Biomarkers of atrial cardiopathy in patients with different pathogenetic subtypes of ischemic stroke

Mekhryakov, S. A.; Кулеш, А. А.; Syromyatnikova, L. I.; Sobyanin, К. V.

doi:10.14412/2074-2711-2020-6-33-41

Cited by 6 publications

(1 citation statement)

References 30 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Пролонгированный мониторинг у пациентов с маркерами предсердной кардиопатии более эффективен: 12-месячное наблюдение позволяет выявить ФП у 33% пациентов [71]. В рутинной практике наиболее удобными биомаркерами предсердной кардиопатии представляются структурные и функциональные характеристики левого предсердия по данным трансторакальной эхокардиографии: диаметр, индекс объема (LAVI), фракция выброса (LAEF) [72], а также сывороточная концентрация натрийуретических пептидов, особенно NT-proBNP [73][74][75]. Данные маркеры целесообразно использовать для отбора пациентов на пролонгированный мониторинг.…”

Section: Characteristics Of Multicenter Observational Studies Focused On the Oacs Initiation After Isunclassified

Difficult issues in the management of patients with atrial fibrillation: a neurologist's point of view

Кулеш

2021

RJTAO

Self Cite

View full text Add to dashboard Cite

The article evaluates recent perspectives about the role of oral anticoagulants in the secondary prevention of cardioembolic stroke. The timing of prescribing drugs for ischemic stroke and transient ischemic attack is discussed in accordance with current clinical guidelines and the results of clinical trials. The issues of prescribing oral anticoagulants in some problematic situations, such as the elderly and senile age, reperfusion therapy, presence of hemorrhagic transformation, combined atherosclerosis of major head and neck arteries, cerebral microangiopathy, history of intracerebral hemorrhage, cryptogenic stroke, and low patient compliance are considered. Finally, an anticoagulant therapy algorithm in the acute period of cardioembolic stroke is presented.

show abstract

Section: Characteristics Of Multicenter Observational Studies Focused On the Oacs Initiation After Isunclassified

Difficult issues in the management of patients with atrial fibrillation: a neurologist's point of view

Кулеш

2021

RJTAO

Self Cite

View full text Add to dashboard Cite

show abstract

Role of insular cortex lesions in determining the pathogenetic subtype of ischemic stroke

Кулеш

Kulikova²,

Дробаха

et al. 2022

RJTAO

Self Cite

View full text Add to dashboard Cite

Timely evaluation of cardioembolic stroke (CES) caused by atrial fibrillation is critical from the point of view of the possibility of prescribing effective secondary prevention with oral anticoagulants. Insular lesion is considered as a promising neuroimaging marker of CES.Objective: to analyze the role of insular cortex lesions using magnetic resonance imaging (MRI) of the brain as a potential neuroimaging marker of the pathogenetic subtype of ischemic stroke (IS).Patients and methods. 225 patients in the acute period of IS were examined. Depending on the stroke etiology, patients were divided into three groups: cryptogenic stroke (CS; n=99), CES (n=45), and non-CES (n=81). All patients underwent an MRI of the brain to analyze the insular cortex lesions. In 57 patients, foci of cerebral infarction were additionally marked manually on axial slices of diffusion-weighted MRI using the Anatomist software. The calculated MRI characteristics of foci for CES and non-CES groups were used to construct a decision tree in the WEKA 3.6 package. Echocardiographic markers of atrial cardiopathy were assessed in all patients – the left atrium (LA) emptying fraction and LA function index; in 68 patients, the concentration of serum NT-proBNP was also assessed.Results and discussion. The insula was affected in 12% of patients: most often in CES (33%), significantly less often in CS and non-CES (6 and 7.4%, respectively), without significant differences between the latter groups. The presence of insula lesion in relation to CES has a sensitivity of 33% and a specificity of 93% (p=0.002); odds ratio 6.25; 95% confidence interval 2.22–17.63. In most patients, the posterior insular cortex was involved in the pathological process. Isolated insular infarction occurred in only one patient with CES, while the involvement of the insula and adjacent zone, and the combination of insular infarction with territorial infarction, were observed more often. The group of patients with insular lesions was distinguished by the predominance of women, greater severity of stroke at admission, less deficit at discharge, larger LA diameter, lower LA emptying fraction, and functional index. CES was four times more common in the insular lesion group, while CS was two times more common in those without insular lesions. Insula involvement identifies three out of five CES patients according to the decision tree. Further analysis of the total lesion volume can locate almost all remaining patients with CES: they are characterized by the indicator >12 sm3.Conclusion. Insular lesions allow reliable differentiation of patients with CES and non-CES and can be considered a potential marker of the cardioembolic subtype of IS, which requires further investigation.

show abstract

Cryptogenic stroke. Part 2: paradoxical embolism

et al. 2021

Self Cite

View full text Add to dashboard Cite

Cryptogenic stroke (CS) is defined as a subtype of stroke associated with a heterogeneous group of pathogenetic mechanisms that remained undetermined in the course of advanced diagnostic research. One third or fourth of the ischemic strokes is cryptogenic. Paradoxical embolism is considered the important cause of cryptogenic stroke and transient ischaemic attack (TIA) in young patients. It may occur via the following: patent foramen ovale (PFO), atrial septal defect (ASD), and pulmonary arteriovenous malformation (PAVM). When interviewing patients with suspected paradoxical embolism to obtain their health history, a practitioner should consider factors associated with Valsalva maneuvers, deep vein thrombosis/PE or predisposing conditions or situations, as well as symptoms of hereditary hemorrhagic telangiectasia (telangiectasia of the skin and mucous membranes, hemorrhagic syndrome) and pulmonary arteriovenous malformations (PAVMs) (shortness of breath, hemoptysis). If paradoxical embolism is suspected, it is necessary to conduct a stepwise diagnostic search, including transcranial Doppler ultrasound with bubble test, contrast-enhanced transesophageal echocardiography, and CT angiopulmonography. Diagnosis of relevant clinical conditions involves a search of atrial tachyarrhythmias, deep vein thrombosis, and thrombophilia. As the pathogenetic role of ASD and PAVMs in the development of embolic cryptogenic stroke is beyond doubt, the clinical significance of PFO should be determined taking into account several factors, including the presence of deep vein thrombosis/PE, the severity of the right-left shunt, the presence of ASD, the RoPE score, and detection of thrombophilia. The secondary prevention techniques of ischemic stroke or TIA with underlying PFO should be selected on a case-by-case basis, depending on the clinical significance of the anomaly, comorbid pathology, life expectancy of the patient: endovascular occlusion, anticoagulant or antiplatelet therapy. The secondary prevention with underlying ASD and LAVM includes surgical techniques such as endovascular occlusion or open surgery followed by monitoring of their effectiveness.

show abstract

Biomarkers of atrial cardiopathy in patients with different pathogenetic subtypes of ischemic stroke

Cited by 6 publications

References 30 publications

Difficult issues in the management of patients with atrial fibrillation: a neurologist's point of view

Difficult issues in the management of patients with atrial fibrillation: a neurologist's point of view

Role of insular cortex lesions in determining the pathogenetic subtype of ischemic stroke

Cryptogenic stroke. Part 2: paradoxical embolism

Contact Info

Product

Resources

About