Nikolaos Kakaletsis

Background: Estimated pulse wave velocity (ePWV), an easy to calculate proxy of carotid to femoral PWV (cfPWV), can be derived from 24-hour blood pressure monitoring (24h-BPM). Its role in acute ischemic stroke (AIS) has not previously been investigated in large multinational datasets. Methods: A pooled individual patient data analysis from 13 cohorts across seven countries was conducted, including 2933 AIS patients who underwent 24h-BPM during the hyperacute to subacute phase. ePWV was calculated using a validated equation. Associations with clinical characteristics, stroke severity, etiologic subtypes, and outcomes were assessed with logistic regression. The primary outcome was poor functional outcome at 90 days, defined as a modified Rankin Scale (mRS) >2. Results: Patients with higher ePWV presented with more severe strokes (median NIHSS 7 vs. 3, P < .001) and had poorer outcomes both at 90 days (63.7% vs. 23.7%, P < .001) and discharge (61.9% vs 29.1%, P < .001). ePWV was associated with poor outcome at 90 days (aOR: 1.24, 95% CI: 1.05-1.45) and discharge (aOR: 1.26, 95% CI: 1.12-1.42), per 1 m/s increase in ePWV, after adjustment for conventional risk factors and stroke severity. In patients ≤50 years, ePWV was highest in those with small vessel disease (SVD), who also had more cardiovascular risk factors than other stroke subtypes. Conclusions: ePWV derived from 24h-BPM is a simple, widely applicable measure of vascular aging that is associated with functional outcome after AIS. The higher ePWV observed in young patients with SVD underscores a potential early arteriosclerotic burden in this subgroup.

Tuberculosis remains the world’s top fatal infectious disease, causing more than 1.5 million deaths globally annually, especially in low and/or middle-income countries. Greece, although still considered to be a low prevalence country according to the National and Global Report data, has experienced an epidemiological rise in the post covid era. A major limitation in the identification of the true epidemiological burden is the underreporting, especially of probable cases. The aim of this 4-year retrospective, epidemiological study was to record all newly diagnosed patients with active tuberculosis in a large, tertiary hospital of Northern Greece with their epidemiological and clinical characteristics. The temporal trend of newly diagnosed cases was identified and compared with the reports of the corresponding National Surveillance data. A total of 45 patients were identified with active tuberculosis in the years 2022-2025 with a mean symptom duration of 45 days prior to diagnosis. The patients were mostly adults (≥18 years, 74%), male (66%), of 39 years median age, and 67% natives, of Greek origin. In 38% of the patients the manifestations were exclusively extrapulmonary, more frequently so in the native population. Three strains (6,6%) were rifampicin resistant. This real-world epidemiological study provides a direct reflection of the presentation and prevalence of tuberculosis in the community, describes the clinical spectrum and the available diagnostic approaches, and identifies potential weaknesses of the Health Surveillance system.

Introduction Assessing vascular aging to identify and categorize the residual risk of adverse outcomes in acute ischemic stroke (AIS) is important for improving AIS prognoses. This study aimed to investigate the prognostic value and correlation among three indirect measures of vascular aging derived from 24-hour blood pressure monitoring (24 h-BPM) following AIS. Furthermore, it aimed to develop a new score that includes vascular aging metrics to enhance the prognostic accuracy for stroke outcomes. Methods A total of 2,730 AIS patients with a mean age of 72.0 ± 14.4 years who underwent 24 h-BPM were included. Three vascular aging indexes derived from 24 h-BPM: estimated pulse wave velocity (ePWV), early vascular aging ambulatory score (EVAAs), and 24-hour pulse pressure (24 h-PP) were evaluated. Primary outcome was the modified Rankin Scale (mRS) score > 2 at 3 months post-stroke. Result ePWV showed superior predictive value for poor functional outcome (AUC: 0.77, 95% CI: 0.74–0.79) at 3 months post-stroke. Optimal cutoff points for predicting poor functional outcome at 3 months were 12.2 m/s for ePWV (sensitivity: 79.4%, specificity: 61.7%), 65% for EVAAs (sensitivity: 66.4%, specificity: 51.5%), and 51.1mmHg for 24 h-PP (sensitivity: 66.7%, specificity: 46.6%). A new “Severity and Arterial Stiffness” (SASt) score was formulated: SASt = NIHSS + 2*ePWV, which demonstrated excellent discriminatory power for predicting poor functional outcome (AUC: 0.87, 95% CI: 0.85–0.88) at 3 months post-stroke. Conclusions The ePWV and the new SASt score show promising potential as tools for identifying patients at higher risk for poor outcomes at 3 months post-stroke. While these findings are encouraging, further prospective studies are needed to validate their utility before they can be adopted in clinical practice.

