1
|
van Lith TJ, Sluis WM, Wijers NT, Meijer FJA, Ulzen KKV, de Bresser J, Dankbaar JW, de Mast Q, Klok FA, Cannegieter SC, Wermer MJH, Huisman MV, Tuladhar AM, van der Worp HB, de Leeuw FE. Prevalence and 3-month follow-up of cerebrovascular MRI markers in hospitalized COVID-19 patients: the CORONIS study. Neuroradiology 2024; 66:1565-1575. [PMID: 38953988 PMCID: PMC11322373 DOI: 10.1007/s00234-024-03411-1] [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: 01/23/2024] [Accepted: 06/21/2024] [Indexed: 07/04/2024]
Abstract
PURPOSE To investigate the prevalence of cerebrovascular MRI markers in unselected patients hospitalized for COVID-19 (Coronavirus disease 2019), we compared these with healthy controls without previous SARS-CoV-2 infection or hospitalization and subsequently, investigated longitudinal (incidental) lesions in patients after three months. METHODS CORONIS (CORONavirus and Ischemic Stroke) was an observational cohort study in adult hospitalized patients for COVID-19 and controls without COVID-19, conducted between April 2021 and September 2022. Brain MRI was performed shortly after discharge and after 3 months. Outcomes included recent ischemic (DWI-positive) lesions, previous infarction, microbleeds, white matter hyperintensities (WMH) and intracerebral hemorrhage and were analysed with logistic regression to adjust for confounders. RESULTS 125 patients with COVID-19 and 47 controls underwent brain MRI a median of 41.5 days after symptom onset. DWI-positive lesions were found in one patient (1%) and in one (2%) control, both clinically silent. WMH were more prevalent in patients (78%) than in controls (62%) (adjusted OR: 2.95 [95% CI: 1.07-8.57]), other cerebrovascular MRI markers did not differ. Prevalence of markers in ICU vs. non-ICU patients was similar. After three months, five patients (5%) had new cerebrovascular lesions, including DWI-positive lesions (1 patient, 1.0%), cerebral infarction (2 patients, 2.0%) and microbleeds (3 patients, 3.1%). CONCLUSION Overall, we found no higher prevalence of cerebrovascular markers in unselected hospitalized COVID-19 patients compared to controls. The few incident DWI-lesions were most likely to be explained by risk-factors of small vessel disease. In the general hospitalized COVID-19 population, COVID-19 shows limited impact on cerebrovascular MRI markers shortly after hospitalization.
Collapse
Affiliation(s)
- Theresa J van Lith
- Department of Neurology, Donders Center for Medical Neuroscience, Radboud University Medical Center, PO Box 9101, Nijmegen, 6500 HB, the Netherlands
| | - Wouter M Sluis
- Department of Neurology and Neurosurgery, Brain Center, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Naomi T Wijers
- Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands
| | - Frederick J A Meijer
- Department of Medical Imaging, Radboud University Medical Center, Nijmegen, The Netherlands
| | | | - Jeroen de Bresser
- Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Jan Willem Dankbaar
- Department of Radiology and Nuclear Medicine, University Medical Center, Utrecht University, Utrecht, The Netherlands
| | - Quirijn de Mast
- Department of Internal Medicine, Radboud Center for Infectious Diseases, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Frederikus A Klok
- Department of Medicine - Thrombosis and Hemostasis, Leiden University Medical Centre, Leiden, The Netherlands
| | - Suzanne C Cannegieter
- Department of Medicine - Thrombosis and Hemostasis, Leiden University Medical Centre, Leiden, The Netherlands
- Department of Clinical Epidemiology, Leiden University Medical Centre, Leiden, The Netherlands
| | - Marieke J H Wermer
- Department of Neurology, University Medical Center, Groningen, The Netherlands
| | - Menno V Huisman
- Department of Medicine - Thrombosis and Hemostasis, Leiden University Medical Centre, Leiden, The Netherlands
| | - Anil M Tuladhar
- Department of Neurology, Donders Center for Medical Neuroscience, Radboud University Medical Center, PO Box 9101, Nijmegen, 6500 HB, the Netherlands
| | - H Bart van der Worp
- Department of Neurology and Neurosurgery, Brain Center, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Frank-Erik de Leeuw
- Department of Neurology, Donders Center for Medical Neuroscience, Radboud University Medical Center, PO Box 9101, Nijmegen, 6500 HB, the Netherlands.
| |
Collapse
|
2
|
Abdulsalam MF, Shaheen N, Shaheen A, Alabdallat YJ, Ramadan A, Meshref M, Mansour FM, Abed E, Fayed AGI, Zaki MA, El-Adawy AF, Flouty O, Hamed M. Correlation of silent brain infarcts and leukoaraiosis in middle-aged ischemic stroke patients: a retrospective study. Front Neurol 2024; 15:1430231. [PMID: 39233677 PMCID: PMC11371556 DOI: 10.3389/fneur.2024.1430231] [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: 05/09/2024] [Accepted: 08/08/2024] [Indexed: 09/06/2024] Open
Abstract
Background Cerebrovascular diseases of the brain are usually defined by transient ischemic attacks and strokes. However, they can also cause brain injuries without neurological events. Silent brain infarcts (SBI) and leukoaraiosis are symptoms of both vascular and neurological abnormalities. This study aims to investigate the association between SBI, leukoaraiosis, and middle-aged patients with ischemic stroke. Methods A single-center retrospective study of 50 middle-aged, ischemic stroke patients were studied from November 2022 and May 2023. The patients were divided into two groups based on the presence or absence of leukoaraiosis. History taking, physical examination, brain CT scan, and MRI were all part of the diagnostic process. Metabolic syndrome (MetS) was also assessed through various factors. The statistical analysis included descriptive statistics, logistic regression analysis, and chi-square test. Results Out of the cohort comprising 50 patients, characterized by a mean age of 52.26 years (SD 5.29), 32 were male, constituting 64% of the sample. Among these patients, 26 individuals exhibited leukoaraiosis, with 17 of them (65.4%) also presenting with SBI. Moreover, within this cohort, 22 patients were diagnosed with MetS, representing 84.6% of those affected. The Multivariate logistic regression analysis showed a strong and independent association between leukoaraiosis and SBI. Individuals with leukoaraiosis were nearly five times more likely to have SBI compared to those without leukoaraiosis. Conclusion The study highlights leukoaraiosis as a significant risk factor for SBI, alongside MetS. Advanced imaging techniques have facilitated their detection, revealing a higher prevalence among stroke patients, particularly associated with age and hypertension. Further research is needed to fully understand their complex relationship and develop better management strategies for cerebrovascular diseases, ultimately improving patient outcomes.
Collapse
Affiliation(s)
| | - Nour Shaheen
- Alexandria Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Ahmed Shaheen
- Alexandria Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | | | | | - Mostafa Meshref
- Department of Neurology, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | | | - Elsayed Abed
- Department of Neurology, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | | | - Mohamed Ahmed Zaki
- Department of Neurology, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | - Ahmad F El-Adawy
- Department of Neurology, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | - Oliver Flouty
- Department of Neurosurgery and Brain Repair, University of South Florida, Tampa, FL, United States
| | - Mohamed Hamed
- Department of Neurology, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| |
Collapse
|
3
|
Altunova M, Demir Y, Gulmez R, Evsen A, Aktemur T, Anil Sahin A, Arslan E, Celik O. Hematological predictors of silent new cerebral ischemic lesions in carotid artery stenting: A retrospective study. J Clin Neurosci 2024; 124:30-35. [PMID: 38640806 DOI: 10.1016/j.jocn.2024.04.002] [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: 01/18/2024] [Revised: 03/23/2024] [Accepted: 04/03/2024] [Indexed: 04/21/2024]
Abstract
BACKGROUND Silent new cerebral ischemic lesions (sNCIL) are a common complication of carotid artery stenting (CAS) that can lead to an increase in morbidity and mortality. We aimed to evaluate the impact of hematological parameters on sNCIL in patients undergoing CAS. METHODS We retrospectively evaluated 103 patients who underwent CAS, with a mean age of 70.5 ± 6.7 years, and 31 (20.1 %) of whom were female. Stents were placed for internal carotid artery revascularization. The presence of new hyperintense lesions on diffusion-weighted imaging (DWI) without neurological symptoms was considered as sNCIL in cases without apparent neurological findings. Patients were categorized into two groups based on DWI results: positive (29) and negative (74). RESULTS In the study population, sNCIL was observed in 29 patients (28.2 %). The DWI-positive group exhibited significantly higher Plateletcrit (PCT) levels, advanced age, and a lack of embolic protection device usage compared to the DWI-negative group. The Receiver Operating Characteristic (ROC) analysis identified a PCT value of 0.26 as the optimal threshold, detecting the development of sNCIL with a sensitivity of 75.9 % and specificity of 59.1 % (AUC: 0.700; 95 % CI: 0.594-0.806, p = 0.002). CONCLUSION To be determined by a simple blood parameter, PCT can predict the risk of sNCIL before CAS and holds clinical value in the treatment of patients with carotid artery stenosis.
Collapse
Affiliation(s)
- Mehmet Altunova
- University of Health Sciences, Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Department of Cardiology, Istanbul, Turkey.
| | - Yusuf Demir
- Cigli Training and Research Hospital, Department of Cardiology, Izmir, Turkey
| | - Recep Gulmez
- University of Health Sciences, Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Department of Cardiology, Istanbul, Turkey
| | - Ali Evsen
- Dicle University, Faculty of Medicine, Department of Cardiology, Diyarbakir, Turkey
| | - Tugba Aktemur
- University of Health Sciences, Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Department of Cardiology, Istanbul, Turkey
| | - Ahmet Anil Sahin
- Istinye University, Faculty of Medicine, Department of Cardiology, Liv Bahcesehir Hospital, Istanbul, Turkey
| | - Enes Arslan
- University of Health Sciences, Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Department of Cardiology, Istanbul, Turkey
| | - Omer Celik
- University of Health Sciences, Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Department of Cardiology, Istanbul, Turkey
| |
Collapse
|
4
|
Gills JL, Napoleon DA, Budak M, Fausto BA, Gluck MA, Malin SK. Hypertension is associated with reduced resting-state medial temporal lobe dynamic network flexibility in older African Americans. Physiol Rep 2024; 12:e16084. [PMID: 38850124 PMCID: PMC11161824 DOI: 10.14814/phy2.16084] [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: 04/17/2024] [Revised: 05/10/2024] [Accepted: 05/10/2024] [Indexed: 06/09/2024] Open
Abstract
Hypertension disproportionately affects African Americans and is a risk factor for Alzheimer's disease (AD). We investigated the relationship of blood pressure (BP) with medial temporal lobe (MTL) dynamic network flexibility (a novel AD biomarker) and cognitive generalization in older African Americans. In a cross-sectional study, 37 normotensive (systolic BP <130 mmHg, 82.5% F, 64.4 ± 4.9 years; 14.3 ± 2.1 years of education) versus 79 hypertensive (systolic BP ≥130 mmHg, 79.5% F, 66.8 ± 4.1 years; 14.0 ± 0.2 years of education) participants were enrolled. All participants completed a 10-min resting-state functional magnetic resonance imaging scan to assess MTL dynamic network flexibility and two generalization tasks to assess cognition. Anthropometrics and aerobic fitness (via 6-min walk test) were also determined. There was no difference in BMI (29.7 ± 6.4 vs. 31.9 ± 6.3 kg/m2, p = 0.083) or aerobic fitness (15.5 ± 2.6 vs. 15.1 ± 2.6 mL/kg/min; p = 0.445) between normotensive and hypertensive groups. However, normotensive participants had higher MTL dynamic network flexibility compared to hypertensive participants (0.42 ± 0.23 vs. 0.32 ± 0.25 mL, p = 0.040), and this was associated with higher mean arterial blood pressure (r = -0.21, p = 0.036). Therefore, hypertensive older African Americans demonstrated lower MTL dynamic network flexibility compared to their normotensive counterparts independent of BMI and aerobic fitness. Further studies are required to determine how blood pressure mediates AD risk in African Americans.
