The potential role of inflammation in cryptogenic stroke

Gąsiorek, Paulina; Banach, Maciej; Sakowicz, Agata; Głąbiński, Andrzej; Sosnowska, Bożena; Maciejewski, Marek; Bielecka‐Dąbrowa, Agata

doi:10.1016/j.advms.2019.06.001

Cited by 8 publications

(9 citation statements)

References 31 publications

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“…We enrolled patients (males, females; age median 54 (interquartile range, IQR 47-58) years) with ESUS and 36 to the control group (median 53 age 47-58 years, 61% male) from the Department of Hypertension, Medical University of Lodz. All patients underwent neuroimaging examination, arterial ultrasound examination, electrocardiogram (ECG) monitoring, echocardiography, and noninvasive assessment of hemodynamic parameters using a SphygmoCor tonometer [9, 11]. Other measurements obtained included the levels of selected biochemical biomarkers.…”

Section: Methodsmentioning

confidence: 99%

“…A growing number of studies have demonstrated the association between parameters of arterial stiffness and stroke [8]. Endothelial dysfunction assessed by an increased level of asymmetric dimethylarginine (ADMA) may affect the inflammatory state in patients with ESUS [9]. It is very important to detect useful biomarkers of the risk of ESUS for appropriate intervention.…”

Section: Introductionmentioning

confidence: 99%

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Arterial Stiffness and Indices of Left Ventricular Diastolic Dysfunction in Patients with Embolic Stroke of Undetermined Etiology

et al. 2019

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Purpose. The study is aimed at identifying echocardiographic and circulating biomarkers as well as hemodynamic indices of embolic stroke of undetermined etiology (ESUS) in patients aged <65. Methods. We prospectively investigated 520 patients with confirmed ischemic stroke and selected those 65 patients who were diagnosed with ESUS (age 54 (47-58) years, 42% male). An additional 36 without stroke but with a similar risk profile were included as a control group (age 53 (47-58) years, 61% male). All patients underwent echocardiography, noninvasive assessment of hemodynamic parameters using a SphygmoCor tonometer (AtCor Med., Australia), and measurements of selected biomarkers. Results. ESUS patients and controls were well matched for baseline characteristics including blood pressure and left ventricular ejection fraction (LVEF). Compared to controls, patients with ESUS had lower mean early diastolic (E′) and systolic (S′) mitral annular velocities and a higher ratio of the peak velocity of early diastolic transmitral flow to the peak velocity of early diastolic mitral annular motion (all p<0.01). The peak velocity flow in the late diastole (A wave) value and LV mass indexed to the body surface area (LVMI) (g/m2) were higher in the ESUS group than in the control group (both p<0.01). The isovolumetric relaxation time (IVRT) was longer and the mean left atrial volume index (LAVI) was higher in ESUS patients compared to the control group. Parameters of arterial stiffness such as augmentation pressure, augmentation index, and augmentation index adjusted to a heart rate of 75 bpm (AIx75) were higher in ESUS patients compared to controls (p<0.05). Patients in the ESUS group had higher levels of asymmetric dimethylarginine, interleukin 6, and N-terminal probrain natriuretic peptide (NT-proBNP, all p<0.05) than those in the control group. In multivariate analysis, the following factors were significantly associated with the presence of ESUS: AIx75 (odds ratio (OR) 1.095, 95% confidence interval (CI) 1.004-1.194; p=0.04), IVRT (OR 1.045, 95% CI: 1.009-1.082; p=0.014), LAVI (OR 1.3, 95% CI: 1.099-1.537; p=0.002), and NT-proBNP (OR 1.003, 95% CI: 1.001-1.005; p=0.005). Conclusions. Increased arterial stiffness and indices of diastolic dysfunction as well as a higher NT-proBNP level are significantly associated with ESUS. These parameters require further scrutiny over time to understand their impact on the development of symptomatic heart failure. The ClinicalTrials.gov identifier is NCT03377465.

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Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Arterial Stiffness and Indices of Left Ventricular Diastolic Dysfunction in Patients with Embolic Stroke of Undetermined Etiology

et al. 2019

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“…It was also noted that the levels of D-dimer and pro-inflammatory cytokines such as interleukin (IL) -2, IL-6, IL-8, IL-10, and tumor necrosis factor-α were significantly higher in deceased cases (18). IL-6 probably causes the initiation and the development of inflammatory damage in the brain and microvascular endothelial cells in ischemic strokes, and the release of this cytokine also disrupts cerebrovascular autoregulation (19). It is well known that the immune system activation and related to inflammatory processes that develop at the post-infectious stage, play an important role in the development of both atherothrombotic and cardioembolic ischemic strokes.…”

