Stroke
Early Risk Stratification After Stroke
After identifying copeptin as a novel hypothalamic stress marker in 2007 she could demonstrate that it improved currently used risk stratification algorithms of stroke patients. To externally validate the incremental value of copeptin she performed an independent international multi-center cohort study. With her team they further aimed at assessing copeptin’s reliability for risk stratification in patients with transient ischemic attacks (TIAs) and they were able to validate these results again in an independent international multicenter cohort study. Thus routine copeptin measurement is an additional tool for risk stratification and targeted resource allocation after stroke and TIA. A new prognostic score based on copeptin levels has been developed and is available to the community to use in clinical practice.
Novel Risk Factor Identification For Primary Prevention
Based on epidemiological data chronic infections and neuroendocrine dysfunction may play a role in the development of incident ischemic stroke. She identified procalcitonin (PCT) as a marker of chronic infection, as well as mid-regional pro atrial natriuretic peptide (MR-proANP) as a marker of underlying cardiopathy and hemodynamic stress. Both were highly associated with ischemic stroke risk during a median follow up time of 11 years in the Northern Manhattan Stroke cohort (one of the largest population base stroke studies). PCT was specifically associated with small vessel and MRproANP with cardioembolic stroke risk.
Identification Of Underlying Stroke Etiology For Secondary Prevention
She also identified mid-regional pro atrial natriuretic peptide (MR-proANP) as new independent and reliable diagnostic marker for cardioembolic etiology in acute stroke patients. Together with her team they were able to further validate MR-proANP as a surrogate cardio-embolic (CE) stroke marker in a multicenter study (CoRisk study n=788).In a next step they were able to validate the pre-specified MR-proANP cut off for the identification of CE stroke. Finally, MR-proANP predicted the future detection of AF during the one-year follow-up period of the BIOSIGNAL study (n=1800). Based on these results, demonstrating that MRproANP is a validated marker of underlying cardioembolic stroke mechanism, she is currently conducting the first blood biomarker guided secondary preventive acute stroke RCT (The MOSES-trial) mainly funded by the SNF.
Moreover, her group was able to show in a multicenter cohort study of 1733 stroke patients that lipoprotein (a), a lipoprotein composed of apolipoprotein B-100 and apolipoprotein(a) is an novel independent and reliable diagnostic marker for large artery atherosclerotic (LAA) stroke. In this study age was found to be a potent effect modifier resulting in an even stronger relationship of Lp(a) with LAA stroke among patients age < 60 years an often understudied patient group. Among these younger stroke patients Lp(a) levels ≥100 nmol/l were also associated with an increased risk for recurrent events, with an adjusted hazard ratio (HR) of 2.40, (95% CI 1.05-5.47).
In conclusion, in the last years she has built up large acute stroke cohort studies (with a biobank including more than 2500 samples).