNP level and myocardial perfusion scan may prompt efforts to achieve tighter control of risk factors, such as blood pressure, than usual, Dr. Wong and colleagues suggest in their report.

Asymptomatic stroke survivors with reversible myocardial ischemia might also benefit from intensified statin therapy, they add.

Future research is needed to determine whether a strategy of obtaining BNP levels and myocardial perfusion scans "would ultimately reduce the high incidence of cardiac death in stroke survivors," Dr. Wong said.

Reuters Health Information 2006. © 2006 Reuters Ltd.