1
|
Jiang R, Lu Z, Wang C, Tu W, Yao Q, Shen J, Zhu X, Wang Z, Chen Y, Yang Y, Kang K, Gong P. Astrocyte-derived Interleukin-31 causes poor prognosis in elderly patients with intracerebral hemorrhage. Brain Pathol 2024; 34:e13245. [PMID: 38354695 PMCID: PMC11328350 DOI: 10.1111/bpa.13245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Accepted: 01/19/2024] [Indexed: 02/16/2024] Open
Abstract
The incidence of intracerebral hemorrhage (ICH) is increasing every year, with very high rates of mortality and disability. The prognosis of elderly ICH patients is extremely unfavorable. Interleukin, as an important participant in building the inflammatory microenvironment of the central nervous system after ICH, has long been the focus of neuroimmunology research. However, there are no studies on the role IL31 play in the pathologic process of ICH. We collected para-lesion tissue for immunofluorescence and flow cytometry from the elderly and young ICH patients who underwent surgery. Here, we found that IL31 expression in the lesion of elderly ICH patients was significantly higher than that of young patients. The activation of astrocytes after ICH releases a large amount of IL31, which binds to microglia through IL31R, causing a large number of microglia to converge to the hematoma area, leading to the spread of neuroinflammation, apoptosis of neurons, and ultimately resulting in poorer recovery of nerve function. Interfering with IL31 expression suppresses neuroinflammation and promotes the recovery of neurological function. Our study demonstrated that elderly patients release more IL31 after ICH than young patients. IL31 promotes the progression of neuroinflammation, leading to neuronal apoptosis as well as neurological decline. Suppression of high IL31 concentrations in the brain after ICH may be a promising therapeutic strategy for ICH.
Collapse
Affiliation(s)
- Rui Jiang
- Department of Neurosurgery, Affiliated Hospital of Nantong University, Medical School of Nantong University, Nantong, China
- Neuro-Microscopy and Minimally Invasive Translational Medicine Innovation Center, Affiliated Hospital of Nantong University, Nantong, China
- Jiangsu Medical Innovation Center, Neurological Disease Diagnosis and Treatment Center, Affiliated Hospital of Nantong University, Nantong, China
| | - Zhichao Lu
- Department of Neurosurgery, Affiliated Hospital of Nantong University, Medical School of Nantong University, Nantong, China
- Research Center of Clinical Medicine, Affiliated Hospital of Nantong University, Nantong, China
| | - Chenxing Wang
- Department of Neurosurgery, Affiliated Hospital of Nantong University, Medical School of Nantong University, Nantong, China
- Research Center of Clinical Medicine, Affiliated Hospital of Nantong University, Nantong, China
| | - WenJun Tu
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Qi Yao
- Department of Neurosurgery, Affiliated Hospital of Nantong University, Medical School of Nantong University, Nantong, China
- Neuro-Microscopy and Minimally Invasive Translational Medicine Innovation Center, Affiliated Hospital of Nantong University, Nantong, China
- Jiangsu Medical Innovation Center, Neurological Disease Diagnosis and Treatment Center, Affiliated Hospital of Nantong University, Nantong, China
| | - Jiabing Shen
- Department of Neurology, Affiliated Hospital of Nantong University, Nantong, China
| | - Xingjia Zhu
- Department of Neurosurgery, Affiliated Hospital of Nantong University, Medical School of Nantong University, Nantong, China
- Research Center of Clinical Medicine, Affiliated Hospital of Nantong University, Nantong, China
| | - Ziheng Wang
- Department of Clinical Bio-bank, Affiliated Hospital of Nantong University, Nantong, China
- Centre for Precision Medicine Research and Training, Faculty of Health Sciences, University of Macau, Taipa, China
| | - Yixun Chen
- Research Center of Clinical Medicine, Affiliated Hospital of Nantong University, Nantong, China
| | - Yang Yang
- Department of Trauma Center, Affiliated Hospital of Nantong University, Medical school of Nantong University, Nantong, China
| | - Kaijiang Kang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Peipei Gong
- Department of Neurosurgery, Affiliated Hospital of Nantong University, Medical School of Nantong University, Nantong, China
- Neuro-Microscopy and Minimally Invasive Translational Medicine Innovation Center, Affiliated Hospital of Nantong University, Nantong, China
- Jiangsu Medical Innovation Center, Neurological Disease Diagnosis and Treatment Center, Affiliated Hospital of Nantong University, Nantong, China
| |
Collapse
|
2
|
Johansen MC, von Rennenberg R, Nolte CH, Jensen M, Bustamante A, Katan M. Role of Cardiac Biomarkers in Stroke and Cognitive Impairment. Stroke 2024; 55:2376-2384. [PMID: 39016019 PMCID: PMC11347090 DOI: 10.1161/strokeaha.123.044143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/18/2024]
Abstract
This topical review assesses the growing role of cardiac biomarkers beyond cardiovascular health and focuses on their importance in stroke and dementia. The first part describes blood-based cardiac biomarkers in patients with stroke and highlights applications in the setting of early diagnosis, poststroke complications, outcome prediction as well as secondary prevention. Among other applications, natriuretic peptides can be helpful in differentiating stroke subtypes. They are also currently being investigated to guide prolonged ECG monitoring and secondary prevention in patients with stroke. Elevated cardiac troponin after ischemic stroke can provide information about various poststroke complications recently termed the stroke-heart syndrome. The second part focuses on the role of cardiac biomarkers in vascular cognitive impairment and dementia, emphasizing their association with structural brain lesions. These lesions such as silent brain infarcts and white matter hyperintensities often co-occur with cardiac disease and may be important mediators between cardiovascular disease and subsequent cognitive decline. ECG and echocardiogram measurements, in addition to blood-based biomarkers, show consistent associations with vascular brain changes and incident dementia, suggesting a role in indicating risk for cognitive decline. Together, the current evidence suggests that cardiac blood-based, electrophysiological, and imaging biomarkers can be used to better understand the heart and brain connection in the setting of not only stroke but also dementia.
Collapse
Affiliation(s)
- Michelle C. Johansen
- Department of Neurology, Cerebrovascular Division, John Hopkins University School of Medicine, Baltimore, USA
| | - Regina von Rennenberg
- Department of Neurology with experimental Neurology and Center for Stroke Research Berlin (CSB), Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Christian H. Nolte
- Department of Neurology with experimental Neurology and Center for Stroke Research Berlin (CSB), Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Märit Jensen
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Alejandro Bustamante
- Stroke Unit, Department of Neurology, Hospital Universitari Germans Trias i Pujol, Germans Trias i Pujol Research Institute (IGTP) Barcelona, Spain
| | - Mira Katan
- Department of Neurology, Stroke Center, University and University Hospital of Basel, Basel, Switzerland
| |
Collapse
|
3
|
Kamel H, Elkind MS, Kronmal RA, Longstreth WT, Plummer P, Aragon Garcia R, Broderick JP, Pauls Q, Elm JJ, Nahab F, Janis LS, Di Tullio MR, Soliman EZ, Healey JS, Tirschwell DL. Atrial cardiopathy biomarkers and atrial fibrillation in the ARCADIA trial. Eur Stroke J 2024:23969873241276358. [PMID: 39212178 DOI: 10.1177/23969873241276358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/04/2024] Open
Abstract
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.
Collapse
Affiliation(s)
- Hooman Kamel
- Clinical and Translational Neuroscience Unit, Department of Neurology and Feil Family Brain and Mind Research Institute, Weill Cornell Medicine, New York, NY, USA
| | - Mitchell Sv Elkind
- Department of Neurology, Columbia University, New York, NY, USA
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Richard A Kronmal
- Departments of Biostatistics, University of Washington, Seattle, WA, USA
| | - W T Longstreth
- Neurology, University of Washington, Seattle, WA, USA
- Medicine, University of Washington, Seattle, WA, USA
- Epidemiology, University of Washington, Seattle, WA, USA
| | - Pamela Plummer
- Department of Neurology and Rehabilitation Medicine, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | | | - Joseph P Broderick
- Department of Neurology and Rehabilitation Medicine, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Qi Pauls
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Jordan J Elm
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Fadi Nahab
- Departments of Neurology and Pediatrics, Emory University, Atlanta, GA, USA
| | - L Scott Janis
- National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA
| | - Marco R Di Tullio
- Division of Cardiology, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Elsayed Z Soliman
- Epidemiological Cardiology Research Center, Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Jeff S Healey
- Population Health Research Institute, McMaster University, Hamilton, ON, Canada
| | | |
Collapse
|
4
|
Cameron AC, Arnold M, Katsas G, Yang J, Quinn TJ, Abdul-Rahim AH, Campbell R, Docherty K, De Marchis GM, Arnold M, Kahles T, Nedeltchev K, Cereda CW, Kägi G, Bustamante A, Montaner J, Ntaios G, Foerch C, Spanaus K, Eckardstein AV, Dawson J, Katan M. Natriuretic Peptides to Classify Risk of Atrial Fibrillation Detection After Stroke: Analysis of the BIOSIGNAL and PRECISE Cohort Studies. Neurology 2024; 103:e209625. [PMID: 38950311 PMCID: PMC11226326 DOI: 10.1212/wnl.0000000000209625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Accepted: 05/24/2024] [Indexed: 07/03/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Prolonged cardiac monitoring (PCM) increases atrial fibrillation (AF) detection after ischemic stroke, but access is limited, and it is burdensome for patients. Our objective was to assess whether midregional proatrial natriuretic peptide (MR-proANP) and N-terminal pro-B-type natriuretic peptide (NT-proBNP) could classify people who are unlikely to have AF after ischemic stroke and allow better targeting of PCM. METHODS We analyzed people from the Biomarker Signature of Stroke Aetiology (BIOSIGNAL) study with ischemic stroke, no known AF, and ≥3 days cardiac monitoring. External validation was performed in the Preventing Recurrent Cardioembolic Stroke: Right Approach, Right Patient (PRECISE) study of 28 days of cardiac monitoring in people with ischemic stroke or transient ischemic attack and no known AF. The main outcome is no AF detection. We assessed the discriminatory value of MR-proANP and NT-proBNP combined with clinical variables to identify people with no AF. A decision curve analysis was performed with combined data to determine the net reduction in people who would undergo PCM using the models based on a 15% threshold probability for AF detection. RESULTS We included 621 people from the BIOSIGNAL study. The clinical multivariable prediction model included age, NIH Stroke Scale score, lipid-lowering therapy, creatinine, and smoking status. The area under the receiver-operating characteristic curve (AUROC) for clinical variables was 0.68 (95% CI 0.62-0.74), which improved with the addition of log10MR-proANP (0.72, 0.66-0.78; p = 0.001) or log10NT-proBNP (0.71, 0.65-0.77; p = 0.009). Performance was similar for the models with log10MR-proANP vs log10NT-proBNP (p = 0.28). In 239 people from the PRECISE study, the AUROC for clinical variables was 0.68 (0.59-0.76), which improved with the addition of log10NT-proBNP (0.73, 0.65-0.82; p < 0.001) or log10MR-proANP (0.79, 0.72-0.86; p < 0.001). Performance was better for the model with log10MR-proANP vs log10NT-proBNP (p = 0.03). The models could reduce the number of people who would undergo PCM by 30% (clinical and log10MR-proANP), 27% (clinical and log10NT-proBNP), or 20% (clinical only). DISCUSSION MR-proANP and NT-proBNP help classify people who are unlikely to have AF after ischemic stroke. Measuring MR-proANP or NT-proBNP could reduce the number of people who need PCM by 30%, without reducing the amount of AF detected. TRIAL REGISTRATION INFORMATION NCT02274727; clinicaltrials.gov/study/NCT02274727.
