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Mena L, Mengual JJ, García-Sánchez SM, Avellaneda-Gómez C, Font MÀ, Montull C, Castrillo L, Blanch P, Castellanos P, Lleixa M, Martín-Baranera M, Armario P, Gómez-Choco M. Relationship of arterial stiffness and baseline vascular burden with new lacunes and microbleeds: A longitudinal cohort study. Eur Stroke J 2024; 9:251-258. [PMID: 37873938 PMCID: PMC10916807 DOI: 10.1177/23969873231207764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Accepted: 09/28/2023] [Indexed: 10/25/2023] Open
Abstract
INTRODUCTION Arterial stiffness may have a significant impact on the development of cerebral small vessel disease (cSVD). PATIENTS AND METHODS We obtained pulse wave velocity (24-h PWV) by means of ambulatory blood pressure monitoring (ABPM) in patients with a recent small subcortical infarct (RSSI). Patients with known cardiac or arterial embolic sources were excluded. Lacunes, microbleeds, white matter hyperintensities and enlarged perivascular spaces at baseline were assessed in a brain MRI and included in a cSVD score. A follow-up MRI was obtained 2 years later and assessed for the appearance of new lacunes or microbleeds. We constructed both unadjusted and adjusted models, and subsequently selected the optimal models based on the area under the curve (AUC) of the predicted probabilities. RESULTS Ninety-two patients (mean age 67.04 years, 69.6% men) were evaluated and 25 had new lacunes or microbleeds during follow-up. There was a strong correlation between 24-h PWV and age (r = 0.942, p < 0.001). cSVD was associated with new lacunes or microbleeds when adjusted by age, 24-h PWV, NT-proBNP and hypercholesterolemia (OR 2.453, CI95% 1.381-4.358). The models exhibiting the highest discrimination, as indicated by their area under the curve (AUC) values, were as follows: 1 (AUC 0.854) - Age, cSVD score, 24-h PWV, Hypercholesterolemia; 2 (AUC 0.852) - cSVD score, 24-h PWV, Hypercholesterolemia; and 3 (AUC 0.843) - Age, cSVD score, Hypercholesterolemia. CONCLUSIONS cSVD score is a stronger predictor for cSVD progression than age or hemodynamic parameters in patients with a RSSI.
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Affiliation(s)
- Luis Mena
- Neurology Department, Complex Hospitalari Universitari Moisès Broggi, Sant Joan Despí, Spain
| | - Juan José Mengual
- Neurology Department, Complex Hospitalari Universitari Moisès Broggi, Sant Joan Despí, Spain
| | - Sonia María García-Sánchez
- Neurology Department, Complex Hospitalari Universitari Moisès Broggi, Sant Joan Despí, Spain
- Bellvitge Biomedical Research Institute (IDIBELL), L’Hospitalet de Llobregat, Spain
| | - Carla Avellaneda-Gómez
- Neurology Department, Complex Hospitalari Universitari Moisès Broggi, Sant Joan Despí, Spain
| | - Maria Àngels Font
- Neurology Department, Complex Hospitalari Universitari Moisès Broggi, Sant Joan Despí, Spain
- Bellvitge Biomedical Research Institute (IDIBELL), L’Hospitalet de Llobregat, Spain
| | - Caterina Montull
- Bellvitge Biomedical Research Institute (IDIBELL), L’Hospitalet de Llobregat, Spain
- Radiology Department, Complex Hospitalari Universitari Moisès Broggi, Sant Joan Despí, Spain
| | - Laura Castrillo
- Bellvitge Biomedical Research Institute (IDIBELL), L’Hospitalet de Llobregat, Spain
- Radiology Department, Complex Hospitalari Universitari Moisès Broggi, Sant Joan Despí, Spain
