22. European Stroke Conference 493 Translational stroke research Profile of von Willebrand factor antigen & von Willebrand factor propeptide in an overall population of TIA and ischaemic stroke patients and in specific TOAST subgroups W.O. Tobin1, J.A. Kinsella2, G.F. Kavanagh3, J.S. O’Donnell4, R.A. McGrath5, D.R. Collins6, T. Coughlan7, D. O’Neill8, B. Egan9, S. Tierney10, T.M. Feeley11, R.P. Murphy12, D.J.H. McCabe13 The Adelaide and Meath Hospital, Dublin, incorporating the National Children’s Hospital, Trinity College Dublin, Ireland, Dublin, IRELAND1, The Adelaide and Meath Hospital, Dublin, incorporating the National Children’s Hospital, Trinity College Dublin, Ireland, Dublin, IRELAND2, The Adelaide and Meath Hospital, Dublin, incorporating the National Children’s Hospital, Trinity College Dublin, Ireland, Dublin, IRELAND3, Trinity College Dublin; Haemostasis Research Group, St James’s Hospital, Trinity College Dublin, Ireland., Dublin, IRELAND4, Trinity College Dublin; Haemostasis Research Group, St James’s Hospital, Trinity College Dublin, Ireland., Dublin, IRE-LAND5, The Adelaide and Meath Hospital, Dublin, incorporating the National Children’s Hospital, Trinity College Dublin, Ireland, Dublin, IRELAND6, The Adelaide and Meath Hospital, Dublin, in-corporating the National Children’s Hospital, Trinity College Dublin, Ireland, Dublin, IRELAND7, The Adelaide and Meath Hospital, Dublin, incorporating the National Children’s Hospital, Trinity College Dublin, Ireland, Dublin, IRELAND8, The Adelaide and Meath Hospital, Dublin, incorporat-ing the National Children’s Hospital, Trinity College Dublin, Ireland, Dublin, IRELAND9,The Ad-elaide and Meath Hospital, Dublin, incorporating the National Children’s Hospital, Trinity College Dublin, Ireland, Dublin, IRELAND10, The Adelaide and Meath Hospital, Dublin, incorporating the National Children’s Hospital, Trinity College Dublin, Ireland, Dublin, IRELAND11, The Adelaide and Meath Hospital, Dublin, incorporating the National Children’s Hospital, Trinity College Dublin, Ireland, Dublin, IRELAND12, The Adelaide and Meath Hospital, Dublin, incorporating the National Children’s Hospital, Trinity College Dublin, Ireland, Dublin, IRELAND13 Background: von Willebrand factor propeptide (VWF:Ag II) is proposed to be a more sensitive marker of acute endothelial activation than von Willebrand factor antigen (VWF:Ag) because of its shorter half-life. These biomarkers have not been studied simultaneously following TIA or stroke. Methods: In this prospective, observational, case-control study, plasma VWF:Ag and VWF:Ag II levels were quantified in 164 patients ≤4 weeks of TIA/ischaemic stroke (baseline), and >14 days (14d) and >90 days (90d) later. Data were compared with those from 27 healthy controls. TIA/stroke subtyping was performed according to the TOAST classification. Multiple linear regression analysis was performed, as appropriate. P<0•05 was considered statistically significant. Results: ‘Unadjust-ed’ VWF:Ag and VWF:Ag II levels were higher in patients than controls at baseline, 14d and 90d (p≤0.03). VWF:Ag levels remained higher in patients than controls at baseline (p≤0.03), but not at 14d or 90d after controlling for differences in age or hypertension between groups. VWF:Ag levels were higher in patients than controls at baseline and 90d after controlling independently for smok-ing status (p≤0.04). ‘Adjusted’ VWF:Ag II levels were not higher in patients vs. controls after con-trolling for age, hypertension or smoking (p≥0.1). Patients with TIA or stroke of large vessel aetiol-ogy (N=46) had higher VWF:Ag and VWF:Ag II levels than controls at each timepoint (p≤0.002). Cardioembolic TIA/stroke patients (N=25) only had higher VWF:Ag and VWF:Ag II levels than controls at baseline (p=0.03). Conclusions: von Willebrand factor secretion is enhanced after TIA/ stroke, especially early after symptom onset and in patients with recently symptomatic large artery atherosclerosis. These data will inform the design of longitudinal studies investigating the value of endothelial and platelet biomarkers at predicting the risk of recurrent vascular events during long-term follow-up, especially in specific stroke subgroups. 550 © 2013 S. Karger AG, Basel Scientific Programme 494 Translational stroke research Upright pedalling is a potential intervention for driving lower limb recovery in people who cannot walk early after stroke N.J. Hancock1, L. Shepstone2, P. Rowe3, P.K. Myint4, V.M. Pomeroy5 University of East Anglia, Norwich, UNITED KINGDOM1, University of East Anglia, Norwich, UNITED KINGDOM2, University of Strathclyde, Glasgow, UNITED KINGDOM3, University of East Anglia, Norwich, UNITED KINGDOM4, University of East Anglia, Norwich, UNITED KING-DOM5 Background Substantial paresis early after stroke limits repetitive practice of walking and hence provision of ex-ercise known to drive recovery. This study aimed to test the assumption that people who could not walk early after stroke could produce smooth repetitive lower limb movement during Upright Pedal-ling (UP). Method Design: Sub-section of data from feasibility study. Participants (n = 8): adults, up to 30 days from stroke onset, lower limb paresis, unable to walk without continuous assistance (0-2 on Functional Ambulatory Categories - FAC). Instrumentation: Upright static bike modified with a light sensor to measure crank angle, synchronised with a portable surface EMG system (Biometrics UK) for mea-surement of lower limb muscle activity. Procedure: As part of a wider feasibility study, participants underwent a baseline session of UP, in an acute stroke unit therapy gym. Pedalling Measures: on-set and offset of muscle activity (expressed as percentage activity above resting baseline in each of eight wheel position bins), smoothness of pedalling (S-Ped; expressed as standard deviation of time spent in each wheel position bin) and pedalling cadence. Results All participants (males n= 6 females n=2) completed the baseline pedalling task. All had substantial lower limb weakness (MI, mean 50; range 14 to 78) and severely impaired mobility (FAC 0). All achieved smooth pedalling (S-Ped mean= 0.065, range= 0.012 to 0.164) at cadences of between 18 and 54rpm. Muscle activity patterns demonstrated heterogeneity, from crank propulsion entirely by the unaffected limb to reciprocal inter-limb activity. Conclusions These observational data indicate that people with severe paresis and who cannot walk early after stroke can produce smooth movement during UP, using various muscle activation strategies. An early phase randomised controlled trial to test the hypothesis that UP can drive walking recovery in people with substantial paresis early after stroke is therefore indicated.
Karger_ESC London_2013
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