Jaykumar Vadodariya¹*, Mrudali Babaria², Jimik Patel³, Maulik Langaliya⁴ and Vyoma Joshi⁵

¹The Lundquist Institute of Biomedical Innovation at Harbor UCLA, Torrance - U.S.A
²GMERS Medical College & Hospital - Vadnagar, Gujarat - India
³SBKS Medical College and Research Centre - Vadodara, Gujarat - India
⁴Holy Spirit Hospital, Department of Orthopedics, Mumbai - India
⁵KW Habilitation , Ontario - Canada

*Corresponding Author: Jaykumar Vadodariya, The Lundquist Institute of Biomedical Innovation at Harbor UCLA, Torrance, C A - U.S.A.

Received: January 07, 2025; Published: February 17, 2025

Abstract

Background: Biomarkers offer promising avenues for improving the diagnosis of cardioembolic strokes and filling gaps in our understanding of stroke mechanisms. Despite the range of biomarkers available, achieving high diagnostic accuracy remains a challenge. In this regard, this review aims to outline unique biomarker associated with cardioembolic stroke to improve diagnostic accuracy, with the goal of enhancing patient care.

Methodology: Data from 2014 to 2023 were gathered from reputable sources like PubMed, PubMed Central, Google Scholar, Research Gate, and Science Direct. Inclusion criteria focused on studies exploring innovative biomarkers used in the diagnosis of cardioembolism.

Results and discussion: The study emphasized the importance of blood-specific biomarkers like NT-proBNP, neuron-specific enolase (NSE), D-dimer, and inflammatory markers such as C-reactive protein (CRP), and Neutrophil-lymphocyte ratio (NLR) in comprehending various aspects of cardioembolic stroke, including cardiac dysfunction, neuronal damage, coagulation activation, inflammatory response, immune imbalance, and genetic predisposition with a sensitivity ranging from 65% to 90% and specificity from 70% to 95%. However, the association of apolipoproteins is yet to be determined. Additionally, genetic biomarkers like microRNAs and gene expression profiles have been extensively researched for diagnostic purposes.

Conclusion: The combination of blood-specific biomarkers and genetic biomarkers holds promise for enhancing diagnostic accuracy, risk assessment, and treatment monitoring in cardioembolic stroke, leading to improved clinical outcomes and personalized management strategies.

 Keywords: Cardioembolism; Biomarkers; Stroke; Inflammatory and Genetic Biomarkers; Diagnosis

