Left atrial size and risk of recurrent ischemic stroke in cardiogenic cerebral embolism

Association between pouch morphology, cardiovascular risk factors and ischemic brain lesions in patients with left-sided septal pouches

BACKGROUND

Left atrial outpouching structures such as left atrial diverticula (LADs) and left-sided septal pouches (LSSPs) might be a source of cryptogenic stroke. This imaging study evaluates the association between pouch morphology, patient comorbidities and ischemic brain lesions (IBLs).

METHODS

This is a retrospective single-center analysis of 195 patients who received both a cardiac CT and a cerebral MRI. LADs, LSSPs, and IBLs were retrospectively identified. Size measurements included pouch width, length and volume for LADs and circumference, area and volume for LSSPs. The association between LADs/LSSPs, IBLs and cardiovascular comorbidities was determined by univariate and bivariate regression analyses.

RESULTS

The prevalence and mean volume were 36.4% and 372 ± 569 mm³ for LSSPs, and 40.5% and 415 ± 541 mm³ for LADs. The IBL prevalence was 67.6% in the LSSP group and 48.1% in the LAD group. LSSPs had 2.9-fold increased hazards of IBLs (95%CI: 1.2-7.4, p = 0.024), and LADs showed no significant correlation with IBLs. Size measurements had no impact on IBLs. A co-existing LSSP was associated with an increased prevalence of IBLs in patients with coronary artery disease (HR: 1.5, 95%CI: 1.1-1.9, p = 0.048), heart failure (HR: 3.7, 95%CI: 1.1-14.6, p = 0.032), arterial hypertension (HR: 1.9, 95%CI: 1.1-3.3, p = 0.017), and hyperlipidemia (HR: 2.2, 95%CI: 1.1-4.4, p = 0.018).

CONCLUSION

Co-existing LSSPs were associated with IBLs in patients with cardiovascular risk factors, however, pouch morphology did not correlate with the IBL rate. Upon confirmation by further studies, these findings might be considered in the treatment, risk stratification, and stroke prophylaxis of these patients.

Combination of platelet-to-lymphocyte ratio and D-dimer for the identification of cardiogenic cerebral embolism in non-valvular atrial fibrillation

Background

Non-valvular atrial fibrillation (NVAF) is the most common cause of cardiogenic cerebral embolism (CCE). However, the underlying mechanism between cerebral embolism and NVAF is indefinite, and there is no effective and convenient biomarker to identify potential risk of CCE in patients with NVAF in clinic. The present study aims to identify risk factors for interpreting the potential association of CCE with NVAF and providing valuable biomarkers to predict the risk of CCE for NVAF patients.

Methods

641 NVAF patients diagnosed with CCE and 284 NVAF patients without any history of stroke were recruited in the present study. Clinical data including demographic characteristics, medical history, and clinical assessments, were recorded. Meanwhile, Blood cell counts, lipid profiles, high-sensitivity C-reactive protein, and coagulation function-related indicators were measured. Least absolute shrinkage and selection operator (LASSO) regression analysis was utilized to build a composite indicator model based on the blood risk factors.

Results

(1) CCE patients had significantly increased neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio (PLR), and D-dimer levels as compared with patients in the NVAF group, and these three indicators can distinguish CCE patients from ones in the NVAF group with an area under the curve (AUC) value of over 0.750, respectively. (2) Using the LASSO model, a composite indicator, i.e., the risk score, was determined based on PLR and D-dimer and displayed differential power for distinguishing CCE patients from NVAF patients with an AUC value of over 0.934. (3) The risk score was positively correlated with the National Institutes of Health Stroke Scale and CHADS2 scores in CCE patients. (4) There was a significant association between the change value of the risk score and the recurrence time of stroke in initial CCE patients.

Conclusions

The PLR and D-dimer represent an aggravated process of inflammation and thrombosis in the occurrence of CCE after NVAF. The combination of these two risk factors can contribute to identifying the risk of CCE for patients with NVAF with an accuracy of 93.4%, and the greater in change of composite indicator, the shorter in the recurrence of CCE for NVAF patients.

