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Thromb Haemost 2019; 119(11): 1860-1868
DOI: 10.1055/s-0039-1694752
Stroke, Systemic or Venous Thromboembolism
Georg Thieme Verlag KG Stuttgart · New York

Impaired Arterial Elastic Properties and Endothelial Glycocalyx in Patients with Embolic Stroke of Undetermined Source

Ignatios Ikonomidis
1   Second Cardiology Department, Attikon University Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
,
Alexandra Frogoudaki
1   Second Cardiology Department, Attikon University Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
,
Agathi-Rosa Vrettou
1   Second Cardiology Department, Attikon University Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
,
Ioannis Andreou
1   Second Cardiology Department, Attikon University Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
,
Lina Palaiodimou
2   Second Department of Neurology, Attikon University Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
,
Konstantinos Katogiannis
1   Second Cardiology Department, Attikon University Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
,
Chryssa Liantinioti
2   Second Department of Neurology, Attikon University Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
,
Dimitrios Vlastos
1   Second Cardiology Department, Attikon University Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
,
Paschalis Zervas
2   Second Department of Neurology, Attikon University Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
,
Maria Varoudi
1   Second Cardiology Department, Attikon University Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
,
Vaia Lambadiari
3   Second Department of Internal Medicine, Attikon University Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
,
Helen Triantafyllidi
1   Second Cardiology Department, Attikon University Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
,
George Pavlidis
1   Second Cardiology Department, Attikon University Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
3   Second Department of Internal Medicine, Attikon University Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
,
Panagiotis Efentakis
4   Department of Pharmaceutical Chemistry, School of Pharmacy, National and Kapodistrian University of Athens, Athens, Greece
,
Maria Tsoumani
4   Department of Pharmaceutical Chemistry, School of Pharmacy, National and Kapodistrian University of Athens, Athens, Greece
,
Argirios E. Tsantes
5   Laboratory of Haematology & Blood Bank Unit, Attikon University Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
,
John Parissis
1   Second Cardiology Department, Attikon University Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
,
Ioanna Revela
1   Second Cardiology Department, Attikon University Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
,
Ioanna Andreadou
4   Department of Pharmaceutical Chemistry, School of Pharmacy, National and Kapodistrian University of Athens, Athens, Greece
,
Georgios Tsivgoulis
2   Second Department of Neurology, Attikon University Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
› Author Affiliations Funding None.
Further Information

Publication History

04 December 2018

26 June 2019

Publication Date:
17 August 2019 (online)

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Abstract

Background and Purpose Cardioembolism is a postulated mechanism of embolic stroke of undetermined source (ESUS). We investigated endothelial glycocalyx, aortic elastic properties, oxidative stress, and their association with left atrial (LA) function in ESUS and healthy individuals.

Methods In 90 ESUS patients (age 50.4 ± 13.2) and 90 controls with similar risk factors, we measured: (1) perfused boundary region (PBR) of the sublingual arterial microvessels (range 5–25 µm), a marker inversely related with glycocalyx thickness, (2) pulse wave velocity (PWV), central systolic blood pressure (cSBP), and augmentation index (AIx), (3) LA volume and strain using speckle-tracking imaging, and (4) malondialdehyde (MDA) and protein carbonyls (PCs), as oxidative stress markers.

Results Compared with controls, ESUS had higher PWV, PBR, MDA, and PC levels as well as higher LA volume and reduced reservoir LA strain (p < 0.05). PBR > 1.2 μm of microvessel ranging from 5 to 9 μm and PWV > 10.2 m/s were associated with ESUS on multivariable analysis (odds ratio: 2.374 and 5.429, p < 0.05, respectively) and increased the c-statistic of the initial model from 0.54 to 0.71. In ESUS, glycocalyx damage (increased PBR) was related with increased PWV (p < 0.01) which was linked with LA reservoir strain after controlling for age, sex, and risk factors (p = 0.03). Increased MDA and PC were related with glycocalyx damage, increased PWV (r = 0.67 and r = 0.52), AIx, cSBP, and aortic atheroma (p < 0.01).

Conclusion Arterial function and endothelial glycocalyx are severely impaired in ESUS and are linked to LA dysfunction suggesting their contribution to ESUS pathogenesis.

Clinical Trial Registration URL-http://www.clinicaltrials.gov. Unique identifier: NCT03609437.

Keywords

embolic stroke of undetermined source - endothelium - glycocalyx - left atrium - cardiac - pulse wave velocity
 

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