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Potential role of bolus-tracking data of carotid CT angiography for atrial fibrillation prediction. Eur Radiol 2023; 33:981-987. [PMID: 35962815 DOI: 10.1007/s00330-022-09072-z] [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: 03/27/2022] [Revised: 06/22/2022] [Accepted: 07/26/2022] [Indexed: 02/03/2023]
Abstract
OBJECTIVES Atrial fibrillation (AF), a significant cause of ischemic stroke, often goes undetected because of its asymptomatic nature. This study investigated whether the total bolus-tracking time (TTT) and average slope (AS) of a bolus-tracking graph could be used to predict AF. METHODS This single-center, retrospective study included patients who underwent carotid CTA and a 24-h Holter test. TTT and the average degree of enhancement during bolus-tracking, derived from carotid CTA, were defined as variables of interest. All patients underwent transthoracic echocardiography. Left ventricular diastolic dysfunction and elevated left atrial pressure (LAP) were identified according to the guidelines of the 2016 American Society of Echocardiography/European Association of Cardiovascular Imaging. RESULTS The final cohort comprised 716 patients, 80 of whom presented with AF. The TTT of the AF group was significantly longer (23.8 ± 5.2 s) than that of the non-AF group (18.7 ± 2.8 s); p < 0.001. The AS of the bolus-tracking graph of the AF group was 0.80 ± 0.24, which was significantly lower than that of the non-AF group 1.38 ± 0.21 (p < 0.001). TTT was associated with a significantly higher risk of AF (odds ratio [OR]: 1.36; p < 0.001) and elevated LAP (OR: 1.46; p < 0.001). In contrast, the AS of the bolus-tracking graph was not significantly associated with either AF or an elevated LAP. CONCLUSION TTT derived from bolus-tracking carotid CTA is an effective adjuvant tool for detecting AF related to left ventricular diastolic dysfunction and elevated LAP, confirmed using echocardiography. KEY POINTS • Atrial fibrillation is not only a significant cause of ischemic stroke but is also often masked because of its atypical and asymptomatic features. • The total tracking time, derived from bolus tracking of carotid computed tomography angiography, may be an effective adjuvant tool for detecting undiagnosed atrial fibrillation and elevated left atrial pressure in patients.
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Spartera M, Stracquadanio A, Pessoa-Amorim G, Von Ende A, Fletcher A, Manley P, Ferreira VM, Hess AT, Hopewell JC, Neubauer S, Wijesurendra RS, Casadei B. The impact of atrial fibrillation and stroke risk factors on left atrial blood flow characteristics. Eur Heart J Cardiovasc Imaging 2021; 23:115-123. [PMID: 34687541 PMCID: PMC8685601 DOI: 10.1093/ehjci/jeab213] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Accepted: 10/06/2021] [Indexed: 12/03/2022] Open
Abstract
AIMS Altered left atrial (LA) blood flow characteristics account for an increase in cardioembolic stroke risk in atrial fibrillation (AF). Here, we aimed to assess whether exposure to stroke risk factors is sufficient to alter LA blood flow even in the presence of sinus rhythm (SR). METHODS AND RESULTS We investigated 95 individuals: 37 patients with persistent AF, who were studied before and after cardioversion [Group 1; median CHA2DS2-VASc = 2.0 (1.5-3.5)]; 35 individuals with no history of AF but similar stroke risk to Group 1 [Group 2; median CHA2DS2-VASc = 3.0 (2.0-4.0)]; and 23 low-risk individuals in SR [Group 3; median CHA2DS2-VASc = 0.0 (0.0-0.0)]. Cardiac function and LA flow characteristics were evaluated using cardiac magnetic resonance. Before cardioversion, Group 1 displayed impaired left ventricular (LV) and LA function, reduced LA flow velocities and vorticity, and a higher normalized vortex volume (all P < 0.001 vs. Groups 2 and 3). After restoration of SR at ≥4-week post-cardioversion, LV systolic function and LA flow parameters improved significantly (all P < 0.001 vs. pre-cardioversion) and were no longer different from those in Group 2. However, in the presence of SR, LA flow peak and mean velocity, and vorticity were lower in Groups 1 and 2 vs. Group 3 (all P < 0.01), and were associated with impaired LA emptying fraction (LAEF) and LV diastolic dysfunction. CONCLUSION Patients at moderate-to-high stroke risk display altered LA flow characteristics in SR in association with an LA myopathic phenotype and LV diastolic dysfunction, regardless of a history of AF.
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Affiliation(s)
- Marco Spartera
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Level 6, West Wing, Headley Way, Oxford OX3 9DU, UK
- Oxford Centre for Clinical Magnetic Resonance Research, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, Oxford, UK
| | - Antonio Stracquadanio
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Level 6, West Wing, Headley Way, Oxford OX3 9DU, UK
| | - Guilherme Pessoa-Amorim
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Level 6, West Wing, Headley Way, Oxford OX3 9DU, UK
| | - Adam Von Ende
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Alison Fletcher
- Acute Vascular Imaging Centre, Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | - Peter Manley
- Acute Vascular Imaging Centre, Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | - Vanessa M Ferreira
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Level 6, West Wing, Headley Way, Oxford OX3 9DU, UK
- Oxford Centre for Clinical Magnetic Resonance Research, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, Oxford, UK
| | - Aaron T Hess
- Oxford Centre for Clinical Magnetic Resonance Research, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, Oxford, UK
| | - Jemma C Hopewell
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Stefan Neubauer
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Level 6, West Wing, Headley Way, Oxford OX3 9DU, UK
- Oxford Centre for Clinical Magnetic Resonance Research, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, Oxford, UK
| | - Rohan S Wijesurendra
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Level 6, West Wing, Headley Way, Oxford OX3 9DU, UK
- Oxford Centre for Clinical Magnetic Resonance Research, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, Oxford, UK
| | - Barbara Casadei
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Level 6, West Wing, Headley Way, Oxford OX3 9DU, UK
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Predictive Value of Cardiac CTA, Cardiac MRI, and Transthoracic Echocardiography for Cardioembolic Stroke Recurrence. AJR Am J Roentgenol 2021; 217:336-346. [PMID: 32936016 DOI: 10.2214/ajr.20.23903] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND. Transthoracic echocardiography (TTE) is the standard of care for initial evaluation of patients with suspected cardioembolic stroke. Although TTE is useful for assessing certain sources of cardiac emboli, its diagnostic capability is limited in the detection of other sources, including left atrial thrombus and aortic plaques. OBJECTIVE. The purpose of this article was to investigate sensitivity, specificity, and predictive value of cardiac CTA (CCTA), cardiac MRI (CMRI), and TTE for recurrence in patients with suspected cardioembolic stroke. METHODS. We retrospectively included 151 patients with suspected cardioembolic stroke who underwent TTE and either CMRI (n = 75) or CCTA (n = 76) between January 2013 and May 2017. We evaluated for the presence of left atrial thrombus, left ventricular thrombus, vulnerable aortic plaque, cardiac tumors, and valvular vegetation as causes of cardioembolic stroke. The end point was stroke recurrence. Sensitivity, specificity, PPV, and NPV for recurrent stroke were calculated; the diagnostic accuracy of CMRI, CCTA, and TTE was compared between and within groups using AUC. RESULTS. Twelve and 14 recurrent strokes occurred in the CCTA and CMRI groups, respectively. Sensitivity, specificity, PPV, and NPV were 33.3%, 93.7%, 50.0%, and 88.2% for CCTA; 14.3%, 80.3%, 14.3%, and 80.3% for CMRI; 14.3%, 83.6%, 16.7%, and 80.9% for TTE in the CMRI group; and 8.3%, 93.7%, 20.0%, and 84.5% for TTE in the CCTA group. Accuracy was not different (p > .05) between CCTA (AUC = 0.63; 95% CI, 0.49-0.77), CMRI (0.53; 95% CI, 0.42-0.63), TTE in the CMRI group (0.51; 95% CI, 0.40-0.61), and TTE in the CCTA group (0.51; 95% CI, 0.42-0.59). In the CCTA group, atrial and ventricular thrombus were detected by CCTA in three patients and TTE in one patient; in the CMRI group, thrombus was detected by CMRI in one patient and TTE in two patients. CONCLUSION. CCTA, CMRI, and TTE showed comparably high specificity and NPV for cardioembolic stroke recurrence. CCTA and CMRI may be valid alternatives to TTE. CCTA may be preferred given potentially better detection of atrial and ventricular thrombus. CLINICAL IMPACT. CCTA and CMRI have similar clinical performance as TTE for predicting cardioembolic stroke recurrence. This observation may be especially important when TTE provides equivocal findings.