Background: Diabetes mellitus (DM) is an independent risk factor for severe SARS-CoV-2 infection and is linked to higher incidences of infections and adverse outcomes in patients with DM. This study examines the association between DM and multidrug-resistant Gram-negative bacteria (MDR-GNB) in critically ill, intubated COVID-19 patients in the intensive care unit (ICU) and evaluates mortality rates and clinical factors contributing to unfavorable outcomes. Methods: This retrospective observational study included intubated COVID-19 patients diagnosed with secondary infections due to MDR-GNB. Patients were treated for acute respiratory distress syndrome (ARDS) in a tertiary care university hospital ICU between October 2020 and February 2022. Collected data included demographics, comorbidities, medication, and laboratory parameters including blood tests and culture samples. Results: Among 416 COVID-19 patients, 112 (26.9%) had T2DM. Cultures from lower respiratory tract specimens revealed a significantly higher likelihood of isolating Acinetobacter baumannii in patients with DM (OR: 2.18, 95% CI: 1.40–3.40, p < 0.001), and DM is an independent predictor of isolation Acinetobacter baumannii in bronchial secretions of COVID-19 intubated patients (OR: 2.046, 95% CI: 1.256–3.333. p < 0.004). DM was not significantly associated with differences in length of stay (LOS) until discharge or death (HR: 0.76, 95% CI: 0.51–1.12, p = 0.16; HR: 0.91, 95% CI: 0.70–1.19, p = 0.50) or 28-day ICU mortality (OR: 1.12, 95% CI: 0.52–2.41, p = 0.77). Age was linked to an increased 28-day mortality risk in patients with DM (OR: 1.10, 95% CI: 1.02–1.18, p = 0.011). Conclusions: In critically ill intubated COVID-19 patients, DM emerged as a significant and independent predictor for the isolation of Acinetobacter baumannii from bronchial secretions, highlighting a key link between DM and specific multidrug-resistant pathogens, even though no broader association with MDR-GNB-related secondary infections was observed.

BACKGROUND: Augmentation index (Aix) is a widely used index of pressure wave reflections (PWRs) derived from noninvasive blood pressure waves recordings and pulse wave analysis. Cerebral small vessel disease (cSVD) comprises various pathological processes affecting the brain’s microvasculature and is a major cause of vascular cognitive impairment, ischemic, and hemorrhagic stroke. This meta-analysis aimed to assess the association between PWRs, as measured by AIx, and cSVD as identified through neuroimaging biomarkers, and to explore potential differences based on arterial site of AIx measurement. METHODS: Following a predefined protocol adhering to the Meta-Analysis of Observational Studies in Epidemiology guidelines, nine studies comprising a total of 6,774 participants were included. Pooled effect estimates were calculated to evaluate the relationship between AIx and cSVD markers, including white matter hyperintensities (WMH). RESULTS: A marginal positive association was observed between AIx and cSVD [central (carotid and aortic) AIx: β=0.04 (95% CI: 0.01-0.07) per SD increase; carotid AIx: β=0.05 (95% CI: 0.00-0.09); aortic AIx: β=0.03 (95% CI: 0.00-0.06)]. Similar results were found for the association between AIx and WMH [central (carotid and aortic) AIx: β=0.05 (95% CI: 0.01-0.08); carotid AIx: β=0.05 (95% CI: 0.00-0.10); aortic AIx: β=0.05 (95% CI: 0.00-0.010)]. CONCLUSIONS: AIx showed a marginal positive association with cSVD, but the clinical relevance remains unclear. Substantial heterogeneity across studies, along with the absence of data on other PWR indices, limits the robustness and generalizability of these findings. Future research should employ advanced methodologies capable of assessing local PWR coefficients to better elucidate the relationship between PWRs and brain microcirculation.