| | - Pedro Blanch
- Bellvitge Biomedical Research Institute (IDIBELL), L’Hospitalet de Llobregat, Spain
- Cardiology Department, Complex Hospitalari Universitari Moisès Broggi, Sant Joan Despí, Spain
| | - Pere Castellanos
- Internal Medicine Department, Complex Hospitalari Universitari Moisès Broggi, Sant Joan Despí, Spain
| | - Mercè Lleixa
- Neurology Department, Complex Hospitalari Universitari Moisès Broggi, Sant Joan Despí, Spain
| | - Montserrat Martín-Baranera
- Bellvitge Biomedical Research Institute (IDIBELL), L’Hospitalet de Llobregat, Spain
- Epidemiology Department, Complex Hospitalari Universitari Moisès Broggi, Sant Joan Despí, Spain
- Universitat Autónoma de Barcelona, Barcelona, Spain
| | - Pedro Armario
- Bellvitge Biomedical Research Institute (IDIBELL), L’Hospitalet de Llobregat, Spain
- Internal Medicine Department, Complex Hospitalari Universitari Moisès Broggi, Sant Joan Despí, Spain
- Universitat de Barcelona, Barcelona, Spain
| | - Manuel Gómez-Choco
- Neurology Department, Complex Hospitalari Universitari Moisès Broggi, Sant Joan Despí, Spain
- Bellvitge Biomedical Research Institute (IDIBELL), L’Hospitalet de Llobregat, Spain
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Gómez-Choco M, Mena L, Font MÀ, Mengual JJ, Garcia-Sanchez SM, Avellaneda C, Montull C, Castrillo L, Blanch P, Lleixa M, Martín-Baranera M, Armario P. NT-proBNP, cerebral small vessel disease and cardiac function in patients with a recent lacunar infarct. J Hum Hypertens 2023; 37:62-67. [PMID: 35013570 DOI: 10.1038/s41371-021-00648-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Revised: 11/23/2021] [Accepted: 12/01/2021] [Indexed: 01/31/2023]
Abstract
NT-proBNP is produced from both atria and ventricles and it is increased in patients with cardiac disease. NT-proBNP is also associated with cerebral small vessel disease(cSVD) but there are no studies that had carried out a systematic evaluation of cardiac function in this specific setting. We conducted a prospective observational study in 100 patients within 30 days after a recent lacunar infarct by means of brain MRI, 24 h ambulatory blood pressure monitoring, transthoracic echocardiography, and plasmatic NT-proBNP. Global cSVD burden was quantified using a validated visual score (0 to 4) and dichotomized into 2 groups (0-2 or 3-4). Age (73.8 vs 63.5 years) and NT-proBNP (156 vs 76 pg/ml) were increased in patients with SVD 3-4, while daytime augmentation index normalized for the heart rate of 75 bpm (AIx75) (22.5 vs 25.6%) was decreased. The proportion of patients with left atrial enlargement, left ventricular hypertrophy, or septal e' velocity <7 cm/s was not different between both groups. NT-proBNP was increased in patients with left atrial enlargement (126 vs 88 pg/ml). In multivariate analysis, age (OR 1.129 CI 95% 1.054-1.209), daytime AIx75 (OR 0.91 CI 95% 0.84-0.987,) and NT-proBNP (OR 1.007 CI 95% 1.001-1.012,) were independently associated with cSVD score 3-4. In conclusion, as well as in other patients with cSVD we found an association between NT-proBNP and cSVD. This association was independent of cardiac function.
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Affiliation(s)
- Manuel Gómez-Choco
- Neurology Department, Complex Hospitalari Moisès Broggi, Sant Joan Despí, Spain. .,Bellvitge Biomedical Research Institute (IDIBELL), Barcelona, Spain.