Collapse
Affiliation(s)
- Alan C Cameron
- From the School of Cardiovascular and Metabolic Health (A.C.C., G. Katsas, J.Y., T.J.Q., R.C., K.D., J.D.), University of Glasgow, United Kingdom; Department of Neurology (Markus Arnold), University Hospital Zurich, Switzerland; Liverpool Centre for Cardiovascular Science (A.H.A.-R.), and Cardiovascular and Metabolic Medicine (A.H.A.-R.), Institute of Life Course and Medical Sciences, University of Liverpool, United Kingdom; Department of Neurology and Stroke Centre (G.M.D.M., M.K.), University Hospital Basel and University of Basel; Department of Neurology (Marcel Arnold), University Hospital Bern; Department of Neurology and Stroke Center (T.K., K.N.), Cantonal Hospital Aarau; Department of Neurology (C.W.C.), Neurocenter (EOC) of Southern Switzerland, Lugano; Department of Neurology (G. Kägi), Cantonal Hospital St. Gallen, Switzerland; Neurology Service (A.B.), Germans Trias i Pujol University Hospital, Barcelona; Neurovascular Research Group (J.M.), Biomedicine Institute of Seville, Spain; Department of Internal Medicine (G.N.), Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece; Department of Neurology (C.F.), Goethe University, Frankfurt am Main, Germany; and Institute of Clinical Chemistry (K.S., A.V.E.), University Hospital of Zurich, Switzerland
| | - Markus Arnold
- From the School of Cardiovascular and Metabolic Health (A.C.C., G. Katsas, J.Y., T.J.Q., R.C., K.D., J.D.), University of Glasgow, United Kingdom; Department of Neurology (Markus Arnold), University Hospital Zurich, Switzerland; Liverpool Centre for Cardiovascular Science (A.H.A.-R.), and Cardiovascular and Metabolic Medicine (A.H.A.-R.), Institute of Life Course and Medical Sciences, University of Liverpool, United Kingdom; Department of Neurology and Stroke Centre (G.M.D.M., M.K.), University Hospital Basel and University of Basel; Department of Neurology (Marcel Arnold), University Hospital Bern; Department of Neurology and Stroke Center (T.K., K.N.), Cantonal Hospital Aarau; Department of Neurology (C.W.C.), Neurocenter (EOC) of Southern Switzerland, Lugano; Department of Neurology (G. Kägi), Cantonal Hospital St. Gallen, Switzerland; Neurology Service (A.B.), Germans Trias i Pujol University Hospital, Barcelona; Neurovascular Research Group (J.M.), Biomedicine Institute of Seville, Spain; Department of Internal Medicine (G.N.), Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece; Department of Neurology (C.F.), Goethe University, Frankfurt am Main, Germany; and Institute of Clinical Chemistry (K.S., A.V.E.), University Hospital of Zurich, Switzerland
| | - Georgios Katsas
- From the School of Cardiovascular and Metabolic Health (A.C.C., G. Katsas, J.Y., T.J.Q., R.C., K.D., J.D.), University of Glasgow, United Kingdom; Department of Neurology (Markus Arnold), University Hospital Zurich, Switzerland; Liverpool Centre for Cardiovascular Science (A.H.A.-R.), and Cardiovascular and Metabolic Medicine (A.H.A.-R.), Institute of Life Course and Medical Sciences, University of Liverpool, United Kingdom; Department of Neurology and Stroke Centre (G.M.D.M., M.K.), University Hospital Basel and University of Basel; Department of Neurology (Marcel Arnold), University Hospital Bern; Department of Neurology and Stroke Center (T.K., K.N.), Cantonal Hospital Aarau; Department of Neurology (C.W.C.), Neurocenter (EOC) of Southern Switzerland, Lugano; Department of Neurology (G. Kägi), Cantonal Hospital St. Gallen, Switzerland; Neurology Service (A.B.), Germans Trias i Pujol University Hospital, Barcelona; Neurovascular Research Group (J.M.), Biomedicine Institute of Seville, Spain; Department of Internal Medicine (G.N.), Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece; Department of Neurology (C.F.), Goethe University, Frankfurt am Main, Germany; and Institute of Clinical Chemistry (K.S., A.V.E.), University Hospital of Zurich, Switzerland
| | - Jason Yang
- From the School of Cardiovascular and Metabolic Health (A.C.C., G. Katsas, J.Y., T.J.Q., R.C., K.D., J.D.), University of Glasgow, United Kingdom; Department of Neurology (Markus Arnold), University Hospital Zurich, Switzerland; Liverpool Centre for Cardiovascular Science (A.H.A.-R.), and Cardiovascular and Metabolic Medicine (A.H.A.-R.), Institute of Life Course and Medical Sciences, University of Liverpool, United Kingdom; Department of Neurology and Stroke Centre (G.M.D.M., M.K.), University Hospital Basel and University of Basel; Department of Neurology (Marcel Arnold), University Hospital Bern; Department of Neurology and Stroke Center (T.K., K.N.), Cantonal Hospital Aarau; Department of Neurology (C.W.C.), Neurocenter (EOC) of Southern Switzerland, Lugano; Department of Neurology (G. Kägi), Cantonal Hospital St. Gallen, Switzerland; Neurology Service (A.B.), Germans Trias i Pujol University Hospital, Barcelona; Neurovascular Research Group (J.M.), Biomedicine Institute of Seville, Spain; Department of Internal Medicine (G.N.), Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece; Department of Neurology (C.F.), Goethe University, Frankfurt am Main, Germany; and Institute of Clinical Chemistry (K.S., A.V.E.), University Hospital of Zurich, Switzerland
| | - Terence J Quinn
- From the School of Cardiovascular and Metabolic Health (A.C.C., G. Katsas, J.Y., T.J.Q., R.C., K.D., J.D.), University of Glasgow, United Kingdom; Department of Neurology (Markus Arnold), University Hospital Zurich, Switzerland; Liverpool Centre for Cardiovascular Science (A.H.A.-R.), and Cardiovascular and Metabolic Medicine (A.H.A.-R.), Institute of Life Course and Medical Sciences, University of Liverpool, United Kingdom; Department of Neurology and Stroke Centre (G.M.D.M., M.K.), University Hospital Basel and University of Basel; Department of Neurology (Marcel Arnold), University Hospital Bern; Department of Neurology and Stroke Center (T.K., K.N.), Cantonal Hospital Aarau; Department of Neurology (C.W.C.), Neurocenter (EOC) of Southern Switzerland, Lugano; Department of Neurology (G. Kägi), Cantonal Hospital St. Gallen, Switzerland; Neurology Service (A.B.), Germans Trias i Pujol University Hospital, Barcelona; Neurovascular Research Group (J.M.), Biomedicine Institute of Seville, Spain; Department of Internal Medicine (G.N.), Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece; Department of Neurology (C.F.), Goethe University, Frankfurt am Main, Germany; and Institute of Clinical Chemistry (K.S., A.V.E.), University Hospital of Zurich, Switzerland
| | - Azmil H Abdul-Rahim
- From the School of Cardiovascular and Metabolic Health (A.C.C., G. Katsas, J.Y., T.J.Q., R.C., K.D., J.D.), University of Glasgow, United Kingdom; Department of Neurology (Markus Arnold), University Hospital Zurich, Switzerland; Liverpool Centre for Cardiovascular Science (A.H.A.-R.), and Cardiovascular and Metabolic Medicine (A.H.A.-R.), Institute of Life Course and Medical Sciences, University of Liverpool, United Kingdom; Department of Neurology and Stroke Centre (G.M.D.M., M.K.), University Hospital Basel and University of Basel; Department of Neurology (Marcel Arnold), University Hospital Bern; Department of Neurology and Stroke Center (T.K., K.N.), Cantonal Hospital Aarau; Department of Neurology (C.W.C.), Neurocenter (EOC) of Southern Switzerland, Lugano; Department of Neurology (G. Kägi), Cantonal Hospital St. Gallen, Switzerland; Neurology Service (A.B.), Germans Trias i Pujol University Hospital, Barcelona; Neurovascular Research Group (J.M.), Biomedicine Institute of Seville, Spain; Department of Internal Medicine (G.N.), Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece; Department of Neurology (C.F.), Goethe University, Frankfurt am Main, Germany; and Institute of Clinical Chemistry (K.S., A.V.E.), University Hospital of Zurich, Switzerland
| | - Ross Campbell
- From the School of Cardiovascular and Metabolic Health (A.C.C., G. Katsas, J.Y., T.J.Q., R.C., K.D., J.D.), University of Glasgow, United Kingdom; Department of Neurology (Markus Arnold), University Hospital Zurich, Switzerland; Liverpool Centre for Cardiovascular Science (A.H.A.-R.), and Cardiovascular and Metabolic Medicine (A.H.A.-R.), Institute of Life Course and Medical Sciences, University of Liverpool, United Kingdom; Department of Neurology and Stroke Centre (G.M.D.M., M.K.), University Hospital Basel and University of Basel; Department of Neurology (Marcel Arnold), University Hospital Bern; Department of Neurology and Stroke Center (T.K., K.N.), Cantonal Hospital Aarau; Department of Neurology (C.W.C.), Neurocenter (EOC) of Southern Switzerland, Lugano; Department of Neurology (G. Kägi), Cantonal Hospital St. Gallen, Switzerland; Neurology Service (A.B.), Germans Trias i Pujol University Hospital, Barcelona; Neurovascular Research Group (J.M.), Biomedicine Institute of Seville, Spain; Department of Internal Medicine (G.N.), Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece; Department of Neurology (C.F.), Goethe University, Frankfurt am Main, Germany; and Institute of Clinical Chemistry (K.S., A.V.E.), University Hospital of Zurich, Switzerland
| | - Kieran Docherty
- From the School of Cardiovascular and Metabolic Health (A.C.C., G. Katsas, J.Y., T.J.Q., R.C., K.D., J.D.), University of Glasgow, United Kingdom; Department of Neurology (Markus Arnold), University Hospital Zurich, Switzerland; Liverpool Centre for Cardiovascular Science (A.H.A.-R.), and Cardiovascular and Metabolic Medicine (A.H.A.-R.), Institute of Life Course and Medical Sciences, University of Liverpool, United Kingdom; Department of Neurology and Stroke Centre (G.M.D.M., M.K.), University Hospital Basel and University of Basel; Department of Neurology (Marcel Arnold), University Hospital Bern; Department of Neurology and Stroke Center (T.K., K.N.), Cantonal Hospital Aarau; Department of Neurology (C.W.C.), Neurocenter (EOC) of Southern Switzerland, Lugano; Department of Neurology (G. Kägi), Cantonal Hospital St. Gallen, Switzerland; Neurology Service (A.B.), Germans Trias i Pujol University Hospital, Barcelona; Neurovascular Research Group (J.M.), Biomedicine Institute of Seville, Spain; Department of Internal Medicine (G.N.), Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece; Department of Neurology (C.F.), Goethe University, Frankfurt am Main, Germany; and Institute of Clinical Chemistry (K.S., A.V.E.), University Hospital of Zurich, Switzerland
| | - Gian Marco De Marchis
- From the School of Cardiovascular and Metabolic Health (A.C.C., G. Katsas, J.Y., T.J.Q., R.C., K.D., J.D.), University of Glasgow, United Kingdom; Department of Neurology (Markus Arnold), University Hospital Zurich, Switzerland; Liverpool Centre for Cardiovascular Science (A.H.A.-R.), and Cardiovascular and Metabolic Medicine (A.H.A.-R.), Institute of Life Course and Medical Sciences, University of Liverpool, United Kingdom; Department of Neurology and Stroke Centre (G.M.D.M., M.K.), University Hospital Basel and University of Basel; Department of Neurology (Marcel Arnold), University Hospital Bern; Department of Neurology and Stroke Center (T.K., K.N.), Cantonal Hospital Aarau; Department of Neurology (C.W.C.), Neurocenter (EOC) of Southern Switzerland, Lugano; Department of Neurology (G. Kägi), Cantonal Hospital St. Gallen, Switzerland; Neurology Service (A.B.), Germans Trias i Pujol University Hospital, Barcelona; Neurovascular Research Group (J.M.), Biomedicine Institute of Seville, Spain; Department of Internal Medicine (G.N.), Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece; Department of Neurology (C.F.), Goethe University, Frankfurt am Main, Germany; and Institute of Clinical Chemistry (K.S., A.V.E.), University Hospital of Zurich, Switzerland
| | - Marcel Arnold
- From the School of Cardiovascular and Metabolic Health (A.C.C., G. Katsas, J.Y., T.J.Q., R.C., K.D., J.D.), University of Glasgow, United Kingdom; Department of Neurology (Markus Arnold), University Hospital Zurich, Switzerland; Liverpool Centre for Cardiovascular Science (A.H.A.-R.), and Cardiovascular and Metabolic Medicine (A.H.A.-R.), Institute of Life Course and Medical Sciences, University of Liverpool, United Kingdom; Department of Neurology and Stroke Centre (G.M.D.M., M.K.), University Hospital Basel and University of Basel; Department of Neurology (Marcel Arnold), University Hospital Bern; Department of Neurology and Stroke Center (T.K., K.N.), Cantonal Hospital Aarau; Department of Neurology (C.W.C.), Neurocenter (EOC) of Southern Switzerland, Lugano; Department of Neurology (G. Kägi), Cantonal Hospital St. Gallen, Switzerland; Neurology Service (A.B.), Germans Trias i Pujol University Hospital, Barcelona; Neurovascular Research Group (J.M.), Biomedicine Institute of Seville, Spain; Department of Internal Medicine (G.N.), Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece; Department of Neurology (C.F.), Goethe University, Frankfurt am Main, Germany; and Institute of Clinical Chemistry (K.S., A.V.E.), University Hospital of Zurich, Switzerland
