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Acosta S, Fatemi S, Zarrouk M, Gottsäter A. Novel Plasma Biomarkers Associated with Future Peripheral Atherosclerotic Disease and Abdominal Aortic Aneurysm-Insights from Contemporary Prospective Studies from the Malmö Diet and Cancer Study. Biomolecules 2024; 14:844. [PMID: 39062558 PMCID: PMC11275106 DOI: 10.3390/biom14070844] [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: 05/30/2024] [Revised: 07/06/2024] [Accepted: 07/11/2024] [Indexed: 07/28/2024] Open
Abstract
INTRODUCTION The potential utility of inflammatory and hemodynamic plasma biomarkers for the prediction of incident lower extremity arterial disease (LEAD), carotid artery stenosis (CAS), isolated atherosclerotic disease without concomitant abdominal aortic aneurysm (AAA), and isolated AAA without concomitant atherosclerotic disease has not yet been integrated in clinical practice. The main objective of this prospective study was to find predictive plasma biomarkers for cardiovascular disease and to evaluate differences in plasma biomarker profiles between asymptomatic and symptomatic CAS, as well as between isolated atherosclerotic disease and isolated AAA. METHODS Blood samples collected at baseline from participants in the prospective Malmö Diet and Cancer study (MDCS) cardiovascular cohort (n = 5550 middle-aged individuals; baseline 1991-1994) were used for plasma biomarker analysis. Validation of each incident cardiovascular diagnosis was performed by random sampling. Cox regression analysis was used to calculate hazard ratios (HRs) per one standard deviation increment of each respective log-transformed plasma biomarker with 95% confidence intervals (CI). RESULTS Adjusted lipoprotein-associated phospholipase A2 (Lp-PLA2) activity (HR 1.33; CI 1.17-1.52) and mass (HR 1.20; CI 1.05-1.37), C-reactive protein (CRP) (HR 1.55; CI 1.36-1.76), copeptin (HR 1.46; CI 1.19-1.80), N-terminal pro-B-type natriuretic peptide (N-BNP) (HR 1.28; 1.11-1.48), and cystatin C (HR 1.19; 95% 1.10-1.29) were associated with incident symptomatic LEAD. Adjusted N-BNP (HR 1.59; CI 1.20-2.11), mid-regional proadrenomedullin (HR 1.40; CI 1.13-1.73), cystatin C (HR 1.21; CI 1.02-1.43), and CRP (HR 1.53; CI 1.13-1.73) were associated with incident symptomatic but not asymptomatic CAS. Adjusted HR was higher for Lp-PLA2 (mass) for incident isolated AAA compared to for isolated atherosclerotic disease. CONCLUSIONS Plasma biomarker profile data support that subclinical vascular inflammation and cardiovascular stress seem to be relevant for the development of atherosclerotic disease and AAA.
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Affiliation(s)
- Stefan Acosta
- Department of Clinical Sciences, Lund University, 20213 Malmö, Sweden; (S.F.); (M.Z.); (A.G.)
- Vascular Centre, Department of Cardiothoracic and Vascular Surgery, Skåne University Hospital, Ruth Lundskogsgata 10, 20502 Malmö, Sweden
| | - Shahab Fatemi
- Department of Clinical Sciences, Lund University, 20213 Malmö, Sweden; (S.F.); (M.Z.); (A.G.)
- Vascular Centre, Department of Cardiothoracic and Vascular Surgery, Skåne University Hospital, Ruth Lundskogsgata 10, 20502 Malmö, Sweden
| | - Moncef Zarrouk
- Department of Clinical Sciences, Lund University, 20213 Malmö, Sweden; (S.F.); (M.Z.); (A.G.)
- Vascular Centre, Department of Cardiothoracic and Vascular Surgery, Skåne University Hospital, Ruth Lundskogsgata 10, 20502 Malmö, Sweden
| | - Anders Gottsäter
- Department of Clinical Sciences, Lund University, 20213 Malmö, Sweden; (S.F.); (M.Z.); (A.G.)
- Department of Internal Medicine and Emergency Medicine, Skåne University Hospital, 20502 Malmö, Sweden
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Rosário M, Fonseca AC. Update on Biomarkers Associated with Large-Artery Atherosclerosis Stroke. Biomolecules 2023; 13:1251. [PMID: 37627316 PMCID: PMC10452079 DOI: 10.3390/biom13081251] [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: 06/25/2023] [Revised: 08/03/2023] [Accepted: 08/15/2023] [Indexed: 08/27/2023] Open
Abstract
Intracranial and extracranial large-artery atherosclerosis (LAA) are a main cause of ischemic stroke. Biomarkers may aid in the diagnosis of LAA and help to stratify patients' risk of stroke. We performed a narrative review of the literature, mainly published in the last five years, with the aim of identifying biomarkers associated either with intracranial or extracranial LAA in humans. Several potential biomarkers of LAA, mainly related to lipidic pathways and inflammation, have been studied. Diagnostic biomarkers of LAA were evaluated by measuring biomarkers levels in patients with LAA stroke and other stroke etiologies. Some biomarkers were associated with the functional prognosis of LAA stroke patients. Increased levels of IL-6 and sLOX-1 were associated with a risk of progression of carotid atherosclerotic disease. Findings support the notion that the immune system plays a central role in the pathogenesis of LAA. Overall, in most studies, results were not externally validated. In the future, biomarkers could be useful for the selection of patients for clinical trials. To adopt these biomarkers in clinical practice, we will need robust multicentric studies proving their reproducibility and a clear practical applicability for their use.