| | - Luis Mena
- Neurology Department, Complex Hospitalari Moisès Broggi, Sant Joan Despí, Spain
| | - Maria Àngels Font
- Neurology Department, Complex Hospitalari Moisès Broggi, Sant Joan Despí, Spain.,Bellvitge Biomedical Research Institute (IDIBELL), Barcelona, Spain
| | - Juan José Mengual
- Neurology Department, Complex Hospitalari Moisès Broggi, Sant Joan Despí, Spain
| | - Sonia Maria Garcia-Sanchez
- Neurology Department, Complex Hospitalari Moisès Broggi, Sant Joan Despí, Spain.,Bellvitge Biomedical Research Institute (IDIBELL), Barcelona, Spain
| | - Carla Avellaneda
- Neurology Department, Complex Hospitalari Moisès Broggi, Sant Joan Despí, Spain
| | - Caterina Montull
- Bellvitge Biomedical Research Institute (IDIBELL), Barcelona, Spain.,Radiology Department, Complex Hospitalari Moisès Broggi, Sant Joan Despí, Spain
| | - Laura Castrillo
- Bellvitge Biomedical Research Institute (IDIBELL), Barcelona, Spain.,Radiology Department, Complex Hospitalari Moisès Broggi, Sant Joan Despí, Spain
| | - Pedro Blanch
- Bellvitge Biomedical Research Institute (IDIBELL), Barcelona, Spain.,Cardiology Department, Complex Hospitalari Moisès Broggi, Sant Joan Despí, Spain
| | - Mercè Lleixa
- Neurology Department, Complex Hospitalari Moisès Broggi, Sant Joan Despí, Spain
| | - Montserrat Martín-Baranera
- Bellvitge Biomedical Research Institute (IDIBELL), Barcelona, Spain.,Epidemiology Department, Complex Hospitalari Moisès Broggi, Sant Joan Despí, Spain.,Universitat Autónoma de Barcelona, Barcelona, Spain
| | - Pedro Armario
- Bellvitge Biomedical Research Institute (IDIBELL), Barcelona, Spain.,Internal Medicine Department, Complex Hospitalari Moisès Broggi, Sant Joan Despí, Spain.,Universitat de Barcelona, Barcelona, Spain
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Guisado-Alonso D, Edo MC, Estrada Alarcón PV, García-Sánchez SM, Font MÀ, Mena Romo L, Marrero-González P, Mengual JJ, Castrillo L, Montull C, Corominas H, Gómez-Choco M. Progression of Large Vessel Disease in Patients With Giant Cell Arteritis-Associated Ischemic Stroke: The Role of Vascular Imaging: A Case Series. J Clin Rheumatol 2021; 27:e418-e424. [PMID: 32732523 DOI: 10.1097/rhu.0000000000001498] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Giant cell arteritis (GCA) can cause ischemic stroke (IS) due to the involvement of the internal carotid and vertebral arteries. The aim of our study is to describe the pattern of stroke recurrence in patients with GCA-related IS and the role of vascular imaging in the follow-up of these patients. METHODS We conducted an observational study of 2417 consecutive patients diagnosed with IS and admitted to our hospital from January 2012 to December 2018. We reviewed patients with GCA-related IS and the relationship of erythrocyte sedimentation rate, C-reactive protein, vascular status, and clinical course. RESULTS We found 4 patients with GCA-related IS among 2417 IS patients: 1 woman (25%); median age, 77.3 years (67-85 years). Mean follow-up was 3.6 years. Initial vascular workup showed vertebral artery stenosis in all of them and internal carotid artery stenosis in 2 patients. All patients were started on treatment with full-dose prednisone, associated with methotrexate in 2 cases. Follow-up color-coded duplex sonography disclosed progression of arterial stenoses in 3 patients who suffered a recurrent IS (days after index stroke; mean, 27.67 [SD, 10.97]) despite normal C-reactive protein and erythrocyte sedimentation rate values. CONCLUSIONS Vascular imaging, especially with color-coded duplex sonography, could play a role in the follow-up of patients with GCA-related IS and identify those patients with higher risk of recurrent stroke.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Laura Castrillo