References

1. Leary MC and Caplan LR. “Cardioembolic stroke: an update on etiology, diagnosis and management”. Annals of Indian Academy of Neurology 1 (2008): S52-S63.
2. Arboix A and Alió J. “Cardioembolic stroke: clinical features, specific cardiac disorders and prognosis”. Current Cardiology Reviews 3 (2010): 150-161.
3. Sodiol EAG. “Cardioembolic stroke: a study of its incidence, etiology, clinical presentation and outcome”. Journal of Evidence-Based Medicine and Healthcare 40 (2017): 2851-2859.
4. Kamel H and Healey JS. “Cardioembolic stroke”. Circulation Research 3 (2017): 514-526.
5. Harpaz D., et al. “Blood-based biomarkers are associated with different ischemic stroke mechanisms and enable rapid classification between cardioembolic and atherosclerosis etiologies”. Diagnostics 10 (2012): 804-810.
6. Buck HB., et al. “Stroke mimics: incidence, aetiology, clinical features and treatment”. Annals of Medicine 1 (2021): 420-436.
7. Wu Z., et al. “Validation of the use of B-type natriuretic peptide point-of-care test platform in preliminary recognition of cardioembolic stroke patients in the ED”. The American Journal of Emergency Medicine 33 (2015): 521-526.
8. Kara K., et al. “B-type natriuretic peptide predicts stroke of presumable cardioembolic origin in addition to coronary artery calcification”. European Journal of Neurology 21 (2014): 914-921.
9. Kawase S., et al. “Plasma brain natriuretic peptide is a marker of prognostic functional outcome in non-cardioembolic infarction”. Journal of Stroke and Cerebrovascular Diseases 24 (2015): 2285-2290.
10. Chaudhuri JR., et al. “Association of plasma brain natriuretic peptide levels in acute ischemic stroke subtypes and outcome”. Journal of Stroke and Cerebrovascular Diseases 24 (2015): 485-491.
11. Llombart V., et al. “B-type natriuretic peptides help in cardioembolic stroke diagnosis: pooled data meta-analysis”. Stroke 46 (2015): 1187-1195.
12. Fonseca AC and Coelho P. “Update on biomarkers associated with cardioembolic stroke: a narrative review”. Life 5 (2021): 448.
13. Peng Q., et al. “The relationship between neuron-specific enolase and clinical outcomes in patients undergoing mechanical thrombectomy”. Neuropsychiatric Disease and Treatment 19 (2023): 709-719.
14. Kim YJ., et al. “Different neuroprognostication thresholds of neuron-specific enolase in shockable and non-shockable out-of-hospital cardiac arrest: a prospective multicenter observational study in Korea”. Critcal Care 27 (2023): 313-21.
15. Müller J., et al. “Neuron-specific enolase predicts long-term mortality in adult patients after cardiac arrest: results from a prospective trial”. Medicines 11 (2012): 72.
16. Iłżecki M., et al. “Serum neuron-specific enolase as a marker of brain ischemia-reperfusion injury in patients undergoing carotid endarterectomy”. Acta Clinica Croatica 4 (2016): 579-584.
17. Soomro AY., et al. “The current role and future prospects of D-dimer biomarker. European Heart Journal - Cardiovascular Pharmacotherapy 2 (2016): 175-184.
18. Zi WJ and Shuai J. “Plasma D-dimer levels are associated with stroke subtypes and infarction volume in patients with acute ischemic stroke”. PLoS One 1 (2014): e86465.
19. Ageno W., et al. “Plasma measurement of D-dimer levels for the early diagnosis of ischemic stroke subtypes”. Archives of Internal Medicine 162 (2002): 2589-2593.
20. Bonaventura A., et al. “Update on inflammatory biomarkers and treatments in ischemic stroke”. International Journal of Molecular Sciences 17 (2016): 1967-1975.
21. Mengozzi M., et al. “C-reactive protein predicts further ischemic events in patients with transient ischemic attack or lacunar stroke”. Frontiers in Immunology 11 (2020): 1403.
22. Bafei SEC., et al. “Interactive effect of increased high sensitivity C-reactive protein and dyslipidemia on cardiovascular diseases: a 12-year prospective cohort study”. Lipids Health Disease1 (2023): 95.
23. Wang S., et al. “Elevated high-sensitivity C-reactive protein levels predict poor outcomes among patients with acute cardioembolic stroke”. Annals of Palliative Medicine 3 (2021): 2907-2916.
24. Apolipoprotein - an overview. ScienceDirect Topics (2024).
25. O’Donnell MJ., et al. “Association of lipids, lipoproteins, and apolipoproteins with stroke subtypes in an international case control study (INTERSTROKE)”. Journal of Stroke 2 (2022): 224-235.
26. Zambrelli E., et al. “Apo (a) size in ischemic stroke: relation with subtype and severity on hospital admission”. Neurology 8 (2005): 1366-1370.
27. Kim BS., et al. “Elevated serum lipoprotein (a) as a potential predictor for combined intracranial and extracranial artery stenosis in patients with ischemic stroke”. Atherosclerosis 2 (2010): 682-688.
28. Kumar P., et al. “Lipoprotein (a) level as a risk factor for stroke and its subtype: a systematic review and meta-analysis”. Scientific Reports 1 (2021): 15660.
29. Gokhan S., et al. “Neutrophil-lymphocyte ratios in stroke subtypes and transient ischemic attack”. European Review for Medical and Pharmacological Sciences 17 (2013): 653-657.
30. Chen S., et al. “Day 1 neutrophil-to-lymphocyte ratio (NLR) predicts stroke outcome after intravenous thrombolysis and mechanical thrombectomy”. Frontiers in Neurology 13 (2022): 941251.
31. Quan K., et al. “Neutrophil to lymphocyte ratio and adverse clinical outcomes in patients with ischemic stroke”. Annals of Translational Medicine 13 (2021): 1047-1055.
32. Inogés M., et al. “Gender predicts differences in acute ischemic cardioembolic stroke profile: emphasis on woman-specific clinical data and early outcome-the experience of Sagrat Cor Hospital of Barcelona stroke registry”. Medicina (Kaunas)1 (2024): 101.
33. Jickling GC., et al. “Signatures of cardioembolic and large-vessel ischemic stroke”. Annals of Neurology 5 (2010): 681-692.
34. Komal S., et al. “MicroRNAs: emerging biomarkers for atrial fibrillation”. Journal of Cardiology 6 (2019): 475-482.
35. Zheng L., et al. “MMP-9-related microRNAs as prognostic markers for hemorrhagic transformation in cardioembolic stroke patients”. Frontiers in Neurology 10 (2019): 945-954.
36. Neudecker V., et al. “Emerging roles for microRNAs in perioperative medicine”. Anesthesiology 2 (2016): 489-506.

Citation

Citation: Jaykumar Vadodariya., et al. “An Outline on the Biomarkers Involved in Cardioembolic Stroke”. Acta Scientific Neurology 8.3 (2025): 03-08.

Copyright

Copyright: © 2025 Jaykumar Vadodariya., et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.