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Affiliation(s)
- Madalena Rosário
- Stroke Unit, Neurology, Neuroscience Department, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, 1649-028 Lisboa, Portugal
| | - Ana Catarina Fonseca
- Stroke Unit, Neurology, Neuroscience Department, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, 1649-028 Lisboa, Portugal
- Centro de Estudos Egas Moniz, Faculdade de Medicina da Universidade de Lisboa, 1649-028 Lisboa, Portugal
- Instituto de Medicina Molecular João Lobo Antunes, 1649-028 Lisboa, Portugal
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Zhang J, Yuan T, Wei S, Feng Z, Li B, Huang H. New strategy for clinical etiologic diagnosis of acute ischemic stroke and blood biomarker discovery based on machine learning. RSC Adv 2022; 12:14716-14723. [PMID: 35702238 PMCID: PMC9109259 DOI: 10.1039/d2ra02022j] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Accepted: 05/09/2022] [Indexed: 12/02/2022] Open
Abstract
Acute ischemic stroke (AIS) is a syndrome characterized by high morbidity, prevalence, mortality, recurrence and disability. The longer the delay before proper treatment of a stroke, the greater the likelihood of brain damage and disability. Computed tomography and nuclear magnetic resonance are the primary choices for fast diagnosis of AIS in the early stage, which can provide certain information about infarction location and degree, and even the vascular distribution of lesions responsible for strokes. However, this is quite difficult to achieve in small clinics or at-home diagnoses. Hematology tests could quickly obtain a large number of pathology-related indicators, and offer an effective method for rapid AIS diagnosis when combined with the machine learning technique. To explore a reliable, predictable method for early clinical etiologic diagnosis of AIS, a retrospective study was deployed on 456 AIS patients at the early stage and 28 reference subjects without the symptoms of AIS, by means of the selected significant traits amongst 64 clinical and blood traits in conjunction with powerful machine learning strategies. Five representative biomarkers were closely related to cardioembolic (CE), 22 to large artery atherosclerosis (LAA), and 15 to small vessel occlusion (SVO) strokes, respectively. With these biomarkers, different etiologic subtypes of stroke patients were determined with high accuracy of >0.73, sensitivity of >0.73, and specificity of >0.70, which was comparable to the accuracy obtained in the emergency department by clinical diagnosis. The proposed method may offer an alternative strategy for the etiologic diagnosis of AIS at the early stage when integrating significant blood traits into machine learning. A rapid and safe strategy was proposed for clinical etiologic diagnosis of acute ischemic stroke at the early stage using clinical hematology traits and machine learning. Blood biomarkers were effectively identified.![]()
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Affiliation(s)
- Jin Zhang
- School of Public Health/Key Laboratory of Endemic and Ethnic Diseases, Ministry of Education & Key Laboratory of Medical Molecular Biology of Guizhou Province, Guizhou Medical University Guiyang 550025 China
| | - Ting Yuan
- Center for Clinical Laboratories, The Affiliated Hospital of Guizhou Medical University Guiyang 550014 China.,School of Clinical Laboratory Science, Guizhou Medical University Guiyang 550025 China
| | - Sixi Wei
- Center for Clinical Laboratories, The Affiliated Hospital of Guizhou Medical University Guiyang 550014 China.,School of Clinical Laboratory Science, Guizhou Medical University Guiyang 550025 China
| | - Zhanhui Feng
- Neurological Department, The Affiliated Hospital of Guizhou Medical University Guiyang 550014 China
| | - Boyan Li
- School of Public Health/Key Laboratory of Endemic and Ethnic Diseases, Ministry of Education & Key Laboratory of Medical Molecular Biology of Guizhou Province, Guizhou Medical University Guiyang 550025 China
| | - Hai Huang
- Center for Clinical Laboratories, The Affiliated Hospital of Guizhou Medical University Guiyang 550014 China.,School of Clinical Laboratory Science, Guizhou Medical University Guiyang 550025 China
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Fatemi S, Acosta S, Zarrouk M, Engström G, Melander O, Gottsäter A. Circulating Biomarkers Predict Symptomatic but Not Asymptomatic Carotid Artery Stenosis. Cerebrovasc Dis 2022; 51:623-629. [PMID: 35340013 DOI: 10.1159/000523839] [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: 12/06/2021] [Accepted: 02/15/2022] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Subjects exposed to risk factors such as age, gender, hypertension, diabetes mellitus, and smoking are prone to atherosclerotic events. AIMS The main aim of this longitudinal cohort study was to determine whether the role of novel plasma biomarkers for atherosclerotic carotid artery disease is different in subjects developing symptomatic carotid artery stenosis (CAS), as opposed to those with incident asymptomatic CAS. METHODS The following biomarkers were measured in 5,550 middle-aged subjects in a population-based cohort study: C-reactive protein (CRP), lipoprotein-associated phospholipase A2 mass and activity, proneurotensin, midregional proadrenomedullin (MR-proADM), midregional proatrial natriuretic peptide (MR-proANP), N-terminal pro-B-type natriuretic peptide (NT pro-BNP), copeptin, and cystatin C. After exclusion of those with prevalent CAS, subjects were thereafter followed in national patient registers for 23.4 (interquartile range 19.5-24.3) years regarding incident symptomatic and asymptomatic CAS. RESULTS Among 110 patients with confirmed incident CAS, 56 were symptomatic and 54 were asymptomatic. When including conventional risk markers in a Cox regression analysis, NT pro-BNP (hazard ratio [HR] 1.59; 95% confidence interval [CI]: 1.20-2.11), MR-proADM (HR 1.40; CI: 1.13-1.73), cystatin C (HR 1.21; CI: 1.02-1.43), and CRP (HR 1.53; CI: 1.13-1.73) were independently associated with incident symptomatic CAS, whereas no plasma biomarker was associated with incident asymptomatic CAS. CONCLUSION Plasma biomarkers NT pro-BNP, MR-proADM, cystatin C, and CRP were independently associated with incident symptomatic CAS, whereas no such association could be demonstrated with incident asymptomatic CAS. As these biomarkers indicate future development of clinically relevant atherosclerotic CAS, their potential utility in relation to intensified preventive measures and selection of potential candidates for carotid surgery should be further evaluated.
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Affiliation(s)
- Shahab Fatemi
- Department of Clinical Sciences, Lund University, Malmö, Sweden.,Department of Internal and Emergency Medicine and Skåne University Hospital, Malmö, Sweden
| | - Stefan Acosta
- Department of Clinical Sciences, Lund University, Malmö, Sweden.,Vascular Centre, Department of Cardiothoracic and Vascular Surgery, Skåne University Hospital, Malmö, Sweden
| | - Moncef Zarrouk
- Department of Clinical Sciences, Lund University, Malmö, Sweden.,Vascular Centre, Department of Cardiothoracic and Vascular Surgery, Skåne University Hospital, Malmö, Sweden
| | - Gunnar Engström
- Department of Clinical Sciences, Lund University, Malmö, Sweden.,Department of Internal and Emergency Medicine and Skåne University Hospital, Malmö, Sweden
| | - Olle Melander
- Department of Clinical Sciences, Lund University, Malmö, Sweden.,Department of Internal and Emergency Medicine and Skåne University Hospital, Malmö, Sweden
| | - Anders Gottsäter
- Department of Clinical Sciences, Lund University, Malmö, Sweden.,Department of Internal and Emergency Medicine and Skåne University Hospital, Malmö, Sweden
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Jia Y, Liu X, Zhang L, Kong X, Chen S, Zhang L, Wang J, Shu S, Liu J, Fu X, Liu D, Wang J, Shi H. Integrated head and neck imaging of symptomatic patients with stroke using simultaneous non-contrast cardiovascular magnetic resonance angiography and intraplaque hemorrhage imaging as compared with digital subtraction angiography. J Cardiovasc Magn Reson 2022; 24:19. [PMID: 35307027 PMCID: PMC8935695 DOI: 10.1186/s12968-022-00849-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 02/17/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Both stenosis rate and intraplaque hemorrhage (IPH) are important predictors of stroke risk. Simultaneous non-contrast angiography and intraplaque hemorrhage (SNAP) cardiovascular magnetic resonance (CMR) imaging can detect both stenosis rate and IPH. We aimed to evaluate consistency between SNAP and digital subtraction angiography (DSA) to assess symptomatic patients with stroke and explore the performance of SNAP to identify IPH and the clinical factors associated with IPH. METHODS Eighty-one symptomatic patients with stroke, admitted to Wuhan Union Hospital who underwent CMR high-resolution vessel wall imaging (HR-VWI) and SNAP, were retrospectively identified. For patients who received interventional therapy, the imaging functions of SNAP and HR-VWI were compared with DSA. The diameters of the intracranial and carotid vessels were measured, and stenotic vessels were identified. The consistency of SNAP and HR-VWI in identifying IPH was also examined, and the correlations between IPH and clinical factors were analyzed. RESULTS SNAP was more consistent with DSA than HR-VWI in measuring vascular stenosis (intraclass correlation coefficient [ICC]SNAP-DSA = 0.917, ICC HR-VWI-DSA = 0.878). Regarding the diameter measurements of each intracranial and carotid vessel segment, SNAP was superior or similar to HR-VWI, and both were consistent with DSA in the measurement of major intracranial vascular segments. HR-VWI and SNAP exhibited acceptable agreement in identifying IPH (Kappa = 0.839, 95% confidence interval [CI]: 0.704-0.974). Patients who underwent interventional therapy had a higher plaque burden (P < 0.001). Patients with IPH had lower levels of high-density lipoprotein cholesterol (HDL) (P = 0.038) and higher levels of blood glucose (P = 0.007) and cystatin C (P = 0.040). CONCLUSIONS CMR SNAP is consistent with DSA in measuring vessel diameters and identifying atherosclerosis stenosis in each intracranial and carotid vessel segment. SNAP is also a potential alternative to HR-VWI in identifying stenosis and IPH.
