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Lambert AT, Sætre DO, Ratajczak-Tretel B, Gleditsch J, Høie G, Al-Ani R, Pesonen M, Atar D, Aamodt AH. Imaging features for the identification of atrial fibrillation in cryptogenic stroke patients. J Neurol 2024:10.1007/s00415-024-12397-y. [PMID: 38904781 DOI: 10.1007/s00415-024-12397-y] [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: 03/16/2024] [Revised: 04/18/2024] [Accepted: 04/22/2024] [Indexed: 06/22/2024]
Abstract
BACKGROUND Whether specific imaging aspects can be used to identify cryptogenic stroke (CS) patients with high risk of underlying atrial fibrillation (AF) remains unclear. The purpose of this study was to evaluate brain-imaging features in CS patients and their utility as AF predictors. METHODS The Nordic Atrial Fibrillation and Stroke study was a prospective observational study of CS and transient ischemic attack patients undergoing 12-month cardiac-rhythm monitoring, biomarker and clinical assessments. In this imaging sub-study, brain magnetic resonance imaging and computed tomography scans from 106 patients were assessed for acute and chronic ischemic lesions in relation to AF occurrence and included in a score to predict AF. Receiver operating characteristics (ROC) curve was used to evaluate the discriminative ability of the score and for its dichotomization for predictive model. RESULTS Age, periventricular white-matter hyperintensities (PVWMH), acute lesion size, and vessel occlusion were significantly associated with AF. Acute and chronic cortical infarcts as well as chronic cerebellar infarcts were numerically more frequent in the AF group than the non-AF group. A score consisting of six features (0-6 points) was proposed (age ≥ 65 years, chronic cortical or cerebellar lesions, acute cortical lesions, PVWMH ≥ 2 in Fazekas scale, vessel occlusion, and acute lesion size ≥ 10 mm). Area under ROC curve was 0.735 and a score of ≥ 3 points was a predictor of AF. CONCLUSIONS The suggested score was shown to identify CS patients with an increased risk of underlying AF.
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Affiliation(s)
- Anna Tancin Lambert
- Department of Neurology, Østfold Hospital Trust, Grålum, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Dag Ottar Sætre
- Dapartment of Radiology, Østfold Hospital Trust, Grålum, Norway
| | - Barbara Ratajczak-Tretel
- Department of Neurology, Østfold Hospital Trust, Grålum, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Jostein Gleditsch
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Dapartment of Radiology, Østfold Hospital Trust, Grålum, Norway
| | - Gudrun Høie
- Department of Cardiology, Østfold Hospital Trust, Grålum, Norway
| | - Riadh Al-Ani
- Department of Cardiology, Østfold Hospital Trust, Grålum, Norway
| | - Maiju Pesonen
- Center for Biostatistics and Epidemiology, Oslo University Hospital, Oslo, Norway
| | - Dan Atar
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Cardiology, Oslo University Hospital, Ullevål, Oslo, Norway
| | - Anne Hege Aamodt
- Department of Neurology, Oslo University Hospital, Rikshospitalet, Sognsvannsveien 20, 0372, Oslo, Norway.
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2
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Pimentel BC, Ingwersen T, Haeusler KG, Schlemm E, Forkert ND, Rajashekar D, Mouches P, Königsberg A, Kirchhof P, Kunze C, Tütüncü S, Olma MC, Krämer M, Michalski D, Kraft A, Rizos T, Helberg T, Ehrlich S, Nabavi DG, Röther J, Laufs U, Veltkamp R, Heuschmann PU, Cheng B, Endres M, Thomalla G. Association of stroke lesion shape with newly detected atrial fibrillation – Results from the MonDAFIS study. Eur Stroke J 2022; 7:230-237. [PMID: 36082264 PMCID: PMC9446317 DOI: 10.1177/23969873221100895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Accepted: 04/26/2022] [Indexed: 11/16/2022] Open
Abstract
Paroxysmal Atrial fibrillation (AF) is often clinically silent and may be missed
by the usual diagnostic workup after ischemic stroke. We aimed to determine
whether shape characteristics of ischemic stroke lesions can be used to predict
AF in stroke patients without known AF at baseline. Lesion shape quantification
on brain MRI was performed in selected patients from the intervention arm of the
Impact of standardized MONitoring for Detection of Atrial
Fibrillation in Ischemic Stroke (MonDAFIS) study, which included
patients with ischemic stroke or TIA without prior AF. Multiple morphologic
parameters were calculated based on lesion segmentation in acute brain MRI data.