Collapse
Affiliation(s)
- Joshua L. Gills
- Department of PsychiatryNew York University Grossman School of MedicineNew YorkNew YorkUSA
- Department of Population HealthNew York University Grossman School of MedicineNew YorkNew YorkUSA
- Center for Molecular and Behavioral NeuroscienceRutgers University‐NewarkNewarkNew JerseyUSA
| | - Darian A. Napoleon
- Center for Molecular and Behavioral NeuroscienceRutgers University‐NewarkNewarkNew JerseyUSA
| | - Miray Budak
- Center for Molecular and Behavioral NeuroscienceRutgers University‐NewarkNewarkNew JerseyUSA
| | - Bernadette A. Fausto
- Center for Molecular and Behavioral NeuroscienceRutgers University‐NewarkNewarkNew JerseyUSA
| | - Mark A. Gluck
- Center for Molecular and Behavioral NeuroscienceRutgers University‐NewarkNewarkNew JerseyUSA
| | - Steven K. Malin
- Department of Kinesiology and HealthRutgers UniversityNew BrunswickNew JerseyUSA
- Division of Endocrinology, Metabolism and NutritionRutgers UniversityNew BrunswickNew JerseyUSA
- New Jersey Institute for Food, Nutrition and HealthRutgers UniversityNew BrunswickNew JerseyUSA
- Institute of Translational Medicine and ScienceRutgers UniversityNew BrunswickNew JerseyUSA
| |
Collapse
|
5
|
Stickel AM, Tarraf W, Gonzalez KA, Paredes AM, Zeng D, Cai J, Isasi CR, Kaplan R, Lipton RB, Daviglus ML, Testai FD, Lamar M, Gallo LC, Talavera GA, Gellman MD, Ramos AR, Ivanovic V, Seiler S, González HM, DeCarli C. Cardiovascular disease risk exacerbates brain aging among Hispanic/Latino adults in the SOL-INCA-MRI Study. Front Aging Neurosci 2024; 16:1390200. [PMID: 38778863 PMCID: PMC11110680 DOI: 10.3389/fnagi.2024.1390200] [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: 02/22/2024] [Accepted: 04/09/2024] [Indexed: 05/25/2024] Open
Abstract
Background Cardiovascular disease (CVD) risk factors are highly prevalent among Hispanic/Latino adults, while the prevalence of MRI infarcts is not well-documented. We, therefore, sought to examine the relationships between CVD risk factors and infarcts with brain structure among Hispanic/Latino individuals. Methods Participants included 1,886 Hispanic/Latino adults (50-85 years) who underwent magnetic resonance imaging (MRI) as part of the Study of Latinos-Investigation of Neurocognitive Aging-MRI (SOL-INCA-MRI) study. CVD risk was measured approximately 10.5 years before MRI using the Framingham cardiovascular risk score, a measure of 10-year CVD risk (low (<10%), medium (10- < 20%), and high (≥20%)). MR infarcts were determined as present or absent. Outcomes included total brain, cerebral and lobar cortical gray matter, hippocampal, lateral ventricle, and total white matter hyperintensity (WMH) volumes. Linear regression models tested associations between CVD risk and infarct with MRI outcomes and for modifications by age and sex. Results Sixty percent of participants were at medium or high CVD risk. Medium and high CVD risk were associated with lower total brain and frontal gray matter and higher WMH volumes compared to those with low CVD risk. High CVD risk was additionally associated with lower total cortical gray matter and parietal volumes and larger lateral ventricle volumes. Men tended to have greater CVDRF-related differences in total brain volumes than women. The association of CVD risk factors on total brain volumes increased with age, equal to an approximate 7-year increase in total brain aging among the high-CVD-risk group compared to the low-risk group. The presence of infarct(s) was associated with lower total brain volumes, which was equal to an approximate 5-year increase in brain aging compared to individuals without infarcts. Infarcts were also associated with smaller total cortical gray matter, frontal and parietal volumes, and larger lateral ventricle and WMH volumes. Conclusion The high prevalence of CVD risk among Hispanic/Latino adults may be associated with accelerated brain aging.
Collapse
Affiliation(s)
- Ariana M. Stickel
- Department of Psychology, San Diego State University, San Diego, CA, United States
| | - Wassim Tarraf
- Department of Healthcare Sciences, Institute of Gerontology, Wayne State University, Detroit, MI, United States
| | - Kevin A. Gonzalez
- Department of Neurosciences, University of California, San Diego, La Jolla, CA, United States
| | | | - Donglin Zeng
- Department of Biostatistics, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Jianwen Cai
- Department of Biostatistics, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Carmen R. Isasi
- Department of Epidemiology & Population Health, Albert Einstein College of Medicine, Bronx, NY, United States
| | - Robert Kaplan
- Department of Epidemiology & Population Health, Albert Einstein College of Medicine, Bronx, NY, United States
| | - Richard B. Lipton
- Department of Neurology, Albert Einstein College of Medicine, Bronx, NY, United States
| | - Martha L. Daviglus
- Institute for Minority Health Research, University of Illinois at Chicago, College of Medicine, Chicago, IL, United States
| | - Fernando D. Testai
- Department of Neurology & Neurorehabilitation, College of Medicine, University of Illinois at Chicago, Chicago, IL, United States
| | - Melissa Lamar
- Institute for Minority Health Research, University of Illinois at Chicago, College of Medicine, Chicago, IL, United States
- Rush Alzheimer’s Disease Research Center, Rush University Medical Center, Chicago, IL, United States
| | - Linda C. Gallo
- Department of Psychology, San Diego State University, San Diego, CA, United States
| | - Gregory A. Talavera
- Department of Psychology, San Diego State University, San Diego, CA, United States
| | - Marc D. Gellman
- Department of Psychology, University of Miami, Miami, FL, United States
| | - Alberto R. Ramos
- Department of Neurology, University of Miami Miller School of Medicine, Miami, FL, United States
| | - Vladimir Ivanovic
- Department of Radiology, Medical College of Wisconsin, Milwaukee, WI, United States
| | - Stephan Seiler
- Department of Neurology, Klinikum Klagenfurt, Klagenfurt, Austria
| | - Hector M. González
- Department of Neurosciences, University of California, San Diego, La Jolla, CA, United States
| | - Charles DeCarli
- Department of Neurology, University of California at Davis, Davis, CA, United States
| |
Collapse
|
6
|
Kern KC, Nasrallah IM, Bryan RN, Williamson J, Reboussin DM, Pajewski NM, Wright CB. Intensive Blood Pressure Treatment and Subclinical Brain Infarcts: A Secondary Analysis of SPRINT (Systolic Pressure Intervention Trial). Ann Neurol 2024; 95:866-875. [PMID: 38362733 PMCID: PMC11060925 DOI: 10.1002/ana.26892] [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: 06/25/2023] [Revised: 01/30/2024] [Accepted: 02/03/2024] [Indexed: 02/17/2024]
Abstract
OBJECTIVE Subclinical brain infarcts (SBI) increase the risk for stroke and dementia, but whether they should be considered equivalent to symptomatic stroke when determining blood pressure targets remains unclear. We tested whether intensive systolic blood pressure (SBP) treatment reduced the risk of new SBI or stroke and determined the association between SBI and cognitive impairment. METHODS In this secondary analysis of SPRINT (Systolic Pressure Intervention Trial), participants ≥50 years old, with SBP 130-180mmHg and elevated cardiovascular risk but without known clinical stroke, dementia, or diabetes, were randomized to intensive (<120mmHg) or standard (<140mmHg) SBP treatment. Brain magnetic resonance images collected at baseline and follow-up were read for SBI. The occurrence of mild cognitive impairment (MCI) or probable dementia (PD) was evaluated. RESULTS For 667 participants at baseline, SBI were identified in 75 (11%). At median 3.9 years follow-up, 12 of 457 had new SBI on magnetic resonance imaging (5 intensive, 7 standard), whereas 8 had clinical stroke (4 per group). Baseline SBI (subhazard ratio [sHR] = 3.90; 95% CI 1.49 to 10.24; p = 0.006), but not treatment group, was associated with new SBI or stroke. For participants with baseline SBI, intensive treatment reduced their risk for recurrent SBI or stroke (sHR = 0.050; 95% CI 0.0031 to 0.79; p = 0.033). Baseline SBI also increased risk for MCI or PD during follow-up (sHR = 2.38; 95% CI 1.23 to 4.61; p = 0.010). INTERPRETATION New cerebral ischemic events were infrequent, but intensive treatment mitigated the increased risk for participants with baseline SBI, indicating primary prevention SBP goals are still appropriate when SBI are present. ANN NEUROL 2024;95:866-875.
Collapse
Affiliation(s)
- Kyle C. Kern
- Stroke Branch, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, United States
- Department of Neurology, University of California Los Angeles David Geffen School of Medicine, Los Angeles, CA, United States
| | - Ilya M. Nasrallah
- Radiology, University of Pennsylvania, Philadelphia, PA, United States
| | - R. Nick Bryan
- Radiology, University of Pennsylvania, Philadelphia, PA, United States
| | - Jeff Williamson
- Department of Medicine, Wake Forest University School of Medicine, Winston-Salem, NC, United States
| | - David M. Reboussin
- Department of Biostatistics and Data Science, Wake Forest University School of Medicine, Winston-Salem, NC, United States
| | - Nicholas M. Pajewski
- Department of Biostatistics and Data Science, Wake Forest University School of Medicine, Winston-Salem, NC, United States
| | - Clinton B. Wright
- Stroke Branch, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, United States
| |
Collapse
|
7
|
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.
Collapse
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.
| |
Collapse
|
8
|
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.
Collapse
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
| |
Collapse
|
9
|
Pradella M, Baraboo JJ, Prabhakaran S, Zhao L, Hijaz T, McComb EN, Naidich MJ, Heckbert SR, Nasrallah IM, Bryan RN, Passman RS, Markl M, Greenland P. MRI Investigation of the Association of Left Atrial and Left Atrial Appendage Hemodynamics with Silent Brain Infarction. J Magn Reson Imaging 2024. [PMID: 38490945 DOI: 10.1002/jmri.29349] [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: 12/28/2023] [Revised: 03/01/2024] [Accepted: 03/02/2024] [Indexed: 03/17/2024] Open
Abstract
BACKGROUND Left atrial (LA) myopathy is thought to be associated with silent brain infarctions (SBI) through changes in blood flow hemodynamics leading to thrombogenesis. 4D-flow MRI enables in-vivo hemodynamic quantification in the left atrium (LA) and LA appendage (LAA). PURPOSE To determine whether LA and LAA hemodynamic and volumetric parameters are associated with SBI. STUDY TYPE Prospective observational study. POPULATION A single-site cohort of 125 Participants of the multiethnic study of atherosclerosis (MESA), mean age: 72.3 ± 7.2 years, 56 men. FIELD STRENGTH/SEQUENCE 1.5T. Cardiac MRI: Cine balanced steady state free precession (bSSFP) and 4D-flow sequences. Brain MRI: T1- and T2-weighted SE and FLAIR. ASSESSMENT Presence of SBI was determined from brain MRI by neuroradiologists according to routine diagnostic criteria in all participants without a history of stroke based on the MESA database. Minimum and maximum LA volumes and ejection fraction were calculated from bSSFP data. Blood stasis (% of voxels <10 cm/sec) and peak velocity (cm/sec) in the LA and LAA were assessed by a radiologist using an established 4D-flow workflow. STATISTICAL TESTS Student's t test, Mann-Whitney U test, one-way ANOVA, chi-square test. Multivariable stepwise logistic regression with automatic forward and backward selection. Significance level P < 0.05. RESULTS 26 (20.8%) had at least one SBI. After Bonferroni correction, participants with SBI were significantly older and had significantly lower peak velocities in the LAA. In multivariable analyses, age (per 10-years) (odds ratio (OR) = 1.99 (95% confidence interval (CI): 1.30-3.04)) and LAA peak velocity (per cm/sec) (OR = 0.87 (95% CI: 0.81-0.93)) were significantly associated with SBI. CONCLUSION Older age and lower LAA peak velocity were associated with SBI in multivariable analyses whereas volumetric-based measures from cardiac MRI or cardiovascular risk factors were not. Cardiac 4D-flow MRI showed potential to serve as a novel imaging marker for SBI. LEVEL OF EVIDENCE 3 TECHNICAL EFFICACY: Stage 2.
Collapse
Affiliation(s)
- Maurice Pradella
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
- Department of Radiology, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Justin J Baraboo
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Shyam Prabhakaran
- Department of Neurology, University of Chicago, Chicago, Illinois, USA
| | - Lihui Zhao
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Tarek Hijaz
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Erin N McComb
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Michelle J Naidich
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Susan R Heckbert
- Department of Epidemiology, University of Washington, Seattle, Washington, USA
| | - Ilya M Nasrallah
- Department of Radiology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - R Nick Bryan
- Department of Radiology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Rod S Passman
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
- Division of Cardiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Michael Markl
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Philip Greenland
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
- Division of Cardiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| |
Collapse
|
10
|
Fanning JP, Campbell BCV, Bulbulia R, Gottesman RF, Ko SB, Floyd TF, Messé SR. Perioperative stroke. Nat Rev Dis Primers 2024; 10:3. [PMID: 38238382 DOI: 10.1038/s41572-023-00487-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/01/2023] [Indexed: 01/23/2024]
Abstract
Ischaemic or haemorrhagic perioperative stroke (that is, stroke occurring during or within 30 days following surgery) can be a devastating complication following surgery. Incidence is reported in the 0.1-0.7% range in adults undergoing non-cardiac and non-neurological surgery, in the 1-5% range in patients undergoing cardiac surgery and in the 1-10% range following neurological surgery. However, higher rates have been reported when patients are actively assessed and in high-risk populations. Prognosis is significantly worse than stroke occurring in the community, with double the 30-day mortality, greater disability and diminished quality of life among survivors. Considering the annual volume of surgeries performed worldwide, perioperative stroke represents a substantial burden. Despite notable differences in aetiology, patient populations and clinical settings, existing clinical recommendations for perioperative stroke are extrapolated mainly from stroke in the community. Perioperative in-hospital stroke is unique with respect to the stroke occurring in other settings, and it is essential to apply evidence from other settings with caution and to identify existing knowledge gaps in order to effectively guide patient care and future research.
Collapse
Affiliation(s)
- Jonathon P Fanning
- Critical Care Research Group, The Prince Charles Hospital, Brisbane, Queensland, Australia.
- Anaesthesia & Perfusion Services, The Prince Charles Hospital, Brisbane, Queensland, Australia.
- Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia.
- The George Institute for Global Health, Sydney, New South Wales, Australia.
- Nuffield Department of Population Health, University of Oxford, Oxford, UK.
| | - Bruce C V Campbell
- Department of Neurology, Royal Melbourne Hospital, Parkville, Victoria, Australia
- Department of Medicine, University of Melbourne, Parkville, Victoria, Australia
- Florey Institute of Neuroscience and Mental Health, Parkville, Victoria, Australia
| | - Richard Bulbulia
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
- Department of Vascular Surgery, Gloucestershire Hospitals NHS Foundation Trust, Gloucester, UK
| | | | - Sang-Bae Ko
- Department of Neurology and Department of Critical Care Medicine, Seoul National University Hospital, Seoul, Korea
| | - Thomas F Floyd
- Department of Anaesthesiology & Pain Management, Department of Cardiovascular and Thoracic Surgery, The University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Steven R Messé
- Department of Neurology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| |
Collapse
|
11
|
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.
Collapse
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
| |
Collapse
|
12
|
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.
