Pub Date : 2024-09-01Epub Date: 2024-02-23DOI: 10.1177/23969873241234238
Maria-Ioanna Stefanou, Aikaterini Theodorou, Konark Malhotra, Diana Aguiar de Sousa, Mira Katan, Lina Palaiodimou, Aristeidis H Katsanos, Ioanna Koutroulou, Vaia Lambadiari, Robin Lemmens, Sotirios Giannopoulos, Andrei V Alexandrov, Gerasimos Siasos, Georgios Tsivgoulis
Introduction: Mounting evidence suggests that glucagon-like-peptide-1 receptor-agonists (GLP-1 RAs) attenuate cardiovascular-risk in type-2 diabetes (T2DM). Tirzepatide is the first-in-class, dual glucose-dependent-insulinotropic-polypeptide GIP/GLP-1 RA approved for T2DM.
Patients and methods: A systematic review and meta-analysis of randomized-controlled clinical trials (RCTs) was performed to estimate: (i) the incidence of major adverse cardiovascular events (MACE); and (ii) incidence of stroke, fatal, and nonfatal stroke in T2DM-patients treated with GLP-1 or GIP/GLP-1 RAs (vs placebo).
Results: Thirteen RCTs (9 and 4 on GLP-1 RAs and tirzepatide, respectively) comprising 65,878 T2DM patients were included. Compared to placebo, GLP-1RAs or GIP/GLP-1 RAs reduced MACE (OR: 0.87; 95% CI: 0.81-0.94; p < 0.01; I2 = 37%), all-cause mortality (OR: 0.88; 95% CI: 0.82-0.96; p < 0.01; I2 = 21%) and cardiovascular-mortality (OR: 0.88; 95% CI: 0.80-0.96; p < 0.01; I2 = 14%), without differences between GLP-1 versus GIP/GLP-1 RAs. Additionally, GLP-1 RAs reduced the odds of stroke (OR: 0.84; 95% CI: 0.76-0.93; p < 0.01; I2 = 0%) and nonfatal stroke (OR: 0.85; 95% CI: 0.76-0.94; p < 0.01; I2 = 0%), whereas no association between fatal stroke and GLP-1RAs was uncovered (OR: 0.80; 95% CI: 0.61-1.05; p = 0.105; I2 = 0%). In secondary analyses, GLP-1 RAs prevented ischemic stroke (OR: 0.74; 95% CI: 0.61-0.91; p < 0.01; I2 = 0%) and MACE-recurrence, but not hemorrhagic stroke (OR: 0.92; 95% CI: 0.51-1.66; p = 0.792; I2 = 0%). There was no association between GLP-1RAs or GIP/GLP-1 RAs and fatal or nonfatal myocardial infarction.
Discussion and conclusion: GLP-1 and GIP/GLP-1 RAs reduce cardiovascular-risk and mortality in T2DM. While there is solid evidence that GLP-1 RAs significantly attenuate the risk of ischemic stroke in T2DM, dedicated RCTs are needed to evaluate the efficacy of novel GIP/GLP-1 RAs for primary and secondary stroke prevention.
{"title":"Risk of major adverse cardiovascular events and stroke associated with treatment with GLP-1 or the dual GIP/GLP-1 receptor agonist tirzepatide for type 2 diabetes: A systematic review and meta-analysis.","authors":"Maria-Ioanna Stefanou, Aikaterini Theodorou, Konark Malhotra, Diana Aguiar de Sousa, Mira Katan, Lina Palaiodimou, Aristeidis H Katsanos, Ioanna Koutroulou, Vaia Lambadiari, Robin Lemmens, Sotirios Giannopoulos, Andrei V Alexandrov, Gerasimos Siasos, Georgios Tsivgoulis","doi":"10.1177/23969873241234238","DOIUrl":"10.1177/23969873241234238","url":null,"abstract":"<p><strong>Introduction: </strong>Mounting evidence suggests that glucagon-like-peptide-1 receptor-agonists (GLP-1 RAs) attenuate cardiovascular-risk in type-2 diabetes (T2DM). Tirzepatide is the first-in-class, dual glucose-dependent-insulinotropic-polypeptide GIP/GLP-1 RA approved for T2DM.</p><p><strong>Patients and methods: </strong>A systematic review and meta-analysis of randomized-controlled clinical trials (RCTs) was performed to estimate: (i) the incidence of major adverse cardiovascular events (MACE); and (ii) incidence of stroke, fatal, and nonfatal stroke in T2DM-patients treated with GLP-1 or GIP/GLP-1 RAs (vs placebo).</p><p><strong>Results: </strong>Thirteen RCTs (9 and 4 on GLP-1 RAs and tirzepatide, respectively) comprising 65,878 T2DM patients were included. Compared to placebo, GLP-1RAs or GIP/GLP-1 RAs reduced MACE (OR: 0.87; 95% CI: 0.81-0.94; <i>p</i> < 0.01; <i>I</i><sup>2</sup> = 37%), all-cause mortality (OR: 0.88; 95% CI: 0.82-0.96; <i>p</i> < 0.01; <i>I</i><sup>2</sup> = 21%) and cardiovascular-mortality (OR: 0.88; 95% CI: 0.80-0.96; <i>p</i> < 0.01; <i>I</i><sup>2</sup> = 14%), without differences between GLP-1 versus GIP/GLP-1 RAs. Additionally, GLP-1 RAs reduced the odds of stroke (OR: 0.84; 95% CI: 0.76-0.93; <i>p</i> < 0.01; <i>I</i><sup>2</sup> = 0%) and nonfatal stroke (OR: 0.85; 95% CI: 0.76-0.94; <i>p</i> < 0.01; <i>I</i><sup>2</sup> = 0%), whereas no association between fatal stroke and GLP-1RAs was uncovered (OR: 0.80; 95% CI: 0.61-1.05; <i>p</i> = 0.105; <i>I</i><sup>2</sup> = 0%). In secondary analyses, GLP-1 RAs prevented ischemic stroke (OR: 0.74; 95% CI: 0.61-0.91; <i>p</i> < 0.01; <i>I</i><sup>2</sup> = 0%) and MACE-recurrence, but not hemorrhagic stroke (OR: 0.92; 95% CI: 0.51-1.66; <i>p</i> = 0.792; <i>I</i><sup>2</sup> = 0%). There was no association between GLP-1RAs or GIP/GLP-1 RAs and fatal or nonfatal myocardial infarction.</p><p><strong>Discussion and conclusion: </strong>GLP-1 and GIP/GLP-1 RAs reduce cardiovascular-risk and mortality in T2DM. While there is solid evidence that GLP-1 RAs significantly attenuate the risk of ischemic stroke in T2DM, dedicated RCTs are needed to evaluate the efficacy of novel GIP/GLP-1 RAs for primary and secondary stroke prevention.</p>","PeriodicalId":46821,"journal":{"name":"European Stroke Journal","volume":null,"pages":null},"PeriodicalIF":5.8,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11418422/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139940911","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-01Epub Date: 2024-02-24DOI: 10.1177/23969873241234436
Christoph Vollmuth, Cornelia Fiessler, Felipe A Montellano, Alexander M Kollikowski, Fabian Essig, Patrick Oeckl, Lorenzo Barba, Petra Steinacker, Cara Schulz, Kathrin Ungethüm, Judith Wolf, Mirko Pham, Michael K Schuhmann, Peter U Heuschmann, Karl Georg Haeusler, Guido Stoll, Markus Otto, Hermann Neugebauer
Introduction: Blood-based biomarkers may improve prediction of functional outcome in patients with acute ischemic stroke. The role of neurofilament light chain (NfL) and glial fibrillary acidic (GFAP) as potential biomarkers especially in severe stroke patients is unknown.
