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Yamamoto K, Ueda H, Uchiyama D, Takeji Y, Taniguchi T, Morimoto T, Tabata H, Ishizu K, Morofuji T, Hayashi M, Isotani A, Shirai S, Ohno N, Kakumoto S, Ando K, Minatoya K, Kimura T. Cerebrovascular Disease Detected on Preprocedural Computed Tomography in Patients With Severe Aortic Stenosis Undergoing Aortic Valve Replacement. J Am Heart Assoc 2024; 13:e035078. [PMID: 38979790 PMCID: PMC11292776 DOI: 10.1161/jaha.124.035078] [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: 02/19/2024] [Accepted: 05/16/2024] [Indexed: 07/10/2024]
Abstract
BACKGROUND There is a scarcity of data on the prevalence and clinical impact of cerebrovascular disease detected on preprocedural computed tomography (CT) before aortic valve replacement (AVR) in patients with severe aortic stenosis. METHODS AND RESULTS Among patients with severe aortic stenosis undergoing AVR, the authors compared clinical outcomes between patients with and without cerebrovascular disease detected on preprocedural CT, which was defined as chronic brain infarction or hemorrhage. The primary outcome measure in this study was a composite of all-cause death or stroke. Among 567 study patients, 200 patients (35.3%) had cerebrovascular disease on preprocedural CT. Among 200 patients with cerebrovascular disease on preprocedural CT, only 28.5% of patients had a clinical history of symptomatic stroke. The cumulative 3-year incidence of death or stroke was higher in patients with cerebrovascular disease on preprocedural CT than in those without cerebrovascular disease on preprocedural CT (40.7% versus 24.1%, log-rank P<0.001). After adjusting for confounders, the higher risk of patients with cerebrovascular disease on preprocedural CT relative to those without remained significant for death or stroke (hazard ratio [HR], 1.42 [95% CI, 1.02-1.98]; P=0.04). Among 200 patients with cerebrovascular disease on preprocedural CT, patients with prior symptomatic stroke compared with those without were not associated with higher adjusted risk for death or stroke (HR, 1.18 [95% CI, 0.72-1.94]; P=0.52). CONCLUSIONS Among patients with severe aortic stenosis undergoing AVR, a substantial proportion had cerebrovascular disease on preprocedural CT, with a clinical history of symptomatic stroke in one-fourth of patients. Regardless of history of symptomatic stroke, patients with cerebrovascular disease on preprocedural CT had worse clinical outcomes compared with those without cerebrovascular disease on preprocedural CT.
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Affiliation(s)
- Ko Yamamoto
- Department of CardiologyKokura Memorial HospitalKitakyushuJapan
| | - Hiroyuki Ueda
- Department of RadiologyKokura Memorial HospitalKitakyushuJapan
| | - Daiji Uchiyama
- Department of RadiologyKokura Memorial HospitalKitakyushuJapan
| | - Yasuaki Takeji
- Department of Cardiovascular MedicineKanazawa University Graduate School of Medical SciencesKanazawaJapan
| | - Tomohiko Taniguchi
- Department of Cardiovascular MedicineKobe City Medical Center General HospitalKobeJapan
| | - Takeshi Morimoto
- Department of Clinical EpidemiologyHyogo College of MedicineNishinomiyaJapan
| | - Hiroyuki Tabata
- Department of Cardiovascular Medicine and Hypertension, Graduate School of Medical and Dental SciencesKagoshima UniversityKagoshimaJapan
| | - Kenichi Ishizu
- Department of CardiologyKokura Memorial HospitalKitakyushuJapan
| | - Toru Morofuji
- Department of CardiologyKokura Memorial HospitalKitakyushuJapan
| | - Masaomi Hayashi
- Department of CardiologyKokura Memorial HospitalKitakyushuJapan
| | - Akihiro Isotani
- Department of CardiologyKokura Memorial HospitalKitakyushuJapan
| | - Shinichi Shirai
- Department of CardiologyKokura Memorial HospitalKitakyushuJapan
| | - Nobuhisa Ohno
- Department of Cardiovascular SurgeryKokura Memorial HospitalKitakyushuJapan
| | | | - Kenji Ando
- Department of CardiologyKokura Memorial HospitalKitakyushuJapan
| | - Kenji Minatoya
- Department of Cardiovascular Surgery, Graduate School of MedicineKyoto UniversityKyotoJapan
| | - Takeshi Kimura
- Department of CardiologyHirakata Kohsai HospitalHirakataJapan
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Fleischman DA, Arfanakis K, Leurgans SE, Arvanitakis Z, Lamar M, Han SD, Poole VN, Bennett DA, Barnes LL. Cerebral arteriolosclerosis, lacunar infarcts, and cognition in older Black adults. Alzheimers Dement 2024. [PMID: 38988020 DOI: 10.1002/alz.13917] [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: 02/12/2024] [Revised: 04/05/2024] [Accepted: 05/01/2024] [Indexed: 07/12/2024]
Abstract
INTRODUCTION Older Black adults are at risk of cerebral small vessel disease (CSVD), which contributes to dementia risk. Two subtypes of CSVD, arteriolosclerosis and ischemic lacunar infarcts, have been independently linked to lower cognition and higher dementia risk, but their combined effects on cognition in older Black adults are unclear. METHODS Mixed models were used to examine the associations of in vivo measures of arteriolosclerosis (ARTS) and ischemic lacunar infarcts to cognitive level and change in 370 older Black adults without dementia. RESULTS: Modeled together, higher ARTS load accounted for lower levels of global cognition, episodic memory, semantic memory, and perceptual speed, whereas higher infarct load accounted for lower levels of working memory. There were no associations with rate of cognitive change. DISCUSSION Both arteriolosclerosis and ischemic infarcts impact the cognitive health of older Black adults, but arteriolosclerosis affects cognition more broadly and offers promise as an in vivo biomarker of dementia risk. HIGHLIGHTS Older Black adults are at risk of cerebral small vessel disease (CSVD) and dementia. Examined magnetic resonance imaging-derived measure of arteriolosclerosis (ARTS), infarcts, and cognition. ARTS load was widely associated with lower cognition after adjusting for infarct load. Infarct load was specifically associated with lower complex attention. More within-Black in vivo studies of CSVD subtypes and cognition are needed.
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Affiliation(s)
- Debra A Fleischman
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, Illinois, USA
- Department of Neurological Sciences, Rush University Medical Center, Chicago, Illinois, USA
- Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, Chicago, Illinois, USA
| | - Konstantinos Arfanakis
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, Illinois, USA
- Department of Diagnostic Radiology and Nuclear Medicine, Rush University Medical Center, Chicago, Illinois, USA
- Department of Biomedical Engineering, Illinois Institute of Technology, Chicago, Illinois, USA
| | - Sue E Leurgans
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, Illinois, USA
- Department of Neurological Sciences, Rush University Medical Center, Chicago, Illinois, USA
- Department of Family & Preventive Medicine, Rush University Medical Center, Chicago, Illinois, USA
| | - Zoe Arvanitakis
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, Illinois, USA
- Department of Neurological Sciences, Rush University Medical Center, Chicago, Illinois, USA
| | - Melissa Lamar
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, Illinois, USA
- Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, Chicago, Illinois, USA
| | - S Duke Han
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, Illinois, USA
- Department of Psychology, University of Southern California, Los Angeles, California, USA
| | - Victoria N Poole
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, Illinois, USA
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - David A Bennett
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, Illinois, USA
| | - Lisa L Barnes
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, Illinois, USA
- Department of Neurological Sciences, Rush University Medical Center, Chicago, Illinois, USA
- Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, Chicago, Illinois, USA
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Chauvin SD, Ando S, Holley JA, Sugie A, Zhao FR, Poddar S, Kato R, Miner CA, Nitta Y, Krishnamurthy SR, Saito R, Ning Y, Hatano Y, Kitahara S, Koide S, Stinson WA, Fu J, Surve N, Kumble L, Qian W, Polishchuk O, Andhey PS, Chiang C, Liu G, Colombeau L, Rodriguez R, Manel N, Kakita A, Artyomov MN, Schultz DC, Coates PT, Roberson EDO, Belkaid Y, Greenberg RA, Cherry S, Gack MU, Hardy T, Onodera O, Kato T, Miner JJ. Inherited C-terminal TREX1 variants disrupt homology-directed repair to cause senescence and DNA damage phenotypes in Drosophila, mice, and humans. Nat Commun 2024; 15:4696. [PMID: 38824133 PMCID: PMC11144269 DOI: 10.1038/s41467-024-49066-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Accepted: 05/22/2024] [Indexed: 06/03/2024] Open
Abstract
Age-related microangiopathy, also known as small vessel disease (SVD), causes damage to the brain, retina, liver, and kidney. Based on the DNA damage theory of aging, we reasoned that genomic instability may underlie an SVD caused by dominant C-terminal variants in TREX1, the most abundant 3'-5' DNA exonuclease in mammals. C-terminal TREX1 variants cause an adult-onset SVD known as retinal vasculopathy with cerebral leukoencephalopathy (RVCL or RVCL-S). In RVCL, an aberrant, C-terminally truncated TREX1 mislocalizes to the nucleus due to deletion of its ER-anchoring domain. Since RVCL pathology mimics that of radiation injury, we reasoned that nuclear TREX1 would cause DNA damage. Here, we show that RVCL-associated TREX1 variants trigger DNA damage in humans, mice, and Drosophila, and that cells expressing RVCL mutant TREX1 are more vulnerable to DNA damage induced by chemotherapy and cytokines that up-regulate TREX1, leading to depletion of TREX1-high cells in RVCL mice. RVCL-associated TREX1 mutants inhibit homology-directed repair (HDR), causing DNA deletions and vulnerablility to PARP inhibitors. In women with RVCL, we observe early-onset breast cancer, similar to patients with BRCA1/2 variants. Our results provide a mechanistic basis linking aberrant TREX1 activity to the DNA damage theory of aging, premature senescence, and microvascular disease.
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Affiliation(s)
- Samuel D Chauvin
- Division of Rheumatology, Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
- RVCL Research Center, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Shoichiro Ando
- Department of Neurology, Clinical Neuroscience Branch, Brain Research Institute, Niigata University, Niigata, Japan
| | - Joe A Holley
- Division of Rheumatology, Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
- RVCL Research Center, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Atsushi Sugie
- Department of Neuroscience of Disease, Brain Research Institute, Niigata University, Niigata, Japan
| | - Fang R Zhao
- Department of Medicine, Washington University in Saint Louis, Saint Louis, MO, USA
| | - Subhajit Poddar
- Division of Rheumatology, Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
- RVCL Research Center, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Rei Kato
- Department of Neurology, Clinical Neuroscience Branch, Brain Research Institute, Niigata University, Niigata, Japan
| | - Cathrine A Miner
- Division of Rheumatology, Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
- RVCL Research Center, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Yohei Nitta
- Department of Neuroscience of Disease, Brain Research Institute, Niigata University, Niigata, Japan
| | - Siddharth R Krishnamurthy
- Metaorganism Immunity Section, Laboratory of Immune System Biology, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA
- NIAID Microbiome Program, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA
| | - Rie Saito
- Department of Pathology, Clinical Neuroscience Branch, Brain Research Institute, Niigata University, Niigata, Japan
| | - Yue Ning
- Division of Rheumatology, Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
- RVCL Research Center, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Yuya Hatano
- Department of Neurology, Clinical Neuroscience Branch, Brain Research Institute, Niigata University, Niigata, Japan
| | - Sho Kitahara
- Department of Neurology, Clinical Neuroscience Branch, Brain Research Institute, Niigata University, Niigata, Japan
| | - Shin Koide
- Department of Neurology, Clinical Neuroscience Branch, Brain Research Institute, Niigata University, Niigata, Japan
| | - W Alexander Stinson
- Department of Medicine, Washington University in Saint Louis, Saint Louis, MO, USA
| | - Jiayuan Fu
- Division of Rheumatology, Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
- RVCL Research Center, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Nehalee Surve
- Division of Rheumatology, Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
- RVCL Research Center, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Lindsay Kumble
- Division of Rheumatology, Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
- RVCL Research Center, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Wei Qian
- Department of Medicine, Washington University in Saint Louis, Saint Louis, MO, USA
| | - Oleksiy Polishchuk
- Division of Rheumatology, Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
- RVCL Research Center, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Prabhakar S Andhey
- Department of Pathology and Immunology, Washington University in Saint Louis, Saint Louis, MO, USA
| | - Cindy Chiang
- Department of Microbiology, The University of Chicago, Chicago, IL, USA
- Florida Research and Innovation Center, Cleveland Clinic, Port Saint Lucie, FL, USA
| | - Guanqun Liu
- Department of Microbiology, The University of Chicago, Chicago, IL, USA
- Florida Research and Innovation Center, Cleveland Clinic, Port Saint Lucie, FL, USA
| | - Ludovic Colombeau
- Equipe Labellisée Ligue Contre le Cancer, Institut Curie, CNRS, INSERM, PSL Research University, Paris, France
| | - Raphaël Rodriguez
- Equipe Labellisée Ligue Contre le Cancer, Institut Curie, CNRS, INSERM, PSL Research University, Paris, France
| | - Nicolas Manel
- INSERM U932, Institut Curie, PSL Research University, Paris, France
| | - Akiyoshi Kakita
- Department of Pathology, Clinical Neuroscience Branch, Brain Research Institute, Niigata University, Niigata, Japan
| | - Maxim N Artyomov
- Department of Pathology and Immunology, Washington University in Saint Louis, Saint Louis, MO, USA
| | - David C Schultz
- High-throughput Screening Core, University of Pennsylvania, Philadelphia, PA, USA
| | - P Toby Coates
- Central and Northern Adelaide Renal and Transplantation Service (CNARTS), The Royal Adelaide Hospital, Adelaide, South Australia, Australia
- School of Medicine, Faculty of Health Sciences, University of Adelaide, Adelaide, South Australia, Australia
| | - Elisha D O Roberson
- Department of Medicine, Washington University in Saint Louis, Saint Louis, MO, USA
| | - Yasmine Belkaid
- Metaorganism Immunity Section, Laboratory of Immune System Biology, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA
- NIAID Microbiome Program, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA
- Institut Pasteur, Paris, France
| | - Roger A Greenberg
- Department of Cancer Biology, Penn Center for Genome Integrity, Basser Center for BRCA, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Sara Cherry
- Institute for Immunology and Immune Health, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
- Department of Pathology and Laboratory Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Michaela U Gack
- Department of Microbiology, The University of Chicago, Chicago, IL, USA
- Florida Research and Innovation Center, Cleveland Clinic, Port Saint Lucie, FL, USA
| | - Tristan Hardy
- Genetics, Repromed, Monash IVF, Dulwich, South Australia, Australia
- Genetics and Molecular Pathology, SA Pathology, Adelaide, Australia
| | - Osamu Onodera
- Department of Neurology, Clinical Neuroscience Branch, Brain Research Institute, Niigata University, Niigata, Japan
- Department of Molecular Neuroscience, Brain Science Branch, Brain Research Institute, Niigata University, Niigata, Japan
| | - Taisuke Kato
- Department of Molecular Neuroscience, Brain Science Branch, Brain Research Institute, Niigata University, Niigata, Japan.
| | - Jonathan J Miner
- Division of Rheumatology, Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA.
- RVCL Research Center, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA.
- Department of Medicine, Washington University in Saint Louis, Saint Louis, MO, USA.
- Institute for Immunology and Immune Health, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA.
- Department of Microbiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA.
- Penn Colton Center for Autoimmunity, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA.
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4
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Zhang A, Furgeson S, Shapiro A, Bjornstad P, You Z, Tommerdahl KL, Dixon A, Stenson E, Oh E, Kendrick J. Assessing Cognition in CKD Using the National Institutes of Health Toolbox. KIDNEY360 2024; 5:834-840. [PMID: 38568010 PMCID: PMC11219111 DOI: 10.34067/kid.0000000000000440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Accepted: 03/29/2024] [Indexed: 06/01/2024]
Abstract
Key Points Participants with CKD had detectable cognitive deficits in fluid cognition, dexterity, and total cognition. Sex differences in cognition exist in people with CKD. Background CKD is largely an age-related clinical disorder with accelerated cognitive and cardiovascular aging. Cognitive impairment is a well-documented occurrence in midlife and older adults with CKD and affects multiple domains. We examined cognition function and potential sex differences in cognition in adults with CKD. Methods We included 105 individuals (49.5% women) with CKD stage 3b–4 (eGFR, 15–44 ml/min) from the Bicarbonate Administration in CKD Trial (NCT02915601 ). We measured cognitive function using the National Institutes of Health Toolbox Cognition Battery, which assesses cognitive and motor measures, such as executive function, attention, memory, and dexterity. All study measures were collected and analyzed at the study baseline. Results The mean (SD) age and eGFR were 61±12 years and 34.9±9.8 ml/min per 1.73 m2. Overall, when compared with the National Institutes of Health Toolbox reference population, participants scored, on average, below the 50th percentile across all cognitive domain tests and the dexterity test. Total cognition scores were also below the 50th percentile. Participants with stage 4 CKD had significantly lower fluid cognition scores compared with those with CKD stage 3b (β -estimate −5.4 [95% confidence interval, −9.8 to −0.9]; P = 0.03). Female participants with CKD performed significantly better on the episodic memory tests and dexterity tests (dominant and nondominant pegboard tests) and had higher crystallized cognition scores, on average, compared with male participants. Conclusions Participants with CKD had detectable cognitive deficits in fluid cognition, dexterity, and total cognition. In addition, sex differences in cognitive measures were found among people with CKD.
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Affiliation(s)
- Alexander Zhang
- Division of Renal Diseases and Hypertension, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Seth Furgeson
- Division of Renal Diseases and Hypertension, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Allison Shapiro
- Section of Pediatric Endocrinology, Department of Pediatrics, Children's Hospital Colorado, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Petter Bjornstad
- Division of Renal Diseases and Hypertension, University of Colorado Anschutz Medical Campus, Aurora, Colorado
- Section of Pediatric Endocrinology, Department of Pediatrics, Children's Hospital Colorado, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Zhiying You
- Division of Renal Diseases and Hypertension, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Kalie L. Tommerdahl
- Section of Pediatric Endocrinology, Department of Pediatrics, Children's Hospital Colorado, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Angelina Dixon
- Division of Renal Diseases and Hypertension, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Erin Stenson
- Section of Pediatric Critical Care Medicine, Department of Pediatrics, Children's Hospital Colorado, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Ester Oh
- Division of Renal Diseases and Hypertension, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Jessica Kendrick
- Division of Renal Diseases and Hypertension, University of Colorado Anschutz Medical Campus, Aurora, Colorado
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5
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Zhou Z, You S, Sakamoto Y, Xu Y, Ding S, Xu W, Li W, Yu J, Wang Y, Harris K, Delcourt C, Reeves MJ, Lindley RI, Parsons MW, Woodward M, Anderson C, Du X, Pu J, Wardlaw JM, Carcel C. Covert Cerebrovascular Changes in People With Heart Disease: A Systematic Review and Meta-Analysis. Neurology 2024; 102:e209204. [PMID: 38531010 DOI: 10.1212/wnl.0000000000209204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Accepted: 12/18/2023] [Indexed: 03/28/2024] Open
Abstract
BACKGROUND AND OBJECTIVES To determine the prevalence of silent brain infarction (SBI) and cerebral small vessel disease (CSVD) in adults with atrial fibrillation (AF), coronary artery disease, heart failure or cardiomyopathy, heart valve disease, and patent foramen ovale (PFO), with comparisons between those with and without recent stroke and an exploration of associations between heart disease and SBI/CSVD. METHODS Medline, Embase, and Cochrane Library were systematically searched for hospital-based or community-based studies reporting SBI/CSVD in people with heart disease. Data were extracted from eligible studies. Outcomes were SBI (primary) and individual CSVD subtypes. Summary prevalence (95% confidence intervals [CIs]) were obtained using random-effects meta-analysis. Pooled prevalence ratios (PRs) (95% CI) were calculated to compare those with heart disease with available control participants without heart disease from studies. RESULTS A total of 221 observational studies were included. In those with AF, the prevalence was 36% (31%-41%) for SBI (70 studies, N = 13,589), 25% (19%-31%) for lacune (26 studies, N = 7,172), 62% (49%-74%) for white matter hyperintensity/hypoattenuation (WMH) (34 studies, N = 7,229), and 27% (24%-30%) for microbleed (44 studies, N = 13,654). Stratification by studies where participants with recent stroke were recruited identified no differences in the prevalence of SBI across subgroups (phomogeneity = 0.495). Results were comparable across participants with different heart diseases except for those with PFO, in whom there was a lower prevalence of SBI [21% (13%-30%), 11 studies, N = 1,053] and CSVD. Meta-regressions after pooling those with any heart disease identified associations of increased (study level) age and hypertensives with more SBIs and WMH (pregression <0.05). There was no evidence of a difference in the prevalence of microbleed between those with and without heart disease (PR [95% CI] 1.1 [0.7-1.7]), but a difference was seen in the prevalence of SBI and WMH (PR [95% CI] 2.3 [1.6-3.1] and 1.7 [1.1-2.6], respectively). DISCUSSION People with heart disease have a high prevalence of SBI (and CSVD), which is similar in those with vs without recent stroke. More research is required to assess causal links and implications for management. TRIAL REGISTRATION INFORMATION PROSPERO CRD42022378272 (crd.york.ac.uk/PROSPERO/).