Collapse
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
| |
Collapse
|
13
|
Díaz-Leiva J, Arrondo-Gómez P, Alonso-Sendín E, Gainza-Calleja A, Ostolaza-Ibáñez A, Tellechea-Aramburo P, Gómez-Blasco F, Blanco-Beregaña M, López-Sala P, Cabada-Giadás T. [Delayed cognitive impairment in patients with aortic stenosis treated with surgical valve replacement and transcatheter aortic valve implantation: a comparative study]. Rev Neurol 2023; 77:205-214. [PMID: 37889128 PMCID: PMC10831739 DOI: 10.33588/rn.7709.2022346] [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] [Indexed: 10/28/2023]
Abstract
INTRODUCTION Cognitive impairment secondary to cerebrovascular events is a common complication of aortic valve replacement interventions. Our aim is to study the deterioration profile of patients who have undergone surgical valve replacement or transcatheter valve implantation (TAVI) and whether it differs according to the intervention they underwent and their baseline risk factors. PATIENTS AND METHODS We conducted a prospective observational study with two non-equivalent groups of patients (TAVI group and surgical group) Intergroup comparisons were carried out in several cognitive domains, with a baseline assessment and follow-up measurements six and 12 months after the intervention. RESULTS The TAVI group performed less well than the surgical group in executive and visuospatial functions, with scores partially determined by age (p < 0.01) and prior intellectual level (Pearson prior intelligence quotient-scalar test means: 0.665; p < 0.001). Mean scores at the three measurement points indicate a decline in executive function performance at six months, which is restored at 12 months. Sustained increases in memory were recorded at both time points, while visuospatial function and naming showed no subsequent recovery of the baseline levels. These trends are similar in both groups. CONCLUSION The results obtained do not confirm the appearance of a specific process of post-intervention neurocognitive impairment in complicated aortic stenosis. The deterioration profile does not show any significant differences between groups, but is more evident in TAVI patients, due to the influence of variables related to sample selection.
Collapse
Affiliation(s)
- J Díaz-Leiva
- Hospital Universitario de Navarra, Pamplona, España
| | | | | | | | | | | | | | | | - P López-Sala
- Hospital Universitario de Navarra, Pamplona, España
| | | |
Collapse
|
14
|
Liang Y, Fan T, Bai M, Tang M, Cui N, Chen Y, Chen J, Wang J, Guan Y. A Knowledge Map of the Relationship between Diabetes and Stroke: A Bibliometric Analysis Study. Cerebrovasc Dis 2023; 53:270-287. [PMID: 37722359 DOI: 10.1159/000533383] [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: 03/29/2023] [Accepted: 07/31/2023] [Indexed: 09/20/2023] Open
Abstract
INTRODUCTION The correlation between diabetes and stroke has been studied extensively in epidemiological research. Here, we used bibliometric software to visualize and analyze the literature related to diabetic stroke to provide an overview of the current state of research, hotspots, and future trends in the field. METHODS Based on the Web of Science Core Collection (WoSCC) database, we collected studies related to diabetic stroke from 2007 to December 2022. We used CiteSpace (version 6.1.R5), VOSviewer, and Scimago Graphica to create knowledge maps and conduct visual analyses on authors, countries, institutions, cited references, and keywords, and Origin for statistical analysis. RESULTS We included a total of 5,171 papers on diabetic stroke from the WoSCC database. Overall, there was a steady increase in the number of publications, with a high number of emerging scientists. The USA was the most productive and influential country, which dominated national collaborations. The most common subject category was "neurology." In total, 12 major clusters were generated from the cited references. Keyword analysis showed that keywords related to poststroke injury and treatment are those with the highest burst intensity and latest burst time. CONCLUSIONS Individual disease treatment remains a hot topic, and how to balance acute stroke treatment and glycemic control is currently a difficult clinical problem. At the same time, the mechanism of their interaction and the prevention and treatment of related causative factors remain a hot topic of current and future research.
Collapse
Affiliation(s)
- Yitong Liang
- Department of Pharmacy, Xijing Hospital, Fourth Military Medical University, Xi'an, China,
| | - Tingting Fan
- Department of Pharmacy, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Min Bai
- Department of Pharmacy, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Meng Tang
- Department of Pharmacy, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Na Cui
- Department of Pharmacy, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Yue Chen
- Department of Pharmacy, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Jinyi Chen
- Department of Pharmacy, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Jingwen Wang
- Department of Pharmacy, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Yue Guan
- Department of Pharmacy, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| |
Collapse
|
15
|
Sukumar S, Mazepa MA, Chaturvedi S. Cardiovascular Disease and Stroke in Immune TTP-Challenges and Opportunities. J Clin Med 2023; 12:5961. [PMID: 37762903 PMCID: PMC10531888 DOI: 10.3390/jcm12185961] [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: 06/29/2023] [Revised: 08/29/2023] [Accepted: 09/09/2023] [Indexed: 09/29/2023] Open
Abstract
Advances in the management of immune thrombotic thrombocytopenic purpura (iTTP) have dramatically improved outcomes of acute TTP episodes, and TTP is now treated as a chronic, relapsing disorder. It is now recognized that iTTP survivors are at high risk for vascular disease, with stroke and myocardial infarction occurring at younger ages than in the general population, and cardiovascular disease is the leading cause of premature death in this population. iTTP appears to have a phenotype of accelerated vascular aging with a particular predilection for cerebral circulation, and stroke is much more common than myocardial infarction. In addition to traditional cardiovascular risk factors, low ADAMTS13 activity during clinical remission may be a risk factor for some of these outcomes, such as stroke. Recent studies also suggest that Black patients, who are disproportionately affected by iTTP in the United States, are at higher risk of adverse cardiovascular outcomes, likely due to multifactorial reasons. Additional research is required to establish the risk factors and mechanisms underlying these complications in order to institute optimal screening strategies and identify interventions to improve outcomes.
Collapse
Affiliation(s)
- Senthil Sukumar
- Division of Hematology/Oncology, Department of Medicine, Baylor College of Medicine, Houston, TX 77098, USA;
| | - Marshall A. Mazepa
- Division of Hematology, Oncology, and Transplantation, Department of Medicine, University of Minnesota, Minneapolis, MN 55455, USA;
| | - Shruti Chaturvedi
- Division of Hematology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
| |
Collapse
|
16
|
Kourtidou C, Tziomalos K. Epidemiology and Risk Factors for Stroke in Chronic Kidney Disease: A Narrative Review. Biomedicines 2023; 11:2398. [PMID: 37760839 PMCID: PMC10525494 DOI: 10.3390/biomedicines11092398] [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: 07/29/2023] [Revised: 08/21/2023] [Accepted: 08/24/2023] [Indexed: 09/29/2023] Open
Abstract
Patients with chronic kidney disease (CKD) have a higher risk ofboth ischemic and hemorrhagic stroke. This association appears to be partly independent from the higher prevalence of established risk factors for stroke in patients with CKD, including hypertension and atrial fibrillation. In the present review we aim to discuss the impact of CKD on the risk of stroke and stroke-related consequences, and explore the pathophysiology underpinning the increased risk of stroke in patients with CKD. We cover the clinical association between renal dysfunction and cerebrovascular disease including stroke, silent brain infarct, cerebral small vessel disease, microbleeds, and white matter hyperintensity, and discuss the underlying mechanisms.
Collapse
Affiliation(s)
- Christodoula Kourtidou
- Department of Nephrology, Medical School, Aristotle University of Thessaloniki, AHEPA University Hospital, 54636 Thessaloniki, Greece;
| | - Konstantinos Tziomalos
- First Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, AHEPA University Hospital, 54636 Thessaloniki, Greece
| |
Collapse
|
17
|
Barsky LL, Burke R, Espinosa RD. Timing of Intervention for Left Ventricular Mass in the Setting of Acute Obstructive Coronary Artery Disease. CASE (PHILADELPHIA, PA.) 2023; 7:309-315. [PMID: 37614693 PMCID: PMC10442377 DOI: 10.1016/j.case.2023.03.002] [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] [Indexed: 08/25/2023]
Abstract
•Comorbid need for antiplatelet therapy complicates intracardiac mass management. •Noninvasive mass diagnosis is invaluable for patients at high operative risk. •Guidelines for timing of intervention on masses are currently not well defined.
Collapse
Affiliation(s)
- Lili L. Barsky
- HonorHealth Scottsdale Thompson Peak Medical Center, Heart and Vascular Institute, Scottsdale, Arizona
| | - Robert Burke
- HonorHealth Scottsdale Thompson Peak Medical Center, Heart and Vascular Institute, Scottsdale, Arizona
| | - Renee D. Espinosa
- HonorHealth Scottsdale Thompson Peak Medical Center, Heart and Vascular Institute, Scottsdale, Arizona
| |
Collapse
|
18
|
Chaturvedi S, Yu J, Brown J, Wei A, Selvakumar S, Gerber GF, Moliterno AR, Streiff MB, Kraus P, Logue CM, Yui JC, Naik RP, Latif H, Lanzkron SM, Braunstein EM, Brodsky RA, Gottesman RF, Lin DD. Silent cerebral infarction during immune TTP remission: prevalence, predictors, and impact on cognition. Blood 2023; 142:325-335. [PMID: 37216688 PMCID: PMC10447499 DOI: 10.1182/blood.2023019663] [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: 02/27/2023] [Revised: 04/05/2023] [Accepted: 04/25/2023] [Indexed: 05/24/2023] Open
Abstract
Immune thrombotic thrombocytopenic purpura (iTTP) survivors have increased risk of cardiovascular disease, including strokes, and report persistent cognitive difficulties during remission. We conducted this prospective study involving iTTP survivors during clinical remission to determine the prevalence of silent cerebral infarction (SCI), defined as magnetic resonance imaging (MRI) evidence of brain infarction without corresponding overt neurodeficits. We also tested the hypothesis that SCI is associated with cognitive impairment, assessed using the National Institutes of Health ToolBox Cognition Battery. For cognitive assessments, we used fully corrected T scores adjusted for age, sex, race, and education. Based on the diagnostic and statistical manual 5 criteria, we defined mild and major cognitive impairment as T scores with a 1 or 2 standard deviation (SD) and >2 SD below the mean on at least 1 test, respectively. Forty-two patients were enrolled, with 36 completing MRIs. SCI was present in 50% of the patients (18), of which 8 (44.4%) had prior overt stroke including during acute iTTP. Patients with SCI had higher rates of cognitive impairment (66.7% vs 27.7%; P = .026), including major cognitive impairment (50% vs 5.6%; P = .010). In separate logistic regression models, SCI was associated with any (mild or major) cognitive impairment (odds ratio [OR] 10.5 [95% confidence interval (95% CI), 1.45-76.63]; P = .020) and major cognitive impairment (OR 7.98 [95% CI, 1.11-57.27]; P = .039) after adjusting for history of stroke and Beck depression inventory scores. MRI evidence of brain infarction is common in iTTP survivors; the strong association of SCI with impaired cognition suggests that these silent infarcts are neither silent nor innocuous.
Collapse
Affiliation(s)
- Shruti Chaturvedi
- Division of Hematology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Jia Yu
- Division of Hematology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Jenna Brown
- Division of Hematology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Aria Wei
- Division of Hematology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Sruthi Selvakumar
- Nova Southeastern University College of Allopathic Medicine, Davie, FL
| | - Gloria F. Gerber
- Division of Hematology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Alison R. Moliterno
- Division of Hematology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Michael B. Streiff
- Division of Hematology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Peggy Kraus
- Division of Hematology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Claire M. Logue
- Division of Hematology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Jennifer C. Yui
- Division of Hematology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Rakhi P. Naik
- Division of Hematology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Hira Latif
- Division of Hematology and Oncology, MedStar Georgetown University Hospital Center, Washington, DC
| | - Sophie M. Lanzkron
- Division of Hematology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Evan M. Braunstein
- Division of Hematology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Robert A. Brodsky
- Division of Hematology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Rebecca F. Gottesman
- Stroke, Cognition and Neuroepidemiology Section, National Institute of Neurological Disease and Stroke Intramural Research Program, Bethesda, MD
| | - Doris D. Lin
- Division of Neuroradiology, Department of Radiology, Johns Hopkins University School of Medicine, Baltimore, MD
| |
Collapse
|
19
|
Cao Y, Yue X, Jia M, Wang J. Neuroinflammation and anti-inflammatory therapy for ischemic stroke. Heliyon 2023; 9:e17986. [PMID: 37519706 PMCID: PMC10372247 DOI: 10.1016/j.heliyon.2023.e17986] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Revised: 04/25/2023] [Accepted: 07/04/2023] [Indexed: 08/01/2023] Open
Abstract
Stroke remains one of the most devastating and challenging neurological diseases worldwide. Inflammation, as well as oxidative stress is one of the main contributors to post-stroke injuries, and oxidative stress can further induce inflammation. Moreover, the inflammatory response is closely related to immune modulation in ischemic stroke progression. Hence, major ischemic stroke treatment strategies include targeting inflammatory responses, immune modulation (especially immune cells), and inflammatory response to suppress stroke progression. To date, several drugs have demonstrated clinical efficacy, such as Etanercept and Fingolimod. However, only edaravone dexborneol has successfully passed the phase III clinical trial and been approved by the National Medical Products Administration (NMPA) to treat ischemic stroke in China, which can restore redox balance and regulate inflammatory immune responses, thus providing neuroprotection in ischemic stroke. In this review, we will comprehensively summarize the current advances in the application of inflammatory biomarkers, neuroinflammation and neuro-immunotherapeutic scenarios for ischemic stroke, thus aiming to provide a theoretical basis and new prospects and frontiers for clinical applications.
