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Pisu F, Williamson BJ, Nardi V, Paraskevas KI, Puig J, Vagal A, de Rubeis G, Porcu M, Cau R, Benson JC, Balestrieri A, Lanzino G, Suri JS, Mahammedi A, Saba L. Machine Learning Detects Symptomatic Plaques in Patients With Carotid Atherosclerosis on CT Angiography. Circ Cardiovasc Imaging 2024; 17:e016274. [PMID: 38889214 PMCID: PMC11186714 DOI: 10.1161/circimaging.123.016274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Accepted: 05/03/2024] [Indexed: 06/20/2024]
Abstract
BACKGROUND This study aimed to develop and validate a computed tomography angiography based machine learning model that uses plaque composition data and degree of carotid stenosis to detect symptomatic carotid plaques in patients with carotid atherosclerosis. METHODS The machine learning based model was trained using degree of stenosis and the volumes of 13 computed tomography angiography derived intracarotid plaque subcomponents (eg, lipid, intraplaque hemorrhage, calcium) to identify plaques associated with cerebrovascular events. The model was internally validated through repeated 10-fold cross-validation and tested on a dedicated testing cohort according to discrimination and calibration. RESULTS This retrospective, single-center study evaluated computed tomography angiography scans of 268 patients with both symptomatic and asymptomatic carotid atherosclerosis (163 for the derivation set and 106 for the testing set) performed between March 2013 and October 2019. The area-under-receiver-operating characteristics curve by machine learning on the testing cohort (0.89) was significantly higher than the areas under the curve of traditional logit analysis based on the degree of stenosis (0.51, P<0.001), presence of intraplaque hemorrhage (0.69, P<0.001), and plaque composition (0.78, P<0.001), respectively. Comparable performance was obtained on internal validation. The identified plaque components and associated cutoff values that were significantly associated with a higher likelihood of symptomatic status after adjustment were the ratio of intraplaque hemorrhage to lipid volume (≥50%, 38.5 [10.1-205.1]; odds ratio, 95% CI) and percentage of intraplaque hemorrhage volume (≥10%, 18.5 [5.7-69.4]; odds ratio, 95% CI). CONCLUSIONS This study presented an interpretable machine learning model that accurately identifies symptomatic carotid plaques using computed tomography angiography derived plaque composition features, aiding clinical decision-making.
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Affiliation(s)
- Francesco Pisu
- Department of Radiology, Azienda Ospedaliero-Universitaria, Monserrato (Cagliari), Italy (F.P., M.P., R.C., A.B., L.S.)
| | - Brady J. Williamson
- Department of Radiology, University of Cincinnati, Cincinnati, OH (B.J.W., A.V., A.M.)
| | - Valentina Nardi
- Department of Radiology, Mayo Clinic, Rochester, MN (V.N., J.C.B., G.L.)
| | - Kosmas I. Paraskevas
- Department of Vascular Surgery, Central Clinic of Athens, Athens, Greece (K.I.P.)
| | - Josep Puig
- Department of Radiology (IDI), Hospital Universitari de Girona, Girona, Spain (J.P.)
| | - Achala Vagal
- Department of Radiology, University of Cincinnati, Cincinnati, OH (B.J.W., A.V., A.M.)
| | - Gianluca de Rubeis
- UOC Neuroradiology Diagnostic and Interventional, San Camillo-Forlanini Hospital, Rome, Italy (G.R.)
| | - Michele Porcu
- Department of Radiology, Azienda Ospedaliero-Universitaria, Monserrato (Cagliari), Italy (F.P., M.P., R.C., A.B., L.S.)
| | - Riccardo Cau
- Department of Radiology, Azienda Ospedaliero-Universitaria, Monserrato (Cagliari), Italy (F.P., M.P., R.C., A.B., L.S.)
| | - John C. Benson
- Department of Radiology, Mayo Clinic, Rochester, MN (V.N., J.C.B., G.L.)
| | - Antonella Balestrieri
- Department of Radiology, Azienda Ospedaliero-Universitaria, Monserrato (Cagliari), Italy (F.P., M.P., R.C., A.B., L.S.)
| | - Giuseppe Lanzino
- Department of Radiology, Mayo Clinic, Rochester, MN (V.N., J.C.B., G.L.)
| | - Jasjit S. Suri
- Stroke Diagnosis and Monitoring Division, Atheropoint LLC, Roseville, CA (J.S.S.)
| | - Abdelkader Mahammedi
- Department of Radiology, University of Cincinnati, Cincinnati, OH (B.J.W., A.V., A.M.)
| | - Luca Saba
- Department of Radiology, Azienda Ospedaliero-Universitaria, Monserrato (Cagliari), Italy (F.P., M.P., R.C., A.B., L.S.)
