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Introduction: The screening for atrial fibrillation (AF) scale (SAFE score) was recently developed to provide a prediction of the diagnosis of AF after an ischemic stroke. It includes 7 items: age ≥ 65 years, bronchopathy, thyroid disease, cortical location of stroke, intracranial large vessel occlusion, NT-ProBNP ≥250 pg/mL, and left atrial enlargement. In the internal validation, a good performance was obtained, with an AUC = 0.88 (95% CI 0.84-0.91) and sensitivity and specificity of 83% and 80%, respectively, for scores ≥ 5. The aim of this study is the external validation of the SAFE score in a multicenter cohort. Methods: A retrospective multicenter study, including consecutive patients with ischemic stroke or transient ischemic attack between 2020 and 2022 with at least 24 hours of cardiac monitoring. Patients with previous AF or AF diagnosed on admission ECG were excluded. Results: Overall, 395 patients were recruited for analysis. The SAFE score obtained an AUC = 0.822 (95% CI 0.778-0.866) with a sensitivity of 87.2%, a specificity of 65.4%, a positive predictive value of 44.1%, and a negative predictive value of 94.3% for a SAFE score ≥ 5, with no significant gender differences. Calibration analysis in the external cohort showed an absence of significant differences between the observed values and those predicted by the model (Hosmer-Lemeshow's test 0.089). Conclusions: The SAFE score showed adequate discriminative ability and calibration, so its external validation is justified. Further validations in other external cohorts or specific subpopulations of stroke patients might be required.
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Even though endothelial dysfunction is known to play a role in migraine pathophysiology, studies regarding levels of endothelial biomarkers in migraine have controversial results. Our aim was to evaluate the role of pentraxin 3 (PTX3) and soluble tumour necrosis factor-like weak inducer of apoptosis (sTWEAK) as potential biomarkers of endothelial dysfunction in chronic migraine (CM). We performed a case-control study including 102 CM patients and 28 control subjects and measured serum levels of markers of endothelial dysfunction (PTX3 and sTWEAK) and inflammation [high-sensitivity C-reactive protein (hs-CRP)] as well as brachial artery flow-mediated dilation (FMD) during interictal periods. Interictal serum levels of PTX3 and sTWEAK were higher in CM patients than in controls (1350.6 ± 54.8 versus 476.1 ± 49.4 pg/mL, p < 0.001 and 255.7 ± 21.1 versus 26.4 ± 2.6 pg/mL, p < 0.0001; respectively). FMD was diminished in CM patients compared to controls (9.6 ± 0.6 versus 15.2 ± 0.9%, p < 0.001). Both PTX3 and sTWEAK were negatively correlated with FMD (r = -0.508, p < 0.001 and r = -0.188, p = 0.033; respectively). After adjustment of confounders, PTX3 remained significantly correlated to FMD (r = -0.250, p = 0.013). Diagnosis of CM was 68.4 times more likely in an individual with levels of PTX3 ≥ 832.5 pg/mL, suggesting that PTX3 could be a novel biomarker of endothelial dysfunction in CM.
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Humans , Myasthenia Gravis/drug therapy , Immunoglobulins/therapeutic use , Treatment Outcome , Administration, Intravenous , Autoimmune Diseases/drug therapy , Adrenal Cortex HormonesABSTRACT
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Humans , Male , Female , Young Adult , Adult , Meningitis/chemically induced , Meningitis/pathology , Meningitis/therapy , Immunoglobulins/adverse effects , Immunoglobulins/administration & dosage , Immunoglobulins/therapeutic use , Myasthenia Gravis/complications , Myasthenia Gravis/pathology , Myasthenia Gravis/etiology , Injections, Spinal/instrumentation , Injections, Spinal/methods , Capillary Permeability/physiology , Adrenal Cortex Hormones/administration & dosage , Adrenal Cortex Hormones/analysis , Adrenal Cortex Hormones/therapeutic use , Acetaminophen/adverse effects , Acetaminophen/toxicity , Histamine Antagonists/adverse effects , Histamine Antagonists/toxicitySubject(s)
Seizures/physiopathology , Sneezing/physiology , Aged , Humans , Male , Seizures/complicationsABSTRACT
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Humans , Female , Aged, 80 and over , Angioedema/etiology , Thrombolytic Therapy/adverse effects , Tissue Plasminogen Activator/adverse effects , Stroke/drug therapyABSTRACT
TITLE: Angioedema orolingual tras trombolisis intravenosa.
