Cardio-embolic Stroke and Blood Bio-markers
Condition: Ischemic Stroke
MeSH terms: Stroke; Ischemic Stroke; Embolic Stroke
Study type: Observational

Summary: 
      Brain is a productive source of variety of enzymes and any brain injury like stroke to brain
      tissue could similarly result in an increase in these enzymes in cerebrospinal fluid and
      serum. Evaluation of these enzymes represent a simple method for the ischemic stroke subtype
      diagnosis and prognosis .Objective: The aim of this study was to determine the role Brain
      natriuretic peptide (BNP) , D-Dimer , creatine kinase- MB(CK-MB) , C reactive protein (CRP)
      serum levels and G/A ratio in diagnosis of CES stroke and its ability to predict short term
      outcome. Methods: This study was conducted on 96 patients with acute ischemic stroke,
      subdivided into two groups, group Ι was 48 patients with cardio-embolic stroke and group ΙΙ
      was 48 patients with non- cardio-embolic. all patients were subjected to assessment of serum
      BNP, D-Dimer and CK-MB and CRP and globulin /albumin ratio within the first 24 h of stroke
      .At third week ,they were assessed by mRS.
    

Detailed description: 
      participants and methods : 96 acute ischemic stroke patients divided to two groups ; group Ι
      : 48 patients with cardio-embolic stroke (CES) and group ΙΙ: 48 patients with cerebrovascular
      stroke other than cardio-embolic stroke (non CES), with first-ever acute ischemic stroke
      within 24 h of onset of symptoms admitted to Intensive Care and Stroke Unit .

      All patients were subjected to full detailed neurological history with stressing on the
      vascular and cardiac risk factors , and general and neurological examination. Stroke severity
      was assessed using Glasgow Coma Scale (GCS) and the National Institutes of Health Stroke
      Scale (NIHSS)

      Laboratory investigations:15 ml venous blood were obtained from the patients within the first
      24 hours of stroke. All routine and special laboratory investigations were done at Clinical
      pathology department, Zagazig university hospitals including CBC, liver function, kidney
      function, ESR and lipid profile.

      Brain natriuretic peptide : 4 ml blood was placed in a polypro pane tube containing a mixture
      of sodium salt of ethylene diamine tetra acetic acid (EDTA) at a concentration of 1mg /ml of
      blood and aprotinin at a concentration of 500 kallikerin inhibitory unit (kiu) /ml of blood
      serving as a natural proteinase inhibitor which act as a preservative for natriuretic
      peptides , then mixing of the blood was done . then the tube was centrifuged at 5000 rpm for
      15 minutes in the cool centrifuge , the separated serum was stored at -70 degree c until
      analysis.

      Later on the assay was done using human BNP Elisa kits (Spain react kits sr 19369u) which are
      immune-sorbent assay for quantitative measurement , the least sensitivity is 14 pg/ml and
      ranges 14 -1000pg/ml .

      D-Dimer: 3ml blood was collected within a vacuum tubes containing 0.5 ml buffered sodium
      citrate before the initiation of any oral, enteral or parenteral feeding or medications.
      Blood samples were mixed well with avoiding of foam formation then immediately centrifuged at
      3000 rpm for 15 min at ambient room temperature and plasma is separated. D-Dimer was measured
      turbidmetry (SAT Liatest D-Di; Diagnostica STAGO) on the STAgo compact analyzer, Normal value
      is less than 500 ng / ml (15).

      Creatine Kinase MB : 4 ml blood were derived within a plastic tube centrifuged at 4000rpm for
      3minutes , the separated serum was assayed for CK MB using Spain react kits with normal value
      up to 2.8ng /L C reactive protein : 4ml were withdrawn in a plastic tube centrifuged at
      4000rpm for 3minutes , the separated serum used for analysis of CRP measured using Olympus
      640 analyzer with normal value up to 5 mg / L Globulin/Albumin ratio( G/A) was calculated
      with normal ratio 0.6-0.7 . All patients were evaluated by Brain CT or MRI for diagnosis of
      ischemic stroke .

      Each patient underwent to Electrocardiogram, Echocardiography and Carotid Doppler
      ultrasonography to define etiological stoke subtype.
    

Intervention name(s): blood biomarkers
Intervention type(s): Other
Intervention description(s): assessment of serum BNP, D-Dimer and CK-MB and CRP and globulin /albumin ratio stroke outcome
Observational model: Case-Control
Time perspective: Prospective
Sampling method: Probability Sample
Study population: 
        96 AIS patients divided to two groups ; group Ι : 48 patients with cardio-embolic stroke
        (CES) and group ΙΙ: 48 patients with cerebrovascular stroke other than cardio-embolic
        stroke (non CES), with first-ever acute ischemic stroke within 24 h of onset of symptoms
        admitted to Intensive Care and Stroke Unit