scholarly journals Serum soluble ST2 is a predictor for poor long-term prognosis after transient ischemic attack and ischemic stroke: a cohort study

2019 ◽  
Author(s):  
Xuan Tian ◽  
Yinan Guo ◽  
Xiao Wang ◽  
Lulu Pei ◽  
Xin Wang ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Adverse Events ◽  
Transient Ischemic Attack ◽  
Predictive Value ◽  
Adverse Outcomes ◽  
Soluble St2 ◽  
Logistic Regression Models ◽  
C Statistic ◽  
Kaplan Meier ◽  
Ischemic Attack

Abstract Background Soluble ST2 (sST2) is a novel inflammation marker for the prediction of adverse outcomes in patients with cardiovascular disease and diabetes mellitus. The aim of the present study was to examine the predictive value of serum sST2 for prognostic outcomes in patients with transient ischemic attack (TIA)/ischemic stroke.Methods Patients within 24 h after symptom onset were prospectively enrolled based on the TIA/ischemic stroke database of the First Affiliated Hospital of Zhengzhou University. The 1-year prognostic outcomes were composite adverse events (including ischemic and hemorrhagic stroke, myocardial infarction, and all-cause death) and a combination of major disability and death [modified Rankin Scale (mRS), 3-6]. Cox proportional hazard and logistic regression models were used to evaluate the association between serum sST2 and TIA/ischemic stroke prognosis. The C statistic, net reclassification index (NRI), and integrated discrimination index (IDI) were used to present improvement in risk classification.Results Serum sST2 levels were positively correlated with National Institutes of Health Stroke Scale (NIHSS) scores. Kaplan-Meier analysis indicated a significantly different risk in composite adverse events between patients with higher and those with lower levels of sST2 (P=0.006). Serum sST2 was an independent predictor for composite adverse events (HR: 2.517, 95% CI: 1.279-4.956, P=0.008) and major disability or death (OR: 3.126, 95% CI: 1.452-6.728, P=0.004) after multivariate adjustment. The addition of the sST2 to the NIHSS score significantly improved the predictive value for prognostic outcomes in patients with TIA/ischemic stroke (C statistic: 0.021, IDI: 1.91%, P=0.042 for composite adverse events; NRI: 32.82%, P=0.042 for major disability or death).Conclusions Serum sST2 levels were positively associated with the severity of TIA/ischemic stroke and could independently predict composite adverse events and major disability or death, indicating that sST2 may be a potential prognostic marker for TIA/ischemic stroke.

scholarly journals Serum soluble ST2 is a predictor for poor long-term prognosis after transient ischemic attack and ischemic stroke: a cohort study

2019 ◽  
Author(s):  
Xuan Tian ◽  
Yinan Guo ◽  
Xiao Wang ◽  
Lulu Pei ◽  
Xin Wang ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Adverse Events ◽  
Transient Ischemic Attack ◽  
Predictive Value ◽  
Adverse Outcomes ◽  
Soluble St2 ◽  
Logistic Regression Models ◽  
C Statistic ◽  
Kaplan Meier ◽  
Ischemic Attack

Abstract Background: Soluble ST2 (sST2) is a novel inflammation marker for the prediction of adverse outcomes in patients with cardiovascular disease and diabetes mellitus. The aim of the present study was to examine the predictive value of serum sST2 for prognostic outcomes in patients with transient ischemic attack (TIA)/ischemic stroke.Methods: Patients within 24 h after symptom onset were prospectively enrolled based on the TIA/ischemic stroke database of the First Affiliated Hospital of Zhengzhou University. The 1-year prognostic outcomes were composite adverse events (including ischemic and hemorrhagic stroke, myocardial infarction, and all-cause death) and a combination of major disability and death [modified Rankin Scale (mRS), 3-6]. Cox proportional hazard and logistic regression models were used to evaluate the association between serum sST2 and TIA/ischemic stroke prognosis. The C statistic, net reclassification index (NRI), and integrated discrimination index (IDI) were used to present improvement in risk classification.Results: Serum sST2 levels were positively correlated with National Institutes of Health Stroke Scale (NIHSS) scores. Kaplan-Meier analysis indicated a significantly different risk in composite adverse events between patients with higher and those with lower levels of sST2 ( P =0.006). Serum sST2 was an independent predictor for composite adverse events (HR: 2.517, 95% CI: 1.279-4.956, P =0.008) and major disability or death (OR: 3.126, 95% CI: 1.452-6.728, P =0.004) after multivariate adjustment. The addition of the sST2 to the NIHSS score significantly improved the predictive value for prognostic outcomes in patients with TIA/ischemic stroke (C statistic: 0.021, IDI: 1.91%, P =0.042 for composite adverse events; NRI: 32.82%, P =0.042 for major disability or death).Conclusions: Serum sST2 levels were positively associated with the severity of TIA/ischemic stroke and could independently predict composite adverse events and major disability or death, indicating that sST2 may be a potential prognostic marker for TIA/ischemic stroke.