Collapse
Affiliation(s)
- Yangyue Cao
- Department of Neurology, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Xuanye Yue
- Department of Neurology, Tianjin Medical University General Hospital, Tianjin, China
| | - Meng Jia
- National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Jiawei Wang
- Department of Neurology, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| |
Collapse
|
20
|
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
| |
Collapse
|
21
|
Wang Z, Wang K, Lu S, Zhang L, Li M, Ju W, Ni B, Gu W, Shao Y, Chen M. Surgical and percutaneous left atrial appendage intervention: silent cerebral embolism considerations. Eur J Cardiothorac Surg 2023; 63:ezad074. [PMID: 36857577 PMCID: PMC10275913 DOI: 10.1093/ejcts/ezad074] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 02/08/2023] [Accepted: 02/28/2023] [Indexed: 03/03/2023] Open
Abstract
OBJECTIVES Left atrial appendage intervention is an alternative to oral anticoagulation for thromboprophylaxis in atrial fibrillation. The aim of our study was to compare the incidence of silent cerebral embolisms after surgical and percutaneous intervention and to identify the risk factors for procedure-related silent cerebral embolisms after intervention. METHODS This prospective observational study included consecutive atrial fibrillation patients from 2 independent cohorts (left atrial appendage excision (LAAE) cohort and left atrial appendage occlusion cohort) between September 2018 and December 2020. All patients underwent cerebral magnetic resonance imaging before and after the procedure. Silent cerebral embolism was defined as new focal hyperintense lesions detected only on postprocedural sequence. RESULTS Thirty-two patients from the LAAE cohort and 42 patients from the occlusion cohort were enrolled. A significantly lower incidence of silent cerebral embolism was observed in the LAAE cohort as compared with occlusion (6.3% vs 54.8%, P < 0.001). In the left atrial appendage occlusion cohort, patients who developed silent cerebral embolism after the procedure had significantly higher CHA2DS2-VASc scores [odds ratio (OR) 2.172; 95% confidence interval (CI) 1.149-4.104; P = 0.017], longer occlusion placement time (OR 1.067; 95% CI 1.018-1.118; P = 0.006) and lower peak activated clotting time level after transseptal puncture (OR 0.976; 95% CI 0.954-0.998; P = 0.035). CONCLUSIONS The incidence of procedure-related silent cerebral embolism was strikingly lower in patients with LAAE than in patients with occlusion. More cardiovascular comorbidities, longer occlusion placement time and lower activated clotting time level were significantly associated with the development of procedure-related silent cerebral embolism.
Collapse
Affiliation(s)
- Zidun Wang
- Division of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Kexin Wang
- Division of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Shanshan Lu
- Division of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Lian Zhang
- Division of Neurology, 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
| | - Weizhu Ju
- Division of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Buqing Ni
- Division of Cardiovascular Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Weidong Gu
- Division of Cardiovascular Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Yongfeng Shao
- Division of Cardiovascular Surgery, 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
| |
Collapse
|
22
|
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.
Collapse
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
| |
Collapse
|
23
|
Johansen MC. The Future of Ischemic Stroke Diagnosis and a Review of Underrecognized Ischemic Stroke Etiologies. Neurotherapeutics 2023; 20:613-623. [PMID: 37157043 PMCID: PMC10275839 DOI: 10.1007/s13311-023-01383-3] [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] [Accepted: 04/19/2023] [Indexed: 05/10/2023] Open
Abstract
Accurate ischemic stroke etiologic determination and diagnosis form the foundation of excellent cerebrovascular care as from it stems initiation of the appropriate secondary prevention strategy as well as appropriate patient education regarding specific risk factors for that subtype. Recurrent stroke rates are highest among those patients who receive an incorrect initial stroke diagnosis. Patient distrust and patient reported depression are also higher. The cause of the ischemic stroke also informs predicted patient outcomes and the anticipated recovery trajectory. Finally, determining the accurate cause of the ischemic stroke provides the patient the opportunity to enroll in appropriate research studies studying mechanism, or targeting treatment approaches for that particular disease process. Advances in ischemic stroke research, imaging techniques, biomarkers, and the ability to rapidly perform genetic sequencing over the past decade have shown that classifying patients into large etiologic buckets may not always be appropriate and may represent one reason why some patients are labeled as cryptogenic, or for whom an underlying etiology is never found. Aside from the more traditional stroke mechanisms, there is new research emerging regarding clinical findings that are not normative, but the contributions to ischemic stroke are unclear. In this article, we first review the essential steps to accurate ischemic stroke etiologic classification and then transition to a discussion of embolic stroke of undetermined source (ESUS) and other new entities that have been postulated as causal in ischemic stroke (i.e., genetics and subclinical atherosclerosis). We also discuss the limitations that are inherent in the current ischemic stroke diagnostic algorithms and finally review the most recent studies regarding more uncommon diagnoses and the future of stroke diagnostics and classification.
Collapse
|
24
|
Sharrief A. Diagnosis and Management of Cerebral Small Vessel Disease. Continuum (Minneap Minn) 2023; 29:501-518. [PMID: 37039407 DOI: 10.1212/con.0000000000001232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/12/2023]
Abstract
OBJECTIVE Cerebral small vessel disease (CSVD) is a common neurologic condition that contributes to considerable mortality and disability because of its impact on ischemic and hemorrhagic stroke risk and dementia. While attributes of the disease have been recognized for over two centuries, gaps in knowledge remain related to its prevention and management. The purpose of this review is to provide an overview of the current state of knowledge for CSVD. LATEST DEVELOPMENTS CSVD can be recognized by well-defined radiographic criteria, but the pathogenic mechanism behind the disease is unclear. Hypertension control remains the best-known strategy for stroke prevention in patients with CSVD, and recent guidelines provide a long-term blood pressure target of less than 130/80 mm Hg for patients with ischemic and hemorrhagic stroke, including those with stroke related to CSVD. Cerebral amyloid angiopathy is the second leading cause of intracerebral hemorrhage and may be increasingly recognized because of newer, more sensitive imaging modalities. Transient focal neurologic episodes is a relatively new term used to describe "amyloid spells." Guidance on distinguishing these events from seizures and transient ischemic attacks has been published. ESSENTIAL POINTS CSVD is prevalent and will likely be encountered by all neurologists in clinical practice. It is important for neurologists to be able to recognize CSVD, both radiographically and clinically, and to counsel patients on the prevention of disease progression. Blood pressure control is especially relevant, and strategies are needed to improve blood pressure control for primary and secondary stroke prevention in patients with CSVD.
Collapse
Affiliation(s)
- Anjail Sharrief
- Associate Professor of Neurology, Department of Neurology, McGovern Medical School, University of Texas Health Sciences Center, Houston, Texas
| |
Collapse
|
25
|
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.
Collapse
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
| |
Collapse
|
26
|
Recurrence of ischaemic stroke using epidemiology and neuroimaging: A retrospective study in Gansu Province. Heliyon 2023; 9:e13495. [PMID: 36825169 PMCID: PMC9941996 DOI: 10.1016/j.heliyon.2023.e13495] [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: 07/01/2022] [Revised: 12/30/2022] [Accepted: 01/31/2023] [Indexed: 02/08/2023] Open
Abstract
Objectives This retrospective study aimed to investigate the clinical and imaging recurrence of ischaemic stroke (IS), and to evaluate the risk factors for recurrence. A combined clinical and imaging diagnostic model is important for stroke prevention and management. Methods and materials In accordance with the inclusion and exclusion criteria, we retrospectively analysed consecutively hospitalised patients with acute IS at the Affiliated Hospital of Gansu University of Chinese Medicine. Based on the epidemiological and imaging results, stroke episodes were divided into four categories: clinical first episode (CFE), clinical recurrence (CR), imaging first episode (IFE), and imaging recurrence (IR). Based on the above categories and clinical practice, a joint diagnostic system for IS was established for the first time, including the following five types: IFE, IR, CFE and IFE, CFE and IR, and CR and IR. A binomial logistic regression analysis was conducted to determine the factors which contributed to CR and IR. Results In total, 280 patients were assessed. The CR rate was 22.9% (64/280) and the IR rate was 62.9% (176/280). The only predictor of CR was hypertension (P = 0.019, odds ratio [OR] = 3.041, 95% confidence interval [95%CI] = 1.200-7.704). The factors of hypertension (P < 0.001, OR = 3.551, 95%CI = 1.781-7.080) and age (P = 0.031, OR = 1.031, 95%CI = 1.003-1.060) were predictors of IR. Conclusion The IR rates for IS were three times higher than the CR rates. The key to preventing IR and CR in IS was the management of blood pressure. Neuroimaging examinations were important for the early detection of IFE and IR in elderly patients with hypertension. A combined clinical imaging diagnostic model was developed for the first time.
Collapse
|
27
|
Zhou Y, Zhang Y, Xu G, Shang X. Association between estimated pulse wave velocity and silent lacunar infarct in a Korean population. Front Cardiovasc Med 2023; 10:1070997. [PMID: 36760572 PMCID: PMC9905668 DOI: 10.3389/fcvm.2023.1070997] [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: 10/15/2022] [Accepted: 01/09/2023] [Indexed: 01/26/2023] Open
Abstract
Aims Previous studies have proposed the estimated pulse wave velocity (ePWV) as a simple and cost-effective measure of arterial stiffness. Since arterial stiffness plays a role in the progression of silent lacunar infarct (SLI), our present work aims to evaluate the association between ePWV and the presence of SLI. Methods The present work was based on a cross-section study. Our study included 1,011 neurologically healthy Korean participants. The SLI was evaluated using brain magnetic resonance images (MRI). The ePWV was derived from a published equation using age and mean blood pressure (MBP). Logistic regression analyses were performed to investigate the association between ePWV and SLI. The linear relationship and robustness were evaluated using smooth curve fitting and subgroup analyses, respectively. Results The prevalence of SLI was 11.87%. After fully adjusting for covariates, per 1 m/s increase of ePWV casted 31% additional risk for SLI (P = 0.009). When dividing the ePWV into quartiles, the top quartile had 4.01 times risk compared with the bottom quartile. The increasing trend across the quartiles was statistically significant (P for trend < 0.001). Consistently, smooth curve fitting revealed that the risk of SLI elevated linearly with the increase of ePWV. Finally, subgroup analysis suggested that the association was robust in several sub-populations divided by age, sex, smoking, hypertension, diabetes mellitus (DM), coronary artery occlusive disease (CAOD), hyperlipidemia, and statin medication (all P for interaction > 0.05). Conclusion The current study revealed an independent and positive association between ePWV and the presence of SLI in a neurologically healthy Korean population.
Collapse
Affiliation(s)
- Yaping Zhou
- Department of Rehabilitation Medicine, Shanghai Tenth People’s Hospital, Tongji University School of Medicine, Shanghai, China
| | - Yu Zhang
- Department of Rehabilitation Medicine, Shanghai Tenth People’s Hospital, Tongji University School of Medicine, Shanghai, China
| | - Gang Xu
- Department of Rehabilitation Medicine, Shanghai Tenth People’s Hospital, Tongji University School of Medicine, Shanghai, China,*Correspondence: Gang Xu,
| | - Xiuli Shang
- Department of Neurology, The First Hospital of China Medical University, Shenyang, China,Xiuli Shang,
| |
Collapse
|
28
|
Li X, Cao X, Ma F, Jia P, Wang F, Cao X. The correlation between non-arteritic anterior ischemic optic neuropathy and cerebral infarction. Transl Neurosci 2023; 14:20220281. [PMID: 36949871 PMCID: PMC10025508 DOI: 10.1515/tnsci-2022-0281] [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: 01/30/2023] [Revised: 02/24/2023] [Accepted: 02/28/2023] [Indexed: 03/24/2023] Open
Abstract
Background The aim of this study was to explore the correlation between non-arteritic anterior ischemic optic neuropathy (NAION) and cerebral infarction (CI). Moreover, the ocular and systemic parameters are also compared between NAION patients with or without CI. Methods Retrospective analysis is performed for NAION patients and the controls. The controls were collected at the eye outpatient with cranial computed tomography (CT), and data of blood triglyceride, cholesterol, low-density lipoprotein, high-density lipoprotein, and apolipoprotein B were drawn. The diagnosed NAION patients with cranial CT are included, and data of clinical history and routine clinical examination were drawn from the medical record. Visual acuity, intraocular pressure (IOP), visual field, and visual evoked potential were also drawn. Results Eighty-two unilateral and 6 bilateral patients, totally 94 eyes for 88 NAION patients and 69 controls are included. NAION and control patients have matched age, gender, and weight. There is no difference in triglyceride, cholesterol, low-density lipoprotein, high-density lipoprotein, and apolipoprotein B between these two groups. NAION patients (43.18%, 38/88) have a higher ratio of CI than the controls (14.49%, 10/69) (p = 0.000). For NAION, the odds ratio (OR) of CI is 2.691 (p = 0.011). Body mass index, height, and IOP show no significant difference between NAION patients with or without CI. NAION patients with CI have a significant higher ratio of hypertension than those without CI, and the OR of HBP is 2.623 (p = 0.008). Conclusions The correlation between NAION and CI is possible as NAION patients have a significant higher ratio with CI. In NAION patients, hypertension is a risk factor for those with CI.
