Cardiovascular diseases and ischemic stroke: the importance of embolism and thrombosis

Amirinikpour, Mohammadreza; Zolfi-Gol, Ali; Nazarbaghi, Surena; Mosarrezaii, Arash; Hamzeh, Fatemeh; Gholinejad, Zafar

doi:10.61186/rabms.11.1.48

Volume 11, Issue 1 (1-2025) Journal of Research in Applied and Basic Medical Sciences 2025, 11(1): 48-58 | Back to browse issues page

‎ 10.61186/rabms.11.1.48

Ethics code: IR.UMSU.REC.1400.235

Mendeley

Zotero

RefWorks

Amirinikpour M, Zolfi-Gol A, Nazarbaghi S, Mosarrezaii A, Hamzeh F, Gholinejad Z. Cardiovascular diseases and ischemic stroke: the importance of embolism and thrombosis. Journal of Research in Applied and Basic Medical Sciences 2025; 11 (1) :48-58
URL: http://ijrabms.umsu.ac.ir/article-1-384-en.html

Cardiovascular diseases and ischemic stroke: the importance of embolism and thrombosis

Mohammadreza Amirinikpour ^*

Department of Neurology, Urmia University of Medical Sciences, Urmia, Iran , ghzafar1@yahoo.com

Abstract: (366 Views)

Background & Aims: Congestive heart failure (CHF) is a risk factor for acute ischemic stroke (AIS) incidence. Currently, no specific biomarker exists to differentiate thrombotic and embolic strokes. Managing and treating AIS patients with CHF, particularly those with embolic or thrombotic causes, requires a nuanced understanding of CHF’s role in AIS.
Materials & Methods: In this study, we reevaluated the medical records of patients admitted to Urmia Imam Khomeini Hospital from 2006 to 2023. The data was entered into SPSS IBM 23 and evaluated statistically. The exclusion criterion was incomplete medical records.
Results: Our results showed that the mean age of AIS patients with and without CHF was 71.18 ± 13.00 and 66.22 ± 14.76 years, respectively (p = 0.001). Hemoglobin levels, lymphocyte and neutrophil counts, and white blood cell counts showed a statistically significant difference between AIS patients with and without CHF. The frequency of thrombotic strokes was twice than that of embolic strokes, with the mean ages 68.75 ± 13.00 and 64.76 ± 16.38 years, respectively (p < 0.001). Patients with atrial fibrillation had an 8.27-fold increased risk of embolic ischemic stroke compared to those without atrial fibrillation (p < 0.001). Blood glucose, red blood cell count, total cholesterol, and LDLc cholesterol showed significant differences between embolic and thrombotic ischemic stroke patients.
Conclusion: In conclusion, the findings show that CHF is a risk factor for AIS that acts independently of gender. Monitoring immunological processes may be more clinically significant than RBC count and HCT levels in AIS patients with CHF. Additionally, age, RBC count, anemia, cholesterol, lipoproteins, and blood glucose levels could be used in clinical settings for the differential diagnosis of thrombotic versus embolic ischemic stroke.

Keywords: Congestive heart failure, Embolic, Ischemic stroke, Laboratory findings, Thrombotic

Full-Text [PDF 533 kb] (230 Downloads)

Type of Study: orginal article | Subject: Other

References

1. Feigin VL, Brainin M, Norrving B, Martins S, Sacco RL, Hacke W, et al. World stroke organization (WSO): Global Stroke Fact Sheet 2022. Int. J. Stroke 2022;17(1):18-29. [DOI:10.1177/17474930211065917] [PMID]

2. Fan, J., et al., Global burden, risk factor analysis, and prediction study of ischemic stroke, 1990-2030. Neurology, 2023. 101(2): p. e137-e150. [DOI:10.1212/WNL.0000000000207387]

3. Arboix A. Cardiovascular risk factors for acute stroke: Risk profiles in the different subtypes of ischemic stroke. World J. Clin. Cases 2015;3(5):418-29. [DOI:10.12998/wjcc.v3.i5.418] [PMID] [PMCID]

4. Chong AY, Blann AD, Patel J, Freestone B, Hughes E, Lip GY. Endothelial dysfunction and damage in congestive heart failure: relation of flow-mediated dilation to circulating endothelial cells, plasma indexes of endothelial damage, and brain natriuretic peptide. Circulation 2004. 110(13): p. 1794-1798. [DOI:10.1161/01.CIR.0000143073.60937.50] [PMID]

