Alejandro Quílez

Metabolomics predicts stroke recurrence after transient ischemic attack

Objective: To discover, by using metabolomics, novel candidate biomarkers for stroke recurrence (SR) with a higher prediction power than present ones. Methods: Metabolomic analysis was performed by liquid chromatography coupled to mass spectrometry in plasma samples from an initial cohort of 131 TIA patients recruited <24 hours after the onset of symptoms. Pattern analysis and metabolomic profiling, performed by multivariate statistics, disclosed specific SR and large-artery atherosclerosis (LAA) biomarkers. The use of these methods in an independent cohort (162 subjects) confirmed the results obtained in the first cohort. Results: Metabolomics analyses could predict SR using pattern recognition methods. Low concentrations of a specific lysophosphatidylcholine (LysoPC[16:0]) were significantly associated with SR. Moreover, LysoPC(20:4) also arose as a potential SR biomarker, increasing the prediction power of age, blood pressure, clinical features, duration of symptoms, and diabetes scale (ABCD2) and LAA. Individuals who present early (<3 months) recurrence have a specific metabolomic pattern, differing from non-SR and late SR subjects. Finally, a potential LAA biomarker, LysoPC(22:6), was also described. Conclusions: The use of metabolomics in SR biomarker research improves the predictive power of conventional predictors such as ABCD2 and LAA. Moreover, pattern recognition methods allow us to discriminate not only SR patients but also early and late SR cases.

The California, ABCD, and Unified ABCD2 Risk Scores and the Presence of Acute Ischemic Lesions on Diffusion-Weighted Imaging in TIA Patients

Background and Purpose— Some clinical models, like California ABCD and unified ABCD2 scores, are now available to predict the early risk of stroke after a TIA. Despite the transitivity of symptoms, DWI identified an area of acute brain ischemia in almost half of patients. It would be interesting to know how the presence of DWI abnormalities relates to clinical risk scores to plan other prognostic variables or to recommend the performance of DWI. Methods— We prospectively studied 135 consecutive TIA patients visited by the neurologists in our institution. All patients underwent DWI (3.8±1.7 days after symptoms onset). Clinical risk scores (California, ABCD, and ABCD2) were calculated prospectively for each patient. The identification of acute ischemic lesions (positive DWI) was related to the presence of clinical features and clinical risk scores. Results— DWI were positive in 67 (49.6%) patients. After Bonferroni adjustment, elevated ABCD, ABCD2, and California scores were not associated with a positive DWI. However, some clinical symptoms such as facial palsy and motor weakness were associated with a positive DWI (P<0.001). The logistic regression model identified only facial palsy as an independent predictor of acute ischemic lesions (odds ratio 6.26, 95% CI 2.49 to 15.71, P<0.001). Conclusion— Clinical symptoms such as motor impairment, but not clinical risk scores, were associated with a positive DWI. Performing a DWI may add prognostic information to clinical risk scales as a predictor of stroke recurrence after TIA in future large studies.

Predictive value of ankle brachial index in patients with acute ischaemic stroke.

Background:  The ankle brachial index (ABI) is a known measure of lower‐limb peripheral artery disease (PAD), as well as a marker for other cardiovascular disease events.

Patterns of diffusion‐weighted magnetic resonance imaging associated with etiology improve the accuracy of prognosis after transient ischaemic attack

Objective:  Diffusion‐weighted magnetic resonance imaging (DWI) is a sensitive diagnostic tool for detecting acute ischaemic lesions in patients with transient ischaemic attacks (TIAs). The additional predictive value of DWI lesion patterns is not well known.

Contribution of High‐b‐Value Diffusion‐Weighted Imaging in Determination of Brain Ischemia in Transient Ischemic Attack Patients

High‐b‐value diffusion‐weighted imaging (DWI) (b= 2,000 and b= 3,000 second/mm2) offers theoretical advantages over DWI examinations at b= 1,000 second/mm2 for detection of acute ischemic stroke. The purpose of this study was to determine whether high‐b‐value DWI are better than b= 1,000 images in TIA patients.

N‐terminal pro‐brain natriuretic peptide level determined at different times identifies transient ischaemic attack patients with atrial fibrillation

The etiological classification of patients with transient ischaemic attack (TIA) is a difficult endeavor and the use of serum biomarkers could improve the diagnostic accuracy. The aim of this study was to correlate atrial fibrillation, the main cardioembolic etiology (CE), with different serum biomarkers measured in consecutive TIA patients.

