- Email: [email protected]
ALPHA2HS-GLYCOPROTEIN AND CD40 L IN TOAST STROKE SUBTYPES: CORRELATION WITH LABORATORY, CLINICAL VARIABLES AND PROGNOSIS
Abstracts, XXII National Congress of the Italian Society for the Study of Arteriosclerosis (SISA) subtype of stroke, compared to other subtypes, PWV was positively related to TNF-a, IL1b IL-6 and VWF plasma levels. Discussion: The main our findings were that patients with acute ischemic stroke had both raised inflammatory markers and arterial stiffness, as assessed by the AIx, and by aortic PWV, compared with control subjects without acute ischemic stroke. Nevertheless these relationships appair different in each TOAST subtype of stroke, probably due to different pathophysiology and inflammatory background pathways of these different subtype of ischemic stroke. 41 SERUM FETUIN A/ALPHA2HS-GLYCOPROTEIN AND CD40 L IN TOAST STROKE SUBTYPES: CORRELATION WITH LABORATORY, CLINICAL VARIABLES AND PROGNOSIS R. Di Sciacca1 , A. Tuttolomondo1 , D. Di Raimondo1 , G. Bivona2 , C. Bellia2 , M. Ciaccio2 , A. Pinto1 , G. Licata1 . 1 Dipartimento Biomedico di Medicina Interna e Specialistica, Universit` a degli Studi di Palermo, 2 Dipartimento di Biochimica Clinica, Universit` a degli Studi di Palermo, Italy E-mail: [email protected] Background: Fetuin A/alpha2HS-glycoprotein (AHSG) is a member of the cystatin superfamily of cysteine protease inhibitors involved in vascular pathology and bone metabolism. There is very little information with regard the relationship between serum levels of AHSG and the severity of disease in patients with atherosclerosis not associated with end stage renal disease (ESRD) or dialysis treatment and no study, has evaluated the role of fetuin in acute cardiovascular events such as AMI or stroke. Moreover few studies evaluated the role of CD40 L in acute ischemic stroke and no study to our knowledge analyzed the relationship between CD40 L and AHSG. On this basis, in the present study, we evaluated the serum concentration of AHSG and CD40 L in subjects with acute ischemic stroke and their possible association with other laboratory and clinical variabilit Methods: from October 2006 and march 2008 we enrolled all consecutive patients with acute ischemic stroke. Diagnostic subtypes of acute ischemic stroke were classified by means TOAST Classification. We evaluated plasma levels of Fetuin A and CD40 L. Outcome indicators were NIHHS score and m-rankin score at discharge. Results: We enrolled 107 subjects with acute ischemic stroke. 32 were classified as atherothrombotic (LAAS), 41 as lacunar and 32 as cardioembolic (CEI) whereas 2 were classified as other determined etiology (ODE). No significant differences in plasma CD40 L or AHSG levels among different TOAST groups were detected. At intragroup analysis, among subjects classified as LAAS, AHSG plasma levels were positively correlated with total cholesterol plasma levels, NIHSS score, WBC count and negatively correlated with haematocrit, whereas in the same group CD40 L plasma levels were positively correlated with trygliceride plasma levels. Among subjects classified as lacunar group CD40 L plasma levels were positively correlated with LDL plasma levels whereas in the same group CD40 L plasma levels were negatively correlated with diabetes. Among subjects with cardioembolic stroke, AHSG plasma levels were negatively correlated with hypertension presence. Discussion: Our findings could indicate a possible involvement of Fetuin A plasma levels in acute cerebrovascular events as marker of more extensive atherosclerosis, but TOAST subtype analysis failed to demonstrate an association with a specific pathogenetic subtype of ischemic stroke. 