Collapse
Affiliation(s)
- Xiaochun Li
- Department of Ophthalmology, Peking University International Hospital, Beijing, China
- Center of Optometry, Department of Ophthalmology, Peking University People’s Hospital, Eye Diseases and Optometry Institute, Beijing Key Laboratory of Diagnosis and Therapy of Retinal and Choroid Diseases, College of Optometry, Peking University Health Science Center, 11# Xizhimen South Street, Xicheng District, Beijing100044, China
| | - Xiaolu Cao
- Hebei Ophthalmology Key Lab, Hebei Eye Hospital, No. 399, Quanbei East Street, Xingtai, 054000, Hebei, China
| | - Fenglou Ma
- Center of Optometry, Department of Ophthalmology, Peking University People’s Hospital, Eye Diseases and Optometry Institute, Beijing Key Laboratory of Diagnosis and Therapy of Retinal and Choroid Diseases, College of Optometry, Peking University Health Science Center, 11# Xizhimen South Street, Xicheng District, Beijing100044, China
| | - Peipei Jia
- Department of Pharmacy, Hebei Eye Hospital, No. 399, Quanbei East Street, Xingtai, 054000, Hebei, China
| | - Fuyin Wang
- Department of Radiology, Hebei Eye Hospital, No. 399, Quanbei East Street, Xingtai, 054000, Hebei, China
| | - Xiaoguang Cao
- Center of Optometry, Department of Ophthalmology, Peking University People’s Hospital, Eye Diseases and Optometry Institute, Beijing Key Laboratory of Diagnosis and Therapy of Retinal and Choroid Diseases, College of Optometry, Peking University Health Science Center, 11# Xizhimen South Street, Xicheng District, Beijing100044, China
| |
Collapse
|
29
|
Kent DM, Leung LY, Zhou Y, Luetmer PH, Kallmes DF, Nelson J, Fu S, Puttock EJ, Zheng C, Liu H, Chen W. Association of Incidentally Discovered Covert Cerebrovascular Disease Identified Using Natural Language Processing and Future Dementia. J Am Heart Assoc 2022; 12:e027672. [PMID: 36565208 PMCID: PMC9973577 DOI: 10.1161/jaha.122.027672] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Background Covert cerebrovascular disease (CCD) has been shown to be associated with dementia in population-based studies with magnetic resonance imaging (MRI) screening, but dementia risk associated with incidentally discovered CCD is not known. Methods and Results Individuals aged ≥50 years enrolled in the Kaiser Permanente Southern California health system receiving head computed tomography (CT) or MRI for nonstroke indications from 2009 to 2019, without prior ischemic stroke/transient ischemic attack, dementia/Alzheimer disease, or visit reason/scan indication suggestive of cognitive decline or stroke were included. Natural language processing identified incidentally discovered covert brain infarction (id-CBI) and white matter disease (id-WMD) on the neuroimage report; white matter disease was characterized as mild, moderate, severe, or undetermined. We estimated risk of dementia associated with id-CBI and id-WMD. Among 241 050 qualified individuals, natural language processing identified 69 931 (29.0%) with id-WMD and 11 328 (4.7%) with id-CBI. Dementia incidence rates (per 1000 person-years) were 23.5 (95% CI, 22.9-24.0) for patients with id-WMD, 29.4 (95% CI, 27.9-31.0) with id-CBI, and 6.0 (95% CI, 5.8-6.2) without id-CCD. The association of id-WMD with future dementia was stronger in younger (aged <70 years) versus older (aged ≥70 years) patients and for CT- versus MRI-discovered lesions. For patients with versus without id-WMD on CT, the adjusted HR was 2.87 (95% CI, 2.58-3.19) for older and 1.87 (95% CI, 1.79-1.95) for younger patients. For patients with versus without id-WMD on MRI, the adjusted HR for dementia risk was 2.28 (95% CI, 1.99-2.62) for older and 1.48 (95% CI, 1.32-1.66) for younger patients. The adjusted HR for id-CBI was 2.02 (95% CI, 1.70-2.41) for older and 1.22 (95% CI, 1.15-1.30) for younger patients for either modality. Dementia risk was strongly correlated with id-WMD severity; adjusted HRs compared with patients who were negative for id-WMD by MRI ranged from 1.41 (95% CI, 1.25-1.60) for those with mild disease on MRI to 4.11 (95% CI, 3.58-4.72) for those with severe disease on CT. Conclusions Incidentally discovered CCD is common and associated with a high risk of dementia, representing an opportunity for prevention. The association is strengthened when discovered at younger age, by increasing id-WMD severity, and when id-WMD is detected by CT scan rather than MRI.
Collapse
Affiliation(s)
- David M. Kent
- Predictive Analytics and Comparative Effectiveness Center, Tufts Medical CenterBostonMA
| | | | - Yichen Zhou
- Department of Research and EvaluationKaiser Permanente Southern CaliforniaPasadenaCA
| | | | | | - Jason Nelson
- Predictive Analytics and Comparative Effectiveness Center, Tufts Medical CenterBostonMA
| | - Sunyang Fu
- Department of AI and InformaticsMayo ClinicRochesterMN
| | - Eric J. Puttock
- Department of Research and EvaluationKaiser Permanente Southern CaliforniaPasadenaCA
| | - Chengyi Zheng
- Department of Research and EvaluationKaiser Permanente Southern CaliforniaPasadenaCA
| | - Hongfang Liu
- Department of AI and InformaticsMayo ClinicRochesterMN
| | - Wansu Chen
- Department of Research and EvaluationKaiser Permanente Southern CaliforniaPasadenaCA
| |
Collapse
|
30
|
Luo C, Luo Y, Ma Q, Chen C, Xian S, Gong F, Zhao W, Zeng J, Luo J. Evaluation of (sdLDLc*HCYc)/HDLc ratio in clinical auxiliary diagnosis of primary cerebral infarction. BMC Cardiovasc Disord 2022; 22:523. [PMID: 36474148 PMCID: PMC9724409 DOI: 10.1186/s12872-022-02969-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Accepted: 11/21/2022] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Timely detection of cerebral infarction is of vital importance in planning intervention effect of rapid rehabilitation. The clinical auxiliary diagnosis value of single biomarker, including small dense low-density lipoprotein concentration (sdLDLc), homocysteine concentration (HCYc) and high-density lipoprotein cholesterol concentration (HDLc) for cerebral infarction has been confirmed by many studies. Whether the use of three biomarkers in combination by calculating (sdLDLc*HCYc)/HDLc ratio could improve the diagnosis ability for primary cerebral infarction remains to be unclear. In the present study, we conducted a cross-sectional study to evaluate the value of (sdLDLc*HCYc)/HDLc ratio in clinical auxiliary diagnosis of primary cerebral infarction. METHODS A total of 583 participants, including 299 healthy participants as control group and 284 participants diagnosed with first cerebral infarction as experiment group, were included in this respective study. The serum sdLDLc, HDLc and HCYc were measured by peroxidase method, enzyme-linked immunosorbent assay and an enzymatic method, respectively. RESULTS The average concentration of sdLDL and HCY (0.69 ± 0.29 mmol/L and 18.14 ± 6.62 μmol/L) in experiment group was significantly higher than those in the control group (0.55 ± 0.22 mmol/L and 10.77 ± 2.67 μmol/L, P < 0.05). However, the average concentration of HDL (1.47 ± 0.25 mmol/L) in the control group was higher than that in the experiment group (1.33 ± 0.28 mmol/L, P < 0.05). Spearman correlation coefficient showed the three indicators are independent of each other. The positive predictive value of (sdLDLc*HCYc)/HDLc ratio (61.27%, 95% CI: 55.31-66.92) is higher than that in single biomarker (sdLDLc: 6.69 95% CI: 4.19-10.42, HCYc: 38.38%, 95% CI: 32.75-44.33, HDLc: 3.87%, 95% CI: 2.05-7.02). Receiver-operating characteristic curve (ROC) analysis illustrated that predictive power of (sdLDLc*HCYc)/HDLc was higher than single biomarker, including sdLDLc, HCYc and HDLc, in primary cerebral infarction. CONCLUSIONS Therefore, (sdLDLc*HCYc)/HDLc ratio might be a better new indicator in clinical auxiliary diagnosis of primary cerebral infarction, which could be contributed to predicting cerebral infarction occurrence and provide a scientific basis for early prevention.
Collapse
Affiliation(s)
- Chunhua Luo
- grid.254148.e0000 0001 0033 6389The First College of Clinical Medical Science, China Three Gorges University, Yichang, China ,grid.508285.20000 0004 1757 7463Yichang Central People’s Hospital, Yichang, China
| | - Yucheng Luo
- grid.254148.e0000 0001 0033 6389The First College of Clinical Medical Science, China Three Gorges University, Yichang, China ,grid.508285.20000 0004 1757 7463Yichang Central People’s Hospital, Yichang, China
| | - Qin Ma
- grid.254148.e0000 0001 0033 6389The First College of Clinical Medical Science, China Three Gorges University, Yichang, China ,grid.508285.20000 0004 1757 7463Yichang Central People’s Hospital, Yichang, China
| | - Chunyan Chen
- grid.254148.e0000 0001 0033 6389The First College of Clinical Medical Science, China Three Gorges University, Yichang, China ,grid.508285.20000 0004 1757 7463Yichang Central People’s Hospital, Yichang, China
| | - Sheng Xian
- grid.254148.e0000 0001 0033 6389The First College of Clinical Medical Science, China Three Gorges University, Yichang, China ,grid.508285.20000 0004 1757 7463Yichang Central People’s Hospital, Yichang, China
| | - Feng Gong
- grid.254148.e0000 0001 0033 6389The First College of Clinical Medical Science, China Three Gorges University, Yichang, China ,grid.508285.20000 0004 1757 7463Yichang Central People’s Hospital, Yichang, China
| | - Wu Zhao
- grid.254148.e0000 0001 0033 6389The First College of Clinical Medical Science, China Three Gorges University, Yichang, China ,grid.508285.20000 0004 1757 7463Yichang Central People’s Hospital, Yichang, China
| | - Jingjing Zeng
- grid.254148.e0000 0001 0033 6389The First College of Clinical Medical Science, China Three Gorges University, Yichang, China ,grid.508285.20000 0004 1757 7463Yichang Central People’s Hospital, Yichang, China
| | - Jun Luo
- grid.254148.e0000 0001 0033 6389The First College of Clinical Medical Science, China Three Gorges University, Yichang, China ,grid.508285.20000 0004 1757 7463Yichang Central People’s Hospital, Yichang, China
| |
Collapse
|
31
|
Rakotomanana JL, Randrianantoandro NR, Rasaholiarison NF, Faoulat AY, Rafanomezantsoa R, Raobela L, Tehindrazanarivelo AD. Correlation between silent lacunar strokes and retinopathies seen on fundus among patients hospitalized for lacunar strokes: An observational study at the neurology department of Befelatanana University Hospital. JOURNAL DE MEDECINE VASCULAIRE 2022; 47:250-255. [PMID: 36464420 DOI: 10.1016/j.jdmv.2022.10.011] [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: 08/08/2022] [Accepted: 10/20/2022] [Indexed: 06/17/2023]
Abstract
Retinal and cerebral arterioles have similar characteristics. Silent infarcts are associated with a risk of incident lacunar stroke and dementia. The objective of our study was to determine the correlation between silent lacunar strokes and retinopathy in patients hospitalized in our department for lacunar strokes. This is an observational, retrospective study, from July 2018 to December 2019, of patients diagnosed with lacunar stroke at the neurology department of Befelatanana Hospital, Antananarivo. Stroke was diagnosed with brain CT scan and retinopathy was classified according to fundus examination. The correlation between the presence of silent lacunar stroke and different types and stages of retinopathy was studied. Silent lacunar lesions were discovered on imaging in 70.59% of patients with lacunar strokes. All patients with symptomatic lacunar stroke, with or without associated silent lacunar lesions, were hypertensives. No statistical difference was found between patients with or without associated silent lacunar lesions according to age and gender. Among patients with silent lacunar lesions, dysexecutive syndrome was more prevalent as compared to patients without silent lesions (52.63% vs. 47.36%, P=0.03). Arteriolopathy was more prevalent in patients with silent lacunar lesions (85.71% vs. 14.28%, P=0.047). Silent lacunar lesions were unique in 72% of cases (P=0.022). The presence of stage II hypertensive retinopathy was significantly correlated with the presence of silent lacunar lesions (OR 5.20 [1.02-267] [1.02-26.47], P=0.018). Upon discovery of stage II hypertensive retinopathy on fundus examination, brain imaging should be performed for silent lacunar stroke screening to optimize hypertension management. This management is expected to prevent the incidence of lacunar stroke and vascular dementia.
Collapse
Affiliation(s)
- J L Rakotomanana
- Neurology Department, University Teaching Hospital Joseph Raseta Befelatanana, Antananarivo, Madagascar.
| | - N R Randrianantoandro
- Neurology Department, University Teaching Hospital Joseph Raseta Befelatanana, Antananarivo, Madagascar
| | - N F Rasaholiarison
- Neurology Department, University Teaching Hospital Tambohobe, Fianarantsoa, Madagascar
| | - A Y Faoulat
- Neurology Department, University Teaching Hospital Joseph Raseta Befelatanana, Antananarivo, Madagascar
| | - R Rafanomezantsoa
- Ophtalmology Department, University Teaching Hospital Joseph Ravoahangy Ampefiloha, Antananarivo, Madagascar
| | - L Raobela
- Ophtalmology Department, University Teaching Hospital Joseph Ravoahangy Ampefiloha, Antananarivo, Madagascar
| | - A D Tehindrazanarivelo
- Neurology Department, University Teaching Hospital Joseph Raseta Befelatanana, Antananarivo, Madagascar
| |
Collapse
|
32
|
Hou Y, Liu Q, Chen J, Wu B, Zeng F, Yang Z, Song H, Liu Y. Application value of T2 fluid-attenuated inversion recovery sequence based on deep learning in static lacunar infarction. Acta Radiol 2022; 64:1650-1658. [PMID: 36285480 DOI: 10.1177/02841851221134114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background Regular monitoring of static lacunar infarction (SLI) lesions plays an important role in preventing disease development and managing prognosis. Magnetic resonance imaging is one method used to monitor SLI lesions. Purpose To evaluate the image quality of the T2 fluid-attenuated inversion recovery (T2-FLAIR) sequence using artificial intelligence-assisted compressed sensing (ACS) in detecting SLI lesions and assess its clinical applicability. Methods A total of 42 patients were prospectively enrolled and scanned by T2-FLAIR. Two independent readers reviewed the images acquired with accelerated modes 1D (acceleration factor 2) and ACS (acceleration factors 2, 3, and 4). The overall image quality and lesion image quality were analyzed, as were signal-to-noise ratio (SNR), contrast-to-noise ratio (CNR), and number of lesions between groups. Results The subjective assessment of overall brain image quality and lesion image quality was consistent between the two readers. The lesion display quality and the overall image quality were better with the traditional 1D acceleration method than with the ACS accelerated method. There was no significant difference in the SNR of the lacunar infarction in the images between the groups. The CNR of the images with the 1D acceleration mode was significantly lower than that of images with the ACS acceleration mode. Images with the 1D, ACS2, and ACS3 acceleration modes showed no significant differences in terms of detecting lesions but scan time can be reduced by 40% (1D vs. ACS3). Conclusion ACS acceleration mode can greatly reduce the scan time. In addition, the images have good SNR, high CNR, and strong SLI lesion detection ability.