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Gyanwali B, Lai MKP, Lui B, Liew OW, Venketasubramanian N, Richards AM, Chen C, Hilal S. Blood-Based Cardiac Biomarkers and the Risk of Cognitive Decline, Cerebrovascular Disease, and Clinical Events. Stroke 2021; 52:2275-2283. [PMID: 33971742 DOI: 10.1161/strokeaha.120.032571] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
[Figure: see text].
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Affiliation(s)
- Bibek Gyanwali
- Department of Biochemistry (B.G.), National University of Singapore
| | - Mitchell K P Lai
- Department of Pharmacology (M.K.P.L., C.C., S.H.), National University of Singapore.,Memory Aging and Cognition Center, National University Health System, Singapore (B.G., M.K.P.L., B.L., C.C., S.H.)
| | - Benedict Lui
- Memory Aging and Cognition Center, National University Health System, Singapore (B.G., M.K.P.L., B.L., C.C., S.H.)
| | - Oi Wah Liew
- Cardiovascular Research Institute, Yong Loo Lin School of Medicine (O.W.L., A.M.R.), National University of Singapore
| | | | - Arthur Mark Richards
- Cardiovascular Research Institute, Yong Loo Lin School of Medicine (O.W.L., A.M.R.), National University of Singapore
| | - Christopher Chen
- Department of Pharmacology (M.K.P.L., C.C., S.H.), National University of Singapore.,Memory Aging and Cognition Center, National University Health System, Singapore (B.G., M.K.P.L., B.L., C.C., S.H.)
| | - Saima Hilal
- Department of Pharmacology (M.K.P.L., C.C., S.H.), National University of Singapore.,Memory Aging and Cognition Center, National University Health System, Singapore (B.G., M.K.P.L., B.L., C.C., S.H.).,Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore (S.H.)
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5
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Bielecka-Dabrowa A, Gasiorek P, Wittczak A, Sakowicz A, Bytyçi I, Banach M. Left Ventricular Diastolic Dysfunction as Predictor of Unfavorable Prognosis After ESUS. J Multidiscip Healthc 2021; 14:617-627. [PMID: 33727824 PMCID: PMC7955868 DOI: 10.2147/jmdh.s297299] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Accepted: 02/09/2021] [Indexed: 12/19/2022] Open
Abstract
Objective Identification of echocardiographic, hemodynamic and biochemical predictors of unfavorable prognosis after embolic strokes of undetermined etiology (ESUS) in patients at age <65. Patients and Methods Out of 520 ischemic stroke patients we selected 64 diagnosed with ESUS and additional 36 without stroke but with similar risk profile. All patients underwent echocardiography, non-invasive assessment of hemodynamic parameters using SphygmoCor tonometer and measurements of selected biomarkers. Follow-up time was 12 months. Results Nine percent of patients died, and recurrent ischemic stroke occurred in 9% of patients only in the ESUS group. Atrial fibrillation (AF) occurred in 10% of patients and the ESUS group had a significantly poorer outcome of AF in the first 2 months after hospitalization. The outcome of re-hospitalization was 28% in the ESUS group and 17% in the control group. In the multivariate analysis mean early diastolic (E’) mitral annular velocity (OR 0.75, 95% CI: 0.6–0.94; p=0.01) was significantly associated with cardiovascular hospitalizations. The only independent predictor of recurrent stroke was the ratio of peak velocity of early diastolic transmitral flow to peak velocity of early diastolic mitral annular motion (E/E’) (OR 0.75, 95% CI: 0.6–0.94; p=0.01). E/E’ was independently associated with composite endpoint (death, hospitalization and recurrent stroke) (OR 1.90, 95% CI 1.1–3.2, p=0.01). Conclusion The indices of diastolic dysfunction are significantly associated with unfavorable prognosis after ESUS. There is a robust role for outpatient cardiac monitoring especially during the first 2 months after ESUS to detect potential AF.