| | - Timo Kahles
- From the School of Cardiovascular and Metabolic Health (A.C.C., G. Katsas, J.Y., T.J.Q., R.C., K.D., J.D.), University of Glasgow, United Kingdom; Department of Neurology (Markus Arnold), University Hospital Zurich, Switzerland; Liverpool Centre for Cardiovascular Science (A.H.A.-R.), and Cardiovascular and Metabolic Medicine (A.H.A.-R.), Institute of Life Course and Medical Sciences, University of Liverpool, United Kingdom; Department of Neurology and Stroke Centre (G.M.D.M., M.K.), University Hospital Basel and University of Basel; Department of Neurology (Marcel Arnold), University Hospital Bern; Department of Neurology and Stroke Center (T.K., K.N.), Cantonal Hospital Aarau; Department of Neurology (C.W.C.), Neurocenter (EOC) of Southern Switzerland, Lugano; Department of Neurology (G. Kägi), Cantonal Hospital St. Gallen, Switzerland; Neurology Service (A.B.), Germans Trias i Pujol University Hospital, Barcelona; Neurovascular Research Group (J.M.), Biomedicine Institute of Seville, Spain; Department of Internal Medicine (G.N.), Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece; Department of Neurology (C.F.), Goethe University, Frankfurt am Main, Germany; and Institute of Clinical Chemistry (K.S., A.V.E.), University Hospital of Zurich, Switzerland
| | - Krassen Nedeltchev
- From the School of Cardiovascular and Metabolic Health (A.C.C., G. Katsas, J.Y., T.J.Q., R.C., K.D., J.D.), University of Glasgow, United Kingdom; Department of Neurology (Markus Arnold), University Hospital Zurich, Switzerland; Liverpool Centre for Cardiovascular Science (A.H.A.-R.), and Cardiovascular and Metabolic Medicine (A.H.A.-R.), Institute of Life Course and Medical Sciences, University of Liverpool, United Kingdom; Department of Neurology and Stroke Centre (G.M.D.M., M.K.), University Hospital Basel and University of Basel; Department of Neurology (Marcel Arnold), University Hospital Bern; Department of Neurology and Stroke Center (T.K., K.N.), Cantonal Hospital Aarau; Department of Neurology (C.W.C.), Neurocenter (EOC) of Southern Switzerland, Lugano; Department of Neurology (G. Kägi), Cantonal Hospital St. Gallen, Switzerland; Neurology Service (A.B.), Germans Trias i Pujol University Hospital, Barcelona; Neurovascular Research Group (J.M.), Biomedicine Institute of Seville, Spain; Department of Internal Medicine (G.N.), Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece; Department of Neurology (C.F.), Goethe University, Frankfurt am Main, Germany; and Institute of Clinical Chemistry (K.S., A.V.E.), University Hospital of Zurich, Switzerland
| | - Carlo W Cereda
- From the School of Cardiovascular and Metabolic Health (A.C.C., G. Katsas, J.Y., T.J.Q., R.C., K.D., J.D.), University of Glasgow, United Kingdom; Department of Neurology (Markus Arnold), University Hospital Zurich, Switzerland; Liverpool Centre for Cardiovascular Science (A.H.A.-R.), and Cardiovascular and Metabolic Medicine (A.H.A.-R.), Institute of Life Course and Medical Sciences, University of Liverpool, United Kingdom; Department of Neurology and Stroke Centre (G.M.D.M., M.K.), University Hospital Basel and University of Basel; Department of Neurology (Marcel Arnold), University Hospital Bern; Department of Neurology and Stroke Center (T.K., K.N.), Cantonal Hospital Aarau; Department of Neurology (C.W.C.), Neurocenter (EOC) of Southern Switzerland, Lugano; Department of Neurology (G. Kägi), Cantonal Hospital St. Gallen, Switzerland; Neurology Service (A.B.), Germans Trias i Pujol University Hospital, Barcelona; Neurovascular Research Group (J.M.), Biomedicine Institute of Seville, Spain; Department of Internal Medicine (G.N.), Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece; Department of Neurology (C.F.), Goethe University, Frankfurt am Main, Germany; and Institute of Clinical Chemistry (K.S., A.V.E.), University Hospital of Zurich, Switzerland
| | - Georg Kägi
- From the School of Cardiovascular and Metabolic Health (A.C.C., G. Katsas, J.Y., T.J.Q., R.C., K.D., J.D.), University of Glasgow, United Kingdom; Department of Neurology (Markus Arnold), University Hospital Zurich, Switzerland; Liverpool Centre for Cardiovascular Science (A.H.A.-R.), and Cardiovascular and Metabolic Medicine (A.H.A.-R.), Institute of Life Course and Medical Sciences, University of Liverpool, United Kingdom; Department of Neurology and Stroke Centre (G.M.D.M., M.K.), University Hospital Basel and University of Basel; Department of Neurology (Marcel Arnold), University Hospital Bern; Department of Neurology and Stroke Center (T.K., K.N.), Cantonal Hospital Aarau; Department of Neurology (C.W.C.), Neurocenter (EOC) of Southern Switzerland, Lugano; Department of Neurology (G. Kägi), Cantonal Hospital St. Gallen, Switzerland; Neurology Service (A.B.), Germans Trias i Pujol University Hospital, Barcelona; Neurovascular Research Group (J.M.), Biomedicine Institute of Seville, Spain; Department of Internal Medicine (G.N.), Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece; Department of Neurology (C.F.), Goethe University, Frankfurt am Main, Germany; and Institute of Clinical Chemistry (K.S., A.V.E.), University Hospital of Zurich, Switzerland
| | - Alejandro Bustamante
- From the School of Cardiovascular and Metabolic Health (A.C.C., G. Katsas, J.Y., T.J.Q., R.C., K.D., J.D.), University of Glasgow, United Kingdom; Department of Neurology (Markus Arnold), University Hospital Zurich, Switzerland; Liverpool Centre for Cardiovascular Science (A.H.A.-R.), and Cardiovascular and Metabolic Medicine (A.H.A.-R.), Institute of Life Course and Medical Sciences, University of Liverpool, United Kingdom; Department of Neurology and Stroke Centre (G.M.D.M., M.K.), University Hospital Basel and University of Basel; Department of Neurology (Marcel Arnold), University Hospital Bern; Department of Neurology and Stroke Center (T.K., K.N.), Cantonal Hospital Aarau; Department of Neurology (C.W.C.), Neurocenter (EOC) of Southern Switzerland, Lugano; Department of Neurology (G. Kägi), Cantonal Hospital St. Gallen, Switzerland; Neurology Service (A.B.), Germans Trias i Pujol University Hospital, Barcelona; Neurovascular Research Group (J.M.), Biomedicine Institute of Seville, Spain; Department of Internal Medicine (G.N.), Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece; Department of Neurology (C.F.), Goethe University, Frankfurt am Main, Germany; and Institute of Clinical Chemistry (K.S., A.V.E.), University Hospital of Zurich, Switzerland
| | - Joan Montaner
- From the School of Cardiovascular and Metabolic Health (A.C.C., G. Katsas, J.Y., T.J.Q., R.C., K.D., J.D.), University of Glasgow, United Kingdom; Department of Neurology (Markus Arnold), University Hospital Zurich, Switzerland; Liverpool Centre for Cardiovascular Science (A.H.A.-R.), and Cardiovascular and Metabolic Medicine (A.H.A.-R.), Institute of Life Course and Medical Sciences, University of Liverpool, United Kingdom; Department of Neurology and Stroke Centre (G.M.D.M., M.K.), University Hospital Basel and University of Basel; Department of Neurology (Marcel Arnold), University Hospital Bern; Department of Neurology and Stroke Center (T.K., K.N.), Cantonal Hospital Aarau; Department of Neurology (C.W.C.), Neurocenter (EOC) of Southern Switzerland, Lugano; Department of Neurology (G. Kägi), Cantonal Hospital St. Gallen, Switzerland; Neurology Service (A.B.), Germans Trias i Pujol University Hospital, Barcelona; Neurovascular Research Group (J.M.), Biomedicine Institute of Seville, Spain; Department of Internal Medicine (G.N.), Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece; Department of Neurology (C.F.), Goethe University, Frankfurt am Main, Germany; and Institute of Clinical Chemistry (K.S., A.V.E.), University Hospital of Zurich, Switzerland
| | - George Ntaios
- From the School of Cardiovascular and Metabolic Health (A.C.C., G. Katsas, J.Y., T.J.Q., R.C., K.D., J.D.), University of Glasgow, United Kingdom; Department of Neurology (Markus Arnold), University Hospital Zurich, Switzerland; Liverpool Centre for Cardiovascular Science (A.H.A.-R.), and Cardiovascular and Metabolic Medicine (A.H.A.-R.), Institute of Life Course and Medical Sciences, University of Liverpool, United Kingdom; Department of Neurology and Stroke Centre (G.M.D.M., M.K.), University Hospital Basel and University of Basel; Department of Neurology (Marcel Arnold), University Hospital Bern; Department of Neurology and Stroke Center (T.K., K.N.), Cantonal Hospital Aarau; Department of Neurology (C.W.C.), Neurocenter (EOC) of Southern Switzerland, Lugano; Department of Neurology (G. Kägi), Cantonal Hospital St. Gallen, Switzerland; Neurology Service (A.B.), Germans Trias i Pujol University Hospital, Barcelona; Neurovascular Research Group (J.M.), Biomedicine Institute of Seville, Spain; Department of Internal Medicine (G.N.), Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece; Department of Neurology (C.F.), Goethe University, Frankfurt am Main, Germany; and Institute of Clinical Chemistry (K.S., A.V.E.), University Hospital of Zurich, Switzerland
| | - Christian Foerch
- From the School of Cardiovascular and Metabolic Health (A.C.C., G. Katsas, J.Y., T.J.Q., R.C., K.D., J.D.), University of Glasgow, United Kingdom; Department of Neurology (Markus Arnold), University Hospital Zurich, Switzerland; Liverpool Centre for Cardiovascular Science (A.H.A.-R.), and Cardiovascular and Metabolic Medicine (A.H.A.-R.), Institute of Life Course and Medical Sciences, University of Liverpool, United Kingdom; Department of Neurology and Stroke Centre (G.M.D.M., M.K.), University Hospital Basel and University of Basel; Department of Neurology (Marcel Arnold), University Hospital Bern; Department of Neurology and Stroke Center (T.K., K.N.), Cantonal Hospital Aarau; Department of Neurology (C.W.C.), Neurocenter (EOC) of Southern Switzerland, Lugano; Department of Neurology (G. Kägi), Cantonal Hospital St. Gallen, Switzerland; Neurology Service (A.B.), Germans Trias i Pujol University Hospital, Barcelona; Neurovascular Research Group (J.M.), Biomedicine Institute of Seville, Spain; Department of Internal Medicine (G.N.), Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece; Department of Neurology (C.F.), Goethe University, Frankfurt am Main, Germany; and Institute of Clinical Chemistry (K.S., A.V.E.), University Hospital of Zurich, Switzerland
| | - Katharina Spanaus
- From the School of Cardiovascular and Metabolic Health (A.C.C., G. Katsas, J.Y., T.J.Q., R.C., K.D., J.D.), University of Glasgow, United Kingdom; Department of Neurology (Markus Arnold), University Hospital Zurich, Switzerland; Liverpool Centre for Cardiovascular Science (A.H.A.-R.), and Cardiovascular and Metabolic Medicine (A.H.A.-R.), Institute of Life Course and Medical Sciences, University of Liverpool, United Kingdom; Department of Neurology and Stroke Centre (G.M.D.M., M.K.), University Hospital Basel and University of Basel; Department of Neurology (Marcel Arnold), University Hospital Bern; Department of Neurology and Stroke Center (T.K., K.N.), Cantonal Hospital Aarau; Department of Neurology (C.W.C.), Neurocenter (EOC) of Southern Switzerland, Lugano; Department of Neurology (G. Kägi), Cantonal Hospital St. Gallen, Switzerland; Neurology Service (A.B.), Germans Trias i Pujol University Hospital, Barcelona; Neurovascular Research Group (J.M.), Biomedicine Institute of Seville, Spain; Department of Internal Medicine (G.N.), Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece; Department of Neurology (C.F.), Goethe University, Frankfurt am Main, Germany; and Institute of Clinical Chemistry (K.S., A.V.E.), University Hospital of Zurich, Switzerland
| | - Arnold Von Eckardstein