Collapse
Affiliation(s)
- Yanzhen Hou
- Medical Imaging Center, 559569Shenzhen Hospital of Southern Medical University, Shenzhen, Guangdong Province, PR China
| | - Qian Liu
- Medical Imaging Center, 559569Shenzhen Hospital of Southern Medical University, Shenzhen, Guangdong Province, PR China
| | - Jialing Chen
- Medical Imaging Center, 559569Shenzhen Hospital of Southern Medical University, Shenzhen, Guangdong Province, PR China
| | - Bin Wu
- Medical Imaging Center, 559569Shenzhen Hospital of Southern Medical University, Shenzhen, Guangdong Province, PR China
| | - Feihong Zeng
- Medical Imaging Center, 559569Shenzhen Hospital of Southern Medical University, Shenzhen, Guangdong Province, PR China
| | - Zhongxian Yang
- Medical Imaging Center, 559569Shenzhen Hospital of Southern Medical University, Shenzhen, Guangdong Province, PR China
| | - Haiyan Song
- Department of Radiology, 499778Shenzhen Second People's Hospital, Shenzhen, Guangdong Province, PR China
| | - Yubao Liu
- Medical Imaging Center, 559569Shenzhen Hospital of Southern Medical University, Shenzhen, Guangdong Province, PR China
| |
Collapse
|
33
|
Wu J, Gao Y, Malik V, Gao X, Shan R, Lv J, Ning Y, Wang B, Li L. Prevalence and risk factors of MRI-defined brain infarcts among Chinese adults. Front Neurol 2022; 13:967077. [PMID: 36313518 PMCID: PMC9597681 DOI: 10.3389/fneur.2022.967077] [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: 06/12/2022] [Accepted: 09/20/2022] [Indexed: 11/24/2022] Open
Abstract
Background Few studies have explored the prevalence and risk factors of brain infarcts (BI) detected by magnetic resonance imaging (MRI) in China. The purpose was to evaluate the prevalence and risk factors of brain infarcts (BI) detected by magnetic resonance imaging (MRI) in 1.4 million Chinese adults. Methods This was a multicenter cross-sectional study conducted on 1,431,527 participants aged ≥18 years (mean age: 46.4 years) who underwent MRI scans in health examinations from 28 provinces of China in 2018. MRI-defined BI was defined as focal parenchymal lesions ≥3 mm. Multivariable logistic regression analyses were performed to evaluate risk factors associated with MRI-defined BI. Results The age- and sex-standardized prevalence of MRI-defined BI, lacunar and non-lacunar infarcts were 5.79% (5.75–5.83%), 4.56% (4.52–4.60%), and 1.23% (1.21–1.25%), respectively. The sex-standardized prevalence of MRI-defined BI ranged from 0.46% among those aged 18–29 years to 37.33% among those aged ≥80 years. Men (6.30%) had a higher age-standardized prevalence of MRI-defined BI than women (5.28%). The highest age- and sex-standardized prevalence of MRI-defined BI was observed in the Northwest (8.34%) and Northeast (8.02%) regions, while the lowest prevalence was observed in the Southwest (4.02%). A higher risk of MRI-defined BI was associated with being male [odd ratio (OR) 1.17, 95% CI 1.15–1.19], older age (OR per 10-year increments 2.33, 2.31–2.35), overweight (1.12, 1.10–1.14) or obesity (1.18, 1.16–1.21), hypertension (1.80, 1.77–1.83), diabetes (1.24, 1.21–1.26), and dyslipidemia (1.07, 1.05–1.08). Conclusion MRI-defined BI is highly prevalent in China, even among young adults. MRI-defined BI was associated with being male, older age, living in the northern region, and metabolic conditions.
Collapse
Affiliation(s)
- Jing Wu
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Center, Beijing, China
| | | | - Vasanti Malik
- Department of Nutritional Sciences, University of Toronto, Toronto, ON, Canada
| | - Xiang Gao
- Department of Nutritional Sciences, The Pennsylvania State University, University Park, State College, PA, United States
| | - Ruiqi Shan
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Center, Beijing, China
| | - Jun Lv
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Center, Beijing, China
- Meinian Public Health Institute, Peking University Health Science Center, Beijing, China
| | - Yi Ning
- Meinian Institute of Health, Beijing, China
- School of Public Health, Hainan Medical University, Haikou, China
- Yi Ning
| | - Bo Wang
- Meinian Institute of Health, Beijing, China
- Meinian Public Health Institute, Peking University Health Science Center, Beijing, China
- Bo Wang
| | - Liming Li
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Center, Beijing, China
- Meinian Public Health Institute, Peking University Health Science Center, Beijing, China
- *Correspondence: Liming Li
| |
Collapse
|
34
|
Schaller-Paule MA, Fritz D, Schaefer JH, Hattingen E, Foerch C, Seiler A. Distribution Pattern Analysis of Cortical Brain Infarcts on Diffusion-Weighted Magnetic Resonance Imaging: A Hypothesis-Generating Approach to the Burden of Silent Embolic Stroke. J Am Heart Assoc 2022; 11:e026438. [PMID: 36172947 DOI: 10.1161/jaha.122.026438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background In patients with covert cerebrovascular disease or proximal source of embolism, embolic silent brain infarction may precede major stroke events. Therefore, characterization of particularly cortical silent brain infarction is essential for identifying affected patients and commencing adequate secondary prevention. This study aimed to investigate differences in the distribution pattern of cortical ischemic stroke lesions to assess potential predilection sites of cortical silent brain infarction. Methods and Results We prospectively included all consecutive patients with stroke presenting from January 1 to December 31, 2018. Diffusion-weighted imaging lesions were used to generate voxel-based lesion maps and assigned to atlas-based cortical regions of interest in middle cerebral artery territories. Each region-of-interest lesion frequency was related to the respective region-of-interest volume to identify frequently affected and underrepresented cerebral cortex areas. Diffusion-weighted imaging data for voxel-based lesion maps were available in 334 out of 633 patients. Primary analysis revealed that small- (<0.24 cc) and medium-sized (0.24-2640 cc) lesions distributed predominantly along regions associated with sensorimotor or language function. Detailed analysis within middle cerebral artery territories showed an approximated frequency of missed cortical stroke lesions of up to 67% in the right and 69% in the left hemisphere. In particular, the frontal, temporal, and occipital cortices were underrepresented. Larger lesion size and areas associated with higher cortical function led to hospital admission. Conclusions Cortical brain infarcts in hospitalized patients are not dispersed equally but are predominantly located in brain structures associated with motor control and sensory and language function. Matching underrepresented cerebral cortex regions to symptoms not yet associated with stroke warrants further exploration.
Collapse
Affiliation(s)
- Martin A Schaller-Paule
- Department of Neurology University Hospital Frankfurt, Goethe-University Frankfurt am Main Germany
| | - Daniel Fritz
- Department of Neurology University Hospital Frankfurt, Goethe-University Frankfurt am Main Germany
| | - Jan Hendrik Schaefer
- Department of Neurology University Hospital Frankfurt, Goethe-University Frankfurt am Main Germany
| | - Elke Hattingen
- Institute of Neuroradiology University Hospital Frankfurt, Goethe-University Frankfurt am Main Germany
| | - Christian Foerch
- Department of Neurology University Hospital Frankfurt, Goethe-University Frankfurt am Main Germany
| | - Alexander Seiler
- Department of Neurology University Hospital Frankfurt, Goethe-University Frankfurt am Main Germany
| |
Collapse
|
35
|
Roskal-Wałek J, Wałek P, Biskup M, Sidło J, Cieśla E, Odrobina D, Mackiewicz J, Wożakowska-Kapłon B. Retinal Artery Occlusion and Its Impact on the Incidence of Stroke, Myocardial Infarction, and All-Cause Mortality during 12-Year Follow-Up. J Clin Med 2022; 11:jcm11144076. [PMID: 35887842 PMCID: PMC9324734 DOI: 10.3390/jcm11144076] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2022] [Revised: 07/08/2022] [Accepted: 07/13/2022] [Indexed: 02/05/2023] Open
Abstract
The aim of the study was to evaluate the incidence of ischemic stroke, myocardial infarction, and all-cause mortality in patients with retinal artery occlusion (RAO). This single-center retrospective study included 139 patients diagnosed with RAO between 2009 and 2020. The control group included 139 age- and sex-matched patients without RAO who underwent cataract surgery. The year of the surgery corresponded to the year of RAO onset. During the 12-year follow-up, patients with RAO had a shorter time to death (49.95 vs. 15.74 months; p = 0.043), a higher all-cause mortality rate (log-rank p = 0.026, and a higher rate of the composite endpoint, including ischemic stroke, myocardial infarction, and all-cause mortality (log-rank p = 0.024), as compared with controls. Patients with RAO younger than 75 years showed a higher risk of cerebral ischemic stroke (log-rank p = 0.008), all-cause mortality (log-rank p = 0.023), and the composite endpoint (log-rank p = 0.001) than controls. However, these associations were not demonstrated for patients aged 75 years or older. Our study confirms that patients with RAO have a higher risk of all-cause mortality than those without RAO. Moreover, patients with RAO who are younger than 75 years are significantly more likely to experience ischemic stroke, death, or the composite endpoint after an occlusion event, as compared with individuals without RAO.
Collapse
Affiliation(s)
- Joanna Roskal-Wałek
- Collegium Medicum, Jan Kochanowski University, 25-317 Kielce, Poland; (J.R.-W.); (E.C.); (D.O.); (B.W.-K.)
- Ophthalmology Clinic, Voivodeship Regional Hospital, 25-736 Kielce, Poland; (M.B.); (J.S.)
| | - Paweł Wałek
- Collegium Medicum, Jan Kochanowski University, 25-317 Kielce, Poland; (J.R.-W.); (E.C.); (D.O.); (B.W.-K.)
- 1st Clinic of Cardiology and Electrotherapy, Swietokrzyskie Cardiology Centre, 25-736 Kielce, Poland
- Correspondence: ; Tel.: +48-413-671-440; Fax: +48-413-671-510
| | - Michał Biskup
- Ophthalmology Clinic, Voivodeship Regional Hospital, 25-736 Kielce, Poland; (M.B.); (J.S.)
| | - Jacek Sidło
- Ophthalmology Clinic, Voivodeship Regional Hospital, 25-736 Kielce, Poland; (M.B.); (J.S.)
| | - Elżbieta Cieśla
- Collegium Medicum, Jan Kochanowski University, 25-317 Kielce, Poland; (J.R.-W.); (E.C.); (D.O.); (B.W.-K.)
| | - Dominik Odrobina
- Collegium Medicum, Jan Kochanowski University, 25-317 Kielce, Poland; (J.R.-W.); (E.C.); (D.O.); (B.W.-K.)
- Ophthalmology Clinic Boni Fratres Lodziensis, 93-357 Łódź, Poland
| | - Jerzy Mackiewicz
- Department of Vitreoretinal Surgery, Medical University of Lublin, 20-079 Lublin, Poland;
| | - Beata Wożakowska-Kapłon
- Collegium Medicum, Jan Kochanowski University, 25-317 Kielce, Poland; (J.R.-W.); (E.C.); (D.O.); (B.W.-K.)
- 1st Clinic of Cardiology and Electrotherapy, Swietokrzyskie Cardiology Centre, 25-736 Kielce, Poland
| |
Collapse
|
36
|
Melgarejo JD, Maestre GE, Gutierrez J, Thijs L, Mena LJ, Gaona C, Leendertz R, Lee JH, Chávez CA, Calmon G, Silva E, Wei D, Terwilliger JD, Vanassche T, Janssens S, Verhamme P, Bos D, Zhang ZY. Subclinical Magnetic Resonance Imaging Markers of Cerebral Small Vessel Disease in Relation to Office and Ambulatory Blood Pressure Measurements. Front Neurol 2022; 13:908260. [PMID: 35911921 PMCID: PMC9330602 DOI: 10.3389/fneur.2022.908260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 06/13/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundTwenty-four-hour and nighttime blood pressure (BP) levels are more strongly associated with cardiovascular risk than office or daytime BP measurements. However, it remains undocumented which of the office and ambulatory BP measurements have the strongest association and predictive information in relation to the presence of type I, or arteriolosclerosis type, cerebral small vessel diseases (CSVD).MethodsA subset of 429 participants from the Maracaibo Aging Study [aged ≥40 years (women, 73.7%; mean age, 59.3 years)] underwent baseline brain magnetic resonance imaging (MRI) to visualize CSVD, which included log-transformed white matter hyperintensities (log-WMH) volume and the presence (yes/no) of lacunes, cerebral microbleeds (CMB), or enlarged perivascular spaces (EPVS). Linear and logistic regression models were applied to examine the association between CSVD and each +10-mmHg increment in the office and ambulatory systolic BP measurements. Improvement in the fit of nested logistic models was assessed by the log-likelihood ratio and the generalized R2 statistic.ResultsOffice and ambulatory systolic BP measurements were related to log-WMH (β-correlation coefficients ≥0.08; P < 0.001). Lacunes and CMB were only associated with ambulatory systolic BP measurements (odds ratios [OR] ranged from 1.31 [95% confidence interval, 1.10-1.55] to 1.46 [1.17–1.84], P ≤ 0.003). Accounted for daytime systolic BP, both the 24-h (β-correlation, 0.170) and nighttime (β-correlation, 0.038) systolic BP measurements remained related to log-WMH. When accounted for 24-h or daytime systolic BP levels, the nighttime systolic BP retained the significant association with lacunes (ORs, 1.05–1.06; 95% CIs, ≥1.01 to ≤ 1.13), whereas the 24-h and daytime systolic BP levels were not associated with lacunes after adjustments for nighttime systolic BP (ORs, ≤ 0.88; 95% CI, ≥0.77 to ≤ 1.14). On top of covariables and office systolic BP, ambulatory systolic BP measurements significantly improved model performance (1.05% ≥ R2 ≤ 3.82%). Compared to 24-h and daytime systolic BP, nighttime systolic BP had the strongest improvement in the model performance; for WMH (1.46 vs. 1.05%) and lacunes (3.06 vs. ≤ 2.05%).ConclusionsTwenty-four-hour and nighttime systolic BP were the more robust BP measurements associated with CSVD, but the nighttime systolic BP level had the strongest association. Controlling ambulatory BP levels might provide additional improvement in the prevention of CSVD.
