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Sajeev J, Burrell LM, Dewey H, Kalman JM, Chou B, Frost T, Patel SK, Roberts L, Cooke JC, Gould M, Ngoh J, Koshy AN, Denver R, Teh AW. P5740ACE2 activity level is associated with embolic stroke of undetermined source. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz746.0680] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
ACE2 activity levels correlate with adverse left atrial remodelling in patients with atrial fibrillation (AF). Several biochemical and structural markers have been associated with embolic stroke of undetermined source (ESUS). The relationship between ACE2 activity and ESUS is unknown.
Purpose
Randomised controlled trials failed to demonstrate a clear benefit of oral anticoagulation in an unselected ESUS population. As selective use of oral anticoagulation guided by biomarker risk-profiling may benefit these patients, we evaluated the association between ACE2 activity and ESUS.
Methods
This prospective case control study compared patients with ESUS against a control group matched for vascular risk factors. ESUS was diagnosed following cerebral vascular imaging and 24 hours of cardiac monitoring to exclude AF. Blood samples were collected for measurement of ACE2 activity, D-Dimer and high sensitivity troponin T (hsTnT).
Results
A total of 51 patients in the ESUS group were compared with 47 patients in the Control group. ACE2 activity and D-Dimer levels were significantly higher in the ESUS group. There was a significant but weak positive correlation between ACE2 activity and hsTnT (r=0.20, p<0.05). Left atrial volume index (LAVI) on echocardiography was significantly higher in the ESUS group. On regression modelling adjusting for LAVI, only ACE2 activity remained significant for ESUS, with a 20% rise in odds for every 4 unit increase in ACE2 activity (OR 1.20; 95% CI: 1.01 - 1.36, p=0.04).
Participant characteristics Control (n=47) ESUS (n=51) P value Age (years) 65.65±6.78 67.20±6.89 0.26 Female gender 22 (45.8) 19 (38.0) 0.43 Hypertension 22 (45.8) 24 (48.0) 0.83 Diabetes mellitus 9 (18.8) 12 (24.0) 0.53 CHA2DS2VASc score 2 (1–3) 2 (1–3) 0.50 LA size & Biomarkers LA volume index (ml/m2) 36.5 (32.6–42.5) 39.1 (36.2–46.0) 0.04 ACE2 (pmol/ml/min) 7.24 (2.66–14.64) 10.16 (4.54–18.80) 0.04 D-Dimer (mg/L) 0.35 (0.3–0.5) 0.40 (0.30–0.60) 0.02 hsTroponin T (ng/L) 7.0 (5–10) 9.00 (6.0–13.5) 0.05 Values are expressed as mean ± standard deviation, median (IQR), or n (%).
Median ACE2 activity
Conclusion(s)
ACE2 activity is associated with ESUS independent of left atrial volume and correlate with elevated Troponin. Further studies are warranted to investigate the utility of ACE2 activity in identifying ESUS patients that may benefit from oral anticoagulation.