Patients and methods: Prospective, monocenter, cohort study including consecutive patients with severe ischemic stroke in the anterior circulation on admission (NIHSS score ⩾ 6 points or indication for mechanical thrombectomy). Outcome was assessed 3 months after the index stroke by the modified Rankin Scale (mRS). Serum biomarkers levels of NfL and GFAP were determined by ultrasensitive ELISA. Univariate and multivariate logistic regression models were performed to determine the association of biomarker levels and functional disability. Discrimination, calibration, and overall performance were analyzed in different models via AUROC, calibration plots (with Emax and Eavg), Brier-score and R2 using variables, identified as important covariates for functional outcome in previous studies.
Results: Between 06/2020 and 08/2021, 213 patients were included [47% female, mean age 76 (SD ± 12) years, median NIHSS score 13 (interquartile range, IQR 9; 17)]. Biomarker serum levels were measured at a median of 1 [IQR, 1; 2] day after admission. Compared to patients with mRS 0-2 at 3 months, patients with mRS 3-6 had higher serum levels of NfL (median: 136 pg/ml vs 41 pg/ml; p < 0.0001) and GFAP (700 ng/ml vs 9.6 ng/ml; p < 0.0001). Both biomarkers were significantly associated with functional outcome [adjusted logistic regression, odds ratio (95% CI) for NfL: 2.63 (1.62; 4.56), GFAP: 2.16 (1.58; 3.09)]. In all models the addition of serum NfL led to a significant improvement in the AUROC, as did the addition of serum GFAP. Calibration plots showed high agreement between the predicted and observed outcomes and after addition of the two blood-based biomarkers there was an improvement of the overall performance.
Conclusion: Prediction of functional outcome after severe acute ischemic stroke was improved by the blood-based biomarkers serum NfL and GFAP, measured in the acute phase of stroke. These findings have to be replicated in independent external cohorts.Study registration: DRKS00022064.
{"title":"Incremental value of serum neurofilament light chain and glial fibrillary acidic protein as blood-based biomarkers for predicting functional outcome in severe acute ischemic stroke.","authors":"Christoph Vollmuth, Cornelia Fiessler, Felipe A Montellano, Alexander M Kollikowski, Fabian Essig, Patrick Oeckl, Lorenzo Barba, Petra Steinacker, Cara Schulz, Kathrin Ungethüm, Judith Wolf, Mirko Pham, Michael K Schuhmann, Peter U Heuschmann, Karl Georg Haeusler, Guido Stoll, Markus Otto, Hermann Neugebauer","doi":"10.1177/23969873241234436","DOIUrl":"10.1177/23969873241234436","url":null,"abstract":"<p><strong>Introduction: </strong>Blood-based biomarkers may improve prediction of functional outcome in patients with acute ischemic stroke. The role of neurofilament light chain (NfL) and glial fibrillary acidic (GFAP) as potential biomarkers especially in severe stroke patients is unknown.</p><p><strong>Patients and methods: </strong>Prospective, monocenter, cohort study including consecutive patients with severe ischemic stroke in the anterior circulation on admission (NIHSS score ⩾ 6 points or indication for mechanical thrombectomy). Outcome was assessed 3 months after the index stroke by the modified Rankin Scale (mRS). Serum biomarkers levels of NfL and GFAP were determined by ultrasensitive ELISA. Univariate and multivariate logistic regression models were performed to determine the association of biomarker levels and functional disability. Discrimination, calibration, and overall performance were analyzed in different models via AUROC, calibration plots (with Emax and Eavg), Brier-score and R2 using variables, identified as important covariates for functional outcome in previous studies.</p><p><strong>Results: </strong>Between 06/2020 and 08/2021, 213 patients were included [47% female, mean age 76 (SD ± 12) years, median NIHSS score 13 (interquartile range, IQR 9; 17)]. Biomarker serum levels were measured at a median of 1 [IQR, 1; 2] day after admission. Compared to patients with mRS 0-2 at 3 months, patients with mRS 3-6 had higher serum levels of NfL (median: 136 pg/ml vs 41 pg/ml; <i>p</i> < 0.0001) and GFAP (700 ng/ml vs 9.6 ng/ml; <i>p</i> < 0.0001). Both biomarkers were significantly associated with functional outcome [adjusted logistic regression, odds ratio (95% CI) for NfL: 2.63 (1.62; 4.56), GFAP: 2.16 (1.58; 3.09)]. In all models the addition of serum NfL led to a significant improvement in the AUROC, as did the addition of serum GFAP. Calibration plots showed high agreement between the predicted and observed outcomes and after addition of the two blood-based biomarkers there was an improvement of the overall performance.</p><p><strong>Conclusion: </strong>Prediction of functional outcome after severe acute ischemic stroke was improved by the blood-based biomarkers serum NfL and GFAP, measured in the acute phase of stroke. These findings have to be replicated in independent external cohorts.Study registration: DRKS00022064.</p>","PeriodicalId":46821,"journal":{"name":"European Stroke Journal","volume":null,"pages":null},"PeriodicalIF":5.8,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11418447/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139944541","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-01Epub Date: 2024-03-11DOI: 10.1177/23969873241237312
Adel Alhazzani, Fahad S Al-Ajlan, Ahmed Alkhiri, Ahmed A Almaghrabi, Aser F Alamri, Basil A Alghamdi, Hassan K Salamatullah, Abdullah R Alharbi, Maher B Almutairi, Hui-Sheng Chen, Yongjun Wang, Mohamad Abdalkader, Guillaume Turc, Pooja Khatri, Thanh N Nguyen
Background: Minor ischemic stroke, defined as National Institute of Health Stroke Scale score of 0-5 on admission, represents half of all acute ischemic strokes. The role of intravenous alteplase (IVA) among patients with minor stroke is inconclusive; therefore, we evaluated clinical outcomes of these patients treated with or without IVA.