Collapse
Affiliation(s)
- Jesus D. Melgarejo
- Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, Studies Coordinating Center, KU Leuven, Leuven, Belgium
- Laboratory of Neurosciences, Faculty of Medicine, University of Zulia, Maracaibo, Venezuela
| | - Gladys E. Maestre
- Laboratory of Neurosciences, Faculty of Medicine, University of Zulia, Maracaibo, Venezuela
- Department of Neurosciences and Department of Human Genetics, University of Texas Rio Grande Valley School of Medicine, Brownsville, TX, United States
- Alzheimer's Disease Resource Center for Minority Aging Research, University of Texas Rio Grande Valley, Brownsville, TX, United States
- South Texas ADRC, Laredo, TX, United States
| | - Jose Gutierrez
- Department of Neurology, College of Physicians and Surgeons, Columbia University, New York, NY, United States
| | - Lutgarde Thijs
- Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, Studies Coordinating Center, KU Leuven, Leuven, Belgium
| | - Luis J. Mena
- Department of Informatics, Universidad Politécnica de Sinaloa, Mazatlán, Mexico
| | - Ciro Gaona
- Laboratory of Neurosciences, Faculty of Medicine, University of Zulia, Maracaibo, Venezuela
| | - Reinier Leendertz
- Laboratory of Neurosciences, Faculty of Medicine, University of Zulia, Maracaibo, Venezuela
| | - Joseph H. Lee
- Taub Institute for Research in Alzheimer's Disease and the Aging Brain and the G.H. Sergievsky Center at Columbia University Medical Center, New York, NY, United States
- Departments of Epidemiology and Neurology, Columbia University Medical Center, New York, NY, United States
| | - Carlos A. Chávez
- Laboratory of Neurosciences, Faculty of Medicine, University of Zulia, Maracaibo, Venezuela
| | - Gustavo Calmon
- Laboratory of Ambulatory Recordings, Cardiovascular Institute (IECLUZ), University of Zulia, Maracaibo, Venezuela
| | - Egle Silva
- Laboratory of Ambulatory Recordings, Cardiovascular Institute (IECLUZ), University of Zulia, Maracaibo, Venezuela
| | - Dongmei Wei
- Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, Studies Coordinating Center, KU Leuven, Leuven, Belgium
| | - Joseph D. Terwilliger
- Department of Genetics and Development, Department of Psychiatry, and G.H. Sergievsky Center, Columbia University, New York, NY, United States
- Division of Medical Genetics, New York State Psychiatric Institute, New York, NY, United States
- Division of Public Health Solutions, National Institute for Health and Welfare, Helsinki, Finland
| | - Thomas Vanassche
- Center for Molecular and Vascular Biology, KU Leuven Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
| | - Stefan Janssens
- Division of Cardiology, Department of Internal Medicine, University Hospitals UZ Leuven, Leuven, Belgium
| | - Peter Verhamme
- Division of Cardiology, Department of Internal Medicine, University Hospitals UZ Leuven, Leuven, Belgium
| | - Daniel Bos
- Department of Epidemiology, Erasmus Medical Center, Rotterdam, Netherlands
- Department of Radiology and Nuclear Medicine, Erasmus Medical Center, Rotterdam, Netherlands
| | - Zhen-Yu Zhang
- Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, Studies Coordinating Center, KU Leuven, Leuven, Belgium
- *Correspondence: Zhen-Yu Zhang
| |
Collapse
|
37
|
Gerstenecker A, Norling AM, Jacob A, Lazar RM. Silent Brain Infarction, Delirium, and Cognition in Three Invasive Cardiovascular Procedures: a Systematic Review. Neuropsychol Rev 2022; 33:474-491. [PMID: 35804216 DOI: 10.1007/s11065-022-09548-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Accepted: 05/09/2022] [Indexed: 12/19/2022]
Abstract
Silent brain infarctions (SBIs) are brain lesions noted on neuroimaging that are not associated with clinical symptoms. SBIs are associated with a number of vascular risk factors and are common following invasive cardiovascular procedures such as atrial fibrillation (AF) ablation, coronary artery bypass graft (CABG), and transcatheter aortic valve replacement (TAVR). Although not eliciting signs of clinical stroke, SBIs are associated with increased frailty, and motor and mood features. Less is known, however, about the relationship between SBI, cognition, and delirium following invasive cardiac procedures and most investigations into these relationships have been reported in large-scale epidemiological studies. In the current paper, we conducted a systematic review to evaluate evidence of a relationship between SBI, delirium, and cognitive decline following CABG, AF ablation, and TAVR. Twenty studies met inclusion criteria. In general, our review identified conflicting results for each cardiac procedure, with some studies suggesting a relationship between SBI, cognitive impairment, and delirium, whereas others showed no relationship between SBI, cognitive impairment, and delirium. Potential reasons for this discrepancy as well as suggestions for future research are discussed.
Collapse
Affiliation(s)
- Adam Gerstenecker
- Department of Neurology, University of Alabama at Birmingham, Birmingham, AL, USA. .,Alzheimer's Disease Center, University of Alabama at Birmingham, Birmingham, AL, USA. .,Evelyn F. McKnight Brain Institute, University of Alabama at Birmingham, Birmingham, AL, USA.
| | - Amani M Norling
- Department of Neurology, University of Alabama at Birmingham, Birmingham, AL, USA.,Evelyn F. McKnight Brain Institute, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Alexandra Jacob
- Department of Psychology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Ronald M Lazar
- Department of Neurology, University of Alabama at Birmingham, Birmingham, AL, USA.,Evelyn F. McKnight Brain Institute, University of Alabama at Birmingham, Birmingham, AL, USA
| |
Collapse
|
38
|
Leung LY, Zhou Y, Fu S, Zheng C, Luetmer PH, Kallmes DF, Liu H, Chen W, Kent DM. Risk Factors for Silent Brain Infarcts and White Matter Disease in a Real-World Cohort Identified by Natural Language Processing. Mayo Clin Proc 2022; 97:1114-1122. [PMID: 35487789 PMCID: PMC9284412 DOI: 10.1016/j.mayocp.2021.11.038] [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: 04/16/2021] [Revised: 11/17/2021] [Accepted: 11/29/2021] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To assess the frequency of silent brain infarcts (SBIs) and white matter disease (WMD) and associations with stroke risk factors (RFs) in a real-world population. PATIENTS AND METHODS This was an observational study of patients 50 years or older in the Kaiser Permanente Southern California health system from January 1, 2009, through June 30, 2019, with head computed tomography or magnetic resonance imaging for nonstroke indications and no history of stroke, transient ischemic attack, or dementia. A natural language processing (NLP) algorithm was applied to the electronic health record to identify individuals with reported SBIs or WMD. Multivariable Poisson regression estimated risk ratios of demographic characteristics, RFs, and scan modality on the presence of SBIs or WMD. RESULTS Among 262,875 individuals, the NLP identified 13,154 (5.0%) with SBIs and 78,330 (29.8%) with WMD. Stroke RFs were highly prevalent. Advanced age was strongly associated with increased risk of SBIs (adjusted relative risks [aRRs], 1.90, 3.23, and 4.72 for those aged in their 60s, 70s, and ≥80s compared with those in their 50s) and increased risk of WMD (aRRs, 1.79, 3.02, and 4.53 for those aged in their 60s, 70s, and ≥80s compared with those in their 50s). Magnetic resonance imaging was associated with a reduced risk of SBIs (aRR, 0.87; 95% CI, 0.83 to 0.91) and an increased risk of WMD (aRR, 2.86; 95% CI, 2.83 to 2.90). Stroke RFs had modest associations with increased risk of SBIs or WMD. CONCLUSION An NLP algorithm can identify a large cohort of patients with incidentally discovered SBIs and WMD. Advanced age is strongly associated with incidentally discovered SBIs and WMD.
Collapse
Affiliation(s)
- Lester Y Leung
- Department of Neurology, Tufts Medical Center, Boston, MA, USA.
| | - Yichen Zhou
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA
| | - Sunyang Fu
- Department of AI and Informatics, Mayo Clinic, Rochester, MN, USA
| | - Chengyi Zheng
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA
| | | | | | - Hongfang Liu
- Department of AI and Informatics, Mayo Clinic, Rochester, MN, USA
| | - Wansu Chen
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA
| | - David M Kent
- Predictive Analytics and Comparative Effectiveness Center, Tufts Medical Center, Boston, MA, USA
| |
Collapse
|
39
|
High Levels of Thromboxane (TX) Are Associated with the Sex-Dependent Non-Dipping Phenomenon in Ischemic Stroke Patients. J Clin Med 2022; 11:jcm11092652. [PMID: 35566778 PMCID: PMC9102581 DOI: 10.3390/jcm11092652] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 05/02/2022] [Accepted: 05/05/2022] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Inflammation and high blood pressure (nondipping profile) during the rest/sleep period have been associated with an effect on the incidence of cardiovascular disorders and a more severe course in the ischemic cerebrovascular event. There are no available data on the relationship between dipping status and the pro-inflammatory metabolites of arachidonic acid (AA); therefore, we undertook a study to investigate the influence of thromboxane on the incidence of nondipping among patients after stroke. METHODS Sixty-two patients with ischemic stroke (including 34 women and 28 men) were tested for the involvement of thromboxane in the nondipping phenomenon. Subjects were analyzed for the presence of the physiological phenomenon of dipping (DIP group) versus its absence-nondipping (NDIP group). Thromboxane (TX) measurements were performed using liquid chromatography, and blood pressure was measured 24 h a day in all subjects. RESULTS The analysis of the thromboxane level in the plasma of patients after ischemic stroke showed significant differences in terms of sex (p = 0.0004). Among women in both groups, the concentration of TX was high, while similar levels were observed in the group of men from the NDIP group. However, when comparing men in the DIP and NDIP groups, a lower TX level was noticeable in the DIP group. CONCLUSIONS A higher level of TX may be associated with a disturbance of the physiological phenomenon of DIP in men and women. However, in our opinion, TX is not the main determinant of the DIP phenomenon and, at the same time, other pro-inflammatory factors may also be involved in the occurrence of this singularity.
Collapse
|
40
|
Lin F, Pa J, Karim R, Hodis HN, Han SD, Henderson VW, St John JA, Mack WJ. Subclinical carotid artery atherosclerosis and cognitive function in older adults. Alzheimers Res Ther 2022; 14:63. [PMID: 35526057 PMCID: PMC9077926 DOI: 10.1186/s13195-022-00997-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Accepted: 04/02/2022] [Indexed: 12/01/2022]
Abstract
Background The combined effects of increased life expectancy and the considerable number of persons reaching old age will magnify the dementia epidemic in the USA. Demonstration that subclinical atherosclerosis precedes and is associated with cognitive impairment suggests a modifiable risk factor for age-associated cognitive impairment and dementia. The purpose of this study is to determine whether subclinical atherosclerosis as measured by carotid artery intima-media thickness (CIMT) is associated with changes in cognitive function over time in older adults. Methods This study combined longitudinal data from three clinical trials conducted between 2000 and 2013: the B-Vitamin Atherosclerosis Intervention Trial (BVAIT), the Women’s Isoflavone Soy Health (WISH) trial, and the Early versus Late Intervention Trial with Estradiol (ELITE). Participants were recruited from the general population in the Greater Los Angeles area and were free of cardiovascular disease and diabetes; no cognitive or psychiatric exclusion criteria were specified. The same standardized protocol for ultrasound image acquisition and measurement of CIMT was used in all trials. CIMT measurements performed at baseline and 2.5 years were used in these analyses. Cognitive function was assessed at baseline and 2.5 years using a battery of 14 standardized cognitive tests. All clinical trials were conducted at the University of Southern California Atherosclerosis Research Unit, Los Angeles, and had at least 2.5 years of cognitive follow-up. Results A total of 308 men and 1187 women, mean age of 61 years, were included in the combined longitudinal dataset for the primary analysis. No associations were found between CIMT and cognitive function at baseline or at 2.5 years. There was a weak inverse association between CIMT measured at baseline and change in global cognition assessed over 2.5 years (β (SE) = − 0.056 (0.028) units per 0.1 mm CIMT, 95% CI − 0.110, − 0.001, p = 0.046). No associations between CIMT at baseline and changes in executive function, verbal memory, or visual memory were found. Conclusions In this sample of healthy older adults, our findings suggest an association between subclinical atherosclerosis and change in global cognitive function over 2.5 years. Stronger associations were observed longitudinally over 2.5 years than cross-sectionally. When analysis was stratified by age group (<65 and ≥65 years old), the inverse association remained statistically significant for participants in the older age group. Subclinical atherosclerosis of the carotid artery may be a modifiable correlate of cognitive decline in middle and older age. Trial registration BVAIT, NCT00114400. WISH, NCT00118846. ELITE, NCT00114517.
