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Sol J, Colàs-Campàs L, Mauri-Capdevila G, Molina-Seguin J, Galo-Licona JD, Torres-Querol C, Aymerich N, Ois Á, Roquer J, Tur S, García-Carreira MDC, Martí-Fàbregas J, Cruz-Culebras A, Segura T, Pamplona R, Portero-Otín M, Arqué G, Jové M, Purroy F. Ischemia preconditioning induces an adaptive response that defines a circulating metabolomic signature in ischemic stroke patients. J Cereb Blood Flow Metab 2022; 42:2201-2215. [PMID: 35869638 PMCID: PMC9670009 DOI: 10.1177/0271678x221116288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Transient ischemic attacks (TIAs) before an acute ischemic stroke (AIS) could induce ischemic tolerance (IT) phenomena. with an endogenous neuroprotective role (Ischemic preconditioning. IPC). A consecutive prospective cohort of patients with AIS were recruited from 8 different hospitals. Participants were classified by those with non-previous recent TIA vs. previous TIA (within seven days. TIA ≤7d). A total of 541 AIS patients were recruited. 40 (7.4%). of them had previous TIA ≤7d. In line with IPC. patients with TIA ≤7d showed: 1) a significantly less severe stroke at admission by NIHSS score. 2) a better outcome at 7-90 days follow-up and reduced infarct volumes. 3) a specific upregulated metabolomics/lipidomic profile composed of diverse lipid categories. Effectively. IPC activates an additional adaptive response on increasing circulation levels of structural and bioactive lipids to facilitate functional recovery after AIS which may support biochemical machinery for neuronal survival. Furthermore. previous TIA before AIS seems to facilitate the production of anti-inflammatory mediators that contribute to a better immune response. Thus. the IT phenomena contributes to a better adaptation of further ischemia. Our study provides first-time evidence of a metabolomics/lipidomic signature related to the development of stroke tolerance in AIS patients induced by recent TIA.
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Affiliation(s)
- Joaquim Sol
- Experimental Medicine Department, Lleida University-Lleida Biomedical Research Institute (UdL-IRBLleida), Lleida, Spain.,Institut Català de la Salut (ICS), Atenció Primària, Lleida, Spain.,Research Support Unit Lleida, Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Lleida, Spain
| | - Laura Colàs-Campàs
- Clinical Neurosciences Group, Institut de Recerca Biomèdica de Lleida, UdL, Lleida, Spain
| | - Gerard Mauri-Capdevila
- Clinical Neurosciences Group, Institut de Recerca Biomèdica de Lleida, UdL, Lleida, Spain.,Stroke Unit, Department of Neurology, Hospital Universitari Arnau de Vilanova de Lleida, Lleida, Spain
| | - Jessica Molina-Seguin
- Clinical Neurosciences Group, Institut de Recerca Biomèdica de Lleida, UdL, Lleida, Spain
| | - José Daniel Galo-Licona
- Experimental Medicine Department, Lleida University-Lleida Biomedical Research Institute (UdL-IRBLleida), Lleida, Spain
| | - Coral Torres-Querol
- Clinical Neurosciences Group, Institut de Recerca Biomèdica de Lleida, UdL, Lleida, Spain
| | | | | | | | - Silvia Tur
- Son Espases Hospital, Palma de Mallorca, Spain
| | | | | | | | - Tomás Segura
- Complejo Hospitalario Universitario de Albacete, Albacete, Spain
| | - Reinald Pamplona
- Experimental Medicine Department, Lleida University-Lleida Biomedical Research Institute (UdL-IRBLleida), Lleida, Spain
| | - Manel Portero-Otín
- Experimental Medicine Department, Lleida University-Lleida Biomedical Research Institute (UdL-IRBLleida), Lleida, Spain
| | - Gloria Arqué
- Clinical Neurosciences Group, Institut de Recerca Biomèdica de Lleida, UdL, Lleida, Spain
| | - Mariona Jové
- Experimental Medicine Department, Lleida University-Lleida Biomedical Research Institute (UdL-IRBLleida), Lleida, Spain
| | - Francisco Purroy
- Clinical Neurosciences Group, Institut de Recerca Biomèdica de Lleida, UdL, Lleida, Spain.,Stroke Unit, Department of Neurology, Hospital Universitari Arnau de Vilanova de Lleida, Lleida, Spain
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2
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Purroy F, Vicente-Pascual M, Arque G, Begue R, Farre J, Gallego Y, Gil-Villar MP, Mauri G, Montalà N, Pereira C, Torres-Querol C, Vazquez-Justes D. Risk of New-Diagnosed Atrial Fibrillation After Transient Ischemic Attack. Front Neurol 2022; 13:905304. [PMID: 35911925 PMCID: PMC9331650 DOI: 10.3389/fneur.2022.905304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2022] [Accepted: 06/07/2022] [Indexed: 12/05/2022] Open
Abstract
Background Transient ischemic attack (TIA) provides a unique opportunity to optimize secondary preventive treatments to avoid subsequent ischemic stroke (SIS). Although atrial fibrillation (AF) is the leading cause of cardioembolism in IS and anticoagulation prevents stroke recurrence (SR), limited data exists about the risk of new-diagnosed AF (NDAF) after TIA and the consequences of the diagnostic delay. The aim of our study was to determine this risk in a cohort of TIA patients with long-term follow-up. Methods We carried out a prospective cohort study of 723 consecutive TIA patients from January 2006 to June 2010. Median follow-up was 6.5 (5.0–9.6) years. In a subgroup of 204 (28.2%) consecutive patients, a panel of biomarkers was assessed during the first 24 h of the onset of symptoms. Multivariate analyses were performed to find out the associated factors of NDAF. Kaplan-Meier analysis was also performed to analyzed risk of SIS. Results NDAF was indentified in 116 (16.0%) patients: 42 (36.2%) during admission, 18 (15.5%) within first year, 29 (25%) between one and five years and 27 (23.3%) beyond 5 years. NDAF was associated with sex (female) [hazard ratio (HR) 1.61 (95% CI, 1.07- 2.41)], age [[HR 1.05 (95% CI, 1.03–1.07)], previous ischemic heart disease (IHD) [HR 1.84, (95% CI 1.15–2.97)] and cortical DWI pattern [HR 2.81 (95% CI, 1.87–4.21)]. In the Kaplan-Meier analysis, NT-proBNP ≥ 218.2 pg/ml (log-rank test P < 0.001) was associated with significant risk of NDAF during the first 5 years of follow-up. Patients with NDAF after admission and before 5 years of follow-up had the highest risk of SIS (P = 0.002). Conclusion The risk of NDAF after TIA is clinically relevant. We identified clinical and neuroimaging factors of NDAF. In addition, NT-proBNP was related to NDAF. Our results can be used to evaluate the benefit of long-term cardiac monitoring in selected patients.
