Biomarkers, Hemodynamic and Echocardiographic Predictors of Ischemic Strokes and Their Influence on the Course and Prognosis
Condition: Embolic Stroke of Undetermined Source; Ischemic Stroke; Atrial Fibrillation and Flutter; Myocardial Infarction; Cardiac Tumor; Endocarditis; Patent Foramen Ovale
MeSH terms: Heart Neoplasms; Stroke; Ischemic Stroke; Cerebral Infarction; Embolic Stroke; Atrial Fibrillation; Myocardial Infarction; Endocarditis; Foramen Ovale, Patent; Ischemia
Study type: Interventional

Summary: 
      A stroke is the second cause of deaths after heart attack, one of the most important causes
      of malfunction as far as adults are concerned and the second as for the frequency cause of
      dementia. In spite of a possibility of the therapy of stroke ( tissue plasminogen activator)
      and recognized most of risk factors there is expected that incidence rate on stroke connected
      with ageing of the society will be growing. It will cause medical and social consequences.

      There are many of potential causes of cardiac strokes, which are not entirely examined.

      More over many cryptogenic strokes are presumed to have an embolic etiology, and the frequent
      cause of these kind of strokes at young age is probably the mechanism of paradoxical embolism
      through patent foramen ovale.

      As far as the investigators are concerned, at present there is lack of any recommendations
      for these scientific hypothesis.
    

Detailed description: 
      A stroke is the second cause of deaths after heart attack, one of the most important causes
      of malfunction as far as adults are concerned and the second as for the frequency cause of
      dementia. In spite of a possibility of the therapy of stroke ( tissue plasminogen activator)
      and recognized most of risk factors there is expected that incidence rate on stroke connected
      with ageing of the society will be growing. It will cause medical and social consequences.

      The risk factors of stroke can be divided into alterable and not alterable. Importantly, the
      not alterable factors are: age, sex, race and genetic factors. After the age of 55 the risk
      of stroke grows twice in every decade of life. Moreover, it was alleged that incidence rate
      on stroke is more frequent at women than at men. At the black race the incidence rate on
      stroke is twice more frequent than at white race.

      Well- known are also genetic syndromes connected with strokes like s. MELAS or CADASIL.

      Well- known alterable factors are:

        -  hypertension

        -  coronary disease

        -  atrial fibrillation

        -  hypercholesterolemia

        -  diabetes

        -  nicotinism

        -  blood clotting disorder

        -  alcoholism

        -  TIA (transient ischemic attack) or previous former stroke

        -  asymptomatic stenosis of internal carotid artery

      Cardiogenic stroke is a stroke caused by embolic material, which was created in cardiac
      cavities or on cardiac valves. They comprised 11% of all strokes and 25% of ischemic strokes.
      Additionally, among patients over 80 years old cardiac causes are responsible for even 40% of
      all ischemic strokes and half of cardiogenic strokes is caused of atrial fibrillation. Among
      young people (below 45 years old) about 50% of strokes are cardiogenic and are connected with
      paradoxical embolism at patients with patent foramen ovale.

      Furthermore, cardiac- brain embolism is a result of:

        -  structural defect of cavities and valves of heart

        -  arrhythmia

        -  disturbances of movability of walls of the heart and function of endocardium which leads
           to increased risk of the risk of parietal thrombus

        -  cardiac insufficiency

      There are many of potential causes of cardiac strokes, which are not entirely examined as for
      example:

        -  small pockets of intra- atrial septum

        -  structures in dextral atrium like Eustachian valve or Chiari network

        -  there is also a theory that even enlargement of left atrium may be the cause of brain
           stroke

        -  aneurysm of intra- atrial septum.

      As far as the investigators are concerned, at present there is lack of any recommendations
      for these scientific hypothesis.

      Available data suggest that in the comparison with atherosclerosis and lacunar strokes
      cardiogenic strokes characterize with high mortality ranging of 27%. Also the risk of relapse
      is higher than in strokes of other etiology.

      Nevertheless, unfortunately, in spite of wide diagnostics at about 25-30% of patients with
      ischemic stroke the cause is unknown. This kind of stroke is called cryptogenic stroke or
      stroke with undefined etiology.

      They constitute almost half of all ischemic stroke at young patients (below 55 years old).
      Many cryptogenic strokes are presumed to have an embolic etiology, and the frequent cause of
      these kind of strokes at young age is probably the mechanism of paradoxical embolism through
      patent foramen ovale.

      To conclude, currently there aren't researches defining recommendations for long- lasting
      treatment patients with rare causes of strokes.
    

Intervention name(s): ADMA (asymmetric dimethylarginine) , NTproBNP (N-terminal pro b-type natriuretic peptide), IL-6 (Interleukin 6), Adiponectina, Leptine, Syndecan, Resistin
Intervention type(s): Diagnostic Test
Intervention description(s): ADMA, NTproBNP, IL-6, Adiponectina, Leptine, Syndecan, Resistin
Intervention MeSH terms: Natriuretic Peptide, Brain; N,N-dimethylarginine
Allocation: Non-Randomized
Intervention model: Parallel Assignment
Masking: Single (Investigator)
Primary purpose: Prevention