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de Melo ES, de Paiva Bezerra R, de Holanda AC, Lira E Silva MJ, Travassos PP, da Silva TFL, de Azevedo Oliveira GM, Alves SMM, Medeiros CDA, da Silveira Barros MDND, de Oliveira WA, Silva GS, de Andrade Valença LPA. Chagas disease stroke and associated risk factors: A case-control study. J Stroke Cerebrovasc Dis 2024; 33:107463. [PMID: 38006768 DOI: 10.1016/j.jstrokecerebrovasdis.2023.107463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2023] [Revised: 10/27/2023] [Accepted: 10/30/2023] [Indexed: 11/27/2023] Open
Abstract
INTRODUCTION The intricate relationship between Chagas disease and ischemic stroke remains unclear. Limited evidence exists concerning secondary prophylaxis, etiological diagnosis, and stroke-related determinants. This study aims to discern factors linked to stroke in Chagas disease by contrasting patients with and without a history of ischemic stroke. METHODS Retrospective data from all outpatient Chagas disease patients from two Brazilian hospitals - one Chagas center and one stroke clinic - were examined. Descriptive analyses were conducted to identify stroke-associated factors. Variables were compared between patients with and without ischemic stroke history. RESULTS Among 678 subjects, 72 had experienced stroke. Univariate associations with stroke included male gender, heart failure, prior or ongoing alcoholism, electrocardiographic features (non-sinus rhythm, left bundle branch, right bundle branch block, left anterosuperior fascicular block, atrial fibrillation), as well as echocardiographic findings indicative of reduced left ventricular ejection fraction and segmental abnormalities. After logistic regression (multivariate analysis), congestive heart failure, right bundle branch block, left anterosuperior divisional block, and atrial fibrillation retained independent associations. CONCLUSION In this study, cardiac involvement emerged as the predominant factor correlated with stroke in Chagas disease. While atherosclerosis-related risk factors were prevalent, their influence on ischemic stroke in Chagas disease appeared limited.
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Affiliation(s)
- Eduardo Sousa de Melo
- Hospital das Clínicas, Centro de Ciências Médicas, Universidade Federal de Pernambuco, Recife, PE, Brazil.
| | | | - Arthur Cesário de Holanda
- Hospital das Clínicas, Centro de Ciências Médicas, Universidade Federal de Pernambuco, Recife, PE, Brazil
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Thong EHE, Kong WKF, Poh KK, Wong R, Chai P, Sia CH. Multimodal Cardiac Imaging in the Assessment of Patients Who Have Suffered a Cardioembolic Stroke: A Review. J Cardiovasc Dev Dis 2023; 11:13. [PMID: 38248883 PMCID: PMC10816708 DOI: 10.3390/jcdd11010013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Revised: 12/21/2023] [Accepted: 12/27/2023] [Indexed: 01/23/2024] Open
Abstract
Cardioembolic strokes account for 20-25% of all ischaemic strokes, with their incidence increasing with age. Cardiac imaging plays a crucial role in identifying cardioembolic causes of stroke, with early and accurate identification affecting treatment, preventing recurrence, and reducing stroke incidence. Echocardiography serves as the mainstay of cardiac evaluation. Transthoracic echocardiography (TTE) is the first line in the basic evaluation of structural heart disorders, valvular disease, vegetations, and intraventricular thrombus. It can be used to measure chamber size and systolic/diastolic function. Trans-oesophageal echocardiography (TOE) yields better results in identifying potential cardioembolic sources of stroke and should be strongly considered, especially if TTE does not yield adequate results. Cardiac computed tomography and cardiac magnetic resonance imaging provide better soft tissue characterisation, high-grade anatomical information, spatial and temporal visualisation, and image reconstruction in multiple planes, especially with contrast. These techniques are useful in cases of inconclusive echocardiograms and can be used to detect and characterise valvular lesions, thrombi, fibrosis, cardiomyopathies, and aortic plaques. Nuclear imaging is not routinely used, but it can be used to assess left-ventricular perfusion, function, and dimensions and may be useful in cases of infective endocarditis. Its use should be considered on a case-by-case basis. The accuracy of each imaging modality depends on the likely source of cardioembolism, and the choice of imaging approach should be tailored to individual patients.