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Affiliation(s)
- Zien Zhou
- From the The George Institute for Global Health (Z.Z., S.Y., Y.S., Y.X., J.Y., Y.W., K.H., C.D., M.W., C.A., C.C.), Faculty of Medicine, University of New South Wales, Sydney, Australia; Department of Neurology and Clinical Research Center of Neurological Disease (S.Y.), The Second Affiliated Hospital of Soochow University, Suzhou, PR China; Department of Neurological Science (Y.S.), Graduate School of Medicine, Nippon Medical School, Tokyo, Japan; Centre for Health Systems and Safety Research (Y.X.), Australian Institute of Health Innovation, Macquarie University, Sydney, Australia; Department of Cardiology (S.D., W.X., J.P.), Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University; Department of Cardiology (W.L., X.D.), Beijing Anzhen Hospital, Capital Medical University; Department of Cardiology (J.Y.), Peking University Third Hospital, Beijing; Department of Neurology (Y.W.), West China Hospital, Sichuan University, Chengdu, PR China; Department of Clinical Medicine (C.D.), Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, Australia; Department of Epidemiology and Biostatistics (M.J.R.), College of Human Medicine, Michigan State University, East Lansing; The George Institute for Global Health and University of Sydney (R.I.L.); South Western Clinical School (M.W.P.), University of New South Wales, Sydney, Australia; The George Institute for Global Health (M.W.), School of Public Health, Imperial College London, United Kingdom; Department of Neurology (C.A., C.C.), Royal Prince Alfred Hospital, Sydney Health Partners, Australia; Edinburgh Imaging and Centre for Clinical Brain Sciences (J.M.W.); and UK Dementia Research Institute (J.M.W.), University of Edinburgh, United Kingdom
| | - Shoujiang You
- From the The George Institute for Global Health (Z.Z., S.Y., Y.S., Y.X., J.Y., Y.W., K.H., C.D., M.W., C.A., C.C.), Faculty of Medicine, University of New South Wales, Sydney, Australia; Department of Neurology and Clinical Research Center of Neurological Disease (S.Y.), The Second Affiliated Hospital of Soochow University, Suzhou, PR China; Department of Neurological Science (Y.S.), Graduate School of Medicine, Nippon Medical School, Tokyo, Japan; Centre for Health Systems and Safety Research (Y.X.), Australian Institute of Health Innovation, Macquarie University, Sydney, Australia; Department of Cardiology (S.D., W.X., J.P.), Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University; Department of Cardiology (W.L., X.D.), Beijing Anzhen Hospital, Capital Medical University; Department of Cardiology (J.Y.), Peking University Third Hospital, Beijing; Department of Neurology (Y.W.), West China Hospital, Sichuan University, Chengdu, PR China; Department of Clinical Medicine (C.D.), Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, Australia; Department of Epidemiology and Biostatistics (M.J.R.), College of Human Medicine, Michigan State University, East Lansing; The George Institute for Global Health and University of Sydney (R.I.L.); South Western Clinical School (M.W.P.), University of New South Wales, Sydney, Australia; The George Institute for Global Health (M.W.), School of Public Health, Imperial College London, United Kingdom; Department of Neurology (C.A., C.C.), Royal Prince Alfred Hospital, Sydney Health Partners, Australia; Edinburgh Imaging and Centre for Clinical Brain Sciences (J.M.W.); and UK Dementia Research Institute (J.M.W.), University of Edinburgh, United Kingdom
| | - Yuki Sakamoto
- From the The George Institute for Global Health (Z.Z., S.Y., Y.S., Y.X., J.Y., Y.W., K.H., C.D., M.W., C.A., C.C.), Faculty of Medicine, University of New South Wales, Sydney, Australia; Department of Neurology and Clinical Research Center of Neurological Disease (S.Y.), The Second Affiliated Hospital of Soochow University, Suzhou, PR China; Department of Neurological Science (Y.S.), Graduate School of Medicine, Nippon Medical School, Tokyo, Japan; Centre for Health Systems and Safety Research (Y.X.), Australian Institute of Health Innovation, Macquarie University, Sydney, Australia; Department of Cardiology (S.D., W.X., J.P.), Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University; Department of Cardiology (W.L., X.D.), Beijing Anzhen Hospital, Capital Medical University; Department of Cardiology (J.Y.), Peking University Third Hospital, Beijing; Department of Neurology (Y.W.), West China Hospital, Sichuan University, Chengdu, PR China; Department of Clinical Medicine (C.D.), Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, Australia; Department of Epidemiology and Biostatistics (M.J.R.), College of Human Medicine, Michigan State University, East Lansing; The George Institute for Global Health and University of Sydney (R.I.L.); South Western Clinical School (M.W.P.), University of New South Wales, Sydney, Australia; The George Institute for Global Health (M.W.), School of Public Health, Imperial College London, United Kingdom; Department of Neurology (C.A., C.C.), Royal Prince Alfred Hospital, Sydney Health Partners, Australia; Edinburgh Imaging and Centre for Clinical Brain Sciences (J.M.W.); and UK Dementia Research Institute (J.M.W.), University of Edinburgh, United Kingdom
| | - Ying Xu
- From the The George Institute for Global Health (Z.Z., S.Y., Y.S., Y.X., J.Y., Y.W., K.H., C.D., M.W., C.A., C.C.), Faculty of Medicine, University of New South Wales, Sydney, Australia; Department of Neurology and Clinical Research Center of Neurological Disease (S.Y.), The Second Affiliated Hospital of Soochow University, Suzhou, PR China; Department of Neurological Science (Y.S.), Graduate School of Medicine, Nippon Medical School, Tokyo, Japan; Centre for Health Systems and Safety Research (Y.X.), Australian Institute of Health Innovation, Macquarie University, Sydney, Australia; Department of Cardiology (S.D., W.X., J.P.), Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University; Department of Cardiology (W.L., X.D.), Beijing Anzhen Hospital, Capital Medical University; Department of Cardiology (J.Y.), Peking University Third Hospital, Beijing; Department of Neurology (Y.W.), West China Hospital, Sichuan University, Chengdu, PR China; Department of Clinical Medicine (C.D.), Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, Australia; Department of Epidemiology and Biostatistics (M.J.R.), College of Human Medicine, Michigan State University, East Lansing; The George Institute for Global Health and University of Sydney (R.I.L.); South Western Clinical School (M.W.P.), University of New South Wales, Sydney, Australia; The George Institute for Global Health (M.W.), School of Public Health, Imperial College London, United Kingdom; Department of Neurology (C.A., C.C.), Royal Prince Alfred Hospital, Sydney Health Partners, Australia; Edinburgh Imaging and Centre for Clinical Brain Sciences (J.M.W.); and UK Dementia Research Institute (J.M.W.), University of Edinburgh, United Kingdom
| | - Song Ding
- From the The George Institute for Global Health (Z.Z., S.Y., Y.S., Y.X., J.Y., Y.W., K.H., C.D., M.W., C.A., C.C.), Faculty of Medicine, University of New South Wales, Sydney, Australia; Department of Neurology and Clinical Research Center of Neurological Disease (S.Y.), The Second Affiliated Hospital of Soochow University, Suzhou, PR China; Department of Neurological Science (Y.S.), Graduate School of Medicine, Nippon Medical School, Tokyo, Japan; Centre for Health Systems and Safety Research (Y.X.), Australian Institute of Health Innovation, Macquarie University, Sydney, Australia; Department of Cardiology (S.D., W.X., J.P.), Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University; Department of Cardiology (W.L., X.D.), Beijing Anzhen Hospital, Capital Medical University; Department of Cardiology (J.Y.), Peking University Third Hospital, Beijing; Department of Neurology (Y.W.), West China Hospital, Sichuan University, Chengdu, PR China; Department of Clinical Medicine (C.D.), Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, Australia; Department of Epidemiology and Biostatistics (M.J.R.), College of Human Medicine, Michigan State University, East Lansing; The George Institute for Global Health and University of Sydney (R.I.L.); South Western Clinical School (M.W.P.), University of New South Wales, Sydney, Australia; The George Institute for Global Health (M.W.), School of Public Health, Imperial College London, United Kingdom; Department of Neurology (C.A., C.C.), Royal Prince Alfred Hospital, Sydney Health Partners, Australia; Edinburgh Imaging and Centre for Clinical Brain Sciences (J.M.W.); and UK Dementia Research Institute (J.M.W.), University of Edinburgh, United Kingdom
| | - Wenyi Xu
- From the The George Institute for Global Health (Z.Z., S.Y., Y.S., Y.X., J.Y., Y.W., K.H., C.D., M.W., C.A., C.C.), Faculty of Medicine, University of New South Wales, Sydney, Australia; Department of Neurology and Clinical Research Center of Neurological Disease (S.Y.), The Second Affiliated Hospital of Soochow University, Suzhou, PR China; Department of Neurological Science (Y.S.), Graduate School of Medicine, Nippon Medical School, Tokyo, Japan; Centre for Health Systems and Safety Research (Y.X.), Australian Institute of Health Innovation, Macquarie University, Sydney, Australia; Department of Cardiology (S.D., W.X., J.P.), Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University; Department of Cardiology (W.L., X.D.), Beijing Anzhen Hospital, Capital Medical University; Department of Cardiology (J.Y.), Peking University Third Hospital, Beijing; Department of Neurology (Y.W.), West China Hospital, Sichuan University, Chengdu, PR China; Department of Clinical Medicine (C.D.), Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, Australia; Department of Epidemiology and Biostatistics (M.J.R.), College of Human Medicine, Michigan State University, East Lansing; The George Institute for Global Health and University of Sydney (R.I.L.); South Western Clinical School (M.W.P.), University of New South Wales, Sydney, Australia; The George Institute for Global Health (M.W.), School of Public Health, Imperial College London, United Kingdom; Department of Neurology (C.A., C.C.), Royal Prince Alfred Hospital, Sydney Health Partners, Australia; Edinburgh Imaging and Centre for Clinical Brain Sciences (J.M.W.); and UK Dementia Research Institute (J.M.W.), University of Edinburgh, United Kingdom
| | - Wenjie Li
- From the The George Institute for Global Health (Z.Z., S.Y., Y.S., Y.X., J.Y., Y.W., K.H., C.D., M.W., C.A., C.C.), Faculty of Medicine, University of New South Wales, Sydney, Australia; Department of Neurology and Clinical Research Center of Neurological Disease (S.Y.), The Second Affiliated Hospital of Soochow University, Suzhou, PR China; Department of Neurological Science (Y.S.), Graduate School of Medicine, Nippon Medical School, Tokyo, Japan; Centre for Health Systems and Safety Research (Y.X.), Australian Institute of Health Innovation, Macquarie University, Sydney, Australia; Department of Cardiology (S.D., W.X., J.P.), Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University; Department of Cardiology (W.L., X.D.), Beijing Anzhen Hospital, Capital Medical University; Department of Cardiology (J.Y.), Peking University Third Hospital, Beijing; Department of Neurology (Y.W.), West China Hospital, Sichuan University, Chengdu, PR China; Department of Clinical Medicine (C.D.), Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, Australia; Department of Epidemiology and Biostatistics (M.J.R.), College of Human Medicine, Michigan State University, East Lansing; The George Institute for Global Health and University of Sydney (R.I.L.); South Western Clinical School (M.W.P.), University of New South Wales, Sydney, Australia; The George Institute for Global Health (M.W.), School of Public Health, Imperial College London, United Kingdom; Department of Neurology (C.A., C.C.), Royal Prince Alfred Hospital, Sydney Health Partners, Australia; Edinburgh Imaging and Centre for Clinical Brain Sciences (J.M.W.); and UK Dementia Research Institute (J.M.W.), University of Edinburgh, United Kingdom
| | - Jie Yu
- From the The George Institute for Global Health (Z.Z., S.Y., Y.S., Y.X., J.Y., Y.W., K.H., C.D., M.W., C.A., C.C.), Faculty of Medicine, University of New South Wales, Sydney, Australia; Department of Neurology and Clinical Research Center of Neurological Disease (S.Y.), The Second Affiliated Hospital of Soochow University, Suzhou, PR China; Department of Neurological Science (Y.S.), Graduate School of Medicine, Nippon Medical School, Tokyo, Japan; Centre for Health Systems and Safety Research (Y.X.), Australian Institute of Health Innovation, Macquarie University, Sydney, Australia; Department of Cardiology (S.D., W.X., J.P.), Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University; Department of Cardiology (W.L., X.D.), Beijing Anzhen Hospital, Capital Medical University; Department of Cardiology (J.Y.), Peking University Third Hospital, Beijing; Department of Neurology (Y.W.), West China Hospital, Sichuan University, Chengdu, PR China; Department of Clinical Medicine (C.D.), Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, Australia; Department of Epidemiology and Biostatistics (M.J.R.), College of Human Medicine, Michigan State University, East Lansing; The George Institute for Global Health and University of Sydney (R.I.L.); South Western Clinical School (M.W.P.), University of New South Wales, Sydney, Australia; The George Institute for Global Health (M.W.), School of Public Health, Imperial College London, United Kingdom; Department of Neurology (C.A., C.C.), Royal Prince Alfred Hospital, Sydney Health Partners, Australia; Edinburgh Imaging and Centre for Clinical Brain Sciences (J.M.W.); and UK Dementia Research Institute (J.M.W.), University of Edinburgh, United Kingdom
| | - Yanan Wang
- From the The George Institute for Global Health (Z.Z., S.Y., Y.S., Y.X., J.Y., Y.W., K.H., C.D., M.W., C.A., C.C.), Faculty of Medicine, University of New South Wales, Sydney, Australia; Department of Neurology and Clinical Research Center of Neurological Disease (S.Y.), The Second Affiliated Hospital of Soochow University, Suzhou, PR China; Department of Neurological Science (Y.S.), Graduate School of Medicine, Nippon Medical School, Tokyo, Japan; Centre for Health Systems and Safety Research (Y.X.), Australian Institute of Health Innovation, Macquarie University, Sydney, Australia; Department of Cardiology (S.D., W.X., J.P.), Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University; Department of Cardiology (W.L., X.D.), Beijing Anzhen Hospital, Capital Medical University; Department of Cardiology (J.Y.), Peking University Third Hospital, Beijing; Department of Neurology (Y.W.), West China Hospital, Sichuan University, Chengdu, PR China; Department of Clinical Medicine (C.D.), Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, Australia; Department of Epidemiology and Biostatistics (M.J.R.), College of Human Medicine, Michigan State University, East Lansing; The George Institute for Global Health and University of Sydney (R.I.L.); South Western Clinical School (M.W.P.), University of New South Wales, Sydney, Australia; The George Institute for Global Health (M.W.), School of Public Health, Imperial College London, United Kingdom; Department of Neurology (C.A., C.C.), Royal Prince Alfred Hospital, Sydney Health Partners, Australia; Edinburgh Imaging and Centre for Clinical Brain Sciences (J.M.W.); and UK Dementia Research Institute (J.M.W.), University of Edinburgh, United Kingdom
| | - Katie Harris
- From the The George Institute for Global Health (Z.Z., S.Y., Y.S., Y.X., J.Y., Y.W., K.H., C.D., M.W., C.A., C.C.), Faculty of Medicine, University of New South Wales, Sydney, Australia; Department of Neurology and Clinical Research Center of Neurological Disease (S.Y.), The Second Affiliated Hospital of Soochow University, Suzhou, PR China; Department of Neurological Science (Y.S.), Graduate School of Medicine, Nippon Medical School, Tokyo, Japan; Centre for Health Systems and Safety Research (Y.X.), Australian Institute of Health Innovation, Macquarie University, Sydney, Australia; Department of Cardiology (S.D., W.X., J.P.), Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University; Department of Cardiology (W.L., X.D.), Beijing Anzhen Hospital, Capital Medical University; Department of Cardiology (J.Y.), Peking University Third Hospital, Beijing; Department of Neurology (Y.W.), West China Hospital, Sichuan University, Chengdu, PR China; Department of Clinical Medicine (C.D.), Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, Australia; Department of Epidemiology and Biostatistics (M.J.R.), College of Human Medicine, Michigan State University, East Lansing; The George Institute for Global Health and University of Sydney (R.I.L.); South Western Clinical School (M.W.P.), University of New South Wales, Sydney, Australia; The George Institute for Global Health (M.W.), School of Public Health, Imperial College London, United Kingdom; Department of Neurology (C.A., C.C.), Royal Prince Alfred Hospital, Sydney Health Partners, Australia; Edinburgh Imaging and Centre for Clinical Brain Sciences (J.M.W.); and UK Dementia Research Institute (J.M.W.), University of Edinburgh, United Kingdom
| | - Candice Delcourt
- From the The George Institute for Global Health (Z.Z., S.Y., Y.S., Y.X., J.Y., Y.W., K.H., C.D., M.W., C.A., C.C.), Faculty of Medicine, University of New South Wales, Sydney, Australia; Department of Neurology and Clinical Research Center of Neurological Disease (S.Y.), The Second Affiliated Hospital of Soochow University, Suzhou, PR China; Department of Neurological Science (Y.S.), Graduate School of Medicine, Nippon Medical School, Tokyo, Japan; Centre for Health Systems and Safety Research (Y.X.), Australian Institute of Health Innovation, Macquarie University, Sydney, Australia; Department of Cardiology (S.D., W.X., J.P.), Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University; Department of Cardiology (W.L., X.D.), Beijing Anzhen Hospital, Capital Medical University; Department of Cardiology (J.Y.), Peking University Third Hospital, Beijing; Department of Neurology (Y.W.), West China Hospital, Sichuan University, Chengdu, PR China; Department of Clinical Medicine (C.D.), Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, Australia; Department of Epidemiology and Biostatistics (M.J.R.), College of Human Medicine, Michigan State University, East Lansing; The George Institute for Global Health and University of Sydney (R.I.L.); South Western Clinical School (M.W.P.), University of New South Wales, Sydney, Australia; The George Institute for Global Health (M.W.), School of Public Health, Imperial College London, United Kingdom; Department of Neurology (C.A., C.C.), Royal Prince Alfred Hospital, Sydney Health Partners, Australia; Edinburgh Imaging and Centre for Clinical Brain Sciences (J.M.W.); and UK Dementia Research Institute (J.M.W.), University of Edinburgh, United Kingdom
| | - Mathew J Reeves
- From the The George Institute for Global Health (Z.Z., S.Y., Y.S., Y.X., J.Y., Y.W., K.H., C.D., M.W., C.A., C.C.), Faculty of Medicine, University of New South Wales, Sydney, Australia; Department of Neurology and Clinical Research Center of Neurological Disease (S.Y.), The Second Affiliated Hospital of Soochow University, Suzhou, PR China; Department of Neurological Science (Y.S.), Graduate School of Medicine, Nippon Medical School, Tokyo, Japan; Centre for Health Systems and Safety Research (Y.X.), Australian Institute of Health Innovation, Macquarie University, Sydney, Australia; Department of Cardiology (S.D., W.X., J.P.), Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University; Department of Cardiology (W.L., X.D.), Beijing Anzhen Hospital, Capital Medical University; Department of Cardiology (J.Y.), Peking University Third Hospital, Beijing; Department of Neurology (Y.W.), West China Hospital, Sichuan University, Chengdu, PR China; Department of Clinical Medicine (C.D.), Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, Australia; Department of Epidemiology and Biostatistics (M.J.R.), College of Human Medicine, Michigan State University, East Lansing; The George Institute for Global Health and University of Sydney (R.I.L.); South Western Clinical School (M.W.P.), University of New South Wales, Sydney, Australia; The George Institute for Global Health (M.W.), School of Public Health, Imperial College London, United Kingdom; Department of Neurology (C.A., C.C.), Royal Prince Alfred Hospital, Sydney Health Partners, Australia; Edinburgh Imaging and Centre for Clinical Brain Sciences (J.M.W.); and UK Dementia Research Institute (J.M.W.), University of Edinburgh, United Kingdom
| | - Richard I Lindley
- From the The George Institute for Global Health (Z.Z., S.Y., Y.S., Y.X., J.Y., Y.W., K.H., C.D., M.W., C.A., C.C.), Faculty of Medicine, University of New South Wales, Sydney, Australia; Department of Neurology and Clinical Research Center of Neurological Disease (S.Y.), The Second Affiliated Hospital of Soochow University, Suzhou, PR China; Department of Neurological Science (Y.S.), Graduate School of Medicine, Nippon Medical School, Tokyo, Japan; Centre for Health Systems and Safety Research (Y.X.), Australian Institute of Health Innovation, Macquarie University, Sydney, Australia; Department of Cardiology (S.D., W.X., J.P.), Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University; Department of Cardiology (W.L., X.D.), Beijing Anzhen Hospital, Capital Medical University; Department of Cardiology (J.Y.), Peking University Third Hospital, Beijing; Department of Neurology (Y.W.), West China Hospital, Sichuan University, Chengdu, PR China; Department of Clinical Medicine (C.D.), Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, Australia; Department of Epidemiology and Biostatistics (M.J.R.), College of Human Medicine, Michigan State University, East Lansing; The George Institute for Global Health and University of Sydney (R.I.L.); South Western Clinical School (M.W.P.), University of New South Wales, Sydney, Australia; The George Institute for Global Health (M.W.), School of Public Health, Imperial College London, United Kingdom; Department of Neurology (C.A., C.C.), Royal Prince Alfred Hospital, Sydney Health Partners, Australia; Edinburgh Imaging and Centre for Clinical Brain Sciences (J.M.W.); and UK Dementia Research Institute (J.M.W.), University of Edinburgh, United Kingdom
| | - Mark W Parsons
- From the The George Institute for Global Health (Z.Z., S.Y., Y.S., Y.X., J.Y., Y.W., K.H., C.D., M.W., C.A., C.C.), Faculty of Medicine, University of New South Wales, Sydney, Australia; Department of Neurology and Clinical Research Center of Neurological Disease (S.Y.), The Second Affiliated Hospital of Soochow University, Suzhou, PR China; Department of Neurological Science (Y.S.), Graduate School of Medicine, Nippon Medical School, Tokyo, Japan; Centre for Health Systems and Safety Research (Y.X.), Australian Institute of Health Innovation, Macquarie University, Sydney, Australia; Department of Cardiology (S.D., W.X., J.P.), Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University; Department of Cardiology (W.L., X.D.), Beijing Anzhen Hospital, Capital Medical University; Department of Cardiology (J.Y.), Peking University Third Hospital, Beijing; Department of Neurology (Y.W.), West China Hospital, Sichuan University, Chengdu, PR China; Department of Clinical Medicine (C.D.), Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, Australia; Department of Epidemiology and Biostatistics (M.J.R.), College of Human Medicine, Michigan State University, East Lansing; The George Institute for Global Health and University of Sydney (R.I.L.); South Western Clinical School (M.W.P.), University of New South Wales, Sydney, Australia; The George Institute for Global Health (M.W.), School of Public Health, Imperial College London, United Kingdom; Department of Neurology (C.A., C.C.), Royal Prince Alfred Hospital, Sydney Health Partners, Australia; Edinburgh Imaging and Centre for Clinical Brain Sciences (J.M.W.); and UK Dementia Research Institute (J.M.W.), University of Edinburgh, United Kingdom
| | - Mark Woodward
- From the The George Institute for Global Health (Z.Z., S.Y., Y.S., Y.X., J.Y., Y.W., K.H., C.D., M.W., C.A., C.C.), Faculty of Medicine, University of New South Wales, Sydney, Australia; Department of Neurology and Clinical Research Center of Neurological Disease (S.Y.), The Second Affiliated Hospital of Soochow University, Suzhou, PR China; Department of Neurological Science (Y.S.), Graduate School of Medicine, Nippon Medical School, Tokyo, Japan; Centre for Health Systems and Safety Research (Y.X.), Australian Institute of Health Innovation, Macquarie University, Sydney, Australia; Department of Cardiology (S.D., W.X., J.P.), Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University; Department of Cardiology (W.L., X.D.), Beijing Anzhen Hospital, Capital Medical University; Department of Cardiology (J.Y.), Peking University Third Hospital, Beijing; Department of Neurology (Y.W.), West China Hospital, Sichuan University, Chengdu, PR China; Department of Clinical Medicine (C.D.), Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, Australia; Department of Epidemiology and Biostatistics (M.J.R.), College of Human Medicine, Michigan State University, East Lansing; The George Institute for Global Health and University of Sydney (R.I.L.); South Western Clinical School (M.W.P.), University of New South Wales, Sydney, Australia; The George Institute for Global Health (M.W.), School of Public Health, Imperial College London, United Kingdom; Department of Neurology (C.A., C.C.), Royal Prince Alfred Hospital, Sydney Health Partners, Australia; Edinburgh Imaging and Centre for Clinical Brain Sciences (J.M.W.); and UK Dementia Research Institute (J.M.W.), University of Edinburgh, United Kingdom
| | - Craig Anderson
