Abstract Background and aims CT Perfusion (CTP) is utilized in the acute care of ischemic stroke patients. Since few studies explored N-terminal pro-brain natriuretic peptide (NT-proBNP) relationship with CTP-derived hypoperfusion volumes and infarct growth rate (IGR) our study aims to evaluate the relationship between NT-proBNP and IGR. Methods We retrospectively analyzed 66 patients with anterior circulation stroke from large vessel occlusion who underwent EVT at the University Hospital of Trieste (January 2021-August 2023). All patients underwent CTP within 4.5 hours from symptoms onset. Ischemic core was defined as CBV 2.0 mL/100g. IGR was calculated based on core volume and onset-to-imaging (OTI) time and patients with IGR 10mL/h were defined as fast progressors. NT-proBNP levels were assessed within 24 hours from admission. Statistical analyses were performed using SPSS v23.0. Results Median age was 76 years and median admission NIHSS was 15. Median OTI time was 120 minutes. CTP-derived hypoperfusion metrics showed a median CBV volume of 23mL and a median IGR of 11mL/h. 37 (56%) patients were categorized as fast progressors. The median NT-proBNP level was 1082 pg/mL. NT-proBNP levels positively correlated with both CBV volume (p 0.005; rho 0.3) and IGR (p 0.04; rho 0.3). Notably, higher NT-proBNP levels were observed in fast progressors compared to slow-to-intermediate progressors (1395 pg/mL vs 746 pg/mL; p 0.02). Conclusions Early assessment of NT-proBNP provides significant prognostic value by identifying patients with larger core volumes and IGR. Integrating this biomarker into hyper-acute protocols may enhance risk stratification and guide personalized strategies for fast progressors. Conflict of interest Emanuele Vincis, Giovanni Furlanis, Edoardo Ricci, Gabriele Prandin, Magda Quagliotto, Paola Caruso, Marcello Naccarato, Maja Ukmar, Miloš Ajčević, Paolo Manganotti: nothing to disclose
Vincis et al. (2026) studied this question.