Materials and methods: We searched Medline, Embase, Scopus, and the Cochrane library until August 1, 2023. Inclusion was restricted to the English literature of studies that reported on minor nondisabling stroke patients treated with or without IVA. Odds ratios (ORs) with their corresponding 95% CIs were utilized using a random-effects model. Efficacy outcomes included rates of excellent (modified Rankin scale [mRS] of 0-1) and good (mRS of 0-2) functional outcome at 90 days. The main safety outcome was symptomatic intracerebral hemorrhage (sICH).
Results: Five eligible studies, two RCTs and three observational studies, comprising 2764 patients (31.8% female) met inclusion criteria. IVA was administered to 1559 (56.4%) patients. Pooled analysis of the two RCTs revealed no difference between the two groups in terms of 90-days excellent functional outcomes (OR 0.76 [95% CI, 0.51-1.13]; I2 = 0%) and sICH rates (OR 3.76 [95% CI, 0.61-23.20]). No significant differences were observed between the groups in terms of good functional outcomes, 90-day mortality, and 90-day stroke recurrence.
Conclusion: This meta-analysis of minor nondisabling stroke suggests that IVA did not prove more beneficial compared to no-IVA.
{"title":"Intravenous alteplase in minor nondisabling ischemic stroke: A systematic review and meta-analysis.","authors":"Adel Alhazzani, Fahad S Al-Ajlan, Ahmed Alkhiri, Ahmed A Almaghrabi, Aser F Alamri, Basil A Alghamdi, Hassan K Salamatullah, Abdullah R Alharbi, Maher B Almutairi, Hui-Sheng Chen, Yongjun Wang, Mohamad Abdalkader, Guillaume Turc, Pooja Khatri, Thanh N Nguyen","doi":"10.1177/23969873241237312","DOIUrl":"10.1177/23969873241237312","url":null,"abstract":"<p><strong>Background: </strong>Minor ischemic stroke, defined as National Institute of Health Stroke Scale score of 0-5 on admission, represents half of all acute ischemic strokes. The role of intravenous alteplase (IVA) among patients with minor stroke is inconclusive; therefore, we evaluated clinical outcomes of these patients treated with or without IVA.</p><p><strong>Materials and methods: </strong>We searched Medline, Embase, Scopus, and the Cochrane library until August 1, 2023. Inclusion was restricted to the English literature of studies that reported on minor nondisabling stroke patients treated with or without IVA. Odds ratios (ORs) with their corresponding 95% CIs were utilized using a random-effects model. Efficacy outcomes included rates of excellent (modified Rankin scale [mRS] of 0-1) and good (mRS of 0-2) functional outcome at 90 days. The main safety outcome was symptomatic intracerebral hemorrhage (sICH).</p><p><strong>Results: </strong>Five eligible studies, two RCTs and three observational studies, comprising 2764 patients (31.8% female) met inclusion criteria. IVA was administered to 1559 (56.4%) patients. Pooled analysis of the two RCTs revealed no difference between the two groups in terms of 90-days excellent functional outcomes (OR 0.76 [95% CI, 0.51-1.13]; <i>I</i><sup>2</sup> = 0%) and sICH rates (OR 3.76 [95% CI, 0.61-23.20]). No significant differences were observed between the groups in terms of good functional outcomes, 90-day mortality, and 90-day stroke recurrence.</p><p><strong>Conclusion: </strong>This meta-analysis of minor nondisabling stroke suggests that IVA did not prove more beneficial compared to no-IVA.</p>","PeriodicalId":46821,"journal":{"name":"European Stroke Journal","volume":null,"pages":null},"PeriodicalIF":5.8,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11418417/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140094803","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-01Epub Date: 2024-02-14DOI: 10.1177/23969873241232823
Andreas Ziebart, Judith Dremel, Svetlana Hetjens, Dennis J Nieuwkamp, Francisca Hh Linn, Nima Etminan, Gabriel Je Rinkel
Introduction: A previous systematic review of population-based studies from 1973 to 2002 found a decrease in case fatality for spontaneous subarachnoid haemorrhage, but could not find a sufficient number of studies to assess changes in functional outcome. Since then, treatment has advanced distinctly. We assessed whether case fatality has decreased further and whether functional outcome has improved.
Patients and methods: We searched PubMed and Web of Science for new population-based studies using the same criteria as in our previous systematic review. We assessed changes in case fatality and functional outcome over time using linear regression.