The Clinical Noteworthiness of Plasma NT-ProBNP Standard in Sufferers with Cardiogenic Cerebral Embolism and Its Diagnostic Value for Such Sufferers

In order to explore the clinical noteworthiness of plasma NT-proBNP standards in sufferers with cardiogenic cerebral embolism and its diagnostic value for such sufferers, a retrospective study is conducted by the clinical data of sufferers with cerebral embolism. 100 sufferers with cerebral embolism admitted to our hospital from January 2018 to December 2020 are selected. According to the heparin-like drug therapy of acute ischemic stroke test (TOAST) classification criteria, they are divided into cardiac sufferers with cerebral embolism set (43 cases) and noncardiac cerebral embolism set (57 cases). The analysis results show the correlation between serum NT-proBNP standard and neurological impairment score. The detection of-proBNP standard can be used as a diagnostic indicator of disease severity and prognosis for sufferers with cardiogenic cerebral embolism.

Early neurological deterioration in cardiogenic cerebral embolism due to nonvalvular atrial fibrillation: Predisposing factors and clinical implications

PURPOSE

The aim of the study was to investigate factors which may predispose patients to early neurological deterioration (END) and explore peripheral biomarkers for the prediction of END in cardiogenic cerebral embolism (CCE) patients.

METHODS

Patients diagnosed with CCE within 24 hr of onset between January 2017 and January 2019 were included in this study. END was defined as an increase of ≥2 on the National Institutes of Health Stroke Scale (NIHSS) or the emergence of new neurological symptoms within 3 days of admission. Binary logistic regression was used to investigate the factors associated with END. Receiver operating characteristic (ROC) curves were then generated to determine the predictive value of the potential biomarkers and the optimal cutoff values.

RESULTS

Of the 129 (male, 55.81%; mean age 71.85 ± 11.99 years) CCE patients, 55 patients with END were identified. Hemorrhage transformation (HT), coronary heart disease (CHD), diastolic blood pressure, cystatin C levels, NIHSS score, and platelet-to-lymphocyte ratio (PLR) at admission were independently associated with END. A peripheral cystatin C level ≥ 1.41 mg/L and a PLR ≥ 132.97 were predictive factors for END in CCE patients. The lymphocyte-to-monocyte ratio (LMR) was negatively independently associated with HT, and LMR < 2.31 may predict the occurrence of HT in patients with CCE.

CONCLUSIONS

Of the potential predisposing factors considered, increased cystatin C and PLR were associated with END within 3 days of CCE, and a decreased LMR may have predictive value for HT in CCE patients.

Left atrial size and risk of recurrent ischemic stroke in cardiogenic cerebral embolism

BACKGROUND

Left atrial enlargement (LAE) was reported to be associated with ischemic stroke and its recurrence. Limited data are available on the relationship of LAE and cardiogenic cerebral embolism (CCE). Our aim is to access the association of left atrial size and the recurrence of ischemic stroke in CCE.

METHODS

We prospectively included 303 CCE patients who underwent transthoracic echocardiography (TTE). Left atrial size was estimated with left atrial diameter (LAD), diameter/height (LAD/H), and left atrial diameter/body surface area (LAD/BSA). The endpoint was one-year recurrent ischemic stroke. Cox proportional hazard models were performed to access the association between left atrial size and recurrent ischemic stroke.

RESULTS

During follow-up, 27 patients suffered recurrent ischemic stroke. In multivariate COX regression models adjusted for confounders including age, gender, hypertension, diabetes, and history of stroke or transient ischemic attack (TIA), platelet count, fasting blood glucose (FBG), antithrombotic drugs at discharge, stroke volume, and cardiac output, LAD, LAD/H, and LAD/BSA all were independent risk factors of recurrent ischemic stroke [LAD: HR 1.065, 95% CI (1.006-1.128), p = .029; LAD/H: HR 1.157, 95% CI (1.066-1.255), p < .001; LAD/BSA: HR 1.128, 95% CI (1.059-1.202), p < .001]. Receiver-operator characteristic curves showed that LAD/BSA had better predicting effect. The area under the curve (AUC) was 0.543 [95%CI (0.444-0.642), p = .461) for LAD, 0.626 [95%CI (0.530-0.723), p = .03] for LAD/H, and 0.655 [95%CI (0.558-0.752), p = .008] for LAD/BSA.

CONCLUSION

LAE is an independent risk factor for one-year recurrence of ischemic stroke in patients with CCE.