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L-arginine and endothelium dysfunction after stroke
ABSTRACTS L-ARGINIJ'qE AND ENDOTHELIUM DYSFUNCTION A F r E R STROKE. B Zvan. M galetr I Prcmar. A Horvat T Poga?.nik, University Medical Centre, Dept. of Neurology, Ljubljana. Slovenia.
Objectives: Post-ischemic hypoperfit~on may play a significant role in reperfualon injury, However, the endothelium-dependem vasodilatafion should be impaired during hypopeffusinn. L-Arginine (L-arg) is a precursor of nitro oxide (NO) produced by encime NO syntase in vascular endothelium. NO has been identified as endothefium relaxing factor (EDRT), able to eficit eadotheEumdependent vasodgatation of resistant vessels. To determine whether dysfitacdon o f the cerebral vascular endothelJum exists, we studied patients after stroke by L-arg. Methods:The study group con.~-ted of IS padeata with the middle cerebral artery syndrome. They were investigated 7~ day after stroke. The control group consisted of 12 healthy subjects. All subjects received an intravenous infusion of L-arg over 20 rain at die rate 1500mg/mia. The mean arterial velocity (v=) was measured in the middle cerebral artery using bkemporal monitoring system (MULTIDOP X4). At the same time, the mean arterial pressure (MAP) and heart rate 0"IX) were measured by Finapreas. The endtidal CO,. (EtCOe) was monitored by capnograph. The software (TCD8) was utilised to detenaine the v= over five-minute intervals before infusion of L-arg and during infu.don. We also calculated the IhzlsafIity index (PI). Results: Mean arterial velocity during iafimon r increased (p<0.05) in both groups. In the sU'oke patients was v~ significam lower compared with controis (.p<0.05). Pl decreased (p<0.05) in both groups. MAP and HR did not change during infusion (p>0.05) End-tidal CO= also didn't change considerably. Conclur We have concluded, that endothelium function likely to be impaired in the patients after stroke. The L-arg seems to be useful for testing endothelium function in various pathological states.
CONTRIBUTION TO COST-EFFICIENCY IN A STROKE REDUCTION PROGRAM K Volkl M Samastur, G L. Schmidt. H L.echner Health Insurance of The Austrian Miners & Institute for Clinical Neurophysiology and Neurorohabilitation, Graz, Austria It has been proved that reduction of stroke incidence by 80% is possible. Therefore in countries with high incidence of stroke, like Styria, special programs o f stroke preventions have been developed. The goal is to reduce the incidence of stroke considering resulting costs for hospital care, rehabilitation and social welfare. In communities where special health education programs are applied with support of the media, reduction of stroke incidence has been reported but not in the case of Styda. Therefore the cohort with high stroke probability has to be identified by a screening system. So the Styrian Stroke Probability Index (STPl) has been developed not only to identify those volunteers with a high stroke probability but also to follow-up therapeutic strategies to reduce vascular risk. In this connection special therapeutic strategies have been inaugurated. The costs for this project have been established by means of pilot studies. Evaluation has been carried out for the average cost of stroke in acute, long-term care and social welfare. From this knowledge the average costs for one stroke victim in relation to the costs for one volunteer in the above mentioned Stroke Reduction Program will be presented. In this connection the costs for the screening process have to be included as well. By applying the STP[ in our cohort, we selected three out often volunteers with high stroke probability. The costs for this screening process will be further lowered because not only volunteers with high stroke probability but also those with coronary heart disease can be identified. This means that in more than 50% a positive screening effect can be achieved, 25% of the remaining volunteers show hyperlipidemia and need a health education program. Considering these facts, a calculation will be presented to established that point from which the Stroke Reduction Program will be neutral of cost ['or the Health Insurance in relation to the expenses on stroke victims.