Results: We included 24 new studies with 827 patients and analysed 9542 patients described in 62 study periods between 1973 and 2017. Case fatality decreased by 0.3% (95% CI: -0.7 to 0.1) per year. In a sensitivity analysis excluding studies that did not provide 1-month outcome and outliers, the age and sex-adjusted decrease was 0.1% per year (95% CI: -0.9 to 0.6). The mean case fatality rate decreased from 47% (95% CI: 31-63) in the 1970s to 35% (95% CI: 30-39) in the 1990s, and remained stable in the 2000s (34%; 95% CI: 27-41) and 2010s (38%; 95% CI: 15-60). In 15 studies, the mean proportion of patients living independently increased by 0.2% per year (95%CI: -0.7 to 1.1) and the mean was 45% (95% CI: 39-50) in six studies that reported outcome after 12 months.
Discussion and conclusion: From 1973 to 2017, the case-fatality rate of spontaneous subarachnoid haemorrhage declined overall by 13.5%, but remained stable over the last two decades. The data on time trends in functional outcome were inconclusive.
{"title":"Case fatality and functional outcome after spontaneous subarachnoid haemorrhage: A systematic review and meta-analysis of time trends and regional variations in population-based studies.","authors":"Andreas Ziebart, Judith Dremel, Svetlana Hetjens, Dennis J Nieuwkamp, Francisca Hh Linn, Nima Etminan, Gabriel Je Rinkel","doi":"10.1177/23969873241232823","DOIUrl":"10.1177/23969873241232823","url":null,"abstract":"<p><strong>Introduction: </strong>A previous systematic review of population-based studies from 1973 to 2002 found a decrease in case fatality for spontaneous subarachnoid haemorrhage, but could not find a sufficient number of studies to assess changes in functional outcome. Since then, treatment has advanced distinctly. We assessed whether case fatality has decreased further and whether functional outcome has improved.</p><p><strong>Patients and methods: </strong>We searched PubMed and Web of Science for new population-based studies using the same criteria as in our previous systematic review. We assessed changes in case fatality and functional outcome over time using linear regression.</p><p><strong>Results: </strong>We included 24 new studies with 827 patients and analysed 9542 patients described in 62 study periods between 1973 and 2017. Case fatality decreased by 0.3% (95% CI: -0.7 to 0.1) per year. In a sensitivity analysis excluding studies that did not provide 1-month outcome and outliers, the age and sex-adjusted decrease was 0.1% per year (95% CI: -0.9 to 0.6). The mean case fatality rate decreased from 47% (95% CI: 31-63) in the 1970s to 35% (95% CI: 30-39) in the 1990s, and remained stable in the 2000s (34%; 95% CI: 27-41) and 2010s (38%; 95% CI: 15-60). In 15 studies, the mean proportion of patients living independently increased by 0.2% per year (95%CI: -0.7 to 1.1) and the mean was 45% (95% CI: 39-50) in six studies that reported outcome after 12 months.</p><p><strong>Discussion and conclusion: </strong>From 1973 to 2017, the case-fatality rate of spontaneous subarachnoid haemorrhage declined overall by 13.5%, but remained stable over the last two decades. The data on time trends in functional outcome were inconclusive.</p>","PeriodicalId":46821,"journal":{"name":"European Stroke Journal","volume":null,"pages":null},"PeriodicalIF":5.8,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11418425/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139730728","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-01Epub Date: 2024-02-25DOI: 10.1177/23969873241234844
Thomas Accettone, Thomas Personnic, Martin Bretzner, Helene Behal, Charlotte Cordonnier, Hilde Henon, Laurent Puy
Introduction: Even with reperfusion therapies, the prognosis of patients with basilar artery occlusion (BAO) related stroke remains poor. We aimed to test the hypothesis that the presence of prodromal symptoms, an easily available anamnestic data, is a key determinant of poor functional outcome.
Patients and methods: Data from patients with BAO treated in Lille, France, with mechanical thrombectomy (MT) between 2015 and 2021 were prospectively collected. The presence of prodromal symptoms was defined by previous transient neurological deficit or gradual progressive clinical worsening preceding a secondary sudden clinical worsening. We compared the characteristics of patients with and without prodromal symptoms. We built multivariate logistic regression models to study the association between the presence of prodromal symptoms and functional (mRS 0-3 and mortality), and procedural (successful recanalization and early reocclusion) outcomes.
Results: Among the 180 patients, 63 (35%) had prodromal symptoms, most frequently a vertigo. Large artery atherosclerosis was the predominant cause of stroke (41.3%). The presence of prodromal symptoms was an independent predictor of worse 90-day functional outcome (mRS 0-3: 25.4% vs 47.0%, odds ratio (OR) 0.39; 95% confidence interval (CI) 0.16-0.86) and 90-day mortality (OR 2.17; 95% CI 1.02-4.65). Despite similar successful recanalization rate, the proportion of early basilar artery reocclusion was higher in patients with prodromal symptoms (23.8% vs 5.6%, p = 0.002).
Discussion and conclusion: More than one third of BAO patients treated with MT had prodromal symptoms, especially patients with large-artery atherosclerosis. Clinicians should systematically screen for prodromal symptoms given the poor related functional outcome and increased risk of early basilar artery reocclusion.
