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Biomedical subjects

Pierre Amarenco

Publications and source records attributed to Pierre Amarenco.

At least 19 recordsLinked to original sources
PubMed2007

Correlation between the Framingham risk score and intima media thickness: the Paroi Artérielle et Risque Cardio-vasculaire (PARC) study.

AIMS: Carotid intima media thickness (IMT) is associated with an increased risk of cardio-vascular events, but its correlation with the absolute cardio-vascular risk is not well known in large populations. The Paroi Artérielle et Risque Cardio-vasculaire (PARC) study was designed to evaluate the relationship between conventional assessment of the global cardio-vascular risk by means of the Framimgham score and measurement of IMT of the common carotid artery (CCAIMT). METHODS AND RESULTS: About 246 French cardiologists selected 6416 subjects. CCAIMT measurements were performed using a specific methodology designed to harmonize the acquisition and processing of B-mode ultrasound images. The Framingham cardio-vascular score was determined for each individual. The relationship between CCAIMT and Framingham scores was evaluated using linear or polynomial models of regression. We found a significant correlation between CCAIMT and all components of the Framingham score (p < 0.005 for all parameters). The Framingham score and CCAIMT values were non-linearly related (coefficients of determination R2 were 19% and 20% in men, 28% and 29% in women, for subjects with and without personal history of cardio-vascular disease, respectively). The younger the subjects, the steeper the relationship, when the analysis was performed according to decades. CONCLUSIONS: The Framingham score and CCAIMT values were significantly correlated. However variations in CCAIMT only explained a modest part of the Framingham score and vice versa.

Aged↗
PubMed2006

Ischemia-modified albumin in acute stroke.

BACKGROUND: Ischemia-modified albumin (IMA)is a new biological marker of ischemia. Previous studies have found increased serum IMA levels after myocardial ischemia, but no study has investigated the possibility that stroke modifies IMA blood levels. MATERIALS AND METHODS: We studied 118 consecutive patients presenting within 3 h of the onset of an acute neurological deficit [84 brain infarctions (BI), 18 brain hemorrhages (ICH) and 16 transient ischemic attacks lasting less than 1 h or epileptic seizures]. Serum samples were obtained for all patients at initial presentation and repeated only in patients with stroke at 6, 12 and 24 h. IMA was measured by the albumin-cobalt-binding test (Ischemia Technologies, Denver, Colo., USA). RESULTS: The initial median IMA (bootstrap 95% confidence interval, CI) was 83 U/ml (79-86) and 86 U/ml (75-90) in patients with BI and ICH, respectively (p = 0.76), and was 73 U/ml (58-79) in others (p = 0.003 compared with BI, and p = 0.017 with ICH). Baseline IMA levels correlated with the National Institutes of Health Stroke Scale [Spearman correlation coefficient: 0.34 (p = 0.002) in BI, 0.61 (p = 0.008) in ICH]. During the first 24 h, IMA levels increased in BI patients (median, 9.1%; bootstrap 95% CI, 5.2-11.5), whereas no change was observed in ICH patients (median, 1.2%; bootstrap 95% CI, -7.8 to 6.8). CONCLUSIONS: IMA blood levels may be a biomarker for early identification of acute stroke. Further studies are required to investigate the role of IMA in the early detection of acute stroke.

Acute Disease↗
PubMed2006

High-dose atorvastatin after stroke or transient ischemic attack.

BACKGROUND: Statins reduce the incidence of strokes among patients at increased risk for cardiovascular disease; whether they reduce the risk of stroke after a recent stroke or transient ischemic attack (TIA) remains to be established. METHODS: We randomly assigned 4731 patients who had had a stroke or TIA within one to six months before study entry, had low-density lipoprotein (LDL) cholesterol levels of 100 to 190 mg per deciliter (2.6 to 4.9 mmol per liter), and had no known coronary heart disease to double-blind treatment with 80 mg of atorvastatin per day or placebo. The primary end point was a first nonfatal or fatal stroke. RESULTS: The mean LDL cholesterol level during the trial was 73 mg per deciliter (1.9 mmol per liter) among patients receiving atorvastatin and 129 mg per deciliter (3.3 mmol per liter) among patients receiving placebo. During a median follow-up of 4.9 years, 265 patients (11.2 percent) receiving atorvastatin and 311 patients (13.1 percent) receiving placebo had a fatal or nonfatal stroke (5-year absolute reduction in risk, 2.2 percent; adjusted hazard ratio, 0.84; 95 percent confidence interval, 0.71 to 0.99; P=0.03; unadjusted P=0.05). The atorvastatin group had 218 ischemic strokes and 55 hemorrhagic strokes, whereas the placebo group had 274 ischemic strokes and 33 hemorrhagic strokes. The five-year absolute reduction in the risk of major cardiovascular events was 3.5 percent (hazard ratio, 0.80; 95 percent confidence interval, 0.69 to 0.92; P=0.002). The overall mortality rate was similar, with 216 deaths in the atorvastatin group and 211 deaths in the placebo group (P=0.98), as were the rates of serious adverse events. Elevated liver enzyme values were more common in patients taking atorvastatin. CONCLUSIONS: In patients with recent stroke or TIA and without known coronary heart disease, 80 mg of atorvastatin per day reduced the overall incidence of strokes and of cardiovascular events, despite a small increase in the incidence of hemorrhagic stroke. (ClinicalTrials.gov number, NCT00147602 [ClinicalTrials.gov].).