Improving screening for vascular cognitive impairment at three to six months after mild ischemic stroke and transient ischemic attack

2014 ◽  
Vol 26 (5) ◽  
pp. 787-793 ◽  
Author(s):  
YanHong Dong ◽  
Melissa Jane Slavin ◽  
Bernard Poon-Lap Chan ◽  
Narayanaswamy Venketasubramanian ◽  
Vijay Kumar Sharma ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Cognitive Impairment ◽  
Transient Ischemic Attack ◽  
Predictive Value ◽  
Characteristic Curve ◽  
Neuropsychological Testing ◽  
Vascular Cognitive Impairment ◽  
Cognitive Domain ◽  
Speed Test ◽  
Ischemic Attack

ABSTRACTBackground:The Montreal Cognitive Assessment (MoCA) and Mini-Mental State Examination (MMSE) were compared with and without the addition of a brief processing speed test, the symbol digit modalities test (SDMT), for vascular cognitive impairment (VCI) screening at three to six months after stroke.Methods:Patients with ischemic stroke and transient ischemic attack were assessed with MoCA and MMSE, as well as a formal neuropsychological battery three to six months after stroke. VCI was defined by impairment in any cognitive domain on neuropsychological testing. The area under the receiver operating characteristic curve (AUC) was used to compare test discriminatory ability.Results:One hundred and eighty-nine patients out of 327 (58%) had VCI, of whom 180 (95%) had vascular mild cognitive impairment (VaMCI), and nine (5%) had dementia. The overall AUCs of the MoCA and MMSE scores and performance at their respective cut-off points were equivalent in detecting VCI (AUCs: 0.87 (95% CI 0.83–0.91) vs. 0.84 (95% CI 0.80–0.88), p = 0.13; cut-offs: MoCA (≤23) vs. MMSE (≤26), sensitivity: 0.78 vs. 0.71; specificity: 0.80 vs. 0.82; positive predictive value: 0.84 vs. 0.84; negative predictive value: 0.72 vs. 0.67; and correctly classified 78.6% vs. 75.5%; p = 0.42). The AUCs of MMSE and MoCA were improved significantly by the SDMT (AUCs: MMSE+SDMT 0.90 (95% CI 0.87–0.93), p <0.001; MoCA+SDMT 0.91 (95% CI 0.88–0.94), p < 0.02).Conclusions:The MoCA and MMSE are equivalent and moderately sensitive, and can be supplemented with the SDMT to improve their accuracy in VCI screening.

scholarly journals Prediction of stroke risk in patients with transient ischemic attack: ABCD score and its derived scores

2017 ◽  
Vol 5 (12) ◽  
pp. 5093
Author(s):  
Wu Xin-Tong ◽  
Chen Jin-Bo ◽  
Xu Wen-Xiang ◽  
Lu Wen-Xian
Keyword(s):  
Risk Factors ◽  
Risk Assessment ◽  
Ischemic Stroke ◽  
High Risk ◽  
Transient Ischemic Attack ◽  
Predictive Value ◽  
Stroke Risk ◽  
Ischemic Cerebrovascular Disease ◽  
Ischemic Attack ◽  
Abcd Score

Transient Ischemic Attack (TIA) is a high-risk signal of acute ischemic cerebrovascular disease, indicates a significant increase in the risk of ischemic stroke, especially within 7 days. Risk assessment and stratification are important in patient with TIA. A variety of simple prediction scales were developed based on the risk factors for stroke in patients with TIA, such as the California scale, ABCD scale, and ABCD2 scale. Among them, the ABCD scale score is used most commonly, but as its application becomes more and more common, the defects of this scale are also increasingly apparent. In recent years, some derived scales of ABCD score were introduced in order to improve the sensitivity and specificity of prediction. This article reviews the evolution, contents, characteristics, and predictive value of the ABCD score and its derived scales in the prediction of the stroke risk in patients with TIA.

scholarly journals Validation of CSR model to predict stroke risk after transient ischemic attack

2022 ◽  
Vol 12 (1) ◽  
Author(s):  
Lu Zhao ◽  
Shuang Cao ◽  
Lulu Pei ◽  
Hui Fang ◽  
Hao Liu ◽  
...  
Keyword(s):  
Transient Ischemic Attack ◽  
Predictive Value ◽  
Stroke Risk ◽  
Recurrent Stroke ◽  
Predictive Ability ◽  
Roc Curves ◽  
World Health ◽  
Stroke Recurrence ◽  
C Statistic ◽  
Ischemic Attack