导言:即使采用再灌注疗法,基底动脉闭塞(BAO)相关中风患者的预后仍然很差。我们的目的是验证一个假设,即前驱症状的存在是功能预后不良的一个关键决定因素:我们前瞻性地收集了2015年至2021年间在法国里尔接受机械血栓切除术(MT)治疗的BAO患者的数据。前驱症状的定义是在继发性临床症状突然恶化之前出现的一过性神经功能缺损或渐进性临床症状恶化。我们比较了有前驱症状和无前驱症状患者的特征。我们建立了多变量逻辑回归模型,研究前驱症状的存在与功能性(mRS 0-3 和死亡率)和程序性(成功再通畅和早期再闭塞)结果之间的关系:在180名患者中,63人(35%)有前驱症状,最常见的是眩晕。大动脉粥样硬化是导致中风的主要原因(41.3%)。前驱症状是90天功能预后较差(mRS 0-3:25.4% vs 47.0%,几率比(OR)0.39;95% 置信区间(CI)0.16-0.86)和90天死亡率(OR 2.17;95% CI 1.02-4.65)的独立预测因素。尽管再通成功率相似,但有前驱症状的患者早期基底动脉再闭塞的比例更高(23.8% vs 5.6%,P = 0.002):超过三分之一接受 MT 治疗的 BAO 患者有前驱症状,尤其是大动脉粥样硬化患者。考虑到相关功能预后较差以及基底动脉早期再闭塞的风险增加,临床医生应系统筛查前驱症状。
{"title":"Impact of prodromal symptoms on the prognosis of patients with basilar artery occlusion treated with mechanical thrombectomy.","authors":"Thomas Accettone, Thomas Personnic, Martin Bretzner, Helene Behal, Charlotte Cordonnier, Hilde Henon, Laurent Puy","doi":"10.1177/23969873241234844","DOIUrl":"10.1177/23969873241234844","url":null,"abstract":"<p><strong>Introduction: </strong>Even with reperfusion therapies, the prognosis of patients with basilar artery occlusion (BAO) related stroke remains poor. We aimed to test the hypothesis that the presence of prodromal symptoms, an easily available anamnestic data, is a key determinant of poor functional outcome.</p><p><strong>Patients and methods: </strong>Data from patients with BAO treated in Lille, France, with mechanical thrombectomy (MT) between 2015 and 2021 were prospectively collected. The presence of prodromal symptoms was defined by previous transient neurological deficit or gradual progressive clinical worsening preceding a secondary sudden clinical worsening. We compared the characteristics of patients with and without prodromal symptoms. We built multivariate logistic regression models to study the association between the presence of prodromal symptoms and functional (mRS 0-3 and mortality), and procedural (successful recanalization and early reocclusion) outcomes.</p><p><strong>Results: </strong>Among the 180 patients, 63 (35%) had prodromal symptoms, most frequently a vertigo. Large artery atherosclerosis was the predominant cause of stroke (41.3%). The presence of prodromal symptoms was an independent predictor of worse 90-day functional outcome (mRS 0-3: 25.4% vs 47.0%, odds ratio (OR) 0.39; 95% confidence interval (CI) 0.16-0.86) and 90-day mortality (OR 2.17; 95% CI 1.02-4.65). Despite similar successful recanalization rate, the proportion of early basilar artery reocclusion was higher in patients with prodromal symptoms (23.8% vs 5.6%, <i>p</i> = 0.002).</p><p><strong>Discussion and conclusion: </strong>More than one third of BAO patients treated with MT had prodromal symptoms, especially patients with large-artery atherosclerosis. Clinicians should systematically screen for prodromal symptoms given the poor related functional outcome and increased risk of early basilar artery reocclusion.</p>","PeriodicalId":46821,"journal":{"name":"European Stroke Journal","volume":null,"pages":null},"PeriodicalIF":5.8,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11418554/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139973879","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-01Epub Date: 2024-04-27DOI: 10.1177/23969873241249248
Vincent Thijs, Geoffrey C Cloud, Nigel Gilchrist, Brooke Parsons, Forum Tilvawala, Jan Ho, Lara Ruthnam, Vimal Stanislaus, Nikola Sprigg, Marion Walker, Philip M Bath, Leonid Churilov, Julie Bernhardt
Rationale: A large proportion of stroke survivors will have long-lasting, debilitating neurological impairments, yet few efficacious medical treatment options are available. Etanercept inhibits binding of tumor necrosis factor to its receptor and is used in the treatment of inflammatory conditions. Perispinal subcutaneous injection followed by a supine, head down position may bypass the blood brain barrier. In observational studies and one small randomized controlled trial the majority of patients showed improvement in multiple post stroke impairments.
Aim: Perispinal Etanercept to improve STroke Outcomes (PESTO) investigates whether perispinal subcutaneous injection of etanercept improves quality of life and is safe in patients with chronic, disabling, effects of stroke.
Methods and design: PESTO is a multicenter, international, randomized placebo-controlled trial. Adult participants with a history of stroke between 1 and 15 years before enrollment and a current modified Rankin scale between 2 and 5 who are otherwise eligible for etanercept are randomized 1:1 to single dose injection of etanercept or placebo.
Study outcomes: The primary efficacy outcome is quality of life as measured using the Short Form 36 Health Inventory at day 28 after first injection. Safety outcomes include serious adverse events.
Sample size target: A total of 168 participants assuming an improvement of the SF-36 in 11% of participants in the control arm and in 30% of participants in the intervention arm, 80% power and 5% alpha.
Discussion: PESTO aims to provide level 1 evidence on the safety and efficacy of perispinal etanercept in patients with long-term disabling effects of stroke.