455 HIGH STROKE INCIDENCE IN THE L'AQUILA REGISTRY: TWO-YEAR RESULTS. C Marini. P Santalucia, M Di Navoli. L Triaeiani. and A Carolei. Department of Neurology, University of L'Aquila, L'Aquila, Italy. Objective: To investigate the influence of socioeconomic factors on stroke incidence and mortality, in a large and well defined population. Desian/MelhQd~: The community-based L'Aquila S/roke Registry covers the district of L'Aquila with a total population of 297,838 (1991 census), 48% rural, and with 4.7% people over 80. All firstever strokes occurring between January I, 1994 and December 3I, 1995, were traced and analyzed according to clinical, demographic, and socioeconomic variables. Results: After two years, 1666 first-ever strokes were identified, 829 iu women (49.8%) and 837 in men (50.2%). Ninety-two percent of the patients were hospitalized. Clinical diagnoses were confirmed by brain CT or MRI in 89% of the patients. The crude anneal incidence rate was 2.80/I,000 (95% CI 2.62-2.99) or 2.41/I,000 and 2.3311,(300 when respectively adjusted to the 1991 Italian and European populations. Au increase of the crude incidence rate was observed in 1995 with respect to 1994 (2.84 vs 2.75/1,000). Incidence rates were higher in men than in women (2.90 vs 2.70/I,000/year) with a steep rise in patients over 65. In patients over 80 the crude incidence rate was 24.23/l,000/year. The proportions of cerebral ischemia, intracerebral and subaracnoid hemorrhage, and ill-defined events were 81%, 14.8%, 3.1%, and 1.1%, respectively. Thirty-day mortality occurred in 394 patients (23.6%), with a median survival of 5 days. Survival was better after cerebral ischemia than after intracerebral or subarachnoid hemorrhage ( P < 0.000h log-rank test) and in patients under than over 80 (P<0.000i; log-rank test). No significant differences were found in stroke incidence according to risk factors distribution, per capita aonual disposable income, and rural or urban dwelling. Conclusions: We found a high stroke incidence, independent of socioeconomic factors, possibly related to improved survival and aging of [he population.
HIGH PREVALENCE OF CARDIAC DISEASES IN POLAND AS A CAUSE OF HIGH MORTALITY IN STROKE. A. Czlonkowska. D. Rvolewicz. S. Cichv. T. Mendel. W. Lechowicz. D. Hier ~ 2nd Department of Neurology, Institute of Psychiatry and Neurology. Warsaw. Poland; *Department of Neurology, University of Illinois, Chicago, U.S.A. Stroke mortality rates vary more than B-fold in men and women between countries. Poland has one of the highest stroke mortality in Europe (106.41100 000 in men and 787/100 000 in women), that has not changed at least since 1984. High 30 day case fatality is the main reason of those mortality rates. The aim of this study was an analysis of the prevalence of stroke risk factors in patients with ischemic stroke treated in Poland (N=258) and in US* (N=961). The comparison revealed that cardiac diseases are much more common in Poland than in US (Ischemic Stroke Clinical 8enchmarking Data Base, Report #1-9.30.1996, Clinical Process Improvement). In the group of patients with ischemic stroke In Poland angina was diagnosed in 34.5% (95% C[ 28.4 - 40.5), MI in 19.3% (95% C114.3 - 24.3), AF in 24.8% (95% C119.3 - 30.3), CHF in 21.4% (95% C116-27), in US 17% (95% C114.6-19.3), 11.6% (95% CI 9.S-13 6), 12.0% (95% CI 9.9-14.0) and 9.7% (95% CI 8-12) respectivly, differences were statistically significant. The prevalence of hypertension, diabetes and smoking were similar in both populations. The high prevalence of cardiac disease among stroke patients in Poland may indicate the possibility of moce frequent occurrence of severe type of stroke probably of cardioembolic origin. Such possibility is suported by more frequent occurrence of disorders of consciousness at the onset of stroke among patients treated in Poland 39.5% (95% CI 33.3-45.7), compared to patients treated in US* 12.6% (95% C110.6-14.8), and less frequent occurrence of LACI according to OCSPClassification, in Poland 27.3%(95% C120.1-34.2), in comparison to 48.7% (95% CI 36.4%-60.8) diagnosed in US (Neurological Department, University of Illinois). CONCLUSION: Frequent prevalence of cardiac diseases among stroke patients in Poland may be one of the reasons of high mortality due to: increased risk of severe stroke (cardioembolic), increased risk of recurrent stroke, increased risk of death due to cardiologic complications.