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Affiliation(s)
| | - William K. F. Kong
- Department of Cardiology, National University Heart Centre Singapore, Singapore 119074, Singapore; (W.K.F.K.); (K.-K.P.); (R.W.); (P.C.)
| | - Kian-Keong Poh
- Department of Cardiology, National University Heart Centre Singapore, Singapore 119074, Singapore; (W.K.F.K.); (K.-K.P.); (R.W.); (P.C.)
| | - Raymond Wong
- Department of Cardiology, National University Heart Centre Singapore, Singapore 119074, Singapore; (W.K.F.K.); (K.-K.P.); (R.W.); (P.C.)
| | - Ping Chai
- Department of Cardiology, National University Heart Centre Singapore, Singapore 119074, Singapore; (W.K.F.K.); (K.-K.P.); (R.W.); (P.C.)
| | - Ching-Hui Sia
- Department of Cardiology, National University Heart Centre Singapore, Singapore 119074, Singapore; (W.K.F.K.); (K.-K.P.); (R.W.); (P.C.)
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Hu W, Li P, Zeng N, Tan S. Exploring the hub mechanisms of ischemic stroke based on protein-protein interaction networks related to ischemic stroke and inflammatory bowel disease. Sci Rep 2023; 13:1741. [PMID: 36720935 PMCID: PMC9887582 DOI: 10.1038/s41598-023-27459-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Accepted: 01/02/2023] [Indexed: 02/01/2023] Open
Abstract
Ischemic stroke is highly concerning because it often leads to severe long-term neurological disability. Among clinical trials, ischemic stroke and inflammatory bowel disease interactions have been increasingly reported in recent years. Therefore, using bioinformatics approaches to explore novel protein interactions between them is of interest. We performed this exploratory analysis by using bioinformatics tools such as string to analyze gene data downloaded from NHGRI-GWAS data related to ischemic stroke and inflammatory bowel disease. We constructed a prospective protein interaction network for ischemic stroke and inflammatory bowel disease, identifying cytokine and interleukin-related signaling pathways, Spliceosome, Ubiquitin-Proteasome System (UPS), Thrombus, and Anticoagulation pathways as the crucial biological mechanisms of the network. Furthermore, we also used data-independent acquisition mass spectrometry (DIA-MS) to detect differential protein expression in eight samples, which also suggested that immune system, signal transduction, and hemostasis-related pathways are key signaling pathways. These findings may provide a basis for understanding the interaction between these two states and exploring possible molecular and therapeutic studies in the future.
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Affiliation(s)
- Wei Hu
- Department of Neurology, Zhujiang Hospital, Southern Medical University, Guangzhou, 510280, China.,Department of Rehabilitation, Xiangya Bo'ai Rehabilitation Hospital, Changsha, 410004, China
| | - Ping Li
- Department of Rehabilitation, Xiangya Bo'ai Rehabilitation Hospital, Changsha, 410004, China
| | - Nianju Zeng
- Department of Rehabilitation, Xiangya Bo'ai Rehabilitation Hospital, Changsha, 410004, China.
| | - Sheng Tan
- Department of Neurology, Zhujiang Hospital, Southern Medical University, Guangzhou, 510280, China.
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Bestetti RB, Bocchi EA, Bestetti R, Issa VS, Furlan-Daniel RA, Nakazone MA. Management of Cardiovascular Disease in Patients With COVID-19 and Chronic Chagas Disease: Implications to Prevent a Scourge Still Larger. Front Med (Lausanne) 2022; 9:910388. [PMID: 35847824 PMCID: PMC9276991 DOI: 10.3389/fmed.2022.910388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Accepted: 06/03/2022] [Indexed: 12/15/2022] Open
Abstract
Cardiovascular diseases (CVD) are the most important cause of morbidity and mortality in the general population. Because the high prevalence of COVID-19 and chronic Chagas disease (CCD) where the latter is endemic, all such diseases will likely be observed in the same patient. While COVID-19 can provoke generalized endotheliitis, which can lead to a cytokine storm and a hyper-coagulable state culminating into in-site and at a distance thrombosis. Therefore, small-vessel coronary artery disease (CAD), cerebrovascular disease, thromboembolism, and arrhythmias are prominent findings in COVID-19. In CCD, small-vessel CAD, cardioembolic stroke, pulmonary embolism, heart failure and arrhythmias are frequently observed as a result of a similar but less intense mechanism. Consequently, the association of CCD and COVID-19 will likely increase the incidence of CVD. Thus, doctors on the frontline should be on the alert for this diagnostic possibility so that the proper treatment can be given without any delay.
