| dc.description.abstracteng | In industrialized nations, cerebral ischemia manifesting as a stroke or TIA is one of the most frequent causes of death and the most important reason for long-term disability and the overall associated overall costs for society. Most patients tend to survive ischemic events and, frequently, a virtually full recovery is possible. Because cerebral ischemia is a manifestation of arteriosclerotic vascular lesions, it is important for secondary prevention after such an event to determine the lethality risk as well as make a targeted risk assessment of other expressions of arteriosclerosis.
This dissertation investigated the prognostic value of new cardiovascular biomarkers (NTproBNP, proANP, H-FABP, GDF-15 and hsTropT) in predicting the occurrence of all-cause mortality or of a major cardiovascular event (MCE), a combined vascular endpoint that includes acute coronary syndrome, stroke and cardiovascular death. To this aim, 281 patients with cerebral ischemia who presented at the Göttingen University Hospital were studied for one year after the initial event.
The data were gathered and statistically analyzed, demonstrating in the univariate Cox regression analysis that GDF-15 (P=0.009), H-FABP (P=0,023) and hsTropT (P=0.001) were significant predictors for MCE. hsTropT (p<0.001), GDF-15 (p=0.007) and NTproBNP (p=0.050) reached a significance level for predicting all-cause mortality. The multivariate regression analysis showed that hsTropT was the only marker with prognostic relevance both for the occurrence of a cardiovascular event as well as for death of the patient. As a result, the predictive power of the protein proved to be superior to established clinical methods for predicting risk, such as the Essen Stroke Risk Score (ESRS) and the Stroke Prognostic Instrument 2 (SPI-2). When these two risk scores were included in the multivariate analysis, it was possible to prove that hsTropT is independent from other influencing factors linked to pathological processes in the cardiovascular system.
Nevertheless, the data obtained here should be validated on a larger cohort before these biomarkers can be integrated safely and expediently in routine clinical diagnostics. In particular, this refers to the problem of establishing a limit value that can be used to classify patients into high- and low-risk groups. Any improvement in risk prediction secondary to cerebral ischemia would ultimately benefit patients in the form of a targeted, risk-adapted secondary prevention and improve the long-term prognosis of this disease. | de |