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