Acknowledgement/Funding
This study received project funding from the Eastern Health Foundation
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Affiliation(s)
- J Sajeev
- Eastern Health, Department of Cardiology, Melbourne, Australia
| | - L M Burrell
- University of Melbourne, Department of Medicine, Melbourne, Australia
| | - H Dewey
- Eastern Health, Department of Neuroscience, Melbourne, Australia
| | - J M Kalman
- Royal Melbourne Hospital, Department of Cardiology, Melbourne, Australia
| | - B Chou
- Eastern Health, Department of Cardiology, Melbourne, Australia
| | - T Frost
- Eastern Health, Department of Neuroscience, Melbourne, Australia
| | - S K Patel
- University of Melbourne, Department of Medicine, Melbourne, Australia
| | - L Roberts
- Eastern Health, Department of Cardiology, Melbourne, Australia
| | - J C Cooke
- Eastern Health, Department of Cardiology, Melbourne, Australia
| | - M Gould
- Eastern Health, Department of Cardiology, Melbourne, Australia
| | - J Ngoh
- Eastern Health, Department of Cardiology, Melbourne, Australia
| | - A N Koshy
- Austin Health Hospital, Department of Cardiology, Melbourne, Australia
| | - R Denver
- Eastern Health, Department of Cardiology, Melbourne, Australia
| | - A W Teh
- Eastern Health, Department of Cardiology, Melbourne, Australia
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MacPherson M, Sajeev J, Wong G, Kalman J, Dewey H, Koshy A, Roberts L, Cooke J, Teh A. An Elevated P Wave Terminal Force V1 is not Associated with Worsening Atrial Electroanatomic Substrate. Heart Lung Circ 2019. [DOI: 10.1016/j.hlc.2019.06.157] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Sajeev J, Burrell L, Dewey H, Kalman J, Chou B, Frost T, Patel S, Roberts L, Cooke J, Koshy A, Gould M, Ngoh J, Denver R, Teh A. Elevated Plasma Angiotensin Converting Enzyme 2 (ACE2) Activity is Associated with Embolic Stroke of Undetermined Source. Heart Lung Circ 2019. [DOI: 10.1016/j.hlc.2019.06.378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Sajeev J, Bhatia M, Dewey H, Koshy A, Roberts L, Cooke J, Denver R, Teh A. The Utility of P-Wave Terminal Force V1 is Limited by its Reliability. Heart Lung Circ 2018. [DOI: 10.1016/j.hlc.2018.06.352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Balachandran S, Valentine L, Tse G, Fanning L, Dewey H, Choi PM. Dosing accuracy of direct oral anticoagulants: the effect of an educational intervention. Intern Med J 2017. [DOI: 10.1111/imj.2_13461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- S Balachandran
- Department of Neurosciences, Box Hill Hospital; Eastern Health; Melbourne Victoria Australia
| | - L Valentine
- Department of Neurosciences, Box Hill Hospital; Eastern Health; Melbourne Victoria Australia
| | - G Tse
- Department of Neurosciences, Box Hill Hospital; Eastern Health; Melbourne Victoria Australia
| | - L Fanning
- Department of Pharmacy, Box Hill Hospital; Eastern Health; Melbourne Victoria Australia
- Eastern Health Clinical School, Faculty of Medicine, Nursing and Health Sciences; Monash University; Melbourne Victoria Australia
| | - H Dewey
- Department of Neurosciences, Box Hill Hospital; Eastern Health; Melbourne Victoria Australia
- Eastern Health Clinical School, Faculty of Medicine, Nursing and Health Sciences; Monash University; Melbourne Victoria Australia
| | - PM Choi
- Department of Neurosciences, Box Hill Hospital; Eastern Health; Melbourne Victoria Australia
- Eastern Health Clinical School, Faculty of Medicine, Nursing and Health Sciences; Monash University; Melbourne Victoria Australia
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Koshy A, Sajeev J, Cosgrave N, Tan M, Rajakariar K, Pham C, Cooke J, Dewey H, Kynt C, Roberts L, Teh A. High-Sensitivity Troponin Elevation in Ischaemic Stroke and Associated Cardiac Abnormalities. Heart Lung Circ 2017. [DOI: 10.1016/j.hlc.2017.06.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Koshy A, Sajeev J, Cosgrave N, Pham C, Rajakariar K, Tan M, Cooke J, Dewey H, Roberts L, Teh A. Admission High-Sensitivity Troponin Elevation in Thrombolysed Stroke Patients: An Early Predictor of Disability and Mortality? Heart Lung Circ 2017. [DOI: 10.1016/j.hlc.2017.06.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Di Carlo A, Lamassa M, Consoli D, Inzitari D, Gall SL, Donnan G, Dewey H, Thrift A. SEX DIFFERENCES IN PRESENTATION, SEVERITY, AND MANAGEMENT OF STROKE IN A POPULATION-BASED STUDY. Neurology 2010; 75:670-1; author reply 671. [DOI: 10.1212/wnl.0b013e3181ec68b5] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Tay-Teo K, Moodie M, Bernhardt J, Thrift A, Collier J, Donnan G, Dewey H. Economic Evaluation alongside a Phase II, Multi-Centre, Randomised Controlled Trial of Very Early Rehabilitation after Stroke (AVERT). Cerebrovasc Dis 2008; 26:475-81. [DOI: 10.1159/000155984] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2008] [Accepted: 05/19/2008] [Indexed: 11/19/2022] Open