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Affiliation(s)
- Agata Bielecka-Dabrowa
- Heart Failure Unit, Department of Cardiology and Congenital Diseases of Adults, Polish Mother's Memorial Hospital Research Institute (PMMHRI), Lodz, Poland.,Department of Hypertension, Chair of Nephrology and Hypertension, Medical University of Lodz, Lodz, Poland
| | - Paulina Gasiorek
- Department of Hypertension, Chair of Nephrology and Hypertension, Medical University of Lodz, Lodz, Poland
| | - Andrzej Wittczak
- Department of Hypertension, Chair of Nephrology and Hypertension, Medical University of Lodz, Lodz, Poland
| | - Agata Sakowicz
- Department of Medical Biotechnology, Medical University of Lodz, Lodz, Poland
| | - Ibadete Bytyçi
- Clinic of Cardiology, University Clinical Centre of Kosovo, Prishtina, Kosovo.,Institute of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Maciej Banach
- Heart Failure Unit, Department of Cardiology and Congenital Diseases of Adults, Polish Mother's Memorial Hospital Research Institute (PMMHRI), Lodz, Poland.,Department of Hypertension, Chair of Nephrology and Hypertension, Medical University of Lodz, Lodz, Poland
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Heuschmann PU, Montellano FA, Ungethüm K, Rücker V, Wiedmann S, Mackenrodt D, Quilitzsch A, Ludwig T, Kraft P, Albert J, Morbach C, Frantz S, Störk S, Haeusler KG, Kleinschnitz C. Prevalence and determinants of systolic and diastolic cardiac dysfunction and heart failure in acute ischemic stroke patients: The SICFAIL study. ESC Heart Fail 2020; 8:1117-1129. [PMID: 33350167 PMCID: PMC8006617 DOI: 10.1002/ehf2.13145] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Revised: 10/24/2020] [Accepted: 11/15/2020] [Indexed: 01/17/2023] Open
Abstract
AIMS Ischaemic stroke (IS) might induce alterations of cardiac function. Prospective data on frequency of cardiac dysfunction and heart failure (HF) after IS are lacking. We assessed prevalence and determinants of diastolic dysfunction (DD), systolic dysfunction (SD), and HF in patients with acute IS. METHODS AND RESULTS The Stroke-Induced Cardiac FAILure in mice and men (SICFAIL) study is a prospective, hospital-based cohort study. Patients with IS underwent a comprehensive assessment of cardiac function in the acute phase (median 4 days after IS) including clinical examination, standardized transthoracic echocardiography by expert sonographers, and determination of blood-based biomarkers. Information on demographics, lifestyle, risk factors, symptoms suggestive of HF, and medical history was collected by a standardized personal interview. Applying current guidelines, cardiac dysfunction was classified based on echocardiographic criteria into SD (left ventricular ejection fraction < 52% in men or <54% in women) and DD (≥3 signs of DD in patients without SD). Clinically overt HF was classified into HF with reduced, mid-range, or preserved ejection fraction. Between January 2014 and February 2017, 696 IS patients were enrolled. Of them, patients with sufficient echocardiographic data on SD were included in the analyses {n = 644 patients [median age 71 years (interquartile range 60-78), 61.5% male]}. In these patients, full assessment of DD was feasible in 549 patients without SD (94%). Prevalence of cardiac dysfunction and HF was as follows: SD 9.6% [95% confidence interval (CI) 7.6-12.2%]; DD in patients without SD 23.3% (95% CI 20.0-27.0%); and clinically overt HF 5.4% (95% CI 3.9-7.5%) with subcategories of HF with preserved ejection fraction 4.35%, HF with mid-range ejection fraction 0.31%, and HF with reduced ejection fraction 0.78%. In multivariable analysis, SD and fulfilment of HF criteria were associated with history of coronary heart disease [SD: odds ratio (OR) 3.87, 95% CI 1.93-7.75, P = 0.0001; HF: OR 2.29, 95% CI 1.04-5.05, P = 0.0406] and high-sensitive troponin T at baseline (SD: OR 1.78, 95% CI 1.31-2.42, P = 0.0003; HF: OR 1.66, 95% CI 1.17-2.33, P = 0.004); DD was associated with older age (OR 1.08, 95% CI 1.05-1.11, P < 0.0001) and treated hypertension vs. no hypertension (OR 2.84, 95% CI 1.23-6.54, P = 0.0405). CONCLUSIONS A substantial proportion of the study population exhibited subclinical and clinical cardiac dysfunction. SICFAIL provides reliable data on prevalence and determinants of SD, DD, and clinically overt HF in patients with acute IS according to current guidelines, enabling further clarification of its aetiological and prognostic role.
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Affiliation(s)
- Peter U Heuschmann
- Institute of Clinical Epidemiology and Biometry, University of Würzburg, Josef-Schneider-Str. 2, Würzburg, 97080, Germany.,Comprehensive Heart Failure Center, University and University Hospital Würzburg, Würzburg, Germany.,Clinical Trial Center, University Hospital Würzburg, Würzburg, Germany
| | - Felipe A Montellano
- Institute of Clinical Epidemiology and Biometry, University of Würzburg, Josef-Schneider-Str. 2, Würzburg, 97080, Germany.,Interdisciplinary Center for Clinical Research, University of Würzburg, Würzburg, Germany
| | - Kathrin Ungethüm
- Institute of Clinical Epidemiology and Biometry, University of Würzburg, Josef-Schneider-Str. 2, Würzburg, 97080, Germany
| | - Viktoria Rücker
- Institute of Clinical Epidemiology and Biometry, University of Würzburg, Josef-Schneider-Str. 2, Würzburg, 97080, Germany
| | - Silke Wiedmann
- Institute of Clinical Epidemiology and Biometry, University of Würzburg, Josef-Schneider-Str. 2, Würzburg, 97080, Germany.,Comprehensive Heart Failure Center, University and University Hospital Würzburg, Würzburg, Germany.,Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Daniel Mackenrodt
- Institute of Clinical Epidemiology and Biometry, University of Würzburg, Josef-Schneider-Str. 2, Würzburg, 97080, Germany.,Comprehensive Heart Failure Center, University and University Hospital Würzburg, Würzburg, Germany.,Department of Neurology, University Hospital Würzburg, Würzburg, Germany
| | - Anika Quilitzsch
- Institute of Clinical Epidemiology and Biometry, University of Würzburg, Josef-Schneider-Str. 2, Würzburg, 97080, Germany
| | - Timo Ludwig
- Institute of Clinical Epidemiology and Biometry, University of Würzburg, Josef-Schneider-Str. 2, Würzburg, 97080, Germany
| | - Peter Kraft
- Department of Neurology, University Hospital Würzburg, Würzburg, Germany.,Department of Neurology, Klinikum Main-Spessart, Lohr am Main, Germany
| | - Judith Albert
- Comprehensive Heart Failure Center, University and University Hospital Würzburg, Würzburg, Germany.,Department of Internal Medicine I, University Hospital Würzburg, Würzburg, Germany
| | - Caroline Morbach
- Comprehensive Heart Failure Center, University and University Hospital Würzburg, Würzburg, Germany.,Department of Internal Medicine I, University Hospital Würzburg, Würzburg, Germany
| | - Stefan Frantz
- Comprehensive Heart Failure Center, University and University Hospital Würzburg, Würzburg, Germany.,Department of Internal Medicine I, University Hospital Würzburg, Würzburg, Germany
| | - Stefan Störk
- Comprehensive Heart Failure Center, University and University Hospital Würzburg, Würzburg, Germany.,Department of Internal Medicine I, University Hospital Würzburg, Würzburg, Germany
| | - Karl Georg Haeusler
- Comprehensive Heart Failure Center, University and University Hospital Würzburg, Würzburg, Germany.,Department of Neurology, University Hospital Würzburg, Würzburg, Germany
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Wen HJ, Wang XY. Left ventricular diastolic dysfunction is associated with cerebral infarction in young hypertensive patients: A retrospective case-control study. Exp Ther Med 2020; 20:61. [PMID: 32952651 DOI: 10.3892/etm.2020.9189] [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: 08/24/2019] [Accepted: 01/23/2020] [Indexed: 11/06/2022] Open
Abstract
Studies have indicated that hypertension is associated with the occurrence of acute cerebral infarction (CI) in young patients (18-45 years). However, the association between CI and left ventricular diastolic (LVD) dysfunction in young patients with hypertension has rarely been reported. The purpose of the present study was to investigate the association between LVD dysfunction and acute CI in young patients with hypertension. A total of 92 patients with acute CI who had hypertension were selected as the study group (CI group) and 98 young patients with only hypertension were selected as the control group (non-CI group). Blood pressure measurements, LVD functional assessment and cerebral MRI were performed. The χ² test was used to compare the left ventricular diastolic function between the CI and non-CI groups. The results indicated that LVD function of young patients was associated with hypertension and there was a correlation between the decrease in LVD function and the occurrence of acute CI in young patients with hypertension. The incidence of acute CI was higher in patients with decreased LVD function than in those with normal LVD function. In conclusion, hypertension in the young is associated with decreased LVD function and is a risk factor for diastolic dysfunction of the left ventricle. LVD function may be an independent predictor of acute CI in young patients with hypertension and should be considered by clinicians. By predicting the risk of acute CI in young patients with hypertension, LVD testing may aid in the primary prevention of CI or guide early treatment.