- From the The George Institute for Global Health (Z.Z., S.Y., Y.S., Y.X., J.Y., Y.W., K.H., C.D., M.W., C.A., C.C.), Faculty of Medicine, University of New South Wales, Sydney, Australia; Department of Neurology and Clinical Research Center of Neurological Disease (S.Y.), The Second Affiliated Hospital of Soochow University, Suzhou, PR China; Department of Neurological Science (Y.S.), Graduate School of Medicine, Nippon Medical School, Tokyo, Japan; Centre for Health Systems and Safety Research (Y.X.), Australian Institute of Health Innovation, Macquarie University, Sydney, Australia; Department of Cardiology (S.D., W.X., J.P.), Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University; Department of Cardiology (W.L., X.D.), Beijing Anzhen Hospital, Capital Medical University; Department of Cardiology (J.Y.), Peking University Third Hospital, Beijing; Department of Neurology (Y.W.), West China Hospital, Sichuan University, Chengdu, PR China; Department of Clinical Medicine (C.D.), Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, Australia; Department of Epidemiology and Biostatistics (M.J.R.), College of Human Medicine, Michigan State University, East Lansing; The George Institute for Global Health and University of Sydney (R.I.L.); South Western Clinical School (M.W.P.), University of New South Wales, Sydney, Australia; The George Institute for Global Health (M.W.), School of Public Health, Imperial College London, United Kingdom; Department of Neurology (C.A., C.C.), Royal Prince Alfred Hospital, Sydney Health Partners, Australia; Edinburgh Imaging and Centre for Clinical Brain Sciences (J.M.W.); and UK Dementia Research Institute (J.M.W.), University of Edinburgh, United Kingdom
| | - Xin Du
- From the The George Institute for Global Health (Z.Z., S.Y., Y.S., Y.X., J.Y., Y.W., K.H., C.D., M.W., C.A., C.C.), Faculty of Medicine, University of New South Wales, Sydney, Australia; Department of Neurology and Clinical Research Center of Neurological Disease (S.Y.), The Second Affiliated Hospital of Soochow University, Suzhou, PR China; Department of Neurological Science (Y.S.), Graduate School of Medicine, Nippon Medical School, Tokyo, Japan; Centre for Health Systems and Safety Research (Y.X.), Australian Institute of Health Innovation, Macquarie University, Sydney, Australia; Department of Cardiology (S.D., W.X., J.P.), Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University; Department of Cardiology (W.L., X.D.), Beijing Anzhen Hospital, Capital Medical University; Department of Cardiology (J.Y.), Peking University Third Hospital, Beijing; Department of Neurology (Y.W.), West China Hospital, Sichuan University, Chengdu, PR China; Department of Clinical Medicine (C.D.), Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, Australia; Department of Epidemiology and Biostatistics (M.J.R.), College of Human Medicine, Michigan State University, East Lansing; The George Institute for Global Health and University of Sydney (R.I.L.); South Western Clinical School (M.W.P.), University of New South Wales, Sydney, Australia; The George Institute for Global Health (M.W.), School of Public Health, Imperial College London, United Kingdom; Department of Neurology (C.A., C.C.), Royal Prince Alfred Hospital, Sydney Health Partners, Australia; Edinburgh Imaging and Centre for Clinical Brain Sciences (J.M.W.); and UK Dementia Research Institute (J.M.W.), University of Edinburgh, United Kingdom
| | - Jun Pu
- From the The George Institute for Global Health (Z.Z., S.Y., Y.S., Y.X., J.Y., Y.W., K.H., C.D., M.W., C.A., C.C.), Faculty of Medicine, University of New South Wales, Sydney, Australia; Department of Neurology and Clinical Research Center of Neurological Disease (S.Y.), The Second Affiliated Hospital of Soochow University, Suzhou, PR China; Department of Neurological Science (Y.S.), Graduate School of Medicine, Nippon Medical School, Tokyo, Japan; Centre for Health Systems and Safety Research (Y.X.), Australian Institute of Health Innovation, Macquarie University, Sydney, Australia; Department of Cardiology (S.D., W.X., J.P.), Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University; Department of Cardiology (W.L., X.D.), Beijing Anzhen Hospital, Capital Medical University; Department of Cardiology (J.Y.), Peking University Third Hospital, Beijing; Department of Neurology (Y.W.), West China Hospital, Sichuan University, Chengdu, PR China; Department of Clinical Medicine (C.D.), Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, Australia; Department of Epidemiology and Biostatistics (M.J.R.), College of Human Medicine, Michigan State University, East Lansing; The George Institute for Global Health and University of Sydney (R.I.L.); South Western Clinical School (M.W.P.), University of New South Wales, Sydney, Australia; The George Institute for Global Health (M.W.), School of Public Health, Imperial College London, United Kingdom; Department of Neurology (C.A., C.C.), Royal Prince Alfred Hospital, Sydney Health Partners, Australia; Edinburgh Imaging and Centre for Clinical Brain Sciences (J.M.W.); and UK Dementia Research Institute (J.M.W.), University of Edinburgh, United Kingdom
| | - Joanna M Wardlaw
- From the The George Institute for Global Health (Z.Z., S.Y., Y.S., Y.X., J.Y., Y.W., K.H., C.D., M.W., C.A., C.C.), Faculty of Medicine, University of New South Wales, Sydney, Australia; Department of Neurology and Clinical Research Center of Neurological Disease (S.Y.), The Second Affiliated Hospital of Soochow University, Suzhou, PR China; Department of Neurological Science (Y.S.), Graduate School of Medicine, Nippon Medical School, Tokyo, Japan; Centre for Health Systems and Safety Research (Y.X.), Australian Institute of Health Innovation, Macquarie University, Sydney, Australia; Department of Cardiology (S.D., W.X., J.P.), Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University; Department of Cardiology (W.L., X.D.), Beijing Anzhen Hospital, Capital Medical University; Department of Cardiology (J.Y.), Peking University Third Hospital, Beijing; Department of Neurology (Y.W.), West China Hospital, Sichuan University, Chengdu, PR China; Department of Clinical Medicine (C.D.), Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, Australia; Department of Epidemiology and Biostatistics (M.J.R.), College of Human Medicine, Michigan State University, East Lansing; The George Institute for Global Health and University of Sydney (R.I.L.); South Western Clinical School (M.W.P.), University of New South Wales, Sydney, Australia; The George Institute for Global Health (M.W.), School of Public Health, Imperial College London, United Kingdom; Department of Neurology (C.A., C.C.), Royal Prince Alfred Hospital, Sydney Health Partners, Australia; Edinburgh Imaging and Centre for Clinical Brain Sciences (J.M.W.); and UK Dementia Research Institute (J.M.W.), University of Edinburgh, United Kingdom
| | - Cheryl Carcel
- From the The George Institute for Global Health (Z.Z., S.Y., Y.S., Y.X., J.Y., Y.W., K.H., C.D., M.W., C.A., C.C.), Faculty of Medicine, University of New South Wales, Sydney, Australia; Department of Neurology and Clinical Research Center of Neurological Disease (S.Y.), The Second Affiliated Hospital of Soochow University, Suzhou, PR China; Department of Neurological Science (Y.S.), Graduate School of Medicine, Nippon Medical School, Tokyo, Japan; Centre for Health Systems and Safety Research (Y.X.), Australian Institute of Health Innovation, Macquarie University, Sydney, Australia; Department of Cardiology (S.D., W.X., J.P.), Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University; Department of Cardiology (W.L., X.D.), Beijing Anzhen Hospital, Capital Medical University; Department of Cardiology (J.Y.), Peking University Third Hospital, Beijing; Department of Neurology (Y.W.), West China Hospital, Sichuan University, Chengdu, PR China; Department of Clinical Medicine (C.D.), Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, Australia; Department of Epidemiology and Biostatistics (M.J.R.), College of Human Medicine, Michigan State University, East Lansing; The George Institute for Global Health and University of Sydney (R.I.L.); South Western Clinical School (M.W.P.), University of New South Wales, Sydney, Australia; The George Institute for Global Health (M.W.), School of Public Health, Imperial College London, United Kingdom; Department of Neurology (C.A., C.C.), Royal Prince Alfred Hospital, Sydney Health Partners, Australia; Edinburgh Imaging and Centre for Clinical Brain Sciences (J.M.W.); and UK Dementia Research Institute (J.M.W.), University of Edinburgh, United Kingdom
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Carbone G, Bencivenga L, Santoro MA, De Lucia N, Palaia ME, Ercolano E, Scognamiglio F, Edison P, Ferrara N, Vitale DF, Rengo G, Femminella GD. Impact of serum leptin and adiponectin levels on brain infarcts in patients with mild cognitive impairment and Alzheimer's disease: a longitudinal analysis. Front Endocrinol (Lausanne) 2024; 15:1389014. [PMID: 38686200 PMCID: PMC11056582 DOI: 10.3389/fendo.2024.1389014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Accepted: 03/27/2024] [Indexed: 05/02/2024] Open
Abstract
Introduction The adipokines leptin and adiponectin have been associated with atherosclerosis and the risk of cerebral infarcts. Pre-clinical studies, however, suggest a protective role against ischemic brain damage. In this study we analyzed the relationship between serum leptin and adiponectin levels and the onset or progression of brain infarcts in subjects with mild cognitive impairment (MCI) and Alzheimer's disease (AD). Methods All data were extracted from the ADNI database. The final population included 566 subjects, with 58 healthy controls, 396 MCI and 112 AD. All patients with available serum leptin and adiponectin levels at baseline were selected. Demographics, neuropsychological test results, CSF biomarkers, regional brain metabolism with FDG-PET data and the number of brain infarcts on longitudinal MRI scans were extracted. Results Leptin levels were significantly lower in patients with MCI than controls at baseline, while adiponectin levels were not different between the groups. Multivariate logistic regression analysis at baseline for the presence of brain infarcts showed a predictive value for leptin but not for adiponectin. Multivariate longitudinal analysis showed that age was the only significant predictor of brain infarcts development at 15-year follow-up, while serum leptin and adiponectin levels did not play a role in this population. Discussion The evidence on the pathogenetic or protective role of adipokines on ischemic brain damage is mixed. In this MCI and AD population, serum leptin and adiponectin were not associated with the development of brain infarcts; therefore, these results do not support the use of adipokines as biomarkers of cerebrovascular pathology in this population.
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Affiliation(s)
- Giovanni Carbone
- Department of Translational Medical Sciences, “Federico II” University, Naples, Italy
| | - Leonardo Bencivenga
- Department of Translational Medical Sciences, “Federico II” University, Naples, Italy
| | - Maria Angela Santoro
- Department of Translational Medical Sciences, “Federico II” University, Naples, Italy
| | - Natascia De Lucia
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, “Federico II” University, Naples, Italy
| | - Maria Emiliana Palaia
- Department of Translational Medical Sciences, “Federico II” University, Naples, Italy
| | - Erica Ercolano
- Department of Translational Medical Sciences, “Federico II” University, Naples, Italy
| | | | - Paul Edison
- Department of Brain Sciences, Imperial College London, London, United Kingdom
| | - Nicola Ferrara
- Department of Translational Medical Sciences, “Federico II” University, Naples, Italy
| | | | - Giuseppe Rengo
- Department of Translational Medical Sciences, “Federico II” University, Naples, Italy
- Laboratorio di fisiopatologia del sistema neurovegetativo, Istituti Clinici Scientifici Maugeri Istituti di Ricovero e Cura a Carattere Scientifico (IRCCS) - Scientific Institute of Telese Terme, Telese Terme, BN, Italy
| | - Grazia Daniela Femminella
- Department of Translational Medical Sciences, “Federico II” University, Naples, Italy
- Department of Brain Sciences, Imperial College London, London, United Kingdom
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Caccia A, Ruzzenenti G, Bellantonio V, Falco R, Kotinas AS, Preda A, Mazzone P. Challenging Silent Cerebral Embolism during Left Atrial Appendage Occlusion: A Lesson from Recent Studies. Cardiology 2024:1-2. [PMID: 38588645 DOI: 10.1159/000538337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Accepted: 03/08/2024] [Indexed: 04/10/2024]
Affiliation(s)
- Andrea Caccia
- Electrophysiology Unit, De Gasperis Cardio Center, Niguarda Hospital, Milan, Italy
| | - Giacomo Ruzzenenti
- Electrophysiology Unit, De Gasperis Cardio Center, Niguarda Hospital, Milan, Italy
| | | | - Raffaele Falco
- Electrophysiology Unit, De Gasperis Cardio Center, Niguarda Hospital, Milan, Italy
| | | | - Alberto Preda
- Electrophysiology Unit, De Gasperis Cardio Center, Niguarda Hospital, Milan, Italy
| | - Patrizio Mazzone
- Electrophysiology Unit, De Gasperis Cardio Center, Niguarda Hospital, Milan, Italy,
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Pathan N, Kharod MK, Nawab S, Di Scipio M, Paré G, Chong M. Genetic Determinants of Vascular Dementia. Can J Cardiol 2024:S0828-282X(24)00293-9. [PMID: 38579965 DOI: 10.1016/j.cjca.2024.03.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Revised: 03/20/2024] [Accepted: 03/29/2024] [Indexed: 04/07/2024] Open
Abstract
Vascular dementia (VaD) is a prevalent form of cognitive impairment with underlying vascular etiology. In this review, we examine recent genetic advancements in our understanding of VaD, encompassing a range of methodologies including genome-wide association studies, polygenic risk scores, heritability estimates, and family studies for monogenic disorders revealing the complex and heterogeneous nature of the disease. We report well known genetic associations and highlight potential pathways and mechanisms implicated in VaD and its pathological risk factors, including stroke, cerebral small vessel disease, and cerebral amyloid angiopathy. Moreover, we discuss important modifiable risk factors such as hypertension, diabetes, and dyslipidemia, emphasizing the importance of a multifactorial approach in prevention, treatment, and understanding the genetic basis of VaD. Last, we outline several areas of scientific advancements to improve clinical care, highlighting that large-scale collaborative efforts, together with an integromics approach can enhance the robustness of genetic discoveries. Indeed, understanding the genetics of VaD and its pathophysiological risk factors hold the potential to redefine VaD on the basis of molecular mechanisms and to generate novel diagnostic, prognostic, and therapeutic tools.
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Affiliation(s)
- Nazia Pathan
- Population Health Research Institute, David Braley Cardiac, Vascular and Stroke Research Institute, Hamilton Health Sciences and McMaster University, Hamilton, Ontario, Canada; Department of Pathology and Molecular Medicine, McMaster University, Michael G. DeGroote School of Medicine, Hamilton, Ontario, Canada
| | - Muskaan Kaur Kharod
- Population Health Research Institute, David Braley Cardiac, Vascular and Stroke Research Institute, Hamilton Health Sciences and McMaster University, Hamilton, Ontario, Canada
| | - Sajjha Nawab
- Population Health Research Institute, David Braley Cardiac, Vascular and Stroke Research Institute, Hamilton Health Sciences and McMaster University, Hamilton, Ontario, Canada
| | - Matteo Di Scipio
- Population Health Research Institute, David Braley Cardiac, Vascular and Stroke Research Institute, Hamilton Health Sciences and McMaster University, Hamilton, Ontario, Canada; Department of Medicine, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Guillaume Paré
- Population Health Research Institute, David Braley Cardiac, Vascular and Stroke Research Institute, Hamilton Health Sciences and McMaster University, Hamilton, Ontario, Canada; Department of Pathology and Molecular Medicine, McMaster University, Michael G. DeGroote School of Medicine, Hamilton, Ontario, Canada; Department of Medicine, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada; Thrombosis and Atherosclerosis Research Institute, David Braley Cardiac, Vascular and Stroke Research Institute, Hamilton, Ontario, Canada; Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada.
| | - Michael Chong
- Population Health Research Institute, David Braley Cardiac, Vascular and Stroke Research Institute, Hamilton Health Sciences and McMaster University, Hamilton, Ontario, Canada; Department of Pathology and Molecular Medicine, McMaster University, Michael G. DeGroote School of Medicine, Hamilton, Ontario, Canada; Thrombosis and Atherosclerosis Research Institute, David Braley Cardiac, Vascular and Stroke Research Institute, Hamilton, Ontario, Canada.
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Zhu Y, Shi K, Xie J, Hu J, Zhu Y, Jiang J, Du R, Xu Y. Progression of enlarged perivascular spaces contributes to occurrence of silent lacunar infarction in the elderly. Neurol Sci 2024; 45:1529-1535. [PMID: 37940747 DOI: 10.1007/s10072-023-07185-x] [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: 09/11/2023] [Accepted: 11/02/2023] [Indexed: 11/10/2023]
Abstract
INTRODUCTION This study aims to assess the effect of enlarged perivascular spaces (EPVS) in patients using the methods of scale score and 3D volume quantification and to determine whether EPVS progression is related to the occurrence of silent lacunar infarction (SLI). METHOD Three hundred sixty-seven elderly patients with EPVS were screened by MRI on the day of admission and 2 years later; 295 patients were included in the final study, among which 136 patients had EPVS with SLI (EL); and 159 patients had EPVS without SLI (EOL). Both scale score and 3D volume quantification method were used to evaluate EPVS. The 295 patients were divided into three groups based on EPVS progression state: Group 1 (no progression), Group 2 (0-50% EPVS progression), and Group 3 (≥ 50% EPVS progression). Multiple logistic regression analysis was used to analyze the risk of occurrence of SLI. RESULTS The EPVS scores and ΔEPVS scores were not significantly different between the EL and EOL groups (p > 0.05). EPVS volumes and their progression were significantly higher in EL compared with EOL (p < 0.001). The incidence of SLI was increased in Groups 2 and 3 compared with those in Group 1, and the trend test showed statistically significant (p = 0.032). Multiple logistic regression analysis showed that the risk of occurrence of SLI was significantly increased in Group 2 (OR 2.24; p = 0.024) and Group 3 (OR 3.31; p = 0.037) versus that in Group 1. CONCLUSION 3D volume quantification allows for a more sensitive assessment of EPVS changes, and the progression of EPVS volume may contribute to the occurrence of SLI.
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Affiliation(s)
- Yuanyuan Zhu
- Department of Geriatrics, The Affiliated Yixing Hospital of Jiangsu University, Yixing, 214221, Jiangsu, China
| | - Keyun Shi
- Department of Geriatrics, The Affiliated Yixing Hospital of Jiangsu University, Yixing, 214221, Jiangsu, China
| | - Jing Xie
- Department of Geriatrics, The Affiliated Yixing Hospital of Jiangsu University, Yixing, 214221, Jiangsu, China
| | - Jie Hu
- Department of Geriatrics, The Affiliated Yixing Hospital of Jiangsu University, Yixing, 214221, Jiangsu, China
| | - Yan Zhu
- Department of Radiology, The Affiliated Hospital of Jiangsu University, Zhenjiang, 212001, Jiangsu, China
| | - Jianzhong Jiang
- Department of Geriatrics, The Affiliated Yixing Hospital of Jiangsu University, Yixing, 214221, Jiangsu, China.
| | - Rui Du
- Department of Radiology, The Affiliated Hospital of Jiangsu University, Zhenjiang, 212001, Jiangsu, China.
| | - Yuhao Xu
- Department of Neurology, The Affiliated Hospital of Jiangsu University, Zhenjiang, 212001, Jiangsu, China.
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Najmi I, Benmaamar S, Zejli S, Bouchal S, El Fakir S, El Rhazi K, Belahsen MF. Silent brain infarctions in patients with acute cardioembolic stroke. JOURNAL DE MEDECINE VASCULAIRE 2024; 49:80-89. [PMID: 38697714 DOI: 10.1016/j.jdmv.2024.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 02/10/2024] [Indexed: 05/05/2024]
Abstract
INTRODUCTION AND AIM The advances and the wide use of brain imaging have considerably increased the prevalence of silent brain infarctions (SBI). We aim in this study to determine the prevalence of SBI in patients presenting with acute cardioembolic stroke and the predictive cardiovascular risk factors. METHODS This retrospective study included 267 patients presenting with acute cardioembolic stroke in the emergency and/or neurology departments of the Hassan II University Hospital Center. Clinical, biological and echocardiographic characteristics were recorded. All patients were screened for SBI by brain imaging. RESULTS The prevalence of SBI in our series was 46%. A group of 203 non-valvular patients and a group of 64 valvular patients were distinguished. In non-valvular group, the average age was 72.97±10.53years. The prevalence of SBI was 45.3%. Forty-four percent of patients with SBI had atrial fibrillation (AF). In multivariate regression analysis, the history of previous stroke, CHA2DS2-VASc Score≥4, enlarged left atrium (LA), the association of AF with enlarged LA and the lability of International Normalized Ratio in patients initially treated with anticoagulants were significantly associated with the occurrence of SBI (P=0.013, P=0.032, P=0.0001, P=0.01, P=0.03, respectively). Territorial location was significantly the most frequent (P=0.007). In valvular group, the average age was 57.19±14.38years. The prevalence of SBI was 48.4%. In multivariate regression analysis, SBI were significantly associated with moderate or severe mitral stenosis (P=0.02) and with the enlarged LA (P=0.02). In all patients, Modified Rankin Scale at 3 months of discharge from the acute stroke was significantly higher (mRS≥3) in patients with SBI (P=0.04). CONCLUSIONS SBI requires good management of associated cardiovascular risk factors in a population presenting with initial cardioembolic stroke.
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Affiliation(s)
- Imane Najmi
- Department of Neurology, Hassan II University Hospital Center, Fez, Morocco; Laboratory of Epidemiology, Clinical Research, and Health Community, Faculty of Medicine and Pharmacy, Sidi Mohammed Ben Abdallah University, Fez, Morocco.
| | - Soumaya Benmaamar
- Laboratory of Epidemiology, Clinical Research, and Health Community, Faculty of Medicine and Pharmacy, Sidi Mohammed Ben Abdallah University, Fez, Morocco
| | - Sara Zejli
- Department of Neurology, Hassan II University Hospital Center, Fez, Morocco
| | - Siham Bouchal
- Department of Neurology, Hassan II University Hospital Center, Fez, Morocco; Laboratory of Epidemiology, Clinical Research, and Health Community, Faculty of Medicine and Pharmacy, Sidi Mohammed Ben Abdallah University, Fez, Morocco
| | - Samira El Fakir
- Laboratory of Epidemiology, Clinical Research, and Health Community, Faculty of Medicine and Pharmacy, Sidi Mohammed Ben Abdallah University, Fez, Morocco
| | - Karima El Rhazi
- Laboratory of Epidemiology, Clinical Research, and Health Community, Faculty of Medicine and Pharmacy, Sidi Mohammed Ben Abdallah University, Fez, Morocco
| | - Mohammed Faouzi Belahsen
- Department of Neurology, Hassan II University Hospital Center, Fez, Morocco; Laboratory of Epidemiology, Clinical Research, and Health Community, Faculty of Medicine and Pharmacy, Sidi Mohammed Ben Abdallah University, Fez, Morocco
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Tanaka K, Miwa K, Koga M, Yoshimura S, Kamiyama K, Yagita Y, Nagakane Y, Hoshino H, Terasaki T, Okada Y, Yakushiji Y, Takahashi S, Ueda T, Hasegawa Y, Shiozawa M, Sasaki M, Kudo K, Tanaka J, Nishihara M, Yamaguchi Y, Fujita K, Honda Y, Kawano H, Ide T, Yoshimoto T, Ihara M, Hirano T, Toyoda K. Cerebral Small Vessel Disease Burden for Bleeding Risk during Antithrombotic Therapy: Bleeding with Antithrombotic Therapy 2 Study. Ann Neurol 2024; 95:774-787. [PMID: 38146238 DOI: 10.1002/ana.26868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Revised: 12/20/2023] [Accepted: 12/22/2023] [Indexed: 12/27/2023]
Abstract
OBJECTIVE This study was undertaken to determine the excess risk of antithrombotic-related bleeding due to cerebral small vessel disease (SVD) burden. METHODS In this observational, prospective cohort study, patients with cerebrovascular or cardiovascular diseases taking oral antithrombotic agents were enrolled from 52 hospitals across Japan between 2016 and 2019. Baseline multimodal magnetic resonance imaging acquired under prespecified conditions was assessed by a central diagnostic radiology committee to calculate total SVD score. The primary outcome was major bleeding. Secondary outcomes included bleeding at each site and ischemic events. RESULTS Of the analyzed 5,250 patients (1,736 women; median age = 73 years, 9,933 patient-years of follow-up), antiplatelets and anticoagulants were administered at baseline in 3,948 and 1,565, respectively. Median SVD score was 2 (interquartile range = 1-3). Incidence rate of major bleeding was 0.39 (per 100 patinet-years) in score 0, 0.56 in score 1, 0.91 in score 2, 1.35 in score 3, and 2.24 in score 4 (adjusted hazard ratio [aHR] for score 4 vs 0 = 5.47, 95% confidence interval [CI] = 2.26-13.23), that of intracranial hemorrhage was 0.11, 0.33, 0.58, 0.99, and 1.06, respectively (aHR = 9.29, 95% CI = 1.99-43.35), and that of ischemic event was 1.82, 2.27, 3.04, 3.91, and 4.07, respectively (aHR = 1.76, 95% CI = 1.08-2.86). In addition, extracranial major bleeding (aHR = 3.43, 95% CI = 1.13-10.38) and gastrointestinal bleeding (aHR = 2.54, 95% CI = 1.02-6.35) significantly increased in SVD score 4 compared to score 0. INTERPRETATION Total SVD score was predictive for intracranial hemorrhage and probably for extracranial bleeding, suggesting the broader clinical relevance of cerebral SVD as a marker for safe implementation of antithrombotic therapy. ANN NEUROL 2024;95:774-787.
