on May 3, 2007
Published online before print May 3, 2007, doi: 10.1161/STROKEAHA.106.481556
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Submitted on January 3, 2007
From the Department of Neurology (M.C., J.S.) and Biostatistics Unit, (M.G.), Hospital Universitari Doctor Josep Trueta, Girona, Spain; the Department of Neurology (T.S., D.B., J.C.), Neurovascular Research Laboratory, Hospital Clínico Universitario, Universidad de Santiago de Compostela, Santiago de Compostela, Spain; the Department of Neurosciences (M.M., J.A., N.P.d.l.O., A.D.), Hospital Universitari Germans Trias i Pujol, Universitat Autónoma de Barcelona, Badalona, Spain; and the Department of Neurology (F.N., J.V.), Hospital Universitario de La Princesa, Madrid, Spain. * To whom correspondence should be addressed. E-mail: adavalos.germanstrias{at}gencat.net.
Background and Purpose--Plasma levels of cellular fibronectin (c-Fn) Methods--We studied 134 patients treated with t-PA within 3 hours from symptom onset according to the SITS-MOST criteria (median time to infusion, 152 minutes; median National Institutes of Health Stroke Scale score, 14) in 4 university hospitals. Hemorrhagic transformation was classified according to the European-Australasian Acute Stroke Study II definitions on computed tomography scans performed 24 to 36 hours after treatment. Relevant hemorrhagic transformation was defined as hemorrhagic infarction type 2 or any PH. Serum c-Fn and MMP-9 levels were determined by an ELISA om blood samples obtained before treatment. Results--Cranial computed tomography showed hemorrhagic transformation in 27 patients (20%), hemorrhagic infarction in 15 (type 2 in 8 patients), and PH in 12 patients (symptomatic in 4). Serum c-Fn and MMP-9 concentrations at baseline were significantly higher in patients with relevant hemorrhagic transformation and PH than in those without (all P<0.001). The sensitivity, specificity, and positive and negative predictive values for PH by c-Fn levels Conclusions--This prospective study confirmed the high sensitivity and negative predictive value, with retained good specificity, of c-Fn and MMP-9 for the prediction of PH in patients treated with t-PA. Development of faster analytic methods will prove the applicability of these biomarkers in routine clinical practice.
Accepted on January 17, 2007
Serum Cellular Fibronectin and Matrix Metalloproteinase-9 as Screening Biomarkers for the Prediction of Parenchymal Hematoma After Thrombolytic Therapy in Acute Ischemic Stroke. A Multicenter Confirmatory Study
Mar Castellanos MD, PhD;
3.6 µg/mL and of matrix metalloproteinase-9 (MMP-9) 140 ng/mL have been associated with parenchymal hematoma (PH) after treatment with tissue-type plasminogen activator (t-PA) in patients with acute ischemic stroke. In this prospective study, we sought to validate the predictive capacity of the preestablished cutoff values of these biomarkers for PH in a larger series of patients.3.6 µg/mL were 100%, 60%, 20%, and 100%, respectively, whereas corresponding values were 92%, 74%, 26%, and 99% for MMP-9 levels 140 ng/mL. When both biomarkers were at levels above the cutoff points, specificity increased to 87% and the positive predictive value increased to 41%.
Key words: stroke • hemorrhage • thrombolytic therapy • metalloproteinases • biomarkers • blood-brain barrier
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