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Affiliation(s)
- Yuxi Jia
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan, 430022, China
| | - Xiaoming Liu
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan, 430022, China
| | - Lan Zhang
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan, 430022, China
| | - Xiangchuang Kong
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan, 430022, China
| | - Shuo Chen
- Center for Biomedical Imaging Research, Tsinghua University School of Medicine, Haidian District, Beijing, China
| | - Lei Zhang
- Department of Neurology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Jiazheng Wang
- Clinical & Technical Solutions, Philips Healthcare, Beijing, China
| | - Shenglei Shu
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan, 430022, China
| | - Jia Liu
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan, 430022, China
| | - Xiaona Fu
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan, 430022, China
| | - Dingxi Liu
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan, 430022, China
| | - Jing Wang
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China.
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan, 430022, China.
| | - Heshui Shi
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China.
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan, 430022, China.
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Yan X, Chen H, Shang XL. Association between serum cystatin C level and post-stroke cognitive impairment in patients with acute mild ischemic stroke. Brain Behav 2022; 12:e2519. [PMID: 35148465 PMCID: PMC8933790 DOI: 10.1002/brb3.2519] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Revised: 12/19/2021] [Accepted: 01/24/2022] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Mild ischemic stroke (MIS) has been proved to be closely related to post-stroke cognitive impairment (PSCI). However, there are relatively few studies on the risk factors of MIS. We aimed to evaluate the relationship between serum cystatin C (CysC) level and cognitive function in patients with acute MIS. METHODS Four hundred consecutive patients with acute MIS were screened and 281 patients were eligible for this study. The serum CysC levels were detected within 24 h after admission. Cognitive function was assessed by Montreal Cognitive Assessment (MoCA) at 3 months after acute MIS. Logistic regression was used to identify the predictors of PSCI, and the receiver operating characteristic (ROC) curve was applied to explore the optimal cut-off value. RESULTS One hundred sixty-four (58.4%) patients were diagnosed with PSCI at 3 months follow-up. The serum CysC levels in patients with PSCI were significantly higher than patients without PSCI (p < .001). The binary logistic regression analysis showed that higher serum CysC level was an independent predictor for PSCI at 3 months (odds ratio [OR], 5.745; 95% confidence interval, [CI], 1.089-30.311; p = 0.039). The ROC curve showed that area under the curve (AUC) was 0.723, and at a 0.945 mg/l CysC cut-off point, the sensitivity and specificity for PSCI at 3 months were 79.9% and 58.1%, respectively. CONCLUSION Our findings suggested that the serum CysC levels were increased after acute MIS, and higher serum CysC levels at baseline might be an independent risk factor for PSCI in patients with acute MIS, but further research are warranted.
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Affiliation(s)
- Xu Yan
- Department of Neurology, The First Affiliated Hospital of China Medical University and The First people's Hospital of Shenyang., Shenyang, China.,Department of Neurology, The First people's Hospital of Shenyang, Shenyang, China
| | - Huan Chen
- Department of Neurology, The Fourth Affiliated Hospital of China Medical University, Shenyang, China
| | - Xiu-Li Shang
- Department of Neurology, The First Affiliated Hospital of China Medical University and The First people's Hospital of Shenyang., Shenyang, China
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Simsek Z, Alizade E, Güner A, Zehir R. Correlation between serum sortilin levels and severity of extracranial carotid artery stenosis. Int J Clin Pract 2021; 75:e14733. [PMID: 34387924 DOI: 10.1111/ijcp.14733] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2021] [Accepted: 08/10/2021] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVE Atherosclerosis is a chronic inflammatory vascular condition characterised by intimal thickening with cholesterol accumulation and macrophage foam cell infiltration causing plaque formation at the site of the injured vessel wall. This condition is a major contributor to carotid artery stenosis (CAS). Sortilin, a member of the mammalian vacuolar protein sorting 10 protein family, promotes uptake of low-density lipoprotein particles into macrophages with consequent foam cell formation independent of the low-density lipoprotein receptor, and thereby, accelerates atherosclerotic plaque formation and progression. We investigated the correlation between serum sortilin levels and the severity of extracranial CAS. MATERIALS AND METHODS The study included 149 patients who underwent carotid angiography for suspected carotid artery disease. The North American Symptomatic Carotid Endarterectomy Trial 2011 criteria were used to determine the degree of CAS. Serum sortilin concentrations were measured using the enzyme-linked immunosorbent assay. RESULTS Serum sortilin levels were significantly higher in the severe CAS than in the non-severe CAS group (2.71 ± 0.71 ng/mL vs 1.63 ± 0.57 ng/mL, P < .001). Receiver operating characteristic curve analysis showed that serum sortilin levels >1.66 ng/mL predicted severe CAS with sensitivity of 83.49% and specificity of 56.76%. CONCLUSION Current data suggest that prediction of severe CAS may serve as an atherosclerosis biomarker and significantly contribute to research on disease progression in atherosclerosis, as well as in other arterial diseases. Sortilin may be a potential therapeutic target owing to its role in the pathogenesis of atherosclerotic carotid artery disease.