5. Scherbakov N, Haeusler KG, Doehner W. Ischemic stroke and heart failure: facts and numbers: Editorial. ESC Heart Fail 2015;2(1):1-4. [DOI:10.1002/ehf2.12026] [PMID] [PMCID]

6. Haeusler KG, Laufs U, Endres M. Chronic heart failure and ischemic stroke. Stroke 2011. 42(10): p. 2977-2982. [DOI:10.1161/STROKEAHA.111.628479] [PMID]

7. Uzuner N, Uzuner GT. Risk factors for multiple recurrent ischemic strokes. Brain Circ 2023;9(1):21-4. [DOI:10.4103/bc.bc_73_22] [PMID] []

8. Aleksic DZ, Jankovic SM, Mlosavljevic MN, Toncev GL, Miletic Drakulic SD, Stefanovic SM. Potential drug-drug interactions in acute ischemic stroke patients at the Neurological Intensive Care Unit. Open Med. (Warsz.) 2019;14(1):813-26. [DOI:10.1515/med-2019-0093] [PMID] []

9. Johansen MC, Chen J, Schneider ALC, Carlson J, Haight T, Lakshminarayan K, et al. Association between ischemic stroke subtype and stroke severity: The atherosclerosis risk in Communities study: The atherosclerosis risk in Communities study. Neurology 2023;101(9):e913-21. [DOI:10.1212/WNL.0000000000207535]

10. Shehjar F, Maktabi B, Rahman ZA, Bahader GA, James AW, Naqvi A, et al. Stroke: Molecular mechanisms and therapies: Update on recent developments. Neurochem. Int 2023;162(105458):105458. [DOI:10.1016/j.neuint.2022.105458] [PMID] [PMCID]

11. Ay H, Oliveira-Filho J, Buonanno FS, Ezzeddine M, Schaefer PW, Rordorf G, et al. Diffusion-weighted imaging identifies a subset of lacunar infarction associated with embolic source. Stroke, 1999. 30(12): p. 2644-2650. [DOI:10.1161/01.STR.30.12.2644] [PMID]

12. Rojsanga W, Sawanyawisuth K, Chotmongkol V, Tiamkao S, Kongbonkiat K, Kasemsap N. Clinical risk factors predictive of thrombotic stroke with large cerebral infarction. Neurol. Int 2019;11(2):7941. [DOI:10.4081/ni.2019.7941] [PMID] [PMCID]

13. González, RG, Hirsch JA, Koroshetz WJ, Lev MH, Schaefer P. Acute ischemic stroke. AJNR 2007, 28 (8) 1622-1623: [DOI:10.3174/ajnr.A0628] [PMCID]

14. Califf RM. Biomarker definitions and their applications. Exp. Biol. Med. (Maywood) 2018;243(3):213-21. [DOI:10.1177/1535370217750088] [PMID] [PMCID]

15. Fayyazi F, Ebrahimi V, Mamaghani MM, Abgharmi BA, Zarrini G, Mosarrezaii A, et al. N-Acetyl cysteine amide and cerium oxide nanoparticles as a drug delivery for ischemic stroke treatment: Inflammation and oxidative stress crosstalk. J. Trace Elem. Med. Biol 2023;80(127300):127300. [DOI:10.1016/j.jtemb.2023.127300] [PMID]

16. Salehnia F, Gholinejad Z, Nazarbaghi S, Rasmi Y, Nikpour MRA. The Gender Difference of Routine Laboratory Tests Performance in Prediction of Early Mortality in Ischemic Stroke Patients. Yeni Symposium. 2018;56:1. [DOI:10.5455/NYS.20180111022148]

17. Doehner W, Böhm M, Boriani G, Christersson C, Coats AJS, Haeusler KG, et al. Interaction of heart failure and stroke: A clinical consensus statement of the ESC Council on Stroke, the Heart Failure Association (HFA) and the ESC Working Group on Thrombosis. Eur. J. Heart Fail 2023;25(12):2107-29. [DOI:10.1002/ejhf.3071] [PMID]

18. Rich MW. Epidemiology, pathophysiology, and etiology of congestive heart failure in older adults. J. Am. Geriatr. Soc 1997;45(8):968-74. [DOI:10.1111/j.1532-5415.1997.tb02968.x] [PMID]

19. Petty GW, Khandheria BK, Whisnant JP, Sicks JD, O'Fallon WM, Wiebers DO. Outcomes among valvular heart disease patients experiencing ischemic stroke or transient ischemic attack in Olmsted County, Minnesota. Mayo Clin. Proc 2005;80(8):1001-8. [DOI:10.4065/80.8.1001] [PMID]