42 PROGNOSIS OF ACUTE ISCHEMIC STROKE RELATED WITH CARDIOVASCULAR DRUGS TREATMENT DURING HOSPITAL STAY R. Di Sciacca, A. Tuttolomondo, D. Di Raimondo, S. Miceli, A. Pinto, G. Licata. Dipartimento Biomedico di Medicina Interna e Specialistica, Universit` a degli Studi di Palermo, Italy E-mail: [email protected] Introduction and Aim: Treatment with statins reduces the risk of ischemic stroke among patients at increased risk for vascular disease. Recent experimental data suggest neuroprotective properties of statins in acute cerebral ischemia. Morever it has been speculated that some cardiovascular drugs such as ace-inhibitors and Angiotensin receptor blockers (ARBs) may also have beneficial effects on cerebral circulation and brain parenchyma during ischaemic stroke. On this basis the aim of our study was to evaluate the influence of treatment with cardiovascular protective drugs such as antiplatelet drugs, statins, ace-inhibitors and ARBs during hospital stay after acute ischemic stroke. Methods: 17,377 Subjects were enrolled in the GIFA study, a multicenter survey of hospitalized older patients. Among these enrolled patients 808 Subjects with a main discharge diagnosis suggestive of acute ischemic stroke represent the final sample. The primary outcomes (outcome indicators) of this study were: (1) in-hospital mortality; (2) cognitive impairment at discharge; (3) functional status at discharge. Cognitive and functional status was assessed at the time of admission and at discharge. Cognitive function was assessed using the Hodkinson Abbreviated Mental Test (HAMT). Functional status was evaluated using 6 basic activities of daily living (ADL), including transferring from bed to chair, walking in a small room, eating, bathing, using the toilet, and personal hygiene procedures. Patients were considered severely disabled if they needed intensive assistance in at least one activity of daily living. By means of multivariate logistic regression modeling, we determined the influence of intrahospital stay drugs use on the chosen outcome indicators
S45
after adjustment for potential confounding factors and previous use of cardiovascular active drugs. Results: Statin, antiplatelet and ace-inhibitor treatment during hospital stay after an acute ischemic stroke is associated with a lower incidence of inhospital mortality, cognitive impairment and disability at discharge. Discussion: Our findings of a relationship between vasoactive drugs use during hospital stay and a better prognosis after an acute ischemic stroke could indicate possible neuroprotective and antithrombotic effects of these drugs able to accelerate neuroplasticity and to limit inflammatory and thrombotic mechanisms related to ischemic neuronal damage. Nevertheless our findings need to be confirmed in a randomized clinical trial of early administration of these drugs after stroke. 43 CARDIOVASCULAR DRUGS PRE-TREATMENT RELATED PROGNOSIS IN PATIENTS WITH ACUTE ISCHEMIC STROKE R. Di Sciacca, A. Tuttolomondo, D. Di Raimondo, S. La Placa, A. Pinto, G. Licata. Dipartimento Biomedico di Medicina Interna e Specialistica, Universit` a degli Studi di Palermo, Italy E-mail: [email protected] Recent experimental data suggest neuroprotective properties of statins in acute cerebral ischemia, whereas other studies indicate a vessel protective action of Ace-inhibitors and Angiotensin receptor blockers (ARBs). Treatment with statins, ace-inhibitors and ARBs reduce the risk of ischemic stroke among patients at increased risk for vascular disease We investigated whether a premedication with cardiovascular drugs (statins, Ace-inhibitors, ARBs, antiplatelets) is associated with a better outcome in patients with acute ischemic cerebrovascular events. Methods: 17,377 subjects were enrolled in the GIFA study, a multicenter survey of hospitalized older patients. Among these enrolled patients 808 Subjects with a main discharge diagnosis suggestive of acute ischemic stroke represent the final sample. The primary outcomes (outcome indicators) of this study were: (1) in-hospital mortality; (2) cognitive impairment at discharge; (3) functional status at discharge. Cognitive and functional status was assessed at the time of admission and at discharge. Cognitive function was assessed using the Hodkinson Abbreviated Mental Test (HAMT). Functional status was evaluated using 6 basic activities of daily living (ADL), including transferring from bed to chair, walking in a small room, eating, bathing, using the toilet, and personal hygiene procedures. Patients were considered severely disabled if they needed intensive assistance in at least one activity of daily living. By means of multivariate logistic regression modeling, we determined the influence of prior