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Affiliation(s)
- Zeki Simsek
- Cardiology Department, Kartal Kosuyolu Heart Research and Training Hospital, Istanbul, Turkey
| | - Elnur Alizade
- Cardiology Department, Kartal Kosuyolu Heart Research and Training Hospital, Istanbul, Turkey
| | - Ahmet Güner
- Department of Cardiology, Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - Regayip Zehir
- Cardiology Department, Kartal Kosuyolu Heart Research and Training Hospital, Istanbul, Turkey
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Fatemi S, Acosta S, Zarrouk M, Engström G, Melander O, Gottsäter A. Pro B-type Natriuretic Peptide and Midregional Proadrenomedullin are Associated with Incident Carotid Stenosis During Long Term Follow-up. J Stroke Cerebrovasc Dis 2020; 30:105403. [PMID: 33160126 DOI: 10.1016/j.jstrokecerebrovasdis.2020.105403] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Accepted: 10/08/2020] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Plasma biomarkers may be useful to detect healthy individuals at increased risk for atherosclerotic manifestations, such as carotid artery stenosis. The aim of this longitudinal cohort study was to evaluate new biomarkers in relation to C-reactive protein and conventional risk factors for carotid artery stenosis during long term follow-up METHODS: The following markers were measured in 5550 middle-aged subjects: C-reactive protein, lipoprotein-associated phospholipase A2, proneurotensin, midregional pro-adrenomedullin, midregional pro-atrial natriuretic peptide, N-terminal pro B-type natriuretic peptide, copeptin, and cystatin C. Subjects with prevalent carotid artery stenosis were excluded. Subjects were followed in national patient registers for 23.4 (interquartile range 19.5-24.3) years regarding incident carotid artery stenosis, both operated and non-operated. RESULTS When including conventional risk markers in Cox regression, N-terminal pro B-type natriuretic peptide (Hazard ratio 1.36; 95% confidence interval 1.12-1.65; p = 0.002) was independently associated with incident carotid artery stenosis, whereas there were trends for C-reactive protein (HR 1.20; 95% confidence interval 0.98-1.48; p = 0.071), and midregional pro-adrenomedullin (Hazard ratio 1.21; 95% confidence interval 0.99-1.47; p = 0.061). Midregional pro-adrenomedullin (Hazard ratio 1.30; 95% confidence interval 1.03-1.65; p = 0.029) was independently associated with incident surgery for carotid artery stenosis, whereas there was a trend for N-terminal pro B-type natriuretic peptide (Hazard ratio 1.31; 95% confidence interval 1.00-1.72; p = 0.052). CONCLUSIONS N-terminal pro B-type natriuretic peptide and midregional pro-adrenomedullin can be used as predictors for clinically detected carotid artery stenosis during long-term follow-up of healthy subjects.
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Affiliation(s)
- Shahab Fatemi
- Department of Clinical Sciences, Malmö, Sweden; Lund University, Department of Internal and Emergency Medicine, Malmö, Sweden.
| | - Stefan Acosta
- Department of Clinical Sciences, Malmö, Sweden; Vascular Centre, Department of Cardiothoracic and Vascular Surgery, Malmö, Sweden.
| | - Moncef Zarrouk
- Department of Clinical Sciences, Malmö, Sweden; Vascular Centre, Department of Cardiothoracic and Vascular Surgery, Malmö, Sweden.
| | - Gunnar Engström
- Department of Clinical Sciences, Malmö, Sweden; Lund University, Department of Internal and Emergency Medicine, Malmö, Sweden.
| | - Olle Melander
- Department of Clinical Sciences, Malmö, Sweden; Lund University, Department of Internal and Emergency Medicine, Malmö, Sweden.
| | - Anders Gottsäter
- Department of Clinical Sciences, Malmö, Sweden; Vascular Centre, Department of Cardiothoracic and Vascular Surgery, Malmö, Sweden.
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Shi J, Zhang C, Cao Y, Qu X, Liu H, You S. Prognostic Value of Cystatin C in Acute Ischemic Stroke Patients with Intravenous Thrombolysis. Curr Neurovasc Res 2020; 16:301-309. [PMID: 31490754 DOI: 10.2174/1567202616666190906110204] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Revised: 07/15/2019] [Accepted: 07/22/2019] [Indexed: 01/13/2023]
Abstract
BACKGROUND Less is known about the prognostic value of serum cystatin C in acute ischemic stroke (AIS) patients treated with intravenous thrombolysis (IVT). The aim of the present study was to examine the association between serum cystatin C levels and prognosis of AIS patients after IVT. METHODS Serum cystatin C was measured within 24 hours after recombinant tissue plasminogen activator (rt-PA) treatment in 280 consecutively recruited patients with AIS. The main outcomes included combination of death and major disability, death, major disability (modified Rankin Scale score 3-5) and vascular events at 3-month follow-up. RESULTS During the 3-month follow-up, 94 patients (33.6%) experienced death or major disability (28 deaths and 66 major disability) and 49 patients (17.5%) experienced vascular events. After multivariate adjustment, serum cystatin C was significantly associated with an increased risk of the combined outcome of death and major disability (OR=4.51, P = 0.006). Adding serum cystatin C quartiles to a model containing conventional risk factors improved the predictive power for the combined outcome of death and major disability (continuous net reclassification index 43.88%, P < 0.001; categorical net reclassification index 9.15%, P = 0.013; integrated discrimination improvement 2.31%, P = 0.025). Similar phenomena were also observed in major disability and vascular events. CONCLUSION Higher levels of serum cystatin C in AIS patients after IVT were independently associated with increased risks of poor functional outcomes and vascular events, especially combining conventional risk factors, suggesting that serum cystatin C might improve risk prediction for poor prognosis in AIS patients receiving rt-PA treatment.
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Affiliation(s)
- Jijun Shi
- Department of Neurology, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Chunyuan Zhang
- Department of Neurology, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Yongjun Cao
- Department of Neurology, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Xinyuan Qu
- Department of Epidemiology, School of Public Health, Medical College of Soochow University, Suzhou, China
| | - Huihui Liu
- Department of Neurology, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Shoujiang You
- Department of Neurology, The Second Affiliated Hospital of Soochow University, Suzhou, China
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Hao Q, Gottesman RF, Qiao Y, Liu L, Sharma R, Selvin E, Matsushita K, Coresh J, Wasserman BA. Association between kidney disease measures and intracranial atherosclerosis: The ARIC study. Neurology 2020; 94:e2361-e2372. [PMID: 32303651 PMCID: PMC7357292 DOI: 10.1212/wnl.0000000000009311] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Accepted: 01/29/2020] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To test the association between reduced kidney function (assessed by estimated glomerular filtration rate [eGFR] and cystatin C [CysC]) and kidney damage (assessed by urinary albumin-to-creatinine ratio [ACR]) and intracranial atherosclerotic disease (ICAD) by high-resolution vessel wall MRI (VWMRI) in the Atherosclerosis Risk in Communities Neurocognitive Study (ARIC-NCS). METHODS We conducted a cross-sectional analysis of ARIC participants with data on kidney measures and VWMRI in 2011 to 2013. The main outcomes were presence of intracranial plaques and luminal stenosis. Multivariable models were adjusted for demographics, cardiovascular risk factors, and use of antithrombotic medications. RESULTS A total of 1,762 participants (mean ± SD age, 76.3 ± 5.3) were included. eGFR based on CysC (eGFRcysc) <60 mL/min/1.73 m2 (vs ≥60 mL/min/1.73 m2) was associated with plaque presence (adjusted odds ratio [OR] 1.29, 95% confidence interval [CI] 1.04-1.60), any detectable stenosis (adjusted OR 1.31, 95% CI 1.04-1.63), and >70% stenosis or occlusion (adjusted OR 2.15, 95% CI 1.32-3.50). Neither ACR nor CysC showed statistically significant associations with ICAD features in adjusted models. In adjusted multinomial models, participants with eGFRcysc <60 mL/min/1.73 m2 (vs ≥60 mL/min/1.73 m2) had an increased OR of 1.41 (95% CI 1.06-1.87) for having 1 plaque (vs none) but no significant increase for multiple plaques; ACR ≥30 was associated with moderate (50%-70%) stenosis (OR 2.01, 95% CI 1.14-3.55) vs absent or less than 50% stenosis. CONCLUSION In community-dwelling older adults, reduced kidney function or elevated kidney damage was associated with ICAD measured by VWMRI. This finding may help to better identify a population at high risk for ICAD.