20. Regitz-Zagrosek V, Lehmkuhl E, Lehmkuhl HB, Hetzer R. Gender aspects in heart failure. Pathophysiology and medical therapy. Arch. Mal. Coeur Vaiss. 2004;97(9):899-908. [Google Scholar]

21. Simon T, Mary-Krause M, Funck-Brentano C, Jaillon P. Sex differences in the prognosis of congestive heart failure: results from the Cardiac Insufficiency Bisoprolol Study (CIBIS II): Results from the Cardiac Insufficiency Bisoprolol Study (CIBIS II). Circulation 2001;103(3):375-80. [DOI:10.1161/01.CIR.103.3.375] [PMID]

22. Ravandi F, Haj Mohamad Ebrahim Ketabforoush A, Azedi F, Hoshyarkhani M, Fayyaz F, Abbasi Khoshsirat N. Heart failure status among acute ischemic stroke patients: A hospital-based study. Neurol. Res. Int 2022;2022:7348505. [DOI:10.1155/2022/7348505] [PMID] [PMCID]

23. Ali MK, Narayan KMV, Tandon N. Diabetes & coronary heart disease: current perspectives. Indian J. Med. Res 2010;132:584-97. [DOI:10.4103/IJMR.2010_132_05_584] [PMID] [PMCID]

24. Zaman MO, Kim K, Yousafzai OK, Umer M, Jones RG, Shah R, et al. Heart failure with reduced ejection fraction due topolycythemia vera. Oxf Med Case Reports 2021. 2021(10): p. omab104. [DOI:10.1093/omcr/omab104] [PMID] [PMCID]

25. Androne AS, Katz SD, Lund L, LaManca J, Hudaihed A, Hryniewicz K, et al. Hemodilution is common in patients with advanced heart failure. Circulation, 2003. 107(2): p. 226-9. [DOI:10.1161/01.CIR.0000052623.16194.80] [PMID]

26. Desai A, Oh D, Rao EM, Sahoo S, Mahajan UV, Labak CM, et al., Impact of anemia on acute ischemic stroke outcomes: a systematic review of the literature. PLoS One, 2023. 18(1): p. e0280025. [DOI:10.1371/journal.pone.0280025] [PMID] [PMCID]

27. Du J, Wang Q, He B, Liu P, Chen J-Y, Quan H, et al. Association of mean platelet volume and platelet count with the development and prognosis of ischemic and hemorrhagic stroke. Int. J. Lab. Hematol 2016;38(3):233-9. [DOI:10.1111/ijlh.12474] [PMID]

28. Newsome BB, Warnock DG, McClellan WM, Herzog CA, Kiefe CI, Eggers PW, et al. Long-term risk of mortality and end-stage renal disease among the elderly after small increases in serum creatinine level during hospitalization for acute myocardial infarction. Archives of internal medicine, 2008. 168(6): p. 609-616. [DOI:10.1001/archinte.168.6.609] [PMID]

29. Kornej J, Börschel CS, Benjamin EJ, Schnabel RB. Epidemiology of atrial fibrillation in the 21st century: Novel methods and new insights. Circ. Res 2020;127(1):4-20. [DOI:10.1161/CIRCRESAHA.120.316340] [PMID] [PMCID]

30. Lemkes BA, Hermanides J, Devries JH, Holleman F, Meijers JCM, Hoekstra JBL. Hyperglycemia: a prothrombotic factor? J. Thromb. Haemost 2010. 8(8): p. 1663-1669. [DOI:10.1111/j.1538-7836.2010.03910.x] [PMID]

31. Heo J, Youk T-M, Seo K-D. Anemia is a risk factor for the development of ischemic stroke and post-stroke mortality. J. Clin. Med 2021;10(12):2556. [DOI:10.3390/jcm10122556] [PMID] [PMCID]

32. Wu Z, Huang Z, Lichtenstein AH, Liu Y, Chen S, Jin Y, et al. The risk of ischemic stroke and hemorrhagic stroke in Chinese adults with low-density lipoprotein cholesterol concentrations< 70 mg/dL. BMC Med 2021. 19: p. 1-11. [DOI:10.1186/s12916-021-02014-4] [PMID] [PMCID]

33. Lara-Guzmán OJ, Gil-Izquierdo Á, Medina S, Osorio E, Álvarez-Quintero R, Zuluaga N, et al. Oxidized LDL triggers changes in oxidative stress and inflammatory biomarkers in human macrophages. Redox Biol 2018;15:1-11. [DOI:10.1016/j.redox.2017.11.017] [PMID] [PMCID]