Background:
Transient Ischaemic Attacks (TIAs) are a key predictor for ischaemic stroke (1) but diagnosing TIAs is complicated due to overlapping symptomology with minor strokes and other mimic conditions such as migraines, and seizures (2). Investigation into lipidomic pathways to differentiate between TIAs, minor strokes, and TIA mimics could provide insight into potential diagnostic targets for TIAs and reduce the risk of subsequent ischaemic stroke.
Aims:
To identify lipidomic pathways differentially involved in TIAs, TIA mimics, and minor strokes.
Methods:
Patients presenting with TIA-like symptoms were recruited at the Royal Adelaide Hospital (n=50). Plasma samples (9mL) were collected within 48 hours of symptom onset and stored in line with HUPO guidelines (3). Discovery lipidomic investigation was conducted using LC-MS, with preliminary data processing undertaken on Skyline and MetaboAnalyst 5.0. A volcano plot was used to identify individual lipids of interest for further exploration using MS/MS. All patients were clinically classified independently as TIAs/TIA mimics/minor strokes by two vascular neurologists, with any disagreement resolved by a third, senior vascular neurologist.
Results:
We enrolled 50 patients (29 Females, 21 Males) with ages ranging from 39–94 years (Median: 72y) at time of enrolment. All patients were classified based on clinical data with 56% diagnosed as a TIA mimic. A total of 467 lipids were detected in the cohort, and 15 glycerophospholipids were selected from both negative and positive ion datasets based on significance (p<0.05) and magnitude of fold change for further investigation using MS/MS.
Conclusion:
The preliminary findings from this study have identified an initial set of 15 glycerophospholipids of interest that are currently being targeted for further investigation using MS/MS to differentiate between TIAs, TIA mimics, and minor strokes. The outcomes will be expanded to a larger sample set (n=100) with additional assessment using machine learning.