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Affiliation(s)
- Qing Hao
- From the Department of Neurology (Q.H.), Icahn School of Medicine at Mount Sinai, New York, NY; Departments of Neurology (R.F.G.) and Radiology (Y.Q., L.L., B.A.W.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Neurology (R.S.), Yale School of Medicine, New Haven, CT; Department of Epidemiology (E.S., K.M.), Johns Hopkins Bloomberg School of Public Health; and Departments of Epidemiology (J.C.), Biostatistics(J.C.), and Medicine (J.C.), Johns Hopkins Medical Institutions, Baltimore, MD
| | - Rebecca F Gottesman
- From the Department of Neurology (Q.H.), Icahn School of Medicine at Mount Sinai, New York, NY; Departments of Neurology (R.F.G.) and Radiology (Y.Q., L.L., B.A.W.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Neurology (R.S.), Yale School of Medicine, New Haven, CT; Department of Epidemiology (E.S., K.M.), Johns Hopkins Bloomberg School of Public Health; and Departments of Epidemiology (J.C.), Biostatistics(J.C.), and Medicine (J.C.), Johns Hopkins Medical Institutions, Baltimore, MD
| | - Ye Qiao
- From the Department of Neurology (Q.H.), Icahn School of Medicine at Mount Sinai, New York, NY; Departments of Neurology (R.F.G.) and Radiology (Y.Q., L.L., B.A.W.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Neurology (R.S.), Yale School of Medicine, New Haven, CT; Department of Epidemiology (E.S., K.M.), Johns Hopkins Bloomberg School of Public Health; and Departments of Epidemiology (J.C.), Biostatistics(J.C.), and Medicine (J.C.), Johns Hopkins Medical Institutions, Baltimore, MD
| | - Li Liu
- From the Department of Neurology (Q.H.), Icahn School of Medicine at Mount Sinai, New York, NY; Departments of Neurology (R.F.G.) and Radiology (Y.Q., L.L., B.A.W.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Neurology (R.S.), Yale School of Medicine, New Haven, CT; Department of Epidemiology (E.S., K.M.), Johns Hopkins Bloomberg School of Public Health; and Departments of Epidemiology (J.C.), Biostatistics(J.C.), and Medicine (J.C.), Johns Hopkins Medical Institutions, Baltimore, MD
| | - Richa Sharma
- From the Department of Neurology (Q.H.), Icahn School of Medicine at Mount Sinai, New York, NY; Departments of Neurology (R.F.G.) and Radiology (Y.Q., L.L., B.A.W.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Neurology (R.S.), Yale School of Medicine, New Haven, CT; Department of Epidemiology (E.S., K.M.), Johns Hopkins Bloomberg School of Public Health; and Departments of Epidemiology (J.C.), Biostatistics(J.C.), and Medicine (J.C.), Johns Hopkins Medical Institutions, Baltimore, MD
| | - Elizabeth Selvin
- From the Department of Neurology (Q.H.), Icahn School of Medicine at Mount Sinai, New York, NY; Departments of Neurology (R.F.G.) and Radiology (Y.Q., L.L., B.A.W.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Neurology (R.S.), Yale School of Medicine, New Haven, CT; Department of Epidemiology (E.S., K.M.), Johns Hopkins Bloomberg School of Public Health; and Departments of Epidemiology (J.C.), Biostatistics(J.C.), and Medicine (J.C.), Johns Hopkins Medical Institutions, Baltimore, MD
| | - Kunihiro Matsushita
- From the Department of Neurology (Q.H.), Icahn School of Medicine at Mount Sinai, New York, NY; Departments of Neurology (R.F.G.) and Radiology (Y.Q., L.L., B.A.W.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Neurology (R.S.), Yale School of Medicine, New Haven, CT; Department of Epidemiology (E.S., K.M.), Johns Hopkins Bloomberg School of Public Health; and Departments of Epidemiology (J.C.), Biostatistics(J.C.), and Medicine (J.C.), Johns Hopkins Medical Institutions, Baltimore, MD
| | - Josef Coresh
- From the Department of Neurology (Q.H.), Icahn School of Medicine at Mount Sinai, New York, NY; Departments of Neurology (R.F.G.) and Radiology (Y.Q., L.L., B.A.W.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Neurology (R.S.), Yale School of Medicine, New Haven, CT; Department of Epidemiology (E.S., K.M.), Johns Hopkins Bloomberg School of Public Health; and Departments of Epidemiology (J.C.), Biostatistics(J.C.), and Medicine (J.C.), Johns Hopkins Medical Institutions, Baltimore, MD
| | - Bruce A Wasserman
- From the Department of Neurology (Q.H.), Icahn School of Medicine at Mount Sinai, New York, NY; Departments of Neurology (R.F.G.) and Radiology (Y.Q., L.L., B.A.W.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Neurology (R.S.), Yale School of Medicine, New Haven, CT; Department of Epidemiology (E.S., K.M.), Johns Hopkins Bloomberg School of Public Health; and Departments of Epidemiology (J.C.), Biostatistics(J.C.), and Medicine (J.C.), Johns Hopkins Medical Institutions, Baltimore, MD.