Higher carotid intima media thickness predicts extracranial vascular events and not stroke recurrence among transient ischemic attack patients

Background Increased common carotid artery intima-media thickness has been associated with an increased risk of vascular ischemic events. We investigated the relationship between common carotid artery intima-media thickness and extracranial vascular events (coronary heart disease and peripheral arterial disease) or stroke recurrence in a cohort of transient ischemic attack patients from the REGITELL registry. Methods High-resolution B-mode ultrasonographic measurements of the common carotid artery intima-media thickness were performed in a series of 283 consecutive transient ischemic attack patients. Clinical, neuroimaging, ultrasonographic, and etiological data were collected. Patients were followed prospectively for six-months or more. Extracranial vascular events and stroke recurrence were recorded. Results Fifteen extracranial vascular events (12 coronary heart disease and three peripheral arterial disease) and 29 recurrent strokes occurred during a median follow-up period of 12·3 months. Patients who experienced extracranial vascular events had significantly (P < 0·001) higher common carotid artery intima-media thickness values (1·087 (standard deviation 0·189) mm) than subjects who were free of extracranial vascular events (0·887 (standard deviation 0·195) mm). Nevertheless, common carotid artery intima-media thickness was not found to correlate with stroke recurrence. Cox proportional hazards multivariate analyses identified hypercholesterolemia (hazard ratio 6·87, 95% confidence interval: 1·93–24·39, P = 0·003) and common carotid artery intima-media thickness >0·939 mm (hazard ratio 8·90, 95% confidence interval: 2·00–39·49, P = 0·004) as independent predictors of extracranial vascular events after transient ischemic attack. Almost one of every three patients with hypercholesterolemia and high common carotid artery intima-media thickness had extracranial vascular events. Conclusions An elevated common carotid artery intima-media thickness value was associated with a higher long-term risk of extracranial vascular events but no with stroke recurrence. Hypercholesterolemia was the main risk factor for extracranial vascular events. The combination of hypercholesterolemia and common carotid artery intima-media thickness >0·939 mm justify the establishment of aggressive therapies and the study of subclinical coronary heart disease and peripheral arterial disease.

The determination of copeptin levels helps management decisions among transient ischaemic attack patients.

Most approaches to transient ischaemic attack (TIA) triage use clinical scores and vascular imaging; however, some biomarkers have been suggested to improve the prognosis of TIA patients.

Prediction of myocardial infarction in patients with transient ischaemic attack

Determinants of risk of myocardial infarction (MI) after transient ischaemic attack (TIA) are not well defined. The aim of our study was to determine the risk and risk factors for MI after TIA.

Clinical evolution of elderly adults with ischemic stroke

We thank Ulrike Dapp, PhD, overall coordinator of the LUCAS longitudinal cohort study, who provided valuable contributions to the manuscript; Stefan Golgert, responsible for the LUCAS data management who provided the data; and Lilli Neumann for contributing and help with preparing the manuscript. Ethical approval was obtained from the Hamburg General Medical Ethics Committee (€ Arztekammer Hamburg, PV-2856) and the Data Protection Official of the City of Hamburg. Conflict of Interest: The authors declare no conflict of interest. LUCAS was supported by grants from the European Union (QLK6–1999–02205); the Federal Ministry for Family Affairs, Senior Citizens, Women and Youth (Bundesministerium f€ ur Familie, Senioren, Frauen und Jugend); the Robert Bosch Foundation; the Max und Ingeburg HerzFoundation; and the Federal Ministry for Education and Research (Bundesministerium f€ ur Bildung und Forschung; BMBF LUCAS I: 01ET0708, LUCAS II: 01ET1002A, LUCAS III/PROLONG HEALTH: 01EL1407). Author Contributions: von Renteln-Kruse von W.: planned the manuscript, is responsible for data interpretation and the first version of the manuscript. Minder C.: is responsible for data analysis and interpretation and presentation of results and contributed to revisions of the manuscript. Sponsor’s Role: The funding source had no role in the design and conduct of the study; in the collection, analyses, and interpretation of the data; or in the preparation, review, or approval of the manuscript.