- From the School of Cardiovascular and Metabolic Health (A.C.C., G. Katsas, J.Y., T.J.Q., R.C., K.D., J.D.), University of Glasgow, United Kingdom; Department of Neurology (Markus Arnold), University Hospital Zurich, Switzerland; Liverpool Centre for Cardiovascular Science (A.H.A.-R.), and Cardiovascular and Metabolic Medicine (A.H.A.-R.), Institute of Life Course and Medical Sciences, University of Liverpool, United Kingdom; Department of Neurology and Stroke Centre (G.M.D.M., M.K.), University Hospital Basel and University of Basel; Department of Neurology (Marcel Arnold), University Hospital Bern; Department of Neurology and Stroke Center (T.K., K.N.), Cantonal Hospital Aarau; Department of Neurology (C.W.C.), Neurocenter (EOC) of Southern Switzerland, Lugano; Department of Neurology (G. Kägi), Cantonal Hospital St. Gallen, Switzerland; Neurology Service (A.B.), Germans Trias i Pujol University Hospital, Barcelona; Neurovascular Research Group (J.M.), Biomedicine Institute of Seville, Spain; Department of Internal Medicine (G.N.), Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece; Department of Neurology (C.F.), Goethe University, Frankfurt am Main, Germany; and Institute of Clinical Chemistry (K.S., A.V.E.), University Hospital of Zurich, Switzerland
| | - Jesse Dawson
- From the School of Cardiovascular and Metabolic Health (A.C.C., G. Katsas, J.Y., T.J.Q., R.C., K.D., J.D.), University of Glasgow, United Kingdom; Department of Neurology (Markus Arnold), University Hospital Zurich, Switzerland; Liverpool Centre for Cardiovascular Science (A.H.A.-R.), and Cardiovascular and Metabolic Medicine (A.H.A.-R.), Institute of Life Course and Medical Sciences, University of Liverpool, United Kingdom; Department of Neurology and Stroke Centre (G.M.D.M., M.K.), University Hospital Basel and University of Basel; Department of Neurology (Marcel Arnold), University Hospital Bern; Department of Neurology and Stroke Center (T.K., K.N.), Cantonal Hospital Aarau; Department of Neurology (C.W.C.), Neurocenter (EOC) of Southern Switzerland, Lugano; Department of Neurology (G. Kägi), Cantonal Hospital St. Gallen, Switzerland; Neurology Service (A.B.), Germans Trias i Pujol University Hospital, Barcelona; Neurovascular Research Group (J.M.), Biomedicine Institute of Seville, Spain; Department of Internal Medicine (G.N.), Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece; Department of Neurology (C.F.), Goethe University, Frankfurt am Main, Germany; and Institute of Clinical Chemistry (K.S., A.V.E.), University Hospital of Zurich, Switzerland
| | - Mira Katan
- From the School of Cardiovascular and Metabolic Health (A.C.C., G. Katsas, J.Y., T.J.Q., R.C., K.D., J.D.), University of Glasgow, United Kingdom; Department of Neurology (Markus Arnold), University Hospital Zurich, Switzerland; Liverpool Centre for Cardiovascular Science (A.H.A.-R.), and Cardiovascular and Metabolic Medicine (A.H.A.-R.), Institute of Life Course and Medical Sciences, University of Liverpool, United Kingdom; Department of Neurology and Stroke Centre (G.M.D.M., M.K.), University Hospital Basel and University of Basel; Department of Neurology (Marcel Arnold), University Hospital Bern; Department of Neurology and Stroke Center (T.K., K.N.), Cantonal Hospital Aarau; Department of Neurology (C.W.C.), Neurocenter (EOC) of Southern Switzerland, Lugano; Department of Neurology (G. Kägi), Cantonal Hospital St. Gallen, Switzerland; Neurology Service (A.B.), Germans Trias i Pujol University Hospital, Barcelona; Neurovascular Research Group (J.M.), Biomedicine Institute of Seville, Spain; Department of Internal Medicine (G.N.), Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece; Department of Neurology (C.F.), Goethe University, Frankfurt am Main, Germany; and Institute of Clinical Chemistry (K.S., A.V.E.), University Hospital of Zurich, Switzerland
| |
Collapse
|
5
|
Sposato LA, Sur NB, Katan M, Johansen MC, De Marchis GM, Caso V, Fischer U, Chaturvedi S. Embolic Stroke of Undetermined Source: New Data and New Controversies on Cardiac Monitoring and Anticoagulation. Neurology 2024; 103:e209535. [PMID: 38861698 DOI: 10.1212/wnl.0000000000209535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/13/2024] Open
Abstract
Embolic strokes of undetermined source (ESUS) represent 9%-25% of all ischemic strokes. Based on the suspicion that a large proportion of cardioembolic sources remain undetected among embolic stroke of undetermined source patients, it has been hypothesized that a universal approach of anticoagulation would be better than aspirin for preventing recurrent strokes. However, 4 randomized controlled trials (RCTs), with different degrees of patient selection, failed to confirm this hypothesis. In parallel, several RCTs consistently demonstrated that prolonged cardiac monitoring increased atrial fibrillation detection and anticoagulation initiation compared with usual care in patients with ESUS, and later in individuals with ischemic stroke of known cause (e.g., large or small vessel disease). However, none of these trials or subsequent meta-analyses of all available RCTs have shown a reduction in stroke recurrence associated with the use of prolonged cardiac monitoring. In this article, we review the clinical and research implications of recent RCTs of antithrombotic therapy in patients with ESUS and in high-risk populations with and without stroke, with device-detected asymptomatic atrial fibrillation.
Collapse
Affiliation(s)
- Luciano A Sposato
- From the Departments of Clinical Neurological Sciences, Epidemiology and Biostatistics, and Anatomy and Cell Biology (L.A.S.), Schulich School of Medicine and Dentistry, and Heart & Brain Laboratory (L.A.S.), Western University, London, Ontario, Canada; Department of Neurology (N.B.S.), University of Miami Miller School of Medicine, FL; Department of Neurology (M.K.), University Hospital of Basel, Switzerland; Department of Neurology (M.C.J.), The Johns Hopkins University School of Medicine, Baltimore, MD; Kantonsspital St. Gallen (G.M.D.M.), Department of Neurology & Stroke Center, St. Gallen and Department of Clinical Research, University of Basel, Switzerland; Stroke Unit (V.C.), Santa Maria della Misericordia Hospital, University of Perugia, Italy; Department of Neurology (U.F.), University Hospital Basel, Switzerland; and Department of Neurology & Stroke Program (S.C.), University of Maryland School of Medicine, Baltimore
| | - Nicole B Sur
- From the Departments of Clinical Neurological Sciences, Epidemiology and Biostatistics, and Anatomy and Cell Biology (L.A.S.), Schulich School of Medicine and Dentistry, and Heart & Brain Laboratory (L.A.S.), Western University, London, Ontario, Canada; Department of Neurology (N.B.S.), University of Miami Miller School of Medicine, FL; Department of Neurology (M.K.), University Hospital of Basel, Switzerland; Department of Neurology (M.C.J.), The Johns Hopkins University School of Medicine, Baltimore, MD; Kantonsspital St. Gallen (G.M.D.M.), Department of Neurology & Stroke Center, St. Gallen and Department of Clinical Research, University of Basel, Switzerland; Stroke Unit (V.C.), Santa Maria della Misericordia Hospital, University of Perugia, Italy; Department of Neurology (U.F.), University Hospital Basel, Switzerland; and Department of Neurology & Stroke Program (S.C.), University of Maryland School of Medicine, Baltimore
| | - Mira Katan
- From the Departments of Clinical Neurological Sciences, Epidemiology and Biostatistics, and Anatomy and Cell Biology (L.A.S.), Schulich School of Medicine and Dentistry, and Heart & Brain Laboratory (L.A.S.), Western University, London, Ontario, Canada; Department of Neurology (N.B.S.), University of Miami Miller School of Medicine, FL; Department of Neurology (M.K.), University Hospital of Basel, Switzerland; Department of Neurology (M.C.J.), The Johns Hopkins University School of Medicine, Baltimore, MD; Kantonsspital St. Gallen (G.M.D.M.), Department of Neurology & Stroke Center, St. Gallen and Department of Clinical Research, University of Basel, Switzerland; Stroke Unit (V.C.), Santa Maria della Misericordia Hospital, University of Perugia, Italy; Department of Neurology (U.F.), University Hospital Basel, Switzerland; and Department of Neurology & Stroke Program (S.C.), University of Maryland School of Medicine, Baltimore
| | - Michelle C Johansen
- From the Departments of Clinical Neurological Sciences, Epidemiology and Biostatistics, and Anatomy and Cell Biology (L.A.S.), Schulich School of Medicine and Dentistry, and Heart & Brain Laboratory (L.A.S.), Western University, London, Ontario, Canada; Department of Neurology (N.B.S.), University of Miami Miller School of Medicine, FL; Department of Neurology (M.K.), University Hospital of Basel, Switzerland; Department of Neurology (M.C.J.), The Johns Hopkins University School of Medicine, Baltimore, MD; Kantonsspital St. Gallen (G.M.D.M.), Department of Neurology & Stroke Center, St. Gallen and Department of Clinical Research, University of Basel, Switzerland; Stroke Unit (V.C.), Santa Maria della Misericordia Hospital, University of Perugia, Italy; Department of Neurology (U.F.), University Hospital Basel, Switzerland; and Department of Neurology & Stroke Program (S.C.), University of Maryland School of Medicine, Baltimore
| | - Gian Marco De Marchis
- From the Departments of Clinical Neurological Sciences, Epidemiology and Biostatistics, and Anatomy and Cell Biology (L.A.S.), Schulich School of Medicine and Dentistry, and Heart & Brain Laboratory (L.A.S.), Western University, London, Ontario, Canada; Department of Neurology (N.B.S.), University of Miami Miller School of Medicine, FL; Department of Neurology (M.K.), University Hospital of Basel, Switzerland; Department of Neurology (M.C.J.), The Johns Hopkins University School of Medicine, Baltimore, MD; Kantonsspital St. Gallen (G.M.D.M.), Department of Neurology & Stroke Center, St. Gallen and Department of Clinical Research, University of Basel, Switzerland; Stroke Unit (V.C.), Santa Maria della Misericordia Hospital, University of Perugia, Italy; Department of Neurology (U.F.), University Hospital Basel, Switzerland; and Department of Neurology & Stroke Program (S.C.), University of Maryland School of Medicine, Baltimore
| | - Valeria Caso
- From the Departments of Clinical Neurological Sciences, Epidemiology and Biostatistics, and Anatomy and Cell Biology (L.A.S.), Schulich School of Medicine and Dentistry, and Heart & Brain Laboratory (L.A.S.), Western University, London, Ontario, Canada; Department of Neurology (N.B.S.), University of Miami Miller School of Medicine, FL; Department of Neurology (M.K.), University Hospital of Basel, Switzerland; Department of Neurology (M.C.J.), The Johns Hopkins University School of Medicine, Baltimore, MD; Kantonsspital St. Gallen (G.M.D.M.), Department of Neurology & Stroke Center, St. Gallen and Department of Clinical Research, University of Basel, Switzerland; Stroke Unit (V.C.), Santa Maria della Misericordia Hospital, University of Perugia, Italy; Department of Neurology (U.F.), University Hospital Basel, Switzerland; and Department of Neurology & Stroke Program (S.C.), University of Maryland School of Medicine, Baltimore
| | - Urs Fischer
- From the Departments of Clinical Neurological Sciences, Epidemiology and Biostatistics, and Anatomy and Cell Biology (L.A.S.), Schulich School of Medicine and Dentistry, and Heart & Brain Laboratory (L.A.S.), Western University, London, Ontario, Canada; Department of Neurology (N.B.S.), University of Miami Miller School of Medicine, FL; Department of Neurology (M.K.), University Hospital of Basel, Switzerland; Department of Neurology (M.C.J.), The Johns Hopkins University School of Medicine, Baltimore, MD; Kantonsspital St. Gallen (G.M.D.M.), Department of Neurology & Stroke Center, St. Gallen and Department of Clinical Research, University of Basel, Switzerland; Stroke Unit (V.C.), Santa Maria della Misericordia Hospital, University of Perugia, Italy; Department of Neurology (U.F.), University Hospital Basel, Switzerland; and Department of Neurology & Stroke Program (S.C.), University of Maryland School of Medicine, Baltimore
| | - Seemant Chaturvedi
- From the Departments of Clinical Neurological Sciences, Epidemiology and Biostatistics, and Anatomy and Cell Biology (L.A.S.), Schulich School of Medicine and Dentistry, and Heart & Brain Laboratory (L.A.S.), Western University, London, Ontario, Canada; Department of Neurology (N.B.S.), University of Miami Miller School of Medicine, FL; Department of Neurology (M.K.), University Hospital of Basel, Switzerland; Department of Neurology (M.C.J.), The Johns Hopkins University School of Medicine, Baltimore, MD; Kantonsspital St. Gallen (G.M.D.M.), Department of Neurology & Stroke Center, St. Gallen and Department of Clinical Research, University of Basel, Switzerland; Stroke Unit (V.C.), Santa Maria della Misericordia Hospital, University of Perugia, Italy; Department of Neurology (U.F.), University Hospital Basel, Switzerland; and Department of Neurology & Stroke Program (S.C.), University of Maryland School of Medicine, Baltimore