Subject(s)
Angioedema/chemically induced , Fibrinolytic Agents/adverse effects , Thrombolytic Therapy/adverse effects , Tissue Plasminogen Activator/adverse effects , Adrenal Cortex Hormones/therapeutic use , Aged, 80 and over , Angioedema/drug therapy , Angioedema/physiopathology , Angiotensin-Converting Enzyme Inhibitors/adverse effects , Angiotensin-Converting Enzyme Inhibitors/therapeutic use , Antihypertensive Agents/adverse effects , Antihypertensive Agents/therapeutic use , Bradykinin/metabolism , Capillary Permeability/drug effects , Cerebral Cortex/blood supply , Cerebral Cortex/physiopathology , Drug Synergism , Drug Therapy, Combination , Enalapril/therapeutic use , Female , Fibrinolytic Agents/administration & dosage , Fibrinolytic Agents/therapeutic use , Histamine Antagonists/therapeutic use , Humans , Hypertension/complications , Hypertension/drug therapy , Infarction, Middle Cerebral Artery/drug therapy , Infusions, Intravenous , Tissue Plasminogen Activator/administration & dosage , Tissue Plasminogen Activator/therapeutic useABSTRACT
INTRODUCTION: From 15 to 30% of all ischemic strokes are cardioembolic. Transthoracic echocardiography plays a key role in the evaluation, diagnosis and management of the embolic source. The absence of official recommendations for the use of echocardiography in patients with ischemic stroke leads to a universal application showing low diagnostic efficiency. AIM: To analyze the diagnostic accuracy of echocardiograpm in patients with ischemic stroke in two situations: with universal indication and after the application of risk clinical criteria. PATIENTS AND METHODS: Analysis of the echocardiograms performed on patients with acute ischemic stroke from the stroke unit during the years 2009-2011. We study the diagnostic and etiological contribution to the etiological study. Apply a selection criteria: 'high risk patient with need of test performance during admission' (age < 60 years, abnormal baseline electrocardiogram, cardiomegaly on chest radiograph or baseline history of heart disease, suspected endocarditis and/or active neoplasia) and analyzed their validity. RESULTS: From 930 inpatients, 201 (21.6%), underwent echocardiogram. Cardioembolic source was detected in 9.95%. After application of selection criteria, only 97 patients (10.4%) should have undergone it. The proposed criteria have a sensitivity 95%, specificity 56.9%, positive predictive value 19.6% and negative predictive value of 99%. CONCLUSIONS: The application of our criteria in undetermined stroke patients help us to identify with high efficiency cardioembolic sources postponing the test to an ambulatory scenario in the rest of the patients.
TITLE: Es necesaria la realizacion de un ecocardiograma transtoracico a todos los pacientes con ictus isquemico indeterminado durante el ingreso?Introduccion. El 15-30% de los ictus isquemicos son de origen cardioembolico. El ecocardiograma transtoracico desempena un papel fundamental en la evaluacion, diagnostico y manejo de la fuente embolica. La ausencia de recomendaciones oficiales para el empleo del ecocardiograma en pacientes con ictus isquemico lleva a una solicitud universal de la prueba, presentando una baja rentabilidad diagnostica. Objetivo. Analizar la rentabilidad diagnostica del ecocardiograma transtoracico en pacientes con ictus isquemico indeterminado tras la aplicacion de criterios clinicos predefinidos de riesgo. Pacientes y metodos. Se analizan los ecocardiogramas realizados a pacientes con ictus isquemico agudo solicitados durante 2009-2011 desde el servicio de neurologia. Se estudia la rentabilidad diagnostica y su aportacion al estudio etiologico. Se aplican unos 'criterios de seleccion de paciente de alto riego con necesidad de realizacion de la prueba durante el ingreso' (edad < 60 anos, alteraciones en el ecocardiograma basal, cardiomegalia en la radiografia de torax basal, antecedentes de cardiopatia, sospecha clinica de endocarditis o neoplasia activa) y se analiza su validez. Resultados. De 930 pacientes, se realizo ecocardiograma a 201 (21,6%) y se detecto una fuente cardioembolica en el 9,95%. Tras la aplicacion de criterios de seleccion, el numero de ecocardiogramas paso a 97 (10,4%). Los criterios propuestos presentan: sensibilidad, 95%; especificidad, 56,9%; valor predictivo positivo, 19,6%, y valor predictivo negativo, 99%. Conclusiones. La aplicacion de nuestros criterios a pacientes con ictus indeterminado identifica con alta eficiencia la fuente cardioembolica, lo que permite la realizacion del ecocardiograma transtoracico ambulatorio en el resto de los pacientes.
Subject(s)
Brain Ischemia/diagnostic imaging , Diagnostic Tests, Routine/statistics & numerical data , Echocardiography/statistics & numerical data , Intracranial Embolism/diagnostic imaging , Unnecessary Procedures , Aged , Aged, 80 and over , Brain Ischemia/economics , Brain Ischemia/etiology , Cost-Benefit Analysis , Echocardiography/economics , Female , Hospitalization , Humans , Intracranial Embolism/complications , Intracranial Embolism/diagnosis , Intracranial Embolism/economics , Intracranial Embolism/epidemiology , Male , Middle Aged , Patient Selection , Predictive Value of Tests , Retrospective Studies , Risk Factors , Sensitivity and SpecificitySubject(s)
Esthesioneuroblastoma, Olfactory/diagnosis , Nasal Cavity , Nose Neoplasms/diagnosis , Aged , Female , HumansABSTRACT
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