Objectives: Post-ischemic hypoperfit~on may play a significant role in reperfualon injury, However, the endothelium-dependem vasodilatafion should be impaired during hypopeffusinn. L-Arginine (L-arg) is a precursor of nitro oxide (NO) produced by encime NO syntase in vascular endothelium. NO has been identified as endothefium relaxing factor (EDRT), able to eficit eadotheEumdependent vasodgatation of resistant vessels. To determine whether dysfitacdon o f the cerebral vascular endothelJum exists, we studied patients after stroke by L-arg. Methods:The study group con.~-ted of IS padeata with the middle cerebral artery syndrome. They were investigated 7~ day after stroke. The control group consisted of 12 healthy subjects. All subjects received an intravenous infusion of L-arg over 20 rain at die rate 1500mg/mia. The mean arterial velocity (v=) was measured in the middle cerebral artery using bkemporal monitoring system (MULTIDOP X4). At the same time, the mean arterial pressure (MAP) and heart rate 0"IX) were measured by Finapreas. The endtidal CO,. (EtCOe) was monitored by capnograph. The software (TCD8) was utilised to detenaine the v= over five-minute intervals before infusion of L-arg and during infu.don. We also calculated the IhzlsafIity index (PI). Results: Mean arterial velocity during iafimon r increased (p<0.05) in both groups. In the sU'oke patients was v~ significam lower compared with controis (.p<0.05). Pl decreased (p<0.05) in both groups. MAP and HR did not change during infusion (p>0.05) End-tidal CO= also didn't change considerably. Conclur We have concluded, that endothelium function likely to be impaired in the patients after stroke. The L-arg seems to be useful for testing endothelium function in various pathological states.
CONTRIBUTION TO COST-EFFICIENCY IN A STROKE REDUCTION PROGRAM K Volkl M Samastur, G L. Schmidt. H L.echner Health Insurance of The Austrian Miners & Institute for Clinical Neurophysiology and Neurorohabilitation, Graz, Austria It has been proved that reduction of stroke incidence by 80% is possible. Therefore in countries with high incidence of stroke, like Styria, special programs o f stroke preventions have been developed. The goal is to reduce the incidence of stroke considering resulting costs for hospital care, rehabilitation and social welfare. In communities where special health education programs are applied with support of the media, reduction of stroke incidence has been reported but not in the case of Styda. Therefore the cohort with high stroke probability has to be identified by a screening system. So the Styrian Stroke Probability Index (STPl) has been developed not only to identify those volunteers with a high stroke probability but also to follow-up therapeutic strategies to reduce vascular risk. In this connection special therapeutic strategies have been inaugurated. The costs for this project have been established by means of pilot studies. Evaluation has been carried out for the average cost of stroke in acute, long-term care and social welfare. From this knowledge the average costs for one stroke victim in relation to the costs for one volunteer in the above mentioned Stroke Reduction Program will be presented. In this connection the costs for the screening process have to be included as well. By applying the STP[ in our cohort, we selected three out often volunteers with high stroke probability. The costs for this screening process will be further lowered because not only volunteers with high stroke probability but also those with coronary heart disease can be identified. This means that in more than 50% a positive screening effect can be achieved, 25% of the remaining volunteers show hyperlipidemia and need a health education program. Considering these facts, a calculation will be presented to established that point from which the Stroke Reduction Program will be neutral of cost ['or the Health Insurance in relation to the expenses on stroke victims.
