A bioclinical pattern for the early diagnosis of cardioembolic stroke.

Background and Scope. Early etiologic diagnosis of ischemic stroke subtype guides acute management and treatment. We aim to evaluate if plasma biomarkers can predict stroke subtypes in the early phase from stroke onset. Methods. Plasma N-terminal prohormone of brain natriuretic peptide (NT-proBNP), D-dimer, C-reactive protein, serum albumin, and globulin levels have been investigated in 114 consecutive patients presenting at the emergency room within 6 hours of the ischemic stroke onset. Plasma levels of biomarkers have been correlated with stroke aetiology (based on TOAST criteria) by multivariable logistic regression analysis, adjusted for several covariates. Results. Of the 114 patients, 34 (30%) had cardioembolic stroke, 27 (23%) atherothrombotic stroke, 19 (17%) lacunar stroke, and 34 (30%) stroke of undetermined origin. Patients with cardioembolic stroke had significantly higher levels of NT-proBNP and lower globulin/albumin (G/A) ratio compared with the other subgroups. At multiple logistic regression NT-proBNP > 200 pg/mL, G/A ratio > 0.70, and NIHSS score were independent predictors of cardioembolic stroke with high accuracy of the model, either including (AUC, 0.91) or excluding (AUC, 0.84) atrial fibrillation. Conclusions. A prediction model that includes NT-proBNP, G/A ratio, and NIHSS score can be useful for the early etiologic diagnosis of ischemic stroke.

Cardiac papillary fibroelastoma presenting with acute coronary syndrome and syncope.

A 70-year-old female was admitted for syncope preceded by chest pain. On admission ECG showed signs of myocardial ischaemia and cardiac troponin I (cTnI) was mildly elevated. Acute coronary syndrome without ST elevation was diagnosed. During hospitalization transthoracic echocardiography (TTE) revealed the presence of a round echogenic pedunculated mass adherent to the aortic valve. Cardiac catheterization revealed normal coronary arteries. According to the hypothesis that the lesion could be responsible for both acute coronary syndrome and syncope, surgical intervention was scheduled. The mass was removed and the histological examination revealed a cardiac papillary fibroelastoma (CPF). CPF is the most common tumour of the cardiac valves, it is often found incidentally but it can cause myocardial infarction, sudden death, syncope and stroke; its embolization is the most common complication. For symptomatic patients surgical excision is curative.