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Affiliation(s)
- Kanta Tanaka
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Kaori Miwa
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Masatoshi Koga
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Sohei Yoshimura
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Kenji Kamiyama
- Department of Neurosurgery, Nakamura Memorial Hospital, Sapporo, Japan
| | - Yoshiki Yagita
- Department of Stroke Medicine, Kawasaki Medical School, Kurashiki, Japan
| | | | - Haruhiko Hoshino
- Department of Neurology, Tokyo Saiseikai Central Hospital, Tokyo, Japan
| | - Tadashi Terasaki
- Department of Neurology, Kumamoto Red Cross Hospital, Kumamoto, Japan
| | - Yasushi Okada
- Department of Cerebrovascular Medicine and Neurology, National Hospital Organization Kyushu Medical Center, Fukuoka, Japan
| | - Yusuke Yakushiji
- Department of Neurology, Kansai Medical University, Hirakata, Japan
- Division of Neurology, Department of Internal Medicine, Saga University Faculty of Medicine, Saga, Japan
| | - Shinichi Takahashi
- Department of Neurology, Keio University School of Medicine, Tokyo, Japan
| | - Toshihiro Ueda
- Department of Strokology, Stroke Center, St Marianna University Toyoko Hospital, Kawasaki, Japan
| | - Yasuhiro Hasegawa
- Division of Neurology, Department of Internal Medicine, St Marianna University School of Medicine, Kawasaki, Japan
| | - Masayuki Shiozawa
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Makoto Sasaki
- Institute for Biomedical Sciences, Iwate Medical University, Yahaba, Japan
| | - Kohsuke Kudo
- Department of Diagnostic Imaging, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Jun Tanaka
- Division of Neurology, Department of Internal Medicine, Saga University Faculty of Medicine, Saga, Japan
| | - Masashi Nishihara
- Department of Radiology, Saga University Faculty of Medicine, Saga, Japan
| | - Yoshitaka Yamaguchi
- Department of Neurology, Yamagata Prefectural Central Hospital, Yamagata, Japan
| | - Kyohei Fujita
- Department of Neurology and Neurological Science, Tokyo Medical and Dental University, Tokyo, Japan
| | - Yuko Honda
- Department of Stroke and Cerebrovascular Medicine, Kyorin University, Mitaka, Japan
| | - Hiroyuki Kawano
- Department of Stroke and Cerebrovascular Medicine, Kyorin University, Mitaka, Japan
| | - Toshihiro Ide
- Division of Neurology, Department of Internal Medicine, Saga University Faculty of Medicine, Saga, Japan
| | - Takeshi Yoshimoto
- Department of Neurology, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Masafumi Ihara
- Department of Neurology, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Teruyuki Hirano
- Department of Stroke and Cerebrovascular Medicine, Kyorin University, Mitaka, Japan
| | - Kazunori Toyoda
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
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Mehta VC, Chandrasekhar SA, Quimby DL, Bhandari A, Mazo V, Glaser AD, Rose DZ, Mohanty BD. Cerebral Protection in Trans-Catheter Aortic Valve Replacement: Review and Contemporary Assessment of Randomized Trial Data. Neurohospitalist 2024; 14:157-165. [PMID: 38666284 PMCID: PMC11040624 DOI: 10.1177/19418744231225680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/28/2024] Open
Abstract
As the population has aged and as aortic valve therapies have evolved, the use of trans-catheter aortic valve replacement (TAVR) has grown dramatically over the past decade. A well-known complication of percutaneous cardiac intervention is embolic phenomena, and TAVR is among the highest risk procedures for clinical and subclinical stroke. As indications for TAVR expand to lower-risk and ultimately younger patients, the long-term consequences of stroke are amplified. Cerebral embolic protection (CEP) devices have taken a on unique preventative role following the Food and Drug Administration approval of the SentinelTM Cerebral Protection System (CPS). More recently, the PROTECTED TAVR study has spurred extensive debate in the neuro-cardiac community. In this review we describe the contemporary literature regarding stroke risk associated with TAVR, the history and role of CEP devices, a PROTECTED TAVR sub-group analysis, and implications for next steps in the field. Lastly, we explore the unique need for CEP in a younger TAVR population, as well as directions for future research.
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Affiliation(s)
- Vivek C. Mehta
- Division of Cardiology, Department of Medicine, University of South Florida, Morsani College of Medicine, Tampa, FL, USA
| | - Sanjay A. Chandrasekhar
- Division of Cardiology, Department of Medicine, University of South Florida, Morsani College of Medicine, Tampa, FL, USA
| | - Donald L. Quimby
- Division of Cardiology, Department of Medicine, University of South Florida, Morsani College of Medicine, Tampa, FL, USA
| | - Ajay Bhandari
- Division of Cardiology, Department of Medicine, University of South Florida, Morsani College of Medicine, Tampa, FL, USA
| | - Victoria Mazo
- Division of Vascular Neurology, Department of Neurology, University of South Florida, Morsani College of Medicine, Tampa, FL, USA
| | - Alexander D. Glaser
- Section of Cardiology, Department of Internal Medicine, Louisiana State University, New Orleans, LA, USA
| | - David Z. Rose
- Division of Vascular Neurology, Department of Neurology, University of South Florida, Morsani College of Medicine, Tampa, FL, USA
| | - Bibhu D. Mohanty
- Division of Cardiology, Department of Medicine, University of South Florida, Morsani College of Medicine, Tampa, FL, USA
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Rodriguez L, Araujo AT, D Vera D, Rodríguez Gelvez A, Camacho PA, Mantilla DE, Mantilla JC. Prevalence and imaging characteristics of cerebral small vessel disease in a Colombian population aged 40 years and older. Brain Commun 2024; 6:fcae057. [PMID: 38495303 PMCID: PMC10943569 DOI: 10.1093/braincomms/fcae057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 12/09/2023] [Accepted: 03/12/2024] [Indexed: 03/19/2024] Open
Abstract
Cerebral small vessel disease is a major contributor to both brain aging and cognitive decline. This study aimed to determine the prevalence of cerebral small vessel disease in a Colombian population over 40 years of age who attended a Radiology and Diagnostic Imaging service for brain MRI between October 2018 and March 2019. This was an observational, cross-sectional and analytical study of 710 adult patients over 40 years of age who attended the Radiology and Diagnostic Imaging service for a brain MRI. The analysed data were obtained from an anonymized database of the service. We studied 710 MRI scans of patients aged between 40 and 104 years. The most frequent risk factor was hypertension (36.2%). Brain abnormalities associated with cerebral small vessel disease, such as white matter hyperintensities, were seen in 56.20% of the population, and brain atrophy was observed in 12.96%. Brain disease prevalence increased with age (23.18% for those aged 55 years, 54.49% for those aged 55-64 years, 69.8% for those aged 65-74 years and 90.53% for those older than 75 years). The prevalence of cerebral small vessel disease in our population was similar to that reported in the world literature, as were the prevalence of the evaluated cardiovascular risk factors. Additionally, we identified an association between hypertension and advanced age with cerebral small vessel disease, with white matter hyperintensities being the most characteristic finding.
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Affiliation(s)
- Laura Rodriguez
- Radiology Department, Fundación Oftalmológica de Santander—Clínica Ardila Lülle, Floridablanca 681008, Colombia
| | - Ana T Araujo
- Radiology Department, Fundación Oftalmológica de Santander—Clínica Ardila Lülle, Floridablanca 681008, Colombia
| | - Daniela D Vera
- Radiology Department, Fundación Oftalmológica de Santander—Clínica Ardila Lülle, Floridablanca 681008, Colombia
| | - Adriana Rodríguez Gelvez
- Radiology Department, Fundación Oftalmológica de Santander—Clínica Ardila Lülle, Floridablanca 681008, Colombia
| | - Paul A Camacho
- Research Group Fundación Oftalmológica de Santander—Clínica Ardila Lülle, Floridablanca 681008, Colombia
| | - Daniel E Mantilla
- Radiology Department, Fundación Oftalmológica de Santander—Clínica Ardila Lülle, Floridablanca 681008, Colombia
- Interventional Radiology Department, Fundación Oftalmológica de Santander—Clínica Ardila Lülle, Floridablanca 681008, Colombia
| | - Juan C Mantilla
- Radiology Department, Fundación Oftalmológica de Santander—Clínica Ardila Lülle, Floridablanca 681008, Colombia
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Huang C, Zhang W, Shen Z, Li M, Yin J, Tang Y, Zhou X, Zhu X, Sun Z. The association between alpha diversity of gut microbiota, neuroimaging markers and cognitive function in cerebral small vessel disease. Brain Res 2024; 1827:148757. [PMID: 38215865 DOI: 10.1016/j.brainres.2024.148757] [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: 10/04/2023] [Revised: 11/11/2023] [Accepted: 01/05/2024] [Indexed: 01/14/2024]
Abstract
There is increasing recognition of gut microbial dysbiosis in cerebral small vessel disease (CSVD). The altered diversity in a single ecosystem - alpha diversity index of gut microbiota has attracted wide attention. Our study aims to determine whether the alpha diversity index differs among healthy control (HC), CSVD with and without cognitive impairment. Moreover, we investigate the correlation between the alpha diversity index, neuroimaging markers, and cognitive function. We recruited 40 HC, 43 CSVD patients without cognitive impairment (CSVD-NCI), and 35 CSVD patients with mild cognitive impairment (CSVD-MCI). Clinical and neuropsychological assessments, MRI scanning, and gut microbiota analysis were performed on all participants. The alpha diversity indexes Chao1 and Shannon were calculated to evaluate community richness and diversity in a sample, respectively. Individual neuroimaging markers of CSVD and the CSVD burden score were also evaluated. A significantly lower level of Chao 1 rather than the Shannon index was observed in the CSVD subgroups than in the HC group. The level of the Chao 1 index was negatively correlated with both CMB counts, a neuroimaging characteristic of CSVD, and CSVD burden score in patients with CSVD. Additionally, the Chao 1 index has been associated with general cognitive function, information processing speed, and language function in patients with CSVD. Remarkably, the increased CSVD burden score mediated the effects of decreased levels of Chao 1 on information processing speed and language function. Hence, the alterations in species richness may be associated with CSVD-related cognitive impairment and mediated by CSVD neuroimaging markers.
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Affiliation(s)
- Chaojuan Huang
- Department of Neurology, The First Affiliated Hospital of Anhui Medical University, Hefei 230022, China
| | - Wei Zhang
- Department of Rehabilitation Medicine, The First Affiliated Hospital of Anhui Medical University, Hefei 230022, China
| | - Zhu Shen
- Department of Radiology, North District of the First Affiliated Hospital of Anhui Medical University, Hefei 230011, China; Center of Medical Imaging, Anhui Public Health Clinical Center, Hefei 230011, China
| | - Mingxu Li
- Department of Neurology, The First Affiliated Hospital of Anhui Medical University, Hefei 230022, China
| | - Jiabin Yin
- Department of Neurology, The First Affiliated Hospital of Anhui Medical University, Hefei 230022, China
| | - Yating Tang
- Department of Neurology, The First Affiliated Hospital of Anhui Medical University, Hefei 230022, China
| | - Xia Zhou
- Department of Neurology, The First Affiliated Hospital of Anhui Medical University, Hefei 230022, China
| | - Xiaoqun Zhu
- Department of Neurology, The First Affiliated Hospital of Anhui Medical University, Hefei 230022, China
| | - Zhongwu Sun
- Department of Neurology, The First Affiliated Hospital of Anhui Medical University, Hefei 230022, China.
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15
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Fang J, Wu J, Hong G, Zheng L, Yu L, Liu X, Lin P, Yu Z, Chen D, Lin Q, Jing C, Zhang Q, Wang C, Zhao J, Yuan X, Wu C, Zhang Z, Guo M, Zhang J, Zheng J, Lei A, Zhang T, Lan Q, Kong L, Wang X, Wang Z, Ma Q. Cancer screening in hospitalized ischemic stroke patients: a multicenter study focused on multiparametric analysis to improve management of occult cancers. EPMA J 2024; 15:53-66. [PMID: 38463627 PMCID: PMC10923752 DOI: 10.1007/s13167-024-00354-8] [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: 10/19/2023] [Accepted: 02/02/2024] [Indexed: 03/12/2024]
Abstract
Background/aims The reciprocal promotion of cancer and stroke occurs due to changes in shared risk factors, such as metabolic pathways and molecular targets, creating a "vicious cycle." Cancer plays a direct or indirect role in the pathogenesis of ischemic stroke (IS), along with the reactive medical approach used in the treatment and clinical management of IS patients, resulting in clinical challenges associated with occult cancer in these patients. The lack of reliable and simple tools hinders the effectiveness of the predictive, preventive, and personalized medicine (PPPM/3PM) approach. Therefore, we conducted a multicenter study that focused on multiparametric analysis to facilitate early diagnosis of occult cancer and personalized treatment for stroke associated with cancer. Methods Admission routine clinical examination indicators of IS patients were retrospectively collated from the electronic medical records. The training dataset comprised 136 IS patients with concurrent cancer, matched at a 1:1 ratio with a control group. The risk of occult cancer in IS patients was assessed through logistic regression and five alternative machine-learning models. Subsequently, select the model with the highest predictive efficacy to create a nomogram, which is a quantitative tool for predicting diagnosis in clinical practice. Internal validation employed a ten-fold cross-validation, while external validation involved 239 IS patients from six centers. Validation encompassed receiver operating characteristic (ROC) curves, calibration curves, decision curve analysis (DCA), and comparison with models from prior research. Results The ultimate prediction model was based on logistic regression and incorporated the following variables: regions of ischemic lesions, multiple vascular territories, hypertension, D-dimer, fibrinogen (FIB), and hemoglobin (Hb). The area under the ROC curve (AUC) for the nomogram was 0.871 in the training dataset and 0.834 in the external test dataset. Both calibration curves and DCA underscored the nomogram's strong performance. Conclusions The nomogram enables early occult cancer diagnosis in hospitalized IS patients and helps to accurately identify the cause of IS, while the promotion of IS stratification makes personalized treatment feasible. The online nomogram based on routine clinical examination indicators of IS patients offered a cost-effective platform for secondary care in the framework of PPPM. Supplementary Information The online version contains supplementary material available at 10.1007/s13167-024-00354-8.
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Affiliation(s)
- Jie Fang
- Department of Neurology and Department of Neuroscience, School of Medicine, The First Affiliated Hospital of Xiamen University, Xiamen University, 55 Zhenhai Road, Xiamen, 361003 China
- Fujian Key Laboratory of Brain Tumors Diagnosis and Precision Treatment, Xiamen, China
- Xiamen Key Laboratory of Brain Center, Xiamen, China
- Xiamen Medical Quality Control Center for Neurology, Xiamen, China
- Fujian Provincial Clinical Research Center for Brain Diseases, Xiamen, China
- Xiamen Clinical Research Center for Neurological Diseases, Xiamen, China
- School of Medicine, Xiamen University, Xiamen, China
| | - Jielong Wu
- Department of Neurology and Department of Neuroscience, School of Medicine, The First Affiliated Hospital of Xiamen University, Xiamen University, 55 Zhenhai Road, Xiamen, 361003 China
- School of Medicine, Xiamen University, Xiamen, China
- National Institute for Data Science in Health and Medicine, Xiamen University, Xiamen, China
| | - Ganji Hong
- Cerebrovascular Interventional Department, Zhangzhou Hospital of Fujian Province, Zhangzhou, China
| | - Liangcheng Zheng
- Department of Neurology and Department of Neuroscience, School of Medicine, The First Affiliated Hospital of Xiamen University, Xiamen University, 55 Zhenhai Road, Xiamen, 361003 China
- Fujian Key Laboratory of Brain Tumors Diagnosis and Precision Treatment, Xiamen, China
- Xiamen Key Laboratory of Brain Center, Xiamen, China
- Xiamen Medical Quality Control Center for Neurology, Xiamen, China
- Fujian Provincial Clinical Research Center for Brain Diseases, Xiamen, China
- Xiamen Clinical Research Center for Neurological Diseases, Xiamen, China
| | - Lu Yu
- Department of Neurology, Changxing People’s Hospital, Huzhou, China
| | - Xiuping Liu
- Department of Neurology, The Jilin Center Hospital, Jilin, China
| | - Pan Lin
- Department of Neurology, The Second Hospital of Longyan City, Longyan, China
| | - Zhenzhen Yu
- Department of Neurology, The Second Affiliated Hospital of Xiamen Medical College, Xiamen, China
| | - Dan Chen
- Department of Neurology, Xiamen Haicang Hospital, Xiamen, China
| | - Qing Lin
- Department of Neurology and Department of Neuroscience, School of Medicine, The First Affiliated Hospital of Xiamen University, Xiamen University, 55 Zhenhai Road, Xiamen, 361003 China
- Fujian Key Laboratory of Brain Tumors Diagnosis and Precision Treatment, Xiamen, China
- Xiamen Key Laboratory of Brain Center, Xiamen, China
- Xiamen Medical Quality Control Center for Neurology, Xiamen, China
- Fujian Provincial Clinical Research Center for Brain Diseases, Xiamen, China
- Xiamen Clinical Research Center for Neurological Diseases, Xiamen, China
| | - Chuya Jing
- Department of Neurology and Department of Neuroscience, School of Medicine, The First Affiliated Hospital of Xiamen University, Xiamen University, 55 Zhenhai Road, Xiamen, 361003 China
- Fujian Key Laboratory of Brain Tumors Diagnosis and Precision Treatment, Xiamen, China
- Xiamen Key Laboratory of Brain Center, Xiamen, China
- Xiamen Medical Quality Control Center for Neurology, Xiamen, China
- Fujian Provincial Clinical Research Center for Brain Diseases, Xiamen, China
- Xiamen Clinical Research Center for Neurological Diseases, Xiamen, China
| | - Qiuhong Zhang
- Department of Neurology and Department of Neuroscience, School of Medicine, The First Affiliated Hospital of Xiamen University, Xiamen University, 55 Zhenhai Road, Xiamen, 361003 China
- Fujian Key Laboratory of Brain Tumors Diagnosis and Precision Treatment, Xiamen, China
- Xiamen Key Laboratory of Brain Center, Xiamen, China
- Xiamen Medical Quality Control Center for Neurology, Xiamen, China
- Fujian Provincial Clinical Research Center for Brain Diseases, Xiamen, China
- Xiamen Clinical Research Center for Neurological Diseases, Xiamen, China
| | - Chen Wang
- Department of Neurology and Department of Neuroscience, School of Medicine, The First Affiliated Hospital of Xiamen University, Xiamen University, 55 Zhenhai Road, Xiamen, 361003 China
- Fujian Key Laboratory of Brain Tumors Diagnosis and Precision Treatment, Xiamen, China
- Xiamen Key Laboratory of Brain Center, Xiamen, China
- Xiamen Medical Quality Control Center for Neurology, Xiamen, China
- Fujian Provincial Clinical Research Center for Brain Diseases, Xiamen, China
- Xiamen Clinical Research Center for Neurological Diseases, Xiamen, China
| | - Jiedong Zhao
- School of Clinical Medicine, Fujian Medical University, Fuzhou, China
| | - Xiaodong Yuan
- Department of Gynecology of Xiamen Maternal and Child Health Care Hospital, Xiamen, China
| | - Chunfang Wu
- Department of Neurology, Huaihe Hospital, Henan University, Huaihe, China
| | - Zhaojie Zhang
- Department of Neurology, Kaifeng Hospital of Traditional Chinese Medicine, Kaifeng, China
| | - Mingwei Guo
- Department of Neurology, First Affiliated Hospital of Gannan Medical University, Gannan, China
| | - Junde Zhang
- Department of Neurology, First Affiliated Hospital of Gannan Medical University, Gannan, China
| | - Jingjing Zheng
- Department of Neurology, Ningde Municipal Hospital of Ningde Normal University, Ningde, China
| | - Aidi Lei
- Department of Neurology, The Fifth Hospital of Xiamen, Xiamen, China
| | - Tengkun Zhang
- Department of Neurology, The Fifth Hospital of Xiamen, Xiamen, China
| | - Quan Lan
- Department of Neurology and Department of Neuroscience, School of Medicine, The First Affiliated Hospital of Xiamen University, Xiamen University, 55 Zhenhai Road, Xiamen, 361003 China
- Fujian Key Laboratory of Brain Tumors Diagnosis and Precision Treatment, Xiamen, China
- Xiamen Key Laboratory of Brain Center, Xiamen, China
- Xiamen Medical Quality Control Center for Neurology, Xiamen, China
- Fujian Provincial Clinical Research Center for Brain Diseases, Xiamen, China
- Xiamen Clinical Research Center for Neurological Diseases, Xiamen, China
| | | | - Xinrui Wang
- NHC Key Laboratory of Technical Evaluation of Fertility Regulation for Non-Human Primate (Fujian Maternity and Child Health Hospital), No. 19 Jinjishan Road, Jin’an District, Fuzhou, 350013 China
- Medical Research Center, College of Clinical Medicine for Obstetrics and Gynecology and Pediatrics, Fujian Maternityand Child Health Hospital, Fujian Medical University, Fuzhou, China
| | - Zhanxiang Wang
- Fujian Key Laboratory of Brain Tumors Diagnosis and Precision Treatment, Xiamen, China
- Xiamen Key Laboratory of Brain Center, Xiamen, China
- Xiamen Medical Quality Control Center for Neurology, Xiamen, China
- Fujian Provincial Clinical Research Center for Brain Diseases, Xiamen, China
- Xiamen Clinical Research Center for Neurological Diseases, Xiamen, China
- School of Medicine, Xiamen University, Xiamen, China
- National Institute for Data Science in Health and Medicine, Xiamen University, Xiamen, China
- Department of Neurosurgery and Department of Neuroscience, School of Medicine, The First Affiliated Hospital of Xiamen University, Xiamen University, 55 Zhenhai Road, Xiamen, 361003 China
| | - Qilin Ma
- Department of Neurology and Department of Neuroscience, School of Medicine, The First Affiliated Hospital of Xiamen University, Xiamen University, 55 Zhenhai Road, Xiamen, 361003 China
- Fujian Key Laboratory of Brain Tumors Diagnosis and Precision Treatment, Xiamen, China
- Xiamen Key Laboratory of Brain Center, Xiamen, China
- Xiamen Medical Quality Control Center for Neurology, Xiamen, China
- Fujian Provincial Clinical Research Center for Brain Diseases, Xiamen, China
- Xiamen Clinical Research Center for Neurological Diseases, Xiamen, China
- School of Medicine, Xiamen University, Xiamen, China
- National Institute for Data Science in Health and Medicine, Xiamen University, Xiamen, China
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16
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Golubnitschaja O, Polivka J, Potuznik P, Pesta M, Stetkarova I, Mazurakova A, Lackova L, Kubatka P, Kropp M, Thumann G, Erb C, Fröhlich H, Wang W, Baban B, Kapalla M, Shapira N, Richter K, Karabatsiakis A, Smokovski I, Schmeel LC, Gkika E, Paul F, Parini P, Polivka J. The paradigm change from reactive medical services to 3PM in ischemic stroke: a holistic approach utilising tear fluid multi-omics, mitochondria as a vital biosensor and AI-based multi-professional data interpretation. EPMA J 2024; 15:1-23. [PMID: 38463624 PMCID: PMC10923756 DOI: 10.1007/s13167-024-00356-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Accepted: 02/08/2024] [Indexed: 03/12/2024]
Abstract
Worldwide stroke is the second leading cause of death and the third leading cause of death and disability combined. The estimated global economic burden by stroke is over US$891 billion per year. Within three decades (1990-2019), the incidence increased by 70%, deaths by 43%, prevalence by 102%, and DALYs by 143%. Of over 100 million people affected by stroke, about 76% are ischemic stroke (IS) patients recorded worldwide. Contextually, ischemic stroke moves into particular focus of multi-professional groups including researchers, healthcare industry, economists, and policy-makers. Risk factors of ischemic stroke demonstrate sufficient space for cost-effective prevention interventions in primary (suboptimal health) and secondary (clinically manifested collateral disorders contributing to stroke risks) care. These risks are interrelated. For example, sedentary lifestyle and toxic environment both cause mitochondrial stress, systemic low-grade inflammation and accelerated ageing; inflammageing is a low-grade inflammation associated with accelerated ageing and poor stroke outcomes. Stress overload, decreased mitochondrial bioenergetics and hypomagnesaemia are associated with systemic vasospasm and ischemic lesions in heart and brain of all age groups including teenagers. Imbalanced dietary patterns poor in folate but rich in red and processed meat, refined grains, and sugary beverages are associated with hyperhomocysteinaemia, systemic inflammation, small vessel disease, and increased IS risks. Ongoing 3PM research towards vulnerable groups in the population promoted by the European Association for Predictive, Preventive and Personalised Medicine (EPMA) demonstrates promising results for the holistic patient-friendly non-invasive approach utilising tear fluid-based health risk assessment, mitochondria as a vital biosensor and AI-based multi-professional data interpretation as reported here by the EPMA expert group. Collected data demonstrate that IS-relevant risks and corresponding molecular pathways are interrelated. For examples, there is an evident overlap between molecular patterns involved in IS and diabetic retinopathy as an early indicator of IS risk in diabetic patients. Just to exemplify some of them such as the 5-aminolevulinic acid/pathway, which are also characteristic for an altered mitophagy patterns, insomnia, stress regulation and modulation of microbiota-gut-brain crosstalk. Further, ceramides are considered mediators of oxidative stress and inflammation in cardiometabolic disease, negatively affecting mitochondrial respiratory chain function and fission/fusion activity, altered sleep-wake behaviour, vascular stiffness and remodelling. Xanthine/pathway regulation is involved in mitochondrial homeostasis and stress-driven anxiety-like behaviour as well as molecular mechanisms of arterial stiffness. In order to assess individual health risks, an application of machine learning (AI tool) is essential for an accurate data interpretation performed by the multiparametric analysis. Aspects presented in the paper include the needs of young populations and elderly, personalised risk assessment in primary and secondary care, cost-efficacy, application of innovative technologies and screening programmes, advanced education measures for professionals and general population-all are essential pillars for the paradigm change from reactive medical services to 3PM in the overall IS management promoted by the EPMA.