Adult↗
PubMed2006

Basilar artery diameter and 5-year mortality in patients with stroke.

BACKGROUND AND PURPOSE: Few and conflicting data exist on the case fatality rate in stroke patients with basilar artery dolichoectasia. We analyzed basilar artery characteristics (diameter, height of bifurcation, transverse position) and 5-year mortality (all-cause, nonstroke vascular, and stroke) in patients with brain infarction. METHODS: The basilar artery diameter was measured with a 16-diopter lens in 466 consecutively recruited patients with brain infarction confirmed by magnetic resonance imaging. The height of the bifurcation and the transverse position of the basilar artery were assessed on semiquantitative scales. Patients were followed up for a median of 5.3 years (range, 1.5 to 6.6) and were classified as having had stroke, nonstroke vascular, and nonvascular death according to the French national registry of death certificates. RESULTS: Of the 157 deaths, 88 were vascular (including 54 stroke deaths). Basilar artery diameter was associated with an increased 5-year stroke mortality rate but not with all-cause or nonstroke vascular mortality. The adjusted hazard ratio (HR) of stroke mortality per 1-mm increase in basilar artery diameter was 1.23 (95% confidence interval [CI], 1.07 to 1.41). A higher risk of stroke death was associated with basilar artery diameter at the 95th percentile (diameter >4.3 mm; adjusted HR 3.69; 95% CI, 1.63 to 8.38) and the height of bifurcation (adjusted HR for score >1, 2.08; 95% CI, 0.93 to 4.68) but not with transverse position. CONCLUSIONS: Basilar artery diameter was independently associated with cerebrovascular mortality. A diameter >4.3 mm may be a marker for a high risk of fatal stroke.

Aged↗
PubMed2006

Cytokine polymorphisms associated with carotid intima-media thickness in stroke patients.

BACKGROUND AND PURPOSE: Carotid intima-media thickness (IMT) reflects generalized atherosclerosis and is predictive of future vascular events. Evidence exists that carotid IMT is heritable, and genetic studies can provide clues in the pathogenesis of atherosclerosis. METHODS: We recruited 470 white ischemic stroke patients, measured common carotid artery (CCA) IMT, and analyzed 54 polymorphisms with suspected roles in atherosclerosis. RESULTS: Among the polymorphisms tested, the angiotensin-converting enzyme insertion/deletion, osteopontin (OPN) T-443C, monocyte chemoattractant protein-1 (MCP-1) G-927C, and MCP-1 A-2578G polymorphisms were associated with CCA-IMT in age-gender-adjusted analysis. In multivariate analysis, the association between the OPN and MCP-1 polymorphisms remained significant. The OPN-443C allele was associated with increased IMT in the dominant model (0.053 mm for the TC and CC genotypes; P=0.001). The MCP-1-927C allele was associated with increased IMT in the additive model (0.040 mm for each C allele; P=0.001), and the MCP-1-2578 G allele was associated with decreased IMT in the recessive model (0.088 mm for the GG genotype; P=0.002). CONCLUSIONS: The OPN and MCP-1 genes, coding for 2 cytokines with known roles in atherosclerosis, may contribute to increased carotid IMT and warrant further study.

Adolescent↗
PubMed2006

Blood lipids in brain infarction subtypes.

BACKGROUND: Little is known about the relationship between hypercholesterolaemia and specific aetiological subtypes of brain infarction (BI). METHODS: In a cross-sectional study of 492 pairs of patients with a BI proven by MRI and matched hospital controls, we determined the blood levels of triglycerides, total, HDL and LDL cholesterol, and apolipoprotein A(1) and B, in the same centralized laboratory. We performed aetiological BI subtype classification. RESULTS: Except for triglycerides, the risk of BI increased continuously with the lipid levels, without any heterogeneity between the main BI subtypes or the group on lipid-lowering therapy. The adjusted odds ratio per standard deviation in LDL cholesterol (0.93 mmol/l) was 1.74 (95% confidence interval, 1.02-2.98) in atherothrombotic strokes (n = 109) and 2.71 (95% confidence interval, 1.60-4.55) in lacunar strokes (n = 105). Eighty percent of patients were above the ATP-III guideline threshold LDL cholesterol of 2.59 mmol/l (100 mg/dl), with a major contribution of both atherothrombotic and lacunar stroke subtypes to this group. CONCLUSIONS: These findings suggest that blood lipids, particularly total and LDL cholesterol levels, are associated with all subtypes of BI, and that LDL above 2.59 mmol/l is highly prevalent.