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Affiliation(s)
| | | | - Renato Bestetti
- Department of Medicine, Medical School, University of Ribeirão Preto, Ribeirao Preto, Brazil
| | - Victor Sarli Issa
- Department of Cardiology, Antwerp University Hospital, Antwerp, Belgium
| | | | - Marcelo Arruda Nakazone
- Department of Cardiology and Cardiovascular Surgery, Faculdade de Medicina de São José do Rio Preto, São José do Rio Preto, Brazil
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Montanaro VVA, Hora TF, Guerra AA, Silva GS, Bezerra RDP, Oliveira-Filho J, Santos LSB, de Melo ES, Alves de Andrade LP, Junior WADO, de Meira FCA, Nunes MDCP, Oliveira EMDJ, de Freitas GR. Artificial Inteligence-Based Decision for the Prediction of Cardioembolism in Patients with Chagas Disease and Ischemic Stroke. J Stroke Cerebrovasc Dis 2021; 30:106034. [PMID: 34399284 DOI: 10.1016/j.jstrokecerebrovasdis.2021.106034] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Revised: 07/09/2021] [Accepted: 08/01/2021] [Indexed: 10/20/2022] Open
Abstract
BACKGROUND Chagas disease (CD) and ischemic stroke (IS) have a close, but poorly understood, association. There is paucity of evidence on the ideal secondary prophylaxis and etiological determination, with few cardioembolic patients being identified. AIMS This study aimed to describe a multicenter cohort of patients with concomitant CD and IS admitted in tertiary centers and to create a predictive model for cardioembolic embolism in CD and IS. MATERIALS AND METHODS We retrospectively studied data obtained from electronic medical and regular medical records of patients with CD and IS in several academic, hospital-based, and university hospitals across Brazil. Descriptive analyses of cardioembolic and non-cardioembolic patients were performed. A prediction model for cardioembolism was proposed with 70% of the sample as the derivation sample, and the model was validated in 30% of the sample. RESULTS A total of 499 patients were analyzed. The median age was similar in both groups; however, patients with cardioembolic embolism were younger and tended to have higher alcoholism, smoking, and death rates. The predictive model for the etiological classification showed close relation with the number of abnormalities detected on echocardiography and electrocardiography as well as with vascular risk factors. CONCLUSIONS Our results replicate in part those previously published, with a higher prevalence of vascular risk factors and lower median age in patients with cardioembolic etiology. Our new model for predicting cardioembolic etiology can help identify patients with higher recurrence rate and therefore allow an optimized strategy for secondary prophylaxis.
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Affiliation(s)
- Vinícius Viana Abreu Montanaro
- SARAH Network of Rehabilitation Hospitals, Brasília, Brazil; Programa de Pós Graduação em Medicina (Neurologia) da Universidade Federal Fluminense - UFF, Niterói, RJ, Brazil.