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Affiliation(s)
- Olga Golubnitschaja
- Predictive, Preventive and Personalised (3P) Medicine, Department of Radiation Oncology, University Hospital Bonn, Rheinische Friedrich-Wilhelms-Universität Bonn, 53127 Bonn, Germany
| | - Jiri Polivka
- Department of Histology and Embryology, Faculty of Medicine in Plzen, Charles University, Prague, Czech Republic
- Biomedical Centre, Faculty of Medicine in Plzen, Charles University, Prague, Czech Republic
| | - Pavel Potuznik
- Department of Neurology, University Hospital Plzen and Faculty of Medicine in Plzen, Charles University, Prague, Czech Republic
| | - Martin Pesta
- Department of Biology, Faculty of Medicine in Plzen, Charles University, Prague, Czech Republic
| | - Ivana Stetkarova
- Department of Neurology, University Hospital Kralovske Vinohrady, Third Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Alena Mazurakova
- Department of Anatomy, Jessenius Faculty of Medicine, Comenius University in Bratislava, Martin, Slovakia
| | - Lenka Lackova
- Department of Histology and Embryology, Jessenius Faculty of Medicine, Comenius University in Bratislava, Martin, Slovakia
| | - Peter Kubatka
- Department of Histology and Embryology, Jessenius Faculty of Medicine, Comenius University in Bratislava, Martin, Slovakia
| | - Martina Kropp
- Experimental Ophthalmology, University of Geneva, 1205 Geneva, Switzerland
- Ophthalmology Department, University Hospitals of Geneva, 1205 Geneva, Switzerland
| | - Gabriele Thumann
- Experimental Ophthalmology, University of Geneva, 1205 Geneva, Switzerland
- Ophthalmology Department, University Hospitals of Geneva, 1205 Geneva, Switzerland
| | - Carl Erb
- Private Institute of Applied Ophthalmology, Berlin, Germany
| | - Holger Fröhlich
- Artificial Intelligence & Data Science Group, Fraunhofer SCAI, Sankt Augustin, Germany
- Bonn-Aachen International Center for IT (B-It), University of Bonn, 53115 Bonn, Germany
| | - Wei Wang
- Edith Cowan University, Perth, Australia
- Beijing Municipal Key Laboratory of Clinical Epidemiology, Capital Medical University, Beijing, China
| | - Babak Baban
- The Dental College of Georgia, Departments of Neurology and Surgery, The Medical College of Georgia, Augusta University, Augusta, USA
| | - Marko Kapalla
- Negentropic Systems, Ružomberok, Slovakia
- PPPM Centre, s.r.o., Ruzomberok, Slovakia
| | - Niva Shapira
- Department of Nutrition, School of Health Sciences, Ashkelon Academic College, Ashkelon, Israel
| | - Kneginja Richter
- CuraMed Tagesklinik Nürnberg GmbH, Nuremberg, Germany
- Technische Hochschule Nürnberg GSO, Nuremberg, Germany
- University Clinic for Psychiatry and Psychotherapy, Paracelsus Medical University, Nuremberg, Germany
| | - Alexander Karabatsiakis
- Department of Psychology, Clinical Psychology II, University of Innsbruck, Innsbruck, Austria
| | - Ivica Smokovski
- University Clinic of Endocrinology, Diabetes and Metabolic Disorders Skopje, University Goce Delcev, Faculty of Medical Sciences, Stip, North Macedonia
| | - Leonard Christopher Schmeel
- Department of Radiation Oncology, University Hospital Bonn, Rheinische Friedrich-Wilhelms-Universität Bonn, 53127 Bonn, Germany
| | - Eleni Gkika
- Department of Radiation Oncology, University Hospital Bonn, Rheinische Friedrich-Wilhelms-Universität Bonn, 53127 Bonn, Germany
| | | | - Paolo Parini
- Cardio Metabolic Unit, Department of Medicine Huddinge, and Department of Laboratory Medicine, Karolinska Institutet, and Medicine Unit of Endocrinology, Theme Inflammation and Ageing, Karolinska University Hospital, Stockholm, Sweden
| | - Jiri Polivka
- Department of Neurology, University Hospital Plzen and Faculty of Medicine in Plzen, Charles University, Prague, Czech Republic
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17
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Smith EE. Advances in Cerebral Small Vessel Disease: Sandra E. Black Lecture to the Canadian Neurological Sciences Federation. Can J Neurol Sci 2024:1-8. [PMID: 38410042 DOI: 10.1017/cjn.2024.26] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/28/2024]
Abstract
Cerebral small vessel diseases (CSVDs) are among the most common age-related pathologies of the brain. Arteriolosclerosis and cerebral amyloid angiopathy (CAA) are the most common CSVDs. In addition to causing stroke and dementia, CSVDs can have diverse covert radiological manifestations on computed tomography and magnetic resonance imaging including lacunes, T2-weighted white matter hyperintensities, increased density of visible perivascular spaces, microbleeds and cortical superficial siderosis. Because they cannot be visualized directly, research on the pathophysiology of CSVD has been difficult. However, advances in quantitative imaging methods, including physiological imaging such as measurement of cerebrovascular reactivity and increased vascular permeability, are beginning to allow investigation of the early effects of CSVD in living people. Furthermore, genomics, metabolomics and proteomics have the potential to illuminate previously unrecognized pathways to CSVD that could be important targets for new clinical trials.
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Affiliation(s)
- Eric E Smith
- Department of Clinical Neurosciences, Radiology and Community Health Sciences, University of Calgary, Calgary, AB, Canada
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18
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Wang K, Xu M, Wang Z, Wang Z, Li M, Liu H, Chen H, Ju W, Chen M. Anticoagulation Intensity during Appendage Occlusion: Lessons from Silent Cerebral Embolism. Cardiology 2024; 149:349-356. [PMID: 38354708 DOI: 10.1159/000537708] [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: 08/01/2023] [Accepted: 02/05/2024] [Indexed: 02/16/2024]
Abstract
INTRODUCTION Endovascular left atrial appendage occlusion (LAAO) is associated with a high incidence of peri-procedure silent cerebral embolism (SCE), while the recommended activated clotting time (ACT) level by the expert consensus is lower than that in atrial fibrillation (AF) ablation. The aim of our study was to investigate whether raising the targeted ACT level during LAAO to the same level as AF ablation could decrease the incidence of SCE. METHODS It was a prospective observational cohort study. Consecutive AF patients receiving LAAO between January 2021 and December 2022 were included and categorized into two groups based on the time of enrollment. Patients enrolled in 2021 (group 250) maintained a target ACT level of ≥250 s during LAAO procedure, while patients enrolled in 2022 (group 300) maintained the peri-procedure ACT ≥300 s. All patients underwent cerebral magnetic resonance imaging before and after the procedure. RESULTS A total of 81 patients were included (38 in the group 250 and 43 in the group 300). After inverse probability of treatment weighting (IPTW), patients in the group 250 showed a significantly lower incidence of SCE than group 300 (IPTW p = 0.038). Only a stable high ACT pattern could decrease the risk of SCE. No significant differences were found between other ACT change patterns on the SCE incidence. CONCLUSION Raising the peri-procedure ACT level to a stable 300 s could decrease the risk of the SCE without increasing the major bleeding events.
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Affiliation(s)
- Kexin Wang
- Division of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Mingjia Xu
- Division of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Zhe Wang
- Division of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Zidun Wang
- Division of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Mingfang Li
- Division of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Hailei Liu
- Division of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Hongwu Chen
- Division of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Weizhu Ju
- Division of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Minglong Chen
- Division of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
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Özdemir E, Ekinci AS, Emren SV, Balaban S, Tiryaki MM, Karaca M, Tiryaki ENÖ, Nazlı C. Evaluation of the Relationship between Cognitive Impairment and Atria Score Systems in Patients with Atrial Fibrillation. Ann Indian Acad Neurol 2024; 27:46-52. [PMID: 38495254 PMCID: PMC10941894 DOI: 10.4103/aian.aian_674_23] [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: 07/31/2023] [Revised: 11/27/2023] [Accepted: 11/29/2023] [Indexed: 03/19/2024] Open
Abstract
Background Atrial fibrillation (AF) is the main arrhythmia associated with thromboembolic complications and cognitive impairment. In this study, we aimed to evaluate the relationship between cognitive impairment and different scoring systems developed for AF to improve the medical follow-up of cognitive impairment. Methods Between January 2019 and December 2020, 124 patients between the age of 30 and 80 years, diagnosed with AF for at least 5 years and complaining about memory impairment during cardiological follow-up, were included in the study. The patients were divided into two groups based on their cognitive status as assessed by the Mini-Mental State Examination group 1 consisted of 52 patients with cognitive impairment and group 2 comprised 72 patients without cognitive impairment. Results The ATRIA bleeding score had a positive moderate correlation (r = 0.454, P < 0.001), the ATRIA stroke score had a strong correlation (r = 0.738, P < 0.001), and the SAMe-TT2R2 score had a strong correlation (r = 0.688, P < 0.001) with cognitive impairment. However, CHADS2 and CHA2DS2VASc scores were not statistically correlated with cognitive impairment. According to the receiver operating characteristic (ROC) curve, the area under the curve (AUC) of the ATRIA bleeding score was 0.761 with a 95% confidence interval (CI) of 0.678-0.844 and P < 0.001; also, for the ATRIA stroke score, AUC was 0.930 with a 95% CI of 0.886-0.974 and P < 0.001. In addition, for the SAMe-TT2R2 score, AUC was 0.895 with a 95% CI of 0.838-0.952 and P < 0.001. In the pairwise comparison of AUC on ROC curves, the ATRIA stroke score and the SAMe-TT2R2 score were statistically similar (P = 0.324). ATRIA bleeding, ATRIA stroke, and SAMe-TT2R2 scores were greater than CHADS2 stroke score (P: 0.0004, P < 0.0001, and P < 0.0001, respectively), but CHA2DS2-VASc and CHADS2 stroke scores were statistically similar (P: 0.402). Conclusion Both ATRIA stroke and SAMe-TT2R2 scoring systems can provide a better correlation than CHADS2 and CHA2DS2-VASc scores in patients with AF to evaluate their cognitive status. These two scores can be more useful to monitor the patients with AF for medical follow-up of cognitive status.
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Affiliation(s)
- Emre Özdemir
- Department of Cardiology, Ataturk Research and Training Hospital, Izmir Katip Çelebi University, Izmir/Turkey
| | - Ayşen S. Ekinci
- Department of Neurology, Ataturk Research and Training Hospital, Izmir Katip Çelebi University, Izmir/Turkey
| | - Sadık V. Emren
- Department of Cardiology, Ataturk Research and Training Hospital, Izmir Katip Çelebi University, Izmir/Turkey
| | - Simge Balaban
- Department of Neurology, Ataturk Research and Training Hospital, Izmir Katip Çelebi University, Izmir/Turkey
| | - Muhammet M. Tiryaki
- Department of Cardiology, Ataturk Research and Training Hospital, Izmir Katip Çelebi University, Izmir/Turkey
| | - Mustafa Karaca
- Department of Cardiology, Ataturk Research and Training Hospital, Izmir Katip Çelebi University, Izmir/Turkey
| | - Enise N. Özlem Tiryaki
- Department of Neurology, Ataturk Research and Training Hospital, Izmir Katip Çelebi University, Izmir/Turkey
| | - Cem Nazlı
- Department of Cardiology, Ataturk Research and Training Hospital, Izmir Katip Çelebi University, Izmir/Turkey
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20
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Shin S, Hwangbo L, Lee TH, Ko JK. Silent Embolic Infarction after Neuroform Atlas Stent-Assisted Coiling of Unruptured Intracranial Aneurysms. J Korean Neurosurg Soc 2024; 67:42-49. [PMID: 37661088 PMCID: PMC10788554 DOI: 10.3340/jkns.2023.0091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 06/18/2023] [Accepted: 08/19/2023] [Indexed: 09/05/2023] Open
Abstract
OBJECTIVE There is still controversy regarding whether neck remodeling stent affects the occurrence of silent embolic infarction (SEI) after aneurysm coiling. Thus, the aim of the present study is to investigate the incidence of SEI after stent-assisted coiling (SAC) using Neuroform Atlas Stent (NAS) and possible risk factors. This study also includes a comparison with simple coiling group during the same period to estimate the impact of NAS on the occurrence of SEI. METHODS This study included a total of 96 unruptured intracranial aneurysms in 96 patients treated with SAC using NAS. Correlations of demographic data, aneurysm characteristics, and angiographic parameters with properties of SEI were analyzed. The incidence and characteristics of SEI were investigated in 28 patients who underwent simple coiling during the same period, and the results were compared with the SAC group. RESULTS In the diffusion-weighted imaging obtained on the 1st day after SAC, a total of 106 SEI lesions were observed in 48 (50%) of 96 patients. Of these 48 patients, 38 (79.2%) had 1-3 lesions. Of 106 lesions, 74 (69.8%) had a diameter less than 3 mm. SEI occurred more frequently in older patients (≥60 years, p=0.013). The volume of SEI was found to be significantly increased in older age (≥60 years, p=0.032), hypertension (p=0.036), and aneurysm size ≥5 mm (p=0.047). The incidence and mean volume of SEI in the SAC group (n=96) were similar to those of the simple coiling group (n=28) during the same period. CONCLUSION SEIs are common after NAS-assisted coiling. Their incidence in SAC was comparable to that in simple coiling. They occurred more frequently at an older age. Therefore, the use of NAS in the treatment of unruptured intracranial aneurysm does not seem to be associated with an increased risk of thromboembolic events if antiplatelet premedication has been performed well.
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Affiliation(s)
- Seungho Shin
- Department of Neurosurgery, Biomedical Research Institute, Pusan National University Hospital, School of Medicine, Pusan National University, Busan, Korea
| | - Lee Hwangbo
- Department of Diagnostic Radiology, Biomedical Research Institute, Pusan National University Hospital, School of Medicine, Pusan National University, Busan, Korea
| | - Tae-Hong Lee
- Department of Diagnostic Radiology, Biomedical Research Institute, Pusan National University Hospital, School of Medicine, Pusan National University, Busan, Korea
| | - Jun Kyeung Ko
- Department of Neurosurgery, Biomedical Research Institute, Pusan National University Hospital, School of Medicine, Pusan National University, Busan, Korea
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21
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Liang ZY, Lu ZH, Qu JF, Chen YK. Clinical and imaging associations for non-ketotic hyperglycemic chorea: a case-control study. Front Endocrinol (Lausanne) 2023; 14:1323942. [PMID: 38189042 PMCID: PMC10769489 DOI: 10.3389/fendo.2023.1323942] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Accepted: 12/01/2023] [Indexed: 01/09/2024] Open
Abstract
Background The non-ketotic hyperglycemic chorea (NKHC) was a rare complication for patients with diabetes mellitus, but not been well studied. In the present research, we aimed to investigate the clinical and imaging characteristics of NKHC and explore the potential association. Methods We performed a case-control study with patients diagnosed as NKHC. The patients with group of NKHC were retrospectively recruited, while the matched group were set to screened patients with diabetes mellitus but no NKHC at a 1:3 ratio. The clinical and imaging data were collected for all the participants of the two groups. Firstly, Correlation analysis was conducted to test the difference of all the variables between the NKHC group and matched group. Then, the putative associated factors for NKHC were further identified. Results Eleven men and 9 women with NKHC and 60 matched participants were analyzed. The mean age of the NKHC group was 68.5 ± 14.9 years. Participants with NKHC were more likely to have a higher glycosylated hemoglobin (HbA1c) level (13 ± 2.82 vs. 10.57 ± 2.71, P<0.001), and a higher frequency of renal dysfunction (estimated glomerular filtration rates <60 ml/min/1.73m2) (55% vs. 20%, P=0.005). Logistic regression analyses showed that both higher HbA1c and renal dysfunction were significantly correlated with NKHC. Conclusion A higher value of HbA1c and renal dysfunction may be associated with the occurrence of NKHC.
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Affiliation(s)
- Zhuo-Yuan Liang
- Department of Neurology, The Tenth Affiliated Hospital of Southern Medical University (Dongguan People’s Hospital), Dongguan, Guangdong, China
- Intelligent Brain Imaging and Brain Function Laboratory (Dongguan Key Laboratory), Dongguan People’s Hospital, Dongguan, Guangdong, China
| | - Zhi-Hao Lu
- Department of Neurology, The Tenth Affiliated Hospital of Southern Medical University (Dongguan People’s Hospital), Dongguan, Guangdong, China
- Intelligent Brain Imaging and Brain Function Laboratory (Dongguan Key Laboratory), Dongguan People’s Hospital, Dongguan, Guangdong, China
| | - Jian-Feng Qu
- Department of Neurology, The Tenth Affiliated Hospital of Southern Medical University (Dongguan People’s Hospital), Dongguan, Guangdong, China
- Intelligent Brain Imaging and Brain Function Laboratory (Dongguan Key Laboratory), Dongguan People’s Hospital, Dongguan, Guangdong, China
| | - Yang-Kun Chen
- Department of Neurology, The Tenth Affiliated Hospital of Southern Medical University (Dongguan People’s Hospital), Dongguan, Guangdong, China
- Intelligent Brain Imaging and Brain Function Laboratory (Dongguan Key Laboratory), Dongguan People’s Hospital, Dongguan, Guangdong, China
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22
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Xie H, Yu Y, Yang Y, Sun Q, Li ZY, Ni MH, Li SN, Dai P, Cui YY, Cao XY, Jiang N, Du LJ, Gao W, Bi JJ, Yan LF, Cui GB. Commonalities and distinctions between the type 2 diabetes mellitus and Alzheimer's disease: a systematic review and multimodal neuroimaging meta-analysis. Front Neurosci 2023; 17:1301778. [PMID: 38125399 PMCID: PMC10731270 DOI: 10.3389/fnins.2023.1301778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Accepted: 11/21/2023] [Indexed: 12/23/2023] Open
Abstract
Background Alzheimer's disease (AD) and type 2 diabetes mellitus (T2DM) are aging related diseases with high incidence. Because of the correlation of incidence rate and some possible mechanisms of comorbidity, the two diseases have been studied in combination by many researchers, and even some scholars call AD type 3 diabetes. But the relationship between the two is still controversial. Methods This study used seed-based d mapping software to conduct a meta-analysis of the whole brain resting state functional magnetic resonance imaging (rs-fMRI) study, exploring the differences in amplitude low-frequency fluctuation (ALFF) and cerebral blood flow (CBF) between patients (AD or T2DM) and healthy controls (HCs), and searching for neuroimaging evidence that can explain the relationship between the two diseases. Results The final study included 22 datasets of ALFF and 22 datasets of CBF. The results of T2DM group showed that ALFF increased in both cerebellum and left inferior temporal gyrus regions, but decreased in left middle occipital gyrus, right inferior occipital gyrus, and left anterior central gyrus regions. In the T2DM group, CBF increased in the right supplementary motor area, while decreased in the middle occipital gyrus and inferior parietal gyrus. The results of the AD group showed that the ALFF increased in the right cerebellum, right hippocampus, and right striatum, while decreased in the precuneus gyrus and right superior temporal gyrus. In the AD group, CBF in the anterior precuneus gyrus and inferior parietal gyrus decreased. Multimodal analysis within a disease showed that ALFF and CBF both decreased in the occipital lobe of the T2DM group and in the precuneus and parietal lobe of the AD group. In addition, there was a common decrease of CBF in the right middle occipital gyrus in both groups. Conclusion Based on neuroimaging evidence, we believe that T2DM and AD are two diseases with their respective characteristics of central nervous activity and cerebral perfusion. The changes in CBF between the two diseases partially overlap, which is consistent with their respective clinical characteristics and also indicates a close relationship between them. Systematic review registration PROSPERO [CRD42022370014].
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Affiliation(s)
- Hao Xie
- Department of Radiology, Functional and Molecular Imaging Key Lab of Shaanxi Province, Tangdu Hospital, Fourth Military Medical University (Air Force Medical University), Xi’an, Shaanxi, China
| | - Ying Yu
- Department of Radiology, Functional and Molecular Imaging Key Lab of Shaanxi Province, Tangdu Hospital, Fourth Military Medical University (Air Force Medical University), Xi’an, Shaanxi, China
| | - Yang Yang
- Department of Radiology, Functional and Molecular Imaging Key Lab of Shaanxi Province, Tangdu Hospital, Fourth Military Medical University (Air Force Medical University), Xi’an, Shaanxi, China
| | - Qian Sun
- Department of Radiology, Functional and Molecular Imaging Key Lab of Shaanxi Province, Tangdu Hospital, Fourth Military Medical University (Air Force Medical University), Xi’an, Shaanxi, China
| | - Ze-Yang Li
- Department of Radiology, Functional and Molecular Imaging Key Lab of Shaanxi Province, Tangdu Hospital, Fourth Military Medical University (Air Force Medical University), Xi’an, Shaanxi, China
| | - Min-Hua Ni
- Department of Radiology, Functional and Molecular Imaging Key Lab of Shaanxi Province, Tangdu Hospital, Fourth Military Medical University (Air Force Medical University), Xi’an, Shaanxi, China
| | - Si-Ning Li
- Department of Radiology, Functional and Molecular Imaging Key Lab of Shaanxi Province, Tangdu Hospital, Fourth Military Medical University (Air Force Medical University), Xi’an, Shaanxi, China
- Faculty of Medical Technology, Xi’an Medical University, Xi’an, Shaanxi, China
| | - Pan Dai
- Department of Radiology, Functional and Molecular Imaging Key Lab of Shaanxi Province, Tangdu Hospital, Fourth Military Medical University (Air Force Medical University), Xi’an, Shaanxi, China
- Faculty of Medical Technology, Xi’an Medical University, Xi’an, Shaanxi, China
| | - Yan-Yan Cui
- Department of Radiology, Functional and Molecular Imaging Key Lab of Shaanxi Province, Tangdu Hospital, Fourth Military Medical University (Air Force Medical University), Xi’an, Shaanxi, China
- Faculty of Medical Technology, Shaanxi University of Chinese Medicine, Xianyang, Shaanxi, China
| | - Xin-Yu Cao
- Department of Radiology, Functional and Molecular Imaging Key Lab of Shaanxi Province, Tangdu Hospital, Fourth Military Medical University (Air Force Medical University), Xi’an, Shaanxi, China
- Faculty of Medical Technology, Medical School of Yan’an University, Yan’an, Shaanxi, China
| | - Nan Jiang
- Department of Radiology, Functional and Molecular Imaging Key Lab of Shaanxi Province, Tangdu Hospital, Fourth Military Medical University (Air Force Medical University), Xi’an, Shaanxi, China
| | - Li-Juan Du
- Department of Radiology, Functional and Molecular Imaging Key Lab of Shaanxi Province, Tangdu Hospital, Fourth Military Medical University (Air Force Medical University), Xi’an, Shaanxi, China
| | - Wen Gao
- Student Brigade, Fourth Military Medical University, Xi’an, Shaanxi, China
| | - Jia-Jun Bi
- Student Brigade, Fourth Military Medical University, Xi’an, Shaanxi, China
| | - Lin-Feng Yan
- Department of Radiology, Functional and Molecular Imaging Key Lab of Shaanxi Province, Tangdu Hospital, Fourth Military Medical University (Air Force Medical University), Xi’an, Shaanxi, China
| | - Guang-Bin Cui
- Department of Radiology, Functional and Molecular Imaging Key Lab of Shaanxi Province, Tangdu Hospital, Fourth Military Medical University (Air Force Medical University), Xi’an, Shaanxi, China
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23
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Smith CE, Kukolja J. Prevalence and risk factors of ischemic monocular vision loss and concurrent brain ischemia. Eur Stroke J 2023; 8:982-988. [PMID: 37593943 PMCID: PMC10683730 DOI: 10.1177/23969873231191577] [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: 05/01/2023] [Accepted: 07/09/2023] [Indexed: 08/19/2023] Open
Abstract
INTRODUCTION We performed a retrospective cohort study to identify predictors of concurrent asymptomatic brain ischemia in patients with ischemic monocular vision loss. PATIENTS AND METHODS An inpatient database research of admissions to the Helios University Hospital Wuppertal, Germany between 01/2016 and 12/2020 was conducted. Inclusion criteria were confirmed diagnosis of transient monocular vision loss (MVL), retinal artery occlusion (RAO), and magnetic resonance imaging (MRI) of the brain within 10 days of MVL. Silent brain ischemia (SBI) was defined as diffusion restrictions with corresponding reduced apparent diffusion coefficient in MRI and an absence of neurological deficits besides those complying with MVL in clinical examination. The prevalence and cardiovascular predictors of SBI were analyzed with logistic regression and an artificial neural network. RESULTS One hundred fourteen out of 475 patients treated with monocular vision loss were included in this study. The mean age was 67.7 ± 13.6 years. 48.2% were male and 47.4% had RAO. MRI scan of the brain was performed after 3.9 ± 2.3 days and detected SBI in 17%. Age ⩾67 years, cardiac etiology of MVL, and cerebral ischemia in medical history were revealed as predictors of SBI in MRI. CONCLUSIONS Patients older than 66 years, with a suspected cardiac embolism as the cause of RAO and previous cerebral ischemia, are more likely to present SBI in cerebral MRI. Therefore, MR imaging, particularly in these patients, can be useful.