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Affiliation(s)
- Francisco Purroy
- Stroke Unit, Department of Neurology, Hospital Universitari Arnau de Vilanova de Lleida, Lleida, Spain
- Clinical Neurosciences Group, Institut de Recerca Biomèdica de Lleida (IRBLleida), Universitat de Lleida, Lleida, Spain
| | - Mikel Vicente-Pascual
- Stroke Unit, Department of Neurology, Hospital Universitari Arnau de Vilanova de Lleida, Lleida, Spain
- Clinical Neurosciences Group, Institut de Recerca Biomèdica de Lleida (IRBLleida), Universitat de Lleida, Lleida, Spain
| | - Gloria Arque
- Clinical Neurosciences Group, Institut de Recerca Biomèdica de Lleida (IRBLleida), Universitat de Lleida, Lleida, Spain
| | - Robert Begue
- Clinical Neurosciences Group, Institut de Recerca Biomèdica de Lleida (IRBLleida), Universitat de Lleida, Lleida, Spain
| | - Joan Farre
- Clinical Neurosciences Group, Institut de Recerca Biomèdica de Lleida (IRBLleida), Universitat de Lleida, Lleida, Spain
| | - Yhovany Gallego
- Stroke Unit, Department of Neurology, Hospital Universitari Arnau de Vilanova de Lleida, Lleida, Spain
| | - Maria Pilar Gil-Villar
- Stroke Unit, Department of Neurology, Hospital Universitari Arnau de Vilanova de Lleida, Lleida, Spain
- Clinical Neurosciences Group, Institut de Recerca Biomèdica de Lleida (IRBLleida), Universitat de Lleida, Lleida, Spain
| | - Gerard Mauri
- Stroke Unit, Department of Neurology, Hospital Universitari Arnau de Vilanova de Lleida, Lleida, Spain
- Clinical Neurosciences Group, Institut de Recerca Biomèdica de Lleida (IRBLleida), Universitat de Lleida, Lleida, Spain
| | - Nuria Montalà
- Clinical Neurosciences Group, Institut de Recerca Biomèdica de Lleida (IRBLleida), Universitat de Lleida, Lleida, Spain
- Hospital Universitari Santa Maria de Lleida, Lleida, Spain
| | - Cristina Pereira
- Clinical Neurosciences Group, Institut de Recerca Biomèdica de Lleida (IRBLleida), Universitat de Lleida, Lleida, Spain
| | - Coral Torres-Querol
- Clinical Neurosciences Group, Institut de Recerca Biomèdica de Lleida (IRBLleida), Universitat de Lleida, Lleida, Spain
| | - Daniel Vazquez-Justes
- Stroke Unit, Department of Neurology, Hospital Universitari Arnau de Vilanova de Lleida, Lleida, Spain
- Clinical Neurosciences Group, Institut de Recerca Biomèdica de Lleida (IRBLleida), Universitat de Lleida, Lleida, Spain
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3
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Rubiera M, Aires A, Antonenko K, Lémeret S, Nolte CH, Putaala J, Schnabel RB, Tuladhar AM, Werring DJ, Zeraatkar D, Paciaroni M. European Stroke Organisation (ESO) guideline on screening for subclinical atrial fibrillation after stroke or transient ischaemic attack of undetermined origin. Eur Stroke J 2022; 7:VI. [PMID: 36082257 PMCID: PMC9446336 DOI: 10.1177/23969873221099478] [Citation(s) in RCA: 36] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 04/20/2022] [Indexed: 11/16/2022] Open
Abstract
We aimed to provide practical recommendations for the screening of subclinical atrial fibrillation (AF) in patients with ischaemic stroke or transient ischaemic attack (TIA) of undetermined origin. These guidelines are based on the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) methodology. Five relevant Population, Intervention, Comparator, Outcome questions were defined by a multidisciplinary module working group (MWG). Longer duration of cardiac rhythm monitoring increases the detection of subclinical AF, but the optimal monitoring length is yet to be defined. We advise longer monitoring to increase the rate of anticoagulation, but whether longer monitoring improves clinical outcomes needs to be addressed. AF detection does not differ from in- or out-patient ECG-monitoring with similar monitoring duration, so we consider it reasonable to initiate in-hospital monitoring as soon as possible and continue with outpatient monitoring for more than 48h. Although insertable loop recorders (ILR) increase AF detection based on their longer monitoring duration, comparison with non-implantable ECG devices for similar monitoring time is lacking. We suggest the use of implantable devices, if feasible, for AF detection instead of non- implantable devices to increase the detection of subclinical AF. There is weak evidence of a useful role for blood, ECG, and brain imaging biomarkers for the identification of patients at high risk of AF. In patients with patent foramen ovale, we found insufficient evidence from RCT, but prolonged cardiac monitoring in patients >55 years is advisable for subclinical AF detection. To conclude, in adult patients with ischaemic stroke or TIA of undetermined origin, we recommend longer duration of cardiac rhythm monitoring of more than 48h and if feasible with IRL to increase the detection of subclinical AF.
