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Berdalin AB, Namestnikova DD, Cherkashova EA, Golovin DA, Gubskiy IL, Lelyuk VG. Arterial Hypertension and Its Consequences Are the Main Predictors of Embolic Stroke of Undetermined Source. DISEASE MARKERS 2023; 2023:3469755. [PMID: 38025665 PMCID: PMC10667056 DOI: 10.1155/2023/3469755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Revised: 10/09/2023] [Accepted: 10/28/2023] [Indexed: 12/01/2023]
Abstract
Methods We performed a hospital-based prospective cohort study with 1,317 enrolled participants. We compared patients and healthy volunteers according to the main demographic, anthropometric parameters, stroke risk factors, comorbidities, and data of clinical and instrumental examination. In order to balance the study and the control groups for age and sex, the propensity score matching was performed. In order to generate the overall predictive model, a multivariate analysis was performed using the binary logistic regression method. Results The following predictors of ESUS were identified in current study: arterial hypertension (AH); increased heart rate and pulmonary arterial systolic pressure (PASP); the presence of conduction disturbance; the enlargement of left, right atrium, and left ventricle end-systolic length; increased intima-media thickness (IMT) in right and left common carotid artery (CCA); lowered Montreal Cognitive Assessment (MoСA) cognitive scale score; the presence of subcortical microbleeds; central brain atrophy; the larger size of third ventricle; and the higher medial temporal lobe atrophy (MTA) score. The following risk factors were included in the final predictive model: the presence of AH (p < 0.0005; OR = 12.98 (95% CI: 4.53-37.21)) and PASP (p=0.018; OR = 1.13 (95% CI: 1.02-1.25)) and male sex (p=0.046; OR = 2.771 (95% CI: 1.017-7.555)). The Nagelkerke's pseudo-R-squared value was 0.404 and the significance of the Hosmer-Lemeshow test was 0.733, which indicate the goodness of the final logistic regression model. Conclusions We propose that AH and its consequences are the main predictors of ESUS. The results of this study emphasize the importance of AH control for primary and secondary prevention of ESUS.
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Affiliation(s)
- Alexander B. Berdalin
- Federal Center of Brain Research and Neurotechnologies, Federal Medical Biological Agency, Moscow 117513, Russia
| | - Daria D. Namestnikova
- Federal Center of Brain Research and Neurotechnologies, Federal Medical Biological Agency, Moscow 117513, Russia
- Pirogov Russian National Research Medical University, Ministry of Healthcare of the Russian Federation, Moscow 117977, Russia
| | - Elvira A. Cherkashova
- Federal Center of Brain Research and Neurotechnologies, Federal Medical Biological Agency, Moscow 117513, Russia
- Pirogov Russian National Research Medical University, Ministry of Healthcare of the Russian Federation, Moscow 117977, Russia
| | - Denis A. Golovin
- Federal Center of Brain Research and Neurotechnologies, Federal Medical Biological Agency, Moscow 117513, Russia
| | - Ilya L. Gubskiy
- Federal Center of Brain Research and Neurotechnologies, Federal Medical Biological Agency, Moscow 117513, Russia
- Pirogov Russian National Research Medical University, Ministry of Healthcare of the Russian Federation, Moscow 117977, Russia
| | - Vladimir G. Lelyuk
- Federal Center of Brain Research and Neurotechnologies, Federal Medical Biological Agency, Moscow 117513, Russia
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Zhu Y, Zhang J, Huang B, Liu Y, Deng Y, Weng Y, Sun R. Impact of Patent Foramen Ovale Anatomic Features on Right-to-Left Shunt in Patients with Cryptogenic Stroke. ULTRASOUND IN MEDICINE & BIOLOGY 2021; 47:1289-1298. [PMID: 33541750 DOI: 10.1016/j.ultrasmedbio.2021.01.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Revised: 12/24/2020] [Accepted: 01/07/2021] [Indexed: 06/12/2023]
Abstract
The purpose of this study was to investigate the impact of the morphologic characteristics of patent foramen ovale (PFO) on right-to-left shunt (RLS) in patients with PFO and cryptogenic stroke using transesophageal echocardiography and saline contrast transthoracic echocardiography (c-TTE). Of the 165 patients with PFO stroke, both the height and the length of PFO in the provoked RLS group were smaller than those in the constant RLS group. PFO height, interatrial septum mobility and proportion of atrial septal aneurysms were greater in the severe RLS group than in the mild and moderate RLS groups. Multivariate analysis revealed that PFO height and interatrial septum mobility were independent predictors of severe RLS. Multiple territorial ischemic lesions were more common in the severe RLS or constant RLS group. Our findings indicated that the severity of RLS was related to the anatomic features in PFO, inducing different cerebral ischemia lesion patterns in cryptogenic stroke patients with PFO.
