Immuno-inflammatory activation in acute cardio-embolic strokes in comparison with other subtypes of ischaemic stroke

Few studies have examined the relationship between inflammatory biomarker blood levels, cardioembolic stroke subtype and neurological deficit. So the aim of our study is to evaluate plasma levels of immuno-inflammatory variables in patients with cardio-embolic acute ischaemic stroke compared to other diagnostic subtypes and to evaluate the relationship between immuno-inflammatory variables, acute neurological deficit and brain infarct volume. One hundred twenty patients with acute ischaemic stroke and 123 controls without a diagnosis of acute ischaemic stroke were evaluated. The type of acute ischaemic stroke was classified according to the TOAST classification. We evaluated plasma levels of IL-1beta, TNF-alpha, IL-6 and IL-10, E-selectin, P-selectin, sICAM-1,sVCAM-1, vWF, TPA and PAI-1. Patients with ischaemic stroke classified as cardio-embolic (CEI) showed, compared to other subtypes, significantly higher median plasma levels of TNF-alpha , IL-6 and IL-1beta. Furthermore stroke patients classified as lacunar showed, compared to other subtypes, significantly lower median plasma levels of TNF-alpha, IL-6 and IL-1beta. Multiple linear regression showed a significant association between the Scandinavian Stroke Scale (SSS) score at admission and diagnostic subtype, infarct volume of cardio-embolic strokes and some inflammatory variables. Our findings confirm that cardio-embolic strokes have a worse clinical presentation and produce larger and more disabling strokes than other ischaemic stroke subtypes reporting a possible explanation of higher immuno-inflammatory activation of the acute phase.Few studies have examined the relationship between inflammatory biomarker blood levels, cardioembolic stroke subtype and neurological deficit. So the aim of our study is to evaluate plasma levels of immuno-inflammatory variables in patients with cardio-embolic acute ischaemic stroke compared to other diagnostic subtypes and to evaluate the relationship between immuno-inflammatory variables, acute neurological deficit and brain infarct volume. One hundred twenty patients with acute ischaemic stroke and 123 controls without a diagnosis of acute ischaemic stroke were evaluated. The type of acute ischaemic stroke was classified according to the TOAST classification. We evaluated plasma levels of IL-1beta, TNF-alpha, IL-6 and IL-10, E-selectin, P-selectin, sICAM-1,sVCAM-1, vWF, TPA and PAI-1. Patients with ischaemic stroke classified as cardio-embolic (CEI) showed, compared to other subtypes, significantly higher median plasma levels of TNF-alpha , IL-6 and IL-1beta. Furthermore stroke patients classified as lacunar showed, compared to other subtypes, significantly lower median plasma levels of TNF-alpha, IL-6 and IL-1beta. Multiple linear regression showed a significant association between the Scandinavian Stroke Scale (SSS) score at admission and diagnostic subtype, infarct volume of cardio-embolic strokes and some inflammatory variables. Our findings confirm that cardio-embolic strokes have a worse clinical presentation and produce larger and more disabling strokes than other ischaemic stroke subtypes reporting a possible explanation of higher immuno-inflammatory activation of the acute phase. Comment in Inflammatory markers for ischaemic stroke. [Thromb Haemost. 2009

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Previous data showed that PFOs not detected by high-quality transthoracic echocardiography are smaller and associated with small right-to-left shunts (4); therefore, they are far less likely to be associated with embolic stroke features (5)

Arterial stiffness and ischemic stroke in subjects with and without metabolic syndrome.

We conducted a study to evaluate arterial stiffness markers in subjects with acute ischemic stroke and metabolic syndrome and in relation to TOAST subtype of stroke. We enrolled 130 patients with acute ischemic stroke and metabolic syndrome, 127 patients with acute ischemic stroke without metabolic syndrome and 120 control subjects without acute stroke. Applanation tonometry to record pulse wave velocity (PWV). Stroke patients with metabolic syndrome, compared control subjects without stroke showed higher PWV. In subjects with ischemic stroke and metabolic syndrome, PWV was more significantly and positively correlated with body mass index, systolic blood pressure, hypertension, diabetes, glucose blood levels, LDL cholesterol levels, total cholesterol levels, micro-albuminuria, carotid plaque, previous brain infarct at neuro-imaging. Our findings underline important role of both small vessel disease and atherosclerosis on arterial stiffness pathogenesis in the clinical setting of metabolic syndrom

Effects of clinical and laboratory variables and of pretreatment with cardiovascular drugs in acute ischaemic stroke: a retrospective chart review from the GIFA study.