Multivariate logistic models were used to test the association of lesion
morphology, clinical parameters, and AF. A stepwise elimination regression was
conducted to identify the most important variables. A total of 755 patients were
included. Patients with AF detected within 2 years after stroke
(n = 86) had a larger overall oriented bounding box (OBB)
volume (p = 0.003) and a higher number of brain lesion
components (p = 0.008) than patients without AF. In the
multivariate model, OBB volume (OR 1.72, 95%CI 1.29–2.35,
p < 0.001), age (OR 2.13, 95%CI 1.52–3.06,
p < 0.001), and female sex (OR 2.45, 95%CI 1.41–4.31,
p = 0.002) were independently associated with detected AF.
Ischemic lesions in patients with detected AF after stroke presented with a more
dispersed infarct pattern and a higher number of lesion components. Together
with clinical characteristics, these lesion shape characteristics may help in
guiding prolonged cardiac monitoring after stroke.
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Affiliation(s)
- Bernardo Crespo Pimentel
- Department of Neurology, Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Department of Neurology, Christian Doppler Medical Center, Paracelsus Medical University, Salzburg, Austria
| | - Thies Ingwersen
- Department of Neurology, Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Karl Georg Haeusler
- Department of Neurology, Universitätsklinikum Würzburg, Wurzburg, Germany
- German Atrial Fibrillation Network (AFNET), Münster, Germany
| | - Eckhard Schlemm
- Department of Neurology, Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Nils D Forkert
- Department of Radiology, University of Calgary, Calgary, AB, Canada
| | | | - Pauline Mouches
- Department of Radiology, University of Calgary, Calgary, AB, Canada
| | - Alina Königsberg
- Department of Neurology, Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Paulus Kirchhof
- German Atrial Fibrillation Network (AFNET), Münster, Germany
- Institute of Cardiovascular Sciences, College of Medical and Dental Sciences, Medical School, University of Birmingham, UK
- Departments of Cardiology, UHB and SWBH NHS Trusts, Birmingham, UK
- University Heart and Vascular Center Hamburg, Hamburg, Germany
| | - Claudia Kunze
- Center for Stroke Research Berlin, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Serdar Tütüncü
- Center for Stroke Research Berlin, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Manuel C Olma
- Center for Stroke Research Berlin, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Michael Krämer
- Center for Stroke Research Berlin, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Dominik Michalski
- Department of Neurology, Universitätsklinikum Leipzig, Leipzig, Germany
| | - Andrea Kraft
- Department of Neurology, Martha Maria Hospital, Halle Dölau, Germany
| | - Timolaos Rizos
- Department of Neurology, University of Heidelberg, Heidelberg, Germany
| | - Torsten Helberg
- Department of Neurology, Clinical Center of Hubertusburg, Wermsdorf, Germany
| | - Sven Ehrlich
- Clinical Center of Hubertusburg, Wermsdorf, Germany
| | - Darius G Nabavi
- Department of Neurology, Vivantes Klinikum Neukölln, Berlin, Germany
| | - Joachim Röther
- Department of Neurology, Asklepios Klinik Altona, Hamburg, Germany
| | - Ulrich Laufs
- Department of Cardiology, Universitätsklinikum Leipzig, Leipzig, Germany
| | - Roland Veltkamp
- Department of Neurology, Alfried Krupp Krankenhaus, Essen, Germany
- Department of Brain Sciences, Imperial College London, UK
| | - Peter U Heuschmann
- Comprehensive Heart Failure Center & Clinical Trial Centre Würzburg, University Hospital Würzburg, Germany
- Institute of Clinical Epidemiology and Biometry, University Würzburg, Wurzburg, Germany
| | - Bastian Cheng
- Department of Neurology, Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Matthias Endres
- University Heart and Vascular Center Hamburg, Hamburg, Germany
- Klinik und Hochschulambulanz für Neurologie mit Abteilung für Experimentelle Neurologie, Charité-Universitätsmedizin Berlin, Berlin, Germany
- German Center for Neurodegenerative Diseases, Partner Site Berlin, Germany
- German Center for Cardiovascular Diseases, Partner Site Berlin, Germany
- ExcellenceCluster NeuroCure, Berlin, Germany
| | - Götz Thomalla
- Department of Neurology, Medical Center Hamburg-Eppendorf, Hamburg, Germany
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3