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Affiliation(s)
- Ying Zhu
- Department of Medical Ultrasound, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jun Zhang
- Department of Medical Ultrasound, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Bo Huang
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yani Liu
- Department of Medical Ultrasound, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
| | - Youbin Deng
- Department of Medical Ultrasound, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yahui Weng
- Department of Medical Ultrasound, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Ruiying Sun
- Department of Medical Ultrasound, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Fuentes B, Gutiérrez-Zúñiga R, Díez-Tejedor E. It's Time to Say Goodbye to the ESUS Construct. Front Neurol 2020; 11:653. [PMID: 32733368 PMCID: PMC7358305 DOI: 10.3389/fneur.2020.00653] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2020] [Accepted: 06/02/2020] [Indexed: 12/26/2022] Open
Affiliation(s)
- Blanca Fuentes
- Department of Neurology and Stroke Center, Hospital Universitario La Paz, Madrid, Spain.,Department of Medicine, Universidad Autónoma de Madrid, Madrid, Spain
| | - Raquel Gutiérrez-Zúñiga
- Department of Neurology and Stroke Center, Hospital Universitario La Paz, Madrid, Spain.,Department of Medicine, Universidad Autónoma de Madrid, Madrid, Spain
| | - Exuperio Díez-Tejedor
- Department of Neurology and Stroke Center, Hospital Universitario La Paz, Madrid, Spain.,Department of Medicine, Universidad Autónoma de Madrid, Madrid, Spain
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McMahon NE, Bangee M, Benedetto V, Bray EP, Georgiou RF, Gibson JME, Lane DA, Al-Khalidi AH, Chatterjee K, Chauhan U, Clegg AJ, Lightbody CE, Lip GYH, Sekhar A, Watkins CL. Etiologic Workup in Cases of Cryptogenic Stroke: A Systematic Review of International Clinical Practice Guidelines. Stroke 2020; 51:1419-1427. [PMID: 32279620 PMCID: PMC7185056 DOI: 10.1161/strokeaha.119.027123] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Supplemental Digital Content is available in the text. Identifying the etiology of acute ischemic stroke is essential for effective secondary prevention. However, in at least one third of ischemic strokes, existing investigative protocols fail to determine the underlying cause. Establishing etiology is complicated by variation in clinical practice, often reflecting preferences of treating clinicians and variable availability of investigative techniques. In this review, we systematically assess the extent to which there exists consensus, disagreement, and gaps in clinical practice recommendations on etiologic workup in acute ischemic stroke.
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Affiliation(s)
- Naoimh E McMahon
- From the Faculty of Health and Wellbeing, University of Central Lancashire, Preston, United Kingdom (N.E.M., M.B., V.B., E.P.B., R.F.G., J.M.E.G., A.J.C., C.E.L., C.L.W.)
| | - Munirah Bangee
- From the Faculty of Health and Wellbeing, University of Central Lancashire, Preston, United Kingdom (N.E.M., M.B., V.B., E.P.B., R.F.G., J.M.E.G., A.J.C., C.E.L., C.L.W.)
| | - Valerio Benedetto
- From the Faculty of Health and Wellbeing, University of Central Lancashire, Preston, United Kingdom (N.E.M., M.B., V.B., E.P.B., R.F.G., J.M.E.G., A.J.C., C.E.L., C.L.W.)
| | - Emma P Bray
- From the Faculty of Health and Wellbeing, University of Central Lancashire, Preston, United Kingdom (N.E.M., M.B., V.B., E.P.B., R.F.G., J.M.E.G., A.J.C., C.E.L., C.L.W.)
| | - Rachel F Georgiou
- From the Faculty of Health and Wellbeing, University of Central Lancashire, Preston, United Kingdom (N.E.M., M.B., V.B., E.P.B., R.F.G., J.M.E.G., A.J.C., C.E.L., C.L.W.)
| | - Josephine M E Gibson
- From the Faculty of Health and Wellbeing, University of Central Lancashire, Preston, United Kingdom (N.E.M., M.B., V.B., E.P.B., R.F.G., J.M.E.G., A.J.C., C.E.L., C.L.W.)
| | - Deirdre A Lane
- Liverpool Centre for Cardiovascular Science, University of Liverpool & Liverpool Heart and Chest Hospital, United Kingdom (D.A.L., G.Y.H.L.).,Department of Clinical Medicine, Aalborg University, Denmark (D.A.L., G.Y.H.L.)
| | | | | | - Umesh Chauhan
- Faculty of Clinical and Biomedical Sciences, University of Central Lancashire, Preston, United Kingdom (U.C.)
| | - Andrew J Clegg
- From the Faculty of Health and Wellbeing, University of Central Lancashire, Preston, United Kingdom (N.E.M., M.B., V.B., E.P.B., R.F.G., J.M.E.G., A.J.C., C.E.L., C.L.W.)
| | - C Elizabeth Lightbody
- From the Faculty of Health and Wellbeing, University of Central Lancashire, Preston, United Kingdom (N.E.M., M.B., V.B., E.P.B., R.F.G., J.M.E.G., A.J.C., C.E.L., C.L.W.)
| | - Gregory Y H Lip
- Department of Clinical Medicine, Aalborg University, Denmark (D.A.L., G.Y.H.L.).,Medtronic Limited, Watford, United Kingdom (A.H.A.-K.)
| | - Alakendu Sekhar
- The Walton Centre NHS Foundation Trust, Liverpool, United Kingdom (A.S.)
| | - Caroline L Watkins
- From the Faculty of Health and Wellbeing, University of Central Lancashire, Preston, United Kingdom (N.E.M., M.B., V.B., E.P.B., R.F.G., J.M.E.G., A.J.C., C.E.L., C.L.W.)
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