Background: Few studies have examined the role of cardiovascular drugs on acute ischaemic stroke prognosis. Aims: To evaluate the relationship between a favourable outcome in patients with acute ischaemic stroke and specific demographic, clinical and laboratory variables and cardiovascular drug pretreatment. Methods: The 1096 patients enrolled in the GIFA study (who had a main discharge diagnosis of ischaemic stroke) represent the final patient sample used in this analysis. Drugs considered in the analysis included angiotensin converting enzyme (ACE)-inhibitors, angiotensin II receptor blockers, statins, calcium channel blockers, anti-platelet drugs, vitamin K antagonists and heparins. The outcomes analyzed included in-hospital mortality, cognitive function evaluated by the Hodkinson Abbreviated Mental Test (HAMT), and functional status evaluated by activities of daily living (ADL). The definition of a good outcome was no in-hospital mortality, a HAMT score of >= 6 and no ADL impairment. Results: Patients with no in-hospital mortality, a HAMT score of >6 and no ADL impairment were more likely to be younger at baseline and have a lower blood glucose level and a systolic blood pressure (SBP) between 120 and 180 mmHg, a higher plasma total cholesterol level, a lower white blood cell count, and a lower Charlson Index (CI) score, a higher rate of pretreatment with ACE-inhibitors, calcium channel blockers and a lower rate of pretreatment with heparin. Conclusions: Predictors of good outcome, in terms of in-hospital mortality and cognitive and functional performance at discharge, included higher SBP at admission between 120 and 180 mmHg, a SBP plasma total cholesterol levels, a lower CI score, and pretreatment with ACE-inhibitors, calcium channel blockers and anti-platelets. (C) 2010 Elsevier Ireland Ltd. All rights reserved

Rizik neželjenih događaja kod bolesnika s otvorenim foramen ovale liječenih lijekovima: pregled literature

Patent foramen ovale is associated with stroke. However, the rate of recurrent events in medically treated patients with patent foramen ovale remains undefined. Estimates differ by the studies. In order to provide a more accurate estimate of the recurrent adverse event rates in medically treated patients with patent foramen ovale, we reviewed the literature and analyzed the results from a total of 1,108 patients combining 12 studies. We found the annual rate of stroke or death to be 3.12% (95% CI, 2.32-4.11%). This estimate will provide a valuable guideline for any future study to compare the efficacy of other modalities such as percutaneous device closure of patent foramen ovale with medical treatment.Otvoreni foramen ovale (OFO) udružen je s moždanim udarom. Međutim, učestalost rekurentnih neželjenih događaja u bolesnika liječenih lijekovima s otvorenim foramen ovale nije poznata, a procjene iz različitih studija se razlikuju. Stoga smo obavili pregled literature i analizirali rezultate za ukupno 1.108 bolesnika iz 12 studija, kako bismo dobili točniju procjenu učestalosti neželjenih događaja u bolesnika s otvorenim foramen ovale liječenih lijekovima. Utvrdili smo godišnju stopu moždanog udara ili smrti od 3,12% (95% CI, 2,32-4,11%). Ova će procjena poslužiti kao vrijedna smjernica za buduća ispitivanja u kojima će se uspoređivati učinkovitost drugih načina liječenja, primjerice, zatvaranje otvorenog foramen ovale pomoću perkutanog uređaja uz medikamentno liječenje

Immuno-inflammatory and thrombotic/fibrinolytic variables associated with acute ischemic stroke diagnosis.

towards diagnosis of acute ischemic stroke. MATERIALS AND METHODS: We enrolled 120 consecutive patients with a diagnosis of acute ischemic stroke and 123 consecutive hospitalized control patients without a diagnosis of acute ischemic stroke. We evaluated plasma levels of IL-1beta, TNF-beta, IL-6 and IL-10, E-selectin, P-selectin, sICAM-1 and sVCAM-1 as markers of immuno-inflammatory activation, vWF plasma levels as a marker of endothelial dysfunction, TPA antigen and PAI-1 plasma levels as a marker of a prothrombotic state. RESULTS: TNF-alpha, PAI-1 and TPA on bivariate logistic regression were highly correlated to stroke diagnosis. Among the other variables maintained in the final model ILbeta, Selectin E, were significantly associated with acute ischemic stroke diagnosis, whereas IL-6, VICAM-1, ICAM-1 and neutrophil percentage showed only a slight or no association with stroke diagnosis. Furthermore, only the continuous values of TNF-alpha, PAI-1 and TPA showed a significant predictive value and likelihood ratio, with an area under the ROC curve of 98.6%, 97.1% and 99.9%, respectively. DISCUSSION: Our findings could suggest the high diagnostic power of these immuno-inflammatory and thrombotic/fibrinolytic variables in patients with acute ischemic stroke. Although our results are encouraging, additional studies are needed to establish the validity of this approac

Immune-inflammatory markers and arterial stiffness indexes in subjects with acute ischemic stroke with and without metabolic syndrome.