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Affiliation(s)
- Cathy E Smith
- Department of Neurology and Clinical Neurophysiology, Helios University Hospital Wuppertal, Wuppertal, Germany
- Faculty of Health, Witten/Herdecke University, Witten, Germany
| | - Juraj Kukolja
- Department of Neurology and Clinical Neurophysiology, Helios University Hospital Wuppertal, Wuppertal, Germany
- Faculty of Health, Witten/Herdecke University, Witten, Germany
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24
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Kraft P, Häusler KG. [Stroke-Related Cognitive Dysfunction]. FORTSCHRITTE DER NEUROLOGIE-PSYCHIATRIE 2023; 91:503-509. [PMID: 37857330 DOI: 10.1055/a-2176-7862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2023]
Abstract
ZusammenfassungEine kognitive Dysfunktion nach Schlaganfall besteht häufig und
korreliert mit der Lokalisation und dem Ausmaß des Schlaganfalls sowie
mit dem Zeitpunkt der Erhebung, die anhand standardisierter und etablierter
Testverfahren erfolgen sollte. Eine kognitive Dysfunktion nach Schlaganfall ist
im Kontext einer so genannten post-stroke dementia für das funktionelle
Outcome relevant. Zudem ist das Bestehen einer kognitiven Dysfunktion mit einer
erhöhten Wahrscheinlichkeit für ein Schlaganfallrezidiv
assoziiert. Kognitive Defizite als mögliche Folge eines Schlaganfalls
sollte daher auch abseits von Komplex- und Rehabilitationsbehandlungen Beachtung
finden, zumal in Deutschland bis dato kein ambulantes Nachsorgekonzept nach
stattgehabtem Schlaganfall etabliert wurde. Nicht nur zerebrovaskuläre
Ereignisse selbst, sondern auch das Bestehen vaskulärer Risikofaktoren
wie Herzinsuffizienz, Vorhofflimmern, Hypercholesterinämie und
Niereninsuffizienz können zur Entwicklung einer kognitiven
Funktionsstörung beitragen und eine kognitive Dysfunktion nach
Schlaganfall verstärken. Die bestmögliche Therapie bekannter
vaskulärer Risikofaktoren und eine gesunde Lebensweise sind im Kontext
bis dato fehlender spezifischer medikamentöser Therapien einer
kognitiven Dysfunktion nach Schlaganfall angezeigt. Eine gezielte Rehabilitation
kann zur Erhaltung und Verbesserung kognitiver Funktionen bei kognitiver
Dysfunktion nach Schlaganfall beitragen. Prospektive (randomisierte)
Schlaganfallstudien sollten eine standardisierte Erfassung kognitiver Endpunkte
einschließen und bestenfalls auf die Entwicklung präventiver
Therapiestrategien für die kognitive Dysfunktion abzielen.
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Affiliation(s)
- Peter Kraft
- Neurologie, Klinikum Main-Spessart, Lohr, Germany
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25
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Meinel TR, Triulzi CB, Kaesmacher J, Mujanovic A, Pasi M, Leung LY, Kent DM, Sui Y, Seiffge D, Bücke P, Umarova R, Arnold M, Roten L, Nguyen TN, Wardlaw J, Fischer U. Management of covert brain infarction survey: A call to care for and trial this neglected population. Eur Stroke J 2023; 8:1079-1088. [PMID: 37427426 PMCID: PMC10683731 DOI: 10.1177/23969873231187444] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Accepted: 06/26/2023] [Indexed: 07/11/2023] Open
Abstract
BACKGROUND Covert brain infarction (CBI) is highly prevalent and linked with stroke risk factors, increased mortality, and morbidity. Evidence to guide management is sparse. We sought to gain information on current practice and attitudes toward CBI and to compare differences in management according to CBI phenotype. METHODS We conducted a web-based, structured, international survey from November 2021 to February 2022 among neurologists and neuroradiologists. The survey captured respondents' baseline characteristics, general approach toward CBI and included two case scenarios designed to evaluate management decisions taken upon incidental detection of an embolic-phenotype and a small-vessel-disease phenotype. RESULTS Of 627 respondents (38% vascular neurologists, 24% general neurologists, and 26% neuroradiologists), 362 (58%) had a partial, and 305 (49%) a complete response. Most respondents were university hospital senior faculty members experienced in stroke, mostly from Europe and Asia. Only 66 (18%) of respondents had established institutional written protocols to manage CBI. The majority indicated that they were uncertain regarding useful investigations and further management of CBI patients (median 67 on a slider 0-100, 95% CI 35-81). Almost all respondents (97%) indicated that they would assess vascular risk factors. Although most would investigate and treat similarly to ischemic stroke for both phenotypes, including initiating antithrombotic treatment, there was considerable diagnostic and therapeutic heterogeneity. Less than half of respondents (42%) would assess cognitive function or depression. CONCLUSIONS There is a high degree of uncertainty and heterogeneity regarding management of two common types of CBI, even among experienced stroke physicians. Respondents were more proactive regarding the diagnostic and therapeutic management than the minimum recommended by current expert opinions. More data are required to guide management of CBI; meantime, more consistent approaches to identification and consistent application of current knowledge, that also consider cognition and mood, would be promising first steps to improve consistency of care.
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Affiliation(s)
- Thomas R Meinel
- Neurology, Stroke Research Center Bern, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Camilla B Triulzi
- Neurology, Stroke Research Center Bern, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Johannes Kaesmacher
- Institute of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland
| | - Adnan Mujanovic
- Neurology, Stroke Research Center Bern, Bern University Hospital, University of Bern, Bern, Switzerland
- Institute of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland
| | - Marco Pasi
- University of Lille, Inserm, CHU Lille, U1172-Lille Neuroscience & Cognition (LilNCog), Lille, France
| | - Lester Y Leung
- Department of Neurology, Tufts Medical Center, Boston, MA, USA
| | - David M Kent
- Predictive Analytics and Comparative Effectiveness Center, Tufts Medical Center, Boston, MA, USA
| | - Yi Sui
- Department of Neurology, The First Affiliated Hospital of China Medical University, Shenyang, China
- Department of Neurology, Shenyang First People’s Hospital, Shenyang Brain Institute, Shenyang, China
| | - David Seiffge
- Neurology, Stroke Research Center Bern, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Philipp Bücke
- Neurology, Stroke Research Center Bern, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Roza Umarova
- Neurology, Stroke Research Center Bern, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Marcel Arnold
- Neurology, Stroke Research Center Bern, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Laurent Roten
- Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Thanh N Nguyen
- Neurology and Radiology, Boston Medical Center, Boston, MA, USA
| | - Joanna Wardlaw
- Division of Neuroimaging Sciences, Brain Research Imaging Centre, Centre for Clinical Brain Sciences, UK Dementia Research Institute at the University of Edinburgh, Edinburgh, UK
| | - Urs Fischer
- Neurology, Stroke Research Center Bern, Bern University Hospital, University of Bern, Bern, Switzerland
- Neurology, Basel University Hospital, University of Basel, Basel, Switzerland
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26
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Choi JH, Park W, Park JC, Kwun BD, Ahn JS. Clipping of Unruptured Anterior Choroidal Artery Aneurysms Together with Small Branches: Safety Confirmation Using Intraoperative Indocyanine Green Video-Angiography and Intraoperative Neurophysiological Monitoring. World Neurosurg 2023; 180:e19-e29. [PMID: 37331470 DOI: 10.1016/j.wneu.2023.06.033] [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: 05/26/2023] [Accepted: 06/11/2023] [Indexed: 06/20/2023]
Abstract
BACKGROUND In treating anterior choroidal artery (AChA) aneurysms, preserving the AChA main trunk is of course necessary to prevent postoperative ischemic complications. However, in practice, complete occlusions are often limited by small branches. OBJECTIVE We aimed to demonstrate that even in cases where complete occlusion of the AChA aneurysm is complex due to small branches, complete occlusion can be safely achieved using indocyanine green video-angiography and intraoperative neurophysiological monitoring (IONM). METHODS We performed a retrospective review of all unruptured AChA aneurysms surgically treated at our institution from 2012 to 2021. All available surgical videos were reviewed to find AChA aneurysms clipped with small branches; clinical and radiological data were collected for these cases. RESULTS Among 391 cases of unruptured AChA aneurysms treated surgically, 25 AChA aneurysms were clipped with small branches. AChA-related ischemic complications occurred in 2 cases (8%) without retrograde indocyanine green filling to the branches. These 2 cases had changes in IONM. There were no ischemic complications in the remaining cases with retrograde indocyanine green filling to the branches and no change in IONM. During an average follow-up of 47 months (12-111 months), a small residual neck was observed in 3 cases (12%) and recurrence or progression of the aneurysm was observed in only 1 case (4%). CONCLUSIONS The surgical treatment of AChA aneurysms carries the risk of devastating ischemic complications. Even in cases where complete clip ligation seems impossible due to small branches associated with AChA aneurysms, complete occlusion can be safely achieved using indocyanine green video-angiography and IONM.
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Affiliation(s)
- June Ho Choi
- Department of Neurological Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Wonhyoung Park
- Department of Neurological Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jung Cheol Park
- Department of Neurological Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Byung Duk Kwun
- Department of Neurological Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jae Sung Ahn
- Department of Neurological Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
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27
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Baig AA, Manion C, Khawar WI, Donnelly BM, Raygor K, Turner R, Holmes DR, Iyer VS, Hopkins LN, Davies JM, Levy EI, Siddiqui AH. Cerebral emboli detection and autonomous neuromonitoring using robotic transcranial Doppler with artificial intelligence for transcatheter aortic valve replacement with and without embolic protection devices: a pilot study. J Neurointerv Surg 2023:jnis-2023-020812. [PMID: 37940386 DOI: 10.1136/jnis-2023-020812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Accepted: 09/26/2023] [Indexed: 11/10/2023]
Abstract
BACKGROUND Periprocedural ischemic stroke remains a serious complication in patients undergoing transcatheter aortic valve replacement (TAVR). We used a novel robotic transcranial Doppler (TCD) system equipped with artificial intelligence (AI) for real-time continuous intraoperative neuromonitoring during TAVR to establish the safety and potential validity of this tool in detecting cerebral emboli, report the quantity and distribution of high intensity transient signals (HITS) with and without cerebral protection, and correlate HITS occurrence with various procedural steps. METHODS Consecutive patients undergoing TAVR procedures during which the robotic system was used between October 2021 and May 2022 were prospectively enrolled in this pilot study. The robotic TCD system included autonomous adjustment of the TCD probes and AI-assisted post-processing of HITS and other cerebral flow parameters. Basic demographics and procedural details were recorded. Continuous variables were analyzed by a two-sample Mann-Whitney t-test and categorical variables by a χ2 or Fisher test. RESULTS Thirty-one patients were prospectively enrolled (mean age 79.9±7.6 years; 16 men (51.6%)). Mean aortic valve stenotic area was 0.7 cm2 and mean aortic-ventricular gradient was 43 mmHg (IQR 31.5-50 mmHg). Cerebral protection was used in 16 cases (51.6%). Significantly fewer emboli were observed in the protection group than in the non-protection group (mean 470.38 vs 693.33; p=0.01). Emboli counts during valve positioning and implantation were significantly different in the protection and non-protection groups (mean 249.92 and 387.5, respectively; p=0.01). One (4%) transient ischemic attack occurred post-procedurally in the non-protection group. CONCLUSION We describe a novel real-time intraoperative neuromonitoring tool used in patients undergoing TAVR. Significantly fewer HITS were detected with protection. Valve positioning-implantation was the most significant stage for intraprocedural HITS.
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Affiliation(s)
- Ammad A Baig
- Neurosurgery, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York, USA
- Neurosurgery, Gates Vascular Institute, Buffalo, New York, USA
| | | | - Wasiq I Khawar
- Neurosurgery, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York, USA
| | - Brianna M Donnelly
- Neurosurgery, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York, USA
| | - Kunal Raygor
- Neurosurgery, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York, USA
- Neurosurgery, Gates Vascular Institute, Buffalo, New York, USA
| | - Ryan Turner
- Neurosurgery, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York, USA
- Neurosurgery, Gates Vascular Institute, Buffalo, New York, USA
| | - David R Holmes
- Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota, USA
| | - Vijay S Iyer
- Cardiology, Gates Vascular Institute, Buffalo, New York, USA
| | - L Nelson Hopkins
- Neurosurgery, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York, USA
- Jacobs Institute, Buffalo, New York, USA
| | - Jason M Davies
- Neurosurgery, Gates Vascular Institute, Buffalo, New York, USA
- Jacobs Institute, Buffalo, New York, USA
- Neurosurgery and Bioinformatics and Canon Stroke and Vascular Research Center, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York, USA
| | - Elad I Levy
- Neurosurgery, Gates Vascular Institute, Buffalo, New York, USA
- Jacobs Institute, Buffalo, New York, USA
- Neurosurgery and Radiology and Canon Stroke and Vascular Research Center, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York, USA
| | - Adnan H Siddiqui
- Neurosurgery, Gates Vascular Institute, Buffalo, New York, USA
- Jacobs Institute, Buffalo, New York, USA
- Neurosurgery and Radiology and Canon Stroke and Vascular Research Center, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York, USA
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28
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Marcucci M, Chan MTV, Smith EE, Absalom AR, Devereaux PJ. Prevention of perioperative stroke in patients undergoing non-cardiac surgery. Lancet Neurol 2023; 22:946-958. [PMID: 37739575 DOI: 10.1016/s1474-4422(23)00209-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 03/17/2023] [Accepted: 05/26/2023] [Indexed: 09/24/2023]
Abstract
About 300 million adults undergo non-cardiac surgery annually. Although, in this setting, the incidence of perioperative stroke is low, the absolute number of patients experiencing a stroke is substantial. Furthermore, most patients with this complication will die or end up with severe disability. Covert brain infarctions are more frequent than overt strokes and are associated with postoperative delirium, cognitive decline, and cerebrovascular events at 1 year after surgery. Evidence shows that traditional stroke risk factors including older age, hypertension, and atrial fibrillation are also associated with perioperative stroke; previous stroke is the strongest risk factor for perioperative stroke. Increasing evidence also suggests the pathogenic role of perioperative events, such as hypotension, new atrial fibrillation, paradoxical embolism, and bleeding. Clinicians involved in perioperative care should be aware of this evidence on prevention strategies to improve patient outcomes after non-cardiac surgery.
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Affiliation(s)
- Maura Marcucci
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada; Department of Medicine, McMaster University, Hamilton, ON, Canada; Population Health Research Institute, Hamilton, ON, Canada
| | - Matthew T V Chan
- The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Eric E Smith
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
| | - Anthony R Absalom
- Department of Anaesthesiology, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - P J Devereaux
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada; Department of Medicine, McMaster University, Hamilton, ON, Canada; Population Health Research Institute, Hamilton, ON, Canada.
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29
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Jimenez Diaz VA, Kapadia SR, Linke A, Mylotte D, Lansky AJ, Grube E, Settergren M, Puri R. Cerebral embolic protection during transcatheter heart interventions. EUROINTERVENTION 2023; 19:549-570. [PMID: 37720969 PMCID: PMC10495748 DOI: 10.4244/eij-d-23-00166] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 07/17/2023] [Indexed: 09/19/2023]
Abstract
Stroke remains a devastating complication of transcatheter aortic valve replacement (TAVR), with the incidence of clinically apparent stroke seemingly fixed at around 3% despite TAVR's significant evolution during the past decade. Embolic showers of debris (calcium, atheroma, valve material, foreign material) are captured in the majority of patients who have TAVR using a filter-based cerebral embolic protection device (CEPD). Additionally, in systematic brain imaging studies, the majority of patients receiving TAVR exhibit new cerebral lesions. Mechanistic studies have shown reductions in the volume of new cerebral lesions using CEPDs, yet the first randomised trial powered for periprocedural stroke within 72 hours of a transfemoral TAVR failed to meet its primary endpoint of showing superiority of the SENTINEL CEPD. The present review summarises the clinicopathological rationale for the development of CEPDs, the evidence behind these devices to date and the emerging recognition of cerebral embolisation in many non-TAVR transcatheter procedures. Given the uniqueness of each of the various CEPDs under development, specific trials tailored to their designs will need to be undertaken to broaden the CEPD field, in addition to evaluating the role of CEPD in non-TAVR transcatheter heart interventions. Importantly, the cost-effectiveness of these devices will require assessment to broaden the adoption of CEPDs globally.
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Affiliation(s)
- Victor Alfonso Jimenez Diaz
- Cardiology Department, Hospital Álvaro Cunqueiro, University Hospital of Vigo, Vigo, Spain
- Cardiovascular Research Group, Galicia Sur Health Research Institute (IISGS), SERGAS-UVIGO, Vigo, Spain
| | - Samir R Kapadia
- Department of Cardiovascular Medicine, Miller Family Heart, Vascular & Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Axel Linke
- Department of Internal Medicine and Cardiology, Heart Center Dresden University Hospital, Dresden, Germany and Technische Universität Dresden, Dresden, Germany
| | - Darren Mylotte
- Department of Cardiology, University Hospital Galway, Galway, Ireland and University of Galway, Galway, Ireland
| | | | - Eberhard Grube
- Department of Medicine II, Heart Center, University Hospital Bonn, Bonn, Germany
| | - Magnus Settergren
- Heart and Vascular Unit, Karolinska University Hospital, Stockholm, Sweden and Karolinska Institutet, Stockholm, Sweden
| | - Rishi Puri
- Department of Cardiovascular Medicine, Miller Family Heart, Vascular & Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA
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Sawyer RP, Worrall BB, Howard VJ, Crowe MG, Howard G, Hyacinth HI. Methods of a Study to Assess the Contribution of Cerebral Small Vessel Disease and Dementia Risk Alleles to Racial Disparities in Vascular Cognitive Impairment and Dementia. J Am Heart Assoc 2023; 12:e030925. [PMID: 37642037 PMCID: PMC10547311 DOI: 10.1161/jaha.123.030925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 08/01/2023] [Indexed: 08/31/2023]
Abstract
Background Non-Hispanic Black adults have a higher proportion of vascular cognitive impairment and Alzheimer's disease and related dementias compared with non-Hispanic White adults that may be due to differences in the burden of cerebral small vessel disease and risk alleles for Alzheimer's disease and related dementias. We describe here the methods of an ancillary study to the REGARDS (Reason for Geographic and and Racial Difference in Stroke) study, which will examine the role of magnetic resonance imaging markers of cerebral small vessel disease and vascular as well as genetic risk factors for Alzheimer's disease and related dementias in racial disparity in the prevalence and trajectory of vascular cognitive impairment and dementia in non-Hispanic White and non-Hispanic Black participants. Methods In participants with no prior history of stroke who had an incident stroke or transient ischemic attack after enrollment in the study, magnetic resonance imaging scans will be evaluated using the Standards for Reporting Vascular Changes on Neuroimaging international consensus criteria and automated analysis pipelines for quantification of cerebral small vessel disease. Participants will be genotyped for APOE ε4 and TREM2 risk alleles for Alzheimer's disease and related dementias. The 6-item screener will define global cognitive function and be the primary cognitive outcome. Conclusions With at least 426 non-Hispanic Black and 463 non-Hispanic White participants who have at least 2 prior and 2 poststroke or transient ischemic attack cognitive assessments, we will have at least 80% power to detect a minimum effect size of 0.09 SD change in Z score, with correction for as many as 20 tests (ie, at P<0.0025, after adjusting for up to 20 covariates) for cognitive decline.
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Affiliation(s)
- Russell P. Sawyer
- Department of Neurology and Rehabilitation MedicineUniversity of CincinnatiOHUSA
| | - Bradford B. Worrall
- Department of Neurology and Public Health SciencesUniversity of VirginiaCharlottesvilleVAUSA
| | - Virginia J. Howard
- Department of Epidemiology, School of Public HealthUniversity of Alabama at BirminghamBirminghamALUSA
| | - Michael G. Crowe
- Department of Psychology, College of Arts and SciencesUniversity of Alabama at BirminghamBirminghamALUSA
| | - George Howard
- Department of Biostatistics, School of Public HealthUniversity of Alabama at BirminghamBirminghamALUSA
| | - Hyacinth I. Hyacinth
- Department of Neurology and Rehabilitation MedicineUniversity of CincinnatiOHUSA
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Reddy RK, Ahmad Y, Arnold AD, Howard JP. Cerebral Embolic Protection Devices During Transcatheter Aortic Valve Replacement: A Meta-analysis of Randomized Controlled Trials. JOURNAL OF THE SOCIETY FOR CARDIOVASCULAR ANGIOGRAPHY & INTERVENTIONS 2023; 2:None. [PMID: 37780935 PMCID: PMC10533415 DOI: 10.1016/j.jscai.2023.101031] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Revised: 04/16/2023] [Accepted: 04/23/2023] [Indexed: 10/03/2023]
Abstract
Background Stroke is a feared complication of transcatheter aortic valve replacement (TAVR), which embolic protection devices (EPDs) may mitigate. This systematic review and meta-analysis synthesized randomized controlled trials (RCTs) to evaluate the effect of EPDs in TAVR. Methods All RCTs comparing EPDs with control during TAVR were systematically identified. Prespecified primary end points were all stroke, disabling stroke, nondisabling stroke, and all-cause mortality. Safety and neuroimaging parameters were assessed. Sensitivity analyses were stratified by EPD type. Study registration was a priori (CRD42022377939). Results Eight trials randomizing 4043 patients were included. There was no significant difference between EPDs and control for all stroke (relative risk [RR], 0.88; 95% CI, 0.65-1.18; P = .39; I2 = 0%), disabling stroke (RR, 0.67; 95% CI, 0.31-1.46; P = .32; I2 = 8.6%), nondisabling stroke (RR, 0.99; 95% CI, 0.71-1.40; P = .97; I2 = 0%), or all-cause mortality (RR, 0.87; 95% CI, 0.43-1.78; P = .71; I2 = 2.3%). There were no differences in safety end points of bleeding, vascular complications, or acute kidney injury. EPDs did not result in differences in total lesion volume or the number of new lesions. The Sentinel EPD significantly reduced the risk of disabling stroke (RR, 0.42; 95% CI, 0.20-0.88; P = .022; I2 = 0%) but did not affect all stroke, nondisabling stroke, or all-cause mortality. Conclusions The totality of randomized data for EPDs during TAVR demonstrated no safety concerns or significant differences in clinical or neuroimaging end points. Analyses restricted to the Sentinel EPD demonstrated large, clinically meaningful reductions in disabling stroke. Ongoing RCTs may help validate these results.