| | | | | | - Gisele Sampaio Silva
- Universidade Federal de São Paulo - UNIFESP, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Rodrigo de Paiva Bezerra
- Universidade Federal de São Paulo - UNIFESP, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Jamary Oliveira-Filho
- Programa de Pós-Graduação em Ciências da Saúde, Universidade Federal da Bahia, UFBA, Salvador, BA, Brazil
| | - Leila Souza Brito Santos
- Programa de Pós-Graduação em Ciências da Saúde, Universidade Federal da Bahia, UFBA, Salvador, BA, Brazil
| | - Eduardo Sousa de Melo
- Universidade Federal de Pernambuco - UFPE, Universidade de Pernambuco, UPE, Recife, PE, Brazil
| | | | | | | | | | | | - Gabriel R de Freitas
- Programa de Pós Graduação em Medicina (Neurologia) da Universidade Federal Fluminense - UFF, Niterói, RJ, Brazil; D'Or Institute for Research and Education (IDOR), Rio de Janeiro, Brazil
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M'barek L, Sakka S, Meghdiche F, Turki D, Maalla K, Dammak M, Kallel C, Mhiri C. MTHFR (C677T, A1298C), FV Leiden polymorphisms, and the prothrombin G20210A mutation in arterial ischemic stroke among young tunisian adults. Metab Brain Dis 2021; 36:421-428. [PMID: 33400068 DOI: 10.1007/s11011-020-00663-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Accepted: 12/25/2020] [Indexed: 12/15/2022]
Abstract
Arterial ischemic stroke (AIS) in young adults is less common in older adults, but the underlying pathogenesis and risk factors are more multi-faceted. The role of inherited thrombophilia such as 5, 10-methylenetetrahydrofolate reductase (MTHFR) gene polymorphism, (C677T and A1298C), factor V of Leiden (FVL) polymorphism, and the prothrombin G20210A mutations remains unclear. This study aims to evaluate the role of prothrombin genetic factor in AIS among young adults in Tunisia and to assess the synergistic effect between thrombogenic mutations in the pathogenesis of AIS. In this case-control study, blood samples were collected from patients and healthy controls, all matched for age and gender. The difference between them is evaluated by using the chi-square test. The odds ratio (OR) was carried out to evaluate the associations between each polymorphism and AIS risk using a binary logistic regression model. Values were considered statistically significant when p < 0.05. Patients carrying simultaneously the MTHFR polymorphisms (677T and 1298C) have a higher risk to develop AIS compared to controls. The heterozygous variants FVL increased the risk of AIS only when it is associated with MTHFR C677T or MTHFR A1298C polymorphisms. In conclusion, our study confirmed the involvement of MTHFR polymorphisms as AIS's important risk factors. The existence of FVL polymorphism or prothrombin G20210A mutation alone doesn't correlate with the occurrence of stroke. We assume that the presence of both MTHFR and FVL polymorphisms has a synergistic effect and increased the risk of the AIS.
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Affiliation(s)
- Lamia M'barek
- Laboratory of Neurogenetics, Parkinson's Disease and Cerebrovascular Disease (LR-12-SP-19), Habib Bourguiba University Hospital, University of Sfax, Sfax, Tunisia.
- Clinical Investigation Center (CIC), Habib Bourguiba University Hospital, Sfax, Tunisia.
| | - Salma Sakka
- Laboratory of Neurogenetics, Parkinson's Disease and Cerebrovascular Disease (LR-12-SP-19), Habib Bourguiba University Hospital, University of Sfax, Sfax, Tunisia
| | - Fatma Meghdiche
- Laboratory of Hematology, Habib Bourguiba University Hospital, University of Monastir, Monastir, Tunisia
| | - Dhaker Turki
- Laboratory of Neurogenetics, Parkinson's Disease and Cerebrovascular Disease (LR-12-SP-19), Habib Bourguiba University Hospital, University of Sfax, Sfax, Tunisia
| | - Khadija Maalla
- Laboratory of Neurogenetics, Parkinson's Disease and Cerebrovascular Disease (LR-12-SP-19), Habib Bourguiba University Hospital, University of Sfax, Sfax, Tunisia
| | - Mariem Dammak
- Laboratory of Neurogenetics, Parkinson's Disease and Cerebrovascular Disease (LR-12-SP-19), Habib Bourguiba University Hospital, University of Sfax, Sfax, Tunisia
| | - Choumous Kallel
- Laboratory of Hematology, Habib Bourguiba University Hospital, University of Monastir, Monastir, Tunisia
| | - Chokri Mhiri
- Laboratory of Neurogenetics, Parkinson's Disease and Cerebrovascular Disease (LR-12-SP-19), Habib Bourguiba University Hospital, University of Sfax, Sfax, Tunisia
- Clinical Investigation Center (CIC), Habib Bourguiba University Hospital, Sfax, Tunisia
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Discussing the Score of Cardioembolic Ischemic Stroke in Chagas Disease. Trop Med Infect Dis 2020; 5:tropicalmed5020082. [PMID: 32466425 PMCID: PMC7345975 DOI: 10.3390/tropicalmed5020082] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 04/17/2020] [Accepted: 05/01/2020] [Indexed: 11/30/2022] Open
Abstract
Chagas disease is an important infection in Latin America but it is also reported in non-endemic countries all over the world. Around 30% of infected patients develop chronic Chagas cardiopathy, which is responsible for most poor outcomes, mainly heart failure, arrhythmias and thromboembolic events. Of all thromboembolic events, stroke is the most feared, due to the high probability of evolution to death or disability. Despite its importance, the actual incidence of cardioembolic ischemic stroke in Chagas disease is not completely known. The Instituto de Pesquisa Evandro Chagas/Fundação Oswaldo Cruz (IPEC-FIOCRUZ) score aims to propose prophylaxis strategies against cardioembolic ischemic stroke in Chagas disease based on clinical risk–benefit. To date, the IPEC-FIOCRUZ score is considered the best tool to identify patients for stroke prophylaxis in Chagas disease according the Latin American guideline and Brazilian consensus. It can prevent many cardioembolic strokes that would not be predicted, by applying the current recommendations to other cardiopathies. However, the IPEC-FIOCRUZ score still requires external validation to be used in different Chagas disease populations with an appropriate study design.