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Affiliation(s)
- Marta Rubiera
- Stroke Unit, Neurology, Hospital Vall d'Hebron, Barcelona, Barcelona, Spain
| | - Ana Aires
- Department of Neurology, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Kateryna Antonenko
- Department of Neurology, Bogomolets National Medical University, Kyiv, Ukraine
| | | | - Christian H. Nolte
- Klinik und Hochschulambulanz für Neurologie and Center for Stroke Research Berlin, Charité-Universitätsmedizin Berlin, Berlin, Germany; Freie Universität Berlin, Humboldt- Universität zu Berlin, Berlin Institute of Health, Berlin, Germany
| | - Jukka Putaala
- Neurology, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - Renate B. Schnabel
- Department of Cardiology University Heart and Vascular Center Hamburg, University Medical Center Hamburg Eppendorf Hamburg Germany
- German Center for Cardiovascular Research (DZHK) partner site Hamburg/Kiel/Lübeck Germany
| | - Anil M Tuladhar
- Department of Neurology, Donders Center for Medical Neurosciences, Radboud
University Medical Center, Nijmegen, The Netherlands
| | - David J. Werring
- Stroke Research Centre, Department of Brain Repair and Rehabilitation, UCL Queen Square Institute of Neurology and The National Hospital for Neurology and Neurosurgery, London, United Kingdom
| | - Dena Zeraatkar
- Biomedical Informatics, Harvard Medical School, Boston, Massachusetts, USA
- Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Maurizio Paciaroni
- Stroke Unit, Santa Maria della Misericordia Hospital, University of Perugia, Perugia, Italy
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García-Carmona J, Conesa-García E, Vidal-Mena D, González-Morales M, Ramos-Arenas V, Sánchez-Vizcaíno-Buendía C, Soria-Torrecillas J, Pérez-Vicente J, García-de-Guadiana-Romualdo L. Increased plasma levels of N-terminal pro-B-type natriuretic peptide as biomarker for the diagnosis of cardioembolic ischaemic stroke. Neurologia 2022. [DOI: 10.1016/j.nrl.2021.09.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Purroy F, Farré‐Rodriguez J, Mauri‐Capdevila G, Vicente‐Pascual M, Farré J. Basal IL-6 and S100b levels are associated with infarct volume. Acta Neurol Scand 2021; 144:517-523. [PMID: 34137020 DOI: 10.1111/ane.13487] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Revised: 05/23/2021] [Accepted: 05/25/2021] [Indexed: 01/04/2023]
Abstract
OBJECTIVES The study of biomarkers related to the infarct volume of acute ischaemic stroke (AIS) is a valuable clinical strategy. We conducted a prospective study to evaluate the relationship between a wide panel of biomarkers involved in different biochemical pathways and lesion volume. MATERIALS & METHODS We studied 332 patients with AIS. Infarct volume was calculated from diffusion weighted imaging (DWI). Blood samples were drawn within 24 h of symptom onset to test a panel of biomarkers that included high-sensitivity C-reactive protein (hs-CRP), IL-6, neuron-specific enolase (NSE), N-terminal pro-B-type natriuretic peptide (NT-ProBNP), S100b, troponin and IL-10. RESULTS The median lesion volume was 2.5 cc (IQR: 0.6-15.3). Patients with previous atrial fibrillation, cardioembolic aetiology and total anterior circulation infarct TACI classification had higher lesion volumes than those without them. Patients with previous recent TIA had smaller ischaemic lesions than those without it. Age and NIHSS were significantly correlated with lesion volume. In a linear regression analysis adjusted by aetiology, S100b and IL-6 emerged as the only biomarkers independently associated with infarct volume. In contrast, previous recent TIA and small-vessel disease were inversely related to infarct volume. CONCLUSIONS The correlation between the two blood marker levels and ischaemic lesion volume would support the use of these biomarkers as a surrogate endpoint in AIS, especially in centres without DWI 24/7 but these could not substitute basic neuroimaging. Our findings should be further explored in larger, preferably multicentre studies.
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Affiliation(s)
- Francisco Purroy
- Clinical Neurosciences Group Institut de Recerca Biomèdica de Lleida (IRBLleida) Lleida Spain
- Stroke Unit Hospital universitari Arnau de Vilanova de Lleida Lleida Spain
- Medicine Department Universitat de Lleida Lleida Spain
| | | | - Gerard Mauri‐Capdevila
- Clinical Neurosciences Group Institut de Recerca Biomèdica de Lleida (IRBLleida) Lleida Spain
- Stroke Unit Hospital universitari Arnau de Vilanova de Lleida Lleida Spain
- Medicine Department Universitat de Lleida Lleida Spain
| | - Mikel Vicente‐Pascual
- Clinical Neurosciences Group Institut de Recerca Biomèdica de Lleida (IRBLleida) Lleida Spain
- Stroke Unit Hospital universitari Arnau de Vilanova de Lleida Lleida Spain
- Medicine Department Universitat de Lleida Lleida Spain
| | - Joan Farré
- Clinical Neurosciences Group Institut de Recerca Biomèdica de Lleida (IRBLleida) Lleida Spain
- Medicine Department Universitat de Lleida Lleida Spain
- Clinic analysis department Hospital universitari Arnau de Vilanova de Lleida Lleida Spain
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Cardiac Testing in Search for Occult Atrial Fibrillation after Ischemic Stroke. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2021. [DOI: 10.1007/s11936-021-00908-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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7
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Markus A, Valerie S, Mira K. Promising Biomarker Candidates for Cardioembolic Stroke Etiology. A Brief Narrative Review and Current Opinion. Front Neurol 2021; 12:624930. [PMID: 33716927 PMCID: PMC7947187 DOI: 10.3389/fneur.2021.624930] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Accepted: 01/11/2021] [Indexed: 01/09/2023] Open
Abstract
Determining the cause of stroke is considered one of the main objectives in evaluating a stroke patient in clinical practice. However, ischemic stroke is a heterogeneous disorder and numerous underlying disorders are implicated in its pathogenesis. Although progress has been made in identifying individual stroke etiology, in many cases underlying mechanisms still remain elusive. Since secondary prevention strategies are tailored toward individual stroke mechanisms, patients whose stroke etiology is unknown may not receive optimal preventive treatment. Cardioembolic stroke is commonly defined as cerebral vessel occlusion by distant embolization arising from thrombus formation in the heart. It accounts for the main proportion of ischemic strokes, and its share to stroke etiology is likely to rise even further in future decades. However, it can be challenging to distinguish cardioembolism from other possible etiologies. As personalized medicine advances, stroke researchers' focus is increasingly drawn to etiology-associated biomarkers. They can provide deeper insight regarding specific stroke mechanisms and can help to unravel previously undetected pathologies. Furthermore, etiology-associated biomarkers could play an important role in guiding future stroke prevention strategies. To achieve this, broad validation of promising candidate biomarkers as well as their implementation in well-designed randomized clinical trials is necessary. This review focuses on the most-promising candidates for diagnosis of cardioembolic stroke. It discusses existing evidence for possible clinical applications of these biomarkers, addresses current challenges, and outlines future perspectives.
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Affiliation(s)
- Arnold Markus
- Department of Neurology, University Hospital of Zurich, Zurich, Switzerland
| | - Schütz Valerie
- Department of Neurology, University Hospital of Zurich, Zurich, Switzerland
| | - Katan Mira
- Department of Neurology, University Hospital of Zurich, Zurich, Switzerland
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8
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Colàs-Campàs L, Farre J, Mauri-Capdevila G, Molina-Seguín J, Aymerich N, Ois Á, Roquer J, Tur S, García-Carreira MDC, Martí-Fàbregas J, Cruz-Culebras A, Segura T, Arque G, Purroy F. Inflammatory Response of Ischemic Tolerance in Circulating Plasma: Preconditioning-Induced by Transient Ischemic Attack (TIA) Phenomena in Acute Ischemia Patients (AIS). Front Neurol 2020; 11:552470. [PMID: 33192985 PMCID: PMC7658473 DOI: 10.3389/fneur.2020.552470] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Accepted: 09/30/2020] [Indexed: 11/15/2022] Open
Abstract
Introduction: Ischemic tolerance (IT) refers to a state where cells are resistant to the damaging effects caused by periods of ischemia. In a clinical scenario, the IT phenomenon would be activated by a recent transient ischemic attack (TIA) before an ischemic stroke (IS). The characterization of inflammatory protein expression patterns will contribute to improved understanding of IT. Methods: A total of 477 IS patients from nine hospitals, recruited between January 2011 and January 2016, were included in the current study and divided in three groups: 438 (91.9%) patients without previous TIA (group 1), 22 (4.6%) patients who suffered TIA 24 h before IS (group 2), and 17 (3.5%) patients who suffered TIA between 24 h and 7 days prior to IS (group 3). An inflammatory biomarker panel (IL-6, NT-proBNP, hsCRP, hs-Troponin, NSE, and S-100b) on plasma and a cytokine antibody array was performed to achieve the preconditioning signature potentially induced by TIA phenomena. Primary outcome was modified rankin scale (mRs) score at 90 days. Results: Recent previous TIA was associated with better clinical outcome at 90 days (median mRS of group 1: 2.0 [1.0–4.0]; group 2: 2.0 [0.0–3.0]; group 3: 1.0 [0–2.5]; p = 0.086) and smaller brain lesion (group 1: 3.7 [0.7–18.3]; group 2: 0.8 [0.3–8.9]; group 3: 0.6 [0.1–5.5] mL; p = 0.006). All inflammation biomarkers were down regulated in the groups of recent TIA prior to IS compared to those who did not suffer a TIA events. Moreover, a cytokine antibody array revealed 30 differentially expressed proteins between the three groups. Among them, HRG1-alpha (Fold change 74.4 between group 1 and 2; 74.2 between group 1 and 3) and MAC-1 (Fold change 0.05 between group 1 and 2; 0.06 between group 1 and 3) expression levels would better stratify patients with TIA 7 days before IS. These two proteins showed an earlier inflammation profile that was not detectable by the biomarker panel. Conclusion: Inflammatory pathways were activated by transient ischemic attack, however the period of time between this event and a further ischemic stroke could be determined by a protein signature that would contribute to define the role of ischemic tolerance induced by TIA.