| |
Collapse
|
6
|
Ikenouchi H, Saito S, Ishiyama H, Kitamura A, Tanaka T, Inoue M, Takahashi Y, Koyama T, Kuriyama N, Koga M, Toyoda K, Urushitani M, Ihara M. Predictive Value of Midregional Pro-Atrial Natriuretic Peptide for Cardioembolic Stroke in Hyperacute Ischemic Stroke. J Am Heart Assoc 2024; 13:e033134. [PMID: 38804222 PMCID: PMC11255621 DOI: 10.1161/jaha.123.033134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Accepted: 05/02/2024] [Indexed: 05/29/2024]
Affiliation(s)
- Hajime Ikenouchi
- Department of Neurology, National Cerebral and Cardiovascular CenterSuitaJapan
| | - Satoshi Saito
- Department of Neurology, National Cerebral and Cardiovascular CenterSuitaJapan
| | - Hiroyuki Ishiyama
- Department of Neurology, National Cerebral and Cardiovascular CenterSuitaJapan
| | - Akihiro Kitamura
- Department of NeurologyShiga University of Medical ScienceOtsuJapan
| | - Tomotaka Tanaka
- Department of Neurology, National Cerebral and Cardiovascular CenterSuitaJapan
| | - Manabu Inoue
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular CenterSuitaJapan
| | - Yukako Takahashi
- Department of Neurology, National Cerebral and Cardiovascular CenterSuitaJapan
| | - Teruhide Koyama
- Department of Epidemiology for Community Health and MedicineKyoto Prefectural University of MedicineKyotoJapan
| | - Nagato Kuriyama
- Department of Epidemiology for Community Health and MedicineKyoto Prefectural University of MedicineKyotoJapan
- Shizuoka Graduate University of Public HealthShizuokaJapan
| | - Masatoshi Koga
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular CenterSuitaJapan
| | - Kazunori Toyoda
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular CenterSuitaJapan
| | | | - Masafumi Ihara
- Department of Neurology, National Cerebral and Cardiovascular CenterSuitaJapan
| |
Collapse
|
7
|
Justo ASDS, Nóbrega SMA, Silva ALA. Cardiac Blood-Based Biomarkers of Myocardial Stress as Predictors of Atrial Fibrillation Development in Patients With Embolic Stroke of Undetermined Source/Cryptogenic Stroke: A Systematic Review and Meta-Analysis. J Clin Neurol 2024; 20:256-264. [PMID: 38171502 PMCID: PMC11076184 DOI: 10.3988/jcn.2023.0068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 05/29/2023] [Accepted: 06/27/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND AND PURPOSE Undiagnosed atrial fibrillation (AF) is a major risk factor for stroke that can go unnoticed in individuals with embolic stroke of undetermined source (ESUS) or cryptogenic stroke (CS). Early detection is critical for stroke prognosis and secondary prevention. This study aimed to determine if blood biomarkers of myocardial stress can accurately predict AF in patients with ESUS/CS, which would allow the identification of those who would benefit from closer monitoring. METHODS In February 2023 we performed a systematic date-unrestricted search of three databases for studies on patients with ESUS/CS who were subsequently diagnosed with AF. We examined the relationships between AF and serum myocardial stress markers such as brain natriuretic peptide (BNP), N-terminal-pro-BNP (NT-proBNP), midregional proatrial natriuretic peptide, and troponin. RESULTS Among the 1,527 studies reviewed, 23 eligible studies involving 6,212 participants, including 864 with AF, were analyzed. A meta-analysis of 9 studies indicated that they demonstrated a clear association between higher NT-proBNP levels and an increased risk of AF, with adjusted and raw data indicating 3.06- and 9.03-fold higher AF risks, respectively. Lower NT-proBNP levels had a pooled negative predictive value of 91.7%, indicating the potential to rule out AF with an 8% false-negative rate. CONCLUSIONS Further research is required to fully determine the potential of biomarkers for AF detection after stroke, as results from previous studies lack homogeneity. However, lower NT-proBNP levels have potential in ruling out AF in patients with ESUS/CS. Combining them with other relevant biomarkers may enhance the precision of identifying patients who will not benefit from extended monitoring, which would optimize resource allocation and patient care.
Collapse
Affiliation(s)
| | | | - Ana Luísa Aires Silva
- Department of Neurology, Faculty of Medicine, Centro Hospitalar Universitário São João, Porto, Portugal
| |
Collapse
|
8
|
Lv J, Wang R, Yang J, You L, Yang C, Zhang Y, Liu Q, Yin L, Liu JT, Xie RQ. Left atrial appendage closure in conjunction with radiofrequency ablation: Effects on left atrial functioning in patients with paroxysmal atrial fibrillation. Open Med (Wars) 2024; 19:20240951. [PMID: 38623457 PMCID: PMC11017190 DOI: 10.1515/med-2024-0951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Revised: 03/19/2024] [Accepted: 03/21/2024] [Indexed: 04/17/2024] Open
Abstract
Objective In the present study, we investigated the impact of left atrial appendage closure (LAAC) following catheter ablation (CA) on the left atrial structure and functioning of patients with paroxysmal atrial fibrillation (AF). Methods Patients with paroxysmal AF were enrolled in this single-center prospective cohort study between April 2015 and July 2021; 353 patients received CA alone, while 93 patients received CA in combination with Watchman LAAC. We used age, gender, CHA2DS2-VASc, and HAS-BLED scores as well as other demographic variables to perform propensity score matching. Patients with paroxysmal AF were randomly assigned to the CA combined with Watchman LAAC group (combined treatment group) and the simple CA group, with 89 patients in each group. The left atrial structure, reserve, ventricular diastole, and pump functions and their changes in patients were assessed using routine Doppler echocardiography and 2D speckle tracking echocardiography over the course of a 1-year follow-up. Results At 1-week follow-up, the reserve, ventricular diastole, and pump functions of the left atrium (LA) increased in both groups; these functions were gradually restored at the 1- to 3-month follow-up; they were close to or returned to their pre-operative levels at the 3-month follow-up; and no significant differences were found compared with the pre-operative levels at the 12-month follow-up. In the first 3 months, the reserve (Ƹ, SRs) and pump functions (SRa) in the combined treatment group decreased significantly when compared with the simple CA group, and the differences were statistically significant. Conclusion Patients with paroxysmal AF may experience a short term, partial effect of LAAC on LA reserve and pump functions, which are gradually restored and the effect disappears by 12 months.
Collapse
Affiliation(s)
- Jing Lv
- Division of Cardiology, The Second Hospital of Hebei Medical University, Xinhua District, Shijiazhuang, Hebei, 050051, China
- Division of Cardiology, Xingtai People’s Hospital of Hebei Medical University, Xingtai, Hebei, 054000, China
| | - Rui Wang
- Division of Cardiology, The Second Hospital of Hebei Medical University, Xinhua District, Shijiazhuang, Hebei, 050051, China
| | - Jing Yang
- Division of Cardiology, The Second Hospital of Hebei Medical University, Xinhua District, Shijiazhuang, Hebei, 050051, China
| | - Ling You
- Division of Cardiology, The Second Hospital of Hebei Medical University, Xinhua District, Shijiazhuang, Hebei, 050051, China
| | - Chao Yang
- Division of Cardiology, The Second Hospital of Hebei Medical University, Xinhua District, Shijiazhuang, Hebei, 050051, China
| | - Yan Zhang
- Division of Cardiology, The Second Hospital of Hebei Medical University, Xinhua District, Shijiazhuang, Hebei, 050051, China
| | - Qian Liu
- Division of Cardiology, The Second Hospital of Hebei Medical University, Xinhua District, Shijiazhuang, Hebei, 050051, China
| | - Lei Yin
- Division of Cardiology, The Second Hospital of Hebei Medical University, Xinhua District, Shijiazhuang, Hebei, 050051, China
| | - Jin-ting Liu
- Division of Cardiology, The Second Hospital of Hebei Medical University, Xinhua District, Shijiazhuang, Hebei, 050051, China
| | - Rui-qin Xie
- Division of Cardiology, The Second Hospital of Hebei Medical University, 215 Heping West Road, Xinhua District, Shijiazhuang, Hebei, 050051, China
| |
Collapse
|
9
|
Seiffge DJ, Cancelloni V, Räber L, Paciaroni M, Metzner A, Kirchhof P, Fischer U, Werring DJ, Shoamanesh A, Caso V. Secondary stroke prevention in people with atrial fibrillation: treatments and trials. Lancet Neurol 2024; 23:404-417. [PMID: 38508836 DOI: 10.1016/s1474-4422(24)00037-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 01/19/2024] [Accepted: 01/24/2024] [Indexed: 03/22/2024]
Abstract
Atrial fibrillation is one of the most common cardiac arrhythmias and is a major cause of ischaemic stroke. Recent findings indicate the importance of atrial fibrillation burden (device-detected, subclinical, or paroxysmal and persistent or permanent) and whether atrial fibrillation was known before stroke onset or diagnosed after stroke for the risk of recurrence. Secondary prevention in patients with atrial fibrillation and stroke aims to reduce the risk of recurrent ischaemic stroke. Findings from randomised controlled trials assessing the optimal timing to introduce direct oral anticoagulant therapy after a stroke show that early start (ie, within 48 h for minor to moderate strokes and within 4-5 days for large strokes) seems safe and could reduce the risk of early recurrence. Other promising developments regarding early rhythm control, left atrial appendage occlusion, and novel factor XI inhibitor oral anticoagulants suggest that these therapies have the potential to further reduce the risk of stroke. Secondary prevention strategies in patients with atrial fibrillation who have a stroke despite oral anticoagulation therapy is an unmet medical need. Research advances suggest a heterogeneous spectrum of causes, and ongoing trials are investigating new approaches for secondary prevention in this vulnerable patient group. In patients with atrial fibrillation and a history of intracerebral haemorrhage, the latest data from randomised controlled trials on stroke prevention shows that oral anticoagulation reduces the risk of ischaemic stroke but more data are needed to define the safety profile.
Collapse
Affiliation(s)
- David J Seiffge
- Department of Neurology, Inselspital University Hospital Bern and University of Bern, Switzerland.
| | - Virginia Cancelloni
- Stroke Unit, Santa Maria della Misericordia Hospital, University of Perugia, Perugia, Italy
| | - Lorenz Räber
- Department of Cardiology, Inselspital University Hospital Bern and University of Bern, Switzerland
| | - Maurizio Paciaroni
- Stroke Unit, Santa Maria della Misericordia Hospital, University of Perugia, Perugia, Italy
| | - Andreas Metzner
- Department of Cardiology, University Heart and Vascular Center Hamburg, University Center Hamburg Eppendorf, Hamburg, Germany; German Center for Cardiovascular Research, partner site Hamburg, Kiel, and Lübeck, Germany
| | - Paulus Kirchhof
- Department of Cardiology, University Heart and Vascular Center Hamburg, University Center Hamburg Eppendorf, Hamburg, Germany; German Center for Cardiovascular Research, partner site Hamburg, Kiel, and Lübeck, Germany; Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK
| | - Urs Fischer
- Department of Neurology, Inselspital University Hospital Bern and University of Bern, Switzerland; Department of Neurology, University Hospital Basel, Switzerland
| | - David J Werring
- Stroke Research Centre, UCL Queen Square Institute of Neurology, London, UK
| | - Ashkan Shoamanesh
- Division of Neurology, Department of Medicine, Population Health Research Institute, McMaster University, Hamilton, ON, Canada
| | - Valeria Caso
- Stroke Unit, Santa Maria della Misericordia Hospital, University of Perugia, Perugia, Italy
| |
Collapse
|
10
|
Gandhi PU, Herman PE, Gaggin HK. The Jury Is Still Out on A-Type Natriuretic Peptide Deficiency Relative to B-Type Natriuretic Peptides. JACC. HEART FAILURE 2024; 12:475-478. [PMID: 38206237 DOI: 10.1016/j.jchf.2023.11.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Accepted: 11/27/2023] [Indexed: 01/12/2024]
Affiliation(s)
- Parul U Gandhi
- VA Connecticut Healthcare System, West Haven, Connecticut, USA; Yale University School of Medicine, New Haven, Connecticut, USA.