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Silva GS, Maldonado NJ, Mejia-Mantilla JH, Ortega-Gutierrez S, Claassen J, Varelas P, Suarez JI. Neuroemergencies in South America: How to Fill in the Gaps? Neurocrit Care 2020; 31:573-582. [PMID: 31342447 DOI: 10.1007/s12028-019-00775-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
South America is a subcontinent with 393 million inhabitants with widely distinct countries and diverse ethnicities, cultures, political and societal organizations. The epidemiological transition that accompanied the technological and demographic evolution is happening in South America and leading to a rise in the incidence of neurodegenerative and cardiovascular diseases that now coexist with the still high burden of infectious diseases. South America is also quite heterogeneous regarding the existence of systems of care for the various neurological emergencies, with some countries having well-organized systems for some diseases, while others have no plan of action for the care of patients with acute neurological symptoms. In this article, we discuss the existing systems of care in different countries of South America for the treatment of neurological emergencies, mainly stroke, status epilepticus, and traumatic brain injury. We also will address existing gaps between the current systems and recommendations from the literature to improve the management of such emergencies, as well as strategies on how to solve these disparities.
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Affiliation(s)
- Gisele Sampaio Silva
- Department of Neurology and Neurosurgery, Federal University of São Paulo (UNIFESP) and Albert Einstein Hospital, Albert Einstein Street, 627, Suite 218, São Paulo, SP, 05652-900, Brazil.
| | | | | | | | | | | | - Jose I Suarez
- Neurosciences Critical Care, Departments of Anesthesiology and Critical Care Medicine, Neurology, and Neurosurgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Saba L, Micheletti G, Brinjikji W, Garofalo P, Montisci R, Balestrieri A, Suri JS, DeMarco JK, Lanzino G, Sanfilippo R. Carotid Intraplaque-Hemorrhage Volume and Its Association with Cerebrovascular Events. AJNR Am J Neuroradiol 2019; 40:1731-1737. [PMID: 31558503 DOI: 10.3174/ajnr.a6189] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2019] [Accepted: 07/15/2019] [Indexed: 01/07/2023]
Abstract
BACKGROUND AND PURPOSE Our aim was to assess the relationship between volume and percentage of intraplaque hemorrhage measured using CT and the occurrence of cerebrovascular events at the time of CT. MATERIALS AND METHODS One-hundred-twenty-three consecutive subjects (246 carotid arteries) with a mean age of 69 years who underwent CTA were included in this retrospective study. Plaque volume of components and subcomponents (including intraplaque hemorrhage volume) was quantified with dedicated software. RESULTS Forty-six arteries were excluded because no plaque was identified. In the remaining 200 carotid arteries, a statistically significant difference was found between presentation with cerebrovascular events and lipid volume (P = .002), intraplaque hemorrhage volume (P = .002), percentage of lipid (P = .002), percentage of calcium (P = .001), percentage of intraplaque hemorrhage (P = .001), percentage of lipid-intraplaque hemorrhage (P = .001), and intraplaque hemorrhage/lipid ratio (P = .001). The highest receiver operating characteristic area under the curve was obtained with the intraplaque hemorrhage volume with a value of 0.793 (P = .001), percentage of intraplaque hemorrhage with an area under the curve of 0.812 (P = .001), and the intraplaque hemorrhage/lipid ratio with an area under the curve value of 0.811 (P = .001). CONCLUSIONS Results of our study suggest that Hounsfield unit values <25 have a statistically significant association with the presence of cerebrovascular events and that the ratio intraplaque hemorrhage/lipid volume represents a strong parameter for the association of cerebrovascular events.