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Affiliation(s)
- Laura Colàs-Campàs
- Clinical Neurosciences Group, Institut de Recerca Biomèdica de Lleida, Lleida, Spain
| | - Joan Farre
- Clinical Neurosciences Group, Institut de Recerca Biomèdica de Lleida, Lleida, Spain.,Medical Laboratory, Hospital Universitari Arnau de Vilanova, Lleida, Spain
| | - Gerard Mauri-Capdevila
- Clinical Neurosciences Group, Institut de Recerca Biomèdica de Lleida, Lleida, Spain.,Stroke Unit, Department of Neurology, Hospital Universitari Arnau de Vilanova, Lleida, Spain
| | - Jessica Molina-Seguín
- Clinical Neurosciences Group, Institut de Recerca Biomèdica de Lleida, Lleida, Spain
| | | | | | | | - Silvia Tur
- Hospital Son Espases, Palma de Mallorca, Spain
| | | | | | | | - Tomás Segura
- Complejo Hospitalario Universitario de Albacete, Albacete, Spain
| | - Gloria Arque
- Clinical Neurosciences Group, Institut de Recerca Biomèdica de Lleida, Lleida, Spain
| | - Francisco Purroy
- Clinical Neurosciences Group, Institut de Recerca Biomèdica de Lleida, Lleida, Spain.,Stroke Unit, Department of Neurology, Hospital Universitari Arnau de Vilanova, Lleida, Spain
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9
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Piccardi B, Giralt D, Bustamante A, Llombart V, García-Berrocoso T, Inzitari D, Montaner J. Blood markers of inflammation and endothelial dysfunction in cardioembolic stroke: systematic review and meta-analysis. Biomarkers 2017; 22:200-209. [PMID: 28117601 DOI: 10.1080/1354750x.2017.1286689] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
CONTEXT Various processes including inflammation and endothelial dysfunction have been implicated in the pathogenesis of cardioembolic (CE) strokes. OBJECTIVE To review the evidence and investigate the association between immune-inflammatory biomarkers and CE strokes versus other stroke subtypes. METHODS We systematically reviewed the literature (sources: MEDLINE, web-based register http://stroke-biomarkers.com , reference lists) with quality assessment and meta-analysis of selected articles. RESULTS The most consistent association was found between C-reactive protein (CRP) and CE strokes when compared to other stroke subtypes (standardized mean difference 0.223 (0.116, 0.343); p < 0.001) Conclusions: Our findings confirm a possible association between selected inflammatory biomarkers and CE stroke.
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Affiliation(s)
- Benedetta Piccardi
- a Neuroscience Section, Department of Neurofarba , University of Florence , Florence , Italy
| | - Dolors Giralt
- b Neurovascular Research Laboratory , Vall d'Hebron University Hospital Research Institute (VHIR), Universitat Autònoma de Barcelona , Barcelona , Spain
| | - Alejandro Bustamante
- b Neurovascular Research Laboratory , Vall d'Hebron University Hospital Research Institute (VHIR), Universitat Autònoma de Barcelona , Barcelona , Spain
| | - Victor Llombart
- b Neurovascular Research Laboratory , Vall d'Hebron University Hospital Research Institute (VHIR), Universitat Autònoma de Barcelona , Barcelona , Spain
| | - Teresa García-Berrocoso
- b Neurovascular Research Laboratory , Vall d'Hebron University Hospital Research Institute (VHIR), Universitat Autònoma de Barcelona , Barcelona , Spain
| | - Domenico Inzitari
- a Neuroscience Section, Department of Neurofarba , University of Florence , Florence , Italy.,c Institute of Neuroscience, Italian National Research Council , Florence , Italy
| | - Joan Montaner
- b Neurovascular Research Laboratory , Vall d'Hebron University Hospital Research Institute (VHIR), Universitat Autònoma de Barcelona , Barcelona , Spain
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10
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Purroy F, Suárez-Luis I, Cambray S, Farré J, Benabdelhak I, Mauri-Capdevila G, Sanahuja J, Quílez A, Begué R, Gil MI, Molina-Seguin J, Torreguitart N. The determination of copeptin levels helps management decisions among transient ischaemic attack patients. Acta Neurol Scand 2016; 134:140-7. [PMID: 26471428 DOI: 10.1111/ane.12523] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/25/2015] [Indexed: 11/29/2022]
Abstract
BACKGROUND Most approaches to transient ischaemic attack (TIA) triage use clinical scores and vascular imaging; however, some biomarkers have been suggested to improve the prognosis of TIA patients. METHODS Serum levels of copeptin, adiponectin, neopterin, neuron-specific enolase, high-sensitivity C-reactive protein, IL-6, N-terminal pro-B-type natriuretic peptide, S100β, tumour necrosis factor-alpha and IL-1α as well as clinical characteristics were assessed on consecutive TIA patients during the first 24 h of the onset of symptoms. RESULTS Among 237 consecutive TIA patients, 12 patients (5%) had a stroke within 7 days and 15 (6%) within 90 days. Among all candidate biomarkers analysed, only copeptin was significantly increased in patients with stroke recurrence (SR) within 7 days (P = 0.026) but not within 90 days. A cut-off point of 13.8 pmol/l was established with a great predictive negative value (97.4%). Large artery atherosclerosis (LAA) [hazard ratio (HR) 12.7, 95% CI 3.2-50.1, P < 0.001] and copeptin levels ≥13.8 pmol/l (HR 3.9, 95% CI 1.01-14.4, P = 0.039) were independent predictors of SR at the 7-day follow-up. LAA was the only predictor of 90-day SR (HR 7.4, 95% CI 2.5-21.6, P < 0.001). ABCD3I was associated with 7- and 90-day SRs (P = 0.025 and P = 0.034, respectively). The association between copeptin levels and LAA had a diagnostic accuracy of 90.3%. CONCLUSIONS Serum copeptin could be an important prognostic biomarker to guide management decisions among TIA patients. Therefore, TIA patients with copeptin levels below 13.8 pmol/l and without LAA have an insignificant risk of 7-day SR and could be managed on an outpatient basis.