drugs use on the chosen outcome indicators after adjustment for potential confounding factors Results: Ace-inhibitors and antiplatelet pre-treatment was associated with a lower incidence of in-hospital mortality, cognitive impairment and disability at discharge. No significant relationship was observed between other cardiovascular drug pre-treatment and and the chosen outcome indicators. Conclusions: Our study evaluated prognosis in the light of the three main aspects of mortality, disability and cognitive impairment. We observed a relationship between Ace-inhibitors and antiplatelet pre-treatment and a better prognosis in terms of intrahospital mortality, cognitive and functional status at discharge. Our data could underline the possible neuroprotective role of ace-inhibitors in the setting of acute brain ischemia and a possible action of pre-treatment with antiplatelet drugs toreduce acute neurological deficit and disability at discharge. 44 ROSUVASTATIN PROMOTES EXPANSION OF HUMAN ENDOTHELIAL PROGENITOR CELLS. EVIDENCES FROM MULTIPLE CULTURE PROTOCOLS G.P. Fadini1 , M. Albiero1 , T. Piliego2 , E. Boscaro1 , C. Agostini1 , A. Avogaro1 . University of Padova, Medical School; 2 AstraZeneca Medical Dvision, Italy E-mail: [email protected]
1
Background: Bone marrow-derived endothelial progenitor cells (EPCs) are involved in maintenance of intimal integrity and in processes of new blood vessel formation. Thanks to these functions, EPCs are now considered of paramount importance for cardiovascular homeostasis. Indeed, reduction of EPCs in the setting of risk factors for and established atherosclerosis is a novel mechanism of induction/progression of cardiovascular disease. Therefore, ways to expand EPCs in vivo or ex vivo for future transplantation are actively pursued. Statins have been shown to improve EPC number and function, but the methods used to assess these effects in vitro have been questioned. Aims: We aimed at demonstrating a consistent effect of rosuvastatin on EPCs with the three most commonly used culture protocols. Methods: EPCs were isolated from human healthy subjects using two short-term (the CFU-Hill assay and the Vasa-assay) and one long-term protocol (so-called “late EPCs”). Cells were extensively characterized in terms of morphology and surface antigens. EPCs were quantified as the number of colonies per surface area for CFU-Hill and late EPCs and as Ac-LDL/Ulex-Lectin double positive cells for the Vasa-assay. From the beginning of experiments, culture medium was supplemented with 0 0.1 1 10 100 1000 nM rosuvastatin. We also isolated late EPCs from the bone marrow of subjects with cardiovascular disease to assess the effects of the minimal efficacious dose of rosuvastatin. Results: Antigenic phenotype and morphology of CFU-Hill cells, Vasa-assay cells, and late EPCs were similar to what reported in the literature; indeed,
S45
after adjustment for potential confounding factors and previous use of cardiovascular active drugs. Results: Statin, antiplatelet and ace-inhibitor treatment during hospital stay after an acute ischemic stroke is associated with a lower incidence of inhospital mortality, cognitive impairment and disability at discharge. Discussion: Our findings of a relationship between vasoactive drugs use during hospital stay and a better prognosis after an acute ischemic stroke could indicate possible neuroprotective and antithrombotic effects of these drugs able to accelerate neuroplasticity and to limit inflammatory and thrombotic mechanisms related to ischemic neuronal damage. Nevertheless our findings need to be confirmed in a randomized clinical trial of early administration of these drugs after stroke. 