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11
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Ren J, Dong X, Nao J. Serum cystatin C is associated with carotid atherosclerosis in patients with acute ischemic stroke. Neurol Sci 2020; 41:2793-2800. [PMID: 32281037 DOI: 10.1007/s10072-020-04383-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Accepted: 03/28/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Accumulating studies have shown that cystatin C may play important roles in the pathogenesis of arteriosclerosis. However, the association between serum cystatin C and the characteristics of carotid plaques has not been elucidated. Furthermore, the diagnostic value of serum cystatin C in carotid stenosis has not been studied. METHODS Serum cystatin C in 156 patients with acute ischemic stroke (AIS) in the carotid artery was measured by ELISA. Intima-media thickness (IMT), stenosis of the symptomatic common carotid artery (CCA), extra/intracranial internal carotid artery (ICA) stenosis, and plaque characteristics were measured and recorded. Receiver operating characteristic (ROC) curves were used to assess the diagnostic value of serum cystatin C in carotid stenosis. RESULTS One hundred fifty-six patients were divided into two groups based on their cystatin C levels. The degree of arteriosclerosis, the severity of plaques, and stenosis of the symptomatic CCA were significantly higher in the patients with high cystatin C levels. In addition, the rate of unstable plaques was significantly higher in those with high cystatin C. Serum cystatin C levels of 1.075 and 1.125 mg/L had diagnostic value in distinguishing stenosis of CCA and extracranial ICA, respectively. CONCLUSIONS Higher cystatin C levels were strongly correlated with symptomatic CCA stenosis and the rate of unstable plaques. Analysis of cystatin C levels may be useful for the identification of CCA stenosis and extracranial ICA in patients with AIS.
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Affiliation(s)
- Jing Ren
- Department of Neurology, Shengjing Hospital of China Medical University, 36 Sanhao Street, Heping District, Shenyang, 110004, Liaoning, People's Republic of China
| | - Xiaoyu Dong
- Department of Neurology, Shengjing Hospital of China Medical University, 36 Sanhao Street, Heping District, Shenyang, 110004, Liaoning, People's Republic of China
| | - Jianfei Nao
- Department of Neurology, Shengjing Hospital of China Medical University, 36 Sanhao Street, Heping District, Shenyang, 110004, Liaoning, People's Republic of China.
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12
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Zaki MA, Atty SA, Aboul fotouh AM, Wahdan NS. Cystatin C as a predictor for carotid artery steno-occlusive disease in non-cardioembolic ischemic stroke. THE EGYPTIAN JOURNAL OF NEUROLOGY, PSYCHIATRY AND NEUROSURGERY 2019. [DOI: 10.1186/s41983-019-0096-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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13
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Clinical Usefulness of the Serum Cystatin C Levels in Patients with Transient Ischemic Attack. Neurotox Res 2019; 36:645-652. [DOI: 10.1007/s12640-019-00082-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Revised: 05/31/2019] [Accepted: 06/21/2019] [Indexed: 12/09/2022]
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14
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Ji R, Yu K, Li G, Liu X, Yan Y, Gao S, Yang H, Qin S, Li F, Zhang G, Yang B, He Y, Zhao Y, Li E, Xu L, Zhang N, Fan D, Liu D. ECAS progression score: a web-based model to predict progression of extracranial carotid artery stenosis. Neurol Res 2019; 41:456-465. [PMID: 30759062 DOI: 10.1080/01616412.2019.1576375] [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: 10/27/2022]
Abstract
BACKGROUND AND PURPOSE To develop and validate a risk model (Extracranial Carotid Artery Stenosis progression score, ECAS-PS) and to predict risk of ECAS progression. METHODS The ECAS-PS was developed based on the Renqiu Stroke Screening Study (RSSS), in which eligible participants were randomly divided into derivation (60%) and validation (40%) cohorts. ECAS at baseline and follow-up was diagosed by carotid duplex ultrasound according to the published criteria. ECAS progression was defined as an increase in ECAS to≥50% for those with a baseline of <50% or as an increase to a higher category of stenosis if the baseline stenosis was ≥50%. Independent predictors of ECAS progression were obtained using multivariable logistic regression. The area under the receiver operating characteristic curve (AUROC) and the Hosmer-Lemeshow test were used to assess model discrimination and calibration. RESULTS A total of 4111 participants were included and the mean age was 64.3. A total number of 29 (0.7%), 24 (0.6%) and 48 (1.2%) patients progressed during 2-year follow-up for left, right and bilateral (either left or right) carotid artery, respectively. The ECAS-PS was developed from a set of predictors of ECAS progression. The ECAS-PS demonstrated good discrimination in both the derivation and validation cohorts (AUROC range: 0.824-0.917). The Hosmer-Lemeshow tests of ECAS progression score were not significant in the derivation and validation cohorts (all P > 0.05). CONCLUSION The ECAS progression score is a valid model for predicting the risk of ECAS progression. Further validation of the ECAS-PS in different populations and larger samples is warranted.
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Affiliation(s)
- Ruijun Ji
- a Department of Neurology, Tiantan Hospital , Capital Medical University , Beijing , China.,b Department of rehabilitation medicine (Neurorehabilitation), Tiantan Hospital , Capital Medical University , Beijing , China.,c China National Clinical Research Center for Neurological Diseases , Beijing , China.,d Center of Stroke , Beijing Institute for Brain Disorders , Beijing , China.,e Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease , Beijing , China.,f Beijing Key Laboratory of Brain Function Reconstruction , Beijing , China
| | - Kai Yu
- g Department of Neurology , Kangji Hospital , Hebei , China
| | - Guoyang Li
- a Department of Neurology, Tiantan Hospital , Capital Medical University , Beijing , China.,b Department of rehabilitation medicine (Neurorehabilitation), Tiantan Hospital , Capital Medical University , Beijing , China.,c China National Clinical Research Center for Neurological Diseases , Beijing , China.,d Center of Stroke , Beijing Institute for Brain Disorders , Beijing , China.,e Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease , Beijing , China.,f Beijing Key Laboratory of Brain Function Reconstruction , Beijing , China
| | - Xinyu Liu
