Abstract
BackgroundUnderstanding ischemic stroke pathogenesis helps in prevention, prognosis, and treatment. Stroke is greatly related to inflammation and thrombo-genesis as inflammatory cells (as neutrophils-lymphocytes) and thrombo-genic agents as von Willebrand factor antigen (VWF: Ag) and epicardial fat.Objectives of the studyEvaluation of epicardial fat thickness (EFT), neutrophil/lymphocytic ratio (NLR), and (VWF: Ag) levels as predisposing and prognostic factors of ischemic stroke.Patients and methodsSixty acute ischemic stroke patients were subjected to clinical assessment (Oxford stroke sheet), National Institute Health Stroke Scale: NIHSS), Modified Rankin Scale (MRS), NLR and VWF: Ag levels, transthoracic echo, duplex on carotid and vertebro-basilar arteries, and brain computed tomography (CT). Thirty-five healthy controls matched for age and sex were subjected to the same steps except NIHSS and MRS.ResultsEFT, NLR, and VWF among patients were significantly higher than control group. NLR ≥ 2 and VWF: Ag were significant risk factors among stroke patients with VWF: Ag had the higher risk than NLR ≥ 2. NLR was a high valid prognostic marker in predicting stroke outcome (MRS) with (optimal cutoff value 2.05) for prediction of primary unfavorable outcome. There was no statistical significance between (MRS) and EFT or VWF: Ag level.ConclusionEFT represents inexpensive and readily available clinical marker that may be useful in estimating risk of ischemic stroke. NLR is non-expensive easy marker for predicting stroke severity and primary unfavorable outcome. High VWF level increases ischemic stroke risk.
Highlights
Ischemic stroke is a major cause of disability and death
epicardial fat thickness (EFT), neutrophil/lymphocytic ratio (NLR), and von Willebrand factor antigen (VWF) among patients were significantly higher than control group
NLR ≥ 2 and VWF: Ag were significant risk factors among stroke patients with VWF: Ag had the higher risk than NLR ≥ 2
Summary
Inflammation plays a significant role in the pathogenesis of ischemic stroke, and its mechanism is complex [1]. The infarct area produces several inflammatory cytokines and recruits peripheral inflammatory leukocytes early as neutrophils which mediate and exacerbate ischemic brain injury and stroke severity. Increased EFT is associated with pro-atherogenic and proinflammatory adipokines and Important target of new therapeutics, primary, and secondary prevention in ischemic stroke is VWF which is aglyco protein that rises in thrombogenicity playing a crucial role in platelet adhesion and aggregation (the initial steps in thrombus formation) especially under high shear force [6]. Understanding ischemic stroke pathogenesis helps in prevention, prognosis, and treatment. Stroke is greatly related to inflammation and thrombo-genesis as inflammatory cells (as neutrophils-lymphocytes) and thrombo-genic agents as von Willebrand factor antigen (VWF: Ag) and epicardial fat
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