- Radiology, Hospital de Sant Joan Despí Moisès Broggi, Consorci Sanitari Integral, Barcelona, Spain
| | - Caterina Montull
- Radiology, Hospital de Sant Joan Despí Moisès Broggi, Consorci Sanitari Integral, Barcelona, Spain
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Rudilosso S, Mena L, Esteller D, Olivera M, Mengual JJ, Montull C, Castrillo L, Urra X, Gómez-Choco M. Higher Cerebral Small Vessel Disease Burden in Patients with White Matter Recent Small Subcortical Infarcts. J Stroke Cerebrovasc Dis 2021; 30:105824. [PMID: 33906070 DOI: 10.1016/j.jstrokecerebrovasdis.2021.105824] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Revised: 02/10/2021] [Accepted: 04/04/2021] [Indexed: 02/07/2023] Open
Abstract
INTRODUCTION Recent small subcortical infarcts (RSSI) are considered an acute manifestation of cerebral small vessel disease (CSVD). We assessed whether the topography of RSSI was related to CSVD markers on magnetic resonance imaging (MRI). MATERIAL AND METHODS We screened the local registries of two independent stroke centers in Catalonia and selected patients with a symptomatic RSSI on MRI performed during admission. RSSI location was classified into brainstem, supratentorial subcortical structures (SSS), and centrum semiovale (CSO) regions. Clinical variables, including vascular risk factors, were collected. Radiological markers of CSVD on MRI were evaluated individually and by means of the global CSVD burden score. The associations between each RSSI location and CSVD markers were studied in uni- and multivariate logistic regression analysis. RESULTS Among 475 patients with RSSI, 152 (32%) had an infarct in the brainstem, 227 (48%) in SSS, and 96 (20%) in CSO region. The median CSVD burden score was 2 (IQR, 1-3). After adjusting for confounding factors, a RSSI in CSO was associated with higher periventricular and deep white matter hyperintensity scores [OR 1.64 (95% CI, 1.16-2.33), and OR 1.44 (95% CI, 1.07-1.93), respectively]. Higher CSVD burden score was positively associated with CSO [OR 1.48 (95% CI, 1.22-1.81)] and inversely associated with SSS [0.85 (95% CI, 0.72-0.99)] location after adjusting for relevant confounders. CONCLUSIONS CSO RSSI were related to a higher burden of CSVD, particularly to white matter hyperintensities, compared to other RSSI locations. The pathophysiological significance of such findings should be investigated in the future with advanced neuroimaging techniques.
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Affiliation(s)
- Salvatore Rudilosso
- Comprehensive Stroke Center, Department of Neuroscience, Hospital Clínic of Barcelona. Spain; August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain..
| | - Luis Mena
- Department of Neurology, Hospital Sant Joan Despí Moisès Broggi, Consorci Sanitari Integral, Sant Joan Despí, Spain..
| | - Diana Esteller
- Department of Neurology, Hospital Clínic of Barcelona, Spain..
| | - Marta Olivera
- Department of Neurology, Hospital Clínic of Barcelona, Spain..
| | - Juan José Mengual
- Department of Neurology, Hospital Sant Joan Despí Moisès Broggi, Consorci Sanitari Integral, Sant Joan Despí, Spain..
| | - Caterina Montull
- Department of Radiology, Hospital Sant Joan Despí Moisès Broggi, Consorci Sanitari Integral, Sant Joan Despí, Spain.
| | - Laura Castrillo
- Department of Radiology, Hospital Sant Joan Despí Moisès Broggi, Consorci Sanitari Integral, Sant Joan Despí, Spain.
| | - Xabier Urra
- Comprehensive Stroke Center, Department of Neuroscience, Hospital Clínic of Barcelona. Spain; August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain..
| | - Manuel Gómez-Choco
- Department of Neurology, Hospital Sant Joan Despí Moisès Broggi, Consorci Sanitari Integral, Sant Joan Despí, Spain.; Bellvitge Biomedical Research Institute (IDIBELL), Hospitalet de Llobregat, Spain.