| | - Paige E Herman
- Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Hanna K Gaggin
- Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA; Division of Cardiology, Corrigan Minehan Heart Center, Harvard Medical School, Boston, Massachusetts, USA
| |
Collapse
|
11
|
Kamel H, Longstreth WT, Tirschwell DL, Kronmal RA, Marshall RS, Broderick JP, Aragón García R, Plummer P, Sabagha N, Pauls Q, Cassarly C, Dillon CR, Di Tullio MR, Hod EA, Soliman EZ, Gladstone DJ, Healey JS, Sharma M, Chaturvedi S, Janis LS, Krishnaiah B, Nahab F, Kasner SE, Stanton RJ, Kleindorfer DO, Starr M, Winder TR, Clark WM, Miller BR, Elkind MSV. Apixaban to Prevent Recurrence After Cryptogenic Stroke in Patients With Atrial Cardiopathy: The ARCADIA Randomized Clinical Trial. JAMA 2024; 331:573-581. [PMID: 38324415 PMCID: PMC10851142 DOI: 10.1001/jama.2023.27188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Accepted: 12/13/2023] [Indexed: 02/09/2024]
Abstract
Importance Atrial cardiopathy is associated with stroke in the absence of clinically apparent atrial fibrillation. It is unknown whether anticoagulation, which has proven benefit in atrial fibrillation, prevents stroke in patients with atrial cardiopathy and no atrial fibrillation. Objective To compare anticoagulation vs antiplatelet therapy for secondary stroke prevention in patients with cryptogenic stroke and evidence of atrial cardiopathy. Design, Setting, and Participants Multicenter, double-blind, phase 3 randomized clinical trial of 1015 participants with cryptogenic stroke and evidence of atrial cardiopathy, defined as P-wave terminal force greater than 5000 μV × ms in electrocardiogram lead V1, serum N-terminal pro-B-type natriuretic peptide level greater than 250 pg/mL, or left atrial diameter index of 3 cm/m2 or greater on echocardiogram. Participants had no evidence of atrial fibrillation at the time of randomization. Enrollment and follow-up occurred from February 1, 2018, through February 28, 2023, at 185 sites in the National Institutes of Health StrokeNet and the Canadian Stroke Consortium. Interventions Apixaban, 5 mg or 2.5 mg, twice daily (n = 507) vs aspirin, 81 mg, once daily (n = 508). Main Outcomes and Measures The primary efficacy outcome in a time-to-event analysis was recurrent stroke. All participants, including those diagnosed with atrial fibrillation after randomization, were analyzed according to the groups to which they were randomized. The primary safety outcomes were symptomatic intracranial hemorrhage and other major hemorrhage. Results With 1015 of the target 1100 participants enrolled and mean follow-up of 1.8 years, the trial was stopped for futility after a planned interim analysis. The mean (SD) age of participants was 68.0 (11.0) years, 54.3% were female, and 87.5% completed the full duration of follow-up. Recurrent stroke occurred in 40 patients in the apixaban group (annualized rate, 4.4%) and 40 patients in the aspirin group (annualized rate, 4.4%) (hazard ratio, 1.00 [95% CI, 0.64-1.55]). Symptomatic intracranial hemorrhage occurred in 0 patients taking apixaban and 7 patients taking aspirin (annualized rate, 1.1%). Other major hemorrhages occurred in 5 patients taking apixaban (annualized rate, 0.7%) and 5 patients taking aspirin (annualized rate, 0.8%) (hazard ratio, 1.02 [95% CI, 0.29-3.52]). Conclusions and Relevance In patients with cryptogenic stroke and evidence of atrial cardiopathy without atrial fibrillation, apixaban did not significantly reduce recurrent stroke risk compared with aspirin. Trial Registration ClinicalTrials.gov Identifier: NCT03192215.
Collapse
Affiliation(s)
- Hooman Kamel
- Clinical and Translational Neuroscience Unit, Department of Neurology and Feil Family Brain and Mind Research Institute, Weill Cornell Medicine, New York, New York
| | - W. T. Longstreth
- Department of Neurology, University of Washington, Seattle
- Department of Medicine, University of Washington, Seattle
- Department of Epidemiology, University of Washington, Seattle
| | | | | | - Randolph S. Marshall
- Department of Neurology, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York
| | - Joseph P. Broderick
- Department of Neurology and Rehabilitation Medicine, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Rebeca Aragón García
- Department of Neurology, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York
| | - Pamela Plummer
- Department of Neurology and Rehabilitation Medicine, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Noor Sabagha
- Department of Neurology and Rehabilitation Medicine, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Qi Pauls
- Department of Public Health Sciences, Medical University of South Carolina, Charleston
| | - Christy Cassarly
- Department of Public Health Sciences, Medical University of South Carolina, Charleston
| | - Catherine R. Dillon
- Department of Public Health Sciences, Medical University of South Carolina, Charleston
| | - Marco R. Di Tullio
- Division of Cardiology, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York
| | - Eldad A. Hod
- Department of Pathology, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York
| | - Elsayed Z. Soliman
- Epidemiological Cardiology Research Center, Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - David J. Gladstone
- Sunnybrook Research Institute, Hurvitz Brain Sciences Program, Sunnybrook Health Sciences Centre, and Division of Neurology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Jeff S. Healey
- Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada
| | - Mukul Sharma
- Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada
| | - Seemant Chaturvedi
- Department of Neurology, University of Maryland, and Baltimore VA Hospital, Baltimore
| | - L. Scott Janis
- National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland
| | - Balaji Krishnaiah
- Department of Neurology, University of Tennessee Health Sciences Center, Memphis
| | - Fadi Nahab
- Departments of Neurology and Pediatrics, Emory University, Atlanta, Georgia
| | - Scott E. Kasner
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Robert J. Stanton
- Department of Neurology and Rehabilitation Medicine, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | | | - Matthew Starr
- Department of Neurology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | | | - Wayne M. Clark
- Department of Neurology, Oregon Health & Science University, Portland
| | | | - Mitchell S. V. Elkind
- Department of Neurology, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York
| |
Collapse
|
12
|
Chua W, Khashaba A, Canagarajah H, Nielsen JC, di Biase L, Haeusler KG, Hindricks G, Mont L, Piccini J, Schnabel RB, Schotten U, Wienhues-Thelen UH, Zeller T, Fabritz L, Kirchhof P. Disturbed atrial metabolism, shear stress, and cardiac load contribute to atrial fibrillation after ablation: AXAFA biomolecule study. Europace 2024; 26:euae028. [PMID: 38266130 PMCID: PMC10873713 DOI: 10.1093/europace/euae028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 10/21/2023] [Indexed: 01/26/2024] Open
Abstract
AIMS Different disease processes can combine to cause atrial fibrillation (AF). Their contribution to recurrent AF after ablation in patients is not known. Cardiovascular processes associated with recurrent AF after AF ablation were determined by quantifying biomolecules related to inflammation, metabolism, proliferation, fibrosis, shear stress, atrial pressure, and others in the AXAFA biomolecule study. METHODS AND RESULTS Twelve circulating cardiovascular biomolecules (ANGPT2, BMP10, CA125, hsCRP, ESM1, FABP3, FGF23, GDF15, IGFBP7, IL6, NT-proBNP, and hsTnT) were quantified in plasma samples obtained prior to a first AF ablation using high-throughput, high-precision assays. Cox regression was used to identify biomolecules associated with recurrent AF during the first 3 months after AF ablation. In 433 patients (64 years [58, 70]; 33% women), baseline concentrations of ANGPT2, BMP10, hsCRP, FGF23, FABP3, GDF15, and NT-proBNP were elevated in patients with recurrent AF (120/433; 28%). After adjustment for 11 clinical features and randomized treatment, elevated NT-proBNP [hazard ratio (HR) 1.58, 95% confidence interval (1.29, 1.94)], ANGPT2 [HR 1.37, (1.12, 1.67)], and BMP10 [HR 1.24 (1.02, 1.51)] remained associated with recurrent AF. Concentrations of ANGPT2, BMP10, and NT-proBNP decreased in patients who remained arrhythmia free, but not in patients with recurrent AF, highlighting their connection to AF. The other eight biomarkers showed unchanged concentrations. CONCLUSION Elevated concentrations of ANGPT2, BMP10, and NT-proBNP are associated with recurrent AF after a first AF ablation, suggesting that processes linked to disturbed cardiomyocyte metabolism, altered atrial shear stress, and increased load contribute to AF after AF ablation in patients.
Collapse
Affiliation(s)
- Winnie Chua
- Institute of Cardiovascular Sciences, University of Birmingham, Wolfson Drive, Birmingham, UK
| | - Alya Khashaba
- Institute of Cardiovascular Sciences, University of Birmingham, Wolfson Drive, Birmingham, UK
| | - Hansel Canagarajah
- Institute of Cardiovascular Sciences, University of Birmingham, Wolfson Drive, Birmingham, UK
| | | | - Luigi di Biase
- Albert Einstein College of Medicine, Montefiore Hospital, New York, New York, USA
- Texas Cardiac Arrhythmia Institute at St. David’s Medical Center, Houston, TX, USA
| | - Karl Georg Haeusler
- Atrial Fibrillation NETwork (AFNET), Münster, DE
- Department of Neurology, Universitätsklinikum Würzburg, Würzburg, Germany
| | - Gerhard Hindricks
- Department of Cardiology, German Heart Center Charite, Campus Charite Mitte, Berlin, Germany
| | - Lluis Mont
- Hospital Clinic Barcelona, University of Barcelona, Barcelona, ES
| | - Jonathan Piccini
- Duke Clinical Research Institute (DCRI), Durham, NC, USA
- Division of Cardiology, Duke University Medical Center, Duke University, Durham, NC, USA
| | - Renate B Schnabel
- Atrial Fibrillation NETwork (AFNET), Münster, DE
- German Centre for Cardiovascular Research (DZHK), partner site: Hamburg/Kiel/Lübeck, Germany
- Department of Cardiology, University Heart and Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Building O70, Martinistrasse 52, 20246 Hamburg, Germany
| | - Ulrich Schotten
- Atrial Fibrillation NETwork (AFNET), Münster, DE
- Department of Physiology, University Maastricht, Maastricht, NL
| | | | - Tanja Zeller
- German Centre for Cardiovascular Research (DZHK), partner site: Hamburg/Kiel/Lübeck, Germany
- University Center of Cardiovascular Sciences, University Heart and Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Larissa Fabritz
- Institute of Cardiovascular Sciences, University of Birmingham, Wolfson Drive, Birmingham, UK
- Atrial Fibrillation NETwork (AFNET), Münster, DE
- German Centre for Cardiovascular Research (DZHK), partner site: Hamburg/Kiel/Lübeck, Germany
- Department of Cardiology, University Heart and Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Building O70, Martinistrasse 52, 20246 Hamburg, Germany
- University Center of Cardiovascular Sciences, University Heart and Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Paulus Kirchhof
- Institute of Cardiovascular Sciences, University of Birmingham, Wolfson Drive, Birmingham, UK
- Atrial Fibrillation NETwork (AFNET), Münster, DE
- German Centre for Cardiovascular Research (DZHK), partner site: Hamburg/Kiel/Lübeck, Germany
- Department of Cardiology, University Heart and Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Building O70, Martinistrasse 52, 20246 Hamburg, Germany
| |
Collapse
|
13
|
Yin P, Wu Y, Long X, Zhu S, Chen S, Lu F, Lin K, Xu J. HACE1 expression in heart failure patients might promote mitochondrial oxidative stress and ferroptosis by targeting NRF2. Aging (Albany NY) 2023; 15:13888-13900. [PMID: 38070140 PMCID: PMC10756096 DOI: 10.18632/aging.205272] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 10/17/2023] [Indexed: 12/21/2023]
Abstract
BACKGROUND Heart failure is a prevalent and life-threatening medical condition characterized by abnormal atrial electrical activity, contributing to a higher risk of ischemic stroke. Atrial remodelling, driven by oxidative stress and structural changes, plays a central role in heart failure progression. Recent studies suggest that HACE1, a regulatory gene, may be involved in cardiac protection against heart failure. METHODS Clinical data analysis involved heart failure patients, while an animal model utilized C57BL/6J mice. RT-PCR, microarray analysis, histological examination, ELISA, and Western blot assays were employed to assess gene and protein expression, oxidative stress, and cardiac function. Cell transfection and culture of mouse atrial fibroblasts were performed for in-vitro experiments. RESULTS HACE1 expression was reduced in heart failure patients and correlated negatively with collagen levels. In mouse models, HACE1 up-regulation reduced oxidative stress, mitigated fibrosis, and improved cardiac function. Conversely, HACE1 knockdown exacerbated oxidative stress, fibrosis, and cardiac dysfunction. HACE1 also protected against ferroptosis and mitochondrial damage. NRF2, a transcription factor implicated in oxidative stress, was identified as a target of HACE1, with HACE1 promoting NRF2 activity through ubiquitination. CONCLUSIONS HACE1 emerges as a potential therapeutic target and diagnostic marker for heart failure. It regulates oxidative stress, mitigates cardiac fibrosis, and protects against ferroptosis and mitochondrial damage. The study reveals that HACE1 achieves these effects, at least in part, through NRF2 activation via ubiquitination, offering insights into novel mechanisms for heart failure pathogenesis and potential interventions.