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Affiliation(s)
- Rohin K. Reddy
- Cardiovascular Trials and Epidemiology Section, National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Yousif Ahmad
- Section of Cardiovascular Medicine, Yale University, New Haven, Connecticut
| | - Ahran D. Arnold
- Cardiovascular Trials and Epidemiology Section, National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - James P. Howard
- Cardiovascular Trials and Epidemiology Section, National Heart and Lung Institute, Imperial College London, London, United Kingdom
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Thong EHE, Quek EJW, Loo JH, Yun CY, Teo YN, Teo YH, Leow AST, Li TYW, Sharma VK, Tan BYQ, Yeo LLL, Chong YF, Chan MY, Sia CH. Acute Myocardial Infarction and Risk of Cognitive Impairment and Dementia: A Review. BIOLOGY 2023; 12:1154. [PMID: 37627038 PMCID: PMC10452707 DOI: 10.3390/biology12081154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Revised: 08/05/2023] [Accepted: 08/16/2023] [Indexed: 08/27/2023]
Abstract
Cognitive impairment (CI) shares common cardiovascular risk factors with acute myocardial infarction (AMI), and is increasingly prevalent in our ageing population. Whilst AMI is associated with increased rates of CI, CI remains underreported and infrequently identified in patients with AMI. In this review, we discuss the evidence surrounding AMI and its links to dementia and CI, including pathophysiology, risk factors, management and interventions. Vascular dysregulation plays a major role in CI, with atherosclerosis, platelet activation, microinfarcts and perivascular inflammation resulting in neurovascular unit dysfunction, disordered homeostasis and a dysfunctional neurohormonal response. This subsequently affects perfusion pressure, resulting in enlarged periventricular spaces and hippocampal sclerosis. The increased platelet activation seen in coronary artery disease (CAD) can also result in inflammation and amyloid-β protein deposition which is associated with Alzheimer's Dementia. Post-AMI, reduced blood pressure and reduced left ventricular ejection fraction can cause chronic cerebral hypoperfusion, cerebral infarction and failure of normal circulatory autoregulatory mechanisms. Patients who undergo coronary revascularization (percutaneous coronary intervention or bypass surgery) are at increased risk for post-procedure cognitive impairment, though whether this is related to the intervention itself or underlying cardiovascular risk factors is debated. Mortality rates are higher in dementia patients with AMI, and post-AMI CI is more prevalent in the elderly and in patients with post-AMI heart failure. Medical management (antiplatelet, statin, renin-angiotensin system inhibitors, cardiac rehabilitation) can reduce the risk of post-AMI CI; however, beta-blockers may be associated with functional decline in patients with existing CI. The early identification of those with dementia or CI who present with AMI is important, as subsequent tailoring of management strategies can potentially improve outcomes as well as guide prognosis.
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Affiliation(s)
- Elizabeth Hui En Thong
- Internal Medicine Residency, National University Health System, Singapore 119074, Singapore; (E.H.E.T.); (Y.H.T.); (A.S.T.L.)
| | - Ethan J. W. Quek
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117597, Singapore; (E.J.W.Q.); (J.H.L.); (Y.N.T.); (V.K.S.); (B.Y.Q.T.); (L.L.L.Y.); (M.Y.C.)
| | - Jing Hong Loo
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117597, Singapore; (E.J.W.Q.); (J.H.L.); (Y.N.T.); (V.K.S.); (B.Y.Q.T.); (L.L.L.Y.); (M.Y.C.)
| | - Choi-Ying Yun
- Department of Cardiology, National University Heart Centre Singapore, Singapore 119074, Singapore; (C.-Y.Y.); (T.Y.W.L.)
| | - Yao Neng Teo
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117597, Singapore; (E.J.W.Q.); (J.H.L.); (Y.N.T.); (V.K.S.); (B.Y.Q.T.); (L.L.L.Y.); (M.Y.C.)
| | - Yao Hao Teo
- Internal Medicine Residency, National University Health System, Singapore 119074, Singapore; (E.H.E.T.); (Y.H.T.); (A.S.T.L.)
| | - Aloysius S. T. Leow
- Internal Medicine Residency, National University Health System, Singapore 119074, Singapore; (E.H.E.T.); (Y.H.T.); (A.S.T.L.)
| | - Tony Y. W. Li
- Department of Cardiology, National University Heart Centre Singapore, Singapore 119074, Singapore; (C.-Y.Y.); (T.Y.W.L.)
| | - Vijay K. Sharma
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117597, Singapore; (E.J.W.Q.); (J.H.L.); (Y.N.T.); (V.K.S.); (B.Y.Q.T.); (L.L.L.Y.); (M.Y.C.)
- Division of Neurology, Department of Medicine, National University Hospital, Singapore 119074, Singapore;
| | - Benjamin Y. Q. Tan
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117597, Singapore; (E.J.W.Q.); (J.H.L.); (Y.N.T.); (V.K.S.); (B.Y.Q.T.); (L.L.L.Y.); (M.Y.C.)
- Division of Neurology, Department of Medicine, National University Hospital, Singapore 119074, Singapore;
| | - Leonard L. L. Yeo
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117597, Singapore; (E.J.W.Q.); (J.H.L.); (Y.N.T.); (V.K.S.); (B.Y.Q.T.); (L.L.L.Y.); (M.Y.C.)
- Division of Neurology, Department of Medicine, National University Hospital, Singapore 119074, Singapore;
| | - Yao Feng Chong
- Division of Neurology, Department of Medicine, National University Hospital, Singapore 119074, Singapore;
| | - Mark Y. Chan
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117597, Singapore; (E.J.W.Q.); (J.H.L.); (Y.N.T.); (V.K.S.); (B.Y.Q.T.); (L.L.L.Y.); (M.Y.C.)
- Department of Cardiology, National University Heart Centre Singapore, Singapore 119074, Singapore; (C.-Y.Y.); (T.Y.W.L.)
| | - Ching-Hui Sia
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117597, Singapore; (E.J.W.Q.); (J.H.L.); (Y.N.T.); (V.K.S.); (B.Y.Q.T.); (L.L.L.Y.); (M.Y.C.)
- Department of Cardiology, National University Heart Centre Singapore, Singapore 119074, Singapore; (C.-Y.Y.); (T.Y.W.L.)
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Robinson RG, Jorge RE, Starkstein SE. Poststroke Depression: An Update. J Neuropsychiatry Clin Neurosci 2023; 36:22-35. [PMID: 37559511 DOI: 10.1176/appi.neuropsych.21090231] [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] [Indexed: 08/11/2023]
Abstract
The presence of neuropsychiatric disorders after stroke has been recognized for more than 100 years, but controlled systematic studies did not begin until the 1970s. The most clinically important advances, however, have been in the treatment and prevention of poststroke depression (PSD). Recent meta-analyses of randomized controlled trials (RCTs) for the treatment of PSD have demonstrated the efficacy of antidepressants. Similarly, RCTs for the prevention of PSD have shown that antidepressants significantly decrease the incidence of PSD compared with placebo. Early treatment of PSD with antidepressants also appears to enhance both physical and cognitive recovery from stroke and may increase survival up to 10 years. Genetic and epigenetic variations, white matter disease, cerebrovascular deregulation, altered neuroplasticity, and changes in glutamate neurotransmission may be relevant etiological factors.
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Affiliation(s)
- Robert G Robinson
- Department of Psychiatry, Carver College of Medicine, University of Iowa, Iowa City (Robinson); Mental Health Service Line, Michael E. DeBakey Veterans Affairs Medical Center, and Division of Neuropsychiatry, Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston (Jorge); Department of Psychiatry, University of Western Australia, Perth, Australia (Starkstein)
| | - Ricardo E Jorge
- Department of Psychiatry, Carver College of Medicine, University of Iowa, Iowa City (Robinson); Mental Health Service Line, Michael E. DeBakey Veterans Affairs Medical Center, and Division of Neuropsychiatry, Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston (Jorge); Department of Psychiatry, University of Western Australia, Perth, Australia (Starkstein)
| | - Sergio E Starkstein
- Department of Psychiatry, Carver College of Medicine, University of Iowa, Iowa City (Robinson); Mental Health Service Line, Michael E. DeBakey Veterans Affairs Medical Center, and Division of Neuropsychiatry, Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston (Jorge); Department of Psychiatry, University of Western Australia, Perth, Australia (Starkstein)
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Tap L, Vernooij MW, Wolters F, van den Berg E, Mattace-Raso FUS. New horizons in cognitive and functional impairment as a consequence of cerebral small vessel disease. Age Ageing 2023; 52:afad148. [PMID: 37585592 PMCID: PMC10431695 DOI: 10.1093/ageing/afad148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 06/06/2023] [Indexed: 08/18/2023] Open
Abstract
Cerebral small vessel disease (cSVD) is a frequent finding in imaging of the brain in older adults, especially in the concomitance of cardiovascular disease risk factors. Despite the well-established link between cSVD and (vascular) cognitive impairment (VCI), it remains uncertain how and when these vascular alterations lead to cognitive decline. The extent of acknowledged markers of cSVD is at best modestly associated with the severity of clinical symptoms, but technological advances increasingly allow to identify and quantify the extent and perhaps also the functional impact of cSVD more accurately. This will facilitate a more accurate diagnosis of VCI, against the backdrop of concomitant other neurodegenerative pathology, and help to identify persons with the greatest risk of cognitive and functional deterioration. In this study, we discuss how better assessment of cSVD using refined neuropsychological and comprehensive geriatric assessment as well as modern image analysis techniques may improve diagnosis and possibly the prognosis of VCI. Finally, we discuss new avenues in the treatment of cSVD and outline how these contemporary insights into cSVD can contribute to optimise screening and treatment strategies in older adults with cognitive impairment and multimorbidity.
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Affiliation(s)
- Lisanne Tap
- Department of Internal Medicine, Section of Geriatric Medicine and Alzheimer Center Erasmus MC, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Meike W Vernooij
- Department of Radiology and Nuclear Medicine and Alzheimer Center Erasmus MC, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Frank Wolters
- Department of Epidemiology and Alzheimer Center Erasmus MC, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Esther van den Berg
- Department of Neurology and Alzheimer Center Erasmus MC, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Francesco U S Mattace-Raso
- Department of Internal Medicine, Section of Geriatric Medicine and Alzheimer Center Erasmus MC, Erasmus MC University Medical Center, Rotterdam, The Netherlands
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Marcinkowska-Gapińska A, Siemieniak I, Kawałkiewicz W, Stieler O, Hojan-Jezierska D, Kubisz L. Interdependence of Rheological and Biochemical Parameters of Blood in a Group of Patients with Clinically Silent Multifocal Vascular Cerebral Lesions. Biomedicines 2023; 11:2063. [PMID: 37509703 PMCID: PMC10376949 DOI: 10.3390/biomedicines11072063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 07/13/2023] [Accepted: 07/17/2023] [Indexed: 07/30/2023] Open
Abstract
BACKGROUND Hemorheology is a field of science which often becomes interesting to researchers studying impairments related to blood flow disturbances. Clinically silent vascular cerebral lesions (CSVCLs) are considered a problem of great importance in neurology. OBJECTIVE This work aimed to analyze the interdependencies of the rheological and biochemical parameters of the blood. METHODS The group of patients included persons with clinically silent multifocal vascular cerebral lesions diagnosed using neuroimaging. The control group had no symptoms in the central nervous system (CNS). We analyzed hemorheological profiles in 69 patients with CSVCLs diagnosed via magnetic resonance imaging (MR) or 64-row computer tomography measurements. Rheological data were acquired using a rotary-oscillating rheometer, the Contraves LS-40, an instrument dedicated to blood viscosity measurements. For each sample, the hematocrit value was measured using the standard method. Analysis of erythrocytes' aggregability and deformability was performed using the rheological model of Quemada. Biochemical tests of blood were also performed. RESULTS The results of rheological and biochemical studies were compared with those obtained in the control group. Special attention was paid to the correlation analysis of rheological and biochemical parameters. CONCLUSIONS Such correlations were found, e.g., between the red cells' deformability and the fibrinogen level. The results improve our understanding of blood flow hemodynamics by analyzing the shear-dependent behavior of the aggregation and deformability of red blood cells.
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Affiliation(s)
| | - Izabela Siemieniak
- Rheological Laboratory, Department of Neurology, Poznan University of Medical Sciences, 61-701 Poznań, Poland
| | - Weronika Kawałkiewicz
- Department of Biophysics, Poznan University of Medical Sciences, 61-701 Poznań, Poland
| | - Olgierd Stieler
- Department of Hearing Healthcare Profession, Poznan University of Medical Sciences, 61-701 Poznań, Poland
| | - Dorota Hojan-Jezierska
- Department of Hearing Healthcare Profession, Poznan University of Medical Sciences, 61-701 Poznań, Poland
| | - Leszek Kubisz
- Department of Biophysics, Poznan University of Medical Sciences, 61-701 Poznań, Poland
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Hua M, Ma AJ, Liu ZQ, Ji LL, Zhang J, Xu YF, Chen WY, Mao LL. Arteriolosclerosis CSVD: a common cause of dementia and stroke and its association with cognitive function and total MRI burden. Front Aging Neurosci 2023; 15:1163349. [PMID: 37520130 PMCID: PMC10375409 DOI: 10.3389/fnagi.2023.1163349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Accepted: 06/26/2023] [Indexed: 08/01/2023] Open
Abstract
Objective Arteriolosclerosis cerebral small vessel disease (CSVD) is a common type of CSVD. This study aimed to explore the factors associated with cognitive function and total MRI burden related to the disease. Methods The demographic characteristics, clinical manifestations, cognitive function score, Barthel Index (BI), blood test index, and follow-up results of arteriolosclerosis CSVD patients treated for the first time in our hospital from January 2014 to August 2022 were collected. White matter hyperintensity (WMH) Fazekas score, total MRI burden, and cerebral atrophy grade were evaluated according to brain MRI findings. Factors associated with CSVD cognitive function were analyzed by binary logistic regression. The correlative factors related to the total MRI burden of CSVD were analyzed by ordered multiple logistic regression. Results A total of 146 patients were included in this study, of which 132 cases (90.4%) had hypertension. There were 108 patients (74.0%) with cognitive dysfunction, 97 patients (66.4%) with balance and gait disorders, and 83 patients (56.8%) with moderate-to-severe dependence in daily life (BI ≤ 60 points). Of 146 patients, 79 (54.1%) completed clinical and imaging follow-ups for a median of 3 years. The number of patients with cognitive impairment and BI ≤ 60 points after follow-up significantly increased compared with the first admission (P < 0.001). There were also significant differences in total MRI burden (P = 0.001), WMH Fazekas score, and cerebral atrophy grade (P < 0.001). Mean age (P = 0.012), median deep WMH Fazekas score (P = 0.028), and median deep (P < 0.001) and superficial (P =0.002) cerebral atrophy grade of patients with cognitive impairment at first admission were all higher than those with non-cognitive impairment. Multivariate analysis showed that deep cerebral atrophy was independently and significantly associated with cognitive impairment of CSVD (P = 0.024), and hypertension was significantly and independently associated with total MRI burden (P = 0.001). Conclusion The disease course of arteriolosclerosis CSVD may be related to cognitive function and total MRI burden. Deep cerebral atrophy was an independent risk factor for cognitive dysfunction in arteriolosclerosis CSVD, and hypertension was an independent risk factor for total MRI burden.
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Affiliation(s)
| | | | | | | | | | | | - Wen-Ya Chen
- Department of Neurology, Wujin Hospital Affiliated to Jiangsu University, The Wujin Clinical College of Xuzhou Medical University, Changzhou, Jiangsu, China
| | - Lun-Lin Mao
- Department of Neurology, Wujin Hospital Affiliated to Jiangsu University, The Wujin Clinical College of Xuzhou Medical University, Changzhou, Jiangsu, China
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Inoue Y, Shue F, Bu G, Kanekiyo T. Pathophysiology and probable etiology of cerebral small vessel disease in vascular dementia and Alzheimer's disease. Mol Neurodegener 2023; 18:46. [PMID: 37434208 PMCID: PMC10334598 DOI: 10.1186/s13024-023-00640-5] [Citation(s) in RCA: 25] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 06/28/2023] [Indexed: 07/13/2023] Open
Abstract
Vascular cognitive impairment and dementia (VCID) is commonly caused by vascular injuries in cerebral large and small vessels and is a key driver of age-related cognitive decline. Severe VCID includes post-stroke dementia, subcortical ischemic vascular dementia, multi-infarct dementia, and mixed dementia. While VCID is acknowledged as the second most common form of dementia after Alzheimer's disease (AD) accounting for 20% of dementia cases, VCID and AD frequently coexist. In VCID, cerebral small vessel disease (cSVD) often affects arterioles, capillaries, and venules, where arteriolosclerosis and cerebral amyloid angiopathy (CAA) are major pathologies. White matter hyperintensities, recent small subcortical infarcts, lacunes of presumed vascular origin, enlarged perivascular space, microbleeds, and brain atrophy are neuroimaging hallmarks of cSVD. The current primary approach to cSVD treatment is to control vascular risk factors such as hypertension, dyslipidemia, diabetes, and smoking. However, causal therapeutic strategies have not been established partly due to the heterogeneous pathogenesis of cSVD. In this review, we summarize the pathophysiology of cSVD and discuss the probable etiological pathways by focusing on hypoperfusion/hypoxia, blood-brain barriers (BBB) dysregulation, brain fluid drainage disturbances, and vascular inflammation to define potential diagnostic and therapeutic targets for cSVD.
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Affiliation(s)
- Yasuteru Inoue
- Department of Neuroscience, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL 32224 USA
| | - Francis Shue
- Department of Neuroscience, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL 32224 USA
| | - Guojun Bu
- SciNeuro Pharmaceuticals, Rockville, MD 20850 USA
| | - Takahisa Kanekiyo
- Department of Neuroscience, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL 32224 USA
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Rebelos E, Malloggi E, Parenti M, Dardano A, Tura A, Daniele G. Near-Infrared Spectroscopy: A Free-Living Neuroscience Tool to Better Understand Diabetes and Obesity. Metabolites 2023; 13:814. [PMID: 37512521 PMCID: PMC10384622 DOI: 10.3390/metabo13070814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 06/25/2023] [Accepted: 06/30/2023] [Indexed: 07/30/2023] Open
Abstract
The human brain is the least accessible of all organs and attempts to study it in vivo rely predominantly on neuroimaging. Functional near-infrared spectroscopy (fNIRS) allows for the study of cortical neural activity in a non-invasive manner that may resemble free-living conditions. Moreover, compared to other neuroimaging tools, fNIRS is less expensive, it does not require the use of ionizing radiation, and can be applied to all study populations (patients suffering from claustrophobia, or neonates). In this narrative review, we provide an overview of the available research performed using fNIRS in patients with diabetes and obesity. The few studies conducted to date have presented controversial results regarding patients with diabetes, some reporting a greater hemodynamic response and others reporting a reduced hemodynamic response compared to the controls, with an unclear distinction between types 1 and 2. Subjects with obesity or a binge eating disorder have reduced prefrontal activation in response to inhibitory food or non-food stimuli; however, following an intervention, such as cognitive treatment, prefrontal activation is restored. Moreover, we discuss the potential of future applications of fNIRS for a better understanding of cortical neural activity in the context of metabolic disorders.
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Affiliation(s)
- Eleni Rebelos
- Department of Clinical and Experimental Medicine, University of Pisa, 56126 Pisa, Italy
| | - Eleonora Malloggi
- Department of Clinical and Experimental Medicine, University of Pisa, 56126 Pisa, Italy
| | - Martina Parenti
- Department of Clinical and Experimental Medicine, University of Pisa, 56126 Pisa, Italy
| | - Angela Dardano
- Department of Clinical and Experimental Medicine, University of Pisa, 56126 Pisa, Italy
- CISUP, Center for Instrument Sharing, University of Pisa, 56124 Pisa, Italy
| | - Andrea Tura
- CNR Institute of Neuroscience, 35131 Padova, Italy
| | - Giuseppe Daniele
- Department of Clinical and Experimental Medicine, University of Pisa, 56126 Pisa, Italy
- CISUP, Center for Instrument Sharing, University of Pisa, 56124 Pisa, Italy
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Suh YR, Lee HK, Jung KH, Lee JS, Choi JC. [Neuroimaging Characteristics of Cerebral Autosomal Dominant Arteriopathy with Subcortical Infarcts and Leukoencephalopathy (CADASIL) in Korean Based on Jeju Cohort: A Pictorial Essay]. JOURNAL OF THE KOREAN SOCIETY OF RADIOLOGY 2023; 84:855-865. [PMID: 37559811 PMCID: PMC10407072 DOI: 10.3348/jksr.2023.0004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Revised: 02/14/2023] [Accepted: 03/16/2023] [Indexed: 08/11/2023]
Abstract
Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) is a hereditary small artery vasculopathy caused by mutations in the NOTCH3 gene on chromosome 19. Jeju Island has the highest reported prevalence of CADASIL patients in the world. Even though most studies on the neuroimaging characteristics of CADASIL have focused on Western populations, there are notable differences in Korean CADASIL patients compared to those in Western countries, which may impact their clinical manifestations and prognosis. Herein, this pictorial essay presents the neuroimaging patterns of CADASIL in patients in Korea, with an emphasis on the differences observed from previous reports based on a Western patient population.
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40
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Bilski AE, Aparicio HJ, Gutierrez J, de Leeuw FE, Hilkens N. Antiplatelet Therapy or Not for Asymptomatic/Incidental Lacunar Infarction. Stroke 2023; 54:1954-1959. [PMID: 37191009 PMCID: PMC10421561 DOI: 10.1161/strokeaha.122.040444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Accepted: 04/11/2023] [Indexed: 05/17/2023]
Affiliation(s)
- Amanda E Bilski
- Department of Neurology, New York Presbyterian Hospital/ Columbia University Irving Medical Center
| | - Hugo J. Aparicio
- Department of Neurology, Boston University Chobanian & Avedisian School of Medicine
- Boston Medical Center
| | - Jose Gutierrez
- Department of Neurology, New York Presbyterian Hospital/ Columbia University Irving Medical Center
| | - Frank-Erik de Leeuw
- Department of Neurology, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands
| | - Nina Hilkens
- Department of Neurology, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands
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Zhang L, Wang S, Qiu L, Jiang J, Jiang J, Zhou Y, Ding D, Fang Q. Effects of silent brain infarction on the hemorrhagic transformation and prognosis in patients with acute ischemic stroke after intravenous thrombolysis. Front Neurol 2023; 14:1147290. [PMID: 37251227 PMCID: PMC10212719 DOI: 10.3389/fneur.2023.1147290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Accepted: 04/25/2023] [Indexed: 05/31/2023] Open
Abstract
Background Silent brain infarction (SBI) is a special type of stroke with no definitive time of onset, which can be found on pre-thrombolysis imaging examination in some patients with acute ischemic stroke (AIS). However, the significance of SBI on intracranial hemorrhage transformation (HT) and clinical outcomes after intravenous thrombolysis therapy (IVT) is uncertain. We aimed to explore the effects of SBI on intracranial HT and the 3-month clinical outcome in patients with AIS after IVT. Methods We consecutive collected patients who were diagnosed with ischemic stroke and received IVT from August 2016 to August 2022, and conducted a retrospective analysis in this study. The clinical and laboratory data were obtained from hospitalization data. Patients were divided into SBI and Non-SBI groups based on clinical and neuroimaging data. We use Cohen's Kappa to assess the interrater reliability between the two evaluators, and multivariate logistic regression analysis was used to further assess the association between SBI, HT and clinical outcomes at 3 months after IVT. Results Of the 541 patients, 231 (46.1%) had SBI, 49 (9.1%) had HT, 438 (81%) had favorable outcome, 361 (66.7%) had excellent outcome. There was no significant difference in the incidence of HT (8.2 vs. 9.7%, p = 0.560) and favorable outcome (78.4% vs. 82.9%, p = 0.183) between patients with SBI and Non-SBI. However, patients with SBI had a lower incidence of excellent outcome than the patients with Non-SBI (60.2% vs. 71.6%%, p = 0.005). After adjustment for major covariates, multivariate logistic regression analysis disclosed that SBI was independently associated with the increased risk of worse outcome (OR = 1.922, 95%CI: 1.229-3.006, p = 0.004). Conclusion We found that SBI was no effect for HT after thrombolysis in ischemic stroke patients, and no effect on favorable functional outcome at 3 months. Nevertheless, SBI remained an independent risk factor for non-excellent functional outcomes at 3 months.