43 CARDIOVASCULAR DRUGS PRE-TREATMENT RELATED PROGNOSIS IN PATIENTS WITH ACUTE ISCHEMIC STROKE R. Di Sciacca, A. Tuttolomondo, D. Di Raimondo, S. La Placa, A. Pinto, G. Licata. Dipartimento Biomedico di Medicina Interna e Specialistica, Universit` a degli Studi di Palermo, Italy E-mail: [email protected] Recent experimental data suggest neuroprotective properties of statins in acute cerebral ischemia, whereas other studies indicate a vessel protective action of Ace-inhibitors and Angiotensin receptor blockers (ARBs). Treatment with statins, ace-inhibitors and ARBs reduce the risk of ischemic stroke among patients at increased risk for vascular disease We investigated whether a premedication with cardiovascular drugs (statins, Ace-inhibitors, ARBs, antiplatelets) is associated with a better outcome in patients with acute ischemic cerebrovascular events. Methods: 17,377 subjects were enrolled in the GIFA study, a multicenter survey of hospitalized older patients. Among these enrolled patients 808 Subjects with a main discharge diagnosis suggestive of acute ischemic stroke represent the final sample. The primary outcomes (outcome indicators) of this study were: (1) in-hospital mortality; (2) cognitive impairment at discharge; (3) functional status at discharge. Cognitive and functional status was assessed at the time of admission and at discharge. Cognitive function was assessed using the Hodkinson Abbreviated Mental Test (HAMT). Functional status was evaluated using 6 basic activities of daily living (ADL), including transferring from bed to chair, walking in a small room, eating, bathing, using the toilet, and personal hygiene procedures. Patients were considered severely disabled if they needed intensive assistance in at least one activity of daily living. By means of multivariate logistic regression modeling, we determined the influence of prior drugs use on the chosen outcome indicators after adjustment for potential confounding factors Results: Ace-inhibitors and antiplatelet pre-treatment was associated with a lower incidence of in-hospital mortality, cognitive impairment and disability at discharge. No significant relationship was observed between other cardiovascular drug pre-treatment and and the chosen outcome indicators. Conclusions: Our study evaluated prognosis in the light of the three main aspects of mortality, disability and cognitive impairment. We observed a relationship between Ace-inhibitors and antiplatelet pre-treatment and a better prognosis in terms of intrahospital mortality, cognitive and functional status at discharge. Our data could underline the possible neuroprotective role of ace-inhibitors in the setting of acute brain ischemia and a possible action of pre-treatment with antiplatelet drugs toreduce acute neurological deficit and disability at discharge. 44 ROSUVASTATIN PROMOTES EXPANSION OF HUMAN ENDOTHELIAL PROGENITOR CELLS. EVIDENCES FROM MULTIPLE CULTURE PROTOCOLS G.P. Fadini1 , M. Albiero1 , T. Piliego2 , E. Boscaro1 , C. Agostini1 , A. Avogaro1 . University of Padova, Medical School; 2 AstraZeneca Medical Dvision, Italy E-mail: [email protected]
1
Background: Bone marrow-derived endothelial progenitor cells (EPCs) are involved in maintenance of intimal integrity and in processes of new blood vessel formation. Thanks to these functions, EPCs are now considered of paramount importance for cardiovascular homeostasis. Indeed, reduction of EPCs in the setting of risk factors for and established atherosclerosis is a novel mechanism of induction/progression of cardiovascular disease. Therefore, ways to expand EPCs in vivo or ex vivo for future transplantation are actively pursued. Statins have been shown to improve EPC number and function, but the methods used to assess these effects in vitro have been questioned. Aims: We aimed at demonstrating a consistent effect of rosuvastatin on EPCs with the three most commonly used culture protocols. Methods: EPCs were isolated from human healthy subjects using two short-term (the CFU-Hill assay and the Vasa-assay) and one long-term protocol (so-called “late EPCs”). Cells were extensively characterized in terms of morphology and surface antigens. EPCs were quantified as the number of colonies per surface area for CFU-Hill and late EPCs and as Ac-LDL/Ulex-Lectin double positive cells for the Vasa-assay. From the beginning of experiments, culture medium was supplemented with 0 0.1 1 10 100 1000 nM rosuvastatin. We also isolated late EPCs from the bone marrow of subjects with cardiovascular disease to assess the effects of the minimal efficacious dose of rosuvastatin. Results: Antigenic phenotype and morphology of CFU-Hill cells, Vasa-assay cells, and late EPCs were similar to what reported in the literature; indeed,