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Affiliation(s)
- F. Purroy
- Stroke Unit; Hospital Universitari Arnau de Vilanova; Grup Neurociències Clíniques IRBLleida; Lleida Spain
| | - I. Suárez-Luis
- Stroke Unit; Hospital Universitari Arnau de Vilanova; Grup Neurociències Clíniques IRBLleida; Lleida Spain
| | - S. Cambray
- Stroke Unit; Hospital Universitari Arnau de Vilanova; Grup Neurociències Clíniques IRBLleida; Lleida Spain
| | - J. Farré
- Stroke Unit; Hospital Universitari Arnau de Vilanova; Grup Neurociències Clíniques IRBLleida; Lleida Spain
| | - I. Benabdelhak
- Stroke Unit; Hospital Universitari Arnau de Vilanova; Grup Neurociències Clíniques IRBLleida; Lleida Spain
| | - G. Mauri-Capdevila
- Stroke Unit; Hospital Universitari Arnau de Vilanova; Grup Neurociències Clíniques IRBLleida; Lleida Spain
| | - J. Sanahuja
- Stroke Unit; Hospital Universitari Arnau de Vilanova; Grup Neurociències Clíniques IRBLleida; Lleida Spain
| | - A. Quílez
- Stroke Unit; Hospital Universitari Arnau de Vilanova; Grup Neurociències Clíniques IRBLleida; Lleida Spain
| | - R. Begué
- Stroke Unit; Hospital Universitari Arnau de Vilanova; Grup Neurociències Clíniques IRBLleida; Lleida Spain
| | - M. I. Gil
- Stroke Unit; Hospital Universitari Arnau de Vilanova; Grup Neurociències Clíniques IRBLleida; Lleida Spain
| | - J. Molina-Seguin
- Stroke Unit; Hospital Universitari Arnau de Vilanova; Grup Neurociències Clíniques IRBLleida; Lleida Spain
| | - N. Torreguitart
- Stroke Unit; Hospital Universitari Arnau de Vilanova; Grup Neurociències Clíniques IRBLleida; Lleida Spain
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11
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Affiliation(s)
- A H V Schapira
- Department of Clinical Neurosciences, UCL Institute of Neurology, London, UK.
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12
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Llombart V, Antolin-Fontes A, Bustamante A, Giralt D, Rost NS, Furie K, Shibazaki K, Biteker M, Castillo J, Rodríguez-Yáñez M, Fonseca AC, Watanabe T, Purroy F, Zhixin W, Etgen T, Hosomi N, Jafarian Kerman SR, Sharma JC, Knauer C, Santamarina E, Giannakoulas G, García-Berrocoso T, Montaner J. B-Type Natriuretic Peptides Help in Cardioembolic Stroke Diagnosis. Stroke 2015; 46:1187-95. [DOI: 10.1161/strokeaha.114.008311] [Citation(s) in RCA: 116] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2014] [Accepted: 02/20/2015] [Indexed: 11/16/2022]
Abstract
Background and Purpose—
Determining the underlying cause of stroke is important to optimize secondary prevention treatment. Increased blood levels of natriuretic peptides (B-type natriuretic peptide/N-terminal pro-BNP [BNP/NT-proBNP]) have been repeatedly associated with cardioembolic stroke. Here, we evaluate their clinical value as pathogenic biomarkers for stroke through a literature systematic review and individual participants’ data meta-analysis.
Methods—
We searched publications in PubMed database until November 2013 that compared BNP and NT-proBNP circulating levels among stroke causes. Standardized individual participants’ data were collected to estimate predictive values of BNP/NT-proBNP for cardioembolic stroke. Dichotomized BNP/NT-proBNP levels were included in logistic regression models together with clinical variables to assess the sensitivity and specificity to identify cardioembolic strokes and the additional value of biomarkers using area under the curve and integrated discrimination improvement index.
Results—
From 23 selected articles, we collected information of 2834 patients with a defined cause. BNP/NT-proBNP levels were significantly elevated in cardioembolic stroke until 72 hours from symptoms onset. Predictive models showed a sensitivity >90% and specificity >80% when BNP/NT-proBNP were added considering the lowest and the highest quartile, respectively. Both peptides also increased significantly the area under the curve and integrated discrimination improvement index compared with clinical models. Sensitivity, specificity, and precision of the models were validated in 197 patients with initially undetermined stroke with final pathogenic diagnosis after ancillary follow-up.
Conclusions—
Natriuretic peptides are strongly increased in cardioembolic strokes. Future multicentre prospective studies comparing BNP and NT-proBNP might aid in finding the optimal biomarker, the best time point, and the optimal cutoff points for cardioembolic stroke identification.