- a Department of Neurology, Tiantan Hospital , Capital Medical University , Beijing , China.,b Department of rehabilitation medicine (Neurorehabilitation), Tiantan Hospital , Capital Medical University , Beijing , China.,c China National Clinical Research Center for Neurological Diseases , Beijing , China.,d Center of Stroke , Beijing Institute for Brain Disorders , Beijing , China.,e Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease , Beijing , China.,f Beijing Key Laboratory of Brain Function Reconstruction , Beijing , China
| | - Yinglin Yan
- g Department of Neurology , Kangji Hospital , Hebei , China
| | - Suying Gao
- g Department of Neurology , Kangji Hospital , Hebei , China
| | - Hongna Yang
- g Department of Neurology , Kangji Hospital , Hebei , China
| | - Shangmin Qin
- h Department of Ultrasonography , Kangji Hospital , Hebei , China
| | - Fang Li
- g Department of Neurology , Kangji Hospital , Hebei , China
| | - Guangbo Zhang
- g Department of Neurology , Kangji Hospital , Hebei , China
| | - Bo Yang
- i Department of Cardiology , Kangji Hospital , Hebei , China
| | - Yan He
- j Department of Endocrinology , Kangji Hospital , Hebei , China
| | - Yongna Zhao
- g Department of Neurology , Kangji Hospital , Hebei , China
| | - Enjing Li
- i Department of Cardiology , Kangji Hospital , Hebei , China
| | - Lihua Xu
- g Department of Neurology , Kangji Hospital , Hebei , China
| | - Na Zhang
- g Department of Neurology , Kangji Hospital , Hebei , China
| | - Dongna Fan
- i Department of Cardiology , Kangji Hospital , Hebei , China
| | - Dongliang Liu
- i Department of Cardiology , Kangji Hospital , Hebei , China
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15
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Osaka T, Hamaguchi M, Hashimoto Y, Ushigome E, Tanaka M, Yamazaki M, Fukui M. Decreased the creatinine to cystatin C ratio is a surrogate marker of sarcopenia in patients with type 2 diabetes. Diabetes Res Clin Pract 2018; 139:52-58. [PMID: 29496508 DOI: 10.1016/j.diabres.2018.02.025] [Citation(s) in RCA: 109] [Impact Index Per Article: 18.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2017] [Revised: 01/28/2018] [Accepted: 02/16/2018] [Indexed: 12/13/2022]
Abstract
AIMS Sarcopenia has recently been shown to affect quality of life and mortality in patients with diabetes. However, early detection requires an expensive equipment. We hypothesized that the ratio of the creatinine/cystatin (Cre/CysC) could be used as a marker for sarcopenia. METHODS We investigated the association between the Cre/CysC ratio and sarcopenia in a cross-sectional study of patients with type 2 diabetes. Skeletal muscle mass (SMM) was estimated by bioelectrical impedance. The skeletal muscle index (SMI) was defined as the appendicular SMM divided by the square of the height. Sarcopenia was defined with SMI and a grip strength. RESULTS We identified 285 patients with type 2 diabetes, of whom 25 (8.8%) had sarcopenia. The Cre/CysC ratio was associated with an increased risk of sarcopenia [odds ratio per 0.01 increment, 1.05; 95% confidence interval (CI), 1.01-1.09] after adjusting for covariates. Receiver operating characteristic curve analysis indicated that the optimal the Cre/CysC ratio cut-off point for identifying sarcopenia was 0.9, with an area under the curve, sensitivity, and specificity of 0.683 (95% CI, 0.573-0.793), 0.80, and 0.48, respectively. CONCLUSIONS We recommend the Cre/CysC ratio as a practical screening marker for sarcopenia in patients with type 2 diabetes.
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Affiliation(s)
- Takafumi Osaka
- Department of Endocrinology and Metabolism, Kyoto Prefectural University of Medicine, Graduate School of Medical Science, 465 Kajii-cho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto 602-8566, Japan
| | - Masahide Hamaguchi
- Department of Endocrinology and Metabolism, Kameoka Municipal Hospital, 1-1 Shinoda Shino-cho, Kaweoka, Kyoto 621-8585, Japan
| | - Yoshitaka Hashimoto
- Department of Endocrinology and Metabolism, Kyoto Prefectural University of Medicine, Graduate School of Medical Science, 465 Kajii-cho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto 602-8566, Japan
| | - Emi Ushigome
- Department of Endocrinology and Metabolism, Kyoto Prefectural University of Medicine, Graduate School of Medical Science, 465 Kajii-cho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto 602-8566, Japan
| | - Muhei Tanaka
- Department of Endocrinology and Metabolism, Kyoto Prefectural University of Medicine, Graduate School of Medical Science, 465 Kajii-cho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto 602-8566, Japan
| | - Masahiro Yamazaki
- Department of Endocrinology and Metabolism, Kyoto Prefectural University of Medicine, Graduate School of Medical Science, 465 Kajii-cho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto 602-8566, Japan
| | - Michiaki Fukui
- Department of Endocrinology and Metabolism, Kyoto Prefectural University of Medicine, Graduate School of Medical Science, 465 Kajii-cho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto 602-8566, Japan.
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16
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Yan Y, Gao S, Yang H, Qin S, Li F, Zhang G, Yang B, He Y, Zhao Y, Li E, Xu L, Zhang N, Fan D, Liu D, Yu K, Ji R. ECAS score: a web-based risk model to predict moderate and severe extracranial carotid artery stenosis. Neurol Res 2018; 40:249-257. [PMID: 29392984 DOI: 10.1080/01616412.2018.1431592] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Background and purpose To develop and validate a risk model (Extracranial Carotid Artery Stenosis score, ECAS score) to predict moderate and severe ECAS. Furthermore, we compared discrimination of the ECAS score and three existing models with regard to both moderate and severe ECAS. Methods The ECAS score was developed based on the Renqiu Stroke Screening Study (RSSS), in which eligible patients were randomly divided into derivation (60%) and validation (40%) cohorts. ECAS was diagnosed by carotid duplex ultrasound according to the published criteria. Independent predictors of moderate (≥50%) and severe (≥70%) ECAS were obtained using multivariable logistic regression. The area under the receiver operating characteristic curve (AUROC) and the Hosmer-Lemeshow test were used to assess model discrimination and calibration. Results A total of 5010 participants were included and the mean age was 64.3. The proportion of ECAS of < 50%, 50-69%, 70-99% and occlusion was 4.4, 0.5, 0.4, and 0.4%, respectively. The ECAS score was developed from sets of predictors of moderate and severe ECAS. The ECAS score demonstrated good discrimination in the derivation and validation cohorts (AUROC range: 0.785-0.846). The Hosmer-Lemeshow tests of ECAS score for moderate and severe ECAS were not significant in the derivation and validation cohorts (all P > 0.05). When compared to the three existing models, the ECAS score showed significantly better discrimination for both moderate and severe ECAS (all P < 0.001). Conclusion The ECAS score is a valid model for predicting moderate and severe ECAS. Further validation of the ECAS score in different populations and larger samples is warranted.