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Affiliation(s)
- Hui-Jun Wen
- Department of Neurology, Baoji Municipal Central Hospital, Baoji, Shaanxi 721008, P.R. China
| | - Xiao-Yong Wang
- Department of Neurology, Baoji Municipal Central Hospital, Baoji, Shaanxi 721008, P.R. China
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8
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Yokoseki O, Tsutsumi K, Obinata C, Toba Y. Transient atrial mechanical dysfunction assessed in acute phase of embolic stroke of undetermined source. J Stroke Cerebrovasc Dis 2020; 29:105032. [PMID: 32807444 DOI: 10.1016/j.jstrokecerebrovasdis.2020.105032] [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: 03/13/2020] [Revised: 06/01/2020] [Accepted: 06/04/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND AND PURPOSE Paroxysmal atrial fibrillation (PAF) has been suggested as a major cause of embolic stroke of undetermined source (ESUS). Transient atrial mechanical dysfunction (stunning) frequently occurs after conversion of atrial fibrillation to sinus rhythm. The study aim was to determine if reversible atrial mechanical dysfunction in ESUS could help elucidate the mechanism of stroke. METHODS Eighty-five consecutive patients with acute ischemic stroke were enrolled according to the following inclusion criteria: [1] ≥55 years old; [2] normal sinus rhythm upon admission; [3] no apparent embolic source; and [4] transthoracic echocardiographic evaluation had been performed in both the early phase (<72 h) and late phase (>7 days) after stroke onset. There were 27 patients in the lacunar or atherothrombotic infarction group (controls), 22 in the PAF group, and 36 in the ESUS group. To determine atrial stunning, transmitral flow velocity profiles (Doppler peak E- [early diastolic] and A- [atrial systolic] waves) were obtained. RESULTS In the early phase, an E/A velocity ratio ≥ 1.0 was less common in the control group (1 patient, 3.7%) than in the PAF group (19 patients, 86.4%; p < 0.001) and ESUS group (10 patients, 27.8%; p < 0.05). In the late phase, the E/A ratio decreased to less than 1.0 in six patients (31.6%) who had PAF and in eight patients (80.0%) who had ESUS. CONCLUSION Transient atrial mechanical dysfunction could be a helpful finding for elucidating the stroke mechanism in patients with ESUS, and early echocardiographic assessment could improve its detection.
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Affiliation(s)
- Osamu Yokoseki
- Department of Cardiology, Ueda Hanazono Hospital, 1-15-25 Chuo Nishi, Ueda 386-0023, Japan.
| | - Keiji Tsutsumi
- Department of Neurosurgery, Kobayashi Neurosurgical Neurological Hospital, Ueda, Japan
| | - Chiharu Obinata
- Department of Neurosurgery, Kobayashi Neurosurgical Neurological Hospital, Ueda, Japan.
| | - Yasuyuki Toba
- Department of Neurosurgery, Kobayashi Neurosurgical Neurological Hospital, Ueda, Japan.
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Kamran S, Singh R, Akhtar N, George P, Salam A, Babu B, Own A, Hamid T, Perkins JD. Left Heart Factors in Embolic Stroke of Undetermined Source in a Multiethnic Asian and North African Cohort. J Am Heart Assoc 2020; 9:e016534. [PMID: 32750304 PMCID: PMC7792276 DOI: 10.1161/jaha.120.016534] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Background Cardiac features diverge in Asians; however, it is not known how these differences relate to embolic stroke of unknown source (ESUS) in Southeast Asian and Eastern Mediterranean regions. Methods and Results A retrospective analysis of prospectively collected acute ischemic stroke data from 2014 to 2018 was performed. Stroke subtypes were noncardioembolic stroke (large‐vessel and small‐vessel disease; n=1348), cardioembolic stroke (n=532), and ESUS (n=656). Subtypes were compared by demographic, clinical, and echocardiographic factors. In multivariate logistic regression, patients with ESUS in comparison with noncardioembolic stroke were twice as likely to have left ventricular diastolic dysfunction (P=0.001), 3 times the odds of global hypokinesia (P=0.001), and >7 times the odds of left ventricular wall motion abnormalities (P=0.001). In the second model comparing ESUS with cardioembolic stroke, patients with ESUS were 3 times more likely to have left ventricular wall motion abnormalities (P=0.001) and 1.5 times more likely to have left ventricular diastolic dysfunction grade I (P=0.009), and 3 times more likely to have left ventricular diastolic dysfunction grades II and III (P=0.009), whereas age (P=0.001) and left atrial volume index (P=0.004) showed an inverse relation with ESUS. ESUS in patients ≥61 years old had higher levels of traditional risk factors such as coronary artery disease, but the coronary artery disease was not significantly different in ESUS age groups (P=0.80) despite higher left ventricular wall motion abnormalities (P=0.001). Conclusions Patients with ESUS and noncardioembolic stroke were younger than patients with cardioembolic stroke. While a third of the patients with ESUS >45 years old had coronary artery disease, it was unrecognized or underreported in the older ESUS age group (≥61 years old). In patients with ESUS from Southeast Asia and Eastern Mediterranean regions, left ventricular wall motion abnormalities and left ventricular diastolic dysfunction were related to ESUS.
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Affiliation(s)
- Saadat Kamran
- Neuroscience Institute Hamad General Hospital Doha Qatar.,Weill Cornell Medicine Doha Qatar
| | - Rajvir Singh
- Acute Care Surgery Department Hamad General Hospital Doha Qatar
| | - Naveed Akhtar
- Neuroscience Institute Hamad General Hospital Doha Qatar.,Weill Cornell Medicine Doha Qatar
| | - Pooja George
- Neuroscience Institute Hamad General Hospital Doha Qatar
| | - Abdul Salam
- Neuroscience Institute Hamad General Hospital Doha Qatar
| | - Blessy Babu
- Neuroscience Institute Hamad General Hospital Doha Qatar
| | - Ahmed Own
- Neuroscience Institute Hamad General Hospital Doha Qatar
| | - Tahir Hamid
- Heart Hospital Hamad Medical Corporation Doha Qatar
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10
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Hellwig S, Grittner U, Elgeti M, Wyschkon S, Nagel SN, Fiebach JB, Krause T, Herm J, Scheitz JF, Endres M, Nolte CH, Haeusler KG, Elgeti T. Evaluation of left ventricular function in patients with acute ischaemic stroke using cine cardiovascular magnetic resonance imaging. ESC Heart Fail 2020; 7:2572-2580. [PMID: 32667736 PMCID: PMC7524103 DOI: 10.1002/ehf2.12833] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Revised: 05/05/2020] [Accepted: 05/27/2020] [Indexed: 01/09/2023] Open
Abstract
Aims Heart failure (HF) is frequent in patients with acute ischaemic stroke (AIS) and associated with higher morbidity and mortality. Assessment of cardiac function in AIS patients using cardiovascular MRI (CMR) may help to detect HF. We report the rate of systolic and diastolic dysfunction in a cohort of patients with AIS using CMR and compare cine real‐time (CRT) sequences with the reference of segmented cine steady‐state free precession sequences. Methods and results Patients with AIS without known atrial fibrillation were prospectively enrolled in the HEart and BRain Interfaces in Acute Ischemic Stroke (HEBRAS) study (NCT 02142413) and underwent CMR at 3 Tesla within 7 days after AIS. Validity of CRT sequences was determined in 50 patients. A total of 229 patients were included in the analysis (mean age 66 years; 35% women; HF 2%). Evaluation of cardiac function was successful in 172 (75%) patients. Median time from stroke onset to CMR was 82 h (interquartile range 56–111) and 54 h (interquartile range 31–78) from cerebral MRI to CMR. Systolic dysfunction was observed in 43 (25%) and diastolic dysfunction in 102 (59%) patients. Diagnostic yield was similar using CRT or segmented cine imaging (no significant difference in left ventricular ejection fraction, myocardial mass, time to peak filling rate, and peak filling rate ratio E/A). Intraobserver and interobserver agreement was high (κ = 0.78–1.0 for all modalities). Conclusions Cardiovascular MRI at 3 Tesla is an appropriate method for the evaluation of cardiac function in a selected cohort of patients with AIS. Systolic and diastolic dysfunction is frequent in these patients. CRT imaging allows reliable assessment of systolic and diastolic function.