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Affiliation(s)
- Lulu Zhang
- Department of Neurology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Shan Wang
- Department of Neurology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Lanfeng Qiu
- Department of Emergency, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Juean Jiang
- Department of General Medicine, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Jianhua Jiang
- Department of Neurology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Yun Zhou
- Department of Neurology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Dongxue Ding
- Department of Neurology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Qi Fang
- Department of Neurology, The First Affiliated Hospital of Soochow University, Suzhou, China
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Sedaghat S, Ji Y, Empana JP, Hughes TM, Mosley TH, Gottesman RF, Griswold M, Jack CR, Lutsey PL, van Sloten TT. Changes in Cardiovascular Health Across Midlife and Late-Life and Magnetic Resonance Imaging Markers of Cerebral Vascular Disease in Late-Life. Stroke 2023; 54:1280-1288. [PMID: 36951053 PMCID: PMC10133201 DOI: 10.1161/strokeaha.122.041374] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Accepted: 02/17/2023] [Indexed: 03/24/2023]
Abstract
BACKGROUND Cardiovascular health may be used for prevention of cerebral vascular disease; however, data on the association of cardiovascular health across midlife and late-life with late-life cerebral vascular disease are lacking. Our aim was to examine whether midlife or late-life cardiovascular health as well as changes of cardiovascular health within midlife and between midlife and late-life were associated with prevalence of magnetic resonance imaging markers of cerebral vascular disease at late-life. METHODS Prospective cohort study including 1638 participants from the Atherosclerosis Risk in Communities Study who took part in 2 visits at midlife (mean ages, 53 and 59 years), and a late-life visit (mean age, 76 years). A cardiovascular health Life's Simple 7 score (range, 0-12/0-14, depending on diet availability) including 6 out of 7 items was calculated at each visit, with weight assigned to each item as poor (0), intermediate (1), or ideal (2). Participants underwent 3T brain magnetic resonance imaging scans in late-life visit. Outcomes were white matter hyperintensity volume, microbleeds, and lacunar, subcortical, and cortical infarcts at late-life. Linear and logistic regression models were used to assess the associations of cardiovascular health in midlife and late-life, and improvement of cardiovascular health within midlife, and from midlife to late-life with magnetic resonance imaging markers of cerebral vascular disease, adjusting for potential confounders. RESULTS A higher cardiovascular health in midlife, improvement of cardiovascular health within midlife, higher cardiovascular health at late-life, and improvement of cardiovascular health from midlife to late-life were associated with a lower prevalence of cerebral vascular disease markers. For example, improvement in cardiovascular health (per point) from midlife to late-life was associated with smaller white matter hyperintensity volume (β, -0.07 [95% CI, -0.10 to -0.04]) and lower odds of microbleeds (odds ratio, 0.93 [0.90-0.97]), lacunar (odds ratio, 0.93 [0.89-0.97]), subcortical (odds ratio, 0.93 [0.89-0.97]), and cortical infarcts (odds ratio, 0.92 [0.87-0.97]). CONCLUSIONS Improving cardiovascular health within midlife and from midlife to late-life may prevent development of cerebral vascular disease.
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Affiliation(s)
- Sanaz Sedaghat
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, MN, USA
| | - Yuekai Ji
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, MN, USA
| | - Jean-Philippe Empana
- Université de Paris, INSERM, UMR-S970, Paris Cardiovascular Research Center, Integrative Epidemiology of Cardiovascular Disease (Team 4), Paris, France
| | | | - Thomas H Mosley
- Division of Geriatrics, Department of Medicine, University of Mississippi Medical Center, MS, USA
| | - Rebecca F Gottesman
- Stroke Branch, Intramural Research Program, National Institute of Neurological Disorders and Stroke, Bethesda, MD, USA
| | - Michael Griswold
- Center of Biostatistics and Bioinformatics, University of Mississippi Medical Center, Jackson, MS, USA
| | | | - Pamela L Lutsey
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, MN, USA
| | - Thomas T van Sloten
- Department of Vascular Medicine, University Medical Center Utrecht, Utrecht, the Netherlands
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Russell EJ. A Rock and a Hard Place: Benefit and Risk in the Evolving Practice of Endovascular Therapy for Intracranial Atherosclerotic Stenosis. Radiology 2023; 307:e230493. [PMID: 36975822 PMCID: PMC10323285 DOI: 10.1148/radiol.230493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2023] [Revised: 03/06/2023] [Accepted: 03/07/2023] [Indexed: 03/29/2023]
Affiliation(s)
- Eric J. Russell
- From the Department of Radiology, Northwestern Medicine, 676 N St
Clair St, Suite 1400, Chicago, IL 60611
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Cabrera JÁ, Urmeneta Ulloa J, Jímenez de la Peña M, Rubio Alonso M, López Gavilán M, Bayona Horta S, Pizarro G, Simon K, Migoya T, Martínez de Vega V. White-Matter Lesions and Cortical Cerebral Blood Flow Evaluation by 3D Arterial Spin-Labeled Perfusion MRI in Asymptomatic Divers: Correlation with Patent Foramen Ovale Ocurrence. J Clin Med 2023; 12:jcm12082866. [PMID: 37109204 PMCID: PMC10141148 DOI: 10.3390/jcm12082866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Revised: 03/31/2023] [Accepted: 04/13/2023] [Indexed: 04/29/2023] Open
Abstract
Cerebral white-matter lesions (cWML) can be caused by dilation of Virchow-Robin spaces or may correspond to true lacunar ischemic lesions. The aim of our study was to evaluate in asymptomatic divers the relationship between the presence of patent foramen ovale (PFO) and cWML, as well as their possible effects on cortical cerebral blood flow (CBF) by magnetic resonance (MRI) through the arterial spin labeling (ASL) sequence. Transthoracic echocardiography was performed for the identification of PFO, and cerebral magnetic resonance including the 3D-ASL sequence for CBF quantification. Thirty-eight divers, with a mean age 45.8 ± 8.6 years, were included. Nineteen healthy volunteers, mean age 41 ± 15.2 years, served as the control group. A total of 28.9% of divers had completed more than 1000 dives. It was found that 26.3% of divers presented with PFO in the echocardiographic study. cWML was evidenced in 10.5% of diver MRI studies. There was no statistically significant relationship between the presence of PFO and cWML (p = 0.95). We observed a lower blood flow in all brain areas assessed by the 3D-ASL sequence in the group of divers, compared with the control group. We did not find statistical differences in CBF as a function of the presence or absence of PFO, number of dives, or cWML evidence.
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Affiliation(s)
- José Ángel Cabrera
- Cardiology Department, Hospital Universitario Quirónsalud Madrid, 28223 Madrid, Spain
| | - Javier Urmeneta Ulloa
- Cardiology Department, Hospital Universitario Quirónsalud Madrid, 28223 Madrid, Spain
- Radiology Department, Hospital Universitario Quirónsalud Madrid, 28223 Madrid, Spain
| | | | - Margarita Rubio Alonso
- Faculty of Biomedical and Health Sciences, Universidad Europea de Madrid, 28670 Madrid, Spain
| | | | - Silvia Bayona Horta
- Cardiology Department, Hospital Universitario Quirónsalud Madrid, 28223 Madrid, Spain
| | - Gonzalo Pizarro
- Cardiology Department, Hospital Ruber Juan Bravo, Grupo Quirónsalud, 28006 Madrid, Spain
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Barha CK, Starkey SY, Hsiung GYR, Tam R, Liu-Ambrose T. Aerobic exercise improves executive functions in females, but not males, without the BDNF Val66Met polymorphism. Biol Sex Differ 2023; 14:16. [PMID: 37013586 PMCID: PMC10069071 DOI: 10.1186/s13293-023-00499-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Accepted: 03/10/2023] [Indexed: 04/05/2023] Open
Abstract
BACKGROUND Aerobic exercise promotes cognitive function in older adults; however, variability exists in the degree of benefit. The brain-derived neurotropic factor (BDNF) Val66Met polymorphism and biological sex are biological factors that have been proposed as important modifiers of exercise efficacy. Therefore, we assessed whether the effect of aerobic exercise on executive functions was dependent on the BDNFval66met genotype and biological sex. METHODS We used data from a single-blind randomized controlled trial in older adults with subcortical ischemic vascular cognitive impairment (NCT01027858). Fifty-eight older adults were randomly assigned to either the 6 months, three times per week progressive aerobic training (AT) group or the usual care plus education control (CON) group. The secondary aim of the parent study included executive functions which were assessed with the Trail Making Test (B-A) and the Digit Symbol Substitution Test at baseline and trial completion at 6 months. RESULTS Analysis of covariance, controlling for baseline global cognition and baseline executive functions performance (Trail Making Test or Digit Symbol Substitution Test), tested the three-way interaction between experimental group (AT, CON), BDNFval66met genotype (Val/Val carrier, Met carrier), and biological sex (female, male). Significant three-way interactions were found for the Trail Making Test (F(1,48) = 4.412, p < 0.04) and Digit Symbol Substitution Test (F(1,47) = 10.833, p < 0.002). Posthoc analyses showed female Val/Val carriers benefited the most from 6 months of AT compared with CON for Trail Making Test and Digit Symbol Substitution Test performance. Compared with CON, AT did not improve Trail Making Test performance in male Val/Val carriers or Digit Symbol Substitution Test performance in female Met carriers. CONCLUSIONS These results suggest that future randomized controlled trials should take into consideration BDNF genotype and biological sex to better understand the beneficial effects of AT on cognitive function in vascular cognitive impairment to maximize the beneficial effects of exercise and help establish exercise as medicine for cognitive health.
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Affiliation(s)
- Cindy K Barha
- Aging, Mobility, and Cognitive Neuroscience Lab, Department of Physical Therapy, University of British Columbia, Vancouver, Canada
- Djavad Mowafaghian Centre for Brain Health C/O Liu-Ambrose Lab, 2215 Wesbrook Mall, Vancouver, BC, V6T 2B5, Canada
- Centre for Hip Health and Mobility, Vancouver, Canada
- Faculty of Kinesiology, University of Calgary, Calgary, AB, Canada
| | - Samantha Y Starkey
- Aging, Mobility, and Cognitive Neuroscience Lab, Department of Physical Therapy, University of British Columbia, Vancouver, Canada
- Centre for Hip Health and Mobility, Vancouver, Canada
- Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - G Y Robin Hsiung
- Djavad Mowafaghian Centre for Brain Health C/O Liu-Ambrose Lab, 2215 Wesbrook Mall, Vancouver, BC, V6T 2B5, Canada
- Division of Neurology, University of British Columbia, Vancouver, Canada
- Vancouver Coastal Health Research Institute and University of British Columbia Hospital Clinic for Alzheimer Disease and Related Disorders, Vancouver, Canada
| | - Roger Tam
- Djavad Mowafaghian Centre for Brain Health C/O Liu-Ambrose Lab, 2215 Wesbrook Mall, Vancouver, BC, V6T 2B5, Canada
- School of Biomedical Engineering, University of British Columbia, Vancouver, Canada
| | - Teresa Liu-Ambrose
- Aging, Mobility, and Cognitive Neuroscience Lab, Department of Physical Therapy, University of British Columbia, Vancouver, Canada.
- Djavad Mowafaghian Centre for Brain Health C/O Liu-Ambrose Lab, 2215 Wesbrook Mall, Vancouver, BC, V6T 2B5, Canada.
- Centre for Hip Health and Mobility, Vancouver, Canada.
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Liu Q, Zhang X. Multimodality neuroimaging in vascular mild cognitive impairment: A narrative review of current evidence. Front Aging Neurosci 2023; 15:1073039. [PMID: 37009448 PMCID: PMC10050753 DOI: 10.3389/fnagi.2023.1073039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Accepted: 02/24/2023] [Indexed: 03/17/2023] Open
Abstract
The vascular mild cognitive impairment (VaMCI) is generally accepted as the premonition stage of vascular dementia (VaD). However, most studies are focused mainly on VaD as a diagnosis in patients, thus neglecting the VaMCI stage. VaMCI stage, though, is easily diagnosed by vascular injuries and represents a high-risk period for the future decline of patients’ cognitive functions. The existing studies in China and abroad have found that magnetic resonance imaging technology can provide imaging markers related to the occurrence and development of VaMCI, which is an important tool for detecting the changes in microstructure and function of VaMCI patients. Nevertheless, most of the existing studies evaluate the information of a single modal image. Due to the different imaging principles, the data provided by a single modal image are limited. In contrast, multi-modal magnetic resonance imaging research can provide multiple comprehensive data such as tissue anatomy and function. Here, a narrative review of published articles on multimodality neuroimaging in VaMCI diagnosis was conducted,and the utilization of certain neuroimaging bio-markers in clinical applications was narrated. These markers include evaluation of vascular dysfunction before tissue damages and quantification of the extent of network connectivity disruption. We further provide recommendations for early detection, progress, prompt treatment response of VaMCI, as well as optimization of the personalized treatment plan.
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Affiliation(s)
- Qiuping Liu
- First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, China
- National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, China
- Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Xuezhu Zhang
- First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, China
- National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, China
- *Correspondence: Xuezhu Zhang,
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Lucci C, Rissanen I, de Jong PA, Kappelle LJ, Hendrikse J, Geerlings MI. Ischemic stroke recurrence and mortality in different imaging phenotypes of ischemic cerebrovascular disease: The SMART-MR Study. Eur Stroke J 2023; 8:522-531. [DOI: 10.1177/23969873231162122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/12/2023] Open
Abstract
Background: Diagnosis of cerebrovascular disease is based on both clinical and radiological findings, however, they do not always correlate. Aims: To investigate ischemic stroke recurrence and mortality in patients with different imaging phenotypes of ischemic cerebrovascular disease. Methods: Within the SMART-MR study, a prospective patient cohort with arterial disease, cerebrovascular diseases of participants at baseline were classified as no cerebrovascular disease (reference group, n = 828), symptomatic cerebrovascular disease ( n = 204), covert vascular lesions ( n = 156), or imaging negative ischemia ( n = 90) based upon clinical and MRI findings. Ischemic strokes and deaths were collected at 6 month-intervals up to 17 years of follow-up. With Cox regression, relationships between phenotype and ischemic stroke recurrence, cardiovascular mortality, and non-vascular mortality were studied adjusted for age, sex, and cardiovascular risk factors. Results: Compared to reference group risk for recurrent ischemic stroke was increased not only in the symptomatic cerebrovascular disease (HR 3.9, 95% CI 2.3–6.6), but also in the covert vascular lesion (HR 2.5, 95% CI 1.3–4.8) and the imaging negative ischemia groups (HR 2.4, 95% CI 1.1–5.5). Risk for cardiovascular mortality was increased in the symptomatic cerebrovascular disease (HR 2.2, 95% CI 1.5–3.2) and covert vascular lesions groups (HR 2.3, 95% CI 1.5–3.4), while the risk was less strong but also increased in the imaging negative ischemia group (HR 1.7, 95% CI 0.9–3.0). Conclusions: People with all imaging phenotypes of cerebrovascular disease have increased risk of recurrent ischemic stroke and mortality compared to other arterial diseases. Strict preventive measures should be performed even when imaging findings or clinical symptoms are absent. Data access statement: For use of anonymized data, a reasonable request has to be made in writing to the UCC-SMART study group and the third party has to sign a confidentiality agreement.
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Affiliation(s)
- Carlo Lucci
- Department of Radiology, University Medical Center Utrecht and Utrecht University, Utrecht, The Netherlands
| | - Ina Rissanen
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht and Utrecht University, Utrecht, The Netherlands
| | - Pim A de Jong
- Department of Radiology, University Medical Center Utrecht and Utrecht University, Utrecht, The Netherlands
| | - L Jaap Kappelle
- Department of Neurology, University Medical Center Utrecht and Utrecht University, Utrecht, The Netherlands
| | - Jeroen Hendrikse
- Department of Radiology, University Medical Center Utrecht and Utrecht University, Utrecht, The Netherlands
| | - Mirjam I Geerlings
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht and Utrecht University, Utrecht, The Netherlands
- Department of General Practice, Amsterdam UMC, Location University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Public Health, Aging & Later Life, and Personalized Medicine, Amsterdam, The Netherlands
- Amsterdam Neuroscience, Neurodegeneration, and Mood, Anxiety, Psychosis, Stress, and Sleep, Amsterdam, The Netherlands
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48
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Association between total cerebral small vessel disease score and cognitive function in patients with vascular risk factors. Hypertens Res 2023; 46:1326-1334. [PMID: 36894746 DOI: 10.1038/s41440-023-01244-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Revised: 02/02/2023] [Accepted: 02/10/2023] [Indexed: 03/11/2023]
Abstract
Hypertension is the most important risk factor for cerebral small vessel disease (SVD). In this cross-sectional study, we tested the independent association of cerebral SVD burden with global cognitive function and each cognitive domain in patients with vascular risk factors. The Tokyo Women's Medical University Cerebral Vessel Disease (TWMU CVD) registry is an ongoing prospective, observational registry in which patients with any evidence of CVD in magnetic resonance imaging (MRI) and at least one vascular risk factor were consecutively enrolled. For SVD-related findings, we evaluated white matter hyperintensity, lacunar infarction, cerebral microbleeds, enlarged perivascular space, and medial temporal atrophy. We used the total SVD score as the SVD burden. They underwent the Mini-mental State Examination (MMSE) and Japanese version of the Montreal Cognitive Assessment (MoCA-J) global cognitive tests, and each cognitive domain was evaluated. After excluding patients without MRI T2* images and those with MMSE score <24, we analyzed 648 patients. The total SVD score was significantly associated with MMSE and MoCA-J scores. After adjustment for age, sex, education, risk factors, and medial temporal atrophy, the association between the total SVD score and MoCA-J score remained significant. The total SVD score was independently associated with attention. In conclusion, the total SVD score, cerebral SVD burden, was independently association with global cognitive function and attention. A strategy to reduce SVD burden will have the potential to prevent cognitive decline. A total of 648 patients with any evidence of cerebral small vessel disease (SVD) in MRI and at least one vascular risk factor underwent Mini-mental State Examination (MMSE) and Japanese version of the Montreal Cognitive Assessment (MoCA-J) global cognitive tests. The total SVD scores count the presence of each SVD-related findings (white matter hyperintensity, Lacunar infarction, cerebral microbleeds and enlarged perivascular space), ranging from 0 to 4, as the SVD burden. Total SVD scores were significantly associated with MoCA-J scores (r = -0.203, P < 0.001). After adjustment for age, sex, education, risk factors, and medial temporal atrophy, the association between the total SVD score and global cognitive scores remained significant.
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Oussoren FK, van Leeuwen RB, Schermer TR, Poulsen LNF, Kardux JJ, Bruintjes TD. Cerebral Small Vessel Disease in Elderly Patients with Sudden Sensorineural Hearing Loss. Otol Neurotol 2023; 44:e171-e177. [PMID: 36727811 PMCID: PMC9924965 DOI: 10.1097/mao.0000000000003813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND The cause of sudden sensorineural hearing loss (SSNHL) is uncertain in a significant number of patients. A vascular etiology has been proposed because SSNHL increases the risk of developing a stroke. Cardiovascular risk factors can cause cerebral small vessel disease (CSVD). The presence of CSVD in turn raises the risk of stroke. AIM The aim of this study was to compare the presence of CSVD and cardiovascular risk factors in elderly patients with idiopathic SSNHL (iSSNHL) to a control cohort. METHOD Patients with iSSNHL of 50 years and older were compared with a control cohort with patients suspected of trigeminal neuralgia or vestibular paroxysmia. The primary outcome was the difference in the number of white matter hyperintensities using the ordinal Fazekas scale. Secondary outcomes were the presence of brain infarctions on MRI and the difference in cardiovascular risk factors. RESULTS In the SSNHL cohort, Fazekas score 2 was most frequently seen compared with Fazekas 1 in the control cohort. The distribution of Fazekas scores did not differ significantly. The sum of the Fazekas scores were 13,925 and 14,042 for iSSNHL and controls, respectively ( p = 0.908). Brain infarctions were seen in 8 patients with iSSNHL (n = 118) and in 13 patients in the control cohort (n = 118) ( p = 0.361). None of the cardiovascular risk factors were more frequently seen in the iSSNHL cohort. CONCLUSION Patients with iSSNHL did not exhibit more CSVD on MRI than controls. This result is in contrast with previous literature demonstrating a higher risk of stroke in patients with iSSNHL than in controls. A prospective analysis with a larger study population is therefore warranted.
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Affiliation(s)
- Fieke K. Oussoren
- Apeldoorn Dizziness Centre, Gelre Hospitals, Apeldoorn, The Netherlands
- Department of Otorhinolaryngology, Leiden University Medical Center, Leiden, The Netherlands
| | | | - Tjard R. Schermer
- Department of Primary and Community Care, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | | | - Joost J. Kardux
- Department of Primary and Community Care, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Tjasse D. Bruintjes
- Apeldoorn Dizziness Centre, Gelre Hospitals, Apeldoorn, The Netherlands
- Department of Otorhinolaryngology, Leiden University Medical Center, Leiden, The Netherlands
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50
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Jensen M, Zeller T, Twerenbold R, Thomalla G. Circulating cardiac biomarkers, structural brain changes, and dementia: Emerging insights and perspectives. Alzheimers Dement 2023; 19:1529-1548. [PMID: 36735636 DOI: 10.1002/alz.12926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Accepted: 12/19/2022] [Indexed: 02/04/2023]
Abstract
Diseases of the heart and brain are strongly linked to each other, and cardiac dysfunction is associated with cognitive decline and dementia. This link between cardiovascular disease and dementia offers opportunities for dementia prevention through prevention and treatment of cardiovascular risk factors and heart disease. Increasing evidence suggests the clinical utility of cardiac biomarkers as risk markers for structural brain changes and cognitive impairment. We propose the hypothesis that structural brain changes are the link between impaired cardiac function, as captured by blood-based cardiac biomarkers, and cognitive impairment. This review provides an overview of the literature and illustrates emerging insights into the association of markers of hemodynamic stress (natriuretic peptides) and markers of myocardial injury (cardiac troponins) with imaging findings of brain damage and cognitive impairment or dementia. Based on these findings, we discuss potential pathophysiological mechanisms underlying the association of cardiac biomarkers with structural brain changes and dementia. We suggest testable hypotheses and a research plan to close the gaps in understanding the mechanisms linking vascular damage and neurodegeneration, and to pave the way for targeted effective interventions for dementia prevention. From a clinical perspective, cardiac biomarkers open the window for early identification of patients at risk of dementia, who represent a target population for preventive interventions targeting modifiable cardiovascular risk factors to avert cognitive decline and dementia.
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Affiliation(s)
- Märit Jensen
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,German Centre for Cardiovascular Research (DZHK e.V.), Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany
| | - Tanja Zeller
- German Centre for Cardiovascular Research (DZHK e.V.), Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany.,University Center of Cardiovascular Science, University Heart and Vascular Center Hamburg, Clinic for Cardiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Raphael Twerenbold
- German Centre for Cardiovascular Research (DZHK e.V.), Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany.,University Center of Cardiovascular Science, University Heart and Vascular Center Hamburg, Clinic for Cardiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Götz Thomalla
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,German Centre for Cardiovascular Research (DZHK e.V.), Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany
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