Echocardiographic epicardial fat thickness and immature granulocyte are novel inflammatory predictors of acute ischemic stroke
a prospective study
Keywords:
Ultrasonography, Granulocytes, Ischemic strokeAbstract
BACKGROUND: Acute ischemic stroke (AIS) is the most common type of stroke. Inflammation is the primary factor in the pathogenesis of atherosclerosis. Use of immature granulocytes (IGs) has been recommended as a new indicator of systemic inflammation. However, data on the association between echocardiographic epicardial fat tissue thickness (EFT) and IGs in patients with AIS are limited. OBJECTIVE: To evaluate the association between the presences of IGs, epicardial fat tissue and AIS. DESIGN AND SETTING: Prospective study in a tertiary-care university hospital in Antalya, Turkey. METHODS: Our study included 53 AIS patients and 41 healthy controls with age and gender compatibility. Blood samples and transthoracic echocardiography of all participants were compared. RESULTS: IG levels were significantly higher in patients with AIS than in controls (0.62 ± 0.36 versus 0.28 ± 0.02, P < 0.001). The mean EFT was 3.74 ± 0.61 mm in the control group and 6.33 ± 1.47 mm in the AIS patient group. EFT was significantly greater in AIS patients than in controls (P < 0.001). For the optimum cut-off value for IG (0.95), the area under the curve (AUC) was determined to be 0.840; sensitivity was determined to be 81.1% and specificity, 92.5%. For the optimum cut-off value for EFT (4.95 mm), the AUC was determined to be 0.953; sensitivity was determined to be 90.6% and specificity, 90%. CONCLUSIONS: IG and echocardiographic EFT are clinical markers that can be used to predict AIS risk.
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Topçuoğlu MA, Arsava EM, Özdemir AÖ, et al. Intravenous Thrombolytic Therapy in Acute Stroke: Problems and Solutions. Turk J Neurolol. 2017;23(4):162-75. https://doi.org/10.4274/tnd.71084.
Feng X, Chan KL, Lan L, et al. Stroke mechanisms in symptomatic intracranial atherosclerotic disease: classification and clinical implications. Stroke. 2019;50(10):2692-9. PMID: 31409268; https://doi.org/%2010.1161/strokeaha.119.025732.
Yɩldɩz D, Seferoğlu M, Güneş A, Büyükkoyuncu N, Sɩğɩrlɩ D. Epicardial Adipose Thickness and Neutrophil Lymphocyte Ratio in Acute Occlusive Cerebrovascular Diseases. J Stroke Cerebrovasc Dis. 2020;29(11):105203. PMID: 33066933; https://doi.org/10.1016/j.jstrokecerebrovasdis.2020.105203.
Yu S, Arima H, Bertmar C, Clarke S, et al. Neutrophil to lymphocyte ratio and early clinical outcomes in patients with acute ischemic stroke. J Neurol Sci. 2018;387:115-8. PMID: 29571846; https://doi.org/10.1016/j.jns.2018.02.002.
Bedel C, Korkut M, Avcɩ A, Uzun A. Immature Granulocyte Count and Percentage as New Predictors of Mortality in Patients with Upper Gastrointestinal Bleeding. Indian J Crit Care Med. 2020;24(9):794-8. PMID: 33132562; https://doi.org/10.5005/jp-journals-10071-23563.
Bedel C, Korkut M, Aksoy F, Kus G. Usefulness of Immature Granulocytes to Predict High Coronary SYNTAX Score in Acute Coronary Syndrome; a Cross-sectional Study: Usefulness of immature granulocytes to predict high coronary syntax score. Arch Acad Emerg Med. 2020;8(1):e73. PMID: 33134969.
Ansaldo AM, Montecucco F, Sahebkar A, Dallegri F, Carbone F. Epicardial adipose tissue and cardiovascular diseases. Int J Cardiol. 2019;278:254-60. PMID: 30297191; https://doi.org/10.1016/j.ijcard.2018.09.089.
González N, Moreno-Villegas Z, González-Bris A, Egido J, Lorenzo Ó. Regulation of visceral and epicardial adipose tissue for preventing cardiovascular injuries associated to obesity and diabetes. Cardiovasc Diabetol. 2017;16(1):44. PMID: 28376896; https://doi.org/10.1186/s12933-017-0528-4.
Park J-S, Choi S-Y, Zheng M, et al. Epicardial adipose tissue thickness is a predictor for plaque vulnerability in patients with significant coronary artery disease. Atherosclerosis. 2013;226(1):134-9. PMID: 23206980; https://doi.org/10.1016/j.atherosclerosis.2012.11.001.
Pierdomenico SD, Pierdomenico AM, Cuccurullo F, Iacobellis G. Meta-analysis of the relation of echocardiographic epicardial adipose tissue thickness and the metabolic syndrome. Am J Cardiol. 2013;111(1):73-8. PMID: 23040591; https://doi.org/10.1016/j.amjcard.2012.08.044.
Lang RM, Bierig M, Devereux RB, et al. Recommendations for chamber quantification: a report from the American Society of Echocardiography’s Guidelines and Standards Committee and the Chamber Quantification Writing Group, developed in conjunction with the European Association of Echocardiography, a branch of the European Society of Cardiology. J Am Soc Echocardiogr. 2005;18(12):1440-63. PMID: 16376782; https://doi.org/10.1016/j.echo.2005.10.005.
Iacobellis G, Willens HJ. Echocardiographic epicardial fat: a review of research and clinical applications. J Am Soc Echocardiogr. 2009;22(12):1311-9. PMID: 19944955; https://doi.org/10.1016/j.echo.2009.10.013.