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Affiliation(s)
- Simon Hellwig
- Department of Neurology, Charité-Universitätsmedizin Berlin, Berlin, Germany.,Centre for Stroke Research Berlin, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Ulrike Grittner
- Institute of Biometry and Clinical Epidemiology, Charité-Universitätsmedizin Berlin, Berlin, Germany.,Berlin Institute of Health, Berlin, Germany
| | - Matthias Elgeti
- Jules Stein Eye Institute and Department for Chemistry and Biochemistry, University of California, Los Angeles, CA, USA
| | - Sebastian Wyschkon
- Department of Radiology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Sebastian N Nagel
- Department of Radiology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Jochen B Fiebach
- Centre for Stroke Research Berlin, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Thomas Krause
- Department of Neurology, Jüdisches Krankenhaus Berlin, Berlin, Germany
| | - Juliane Herm
- Department of Neurology, Charité-Universitätsmedizin Berlin, Berlin, Germany.,Centre for Stroke Research Berlin, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Jan F Scheitz
- Department of Neurology, Charité-Universitätsmedizin Berlin, Berlin, Germany.,Centre for Stroke Research Berlin, Charité-Universitätsmedizin Berlin, Berlin, Germany.,Berlin Institute of Health, Berlin, Germany.,German Centre for Cardiovascular Diseases (DZHK), partner site Berlin, Berlin, Germany
| | - Matthias Endres
- Department of Neurology, Charité-Universitätsmedizin Berlin, Berlin, Germany.,Centre for Stroke Research Berlin, Charité-Universitätsmedizin Berlin, Berlin, Germany.,Berlin Institute of Health, Berlin, Germany.,German Centre for Neurodegenerative Diseases (DZNE), partner site Berlin, Berlin, Germany.,German Centre for Cardiovascular Diseases (DZHK), partner site Berlin, Berlin, Germany
| | - Christian H Nolte
- Department of Neurology, Charité-Universitätsmedizin Berlin, Berlin, Germany.,Centre for Stroke Research Berlin, Charité-Universitätsmedizin Berlin, Berlin, Germany.,Berlin Institute of Health, Berlin, Germany.,German Centre for Neurodegenerative Diseases (DZNE), partner site Berlin, Berlin, Germany.,German Centre for Cardiovascular Diseases (DZHK), partner site Berlin, Berlin, Germany
| | | | - Thomas Elgeti
- Department of Radiology, Charité-Universitätsmedizin Berlin, Berlin, Germany
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11
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Jordan K, Yaghi S, Song C. Response by Jordan et al to Letter Regarding Article, "Left Atrial Volume Index Is Associated With Cardioembolic Stroke and Atrial Fibrillation Detection After Embolic Stroke of Undetermined Source". Stroke 2019; 50:e332. [PMID: 31537190 DOI: 10.1161/strokeaha.119.027235] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Kevin Jordan
- Division of Cardiology, Department of Internal Medicine, The Warren Alpert Medical School of Brown University, Providence, RI
| | - Shadi Yaghi
- Department of Neurology, New York University Langone Health, Brooklyn
| | - Christopher Song
- Division of Cardiology, Department of Internal Medicine, The Warren Alpert Medical School of Brown University, Providence, RI
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12
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Ferkh A, Brown P, O'Keefe E, Zada M, Duggins A, Thiagalingam A, Altman M, Boyd A, Byth K, Kizana E, Denniss AR, Thomas L. Clinical and echocardiographic characteristics of cardioembolic stroke. Eur J Neurol 2019; 26:1310-1317. [PMID: 31062440 DOI: 10.1111/ene.13981] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2018] [Accepted: 04/30/2019] [Indexed: 12/01/2022]
Abstract
BACKGROUND AND PURPOSE Ischaemic stroke frequently has a cardioembolic (CE) source. Clinical and echocardiographic parameters associated with CE stroke were evaluated. METHODS In all, 93 consecutive ischaemic stroke patients who underwent a transthoracic echocardiogram were retrospectively analysed; strokes were classified by TOAST (Trial of Org 10172 in Acute Stroke Treatment) criteria. Echocardiographic parameters related to CE stroke, including left atrial volumes and function, were compared to 73 healthy controls. RESULTS Of 93 patients (mean age 66.1 years, 56% male), nine (10%) had large artery atherosclerosis, 38 (41%) CE stroke, two (2%) small vessel disease, two (2%) other and 42 (45%) undetermined aetiology. Left atrial (LA) maximum volumes (LAVImax ) and minimum volumes (LAVImin ) were larger in the CE group than the non-CE group (45 vs. 32 ml/m2 , 32 vs. 13 ml/m2 , respectively, P < 0.001), whilst LA function indices including LA emptying fraction and LA function index (LAFI) were lower in the CE group (34% vs. 55%, and 0.12 vs. 0.35, respectively, P < 0.001). Adjusting for clinical characteristics, LAFI ≤0.3 was an independent predictor of CE stroke (adjusted odds ratio 5.3, P = 0.001). Additionally, LAVImax and LAVImin were larger (61 vs. 44 and 32 vs. 24 ml/m2 respectively, P < 0.01) and LAFI significantly lower (0.34 vs. 0.52, P < 0.001) in the undetermined aetiology group versus healthy controls. CONCLUSIONS Left atrial enlargement with reduced LA function was associated with CE stroke and LAFI was the best independent predictor. LA parameters were also altered in the undetermined aetiology group, suggesting an underlying LA myopathy in this subset.
