Echocardiographic Epicardial Fat Thickness and Neutrophil to Lymphocyte Ratio Are Novel Inflammatory Predictors of Cerebral Ischemic Stroke

Akıl, Eşref; Akıl, Mehmet Ata; Varol, Sefer; Özdemir, Haşan; Yılmaz, Yücel; Arslan, Demet; Akyüz, Abdurahman; Alan, Sait

doi:10.1016/j.jstrokecerebrovasdis.2014.04.028

Cited by 45 publications

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References 31 publications

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“…In the analysis, we assumed that the size of the stroke and control groups were equal because the study was matched. We calculated the sample size as did Akil and colleagues 7 and estimated that at least 50 patients per group were required for 80% power. Data were analyzed with use of SPSS 20.0 (IBM Corporation; Endicott, NY).…”

Section: Discussionmentioning

confidence: 99%

“…22 However, the association between EFT and AIS has never been studied. In 2014, Akil and colleagues 7 reported that EFT and the neutrophil-to-lymphocyte ratio might be novel predictors of ischemic stroke. The major drawback of this 2014 study was that the authors evaluated a very select AIS group 23 : only patients with large-artery atherosclerotic lesions were included, and patients with cardioembolic and lacunar strokes and comorbidities such as hypertension, diabetes mellitus, and obesity were excluded.…”

Section: Discussionmentioning

confidence: 99%

“…The major drawback of this 2014 study was that the authors evaluated a very select AIS group 23 : only patients with large-artery atherosclerotic lesions were included, and patients with cardioembolic and lacunar strokes and comorbidities such as hypertension, diabetes mellitus, and obesity were excluded. Although Akil and colleagues 7 did not encompass the whole spectrum of high-risk patients with AIS, and thus did not model real-world outcomes in all-comer high-risk patients, the authors found that EFT and the neutrophil-lymphocyte ratio are higher among patients with AIS in relation to age-and sex-matched control patients, and that EFT ≥5.35 mm predicts the presence of AIS.…”

Section: Discussionmentioning

confidence: 99%

“…It is a local source of inflammatory mediators associated with the development of atherosclerosis, metabolic syndrome, and cardiovascular disease. 6 Akil and colleagues 7 have shown that echocardiographically measured epicardial fat thickness (EFT) is higher in patients with ischemic stroke than in age-and sex-matched control patients, and that EFT is an independent predictor of ischemic stroke. However, the relationship of echocardiographically measured EFT and realworld AIS is unexplored.…”

Section: Found a Significant Association Between Epicardial Fat Thickmentioning

confidence: 99%

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Increased Epicardial Fat Thickness Correlates with Aortic Stiffness and N-Terminal Pro-Brain Natriuretic Peptide Levels in Acute Ischemic Stroke Patients

Altun¹,

Ünal²,

Başaran³

et al. 2016

Texas Heart Institute Journal

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Epicardial fat, a metabolically active tissue, has emerged as a risk factor and active player in metabolic and cardiovascular diseases. We investigated epicardial fat thickness in patients who had sustained an acute ischemic stroke, and we evaluated the relationship of epicardial fat thickness with other prognostic factors. We enrolled 61 consecutive patients (age, ≥18 yr) who had sustained a first acute ischemic stroke and had been admitted to our hospital within 24 hours of the onset of stroke symptoms. The control group comprised 82 consecutive sex- and age-matched patients free of past or current stroke who had been admitted to our cardiology clinics. Blood samples were taken for measurement of N-terminal pro-brain natriuretic peptide (NT-proBNP) levels at admission. Aortic stiffness indices and epicardial fat thickness were measured by means of transthoracic echocardiography within the first 48 hours. In comparison with the control group, the patients with acute ischemic stroke had significantly higher epicardial fat thickness (4.8 ± 0.9 vs 3.8 ± 0.7 mm; P <0.001), lower aortic distensibility (2.5 ± 0.8 vs 3.4 ± 0.9 cm2·dyn−1; P <0.001) and lower aortic strain (5.5% ± 1.9% vs 6.4% ± 1.8%; P=0.003). We found a significant association between epicardial fat thickness, NT-proBNP levels, and arterial dysfunction in patients who had sustained acute ischemic stroke. Increased epicardial fat thickness might be a novel risk factor and might enable evaluation of subclinical target-organ damage in these patients.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Found a Significant Association Between Epicardial Fat Thickmentioning

confidence: 99%

See 2 more Smart Citations

Increased Epicardial Fat Thickness Correlates with Aortic Stiffness and N-Terminal Pro-Brain Natriuretic Peptide Levels in Acute Ischemic Stroke Patients