Aged↗
PubMed2006

Polypill strategy vs. prevention clinics for stroke prevention.

Thirty years of clinical trials have demonstrated that stroke can be prevented by reducing blood pressure to less than 140/90 mm Hg or by a further decrease of 10/5 mm Hg when blood pressure is controlled, by reducing LDL cholesterol by at least 1 mmol/l (39 mg/dl), and by inhibiting platelet aggregation. The (too simplistic) concept of the polypill strategy combining pharmacologic agents to achieve these goals is supposed to reduce the risk by 80% overall. However, reducing general salt and sugar intake, giving up smoking, developing prevention clinics with prevention nurses to improve adherence to preventive treatments, as well as decreasing poverty and malnutrition, increasing the level of hygiene, fighting against infectious diseases and financially helping developing countries are all combined necessary approaches to decrease the worldwide burden of stroke and other vascular diseases.

Anticholesteremic Agents↗
PubMed2006

Insular involvement in brain infarction increases risk for cardiac arrhythmia and death.

OBJECTIVE: Brain injuries may induce cardiac dysrhythmias and sudden cardiac death. METHODS: We analyzed 12-lead electrocardiograms of 493 consecutive patients with brain infarction (BI) proved by an magnetic resonance imaging and 493 control subjects matched for age, sex, and center. Insular involvement (insula (+/-)) was assessed by two independent readings of the magnetic resonance imaging scans. Cases were followed for 5 years. RESULTS: Acute BI was independently associated with heart rate (< or = 64 beats/min), abnormal repolarization, atrial fibrillation, and ventricular and supraventricular ectopic beats. Lower heart rate in BI patients was due to an interaction with smoking (p for interaction = 0.004). Insula(+) group was significantly associated with abnormal repolarization with no interaction with infarct side. Atrial fibrillation by history was also more frequent in the insula(+) than in the insula(-) group (p = 0.07). After adjustment for age, sex, cardiovascular history, and handicap at admission, right insula(+) BI was significantly associated with 2-year all-cause death (hazard ratio, 2.11; 95% confidence interval, 1.27-3.52) and with vascular death (hazard ratio, 2.00; 95% confidence interval, 1.00-3.93). In multivariate analysis including age, sex, cardiovascular history, handicap at admission, and lesion side, increased QTc interval and left bundle branch block were independent predictors of all-cause and vascular mortality at 2 years in right insula(+) patients. INTERPRETATION: These findings support the notion that right insular involvement may lead to electrocardiographic abnormalities with potential prognostic implications. This could be important for optimal care in patients with right insular infarct.

Adult↗
PubMed2006

Aortic arch atheroma and the risk of stroke.

Brain infarction of unknown cause, known as cryptogenic stroke, represents 30% to 40% of all ischemic strokes, or approximately 400,000 cases each year in western Europe. In this category of patients new potential causes, such as aortic arch atheroma in the elderly, have been investigated in the past two decades.

Aorta, Thoracic↗
PubMed2006

Flow-mediated vasodilatation of carotid and brachial arteries in healthy subjects and in lacunar stroke patients.

The vasodilatory response of arteries can be measured by ultrasound, and it was previously shown that brachial artery (BA) vasodilatation can be tested by postischemic hyperemia. In the current study, the primary objective was to determine if hypercapnia can be used to assess common carotid artery (CCA) flow-mediated vasodilatation (FMVD) in healthy subjects. Secondary objectives were to investigate CCA-FMVD in lacunar patients and whether BA-FMVD parallels CCA-FMVD. We used ultrasound to measure flow-mediated and nitroglycerin (NTG)-mediated vasodilatation in the CCA and BA in 20 healthy subjects and in 17 lacunar patients. BA-FMVD was induced by a postischemic maneuver. For the CCA, FMVD was induced by hypercapnia from CO(2)-enriched inhalation. BA and CCA vasodilatation were measured after sublingual NTG administration. BA dilated significantly in healthy (6.7%) and stroke subjects (4.2%) under postischemic conditions. The CCA dilated significantly after CO(2) inhalation (11.4% in healthy subjects and 4% in lacunar patients) and NTG administration (18% in healthy subjects and 10.6% in lacunar patients). Surprisingly, there was a strong negative correlation between CCA- and BA-FMVD in healthy subjects. CCA vasodilatation induced by CO(2) inhalation and NTG administration can be measured. The strong negative correlation between CCA- and BA-FMVD suggests that there could be different mechanisms of vasodilatation.