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Fridman S, Jimenez-Ruiz A, Vargas-Gonzalez JC, Sposato LA. Differences between Atrial Fibrillation Detected before and after Stroke and TIA: A Systematic Review and Meta-Analysis. Cerebrovasc Dis 2021; 51:152-157. [PMID: 34844239 DOI: 10.1159/000520101] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2021] [Accepted: 10/02/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Preliminary evidence suggests that patients with atrial fibrillation (AF) detected after stroke (AFDAS) may have a lower prevalence of cardiovascular comorbidities and lower risk of stroke recurrence than AF known before stroke (KAF). OBJECTIVE We performed a systematic search and meta-analysis to compare the characteristics of AFDAS and KAF. METHODS We searched PubMed, Scopus, and EMBASE for articles reporting differences between AFDAS and KAF until June 30, 2021. We performed random- or fixed-effects meta-analyses to evaluate differences between AFDAS and KAF in demographic factors, vascular risk factors, prevalent vascular comorbidities, structural heart disease, stroke severity, insular cortex involvement, stroke recurrence, and death. RESULTS In 21 studies including 22,566 patients with ischemic stroke or transient ischemic attack, the prevalence of coronary artery disease, congestive heart failure, prior myocardial infarction, and a history of cerebrovascular events was significantly lower in AFDAS than KAF. Left atrial size was smaller, and left ventricular ejection fraction was higher in AFDAS than KAF. The risk of recurrent stroke was 26% lower in AFDAS than in KAF. There were no differences in age, sex, stroke severity, or death rates between AFDAS and KAF. There were not enough studies to report differences in insular cortex involvement between AF types. CONCLUSIONS We found significant differences in the prevalence of vascular comorbidities, structural heart disease, and stroke recurrence rates between AFDAS and KAF, suggesting that they constitute different clinical entities within the AF spectrum. PROSPERO registration number is CRD42020202622.
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Affiliation(s)
- Sebastian Fridman
- Department of Clinical Neurological Sciences, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Amado Jimenez-Ruiz
- Heart & Brain Laboratory, Western University, London, Canada, Western University, London, Ontario, Canada
| | - Juan Camilo Vargas-Gonzalez
- Heart & Brain Laboratory, Western University, London, Canada, Western University, London, Ontario, Canada.,Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, London, Ontario, Canada
| | - Luciano A Sposato
- Department of Clinical Neurological Sciences, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada.,Heart & Brain Laboratory, Western University, London, Canada, Western University, London, Ontario, Canada.,Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, London, Ontario, Canada.,Department of Anatomy and Cell Biology, Schulich School of Medicine and Dentistry, London, Ontario, Canada.,Robarts Research Institute, London, Ontario, Canada.,Lawson Health Research Institute, London, Ontario, Canada
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4
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Trandafir C, Sandiramourty S, Laurent-Chabalier S, Ter Schiphorst A, Nguyen H, Wacongne A, Ricci JE, Pereira F, Thouvenot E, Renard D. Brain Infarction MRI Pattern in Stroke Patients with Intracardiac Thrombus. Cerebrovasc Dis 2021; 50:581-587. [PMID: 34139688 DOI: 10.1159/000515707] [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: 12/14/2020] [Accepted: 02/25/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Acute infarction patterns have been described in cardioembolic stroke, mainly with atrial fibrillation (AF) or patent foramen ovale. We aimed to analyse acute infarction magnetic resonance imaging (MRI) characteristics in stroke patients with intracardiac thrombus (ICT) compared with stroke patients with AF. METHODS We performed a retrospective study analysing brain MRI scans of consecutive acute symptomatic cardioembolic infarction patients associated with ICT or AF who were recruited and registered in the stroke database between June 2018 and November 2019. Diffusion-weighted imaging performed within 1 week after symptom onset, intra-/extracranial vessel imaging, echocardiography, and ≥24-h ECG monitoring were required for inclusion. Baseline, biological, and echocardiography characteristics were assessed. Analysed MRI characteristics were infarction location (anterior/middle/posterior cerebral artery territory; anterior/posterior/mixed anterior-posterior circulation; multiterritorial infarction; brainstem; cerebellum; small cortical cerebellar infarctions [SCCIs] or non-SCCI; cortical/subcortical/cortico-subcortical), lesion