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Affiliation(s)
- Víctor Llombart
- From the Neurovascular Research Laboratory, Institut de Recerca Vall d’Hebron, Neurovascular Unit, Department of Neurology, Universitat Autònoma de Barcelona, Barcelona, Spain (V.L., A.A.-F., A.B., D.G., T.G.-B., J.M.); Acute Stroke Services, Massachusetts General Hospital, J. Philip Kistler Stroke Research Center, Boston (N.S.R.); Department of Neurology, Rhode Island Hospital, Alpert Medical School of Brown University, Providence (K.F.); Department of Stroke Medicine, Kawasaki Medical School,
| | - Albert Antolin-Fontes
- From the Neurovascular Research Laboratory, Institut de Recerca Vall d’Hebron, Neurovascular Unit, Department of Neurology, Universitat Autònoma de Barcelona, Barcelona, Spain (V.L., A.A.-F., A.B., D.G., T.G.-B., J.M.); Acute Stroke Services, Massachusetts General Hospital, J. Philip Kistler Stroke Research Center, Boston (N.S.R.); Department of Neurology, Rhode Island Hospital, Alpert Medical School of Brown University, Providence (K.F.); Department of Stroke Medicine, Kawasaki Medical School,
| | - Alejandro Bustamante
- From the Neurovascular Research Laboratory, Institut de Recerca Vall d’Hebron, Neurovascular Unit, Department of Neurology, Universitat Autònoma de Barcelona, Barcelona, Spain (V.L., A.A.-F., A.B., D.G., T.G.-B., J.M.); Acute Stroke Services, Massachusetts General Hospital, J. Philip Kistler Stroke Research Center, Boston (N.S.R.); Department of Neurology, Rhode Island Hospital, Alpert Medical School of Brown University, Providence (K.F.); Department of Stroke Medicine, Kawasaki Medical School,
| | - Dolors Giralt
- From the Neurovascular Research Laboratory, Institut de Recerca Vall d’Hebron, Neurovascular Unit, Department of Neurology, Universitat Autònoma de Barcelona, Barcelona, Spain (V.L., A.A.-F., A.B., D.G., T.G.-B., J.M.); Acute Stroke Services, Massachusetts General Hospital, J. Philip Kistler Stroke Research Center, Boston (N.S.R.); Department of Neurology, Rhode Island Hospital, Alpert Medical School of Brown University, Providence (K.F.); Department of Stroke Medicine, Kawasaki Medical School,
| | - Natalia S. Rost
- From the Neurovascular Research Laboratory, Institut de Recerca Vall d’Hebron, Neurovascular Unit, Department of Neurology, Universitat Autònoma de Barcelona, Barcelona, Spain (V.L., A.A.-F., A.B., D.G., T.G.-B., J.M.); Acute Stroke Services, Massachusetts General Hospital, J. Philip Kistler Stroke Research Center, Boston (N.S.R.); Department of Neurology, Rhode Island Hospital, Alpert Medical School of Brown University, Providence (K.F.); Department of Stroke Medicine, Kawasaki Medical School,
| | - Karen Furie
- From the Neurovascular Research Laboratory, Institut de Recerca Vall d’Hebron, Neurovascular Unit, Department of Neurology, Universitat Autònoma de Barcelona, Barcelona, Spain (V.L., A.A.-F., A.B., D.G., T.G.-B., J.M.); Acute Stroke Services, Massachusetts General Hospital, J. Philip Kistler Stroke Research Center, Boston (N.S.R.); Department of Neurology, Rhode Island Hospital, Alpert Medical School of Brown University, Providence (K.F.); Department of Stroke Medicine, Kawasaki Medical School,
| | - Kensaku Shibazaki
- From the Neurovascular Research Laboratory, Institut de Recerca Vall d’Hebron, Neurovascular Unit, Department of Neurology, Universitat Autònoma de Barcelona, Barcelona, Spain (V.L., A.A.-F., A.B., D.G., T.G.-B., J.M.); Acute Stroke Services, Massachusetts General Hospital, J. Philip Kistler Stroke Research Center, Boston (N.S.R.); Department of Neurology, Rhode Island Hospital, Alpert Medical School of Brown University, Providence (K.F.); Department of Stroke Medicine, Kawasaki Medical School,
| | - Murat Biteker
- From the Neurovascular Research Laboratory, Institut de Recerca Vall d’Hebron, Neurovascular Unit, Department of Neurology, Universitat Autònoma de Barcelona, Barcelona, Spain (V.L., A.A.-F., A.B., D.G., T.G.-B., J.M.); Acute Stroke Services, Massachusetts General Hospital, J. Philip Kistler Stroke Research Center, Boston (N.S.R.); Department of Neurology, Rhode Island Hospital, Alpert Medical School of Brown University, Providence (K.F.); Department of Stroke Medicine, Kawasaki Medical School,
| | - José Castillo
- From the Neurovascular Research Laboratory, Institut de Recerca Vall d’Hebron, Neurovascular Unit, Department of Neurology, Universitat Autònoma de Barcelona, Barcelona, Spain (V.L., A.A.-F., A.B., D.G., T.G.-B., J.M.); Acute Stroke Services, Massachusetts General Hospital, J. Philip Kistler Stroke Research Center, Boston (N.S.R.); Department of Neurology, Rhode Island Hospital, Alpert Medical School of Brown University, Providence (K.F.); Department of Stroke Medicine, Kawasaki Medical School,
| | - Manuel Rodríguez-Yáñez
- From the Neurovascular Research Laboratory, Institut de Recerca Vall d’Hebron, Neurovascular Unit, Department of Neurology, Universitat Autònoma de Barcelona, Barcelona, Spain (V.L., A.A.-F., A.B., D.G., T.G.-B., J.M.); Acute Stroke Services, Massachusetts General Hospital, J. Philip Kistler Stroke Research Center, Boston (N.S.R.); Department of Neurology, Rhode Island Hospital, Alpert Medical School of Brown University, Providence (K.F.); Department of Stroke Medicine, Kawasaki Medical School,
| | - Ana Catarina Fonseca
- From the Neurovascular Research Laboratory, Institut de Recerca Vall d’Hebron, Neurovascular Unit, Department of Neurology, Universitat Autònoma de Barcelona, Barcelona, Spain (V.L., A.A.-F., A.B., D.G., T.G.-B., J.M.); Acute Stroke Services, Massachusetts General Hospital, J. Philip Kistler Stroke Research Center, Boston (N.S.R.); Department of Neurology, Rhode Island Hospital, Alpert Medical School of Brown University, Providence (K.F.); Department of Stroke Medicine, Kawasaki Medical School,
| | - Tetsu Watanabe
- From the Neurovascular Research Laboratory, Institut de Recerca Vall d’Hebron, Neurovascular Unit, Department of Neurology, Universitat Autònoma de Barcelona, Barcelona, Spain (V.L., A.A.-F., A.B., D.G., T.G.-B., J.M.); Acute Stroke Services, Massachusetts General Hospital, J. Philip Kistler Stroke Research Center, Boston (N.S.R.); Department of Neurology, Rhode Island Hospital, Alpert Medical School of Brown University, Providence (K.F.); Department of Stroke Medicine, Kawasaki Medical School,
| | - Francisco Purroy
- From the Neurovascular Research Laboratory, Institut de Recerca Vall d’Hebron, Neurovascular Unit, Department of Neurology, Universitat Autònoma de Barcelona, Barcelona, Spain (V.L., A.A.-F., A.B., D.G., T.G.-B., J.M.); Acute Stroke Services, Massachusetts General Hospital, J. Philip Kistler Stroke Research Center, Boston (N.S.R.); Department of Neurology, Rhode Island Hospital, Alpert Medical School of Brown University, Providence (K.F.); Department of Stroke Medicine, Kawasaki Medical School,
| | - Wu Zhixin