Section: Sars-cov-2 Related Neurological Involvements Reported Up To mentioning

confidence: 99%

Coronavirus Disease 2019 (COVID-19) from the point of view of Neurologists: Consideration of Neurological Findings and Symptoms during the Combat against a Pandemic

Acarlı¹,

Samancı²,

Eki̇zoğlu³

et al. 2020

Archives of Neuropsychiatry

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Some respiratory viruses have long been known to cause neurological involvement. A novel coronavirus, leading to severe acute respiratory syndrome, also called coronavirus disease 19 (COVID-19), seems to be a new member of neuroinvasive viruses. While severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) keeps on spreading around the world rapidly, reports about the neurological manifestations associated with SARS-CoV-2, increases day by day. It is reported that a variety of symptoms and syndromes such as headache, dizziness, confusion, ataxia, epilepsy, ischemic stroke, neuropathic pain and myopathy are common especially in more severe COVID-19 patients. It is also suggested that the development of neurological complications is strongly associated with a poor outcome. On the other hand, hyposmia can be the unique symptom in COVID-19 carriers and this can serve as a marker for identifying the otherwise asymptomatically infected patients. It is thought that SARS-CoV-2 may cause neurological symptoms through direct or indirect mechanisms. Nevertheless, neuroinvasion capability of SARS-CoV2 is confirmed by the presence of the virus, in the cerebrospinal fluid of a COVID-19 patient with encephalitis, and this is proven by gene sequencing. In conclusion, during the COVID-19 pandemic, it is crucial to be aware of the possible neurological complications of the disease. Therefore, in this review, we aimed to report neurological manifestations associated with SARS-CoV-2 and possible underlying pathophysiological mechanisms. Due to the high homology of SARS-CoV-2 with other human coronaviruses such as SARS-CoV or Middle East Respiratory Syndrome (MERS)-CoV, reviewing the neurological involvement also associated with these coronaviruses will provide an idea about the longterm complications of COVID-19.

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“…A biomarker should be specific (reflect the extent of brain damage), sensitive (easily detected), and selective (reflect therapeutic efficacy) [ 56 , 57 ]. Stroke is associated with a variety of pathophysiological changes, which lead to the triggering of different biochemical processes and related biomarkers [ 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 , 67 , 68 , 69 , 70 ]. Over the past decades, B-type natriuretic peptide (BNP) and its derivative N-terminal pro-BNP (NT-proBNP) have been increasingly investigated and highlighted as significant cardiovascular biomarkers, especially for heart failure (HF) and recently also for stroke [ 71 , 72 ].…”

Section: Introductionmentioning

confidence: 99%

B-Type Natriuretic Peptide as a Significant Brain Biomarker for Stroke Triaging Using a Bedside Point-of-Care Monitoring Biosensor

et al. 2020

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Stroke is a widespread condition that causes 7 million deaths globally. Survivors suffer from a range of disabilities that affect their everyday life. It is a complex condition and there is a need to monitor the different signals that are associated with it. Stroke patients need to be rapidly diagnosed in the emergency department in order to allow the admission of the time-limited treatment of tissue plasminogen activator (tPA). Stroke diagnostics show the use of sophisticated technologies; however, they still contain limitations. The hidden information and technological advancements behind the utilization of biomarkers for stroke triaging are significant. Stroke biomarkers can revolutionize the way stroke patients are diagnosed, monitored, and how they recover. Different biomarkers indicate different cascades and exhibit unique expression patterns which are connected to certain pathologies in the human body. Over the past decades, B-type natriuretic peptide (BNP) and its derivative N-terminal fragment (NT-proBNP) have been increasingly investigated and highlighted as significant cardiovascular biomarkers. This work reviews the recent studies that have reported on the usefulness of BNP and NT-proBNP for stroke triaging. Their classification association is also presented, with increased mortality in stroke, correlation with cardioembolic stroke, and an indication of a second stroke recurrence. Moreover, recent scientific efforts conducted for the technological advancement of a bedside point-of-care (POC) device for BNP and NT-proBNP measurements are discussed. The conclusions presented in this review may hopefully assist in the major efforts that are currently being conducted in order to improve the care of stroke patients.

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The potential role of inflammation in cryptogenic stroke

Cited by 8 publications

References 31 publications

Arterial Stiffness and Indices of Left Ventricular Diastolic Dysfunction in Patients with Embolic Stroke of Undetermined Etiology

Arterial Stiffness and Indices of Left Ventricular Diastolic Dysfunction in Patients with Embolic Stroke of Undetermined Etiology

Coronavirus Disease 2019 (COVID-19) from the point of view of Neurologists: Consideration of Neurological Findings and Symptoms during the Combat against a Pandemic

B-Type Natriuretic Peptide as a Significant Brain Biomarker for Stroke Triaging Using a Bedside Point-of-Care Monitoring Biosensor

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