Assessment of relationship between acute ischemic stroke and heart disease - protocol of a prospective observational trial

Abstract

aBackground. Stroke and acute myocardial infarction are the leading causes of death and disability in industrialized countries. Multiple interactions exist between the various forms of cardiovascular and cerebrovascular diseases, and risk factors for development of stroke and major cardiovascular events are similar. There is currently no clear link between acute coronary syndrome and stroke, although it has been repeatedly described. In addition, there are currently no clear recommendations for how to proceed in the case of signs of myocardial damage in patients with acute stroke and how to manage the next follow-up. Methods-Design. In this prospective observational trial, 500 consecutive ischemic stroke patients admitted at the Comprehensive Stroke Center will be enrolled within 12 h from stroke onset. The set of examinations will consist of: 1) Acute brain computed tomography or magnetic resonance imaging 2) Laboratory tests: A) within 12 h from stroke onset: NT pro B-type of natriuretic peptide, pro-atrial natriuretic peptide, creatinekinase MB, troponin T (cTnT), interleukin 6, procalcitonin, high sensitive C-reactive protein and D-dimers. B) control level of cTnT after 4 h from admission C) nonacute laboratory samples within 60 h from stroke onset: glycated haemoglobine, serum lipids; 3) Electrocardiogram (ECG) on admission and 4 h from stroke onset; 4) Transesophageal or transthoracal echocardiography and 24-h ECGHolter within 15 days from stroke onset; 5) Neurosonological examination within 60 h from stroke onset; 6) Thirty patients with a positive finding of acute myocardial ischemia (ECG, cTnT) will be examined by coronary angiography (CAG); 7) Epidemiological data will be acquired. Statistics. The epidemiological characteristics of the whole sample of patients; correlation between differences between group of cardioembolic ischemic stroke patients and group of patients with ischemic stroke of another etiology; correlation of infarction volume on DWI-MRI with the level of cTnT; correlation of the ECG findings with the level of cTnT and clinical signs; correlation of the CAG findings with level of cTnT and ECG findings will be statistically evaluated at the 5% level of statistical significance. Conclusion. The main goal of the project is to improve identification of patients with acute coronary syndrome and with concurrent acute ischemic stroke as these patients require specific treatment and secondary prevention of ischemic events. Trial registration. Clinicaltrials.gov NCT01541163.

Biomarkers for the early detection of anthracycline-induced cardiotoxicity: current status

“…Previous reports consistently laid the theoretical basis for the possible use of cardiac troponins and natriuretic peptides in the early detection of cardiotoxicity in clinical practice, whereas creatine kinase MB (CK-MB) does not seem to be effective owing to a short time window of the serum elevation after myocardial injury and its imperfect cardiac specificity and sensitivity [29][30][31] . In 2011, a position statement from the Heart Failure Association of the European Society of Cardiology on "Cardiovascular side effects of cancer therapies" was published 32 .…”

Atrial Fibrillation in Young Ischemic Stroke Patients: An Underestimated Cause?

“…Serial laboratory panel done in this study contained the following samples: (1) standard biochemistry panel, (2) standard coagulation parameters including markers of thrombophilia, (3) serum cardiac markers (12 h after stroke onset: N-terminal pro-brain natriuretic peptide (NT-proBNP) and high-sensitive Troponin T (hsTnT), 4) serum markers <60 h after stroke onset (glycosylated hemoglobin and serum lipids) and standard screening panel of thrombophilia including genetic screening. The details and normal values of all used methods were published previously [18]. In all patients without the presence of AF at admission or during a hospital stay at stroke unit, a 24-h ECG Holter and 3-week ECG Holter monitoring were performed.…”

“…The study set consisted of consecutive acute IS patients ≤50 years enrolled in the prospective single-center observational HISTORY (Heart and Ischemic STrOke Relationship studY) study registered on ClinicalTrials.gov (identifier NCT01541163) between 2011 and 2014 [18]. In all included patients, the brain ischemia was confirmed on computed tomography (CT) or magnetic resonance (MRI) including CT or MRI angiography.…”

Comparison of Risk Factors of Stroke and Myocardial Infarction in Patients 15 to 45 Years in Affiliated Hospitals of Babol University of Medical Sciences

“…This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International License (http://creativecommons.org/licenses/by-nc/4.0/) which permits copy and redistribute the material just in noncommercial usages, provided the original work is properly cited. different in young patients than in adults [16,17]. Studies show that young patients with more than three risk factors have a high probability for severe heart and brain disease [18].…”