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Dewey H, Macdonell R, Donnan G, Freeman E, Thrift A, Sharples C. Inter-rater reliability of stroke sub-type classification by neurologists and nurses within a community-based stroke incidence study. J Clin Neurosci 2001; 8:14-7. [PMID: 11320972 DOI: 10.1054/jocn.2000.0786] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [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: 11/18/2022]
Abstract
The stroke classification developed for use in the Oxfordshire Community Stroke Project (OCSP) is simple, clinically meaningful and requires no investigations. However, its inter-rater reliability in a community setting is unknown. We aimed to assess the inter-rater reliability of this classification among neurologists and nurses within a community-based stroke incidence study. Fifty-four stroke patients with cerebral infarction who were registered in the North East Melbourne Stroke Incidence Study (NEMESIS) were assigned OCSP classifications by two neurologists and one of seven research nurses. There was moderate agreement between neurologists (kappa = 0.53), fair agreement between neurologist 1 and nurse (kappa = 0.31) and moderate agreement between neurologist 2 and nurse (kappa = 0.45). Disagreement about the neurological signs was an important reason for classification differences. The OCSP classification can be easily applied in a community setting with moderate inter-rater reliability and is thus a useful instrument for commun ity-based epidemiological studies.
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Affiliation(s)
- H Dewey
- National Stroke Research Institute, Austin & Repatriation Medical Center, West Heidelberg, Vic, Australia
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Hesketh P, Caguioa P, Koh H, Dewey H, Facada A, McCaffrey R, Parker K, Nylen P, Woodworth T. Clinical activity of a cytotoxic fusion protein in the treatment of cutaneous T-cell lymphoma. J Clin Oncol 1993; 11:1682-90. [PMID: 8355035 DOI: 10.1200/jco.1993.11.9.1682] [Citation(s) in RCA: 42] [Impact Index Per Article: 1.4] [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: 01/30/2023] Open
Abstract
PURPOSE A phase I trial in patients with refractory hematologic malignancies was performed at our institution to test the clinical relevance of the selective cytotoxic activity of the interleukin-2 (IL-2)-diphtheria toxin fusion protein, DAB486IL-2. A subset of five patients from this trial, all with cutaneous T-cell lymphomas (CTCL), forms the basis of this report. PATIENTS AND METHODS Two treatment schedules were used. One patient received DAB486IL-2 at a dose of 0.075 mg/kg/d intravenous (i.v.) bolus over 15 minutes daily for 5 consecutive days. The other four patients received DAB486IL-2 at a dose of 0.1 mg/kg as an i.v. infusion over 180 minutes weekly for 5 consecutive weeks. RESULTS Three of the five CTCL patients achieved significant tumor responses. One patient attained a complete clinical and pathologic response (CR), which has been sustained without any interval treatment for 33+ months. Two other patients achieved partial responses (PRs) of 17+ and 4 months' duration, respectively. Treatment was well tolerated. The most common adverse effect was a transient increase in hepatic transaminases experienced by all five patients. CONCLUSION The growth factor-cytotoxin fusion protein DAB486IL-2 demonstrated significant clinical activity with acceptable toxicity in a group of heavily pretreated patients with CTCL.
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Affiliation(s)
- P Hesketh
- Evans Memorial Department of Clinical Research, Boston University Medical Center, MA
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