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Affiliation(s)
- A Ferkh
- University of Sydney, Camperdown, NSW, Australia.,Cardiology Department, Westmead Hospital, Sydney, NSW, Australia
| | - P Brown
- Cardiology Department, Westmead Hospital, Sydney, NSW, Australia
| | - E O'Keefe
- Cardiology Department, Westmead Hospital, Sydney, NSW, Australia
| | - M Zada
- Cardiology Department, Westmead Hospital, Sydney, NSW, Australia
| | - A Duggins
- Neurology Department, Westmead Hospital, Sydney, NSW, Australia
| | - A Thiagalingam
- University of Sydney, Camperdown, NSW, Australia.,Cardiology Department, Westmead Hospital, Sydney, NSW, Australia
| | - M Altman
- Cardiology Department, Westmead Hospital, Sydney, NSW, Australia
| | - A Boyd
- University of Sydney, Camperdown, NSW, Australia
| | - K Byth
- University of Sydney, Camperdown, NSW, Australia
| | - E Kizana
- University of Sydney, Camperdown, NSW, Australia.,Cardiology Department, Westmead Hospital, Sydney, NSW, Australia.,Westmead Institute of Medical Research, Sydney, NSW, Australia
| | - A R Denniss
- University of Sydney, Camperdown, NSW, Australia.,Cardiology Department, Westmead Hospital, Sydney, NSW, Australia
| | - L Thomas
- University of Sydney, Camperdown, NSW, Australia.,Cardiology Department, Westmead Hospital, Sydney, NSW, Australia.,South Western Clinical School, University of New South Wales, Sydney, NSW, Australia
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13
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Left atrial volume index and left ventricular global longitudinal strain predict new-onset atrial fibrillation in patients with transient ischemic attack. Int J Cardiovasc Imaging 2019; 35:1277-1286. [DOI: 10.1007/s10554-019-01586-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Accepted: 03/20/2019] [Indexed: 10/27/2022]
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14
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Basu Ray I, Shah SK. Formulating a More Comprehensive Stroke-Risk Evaluation Scale. Tex Heart Inst J 2018; 45:168-171. [PMID: 30072855 DOI: 10.14503/thij-18-6686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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15
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Ryu WS, Bae EK, Park SH, Jeong SW, Schellingerhout D, Nahrendorf M, Kim DE. Increased Left Ventricular Filling Pressure and Arterial Occlusion in Stroke Related to Atrial Fibrillation. J Stroke Cerebrovasc Dis 2018; 27:1275-1282. [DOI: 10.1016/j.jstrokecerebrovasdis.2017.12.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2017] [Revised: 11/07/2017] [Accepted: 12/05/2017] [Indexed: 01/05/2023] Open
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16
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Zhang J, Li J, Ma L, Lou J. Retracted
: RNA interference‐mediated silencing of S100B improves nerve function recovery and inhibits hippocampal cell apoptosis in rat models of ischemic stroke. J Cell Biochem 2018; 119:8095-8111. [DOI: 10.1002/jcb.26747] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2017] [Accepted: 01/25/2018] [Indexed: 11/10/2022]
Affiliation(s)
- Jin‐Hua Zhang
- Department of NeurologyThe Second Affiliated Hospital of Zhengzhou UniversityZhengzhouP.R. China
- Department of NeurologyKaifeng Central HospitalKaifengP.R. China
| | - Jiang‐Kun Li
- Department of NeurologyKaifeng Central HospitalKaifengP.R. China
| | - Li‐Li Ma
- Department of NeurologyKaifeng Central HospitalKaifengP.R. China
| | - Ji‐Yu Lou
- Department of NeurologyThe Second Affiliated Hospital of Zhengzhou UniversityZhengzhouP.R. China
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17
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Lee JY, Sunwoo JS, Kwon KY, Roh H, Ahn MY, Lee MH, Park BW, Hyon MS, Lee KB. Left Ventricular Ejection Fraction Predicts Poststroke Cardiovascular Events and Mortality in Patients without Atrial Fibrillation and Coronary Heart Disease. Korean Circ J 2018; 48:1148-1156. [PMID: 30403019 PMCID: PMC6221865 DOI: 10.4070/kcj.2018.0115] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2018] [Revised: 07/18/2018] [Accepted: 07/24/2018] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND AND OBJECTIVES It is controversial that decreased left ventricular function could predict poststroke outcomes. The purpose of this study is to elucidate whether left ventricular ejection fraction (LVEF) can predict cardiovascular events and mortality in acute ischemic stroke (AIS) without atrial fibrillation (AF) and coronary heart disease (CHD). METHODS Transthoracic echocardiography was conducted consecutively in patients with AIS or transient ischemic attack at Soonchunhyang University Hospital between January 2008 and July 2016. The clinical data and echocardiographic LVEF of 1,465 patients were reviewed after excluding AF and CHD. Poststroke disability, major adverse cardiac events (MACE; nonfatal stroke, nonfatal myocardial infarction, and cardiovascular death) and all-cause mortality during 1 year after index stroke were prospectively captured. Cox proportional hazards regressions analysis were applied adjusting traditional risk factors and potential determinants. RESULTS The mean follow-up time was 259.9±148.8 days with a total of 29 non-fatal strokes, 3 myocardial infarctions, 33 cardiovascular deaths, and 53 all-cause mortality. The cumulative incidence of MACE and all-cause mortality were significantly higher in the lowest LVEF (<55) group compared with the others (p=0.022 and 0.009). In prediction models, LVEF (per 10%) had hazards ratios of 0.54 (95% confidence interval [CI], 0.36-0.80, p=0.002) for MACE and 0.61 (95% CI, 0.39-0.97, p=0.037) for all-cause mortality. CONCLUSIONS LVEF could be an independent predictor of cardiovascular events and mortality after AIS in the absence of AF and CHD.
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Affiliation(s)
- Jeong Yoon Lee
- Department of Neurology, Soonchunhyang University School of Medicine, Seoul, Korea
| | - Jun Sang Sunwoo
- Department of Neurology, Soonchunhyang University School of Medicine, Seoul, Korea
| | - Kyum Yil Kwon
- Department of Neurology, Soonchunhyang University School of Medicine, Seoul, Korea
| | - Hakjae Roh
- Department of Neurology, Soonchunhyang University School of Medicine, Seoul, Korea
| | - Moo Young Ahn
- Department of Neurology, Soonchunhyang University School of Medicine, Seoul, Korea
| | - Min Ho Lee
- Department of Cardiology, Soonchunhyang University School of Medicine, Seoul, Korea
| | - Byoung Won Park
- Department of Cardiology, Soonchunhyang University School of Medicine, Seoul, Korea
| | - Min Su Hyon
- Department of Cardiology, Soonchunhyang University School of Medicine, Seoul, Korea
| | - Kyung Bok Lee
- Department of Neurology, Soonchunhyang University School of Medicine, Seoul, Korea.
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18
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Abstract
Neurocardiology is an emerging specialty that addresses the interaction between the brain and the heart, that is, the effects of cardiac injury on the brain and the effects of brain injury on the heart. This review article focuses on cardiac dysfunction in the setting of stroke such as ischemic stroke, brain hemorrhage, and subarachnoid hemorrhage. The majority of post-stroke deaths are attributed to neurological damage, and cardiovascular complications are the second leading cause of post-stroke mortality. Accumulating clinical and experimental evidence suggests a causal relationship between brain damage and heart dysfunction. Thus, it is important to determine whether cardiac dysfunction is triggered by stroke, is an unrelated complication, or is the underlying cause of stroke. Stroke-induced cardiac damage may lead to fatality or potentially lifelong cardiac problems (such as heart failure), or to mild and recoverable damage such as neurogenic stress cardiomyopathy and Takotsubo cardiomyopathy. The role of location and lateralization of brain lesions after stroke in brain-heart interaction; clinical biomarkers and manifestations of cardiac complications; and underlying mechanisms of brain-heart interaction after stroke, such as the hypothalamic-pituitary-adrenal axis; catecholamine surge; sympathetic and parasympathetic regulation; microvesicles; microRNAs; gut microbiome, immunoresponse, and systemic inflammation, are discussed.