455 HIGH STROKE INCIDENCE IN THE L'AQUILA REGISTRY: TWO-YEAR RESULTS. C Marini. P Santalucia, M Di Navoli. L Triaeiani. and A Carolei. Department of Neurology, University of L'Aquila, L'Aquila, Italy. Objective: To investigate the influence of socioeconomic factors on stroke incidence and mortality, in a large and well defined population. Desian/MelhQd~: The community-based L'Aquila S/roke Registry covers the district of L'Aquila with a total population of 297,838 (1991 census), 48% rural, and with 4.7% people over 80. All firstever strokes occurring between January I, 1994 and December 3I, 1995, were traced and analyzed according to clinical, demographic, and socioeconomic variables. Results: After two years, 1666 first-ever strokes were identified, 829 iu women (49.8%) and 837 in men (50.2%). Ninety-two percent of the patients were hospitalized. Clinical diagnoses were confirmed by brain CT or MRI in 89% of the patients. The crude anneal incidence rate was 2.80/I,000 (95% CI 2.62-2.99) or 2.41/I,000 and 2.3311,(300 when respectively adjusted to the 1991 Italian and European populations. Au increase of the crude incidence rate was observed in 1995 with respect to 1994 (2.84 vs 2.75/1,000). Incidence rates were higher in men than in women (2.90 vs 2.70/I,000/year) with a steep rise in patients over 65. In patients over 80 the crude incidence rate was 24.23/l,000/year. The proportions of cerebral ischemia, intracerebral and subaracnoid hemorrhage, and ill-defined events were 81%, 14.8%, 3.1%, and 1.1%, respectively. Thirty-day mortality occurred in 394 patients (23.6%), with a median survival of 5 days. Survival was better after cerebral ischemia than after intracerebral or subarachnoid hemorrhage ( P < 0.000h log-rank test) and in patients under than over 80 (P<0.000i; log-rank test). No significant differences were found in stroke incidence according to risk factors distribution, per capita aonual disposable income, and rural or urban dwelling. Conclusions: We found a high stroke incidence, independent of socioeconomic factors, possibly related to improved survival and aging of [he population.
HIGH PREVALENCE OF CARDIAC DISEASES IN POLAND AS A CAUSE OF HIGH MORTALITY IN STROKE. A. Czlonkowska. D. Rvolewicz. S. Cichv. T. Mendel. W. Lechowicz. D. Hier ~ 2nd Department of Neurology, Institute of Psychiatry and Neurology. Warsaw. Poland; *Department of Neurology, University of Illinois, Chicago, U.S.A. Stroke mortality rates vary more than B-fold in men and women between countries. Poland has one of the highest stroke mortality in Europe (106.41100 000 in men and 787/100 000 in women), that has not changed at least since 1984. High 30 day case fatality is the main reason of those mortality rates. The aim of this study was an analysis of the prevalence of stroke risk factors in patients with ischemic stroke treated in Poland (N=258) and in US* (N=961). The comparison revealed that cardiac diseases are much more common in Poland than in US (Ischemic Stroke Clinical 8enchmarking Data Base, Report #1-9.30.1996, Clinical Process Improvement). In the group of patients with ischemic stroke In Poland angina was diagnosed in 34.5% (95% C[ 28.4 - 40.5), MI in 19.3% (95% C114.3 - 24.3), AF in 24.8% (95% C119.3 - 30.3), CHF in 21.4% (95% C116-27), in US 17% (95% C114.6-19.3), 11.6% (95% CI 9.S-13 6), 12.0% (95% CI 9.9-14.0) and 9.7% (95% CI 8-12) respectivly, differences were statistically significant. The prevalence of hypertension, diabetes and smoking were similar in both populations. The high prevalence of cardiac disease among stroke patients in Poland may indicate the possibility of moce frequent occurrence of severe type of stroke probably of cardioembolic origin. Such possibility is suported by more frequent occurrence of disorders of consciousness at the onset of stroke among patients treated in Poland 39.5% (95% CI 33.3-45.7), compared to patients treated in US* 12.6% (95% C110.6-14.8), and less frequent occurrence of LACI according to OCSPClassification, in Poland 27.3%(95% C120.1-34.2), in comparison to 48.7% (95% CI 36.4%-60.8) diagnosed in US (Neurological Department, University of Illinois). CONCLUSION: Frequent prevalence of cardiac diseases among stroke patients in Poland may be one of the reasons of high mortality due to: increased risk of severe stroke (cardioembolic), increased risk of recurrent stroke, increased risk of death due to cardiologic complications.