Understanding the impact of early vascular aging (EVA) on acute ischemic stroke (AIS) outcomes may provide new insights for improving prognostic assessments and developing targeted therapeutic strategies. This study aimed to validate the EVA ambulatory score (EVAAs) in AIS patients, assessing its association with stroke type, severity, and prognosis. Among the 2,730 AIS patients with a mean age of 72.0 ± 14.4 years, 83.4% exhibited EVA. EVA was identified as an independent predictor of poor outcome at both discharges (aOR:1.72, 95%CI:1.25–2.36, p < 0.001) and at 90 days (aOR:2.22, 95%CI:1.49–3.31, p < 0.001). In subgroup analyses, EVAAs showed improved predictive value in AIS patients with a lower cardiovascular disease burden and a non-atherogenic lipid profile. The EVAAs, as an indicator of EVA that could be easily integrated into daily clinical practice, are a significant predictor of adverse outcomes in AIS patients.

Kakaletsis N, et al. Clin Hypertens. 2025 Dec;31:e38. https://doi.org/10.5646/ch.2025.31.e38

Stroke is the third leading cause of death in the developed world and a major cause of chronic disability, especially among the elderly population. The major biomarkers of stroke which are the most promising for predicting onset time and independently differentiating ischemic from hemorrhagic and other stroke subtypes are at present limited to a few. This review aims to emphasize on the prognostic role of S100 calcium-binding protein b (S100B), and Glial Fibrillary Acidic Protein (GFAP) in patients with stroke. An electronic search of the published research from January 2000 to February 2024 was conducted using the MEDLINE, Scopus, and Cochrane databases. The implementation of S100B and GFAP in existing clinical scales and imaging modalities may be used to improve diagnostic accuracy and realize the potential of blood biomarkers in clinical practice. The reviewed studies highlight the potential of S100B and GFAP as significant biomarkers in the prognosis and diagnosis of patients with stroke and their ability of predicting long-term neurological deficits. They demonstrate high sensitivity and specificity in differentiating between ischemic and hemorrhagic stroke and they correlate well with stroke severity and outcomes. Several studies also emphasize on the early elevation of these biomarkers post-stroke onset, underscoring their value in early diagnosis and risk stratification. The ongoing research in this field should aim at improving patient outcomes and reducing stroke-related morbidity and mortality by developing a reliable, non-invasive diagnostic tool that can be easily implemented in several healthcare settings, with the ultimate goal of improving stroke management.

Pulse wave velocity (PWV) is as a reliable marker of arterial stiffness and vascular aging, surpassing traditional risk factors in predicting detrimental cardiovascular events. The present meta-analysis aims to investigate PWV thresholds and assess its prognostic value in outcomes of acute ischemic stroke (AIS). A search was conducted in PubMed, Cochrane, Web of Science, and Scopus for studies published up to January 2024, focusing on patients admitted with AIS, wherein arterial stiffness was assessed through PWV measurements during hospitalization. Identified studies reported PWV values in individuals with both favorable and unfavorable outcomes at the end of follow-up. Initially, 35 eligible studies provided data for weighted mean baPWV (11,953 AIS patients) and cfPWV (2,197 AIS patients) calculations. The average age was 67 years, with approximately 60% male, 67% hypertensive, 30% diabetic and 30% smoker participants. The weighted mean systolic blood pressure was approximately 150 mmHg. In AIS patients, the mean PWV was 10 m/s for standard cfPWV and 20 m/s for baPWV. Nine cohort studies (6,006 AIS patients) were included in the quantitative analysis of clinical outcomes. Higher PWV levels were associated with poorer functional outcomes (2.3 m/s higher, 95%CI:1.2–3.4, p < 0.001; I² = 87.4%). AIS patients with arterial stiffness/vascular aging (higher PWV) had approximately 46.2% increased risk of poor functional outcome, 12.7% higher risk of mortality, 13.9% greater risk of major adverse cardiovascular events, and 13.9% greater risk of stroke recurrence over the long term compared to those without arterial stiffness. Advanced vascular aging, as indicated by PWV, significantly predicts adverse outcomes in AIS patients. Integrating the assessment of vascular aging into clinical practice can improve risk perception in these patients.