- From the Neurovascular Research Laboratory, Institut de Recerca Vall d’Hebron, Neurovascular Unit, Department of Neurology, Universitat Autònoma de Barcelona, Barcelona, Spain (V.L., A.A.-F., A.B., D.G., T.G.-B., J.M.); Acute Stroke Services, Massachusetts General Hospital, J. Philip Kistler Stroke Research Center, Boston (N.S.R.); Department of Neurology, Rhode Island Hospital, Alpert Medical School of Brown University, Providence (K.F.); Department of Stroke Medicine, Kawasaki Medical School,
| | - Thorleif Etgen
- From the Neurovascular Research Laboratory, Institut de Recerca Vall d’Hebron, Neurovascular Unit, Department of Neurology, Universitat Autònoma de Barcelona, Barcelona, Spain (V.L., A.A.-F., A.B., D.G., T.G.-B., J.M.); Acute Stroke Services, Massachusetts General Hospital, J. Philip Kistler Stroke Research Center, Boston (N.S.R.); Department of Neurology, Rhode Island Hospital, Alpert Medical School of Brown University, Providence (K.F.); Department of Stroke Medicine, Kawasaki Medical School,
| | - Naohisa Hosomi
- From the Neurovascular Research Laboratory, Institut de Recerca Vall d’Hebron, Neurovascular Unit, Department of Neurology, Universitat Autònoma de Barcelona, Barcelona, Spain (V.L., A.A.-F., A.B., D.G., T.G.-B., J.M.); Acute Stroke Services, Massachusetts General Hospital, J. Philip Kistler Stroke Research Center, Boston (N.S.R.); Department of Neurology, Rhode Island Hospital, Alpert Medical School of Brown University, Providence (K.F.); Department of Stroke Medicine, Kawasaki Medical School,
| | - Scott Reza Jafarian Kerman
- From the Neurovascular Research Laboratory, Institut de Recerca Vall d’Hebron, Neurovascular Unit, Department of Neurology, Universitat Autònoma de Barcelona, Barcelona, Spain (V.L., A.A.-F., A.B., D.G., T.G.-B., J.M.); Acute Stroke Services, Massachusetts General Hospital, J. Philip Kistler Stroke Research Center, Boston (N.S.R.); Department of Neurology, Rhode Island Hospital, Alpert Medical School of Brown University, Providence (K.F.); Department of Stroke Medicine, Kawasaki Medical School,
| | - Jagdish C. Sharma
- From the Neurovascular Research Laboratory, Institut de Recerca Vall d’Hebron, Neurovascular Unit, Department of Neurology, Universitat Autònoma de Barcelona, Barcelona, Spain (V.L., A.A.-F., A.B., D.G., T.G.-B., J.M.); Acute Stroke Services, Massachusetts General Hospital, J. Philip Kistler Stroke Research Center, Boston (N.S.R.); Department of Neurology, Rhode Island Hospital, Alpert Medical School of Brown University, Providence (K.F.); Department of Stroke Medicine, Kawasaki Medical School,
| | - Carolin Knauer
- From the Neurovascular Research Laboratory, Institut de Recerca Vall d’Hebron, Neurovascular Unit, Department of Neurology, Universitat Autònoma de Barcelona, Barcelona, Spain (V.L., A.A.-F., A.B., D.G., T.G.-B., J.M.); Acute Stroke Services, Massachusetts General Hospital, J. Philip Kistler Stroke Research Center, Boston (N.S.R.); Department of Neurology, Rhode Island Hospital, Alpert Medical School of Brown University, Providence (K.F.); Department of Stroke Medicine, Kawasaki Medical School,
| | - Estevo Santamarina
- From the Neurovascular Research Laboratory, Institut de Recerca Vall d’Hebron, Neurovascular Unit, Department of Neurology, Universitat Autònoma de Barcelona, Barcelona, Spain (V.L., A.A.-F., A.B., D.G., T.G.-B., J.M.); Acute Stroke Services, Massachusetts General Hospital, J. Philip Kistler Stroke Research Center, Boston (N.S.R.); Department of Neurology, Rhode Island Hospital, Alpert Medical School of Brown University, Providence (K.F.); Department of Stroke Medicine, Kawasaki Medical School,
| | - George Giannakoulas
- From the Neurovascular Research Laboratory, Institut de Recerca Vall d’Hebron, Neurovascular Unit, Department of Neurology, Universitat Autònoma de Barcelona, Barcelona, Spain (V.L., A.A.-F., A.B., D.G., T.G.-B., J.M.); Acute Stroke Services, Massachusetts General Hospital, J. Philip Kistler Stroke Research Center, Boston (N.S.R.); Department of Neurology, Rhode Island Hospital, Alpert Medical School of Brown University, Providence (K.F.); Department of Stroke Medicine, Kawasaki Medical School,
| | - Teresa García-Berrocoso
- From the Neurovascular Research Laboratory, Institut de Recerca Vall d’Hebron, Neurovascular Unit, Department of Neurology, Universitat Autònoma de Barcelona, Barcelona, Spain (V.L., A.A.-F., A.B., D.G., T.G.-B., J.M.); Acute Stroke Services, Massachusetts General Hospital, J. Philip Kistler Stroke Research Center, Boston (N.S.R.); Department of Neurology, Rhode Island Hospital, Alpert Medical School of Brown University, Providence (K.F.); Department of Stroke Medicine, Kawasaki Medical School,
| | - Joan Montaner
- From the Neurovascular Research Laboratory, Institut de Recerca Vall d’Hebron, Neurovascular Unit, Department of Neurology, Universitat Autònoma de Barcelona, Barcelona, Spain (V.L., A.A.-F., A.B., D.G., T.G.-B., J.M.); Acute Stroke Services, Massachusetts General Hospital, J. Philip Kistler Stroke Research Center, Boston (N.S.R.); Department of Neurology, Rhode Island Hospital, Alpert Medical School of Brown University, Providence (K.F.); Department of Stroke Medicine, Kawasaki Medical School,
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13
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Jové M, Mauri-Capdevila G, Suárez I, Cambray S, Sanahuja J, Quílez A, Farré J, Benabdelhak I, Pamplona R, Portero-Otín M, Purroy F. Metabolomics predicts stroke recurrence after transient ischemic attack. Neurology 2014; 84:36-45. [PMID: 25471397 DOI: 10.1212/wnl.0000000000001093] [Citation(s) in RCA: 75] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVE To discover, by using metabolomics, novel candidate biomarkers for stroke recurrence (SR) with a higher prediction power than present ones. METHODS Metabolomic analysis was performed by liquid chromatography coupled to mass spectrometry in plasma samples from an initial cohort of 131 TIA patients recruited <24 hours after the onset of symptoms. Pattern analysis and metabolomic profiling, performed by multivariate statistics, disclosed specific SR and large-artery atherosclerosis (LAA) biomarkers. The use of these methods in an independent cohort (162 subjects) confirmed the results obtained in the first cohort. RESULTS Metabolomics analyses could predict SR using pattern recognition methods. Low concentrations of a specific lysophosphatidylcholine (LysoPC[16:0]) were significantly associated with SR. Moreover, LysoPC(20:4) also arose as a potential SR biomarker, increasing the prediction power of age, blood pressure, clinical features, duration of symptoms, and diabetes scale (ABCD2) and LAA. Individuals who present early (<3 months) recurrence have a specific metabolomic pattern, differing from non-SR and late SR subjects. Finally, a potential LAA biomarker, LysoPC(22:6), was also described. CONCLUSIONS The use of metabolomics in SR biomarker research improves the predictive power of conventional predictors such as ABCD2 and LAA. Moreover, pattern recognition methods allow us to discriminate not only SR patients but also early and late SR cases.