Blood Flow Velocity↗
PubMed2006

High blood pressure in early acute stroke: a sign of a poor outcome?

OBJECTIVE: To evaluate the prognostic value of admission blood pressure in patients with acute ischemic stroke by determining whether it contributes to clinical outcome and vascular death. METHODS: We studied 230 consecutive patients admitted within the first 24 h after the onset of ischemic stroke. We used the first systolic and diastolic blood pressure measurements recorded on admission. The functional outcome was assessed on the basis of mortality or dependency (Rankin Scale > 3) at the 10-day and 6-month visits. RESULTS: High systolic blood pressure on admission was associated with poor outcome at the 10-day and 6-month visits, independent of the baseline risk factors but not of the severity of the initial stroke (odds ratio, 1.39; 95% confidence interval, 0.50-3.87). The spontaneous decrease in systolic blood pressure within the first 10 days was higher in patients with functional improvement. The admission blood pressure was not significantly associated with total and vascular deaths, except for a threshold effect of diastolic blood pressure. CONCLUSIONS: After an acute stroke, the relationship between blood pressure and clinical outcome depended on the severity of the stroke on presentation, and on the level and trend of the systolic blood pressure during the first 24 h.

Acute Disease↗
PubMed2005

Carotid intima-media thickness, plaques, and Framingham risk score as independent determinants of stroke risk.

BACKGROUND AND PURPOSE: The Framingham stroke risk score (FSRS) and Framingham cardiovascular risk score (FCRS) estimate the individual absolute cardiovascular and stroke risks. Common carotid artery intima-media thickness (CCA-IMT) and carotid plaques (CPs) are markers of subclinical atherosclerosis and help in the early identification of presymptomatic individuals. The purpose of this study was to correlate Framingham risk score (FRS) with CCA-IMT and CPs and evaluate their respective contribution to stroke risk. METHODS: In 510 consecutive patients with brain infarction and 510 matched controls, we calculated the FSRS and FCRS for each individual and performed carotid ultrasonography. Mean CCA-IMT was measured off-line at a central core laboratory, and presence of CPs was assessed. RESULTS: FRS progressively increased according to tertiles of CCA-IMT (P for trend <0.0001). The part of the variances of FSRS and FCRS explained by CCA-IMT was respectively 11% and 20%. The relationships between CCA-IMT and FRS were significantly different between patients with or without CPs (P for interaction <0.005). With increasing CCA-IMT, the 10-year FRS gradually increased between 10% and 20% in the presence of CPs and between 5% and 20% in the absence of CPs. Multiple conditional logistic regression for matched sets showed that CCA-IMT, FCRS, and CPs were independently associated with stroke risk, with an odds ratio of 1.68 (1.25 to 2.26; P=0.0006), 2.16 (1.57 to 2.98; P<0.0001), and 2.73 (1.68 to 4.44; P<0.0001), respectively, meaning that each of them may be important for evaluation of the individual cardiovascular risk. CONCLUSIONS: CCA-IMT, CPs, and FRSs correlated well. The CCA-IMT value may help discriminate between subjects at low or high 10-year risk.

Adult↗
PubMed2005

High-resolution MRI identifies basilar artery plaques in paramedian pontine infarct.

Paramedian pontine infarct (PPI) is usually attributed to basilar artery (BA) atherosclerosis. However, this hypothesis has thus far been supported only by post-mortem studies. The authors show that high-resolution MRI is a promising method that can detect BA plaques in patients with PPI at or near the origin of the penetrating artery, whereas MR angiograms may appear normal.

Adult↗
PubMed2005

Adverse associations between CX3CR1 polymorphisms and risk of cardiovascular or cerebrovascular disease.

OBJECTIVE: We investigated the role of monocyte-recruiting chemokines in cerebrovascular diseases among the subjects of the GENIC case-control study of brain infarction (BI). METHODS AND RESULTS: Of the genotypes tested, only homozygosity for the rare CX3CR1 alleles was more frequent in cases than in controls: the I249 and M280 alleles were associated with an increased risk of BI (OR, 1.66 and OR, 2.62 with P<0.05, respectively). This effect was independent of other established risk factors and uncorrelated with disease severity. The study confirmed previous reports of a dominant protective association between CX3CR1-I249 allele and the risk of cardiovascular history. The risk of BI associated with homozygosity for the rare CX3CR1 alleles was enhanced in patients with no previous cardiovascular events. Ex vivo studies showed that the number of monocytes adhering to immobilized CX3CL1, the CX3CR1 ligand, increased proportionally to the number of CX3CR1 mutated alleles carried by the individual. CONCLUSIONS: The rare CX3CR1 alleles were associated with an increased risk of BI and with reduced frequency of cardiovascular history. We propose that the extra adhesion of monocytes observed in individuals carrying rare alleles of CX3CR1 may favor mechanisms leading to stroke.

Adult↗