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Affiliation(s)
- Zhili Chen
- From the Gerontology and Neurological Institute, Tianjin Medical University General Hospital, China (Z.C., T.Y., J.C.); Department of Neurology, Henry Ford Hospital, Detroit, MI (P.V., D.S., M.C., J.C.); and Department of Physics, Oakland University, Rochester, MI (M.C.)
| | - Poornima Venkat
- From the Gerontology and Neurological Institute, Tianjin Medical University General Hospital, China (Z.C., T.Y., J.C.); Department of Neurology, Henry Ford Hospital, Detroit, MI (P.V., D.S., M.C., J.C.); and Department of Physics, Oakland University, Rochester, MI (M.C.)
| | - Don Seyfried
- From the Gerontology and Neurological Institute, Tianjin Medical University General Hospital, China (Z.C., T.Y., J.C.); Department of Neurology, Henry Ford Hospital, Detroit, MI (P.V., D.S., M.C., J.C.); and Department of Physics, Oakland University, Rochester, MI (M.C.)
| | - Michael Chopp
- From the Gerontology and Neurological Institute, Tianjin Medical University General Hospital, China (Z.C., T.Y., J.C.); Department of Neurology, Henry Ford Hospital, Detroit, MI (P.V., D.S., M.C., J.C.); and Department of Physics, Oakland University, Rochester, MI (M.C.)
| | - Tao Yan
- From the Gerontology and Neurological Institute, Tianjin Medical University General Hospital, China (Z.C., T.Y., J.C.); Department of Neurology, Henry Ford Hospital, Detroit, MI (P.V., D.S., M.C., J.C.); and Department of Physics, Oakland University, Rochester, MI (M.C.)
| | - Jieli Chen
- From the Gerontology and Neurological Institute, Tianjin Medical University General Hospital, China (Z.C., T.Y., J.C.); Department of Neurology, Henry Ford Hospital, Detroit, MI (P.V., D.S., M.C., J.C.); and Department of Physics, Oakland University, Rochester, MI (M.C.).
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19
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Choi N, Lee JY, Sunwoo JS, Roh H, Ahn MY, Park ST, Lee KB. Recently Uncontrolled Glycemia in Diabetic Patients Is Associated with the Severity of Intracranial Atherosclerosis. J Stroke Cerebrovasc Dis 2017; 26:2615-2621. [PMID: 28784278 DOI: 10.1016/j.jstrokecerebrovasdis.2017.06.025] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2017] [Revised: 05/22/2017] [Accepted: 06/17/2017] [Indexed: 10/19/2022] Open
Abstract
BACKGROUND AND PURPOSE Diabetes mellitus is a specific risk factor for intracranial atherosclerosis (ICAS) regardless of race. However, it is largely unknown whether poor glycemic control is associated with the severity of ICAS in diabetic patients. METHODS We selected diabetic patients with acute ischemic stroke who were prospectively registered between March 2005 and December 2015. The patients who had a high-risk source of cardiogenic embolism were excluded. ICAS was graded from 0 to 3 by the number of significant (≥50%) stenoses on intracranial magnetic resonance angiography, and was divided into 4 types: unilateral anterior, bilateral anterior, posterior, and anterior plus posterior. Ordinal and multinomial regression tests were applied for the factors influencing the number and types of ICAS. RESULTS A total of 774 patients with noncardioembolic acute ischemic stroke with diabetes were enrolled. The multiplicity of ICAS was independently associated with age (odds ratio [OR], 1.035 per 1 year, 1.018-1.052; P < .001), hypertension (OR, 1.992, 1.336-2.965; P = .001), and glycated hemoglobin (HbA1c; OR, 1.207 per 1%, 1.089-1.338; P < .001) in the ordinal regression model. In multinomial regression, bilateral anterior stenosis tended to be correlated with age (OR, 1.042, 1.008-1.077; P = .016) and HbA1c (OR, 1.201 per 1%, .991-1.520; P = .057). Both anterior and posterior stenoses were significantly associated with age (OR, 1.056, 1.029-1.084; P < .001), hypertension (OR, 2.584, 1.404-4.762; P = .002), and HbA1c (OR, 1.272, 1.070-1.511; P = .006). CONCLUSIONS Age, concomitant hypertension, and HbA1c were factors associated with multiple intracranial stenoses. Further study is warranted to elucidate whether poor glycemic control facilitates ICAS in diabetic patients.
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Affiliation(s)
- Nari Choi
- Departments of Neurology, Soonchunhyang University School of Medicine, Seoul, Republic of Korea
| | - Jeong-Yoon Lee
- Departments of Neurology, Soonchunhyang University School of Medicine, Seoul, Republic of Korea
| | - Jun-Sang Sunwoo
- Departments of Neurology, Soonchunhyang University School of Medicine, Seoul, Republic of Korea
| | - Hakjae Roh
- Departments of Neurology, Soonchunhyang University School of Medicine, Seoul, Republic of Korea
| | - Moo-Young Ahn
- Departments of Neurology, Soonchunhyang University School of Medicine, Seoul, Republic of Korea
| | - Sung-Tae Park
- Departments of Radiology, Soonchunhyang University School of Medicine, Seoul, Republic of Korea
| | - Kyung Bok Lee
- Departments of Neurology, Soonchunhyang University School of Medicine, Seoul, Republic of Korea.
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20
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Echocardiographic characteristics of hypertensive patients affected by transient ischemic attack: a cross-sectional study. ACTA ACUST UNITED AC 2017; 11:213-219. [PMID: 28595718 DOI: 10.1016/j.jash.2017.02.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2016] [Revised: 02/07/2017] [Accepted: 02/12/2017] [Indexed: 01/19/2023]
Abstract
Atrial septal aneurysm (ASA), common finding in normal echocardiographies, has been described in association with transient ischemic attacks (TIAs)/strokes, as well as hypertensive end-organ damage such as left ventricular (LV) hypertrophy. Aim of this study was to assess if a cluster of echocardiographic aspects could characterize TIA hypertensive patients. A cross-sectional study on patients with history of TIA, referring to a Hypertension Center echolab, has been performed. A total of 5223 patients received transthoracic echocardiography. TIA patients were 292 (5.6%). A total of 102 age/sex-matched patients without TIA have been collected as controls. The main characteristic of TIA patients resulted ASA/bulging (B) (TIA 61%, controls 6%, P = .0001). Other aspect was LV concentric remodeling (TIA 32.3%, controls 20.8%, P = .029) and mitral flow aspects of diastolic dysfunction. After adjustment for age and hypertension, ASA/B (odds ratio [OR] = 62.4, 95% confidence interval [CI]: 13.6-73.9, P < .001), followed by LV concentric hypertrophy (OR = 2.1, 95% CI: 1.1-4.3, P = .043), was associated with a positive TIA history. A binary logistic regression performed in ASA/B patients, identified relative wall thickness as the strongest TIA-associated aspect (OR = 53.4, 95% CI: 11.9-74.18, P = .001). ASA/B, common finds in general population, could carry a significant incremental possibility of association with TIA when concentric geometry, frequent hypertensive aspect, is present as well.