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Affiliation(s)
- Mariona Jové
- From NUTREN-Nutrigenomics Center (M.J., M.P.-O.), Department of Experimental Medicine (R.P.), Parc Científic i Tecnològic Agroalimentari de Lleida-Universitat de Lleida-IRBLleida, Lleida; Stroke Unit (G.M.-C., I.S., S.C., J.S., A.Q., I.B., F.P.), Department of Neurology, Universitat de Lleida, Hospital Universitari Arnau de Vilanova de Lleida, IRBLleida; and Laboratori Clinic (J.F.), Universitari Arnau de Vilanova de Lleida, IRBLleida, Spain
| | - Gerard Mauri-Capdevila
- From NUTREN-Nutrigenomics Center (M.J., M.P.-O.), Department of Experimental Medicine (R.P.), Parc Científic i Tecnològic Agroalimentari de Lleida-Universitat de Lleida-IRBLleida, Lleida; Stroke Unit (G.M.-C., I.S., S.C., J.S., A.Q., I.B., F.P.), Department of Neurology, Universitat de Lleida, Hospital Universitari Arnau de Vilanova de Lleida, IRBLleida; and Laboratori Clinic (J.F.), Universitari Arnau de Vilanova de Lleida, IRBLleida, Spain
| | - Idalmis Suárez
- From NUTREN-Nutrigenomics Center (M.J., M.P.-O.), Department of Experimental Medicine (R.P.), Parc Científic i Tecnològic Agroalimentari de Lleida-Universitat de Lleida-IRBLleida, Lleida; Stroke Unit (G.M.-C., I.S., S.C., J.S., A.Q., I.B., F.P.), Department of Neurology, Universitat de Lleida, Hospital Universitari Arnau de Vilanova de Lleida, IRBLleida; and Laboratori Clinic (J.F.), Universitari Arnau de Vilanova de Lleida, IRBLleida, Spain
| | - Serafi Cambray
- From NUTREN-Nutrigenomics Center (M.J., M.P.-O.), Department of Experimental Medicine (R.P.), Parc Científic i Tecnològic Agroalimentari de Lleida-Universitat de Lleida-IRBLleida, Lleida; Stroke Unit (G.M.-C., I.S., S.C., J.S., A.Q., I.B., F.P.), Department of Neurology, Universitat de Lleida, Hospital Universitari Arnau de Vilanova de Lleida, IRBLleida; and Laboratori Clinic (J.F.), Universitari Arnau de Vilanova de Lleida, IRBLleida, Spain
| | - Jordi Sanahuja
- From NUTREN-Nutrigenomics Center (M.J., M.P.-O.), Department of Experimental Medicine (R.P.), Parc Científic i Tecnològic Agroalimentari de Lleida-Universitat de Lleida-IRBLleida, Lleida; Stroke Unit (G.M.-C., I.S., S.C., J.S., A.Q., I.B., F.P.), Department of Neurology, Universitat de Lleida, Hospital Universitari Arnau de Vilanova de Lleida, IRBLleida; and Laboratori Clinic (J.F.), Universitari Arnau de Vilanova de Lleida, IRBLleida, Spain
| | - Alejandro Quílez
- From NUTREN-Nutrigenomics Center (M.J., M.P.-O.), Department of Experimental Medicine (R.P.), Parc Científic i Tecnològic Agroalimentari de Lleida-Universitat de Lleida-IRBLleida, Lleida; Stroke Unit (G.M.-C., I.S., S.C., J.S., A.Q., I.B., F.P.), Department of Neurology, Universitat de Lleida, Hospital Universitari Arnau de Vilanova de Lleida, IRBLleida; and Laboratori Clinic (J.F.), Universitari Arnau de Vilanova de Lleida, IRBLleida, Spain
| | - Joan Farré
- From NUTREN-Nutrigenomics Center (M.J., M.P.-O.), Department of Experimental Medicine (R.P.), Parc Científic i Tecnològic Agroalimentari de Lleida-Universitat de Lleida-IRBLleida, Lleida; Stroke Unit (G.M.-C., I.S., S.C., J.S., A.Q., I.B., F.P.), Department of Neurology, Universitat de Lleida, Hospital Universitari Arnau de Vilanova de Lleida, IRBLleida; and Laboratori Clinic (J.F.), Universitari Arnau de Vilanova de Lleida, IRBLleida, Spain
| | - Ikram Benabdelhak
- From NUTREN-Nutrigenomics Center (M.J., M.P.-O.), Department of Experimental Medicine (R.P.), Parc Científic i Tecnològic Agroalimentari de Lleida-Universitat de Lleida-IRBLleida, Lleida; Stroke Unit (G.M.-C., I.S., S.C., J.S., A.Q., I.B., F.P.), Department of Neurology, Universitat de Lleida, Hospital Universitari Arnau de Vilanova de Lleida, IRBLleida; and Laboratori Clinic (J.F.), Universitari Arnau de Vilanova de Lleida, IRBLleida, Spain
| | - Reinald Pamplona
- From NUTREN-Nutrigenomics Center (M.J., M.P.-O.), Department of Experimental Medicine (R.P.), Parc Científic i Tecnològic Agroalimentari de Lleida-Universitat de Lleida-IRBLleida, Lleida; Stroke Unit (G.M.-C., I.S., S.C., J.S., A.Q., I.B., F.P.), Department of Neurology, Universitat de Lleida, Hospital Universitari Arnau de Vilanova de Lleida, IRBLleida; and Laboratori Clinic (J.F.), Universitari Arnau de Vilanova de Lleida, IRBLleida, Spain
| | - Manuel Portero-Otín
- From NUTREN-Nutrigenomics Center (M.J., M.P.-O.), Department of Experimental Medicine (R.P.), Parc Científic i Tecnològic Agroalimentari de Lleida-Universitat de Lleida-IRBLleida, Lleida; Stroke Unit (G.M.-C., I.S., S.C., J.S., A.Q., I.B., F.P.), Department of Neurology, Universitat de Lleida, Hospital Universitari Arnau de Vilanova de Lleida, IRBLleida; and Laboratori Clinic (J.F.), Universitari Arnau de Vilanova de Lleida, IRBLleida, Spain
| | - Francisco Purroy
- From NUTREN-Nutrigenomics Center (M.J., M.P.-O.), Department of Experimental Medicine (R.P.), Parc Científic i Tecnològic Agroalimentari de Lleida-Universitat de Lleida-IRBLleida, Lleida; Stroke Unit (G.M.-C., I.S., S.C., J.S., A.Q., I.B., F.P.), Department of Neurology, Universitat de Lleida, Hospital Universitari Arnau de Vilanova de Lleida, IRBLleida; and Laboratori Clinic (J.F.), Universitari Arnau de Vilanova de Lleida, IRBLleida, Spain.
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