AbstractIt is essential to identify high risk transient ischemic attack (TIA) patients. The previous study reported that the CSR (comprehensive stroke recurrence) model, a neuroimaging model, had a high predictive ability of recurrent stroke. The aims of this study were to validate the predictive value of CSR model in TIA patients and compare the predictive ability with ABCD3-I score. Data were analyzed from the prospective hospital-based database of patients with TIA which defined by the World Health Organization time-based criteria. The predictive outcome was stroke occurrence at 90 days. The receiver-operating characteristic (ROC) curves were plotted and the C statistics were calculated as a measure of predictive ability. Among 1186 eligible patients, the mean age was 57.28 ± 12.17 years, and 474 (40.0%) patients had positive diffusion-weighted imaging (DWI). There were 118 (9.9%) patients who had stroke within 90 days. In 1186 TIA patients, The C statistic of CSR model (0.754; 95% confidence interval [CI] 0.729–0.778) was similar with that of ABCD3-I score (0.717; 95% CI 0.691–0.743; Z = 1.400; P = 0.1616). In 474 TIA patients with positive DWI, C statistic of CSR model (0.725; 95% CI 0.683–0.765) was statistically higher than that of ABCD3-I score (0.626; 95% CI 0.581–0.670; Z = 2.294; P = 0.0245). The CSR model had good predictive value for assessing stroke risk after TIA, and it had a higher predictive value than ABCD3-I score for assessing stroke risk for TIA patients with positive DWI.

Risk factor control after ischemic stroke or transient ischemic attack

2021 ◽  
Author(s):  
Nanxiang Ouyang ◽  
Chuning Shi ◽  
Xiaofan Guo ◽  
Yihan Chen ◽  
Yingxian Sun
Keyword(s):  
Risk Factor ◽  
Ischemic Stroke ◽  
Transient Ischemic Attack ◽  
Risk Factor Control ◽  
Ischemic Attack

scholarly journals Value of Vascular and Non-Vascular Pattern on Computed Tomography Perfusion in Patients With Acute Isolated Aphasia

Stroke ◽  
2020 ◽  
Vol 51 (8) ◽  
pp. 2480-2487
Author(s):  
Salvatore Rudilosso ◽  
Alejandro Rodríguez ◽  
Sergio Amaro ◽  
Víctor Obach ◽  
Arturo Renú ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Ischemic Stroke ◽  
Clinical Outcome ◽  
Predictive Value ◽  
Brain Perfusion ◽  
Complete Recovery ◽  
Vascular Perfusion ◽  
Computed Tomography Perfusion ◽  
Stroke Mimic ◽  
Ischemic Attack

Background and Purpose: Acute onset aphasia may be due to stroke but also to other causes, which are commonly referred to as stroke mimics. We hypothesized that, in patients with acute isolated aphasia, distinct brain perfusion patterns are related to the cause and the clinical outcome. Herein, we analyzed the prognostic yield and the diagnostic usefulness of computed tomography perfusion (CTP) in patients with acute isolated aphasia. Methods: From a single-center registry, we selected a cohort of 154 patients presenting with acute isolated aphasia who had a whole-brain CTP study available. We collected the main clinical and radiological data. We categorized brain perfusion studies on CTP into vascular and nonvascular perfusion patterns and the cause of aphasia as ischemic stroke, transient ischemic attack, stroke mimic, and undetermined cause. The primary clinical outcome was the persistence of aphasia at discharge. We analyzed the sensitivity, specificity, positive and negative predictive values of perfusion patterns to predict complete clinical recovery and ischemic stroke on follow-up imaging. Results: The cause of aphasia was an ischemic stroke in 58 patients (38%), transient ischemic attack in 3 (2%), stroke mimic in 68 (44%), and undetermined in 25 (16%). CTP showed vascular and nonvascular perfusion pattern in 62 (40%) and 92 (60%) patients, respectively. Overall, complete recovery occurred in 116 patients (75%). A nonvascular perfusion pattern predicted complete recovery (sensitivity 75.9%, specificity 89.5%, positive predictive value 95.7%, and negative predictive value 54.8%), and a vascular perfusion pattern was highly predictive of ischemic stroke (sensitivity 94.8%, specificity 92.7%, positive predictive value 88.7%, and negative predictive value 96.7%). The 3 patients with ischemic stroke without a vascular perfusion pattern fully recovered at discharge. Conclusions: CTP has prognostic value in the workup of patients with acute isolated aphasia. A nonvascular pattern is associated with higher odds of full recovery and may prompt the search for alternative causes of the symptoms.

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