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Affiliation(s)
- L Saba
- From the Departments of Radiology (L.S., G.M., P.G., A.B.)
| | - G Micheletti
- From the Departments of Radiology (L.S., G.M., P.G., A.B.)
| | | | - P Garofalo
- From the Departments of Radiology (L.S., G.M., P.G., A.B.)
| | - R Montisci
- Vascular Surgery (R.M., R.S.), Azienda Ospedaliero Universitaria, Monserrato (Cagliari), Italy
| | - A Balestrieri
- From the Departments of Radiology (L.S., G.M., P.G., A.B.)
| | - J S Suri
- Stroke Monitoring and Diagnostic Division (J.S.S.), AtheroPoint, Roseville, California
- Point-of-Care Devices (J.S.S.), Global Biomedical Technologies, Roseville, California
- Department of Electrical Engineering (J.S.S.), University of Idaho, Moscow, Idaho (Affiliated)
| | - J K DeMarco
- Department of Radiology (J.K.D.), Walter Reed Medical Center, Bethesda, Maryland
| | - G Lanzino
- Neurosurgery (G.L.), Mayo Clinic, Rochester, Minnesota
| | - R Sanfilippo
- Vascular Surgery (R.M., R.S.), Azienda Ospedaliero Universitaria, Monserrato (Cagliari), Italy
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11
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Ischemic stroke and infectious diseases in low-income and middle-income countries. Curr Opin Neurol 2019; 32:43-48. [PMID: 30516643 DOI: 10.1097/wco.0000000000000641] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
PURPOSE OF REVIEW To address the important relationships between stroke and infection, focusing on the most frequent infections found in low-income and middle-income countries. RECENT FINDINGS Stroke is one of the leading causes of mortality and disability worldwide, with a great proportion of the stroke burden occurring in low-income and middle-income countries. Infectious diseases are still a great health problem in developing countries and it is possible that the proportion of infection-related strokes is greater in these nations. Infectious diseases and stroke have a bidirectional relationship. Common infections may act as risk factors and can trigger stroke through different mechanisms in their acute phase. Several intracranial and systemic infections can cause stroke as a direct complication, such as Chagas disease, neurosyphilis, tuberculous meningitis, and neurocysticercosis. These conditions are of particular interest to low-income and middle-income countries, but also relevant to high-income nations because of increasing migration. Finally, infection is a frequent poststroke complication, with great impact in the patient outcome. SUMMARY Infectious diseases and stroke are common problems in low-income and middle-income countries. More studies are necessary to fully elucidate the real impact of infectious diseases on stroke burden, especially in countries where epidemiological data are still scarce.
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Abstract
The relevance of LP(a), Hcy, and D-D in ischemic cerebrovascular disease remains undefined. This study aimed to assess the associations of plasma LP(a), Hcy and D-D levels with the subtype of ischemic cerebrovascular disease.Patients with ischemic cerebrovascular disease admitted to the Taixing People's Hospital were retrospectively enrolled from November 2017 to July 2018. Immunoturbidimetry was used to assess 119 LAA, 107 SAO, and 112 TIA patients for plasma LP(a), Hcy, and D-D levels.Plasma LP(a), Hcy, and D-D levels in the large artery atherosclerosis (LAA) group were significantly lower than those of the transient ischemic attack (TIA) group (all P < .05). LP(a), Hcy, and D-D levels were significantly reduced in the SAO group compared with the TIA group (both P < .05). The LAA and SAO groups showed comparable values for all the above parameters (P > .05).LP(a), Hcy, and D-D levels differ according to the subtype of ischemic cerebrovascular disease.
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Affiliation(s)
- Yong Tang
- Nanjing Medical University, Nanjing
- The Taixing People's Hospital, Taixing, Jiangsu, China
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Bestetti RB, Dellalibera-Joviliano R, Couto LB. Comments on Etiological Classification of Stroke in Patients with Chagas Disease Using TOAST, Causative Classification System TOAST, and ASCOD Phenotyping. J Stroke Cerebrovasc Dis 2018; 27:1434. [DOI: 10.1016/j.jstrokecerebrovasdis.2017.12.049] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Accepted: 12/28/2017] [Indexed: 01/14/2023] Open
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