Collapse
Affiliation(s)
- Peiyi Yin
- Department of Cardiothoracic Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang 330006, China
| | - Yongbin Wu
- Department of Cardiothoracic Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang 330006, China
| | - Xiang Long
- Department of Cardiothoracic Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang 330006, China
| | - Shuqiang Zhu
- Department of Cardiothoracic Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang 330006, China
| | - Shiwei Chen
- Department of Cardiothoracic Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang 330006, China
| | - Feng Lu
- Department of Cardiothoracic Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang 330006, China
| | - Kun Lin
- Department of Cardiothoracic Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang 330006, China
| | - Jianjun Xu
- Department of Cardiothoracic Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang 330006, China
| |
Collapse
|
14
|
Schütz V, Dougoud S, Bracher K, Arnold M, Schweizer J, Nakas C, Westphal LP, Inauen C, Pokorny T, Duru F, Steffel J, Luft A, Spanaus K, Saguner AM, Katan M. The Role of Electrocardiographic Markers for Predicting Atrial Fibrillation in Patients with Acute Ischemic Stroke: Data from the BIOSIGNAL Cohort Study. J Clin Med 2023; 12:6830. [PMID: 37959294 PMCID: PMC10649302 DOI: 10.3390/jcm12216830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 10/09/2023] [Accepted: 10/19/2023] [Indexed: 11/15/2023] Open
Abstract
BACKGROUND AND AIMS P-wave abnormalities in the 12-lead electrocardiogram (ECG) have been associated with a higher risk of acute ischemic stroke (AIS) as well as atrial fibrillation (AF). This study aimed to assess pre-determined ECG criteria during sinus rhythm in unselected AIS patients and their value for predicting newly diagnosed atrial fibrillation (NDAF) after hospital admission. METHODS P-wave alterations were measured on 12-lead ECG on admission in all consecutively enrolled patients without known AF between October 2014 and 2017. The outcome of interest was NDAF, identified by prolonged electrocardiographic monitoring within one year after the index AIS. Univariable and multivariable logistic regression was applied to assess the magnitude and independence of the association between pre-selected ECG markers and NDAF. The discriminatory accuracy was evaluated with the area under the receiver operating characteristic curve (AUC), and the incremental prognostic value was estimated with the net reclassification index. RESULTS NDAF was detected in 87 (10%) of 856 patients during a follow-up of 365 days. Out of the pre-selected ECG parameters, advanced interatrial block (aIAB) and PR interval in lead II were independently associated with NDAF in univariable regression analysis. Only aIAB remained a significant predictor in multivariable analysis. Adding aIAB to the best-performing multivariable regression model improved the discriminatory accuracy to predict NDAF from an AUC of 0.78 (95%-CI 0.77-0.80) to 0.81 (95%-CI 0.80-0.83, p < 0.001). CONCLUSION aIAB is independently and highly associated with NDAF in patients with AIS, has high inter-rater reliability, and therefore may be helpful to refine diagnostic work-up to search for AF in AIS.
Collapse
Affiliation(s)
- Valerie Schütz
- Department of Neurology, University Hospital of Zurich, Neuroscience Center Zurich, University of Zurich, 8006 Zürich, Switzerland (K.B.); (C.I.)
- Department of Neurology, University Hospital of Tulln, 3430 Tulln an der Donau, Austria
| | - Svetlana Dougoud
- Department of Cardiology, University Heart Center, University Hospital of Zurich, 8006 Zürich, Switzerland; (S.D.); (F.D.)
| | - Katja Bracher
- Department of Neurology, University Hospital of Zurich, Neuroscience Center Zurich, University of Zurich, 8006 Zürich, Switzerland (K.B.); (C.I.)
| | - Markus Arnold
- Department of Neurology, University Hospital of Zurich, Neuroscience Center Zurich, University of Zurich, 8006 Zürich, Switzerland (K.B.); (C.I.)
| | - Juliane Schweizer
- Department of Neurology, University Hospital of Zurich, Neuroscience Center Zurich, University of Zurich, 8006 Zürich, Switzerland (K.B.); (C.I.)
| | - Christos Nakas
- Laboratory of Biometry, University of Thessaly, 382 21 Volos, Greece;
- University Institute of Clinical Chemistry, Inselspital, Bern University Hospital, University of Bern, 3012 Bern, Switzerland
| | - Laura P. Westphal
- Department of Neurology, University Hospital of Zurich, Neuroscience Center Zurich, University of Zurich, 8006 Zürich, Switzerland (K.B.); (C.I.)
| | - Corinne Inauen
- Department of Neurology, University Hospital of Zurich, Neuroscience Center Zurich, University of Zurich, 8006 Zürich, Switzerland (K.B.); (C.I.)
| | - Thomas Pokorny
- Department of Neurology, University Hospital of Zurich, Neuroscience Center Zurich, University of Zurich, 8006 Zürich, Switzerland (K.B.); (C.I.)
| | - Firat Duru
- Department of Cardiology, University Heart Center, University Hospital of Zurich, 8006 Zürich, Switzerland; (S.D.); (F.D.)
| | - Jan Steffel
- Department of Cardiology, University Heart Center, University Hospital of Zurich, 8006 Zürich, Switzerland; (S.D.); (F.D.)
| | - Andreas Luft
- Department of Neurology, University Hospital of Zurich, Neuroscience Center Zurich, University of Zurich, 8006 Zürich, Switzerland (K.B.); (C.I.)
| | - Katharina Spanaus
- Institute of Clinical Chemistry, University Hospital of Zurich, 8006 Zürich, Switzerland
| | - Ardan Muammer Saguner
- Department of Cardiology, University Heart Center, University Hospital of Zurich, 8006 Zürich, Switzerland; (S.D.); (F.D.)
- Center for Translational and Experimental Cardiology (CTEC), Department of Cardiology, Zurich University Hospital, University of Zurich, 8952 Schlieren, Switzerland
| | - Mira Katan
- Department of Neurology, University Hospital of Zurich, Neuroscience Center Zurich, University of Zurich, 8006 Zürich, Switzerland (K.B.); (C.I.)
- Department of Neurology, University Hospital and University of Basel, 4031 Basel, Switzerland
| |
Collapse
|
15
|
De Marchis GM, Krisai P, Werlen L, Sinnecker T, Aeschbacher S, Dittrich TD, Polymeris AA, Coslovksy M, Blum MR, Rodondi N, Reichlin T, Moschovitis G, Wuerfel J, Lyrer PA, Fischer U, Conen D, Kastner P, Ziegler A, Osswald S, Kühne M, Bonati LH. Biomarker, Imaging, and Clinical Factors Associated With Overt and Covert Stroke in Patients With Atrial Fibrillation. Stroke 2023; 54:2542-2551. [PMID: 37548011 PMCID: PMC10519288 DOI: 10.1161/strokeaha.123.043302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 06/24/2023] [Accepted: 06/29/2023] [Indexed: 08/08/2023]
Abstract
BACKGROUND Atrial fibrillation is a major risk factor for stroke and silent brain infarcts. We studied whether a multimodal approach offers additional insights to the CHA2DS2-VASc score in predicting stroke or new brain infarcts on magnetic resonance imaging (MRI) over a 2-year follow-up. METHODS Swiss-AF is a prospective, multicenter cohort study of patients with known atrial fibrillation. We included patients with available brain MRI both at enrollment and 2 years later. The dates of the baseline and follow-up visits ranged from March 2014 to November 2020. The primary outcome was assessed 2 years after baseline and was defined as a composite of clinically identified stroke or any new brain infarct on the 2-year MRI. We compared a multivariable logistic regression model including prespecified clinical, biomarker, and baseline MRI variables to the CHA2DS2-VASc score. RESULTS We included 1232 patients, 89.8% of them taking oral anticoagulants. The primary outcome occurred in 78 patients (6.3%). The following baseline variables were included in the final multivariate model and were significantly associated with the primary outcome: white matter lesion volume in milliliters (adjusted odds ratio [aOR], 1.91 [95% CI, 1.45-2.56]), NT-proBNP (N-terminal pro-B-type natriuretic peptide; aOR, 1.75 [95% CI, 1.20-2.63]), GDF-15 (growth differentiation factor-15; aOR, 1.68 [95% CI, 1.11-2.53]), serum creatinine (aOR, 1.50 [95% CI, 1.02-2.22]), IL (interleukin)-6 (aOR, 1.37 [95% CI, 1.00-1.86]), and hFABP (heart-type fatty acid-binding protein; aOR, 0.48 [95% CI, 0.31-0.73]). Overall performance and discrimination of the new model was superior to that of the CHA2DS2-VASc score (C statistic, 0.82 [95% CI, 0.77-0.87] versus 0.64 [95% CI, 0.58-0.70]). CONCLUSIONS In patients with atrial fibrillation, a model incorporating white matter lesion volume on baseline MRI and selected blood markers yielded new insights on residual stroke risk despite a high proportion of patients on oral anticoagulants. This may be relevant to develop further preventive measures.
Collapse
Affiliation(s)
- Gian Marco De Marchis
- Department of Neurology and Stroke Center, University Hospital Basel and University of Basel, Switzerland (G.M.D.M., T.S., T.D.D., A.A.P., P.A.L., U.F., L.H.B.)
- Department of Clinical Research (G.M.D.M., L.W., S.A., T.D.D., M.C., P.A.L., U.F., L.H.B.), University of Basel, Switzerland
- Department of Neurology and Stroke Center, Kantonsspital St.Gallen, Switzerland (G.M.D.M., T.D.D.)
| | - Philipp Krisai
- Cardiology Division, Department of Medicine, University Hospital Basel, Switzerland (P.K., M.C., S.O., M.K.)
| | - Laura Werlen
- Department of Clinical Research (G.M.D.M., L.W., S.A., T.D.D., M.C., P.A.L., U.F., L.H.B.), University of Basel, Switzerland
| | - Tim Sinnecker
- Department of Neurology and Stroke Center, University Hospital Basel and University of Basel, Switzerland (G.M.D.M., T.S., T.D.D., A.A.P., P.A.L., U.F., L.H.B.)
- Department of Biomedical Engineering, Medical Image Analysis Center AG and Qbig (T.S., J.W.), University of Basel, Switzerland
| | - Stefanie Aeschbacher
- Department of Clinical Research (G.M.D.M., L.W., S.A., T.D.D., M.C., P.A.L., U.F., L.H.B.), University of Basel, Switzerland
| | - Tolga D. Dittrich
- Department of Neurology and Stroke Center, University Hospital Basel and University of Basel, Switzerland (G.M.D.M., T.S., T.D.D., A.A.P., P.A.L., U.F., L.H.B.)
- Department of Clinical Research (G.M.D.M., L.W., S.A., T.D.D., M.C., P.A.L., U.F., L.H.B.), University of Basel, Switzerland
- Department of Neurology and Stroke Center, Kantonsspital St.Gallen, Switzerland (G.M.D.M., T.D.D.)
| | - Alexandros A. Polymeris
- Department of Neurology and Stroke Center, University Hospital Basel and University of Basel, Switzerland (G.M.D.M., T.S., T.D.D., A.A.P., P.A.L., U.F., L.H.B.)
| | - Michael Coslovksy
- Department of Clinical Research (G.M.D.M., L.W., S.A., T.D.D., M.C., P.A.L., U.F., L.H.B.), University of Basel, Switzerland
- Cardiology Division, Department of Medicine, University Hospital Basel, Switzerland (P.K., M.C., S.O., M.K.)
| | - Manuel R. Blum
- Institute of Primary Health Care (BIHAM) (M.R.B., N.R.), University of Bern, Switzerland
- Department of General Internal Medicine, Inselspital, Bern University Hospital (M.R.B., N.R.), University of Bern, Switzerland
| | - Nicolas Rodondi
- Institute of Primary Health Care (BIHAM) (M.R.B., N.R.), University of Bern, Switzerland
- Department of General Internal Medicine, Inselspital, Bern University Hospital (M.R.B., N.R.), University of Bern, Switzerland
| | - Tobias Reichlin
- Department of Cardiology, Inselspital, Bern University Hospital (T.R.), University of Bern, Switzerland
| | - Giorgio Moschovitis
- Cardiology Division, Ente Ospedaliero Cantonale, Istituto Cardiocentro Ticino, Regional Hospital of Lugano, Switzerland (G.M.)
| | - Jens Wuerfel
- Department of Biomedical Engineering, Medical Image Analysis Center AG and Qbig (T.S., J.W.), University of Basel, Switzerland
| | - Philippe A. Lyrer
- Department of Neurology and Stroke Center, University Hospital Basel and University of Basel, Switzerland (G.M.D.M., T.S., T.D.D., A.A.P., P.A.L., U.F., L.H.B.)
- Department of Clinical Research (G.M.D.M., L.W., S.A., T.D.D., M.C., P.A.L., U.F., L.H.B.), University of Basel, Switzerland
| | - Urs Fischer
- Department of Neurology and Stroke Center, University Hospital Basel and University of Basel, Switzerland (G.M.D.M., T.S., T.D.D., A.A.P., P.A.L., U.F., L.H.B.)