Altun¹,

Ünal²,

Başaran³

et al. 2016

Texas Heart Institute Journal

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“…Accurately determining the optimal time to test requires additional research. Akil [35] found that the NLR of ischemic stroke patients was significantly higher than NLR of healthy patients and suggested the NLR could predict the risk of developing ischemic stroke. In addition, one study [4] also suggested that a high NLR is associated with a higher risk of recurrent ischemic stroke.…”

Section: Figurementioning

confidence: 99%

The prediction of neutrophil to lymphocyte ratio for outcomes in ischemic stroke

Ye¹,

Ai²,

Fang³

et al. 2017

Oncotarget

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Objective: Neutrophil to lymphocyte ratio (NLR) is a prognostic inflammatory biomarker in patients with cardiovascular disease and hemorrhagic stroke. This metaanalysis aims to evaluate the prognostic values of NLR in predicting clinical outcomes in patients with ischemic stroke.Methods: A literature search was performed using the databases PubMed, EMBASE, Cochrane Central Register of Controlled Trials and China National Knowledge Infrastructure. Two reviewers independently retrieved papers that met the inclusion criteria. Subgroup analyses were performed using in-hospital mortality, 90-day mortality and 90-day poor outcomes (mRS>2) as the outcome measures.Results: Eight studies with 3855 patients were included in the analysis. An elevated NLR was a strong predictor for in-hospital mortality (OR: 1.05; 95% CI: 1.03-1.07, p<0.001) and for 90-day poor outcomes (OR: 2.28; 95% CI: 1.39-3.73, p<0.001), but not for 90-day mortality (OR: 3.04; 95% CI: 0.74-12.55, p=0.12). After performing subgroup analysis, the NLR was found to predict 90-day mortality with a high (>5) cut-off values (OR: 6.69; 95% CI: 1.70-26.33, p=0.007). The lower cut-off values had no significance (OR: 2.17; 95% CI: 0.43-10.86, p=0.35).Conclusions: A high NLR was significantly associated with higher rates of inhospital mortality and 90-day poor outcome in patients with ischemic stroke, especially with a high mean NLR or high cut-off values. With a high cut-off value (>5), NLR could predict the 90-day mortality after ischemic stroke.

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Mean platelets volume and neutrophil to lymphocyte ratio as predictors of stroke

Farah

Samra

2017

Clinical Laboratory Analysis

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Background Mean platelets volume (MPV) is a marker, which indicates platelet function, and is a potential link between inflammation and thrombosis. Previous studies have found a relation between high MPV levels and high risk of stroke. Another factor that has been associated with the risk of stroke is neutrophil to lymphocyte ratio (NLR). Several studies have reported an association between increased NLR and increased risk of cerebrovascular disease. It was found that NLR levels have a relation to the prognosis as well. Since both NLR and MPV have been associated with increased risk of cardiovascular disease, together they may predict the risk of stroke and the prognosis with higher sensitivity and specificity. Methods This is a descriptive retrospective study. Data were gathered from medical records of patients who applied the Ziv medical center and were diagnosed with stroke. Stroke severity was evaluated using the NIHSS (national institutes of health stroke scale). MPV and NLR levels of patients with stroke were compared to those of 30 healthy individuals. Results Neutrophil to lymphocyte ratio levels were found significantly higher in patients with stroke compared with healthy individuals. NLR was also found higher in patients with moderate/severe stroke compared with those with minor stroke. No association was found between MPV level, the risk of stroke, and stroke prognosis. Moreover, an interaction effect between MPV and NLR level was not found. Conclusion Neutrophil to lymphocyte ratio is a good predictive factor of stroke and stroke prognosis. Further prospective studies are needed to establish the relationship between the MPV level and the risk of stroke. NLR and MPV interaction effect can be tested again in the future after establishing the association between MPV, the risk of stroke, and stroke prognosis.

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Echocardiographic Epicardial Fat Thickness and Neutrophil to Lymphocyte Ratio Are Novel Inflammatory Predictors of Cerebral Ischemic Stroke

Cited by 45 publications

References 31 publications

Increased Epicardial Fat Thickness Correlates with Aortic Stiffness and N-Terminal Pro-Brain Natriuretic Peptide Levels in Acute Ischemic Stroke Patients

Increased Epicardial Fat Thickness Correlates with Aortic Stiffness and N-Terminal Pro-Brain Natriuretic Peptide Levels in Acute Ischemic Stroke Patients

The prediction of neutrophil to lymphocyte ratio for outcomes in ischemic stroke

Mean platelets volume and neutrophil to lymphocyte ratio as predictors of stroke

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