Plasma Dimethylarginine Levels and Carotid Intima–Media Thickness are related to Atrial Fibrillation in Patients with Embolic Stroke
Abstract
:1. Introduction
2. Results
2.1. Epidemiological Data
2.2. Plasma Dimethylarginine Levels in Ischemic Stroke of Different Causes
2.3. L-arginine/SDMA Ratio as A Potential Marker for Identifying AF in Patients Admitted with ESUS
2.4. Carotid Intima–Media Thickness Differs between Patients with ESUS and Other Etiologies
2.5. Markers of Endothelial Dysfunction and Thrombembolic Risk
2.6. Markers of Endothelial Dysfunction and Renal Function
3. Discussion
4. Materials and Methods
4.1. Study Population
4.2. Clinical Evaluation
4.3. Biomarker Analysis
4.4. Statistical Analysis
Supplementary Materials
Author Contributions
Funding
Conflicts of Interest
Abbreviations
ADMA | asymmetric dimethylarginine |
AF | atrial fibrillation |
ASA | acetylsalicylic acid |
AUC | area under the curve |
BMI | body mass index |
CI | confidence interval |
CIMT | carotid intima–media thickness |
DWI | diffusion-weighted imaging |
ECG | electrocardiography |
ESRS | Essen Stroke Risk Score |
ESUS | embolic stroke of undetermined source |
MRI | magnetic resonance imaging |
NIHSS | National Institutes of Health Stroke Scale |
NO | nitric oxide |
NOAC | non-vitamin K oral anticoagulant |
PFO | patent foramen ovale |
ROC | receiver operating characteristic |
SDMA | symmetric dimethylarginine |
TEE | transesophageal echocardiography |
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ESUS | AF (N = 25) | Angiopathic Stroke | p-Value | ||
---|---|---|---|---|---|
Previously Diagnosed | Newly Diagnosed | ||||
N | 43 | 9 | 16 | 20 | |
Age (a) (IQR) | 65.00 $$ (52–75) | 83.00 **ßß (74–91) | 77.50 (70–82.25) | 68.50 §§ (59.50–78.00) | 0.001 |
Male | 28 $ (65%) | 3 $ (33%) | 15 *§ (94%) | 13 (65%) | 0.019 |
Female | 15 $ (35%) | 6 $ (66%) | 1 *§ (6%) | 7 (35%) | |
ESRS (IQR) | 2.00 (1–3) | 3.00 (2.5–3.5) | 3.50 (2.25–4) | 3.00 (2–4) | 0.016 |
CHA2DS2 VASC (IQR) | 4.00 $ (3–5) | 6.00 * (5–7) | 6.00 (5–7) | 5.00 (4–6.75) | 0.001 |
Previous ischemic stroke | 8 (19%) | 1 (11%) | 3 (19%) | 8 (40%) | 0.199 |
BMI (kg/m2) (IQR) | 26.06 (23.15–28.76) | 24.45 $ß (23.42–25.77) | 26.23 § (24.69–29.91) | 27.49 § (24.93–31.38) | 0.108 |
NIHSS on admission (IQR) | 2 (1–5) | 4.00 (2–15.5) | 4.00 (1.25–6.75) | 3.00 (2–5) | 0.045 |
Symptom to venous puncture time (days) (IQR) | 7.00 (6–7) | 7.00 (7–7) | 7.00 (6–7) | 7.00 (7–8) | 0.127 |
Serum creatinine (µmol/L) (IQR) | 78.00 (65–93) | 75.00 (61–108) | 89 (74–112) | 81.50 (71.50–93) | 0.215 |
ESUS | Newly Diagnosed AF | AF (Total) | |||
---|---|---|---|---|---|
L-arginine (µmol/L) (median (IQR)) | 85.80 (69.70–106.10) | 73.25 (58.40–88.80) | p = 0.03 | 74.40 (57.24–93.52) | p = 0.031 |
ADMA (µmol/L) (median (IQR)) | 0.48 (0.41–0.55) | 0.51 (0.46–0.56) | p = 0.223 | 0.50 (0.46–0.56) | p = 0.26 |
SDMA (µmol/L) (median (IQR)) | 0.49 (0.41–0.61) | 0.56 (0.52–0.77) | p = 0.026 | 0.58 (0.52–0.80) | p = 0.004 |
L-arginine/ADMA ratio (median (IQR)) | 176.51 (153.39–236.50) | 148.75 (120.83–171.65) | p = 0.009 | 148.64 (121.68–181.60) | p = 0.006 |
L-arginine/SDMA ratio (median (IQR)) | 177.84 (130.85–222.12) | 126.17 (84.99–162.44) | p = 0.004 | 118.03 (80.16–175.79) | p = 0.002 |
ADMA/SDMA ratio (median (IQR)) | 0.96 (0.77–1.17) | 0.85 (0.68–0.95) | p = 0.046 | 0.83 (0.67–0.95) | p = 0.013 |
CIMT (mm) (median (IQR)) | 0.66 (0.57–0.75) | 0.83 (0.69–0.91) | p = 0.001 | 0.85 (0.76–0.92) | p < 0.001 |
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Grosse, G.M.; Biber, S.; Sieweke, J.-T.; Martens-Lobenhoffer, J.; Gabriel, M.M.; Putzer, A.-S.; Hasse, I.; van Gemmeren, T.; Schuppner, R.; Worthmann, H.; et al. Plasma Dimethylarginine Levels and Carotid Intima–Media Thickness are related to Atrial Fibrillation in Patients with Embolic Stroke. Int. J. Mol. Sci. 2019, 20, 730. https://doi.org/10.3390/ijms20030730
Grosse GM, Biber S, Sieweke J-T, Martens-Lobenhoffer J, Gabriel MM, Putzer A-S, Hasse I, van Gemmeren T, Schuppner R, Worthmann H, et al. Plasma Dimethylarginine Levels and Carotid Intima–Media Thickness are related to Atrial Fibrillation in Patients with Embolic Stroke. International Journal of Molecular Sciences. 2019; 20(3):730. https://doi.org/10.3390/ijms20030730
Chicago/Turabian StyleGrosse, Gerrit M., Saskia Biber, Jan-Thorben Sieweke, Jens Martens-Lobenhoffer, Maria M. Gabriel, Anne-Sophie Putzer, Isabel Hasse, Till van Gemmeren, Ramona Schuppner, Hans Worthmann, and et al. 2019. "Plasma Dimethylarginine Levels and Carotid Intima–Media Thickness are related to Atrial Fibrillation in Patients with Embolic Stroke" International Journal of Molecular Sciences 20, no. 3: 730. https://doi.org/10.3390/ijms20030730