{"title":"Perispinal Etanercept to improve STroke Outcomes (PESTO): Protocol for a multicenter, international, randomized placebo-controlled trial.","authors":"Vincent Thijs, Geoffrey C Cloud, Nigel Gilchrist, Brooke Parsons, Forum Tilvawala, Jan Ho, Lara Ruthnam, Vimal Stanislaus, Nikola Sprigg, Marion Walker, Philip M Bath, Leonid Churilov, Julie Bernhardt","doi":"10.1177/23969873241249248","DOIUrl":"10.1177/23969873241249248","url":null,"abstract":"<p><strong>Rationale: </strong>A large proportion of stroke survivors will have long-lasting, debilitating neurological impairments, yet few efficacious medical treatment options are available. Etanercept inhibits binding of tumor necrosis factor to its receptor and is used in the treatment of inflammatory conditions. Perispinal subcutaneous injection followed by a supine, head down position may bypass the blood brain barrier. In observational studies and one small randomized controlled trial the majority of patients showed improvement in multiple post stroke impairments.</p><p><strong>Aim: </strong>Perispinal Etanercept to improve STroke Outcomes (PESTO) investigates whether perispinal subcutaneous injection of etanercept improves quality of life and is safe in patients with chronic, disabling, effects of stroke.</p><p><strong>Methods and design: </strong>PESTO is a multicenter, international, randomized placebo-controlled trial. Adult participants with a history of stroke between 1 and 15 years before enrollment and a current modified Rankin scale between 2 and 5 who are otherwise eligible for etanercept are randomized 1:1 to single dose injection of etanercept or placebo.</p><p><strong>Study outcomes: </strong>The primary efficacy outcome is quality of life as measured using the Short Form 36 Health Inventory at day 28 after first injection. Safety outcomes include serious adverse events.</p><p><strong>Sample size target: </strong>A total of 168 participants assuming an improvement of the SF-36 in 11% of participants in the control arm and in 30% of participants in the intervention arm, 80% power and 5% alpha.</p><p><strong>Discussion: </strong>PESTO aims to provide level 1 evidence on the safety and efficacy of perispinal etanercept in patients with long-term disabling effects of stroke.</p>","PeriodicalId":46821,"journal":{"name":"European Stroke Journal","volume":null,"pages":null},"PeriodicalIF":5.8,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11418453/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140869235","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Introduction: Aneurysmal subarachnoid hemorrhage (aSAH) and intracerebral hemorrhage (ICH) are main forms of hemorrhagic stroke. Data regarding cerebral small vessel disease (SVD) burden and incidental small lesions on diffusion-weighted imaging (DWI) following aSAH are sparse.
Patients and methods: We retrospectively analyzed a prospective cohort of aSAH and ICH patients with brain MRI within 30 days after onset from March 2015 to January 2023. White matter hyperintensity (WMH), lacune, perivascular space, cerebral microbleed (CMB), total SVD score, and incidental DWI lesions were assessed and compared between aSAH and ICH. Clinical and radiological characteristics associated with small DWI lesions in aSAH were investigated.
Results: We included 180 patients with aSAH (median age [IQR] 53 [47-61] years) and 299 with ICH (63 [53-73] years). DWI lesions were more common in aSAH than ICH (47.8% vs 14.4%, p < 0.001). Higher total SVD score was associated with ICH versus aSAH irrespective of hematoma location, whereas DWI lesions and strictly lobar CMBs were correlated with aSAH. Multivariable analysis showed that shorter time from onset to MRI, anterior circulation aneurysm rupture, CMB ⩾ 5, and total SVD score were associated with DWI lesions in aSAH.
Discussion and conclusion: Incidental DWI lesions and strictly lobar CMBs were more frequent in aSAH versus ICH whereas ICH had higher SVD burden. Incidental DWI lesions in aSAH were associated with multiple clinical and imaging factors. Longitudinal studies to investigate the dynamic change and prognostic value of the covert hemorrhagic and ischemic lesions in aSAH seem justified.
导言:动脉瘤性蛛网膜下腔出血(aSAH)和脑内出血(ICH)是出血性卒中的主要形式。有关蛛网膜下腔出血后脑小血管疾病(SVD)负担和弥散加权成像(DWI)中偶然出现的小病灶的数据非常稀少:我们对2015年3月至2023年1月期间发病后30天内进行脑磁共振成像的前瞻性队列中的aSAH和ICH患者进行了回顾性分析。我们评估了白质高密度(WMH)、裂隙、血管周围间隙、脑微出血(CMB)、SVD 总分和附带 DWI 病变,并对 aSAH 和 ICH 进行了比较。结果:我们共纳入了180例ASAH患者:我们纳入了 180 名 aSAH 患者(中位年龄 [IQR] 53 [47-61] 岁)和 299 名 ICH 患者(63 [53-73] 岁)。与 ICH 相比,DWI 病变在 aSAH 中更为常见(47.8% 对 14.4%,P 讨论和结论:aSAH 与 ICH 相比,偶发 DWI 病变和严格意义上的叶状 CMB 更为常见,而 ICH 的 SVD 负荷更高。aSAH 中的偶发 DWI 病变与多种临床和影像学因素有关。似乎有必要进行纵向研究,以探讨隐匿性出血性和缺血性病变在 aSAH 中的动态变化和预后价值。
{"title":"Prevalence of small vessel disease and incidental DWI-positive lesions in patients with aneurysmal subarachnoid hemorrhage versus intracerebral hemorrhage.","authors":"Zi-Jie Wang, Xiao Hu, Yan-Fang Xie, Wen-Jun Yao, Lan Deng, Zuo-Qiao Li, Ming-Jun Pu, Xin-Ni Lv, Zi-Cheng Hu, Jiang-Tao Zhang, Qi Li","doi":"10.1177/23969873241232327","DOIUrl":"10.1177/23969873241232327","url":null,"abstract":"<p><strong>Introduction: </strong>Aneurysmal subarachnoid hemorrhage (aSAH) and intracerebral hemorrhage (ICH) are main forms of hemorrhagic stroke. Data regarding cerebral small vessel disease (SVD) burden and incidental small lesions on diffusion-weighted imaging (DWI) following aSAH are sparse.</p><p><strong>Patients and methods: </strong>We retrospectively analyzed a prospective cohort of aSAH and ICH patients with brain MRI within 30 days after onset from March 2015 to January 2023. White matter hyperintensity (WMH), lacune, perivascular space, cerebral microbleed (CMB), total SVD score, and incidental DWI lesions were assessed and compared between aSAH and ICH. Clinical and radiological characteristics associated with small DWI lesions in aSAH were investigated.</p><p><strong>Results: </strong>We included 180 patients with aSAH (median age [IQR] 53 [47-61] years) and 299 with ICH (63 [53-73] years). DWI lesions were more common in aSAH than ICH (47.8% vs 14.4%, <i>p</i> < 0.001). Higher total SVD score was associated with ICH versus aSAH irrespective of hematoma location, whereas DWI lesions and strictly lobar CMBs were correlated with aSAH. Multivariable analysis showed that shorter time from onset to MRI, anterior circulation aneurysm rupture, CMB ⩾ 5, and total SVD score were associated with DWI lesions in aSAH.</p><p><strong>Discussion and conclusion: </strong>Incidental DWI lesions and strictly lobar CMBs were more frequent in aSAH versus ICH whereas ICH had higher SVD burden. Incidental DWI lesions in aSAH were associated with multiple clinical and imaging factors. Longitudinal studies to investigate the dynamic change and prognostic value of the covert hemorrhagic and ischemic lesions in aSAH seem justified.</p>","PeriodicalId":46821,"journal":{"name":"European Stroke Journal","volume":null,"pages":null},"PeriodicalIF":5.8,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11418497/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139900632","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-01Epub Date: 2024-03-20DOI: 10.1177/23969873241239787
Bernhard P Berghout, Robin Yr Camarasa, Dianne Hk Van Dam-Nolen, Aad van der Lugt, Marleen de Bruijne, Peter J Koudstaal, M Kamran Ikram, Daniel Bos
Introduction: The diagnostic workup of stroke doesn't identify an underlying cause in two-fifths of ischemic strokes. Intracranial arteriosclerosis is acknowledged as a cause of stroke in Asian and Black populations, but is underappreciated as such in whites. We explored the burden of Intracranial Artery Calcification (IAC), a marker of intracranial arteriosclerosis, as a potential cause of stroke among white patients with recent ischemic stroke or TIA.