Aksoy F, Guler S, Kahraman F, Oskay T, Varol E. The relation between echocardiographic epicardial fat thickness and CHA2DS2-VASc score in patients with sinus rhythm. Braz J Cardiovasc Surg. 2019;34(1):41-7. PMID: 30810673; https://doi.org/10.21470/1678-9741-2018-0230.
Nagy E, Jermendy AL, Merkely B, Maurovich-Horvat P. Clinical importance of epicardial adipose tissue. Arch Med Sci. 2017;13(4):864. PMID: 28721155; https://doi.org/10.5114/aoms.2016.63259.
Chu C-Y, Lee W-H, Hsu P-C, et al. Association of increased epicardial adipose tissue thickness with adverse cardiovascular outcomes in patients with atrial fibrillation. Medicine. 2016;95(11). PMID: 26986099; https://doi.org/10.1097/MD.0000000000002874.
Iacobellis G, Zaki M, Garcia D, Willens H. Epicardial fat in atrial fibrillation and heart failure. Horm Metab Res. 2014;46(08):587-90. PMID: 24557503; https://doi.org/10.1055/s-0034-1367078.
Wang T, Liu Q, Liu C, et al. Correlation of echocardiographic epicardial fat thickness with severity of coronary artery disease in patients with acute myocardial infarction. Echocardiography. 2014;31(10):1177-81. PMID: 24645963; https://doi.org/10.1111/echo.12545.
Tanindi A, Erkan AF, Ekici B. Epicardial adipose tissue thickness can be used to predict major adverse cardiac events. Coron Artery Dis. 2015;26(8):686-91. PMID: 26267746; https://doi.org/10.1097/MCA.0000000000000296.
Saçmacɩ H, Turan Y. Increased epicardial fat thickness and carotid intima–media thickness in migraine patients. Neurol Sci. 2020;41(1):49-56. PMID: 31418116; https://doi.org/10.1007/s10072-019-04008-w.
Akɩl E, Akɩl MA, Varol S, et al. Echocardiographic epicardial fat thickness and neutrophil to lymphocyte ratio are novel inflammatory predictors of cerebral ischemic stroke. J Stroke Cerebrovasc Dis. 2014;23(9):2328-34. PMID: 25200242; https://doi.org/10.1016/j.jstrokecerebrovasdis.2014.04.028.
Zhang L, Yang L. Anti-inflammatory effects of vinpocetine in atherosclerosis and ischemic stroke: a review of the literature. Molecules. 2015;20(1):335-47. PMID: 25549058; https://doi.org/10.3390/molecules20010335.
Sun R, Wang L, Guan C, Cao W, Tian B. Carotid atherosclerotic plaque features in patients with acute ischemic stroke. World Neurosurg. 2018;112:e223-e8. PMID: 29325936; https://doi.org/10.1016/j.wneu.2018.01.026.
Deng Q-W, Gong P-Y, Chen X-L, et al. Admission blood cell counts are predictive of stroke-associated infection in acute ischemic stroke patients treated with endovascular therapy. Neurol Sci. 2021;42(6):2397-409 PMID: 33057978; https://doi.org/10.1007/s10072-020-04827-2.
Hu J, Zhou W, Zhou Z, Han J, Dong W. Elevated neutrophil-to-lymphocyte and platelet-to-lymphocyte ratios predict post-stroke depression with acute ischemic stroke. Exp Ther Med. 2020;19(4):2497-504. PMID: 32256727; https://doi.org/10.3892/etm.2020.8514.
Fernandes B, Hamaguchi Y. Automated enumeration of immature granulocytes. Am J Clin Pathol. 2007;128(3):454-63. PMID: 17709320; https://doi.org/10.1309/tvgkd5tvb7w9hhc7.
Lima LR, Cunha GS, Nogueira KS, Comar SR. Automated immature granulocyte count in patients of the intensive care unit with suspected infection. J Bras Patol Med Lab. 2019;55(3):267-80. https://doi.org/10.5935/1676-2444.20190031
Park JH, Byeon HJ, Lee KH, et al. Delta neutrophil index (DNI) as a novel diagnostic and prognostic marker of infection: a systematic review and meta-analysis. Inflamm Res. 2017;66(10):863-70. PMID: 28646289; https://doi.org/10.1007/s00011-017-1066-y.
Zeng L, Wang S, Lin M, et al. Evaluation of time to positivity for blood culture combined with immature granulocytes, neutrophil-to-lymphocyte ratio, and CRP in identifying bloodstream coagulase-negative Staphylococci infection in pediatric patients. J Clin Lab Anal. 2020;34(11):e23473. PMID: 33463771; https://doi.org/10.1002/jcla.23473.
Korkut M, Bedel C, Selvi F. Are immature granulocytes and derivatives early predictors of acute appendicitis and acute complicated appendicitis in adults? Formos J Surg. 2020;53(4):123. https://doi.org/10.4103/fjs.fjs_111_19.
Incir S, Calti HK, Palaoglu KE. The role of immature granulocytes and inflammatory hemogram indices in the inflammation. Int J Med Biochem. 2020;3(3):125-30. https://doi.org/10.14744/ijmb.2020.02986.
Karakulak S, Narcɩ H, Ayrɩk C, Erdoğan S, Üçbilek E. The prognostic value of immature granulocyte in patients with acute pancreatitis. Am J Emerg Med. 2021;44:203-7. PMID: 32220526; https://doi.org/10.1016/j.ajem.2020.03.028.