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Fernández-Guarino M, Harto A, Pérez-García B, Montull C, De Las Heras E, Jaén P. Micosis fungoide en fase de placas tratada con terapia fotodinámica: resultados en 12 pacientes. Actas Dermo-Sifiliográficas 2010. [DOI: 10.1016/j.ad.2010.06.015] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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Fernández-Guarino M, Harto A, Pérez-García B, Montull C, De Las Heras E, Jaén P. [Plaque-phase mycosis fungoides treated with photodynamic therapy: results from 12 patients]. Actas Dermosifiliogr 2010; 101:785-791. [PMID: 21034709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023] Open
Abstract
BACKGROUND Recent years have seen an increase in the off-label use of photodynamic therapy for the treatment of a variety of skin diseases. Plaque-phase mycosis fungoides is among the most promising possibilities for the use of this treatment. OBJECTIVES To evaluate the treatment of plaque-phase mycosis fungoides with photodynamic therapy and compare the results obtained using fluorescence photography. MATERIALS AND METHODS We performed a prospective, descriptive, observational study. Twelve patients with 24 lesions were treated with topical methyl aminolevulinate (MAL) under an occlusive dressing for 3 h, followed by 8 min of red light (630 nm, 37 J/cm2; Aktilite). RESULTS Six patients had a complete response, 5 a partial response, and 1 did not respond to treatment. A mean of 5.7 sessions was applied and no side effects were reported. Treatment tolerance was excellent. CONCLUSIONS Photodynamic therapy with MAL appears to be a good treatment option for patients with plaque-phase mycosis fungoides with a small number of lesions.
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Affiliation(s)
- M Fernández-Guarino
- Servicio de Dermatología, Hospital Universitario Ramón y Cajal, Universidad de Alcalá, Madrid, España.
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Fernández-Guarino M, Harto A, Pérez-García B, Montull C, De Las Heras E, Jaén P. Plaque-Phase Mycosis Fungoides Treated with Photodynamic Therapy: Results from 12 Patients. Actas Dermo-Sifiliográficas (English Edition) 2010. [DOI: 10.1016/s1578-2190(10)70717-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Fernández-Guarino M, García-Morales I, Harto A, Montull C, Pérez-García B, Jaén P. Terapia fotodinámica: nuevas indicaciones. Actas Dermo-Sifiliográficas 2007. [DOI: 10.1016/s0001-7310(07)70091-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Fernández-Guarino M, García-Morales I, Harto A, Montull C, Pérez-García B, Jaén P. [Photodynamic therapy: new indications]. Actas Dermosifiliogr 2007; 98:377-95. [PMID: 17663928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/16/2023] Open
Abstract
Photodynamic therapy (PDT) is approved for the treatment of actinic keratoses, superficial and nodular basal cell carcinomas, and recently, Bowen's disease. In the last decade the advances experienced in the study of the photodynamic reaction have expanded the spectrum of application to other cutaneous diseases, neoplastic as well as inflammatory and infectious ones. The experience in psoriasis, acne, common warts and cutaneous T cell lymphoma starts to be broad and interesting, which permits to define its use in these entities. Photodynamic therapy is also been tested for a great variety of dermatoses with different photosensitizers and light sources with variable results. In this paper we review the treatment of Bowen's disease and other indications different from non melanoma skin cancer with PDT, providing our experience.
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Affiliation(s)
- M Fernández-Guarino
- Servicio de Dermatología, Hospital Universitario Ramón y Cajal, Universidad de Alcalá de Henares, Madrid, España.
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Abstract
Rhombencephalosynapsis is an unusual disorder characterised by maldevelopment of the rhombencephalon, sometimes with supratentorial midline anomalies. We report MRI findings in a 39-year-old woman, the oldest in the literature. MRI demonstrated hypoplasia of the cerebellar vermis, with fusion of the cerebellar hemispheres and abnormally oriented folia. Supratentorial anomalies were also seen.
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Affiliation(s)
- C Montull
- Hospital Clínic-CRC, Universitat de Barcelona, Servicio de Radiodiagnóstico, Spain
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Affiliation(s)
- E Sánchez Yus
- Department of Dermatology, San Carlos Hospital, Madrid, Spain
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