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21
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Kim Y, Lee SH. Embolic stroke and after-admission atrial fibrillation. Int J Cardiol 2016; 222:576-580. [PMID: 27513654 DOI: 10.1016/j.ijcard.2016.07.265] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2016] [Revised: 07/29/2016] [Accepted: 07/30/2016] [Indexed: 11/19/2022]
Abstract
BACKGROUND Although atrial fibrillation (AF) is a leading cause of recurrent embolic stroke, secondary AF after stroke has been reported frequently. Because of the different treatment each uses, it is important to detect the exact stroke-etiology. OBJECTIVES The aim of this study was to compare the embolic stroke in patients with known AF and after-admission AF (AAAF). METHODS Between October 2002 and July 2009, those who were diagnosed with AF (n=354) were enrolled in our study out of a total of 2026 acute ischemic stroke (IS) patients. The embolic lesion patterns were assessed by two stroke specialists who were blinded to the clinical information. RESULTS Among 354 IS patients with AF, the number of patients with embolic stroke was 314. Patients with embolic stroke were younger and more likely to have larger left atrial (LA)/Aortic diameter ratio. Approximately 90.4% of those with known AF had embolic stroke, while <60% of patients with AAAF had embolic stroke. Nevertheless, anticoagulants were prescribed similarly in both groups at discharge. The LA/Aortic diameter ratio<1.5 was significantly related to AAAF. After adjusting for multiple co-variables, compared to the patients with known AF, patients with AAAF had reduced risk of embolic stroke (Odds ratio 0.11, 95% Confidence interval 0.03-0.36, p-value<0.001). CONCLUSIONS Compared to AAAF after stroke, known AF was associated with embolic stroke. Therefore, we suggest that stroke etiology and some novel echocardiographic indicators such as LA enlargement might be contemplated before routine using of anticoagulants in IS patients with AF.
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Affiliation(s)
- Yerim Kim
- Department of Neurology, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Republic of Korea
| | - Seung-Hoon Lee
- Department of Neurology, Seoul National University Hospital, Seoul, Republic of Korea.
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22
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Park HK, Kim BJ, Yoon CH, Yang MH, Han MK, Bae HJ. Left Ventricular Diastolic Dysfunction in Ischemic Stroke: Functional and Vascular Outcomes. J Stroke 2016; 18:195-202. [PMID: 27283279 PMCID: PMC4901948 DOI: 10.5853/jos.2015.01697] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2015] [Revised: 03/14/2016] [Accepted: 03/21/2016] [Indexed: 01/09/2023] Open
Abstract
Background and Purpose Left ventricular (LV) diastolic dysfunction, developed in relation to myocardial dysfunction and remodeling, is documented in 15%-25% of the population. However, its role in functional recovery and recurrent vascular events after acute ischemic stroke has not been thoroughly investigated. Methods In this retrospective observational study, we identified 2,827 ischemic stroke cases with adequate echocardiographic evaluations to assess LV diastolic dysfunction within 1 month after the index stroke. The peak transmitral filling velocity/mean mitral annular velocity during early diastole (E/e’) was used to estimate LV diastolic dysfunction. We divided patients into 3 groups according to E/e’ as follows: <8, 8-15, and ≥15. Recurrent vascular events and functional recovery were prospectively collected at 3 months and 1 year. Results Among included patients, E/e’ was 10.6±6.4: E/e’ <8 in 993 (35%), 8-15 in 1,444 (51%), and ≥15 in 378 (13%) cases. Functional dependency or death (modified Rankin Scale score ≥2) and composite vascular events were documented in 1,298 (46%) and 187 (7%) patients, respectively, at 3 months. In multivariable analyses, ischemic stroke cases with E/e’ ≥15 had increased odds of functional dependence or death at 3 months (adjusted OR [95% CI]: 1.73 [1.27-2.35]) or 1 year (1.47 [1.06-2.06]) and vascular events within 1 year (1.65 [1.08-2.51]). Subgroups with normal ejection fraction or sinus rhythm exhibited a similar overall pattern and direction. Conclusions LV diastolic dysfunction was associated with poor functional outcomes and composite vascular events up to 1 year.
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Affiliation(s)
- Hong-Kyun Park
- Department of Neurology and Cerebrovascular Center, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Beom Joon Kim
- Department of Neurology and Cerebrovascular Center, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Chang-Hwan Yoon
- Division of Cardiology, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Mi Hwa Yang
- Department of Neurology and Cerebrovascular Center, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Moon-Ku Han
- Department of Neurology and Cerebrovascular Center, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Hee-Joon Bae
- Department of Neurology and Cerebrovascular Center, Seoul National University Bundang Hospital, Seongnam, Korea
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23
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Kim Y, Kim TJ, Park J, Lee S, Kim Y, Lee JS, Lee S. Novel echocardiographic indicator for potential cardioembolic stroke. Eur J Neurol 2015; 23:613-20. [DOI: 10.1111/ene.12909] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2015] [Accepted: 10/01/2015] [Indexed: 01/26/2023]
Affiliation(s)
- Y. Kim
- Department of Neurology Seoul National University Hospital SeoulKorea
- Department of Neurology Catholic University of Korea Bucheon St Mary's Hospital GyeonggidoKorea
| | - T. J. Kim
- Department of Neurology Seoul National University Hospital SeoulKorea
| | - J.‐B. Park
- Department of Cardiology Seoul National University Hospital SeoulKorea
| | - S. Lee
- Department of Cardiology Seoul National University Hospital SeoulKorea
| | - Y.‐J. Kim
- Department of Cardiology Seoul National University Hospital SeoulKorea
| | - J. S. Lee
- Clinical Research Center Asan Medical Center Seoul Korea
| | - S.‐H. Lee
- Department of Neurology Seoul National University Hospital SeoulKorea
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24
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Association between Hypertriglyceridemia and Lacunar Infarction in Type 2 Diabetes Mellitus. J Stroke Cerebrovasc Dis 2015; 24:1873-8. [DOI: 10.1016/j.jstrokecerebrovasdis.2015.04.030] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2015] [Revised: 04/16/2015] [Accepted: 04/21/2015] [Indexed: 11/23/2022] Open
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25
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Kosiuk J, Hindricks G, Bollmann A. Letter by Kosiuk et al Regarding Article, “Implication of Left Ventricular Diastolic Dysfunction in Cryptogenic Ischemic Stroke”. Stroke 2014; 45:e234. [DOI: 10.1161/strokeaha.114.007023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Jedrzej Kosiuk
- Department of Electrophysiology, Heart Center Leipzig GmbH, University of Leipzig, Leipzig, Germany
| | - Gerhard Hindricks
- Department of Electrophysiology, Heart Center Leipzig GmbH, University of Leipzig, Leipzig, Germany
| | - Andreas Bollmann
- Department of Electrophysiology, Heart Center Leipzig GmbH, University of Leipzig, Leipzig, Germany
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