Patients and methods: Between December 2005 and October 2010, 943 patients (mean age 63.8 (SD ± 14.0) years, 47.9% female) were recruited, of whom 561 had ischemic stroke and 382 a TIA. CT-angiography was conducted according to stroke analysis protocols. The burden of IAC was quantified on these images, whereafter we assessed the presence of IAC per TOAST etiology underlying the stroke and assessed associations between IAC burden, symptom severity, and short-term functional outcome.
Results: IAC was present in 62.4% of patients. Furthermore, IAC was seen in 84.8% of atherosclerotic strokes, and also in the majority of strokes with an undetermined etiology (58.5%). Additionally, patients with larger IAC burden presented with heavier symptoms (adjusted OR 1.56 (95% CI [1.06-2.29]), but there was no difference in short-term functional outcome (1.14 [0.80-1.61]).
Conclusion: IAC is seen in the majority of white ischemic stroke patients, aligning with findings from patient studies in other ethnicities. Furthermore, over half of patients with a stroke of undetermined etiology presented with IAC. Assessing IAC burden may help identify the cause in ischemic stroke of undetermined etiology, and could offer important prognostic information.
{"title":"Burden of intracranial artery calcification in white patients with ischemic stroke.","authors":"Bernhard P Berghout, Robin Yr Camarasa, Dianne Hk Van Dam-Nolen, Aad van der Lugt, Marleen de Bruijne, Peter J Koudstaal, M Kamran Ikram, Daniel Bos","doi":"10.1177/23969873241239787","DOIUrl":"10.1177/23969873241239787","url":null,"abstract":"<p><strong>Introduction: </strong>The diagnostic workup of stroke doesn't identify an underlying cause in two-fifths of ischemic strokes. Intracranial arteriosclerosis is acknowledged as a cause of stroke in Asian and Black populations, but is underappreciated as such in whites. We explored the burden of Intracranial Artery Calcification (IAC), a marker of intracranial arteriosclerosis, as a potential cause of stroke among white patients with recent ischemic stroke or TIA.</p><p><strong>Patients and methods: </strong>Between December 2005 and October 2010, 943 patients (mean age 63.8 (SD ± 14.0) years, 47.9% female) were recruited, of whom 561 had ischemic stroke and 382 a TIA. CT-angiography was conducted according to stroke analysis protocols. The burden of IAC was quantified on these images, whereafter we assessed the presence of IAC per TOAST etiology underlying the stroke and assessed associations between IAC burden, symptom severity, and short-term functional outcome.</p><p><strong>Results: </strong>IAC was present in 62.4% of patients. Furthermore, IAC was seen in 84.8% of atherosclerotic strokes, and also in the majority of strokes with an undetermined etiology (58.5%). Additionally, patients with larger IAC burden presented with heavier symptoms (adjusted OR 1.56 (95% CI [1.06-2.29]), but there was no difference in short-term functional outcome (1.14 [0.80-1.61]).</p><p><strong>Conclusion: </strong>IAC is seen in the majority of white ischemic stroke patients, aligning with findings from patient studies in other ethnicities. Furthermore, over half of patients with a stroke of undetermined etiology presented with IAC. Assessing IAC burden may help identify the cause in ischemic stroke of undetermined etiology, and could offer important prognostic information.</p>","PeriodicalId":46821,"journal":{"name":"European Stroke Journal","volume":null,"pages":null},"PeriodicalIF":5.8,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11418433/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140177156","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-30DOI: 10.1177/23969873241276357
Maurizio Acampa, Pietro Enea Lazzerini
{"title":"Searching for biomarkers of atrial cardiomyopathy at high risk of cardioembolism: What are the missing pieces of the puzzle?","authors":"Maurizio Acampa, Pietro Enea Lazzerini","doi":"10.1177/23969873241276357","DOIUrl":"https://doi.org/10.1177/23969873241276357","url":null,"abstract":"","PeriodicalId":46821,"journal":{"name":"European Stroke Journal","volume":null,"pages":null},"PeriodicalIF":5.8,"publicationDate":"2024-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142113256","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-30DOI: 10.1177/23969873241276358
Hooman Kamel, Mitchell Sv Elkind, Richard A Kronmal, W T Longstreth, Pamela Plummer, Rebeca Aragon Garcia, Joseph P Broderick, Qi Pauls, Jordan J Elm, Fadi Nahab, L Scott Janis, Marco R Di Tullio, Elsayed Z Soliman, Jeff S Healey, David L Tirschwell
Background: ARCADIA compared apixaban to aspirin for secondary stroke prevention in patients with cryptogenic stroke and atrial cardiopathy. One possible explanation for the neutral result is that biomarkers used did not optimally identify atrial cardiopathy. We examined the relationship between biomarker levels and subsequent detection of AF, the hallmark of atrial cardiopathy.