number, subcortical lesion size (> or <15 mm), and total infarction volume. RESULTS We included 28 ICT and 94 AF patients presenting with acute stroke. ICT patients were younger (median age 66 vs. 81 years, p < 0.001), more frequently male (79 vs. 47%, p = 0.003), and smokers (39 vs. 17%, p = 0.013), had more frequent history of diabetes (36 vs. 18%, p = 0.049) and ischaemic heart disease (57 vs. 21%, p < 0.001), and had lower HDL cholesterol levels (0.39 vs. 0.53 g/L, p < 0.001). On MRI, SCCI was more frequent in the ICT group (25 vs. 5%, p = 0.006) in the absence of other differences in infarction localisation, number, size, or volume on MRI. On multivariate analysis, younger age (p < 0.001), history of ischaemic heart disease (p < 0.001), and low HDL cholesterol levels (p = 0.01) were significantly associated with ICT. Results approaching statistical significance were observed for SCCI (more frequent in the ICT group, p = 0.053) and non-SCCI (more frequent in the AF group, p = 0.053) on MRI. CONCLUSIONS ICT-related stroke is associated with acute SCCI presence on MRI. Clinical Trial Registration-URL: http://www.clinicaltrials.gov. Unique identifier: NCT04456309.
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Affiliation(s)
- Cassiana Trandafir
- Department of Neurology, CHU Nîmes, University of Montpellier, Nîmes, France
| | - Shridevi Sandiramourty
- Department of Radiology, Research Team EA 2992, CHU Nîmes, University of Montpellier, Nîmes, France
| | - Sabine Laurent-Chabalier
- Department of Biostatistics, Clinical Epidemiology, Public Health, and Innovation in Methodology, CHU Nîmes, University of Montpellier, Nîmes, France
| | | | - Hai Nguyen
- Department of Radiology, Research Team EA 2992, CHU Nîmes, University of Montpellier, Nîmes, France
| | - Anne Wacongne
- Department of Neurology, CHU Nîmes, University of Montpellier, Nîmes, France
| | - Jean-Etienne Ricci
- Department of Cardiology, CHU Nîmes, University of Montpellier, Nîmes, France
| | - Fabricio Pereira
- Department of Radiology, Research Team EA 2992, CHU Nîmes, University of Montpellier, Nîmes, France
| | - Eric Thouvenot
- Department of Neurology, CHU Nîmes, University of Montpellier, Nîmes, France.,Institut de Génomique Fonctionnelle, CNRS UMR5203, INSERM 1191, University of Montpellier, Montpellier, France
| | - Dimitri Renard
- Department of Neurology, CHU Nîmes, University of Montpellier, Nîmes, France
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5
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Yao Y, Zhang Y, Liao X, Yang R, Lei Y, Luo J. Potential Therapies for Cerebral Edema After Ischemic Stroke: A Mini Review. Front Aging Neurosci 2021; 12:618819. [PMID: 33613264 PMCID: PMC7890111 DOI: 10.3389/fnagi.2020.618819] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2020] [Accepted: 12/28/2020] [Indexed: 02/05/2023] Open
Abstract
Stroke is the leading cause of global mortality and disability. Cerebral edema and intracranial hypertension are common complications of cerebral infarction and the major causes of mortality. The formation of cerebral edema includes three stages (cytotoxic edema, ionic edema, and vasogenic edema), which involve multiple proteins and ion channels. A range of therapeutic agents that successfully target cerebral edema have been developed in animal studies, some of which have been assessed in clinical trials. Herein, we review the mechanisms of cerebral edema and the research progress of anti-edema therapies for use after ischemic stroke.
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Affiliation(s)
- Yi Yao
- International Medical Center, Ward of General Practice and National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, China
| | - Yonggang Zhang
- Department of Periodical Press and National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, China
- Nursing Key Laboratory of Sichuan Province, Chengdu, China
- Chinese Evidence-Based Medicine Center, West China Hospital, Sichuan University, Chengdu, China
| | - Xiaoyang Liao
- International Medical Center, Ward of General Practice and National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, China
| | - Rong Yang
- International Medical Center, Ward of General Practice and National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, China
| | - Yi Lei
- International Medical Center, Ward of General Practice and National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, China
| | - Jianzhao Luo
- International Medical Center, Ward of General Practice and National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, China
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