Elevated Admission N-Terminal Pro-Brain Natriuretic Peptide as a Predictor of Computed Tomography Perfusion Core Infarct Overestimation in Acute Ischemic Stroke in a Sample of Chinese Patients

Guosen Bu; Li Yang; Jianhua Ma; Dengfeng Han; Yuchun Yang; Zhen Bao; Muhuyati Wulasihan

doi:10.1016/j.wneu.2025.124079

Elevated Admission N-Terminal Pro-Brain Natriuretic Peptide as a Predictor of Computed Tomography Perfusion Core Infarct Overestimation in Acute Ischemic Stroke in a Sample of Chinese Patients

World Neurosurg. 2025 May 14:199:124079. doi: 10.1016/j.wneu.2025.124079. Online ahead of print.

Authors

Guosen Bu¹, Li Yang², Jianhua Ma¹, Dengfeng Han¹, Yuchun Yang¹, Zhen Bao¹, Muhuyati Wulasihan³

Affiliations

¹ Department of Neurology, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China.
² Department of Prenatal Diagnosis, Center for Reproductive Medicine, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China.
³ Department of General Cardiology, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China. Electronic address: mhyt567@163.com.

PMID: 40379211
DOI: 10.1016/j.wneu.2025.124079

Abstract

Background: Overestimation of computed tomography perfusion (CTP) core infarcts in ischemic stroke is common and may interfere with treatment decisions. We aim to assess the value of admission N-terminal pro-brain natriuretic peptide (NT-pro BNP) in predicting CTP core infarct overestimation.

Methods: A total of 353 patients with anterior circulation large vessel occlusion stroke who achieved satisfactory recanalization (extended thrombolysis in cerebral infarction ≥ 2c) from a single-center prospective database were enrolled in this study. Core infarct overestimation was considered when the CTP-derived infarct was larger than the final infarct measured on 24- to 48-hour noncontrast CT. Multivariable logistic regression analysis was performed to identify variables associated with overestimation.

Results: Fifty-two (14.8%) patients presented with CTP core infarct overestimation. Multivariate analysis, adjusted for covariates, showed that admission NT-pro BNP (adjusted odds ratio [OR] 1.34; 95% confidence interval [CI] 1.13-1.69), poor collaterals (adjusted OR 3.13; 95% CI 1.87-4.87), onset-to-imaging time (adjusted OR 0.23; 95% CI 0.17-0.46), and embolism etiology (adjusted OR 1.15; 95% CI 1.09-1.46) were independently associated with overestimation. Based on the receiver operating characteristic curve, the optimal cut-off value of NT-pro BNP for diagnosing infarct overestimation was 876 pg/ml, which yielded a sensitivity of 76.9%, a positive likelihood ratio of 2.796, a negative likelihood ratio of 0.319, and an area under the curve of 0.813 (95% CI: 0.761-0.864).

Conclusions: Elevated admission NT-pro BNP could serve as a predictor of CTP infarct overestimation. CTP results should be interpreted with caution in specific circumstances to ensure that patients who might benefit from thrombectomy are not inadvertently excluded.

Keywords: Infarction; Overestimation; Perfusion; Predict; Stroke.