The augmentation index as a useful indicator for predicting early symptom progression in patients with acute lacunar and atherothrombotic strokes.
OBJECTIVE
The symptoms of about 30% of acute ischemic stroke patients progress, but the mechanism and predictors of the deterioration are not well known. The augmentation index (AIx), estimated with the arterial pulse waveform, is known to be pathophysiologically relevant to the pathogenesis of cardiovascular diseases. The aim of the present study was to investigate the prognostic value of the AIx for early symptom progression (ESP) in patients with acute ischemic stroke.


METHODS
Acute ischemic stroke patients admitted to our stroke center within 24h from onset were prospectively enrolled. The AIx was measured within 48 h from admission. ESP was defined as ≥ 2 increase in the NIHSS score during 7 days from admission. All patients were divided into 2 groups according to the ESP (the ESP group and the non-ESP group).


RESULTS
A total of 147 patients (79 males, median age 74 [IQR 64-82]years, and NIHSS score 3 [1-7]) were enrolled. ESP was observed in 23 (16%) patients. There were no differences in clinical characteristics including the AIx between the two groups. However, when only cases with lacunar and atherothrombotic strokes were evaluated, the AIx was higher in the ESP group (37.0 [32.0-38.0]%) than in the non-ESP group (29.5 [21.8-33.3]%, p=0.003). With the optimal cut-off value of >36%, the AIx was independently associated with ESP (OR 37.3, 95% CI 1.71-811, p=0.021).


CONCLUSIONS
The AIx level was independently related to ESP in patients with acute lacunar and atherothrombotic strokes. The AIx may have a potential to predict ESP in these patients.
Department of Stroke Medicine, Kawasaki Medical School, Kurashiki, Japan. ysakamoto02@gmail.com
Yuki
Y
Sakamoto
Kazumi
K
Kimura
Junya
J
Aoki
Kensaku
K
Shibazaki
D000368:Aged; D000369:Aged, 80 and over; D050197:Atherosclerosis / Q000175:diagnosis* / Q000209:etiology*; D002545:Brain Ischemia / Q000150:complications*; D016001:Confidence Intervals; D018450:Disease Progression; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D011237:Predictive Value of Tests; D012372:ROC Curve; D012720:Severity of Illness Index; D059409:Stroke, Lacunar / Q000175:diagnosis* / Q000209:etiology*