OBJECTIVE: The aim of our study was to evaluate the associations between arterial stiffness indexes and immune-inflammatory markers in subjects with acute ischemic stroke with and without metabolic syndrome. MATERIALS/METHODS: We enrolled 130 patients with acute ischemic stroke and metabolic syndrome, 127 patients with acute ischemic stroke without metabolic syndrome and 120 control subjects without acute stroke. Applanation tonometry was used to record the augmentation index (Aix) and pulse wave velocity (PWV). We also evaluated plasma levels of C-reactive protein (CRP), Interleukin-1beta (IL-1β), tumor necrosis factor-alpha (TNF-α), Interleukin-6 (IL-6) and Interleukin-10 (IL-10), E-selectin, P-selectin, intercellular adhesion molecule-1 (ICAM-1), vascular cell adhesion molecule-1 (VCAM-1), von Willebrand Factor (vWF) plasma levels, tissue plasminogen activator (TPA) and plasminogen activator inhibitor-1 (PAI-1). RESULTS: In subjects with acute ischemic stroke and metabolic syndrome we observed higher median plasma values of immuno-inflammatory markers. In acute ischemic stroke patients and metabolic syndrome in relation of each TOAST subtype we observed a more significant positive correlation between PWV and immuno-inflammatory markers. CONCLUSIONS: Stroke subjects with acute ischemic stroke and metabolic syndrome showed a higher degree of immuno-inflammatory and arterial stiffness indexes possibly due to metabolic background of these types of patients that trigger a more intense immune-inflammatory activation irrespective of stroke subtype, whereas being related to stroke subtype in subjects without metabolic syndrome

Rizik neželjenih događaja kod bolesnika s otvorenim foramen ovale liječenih lijekovima: pregled literature

Patent foramen ovale is associated with stroke. However, the rate of recurrent events in medically treated patients with patent foramen ovale remains undefined. Estimates differ by the studies. In order to provide a more accurate estimate of the recurrent adverse event rates in medically treated patients with patent foramen ovale, we reviewed the literature and analyzed the results from a total of 1,108 patients combining 12 studies. We found the annual rate of stroke or death to be 3.12% (95% CI, 2.32-4.11%). This estimate will provide a valuable guideline for any future study to compare the efficacy of other modalities such as percutaneous device closure of patent foramen ovale with medical treatment.Otvoreni foramen ovale (OFO) udružen je s moždanim udarom. Međutim, učestalost rekurentnih neželjenih događaja u bolesnika liječenih lijekovima s otvorenim foramen ovale nije poznata, a procjene iz različitih studija se razlikuju. Stoga smo obavili pregled literature i analizirali rezultate za ukupno 1.108 bolesnika iz 12 studija, kako bismo dobili točniju procjenu učestalosti neželjenih događaja u bolesnika s otvorenim foramen ovale liječenih lijekovima. Utvrdili smo godišnju stopu moždanog udara ili smrti od 3,12% (95% CI, 2,32-4,11%). Ova će procjena poslužiti kao vrijedna smjernica za buduća ispitivanja u kojima će se uspoređivati učinkovitost drugih načina liječenja, primjerice, zatvaranje otvorenog foramen ovale pomoću perkutanog uređaja uz medikamentno liječenje

Endothelial dysfunction is associated with carotid plaque: a cross-sectional study from the population based Northern Manhattan Study

BACKGROUND: Impaired vascular function occurs early in atherogenesis. Brachial flow mediated dilatation (FMD) is a non-invasive measure of vascular function and may be an important marker of preclinical atherosclerosis. Data on the association between FMD and carotid plaque in multi-ethnic populations are limited. The objective of this study was to determine whether endothelial dysfunction is independently associated with carotid plaque in a community of northern Manhattan. METHODS: In the population-based Northern Manhattan Study (NOMAS), high-resolution B-mode ultrasound images of the brachial and carotid arteries were obtained in 643 stroke-free subjects (mean age 66 years; 55% women; 65% Caribbean-Hispanic, 17% African-American, 16% Caucasian). Brachial FMD was measured during reactive hyperemia. Maximum carotid plaque thickness (MCPT) was measured at the peak plaque prominence. RESULTS: The mean brachial FMD was 5.78 ± 3.83 %. Carotid plaque was present in 339 (53%) subjects. The mean MCPT was 1.68 ± 0.82 mm, and the 75(th )percentile was 2.0 mm. Reduced FMD was significantly associated with increased MCPT. After adjusting for demographics, vascular risk factors, and education, each percent of FMD decrease was associated with a significant 0.02 mm increase in MCPT (p = 0.028). In a dichotomous adjusted model, blunted FMD was associated with an increased risk of MCPT ≥ 2.0 mm (OR, 1.11 for every 1% decrease in FMD; 95% CI, 1.03–1.19). CONCLUSION: Decreased brachial FMD is independently associated with carotid plaque. Non-invasive evaluation of endothelial dysfunction may be a useful marker of preclinical atherosclerosis and help to individualize cardiovascular risk assessment beyond traditional risk factors