- Department of Clinical Research (G.M.D.M., L.W., S.A., T.D.D., M.C., P.A.L., U.F., L.H.B.), University of Basel, Switzerland
- Department of Neurology, University Hospital Bern, Switzerland (U.F.)
| | - David Conen
- Population Health Research Institute, McMaster University, Hamilton, Canada (D.C.)
| | - Peter Kastner
- Roche Diagnostics GmbH, Penzberg, Germany (P.K., A.Z.)
| | - André Ziegler
- Roche Diagnostics GmbH, Penzberg, Germany (P.K., A.Z.)
| | - Stefan Osswald
- Cardiology Division, Department of Medicine, University Hospital Basel, Switzerland (P.K., M.C., S.O., M.K.)
| | - Michael Kühne
- Cardiovascular Research Institute Basel, Switzerland (P.K., S.A., S.O., M.K.)
| | - Leo H. Bonati
- Department of Neurology and Stroke Center, University Hospital Basel and University of Basel, Switzerland (G.M.D.M., T.S., T.D.D., A.A.P., P.A.L., U.F., L.H.B.)
- Department of Clinical Research (G.M.D.M., L.W., S.A., T.D.D., M.C., P.A.L., U.F., L.H.B.), University of Basel, Switzerland
- Rheinfelden Rehabilitation Clinic, Switzerland (L.H.B.)
| |
Collapse
|
16
|
Rahbar Kouibaran F, Sabatino M, Barozzi C, Diemberger I. Atrial Natriuretic Peptides as a Bridge between Atrial Fibrillation, Heart Failure, and Amyloidosis of the Atria. Int J Mol Sci 2023; 24:ijms24076470. [PMID: 37047444 PMCID: PMC10095038 DOI: 10.3390/ijms24076470] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 03/20/2023] [Accepted: 03/23/2023] [Indexed: 04/14/2023] Open
Abstract
ANP is mainly synthesized by the atria, and upon excretion, it serves two primary purposes: vasodilation and increasing the renal excretion of sodium and water. The understanding of ANP's role in cardiac systems has improved considerably in recent decades. This review focuses on several studies demonstrating the importance of analyzing the regulations between the endocrine and mechanical function of the heart and emphasizes the effect of ANP, as the primary hormone of the atria, on atrial fibrillation (AF) and related diseases. The review first discusses the available data on the diagnostic and therapeutic applications of ANP and then explains effect of ANP on heart failure (HF) and atrial fibrillation (AF) and vice versa, where tracking ANP levels could lead to understanding the pathophysiological mechanisms operating in these diseases. Second, it focuses on conventional treatments for AF, such as cardioversion and catheter ablation, and their effects on cardiac endocrine and mechanical function. Finally, it provides a point of view about the delayed recovery of cardiac mechanical and endocrine function after cardioversion, which can contribute to the occurrence of acute heart failure, and the potential impact of restoration of the sinus rhythm by extensive ablation or surgery in losing ANP-producing sites. Overall, ANP plays a key role in heart failure through its effects on vasodilation and natriuresis, leading to a decrease in the activity of the renin-angiotensin-aldosterone system, but it is crucial to understand the intimate role of ANP in HF and AF to improve their diagnosis and personalizing the patients' treatment.
Collapse
Affiliation(s)
| | - Mario Sabatino
- Unit of Heart Failure and Transplantation, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | - Chiara Barozzi
- Department of Medical and Surgical Sciences, University of Bologna, 40138 Bologna, Italy
| | - Igor Diemberger
- Department of Medical and Surgical Sciences, University of Bologna, 40138 Bologna, Italy
- Unit of Cardiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| |
Collapse
|
17
|
Ward K, Vail A, Cameron A, Katan M, Lip GYH, Dawson J, Smith CJ, Kishore AK. Molecular biomarkers predicting newly detected atrial fibrillation after ischaemic stroke or TIA: A systematic review. Eur Stroke J 2022; 8:125-131. [PMID: 37021168 PMCID: PMC10069198 DOI: 10.1177/23969873221136927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Accepted: 10/18/2022] [Indexed: 12/12/2022] Open
Abstract
Background: Several molecular biomarkers are available that predict newly detected atrial fibrillation (NDAF). We aimed to identify such biomarkers that predict NDAF after an Ischaemic stroke (IS)/Transient Ischaemic Attack (TIA) and evaluate their performance. Methods: A systematic review was undertaken in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Studies of patients with IS, TIA, or both, who underwent ECG monitoring for ⩾24 h, which reported molecular biomarkers and frequency of NDAF after electronic searches of multiple databases were included. Results: Twenty-one studies (76% IS, 24% IS and TIA) involving 4640 patients were included. Twelve biomarkers were identified, with cardiac biomarkers evaluated in the majority (75%) of patients. Performance measures were inconsistently reported. Among cohorts selecting high-risk individuals (12 studies), the most studied biomarkers were N-Terminal-Pro Brain Natriuretic Peptide (NT-ProBNP, five studies; C-statistics reported by three studies, 0.69–0.88) and Brain Natriuretic Peptide (BNP, two studies; C-statistics reported in two studies, 0.68–0.77). Among unselected cohorts (nine studies), the most studied biomarker was BNP (six studies; C-statistics reported in five studies, 0.75–0.88). Only BNP was externally validated (two studies) but using different thresholds to categorise risk of NDAF. Conclusion: Cardiac biomarkers appear to have modest to good discrimination for predicting NDAF, although most analyses were limited by small, heterogeneous study populations. Their clinical utility should be explored further, and this review supports the need to assess the role of molecular biomarkers in large prospective studies with standardised selection criteria, definition of clinically significant NDAF and laboratory assays.
Collapse
Affiliation(s)
- Kirsty Ward
- Manchester Centre for Clinical Neurosciences, Geoffrey Jefferson Brain Research Centre, Manchester Academic Health Science Centre, Salford Care organisation, Northern Care Alliance NHS Foundation Trust, UK
| | - Andy Vail
- Centre for Biostatistics, University of Manchester, Manchester Academic Health Science Centre, UK
| | - Alan Cameron
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Mira Katan
- Stroke Center/Dept. Of Neurology University Hospital and University of Basel, Switzerland
- Stroke Center/Dept. Of Neurology University Hospital and University of Zurich, Switzerland
| | - Gregory YH Lip
- Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, Liverpool, UK
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Jesse Dawson
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Craig J Smith
- Manchester Centre for Clinical Neurosciences, Geoffrey Jefferson Brain Research Centre, Manchester Academic Health Science Centre, Salford Care organisation, Northern Care Alliance NHS Foundation Trust, UK
- Division of Cardiovascular Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Amit K Kishore
- Manchester Centre for Clinical Neurosciences, Geoffrey Jefferson Brain Research Centre, Manchester Academic Health Science Centre, Salford Care organisation, Northern Care Alliance NHS Foundation Trust, UK
- Division of Cardiovascular Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| |
Collapse
|
18
|
Tsivgoulis G, Palaiodimou L, Triantafyllou S, Köhrmann M, Dilaveris P, Tsioufis K, Magiorkinis G, Krogias C, Schellinger PD, Caso V, Paciaroni M, Sharma M, Lemmens R, Gladstone DJ, Sanna T, Wachter R, Filippatos G, Katsanos AH. Prolonged cardiac monitoring for stroke prevention: A systematic review and meta-analysis of randomized-controlled clinical trials. Eur Stroke J 2022; 8:106-116. [PMID: 37021198 PMCID: PMC10069201 DOI: 10.1177/23969873221139410] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Accepted: 10/27/2022] [Indexed: 11/22/2022] Open
Abstract
Introduction: Prolonged cardiac monitoring (PCM) substantially improves the detection of subclinical atrial fibrillation (AF) among patients with history of ischemic stroke (IS), leading to prompt initiation of anticoagulants. However, whether PCM may lead to IS prevention remains equivocal. Patients and methods: In this systematic review and meta-analysis, randomized-controlled clinical trials (RCTs) reporting IS rates among patients with known cardiovascular risk factors, including but not limited to history of IS, who received PCM for more than 7 days versus more conservative cardiac rhythm monitoring methods were pooled. Results: Seven RCTs were included comprising a total of 9048 patients with at least one known cardiovascular risk factor that underwent cardiac rhythm monitoring. PCM was associated with reduction of IS occurrence compared to conventional monitoring (Risk Ratio: 0.76; 95% CI: 0.59–0.96; I2 = 0%). This association was also significant in the subgroup of RCTs investigating implantable cardiac monitoring (Risk Ratio: 0.75; 95% CI: 0.58–0.97; I2 = 0%). However, when RCTs assessing PCM in both primary and secondary prevention settings were excluded or when RCTs investigating PCM with a duration of 7 days or less were included, the association between PCM and reduction of IS did not retain its statistical significance. Regarding the secondary outcomes, PCM was related to higher likelihood for AF detection and anticoagulant initiation. No association was documented between PCM and IS/transient ischemic attack occurrence, all-cause mortality, intracranial hemorrhage, or major bleeding. Conclusion: PCM may represent an effective stroke prevention strategy in selected patients. Additional RCTs are warranted to validate the robustness of the reported associations.
Collapse
Affiliation(s)
- Georgios Tsivgoulis
- Second Department of Neurology, “Attikon” University Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
- Department of Neurology, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Lina Palaiodimou
- Second Department of Neurology, “Attikon” University Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Sokratis Triantafyllou
- Second Department of Neurology, “Attikon” University Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Martin Köhrmann
- Department of Neurology, Universitätsklinikum Essen, Essen, Germany
| | - Polychronis Dilaveris
- First Department of Cardiology, National and Kapodistrian University of Athens, School of Medicine, Hippokration Hospital, Athens, Greece
| | - Konstantinos Tsioufis
- First Department of Cardiology, National and Kapodistrian University of Athens, School of Medicine, Hippokration Hospital, Athens, Greece
| | - Gkikas Magiorkinis
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Christos Krogias
- Department of Neurology, St. Josef-Hospital, Ruhr University, Bochum, Germany
| | - Peter D Schellinger
- Department of Neurology and Neurogeriatry, Johannes Wesling Medical Center, Ruhr University Bochum, Minden, Germany
| | - Valeria Caso
- Stroke Unit, Santa Maria Della Misericordia Hospital, University of Perugia, Perugia, Italy
| | - Maurizio Paciaroni
- Stroke Unit, Santa Maria Della Misericordia Hospital, University of Perugia, Perugia, Italy
| | - Mukul Sharma
- Division of Neurology, McMaster University and Population Health Research Institute, Hamilton, ON, Canada
| | - Robin Lemmens
- Department of Neurosciences, Experimental Neurology and Leuven Research Institute for Neuroscience and Disease (LIND), KU Leuven - University of Leuven, Leuven, Belgium
- Center for Brain & Disease Research, Laboratory of Neurobiology, Leuven, Belgium
- Department of Neurology, University Hospitals Leuven, Leuven, Belgium
| | - David J Gladstone
- Sunnybrook Research Institute and Hurvitz Brain Sciences Program, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
- Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Tommaso Sanna
- Fondazione Policlinico Gemelli IRCCS, Rome, Italy
- Catholic University of the Sacred Heart, Institute of Cardiology, Rome, Italy
| | - Rolf Wachter
- Department of Cardiology, University Hospital Leipzig, Leipzig, Germany
- Clinic for Cardiology and Pneumology, University Medicine Göttingen, Germany
- German Centre for Cardiovascular Research (DZHK), Partner Site Göttingen, Germany
| | - Gerasimos Filippatos
- Second Department of Cardiology, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Aristeidis H Katsanos
- Division of Neurology, McMaster University and Population Health Research Institute, Hamilton, ON, Canada
| |
Collapse
|
19
|
Fonseca AC. Leaving no stone unturned: the search for stroke associated with atrial fibrillation. Ann Clin Transl Neurol 2022; 9:1502-1503. [PMID: 36039855 PMCID: PMC9539377 DOI: 10.1002/acn3.51651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Accepted: 08/10/2022] [Indexed: 11/10/2022] Open
Affiliation(s)
- Ana Catarina Fonseca
- Stroke Unit, Department of Neurology, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Lisbon, Portugal.,Cerebral Hemodynamic Lab, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Lisbon, Portugal.,Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal.,Centro de Estudos Egas Moniz, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
| |
Collapse
|
20
|
Piccini JP, Harrington J. Midregional Pro-Atrial Natriuretic Peptide and Atrial Fibrillation: Interesting Association or Practice Changing? J Am Coll Cardiol 2022; 79:1382-1384. [PMID: 35393019 DOI: 10.1016/j.jacc.2022.01.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Accepted: 01/28/2022] [Indexed: 11/25/2022]
Affiliation(s)
- Jonathan P Piccini
- Duke University Medical Center and Duke Clinical Research Institute, Durham, North Carolina, USA.
| | - Josephine Harrington
- Duke University Medical Center and Duke Clinical Research Institute, Durham, North Carolina, USA. https://twitter.com/JLHarrington_MD
| |
Collapse
|