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Affiliation(s)
- Yinglin Yan
- a Department of Neurology , Kangji Hospital , Hebei province , China
| | - Suying Gao
- a Department of Neurology , Kangji Hospital , Hebei province , China
| | - Hongna Yang
- a Department of Neurology , Kangji Hospital , Hebei province , China
| | - Shangmin Qin
- b Department of Ultrasonography , Kangji Hospital , Hebei province , China
| | - Fang Li
- a Department of Neurology , Kangji Hospital , Hebei province , China
| | - Guangbo Zhang
- a Department of Neurology , Kangji Hospital , Hebei province , China
| | - Bo Yang
- c Department of Cardiology , Kangji Hospital , Hebei province , China
| | - Yan He
- d Department of Endocrinology , Kangji Hospital , Hebei province , China
| | - Yongna Zhao
- a Department of Neurology , Kangji Hospital , Hebei province , China
| | - Enjing Li
- c Department of Cardiology , Kangji Hospital , Hebei province , China
| | - Lihua Xu
- a Department of Neurology , Kangji Hospital , Hebei province , China
| | - Na Zhang
- a Department of Neurology , Kangji Hospital , Hebei province , China
| | - Dongna Fan
- c Department of Cardiology , Kangji Hospital , Hebei province , China
| | - Dongliang Liu
- c Department of Cardiology , Kangji Hospital , Hebei province , China
| | - Kai Yu
- a Department of Neurology , Kangji Hospital , Hebei province , China
| | - Ruijun Ji
- e Department of Neurology , Tiantan Hospital, Capital Medical University , Beijing , China.,f China National Clinical Research Center for Neurological Diseases , Beijing , China.,g Center of Stroke , Beijing Institute for Brain Disorders , Beijing , China.,h Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease , Beijing Municipal Science and Technology Commission , Beijing , China.,i Beijing Key Laboratory of Brain Function Reconstruction , Beijing Municipal Science and Technology Commission , Beijing , China
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Xu Z, Leng C, Yang B, Wang H, Sun J, Liu Z, Yang L, Ge W, Zhu J. Serum cystatin C is associated with large cerebral artery stenosis in acute ischemic stroke. Oncotarget 2017; 8:67181-67188. [PMID: 28978025 PMCID: PMC5620165 DOI: 10.18632/oncotarget.18061] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2017] [Accepted: 04/19/2017] [Indexed: 01/08/2023] Open
Abstract
Large cerebral artery stenosis is a major cause of acute ischemic stroke (AIS); however, the correlation between serum cystatin C (CysC) and the stenosis of large cerebral arteries in patients with AIS has not been established. We performed a retrospective review of acute ischemic stroke patients, who were examined by cerebral digital subtraction angiography(DSA). Participants (252 cases) included 131 patients without stenosis and 121 patients with large cerebral artery stenosis. Serum CysC levels in patients with large cerebral artery stenosis were much higher than that of control subjects (p<0.001). However, serum CysC levels were not related to the location of stenosis. Further, logistic regression analyses showed that increased serum CysC was an independent risk factor of large cerebral artery stenosis in patients with acute ischemic stroke. Total participants were subdivided into quintiles based on serum CysC levels. Compared with the first quintile, the odds ratios of risk for large cerebral artery stenosis in the fourth and the fifth quintile were 1.26 (p<0.05) and 4.71(p<0.05) respectively, after the adjustment for age, sex, and smoking, hypertension, type 2 diabetes mellitus(DM), dyslipidemia, creatinine(Cr), urea, uric acid, and C reactive protein(CRP). Therefore, a significant positive correlation was observed between elevated serum CysC levels and large cerebral artery stenosis in patients with acute ischemic stroke. In summary, our findings provide new insights into the correlation between increased serum CysC and large cerebral artery stenosis in patients with acute ischemic stroke.
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Affiliation(s)
- Zhiqiang Xu
- Department of Neurology, The Second Affiliated Hospital of Soochow University, Suzhou City, Jiangsu, China
| | - Cuihua Leng
- Department of Neurology, The Second Affiliated Hospital of Soochow University, Suzhou City, Jiangsu, China
| | - Bo Yang
- Department of Neurology, The Second Affiliated Hospital of Soochow University, Suzhou City, Jiangsu, China
| | - Haili Wang
- Department of Neurology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou City, Jiangsu, China
| | - Jing Sun
- Department of Neurology, The Second Affiliated Hospital of Soochow University, Suzhou City, Jiangsu, China
| | - Zhaoxia Liu
- Department of Neurology, The Second Affiliated Hospital of Soochow University, Suzhou City, Jiangsu, China
| | - Lingli Yang
- Department of Neurology, The Second Affiliated Hospital of Soochow University, Suzhou City, Jiangsu, China
| | - Wei Ge
- Department of Neurology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou City, Jiangsu, China
| | - Jiangtao Zhu
- Department of Radiology, The Second Affiliated Hospital of Soochow University, Suzhou City, Jiangsu, China
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Yang S, Cai J, Lu R, Wu J, Zhang M, Zhou X. Association Between Serum Cystatin C Level and Total Magnetic Resonance Imaging Burden of Cerebral Small Vessel Disease in Patients With Acute Lacunar Stroke. J Stroke Cerebrovasc Dis 2016; 26:186-191. [PMID: 27727072 DOI: 10.1016/j.jstrokecerebrovasdis.2016.09.007] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2016] [Revised: 08/24/2016] [Accepted: 09/03/2016] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE Chronic kidney disease (CKD) is associated with cerebral small vessel disease (cSVD). However, the relationship between serum cystatin C (CysC) level, a highly sensitive marker of impaired kidney function, and cSVD has not been fully understood. This study aimed to investigate the association between serum CysC level and total burden of cSVD on magnetic resonance imaging (MRI) in patients with acute lacunar stroke. MATERIALS AND METHODS A total of 210 patients with first-ever acute lacunar stroke occurring within 1 week after onset were included in this study. Serum CysC level, decreased estimated glomerular filtration rate (eGFR), and proteinuria were used to evaluate kidney function. The combined effect of the markers of cSVD on MRI, including lacunar, white matter lesions, cerebral microbleeds, and enlarged perivascular spaces, were used to evaluate the comprehensive cSVD burden. RESULTS There is a positive association between total cSVD burden and hypertension, low eGFR level, and serum CysC level. After adjustments for potential confounders by ordinal logistic regression, elevated levels of CysC as well as impaired eGFR and the presence of proteinuria were correlated with the burden of total cSVD (odds ratio [OR] 2.633, 95% confidence interval [CI] 1.284-5.403; OR 2.442, 95% CI 1.213-4.918; and OR 2.151, 95% CI 1.162-3.983, respectively). CONCLUSIONS The elevated level of serum CysC is associated with the total burden of cSVD in patients with acute lacunar stroke independent of conventional risk factors.
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Affiliation(s)
- Song Yang
- Department of Neurology, The First People's Hospital of Changzhou, Third Affiliated Hospital of Soochow University, Changzhou 213003, China
| | - Jing Cai
- Department of Neuroscience, The First People's Hospital of Changzhou, Third Affiliated Hospital of Soochow University, Changzhou 213003, China
| | - Rulan Lu
- Department of Neurology, Laboratory of Neurological Diseases, Changzhou No. 2 People's Hospital, The Affiliated Hospital of Nanjing Medical University, Changzhou, Jiangsu Province 213003, China
| | - Jian Wu
- Department of Neurology, The First People's Hospital of Changzhou, Third Affiliated Hospital of Soochow University, Changzhou 213003, China
| | - Min Zhang
- Department of Neurology, Laboratory of Neurological Diseases, Changzhou No. 2 People's Hospital, The Affiliated Hospital of Nanjing Medical University, Changzhou, Jiangsu Province 213003, China
| | - Xianju Zhou
- Department of Neurology, Laboratory of Neurological Diseases, Changzhou No. 2 People's Hospital, The Affiliated Hospital of Nanjing Medical University, Changzhou, Jiangsu Province 213003, China.
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