Methods: Patients were randomized if they met criteria for atrial cardiopathy, defined as P-wave terminal force >5000 μV*ms in ECG lead V1 (PTFV1), NT-proBNP >250 pg/mL, or left atrial diameter index (LADI) ⩾3 cm/m2. For this analysis, the outcome was AF detected per routine care.
Results: Of 3745 patients who consented to screening for atrial cardiopathy, 254 were subsequently diagnosed with AF; 96 before they could be randomized and 158 after randomization. In unadjusted analyses, ln(NT-proBNP) (RR per SD, 1.99; 95% CI, 1.85-2.13), PTFV1 (RR per SD, 1.15; 95% CI, 1.03-1.28) and LADI (RR per SD, 1.34; 95% CI, 1.20-1.50) were associated with AF. In a model containing all 3 biomarkers, demographics, and AF risk factors, age (RR per 10 years, 1.24; 95% CI, 1.09-1.41), ln(NT-proBNP) (RR per SD, 1.88; 95% CI, 1.67-2.11) and LADI (RR per SD, 1.25; 95% CI, 1.14-1.37) were associated with AF. These three variables together had a c-statistic of 0.82 (95% CI, 0.79-0.85) but only modest calibration. Discrimination was attenuated in sensitivity analyses of patients eligible for randomization who may have been more closely followed for AF.
Conclusions: Biomarkers used to identify atrial cardiopathy in ARCADIA were moderately predictive of subsequent AF.
背景ARCADIA 比较了阿哌沙班和阿司匹林对隐源性卒中和心房性心脏病患者进行卒中二级预防的效果。中性结果的一个可能原因是所使用的生物标志物不能最佳地识别心房性心脏病。我们研究了生物标志物水平与随后发现房颤(心房颤动的标志)之间的关系:如果患者符合心房性心脏病的标准,即心电图 V1 导联(PTFV1)P 波终末力>5000 μV*ms、NT-proBNP>250 pg/mL,或左心房直径指数(LADI)⩾3 cm/m2,则对其进行随机分组。本次分析的结果是在常规护理中发现房颤:在 3745 名同意接受心房病变筛查的患者中,有 254 人随后被确诊为房颤;其中 96 人在接受随机化之前,158 人在接受随机化之后。在未经调整的分析中,ln(NT-proBNP) (RR per SD, 1.99; 95% CI, 1.85-2.13)、PTFV1 (RR per SD, 1.15; 95% CI, 1.03-1.28)和 LADI (RR per SD, 1.34; 95% CI, 1.20-1.50)与房颤相关。在包含所有三种生物标志物、人口统计学特征和房颤风险因素的模型中,年龄(每 10 年的 RR 值为 1.24;95% CI 为 1.09-1.41)、ln(NT-proBNP)(每 SD 的 RR 值为 1.88;95% CI 为 1.67-2.11)和 LADI(每 SD 的 RR 值为 1.25;95% CI 为 1.14-1.37)与房颤相关。这三个变量加在一起的 c 统计量为 0.82(95% CI,0.79-0.85),但校准度不高。在对符合随机化条件的患者进行的敏感性分析中,对房颤进行更密切随访的识别率有所降低:结论:在 ARCADIA 中用于识别房颤的生物标志物对后续房颤有一定的预测作用。
{"title":"Atrial cardiopathy biomarkers and atrial fibrillation in the ARCADIA trial.","authors":"Hooman Kamel, Mitchell Sv Elkind, Richard A Kronmal, W T Longstreth, Pamela Plummer, Rebeca Aragon Garcia, Joseph P Broderick, Qi Pauls, Jordan J Elm, Fadi Nahab, L Scott Janis, Marco R Di Tullio, Elsayed Z Soliman, Jeff S Healey, David L Tirschwell","doi":"10.1177/23969873241276358","DOIUrl":"https://doi.org/10.1177/23969873241276358","url":null,"abstract":"<p><strong>Background: </strong>ARCADIA compared apixaban to aspirin for secondary stroke prevention in patients with cryptogenic stroke and atrial cardiopathy. One possible explanation for the neutral result is that biomarkers used did not optimally identify atrial cardiopathy. We examined the relationship between biomarker levels and subsequent detection of AF, the hallmark of atrial cardiopathy.</p><p><strong>Methods: </strong>Patients were randomized if they met criteria for atrial cardiopathy, defined as P-wave terminal force >5000 μV*ms in ECG lead V<sub>1</sub> (PTFV<sub>1</sub>), NT-proBNP >250 pg/mL, or left atrial diameter index (LADI) ⩾3 cm/m<sup>2</sup>. For this analysis, the outcome was AF detected per routine care.</p><p><strong>Results: </strong>Of 3745 patients who consented to screening for atrial cardiopathy, 254 were subsequently diagnosed with AF; 96 before they could be randomized and 158 after randomization. In unadjusted analyses, ln(NT-proBNP) (RR per SD, 1.99; 95% CI, 1.85-2.13), PTFV<sub>1</sub> (RR per SD, 1.15; 95% CI, 1.03-1.28) and LADI (RR per SD, 1.34; 95% CI, 1.20-1.50) were associated with AF. In a model containing all 3 biomarkers, demographics, and AF risk factors, age (RR per 10 years, 1.24; 95% CI, 1.09-1.41), ln(NT-proBNP) (RR per SD, 1.88; 95% CI, 1.67-2.11) and LADI (RR per SD, 1.25; 95% CI, 1.14-1.37) were associated with AF. These three variables together had a c-statistic of 0.82 (95% CI, 0.79-0.85) but only modest calibration. Discrimination was attenuated in sensitivity analyses of patients eligible for randomization who may have been more closely followed for AF.</p><p><strong>Conclusions: </strong>Biomarkers used to identify atrial cardiopathy in ARCADIA were moderately predictive of subsequent AF.</p>","PeriodicalId":46821,"journal":{"name":"European Stroke Journal","volume":null,"pages":null},"PeriodicalIF":5.8,"publicationDate":"2024-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142113253","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}