Collapse
Affiliation(s)
- Felice Lin
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Soto Street Building Suite 202Y, 2001 North Soto St, Los Angeles, CA, 90089, USA.
| | - Judy Pa
- Mark and Mary Stevens Neuroimaging and Informatics Institute, University of Southern California, Los Angeles, CA, USA
| | - Roksana Karim
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Soto Street Building Suite 202Y, 2001 North Soto St, Los Angeles, CA, 90089, USA.,Atherosclerosis Research Unit, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Howard N Hodis
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Soto Street Building Suite 202Y, 2001 North Soto St, Los Angeles, CA, 90089, USA.,Atherosclerosis Research Unit, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.,Department of Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - S Duke Han
- Department of Family Medicine, University of Southern California, Los Angeles, CA, USA.,Department of Neurology, University of Southern California, Los Angeles, CA, USA.,Department of Psychology, University of Southern California, Los Angeles, CA, USA.,School of Gerontology, University of Southern California, Los Angeles, CA, USA
| | - Victor W Henderson
- Departments of Epidemiology and Population Health and of Neurology and Neurological Sciences, Stanford University, Stanford, CA, USA
| | - Jan A St John
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Soto Street Building Suite 202Y, 2001 North Soto St, Los Angeles, CA, 90089, USA.,Atherosclerosis Research Unit, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Wendy J Mack
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Soto Street Building Suite 202Y, 2001 North Soto St, Los Angeles, CA, 90089, USA.,Atherosclerosis Research Unit, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.,School of Gerontology, University of Southern California, Los Angeles, CA, USA
| |
Collapse
|
41
|
Incompleteness of circle of Willis and silent brain infarction in patients with internal carotid artery stenosis. J Clin Neurosci 2022; 98:73-77. [DOI: 10.1016/j.jocn.2022.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Revised: 12/29/2021] [Accepted: 02/01/2022] [Indexed: 11/20/2022]
|
42
|
Schattner A. Silent Brain Infarction - Time for Changing the Paradigm? Am J Med 2022; 135:12-14. [PMID: 34508701 DOI: 10.1016/j.amjmed.2021.07.044] [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: 07/19/2021] [Revised: 07/28/2021] [Accepted: 07/28/2021] [Indexed: 11/25/2022]
Affiliation(s)
- Ami Schattner
- Professor of Medicine, Hebrew University and Hadassah Medical School, Jerusalem, Israel.
| |
Collapse
|
43
|
Covert Brain Infarcts in Patients with Philadelphia Chromosome-Negative Myeloproliferative Disorders. J Clin Med 2021; 11:jcm11010013. [PMID: 35011753 PMCID: PMC8745571 DOI: 10.3390/jcm11010013] [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: 11/19/2021] [Revised: 12/10/2021] [Accepted: 12/17/2021] [Indexed: 11/28/2022] Open
Abstract
Backgrounds and Purpose. Philadelphia chromosome-negative myeloproliferative disorders (Ph-negative MPD) are a rare group of hematological diseases, including three distinct pathologies: essential thrombocythemia (ET), polycythemia vera (PV), and primary myelofibrosis (PMF). They most often manifest with thrombotic complications, including cerebrovascular events. Covert brain infarcts (CBIs) are defin ed as predominantly small ischemic cerebral lesions that are detected using magnetic resonance imaging (MRI) in the absence of clinical stroke events. The relationship between MPD and CBIs remains unclear. Methods. Included in the study were 103 patients with the diagnosis of Ph-MPD (according to WHO 2016 criteria) (median age—47 (35; 54) years; 67% female). In total, 38 patients had ET, 42 had PV, and 23 had PMF. They underwent clinical examination, routine laboratory analyses (complete blood count), brain MRI, ultrasound carotid artery, flow-mediated dilatation (as a measure of endothelial dysfunction—FMD). Results. Overall, 23 patients experienced an ischemic stroke (as per MRI and/or clinical history), of which 16 (15.5%) could be classified as CBIs. The rate of CBIs per MPD subtype was statistically non-significant between groups (p = 0.35): ET–13.2%, PV–21.4%, and PMF–8.7%. The major vascular risk factors, including arterial hypertension, carotid atherosclerosis, and prior venous thrombosis, were not associated with CBIs (p > 0.05). Age was significantly higher in patients with CBIs compared to patients without MRI ischemic lesions: 50 (43; 57) years vs. 36 (29; 48) (p = 0.002). The frequency of headaches was comparable between the two groups. CBIs were associated with endothelial dysfunction (OR - 0.71 (95% CI: 0.49–0.90; p = 0.02)) and higher hemoglobin levels (OR—1.21 (95% CI: 1.06–1.55); p =0.03). Conclusions. CBIs are common in patients with Ph-negative MPD. Arterial hypertension and carotid atherosclerosis were not associated with CBIs in this group of patients. The most significant factors in the development of CBIs were endothelial dysfunction (as measured by FMD) and high hemoglobin levels. Patients with Ph-negative MPD and CBIs were older and had more prevalent endothelial dysfunction.
Collapse
|
44
|
Fast Independent Component Analysis Algorithm-Based Functional Magnetic Resonance Imaging in the Diagnosis of Changes in Brain Functional Areas of Cerebral Infarction. CONTRAST MEDIA & MOLECULAR IMAGING 2021; 2021:5177037. [PMID: 34912182 PMCID: PMC8645397 DOI: 10.1155/2021/5177037] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Revised: 10/24/2021] [Accepted: 10/26/2021] [Indexed: 12/27/2022]
Abstract
The aim of this study was to analyze the application value of functional magnetic resonance imaging (FMRI) optimized by the fast independent component correlation algorithm (ICA algorithm) in the diagnosis of brain functional areas in patients with lumbar disc herniation (LDH). An optimized fast ICA algorithm was established based on the ICA algorithm. 50 patients with cerebral infarction were selected as the research objects, and 30 healthy people were selected as the control group. The 50 patients from the observation group were examined by fMRI based on Fast ICA algorithm, while the control group was tested by fMRI based on the routine ICA algorithm. The performances of the two algorithms, the analysis results of the two groups of brain functional areas, cerebral blood flow (CBF), resting state functional connectivity (rsFC), behavioral data, and image data correlation of patients were compared. The results showed that the sensitivity, specificity, and accuracy of Fast ICA algorithm were 97.83%, 89.52%, and 96.27%, respectively, which in the experimental group were greatly better than the control group (88.73%, 72.19%, and 89.72%), showing statistically significant differences (P < 0.05). The maximum Dice coefficient of FAST ICA algorithm was 0.967, and FAST ICA algorithm was better obviously than the traditional ICA algorithm (P < 0.05). The cerebral blood flow of the healthy superior frontal gyrus (SFG) and healthy superior marginal gyrus (SMG) of the observation group with good motor function recovery were 1.02 ± 0.22 and 1.53 ± 0.61, respectively; both indicators showed an increasing trend, and those in the experimental group were much higher in contrast to the control group, showing statistically obvious differences (P < 0.05). Besides, the detection results of cerebral blood flow (CBF) in the healthy SFG and healthy SMG were negatively correlated with the results of connection test B. In summary, the fMRI based on the Fast ICA algorithm showed a good diagnostic effect in the changes of brain functional areas in patients with cerebral infarction. The experimental results showed that the cerebral blood flow in the brain area was related to motor or cognitive function. The results of this study provided a reliable reference for the examination and diagnosis of brain functional areas in patients with cerebral infarction.
Collapse
|
45
|
Hao Z, Chen Y, Wright N, Qin H, Turnbull I, Guo Y, Kartsonaki C, Sansome S, PeiPei, Yu C, Gu Q, Hu J, Lv J, Li L, Liu M, Wang Y, Clarke R, Chen Z. Natural history of silent lacunar infarction: 10-year follow-up of a community-based prospective study of 0.5 million Chinese adults. THE LANCET REGIONAL HEALTH. WESTERN PACIFIC 2021; 17:100309. [PMID: 34734206 PMCID: PMC8551852 DOI: 10.1016/j.lanwpc.2021.100309] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 09/22/2021] [Accepted: 09/29/2021] [Indexed: 02/08/2023]
Abstract
BACKGROUND Widespread use of brain imaging in China has resulted in an increased prevalence of silent lacunar infarct (LACI) in addition to symptomatic LACI, but their clinical relevance is not fully understood. METHODS We compared the 5-year risks of recurrent stroke and all-cause mortality for silent LACI vs symptomatic LACI in a prospective study of 489,597 Chinese adults with no history of stroke or ischemic heart disease at baseline. Data on recurrent stroke and all-cause mortality were obtained by linkage with local stroke and mortality registries and health insurance records for all hospital admissions. FINDINGS Among 12,150 cases with an adjudicated diagnosis of first-ever LACI, 4,134 (34%) had silent LACI and 8,016 (66%) had symptomatic LACI. All cases had brain imaging, but only 33% of silent LACI and 40% of symptomatic LACI cases had brain magnetic resonance imaging (MRI). The standardized event rates for silent LACI were 2-fold greater in urban than rural areas, but the ratios of silent LACI vs symptomatic LACI were similar in all areas. Cases with silent LACI vs symptomatic LACI had comparable 5-year risks of recurrent stroke (38% vs 43%) and all-cause mortality (11% vs 14%), respectively. For both silent and symptomatic LACI cases, most cases of recurrent stroke had non-LACI (70% vs 72%). While the relative risks of recurrent stroke did not differ by age, sex and area, the absolute risks of all-cause mortality varied by sex, age and area. INTERPRETATION The prognosis of cases with silent LACI was comparable with symptomatic LACI, and the results highlight the need for further randomized trials assessing the efficacy and safety of established treatments for ischemic stroke in cases with silent LACI. FUNDING Wellcome Trust (212946/Z/18/Z, 202922/Z/16/Z, 104085/Z/14/Z, 088158/Z/09/Z) and National Key Research and Development Program of China (2016YFC0900500, 2016YFC0900501, 2016YFC0900504, 2016YFC1303904) and National Natural Science Foundation of China (91843302); UK Medical Research Council (MC_UU_00017/1,MC_UU_12026/2 MC_U137686851), Cancer Research UK (C16077/A29186; C500/A16896) and British Heart Foundation (CH/1996001/9454). ZH was supported West China Hospital, Sichuan University (ZYGD18009 and 2016YFC1300505) for a visiting scholarship to the University of Oxford, UK, during 2018-19.
Collapse
Affiliation(s)
- Zilong Hao
- Center of Cerebrovascular Disease, Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
| | - Yiping Chen
- Medical Research Council Population Health Research Unit, (PHRU), Nuffield Department of Population Health, University of Oxford, Oxford, UK
- Clinical Trial Service Unit and Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Neil Wright
- Clinical Trial Service Unit and Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Haiqiang Qin
- China National Clinical Research Centre for Neurological Disease; Beijing Institute for Brain Disorders; Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease; Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Iain Turnbull
- Clinical Trial Service Unit and Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Yu Guo
- Chinese Academy of Medical Sciences, Dong Cheng District, Beijing, China
| | - Christiana Kartsonaki
- Medical Research Council Population Health Research Unit, (PHRU), Nuffield Department of Population Health, University of Oxford, Oxford, UK
- Clinical Trial Service Unit and Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Sam Sansome
- Clinical Trial Service Unit and Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - PeiPei
- Chinese Academy of Medical Sciences, Dong Cheng District, Beijing, China
| | - Canqing Yu
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Center, Beijing, China
| | - Qijun Gu
- Tongxiang CDC, Tongxiang, Zhejiang, China
| | - Jianming Hu
- Shimen Town Health Center, Tongxiang, Zhejiang, China
| | - Jun Lv
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Center, Beijing, China
| | - Liming Li
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Center, Beijing, China
| | - Ming Liu
- Center of Cerebrovascular Disease, Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
| | - Yongjun Wang
- China National Clinical Research Centre for Neurological Disease; Beijing Institute for Brain Disorders; Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease; Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Robert Clarke
- Clinical Trial Service Unit and Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Zhengming Chen
- Clinical Trial Service Unit and Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, Oxford, UK
| |
Collapse
|
46
|
Sigurdsson S, Aspelund T, Kjartansson O, Gudmundsson E, Jonsson PV, van Buchem MA, Gudnason V, Launer LJ. Cerebrovascular Risk-Factors of Prevalent and Incident Brain Infarcts in the General Population: The AGES-Reykjavik Study. Stroke 2021; 53:1199-1206. [PMID: 34809439 DOI: 10.1161/strokeaha.121.034130] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND AND PURPOSE Studies on the association of cerebrovascular risk factors to magnetic resonance imaging detected brain infarcts have been inconsistent, partly reflecting limits of assessment to infarcts anywhere in the brain, as opposed to specific brain regions. We hypothesized that risk-factors may differ depending on where the infarct is located in subcortical-, cortical-, and cerebellar regions. METHODS Participants (n=2662, mean age 74.6±4.8) from the longitudinal population-based AGES (Age, Gene/Environment Susceptibility)-Reykjavik Study underwent brain magnetic resonance imaging at baseline and on average 5.2 years later. We assessed the number and location of brain infarcts (prevalent versus incident). We estimated the risk-ratios of prevalent (PRR) and incident (IRR) infarcts by baseline cerebrovascular risk-factors using Poisson regression. RESULTS Thirty-one percent of the study participants had prevalent brain infarcts and 21% developed new infarcts over 5 years. Prevalent subcortical infarcts were associated with hypertension (PRR, 2.7 [95% CI, 1.1-6.8]), systolic blood pressure (PRR, 1.2 [95% CI, 1.1-1.4]), and diabetes (PRR, 2.8 [95% CI, 1.9-4.1]); incident subcortical infarcts were associated with systolic (IRR, 1.2 [95% CI, 1.0-1.4]) and diastolic (IRR, 1.3 [95% CI, 1.0-1.6]) blood pressure. Prevalent and incident cortical infarcts were associated with carotid plaques (PRR, 1.8 [95% CI, 1.3-2.5] and IRR, 1.9 [95% CI, 1.3-2.9], respectively), and atrial fibrillation was significantly associated with prevalent cortical infarcts (PRR, 1.8 [95% CI, 1.2-2.7]). Risk-factors for prevalent cerebellar infarcts included hypertension (PRR, 2.45 [95% CI, 1.5-4.0]), carotid plaques (PRR, 1.45 [95% CI, 1.2-1.8]), and migraine with aura (PRR, 1.6 [95% CI, 1.1-2.2]). Incident cerebellar infarcts were only associated with any migraine (IRR, 1.4 [95% CI, 1.0-2.0]). CONCLUSIONS The risk for subcortical infarcts tends to increase with small vessel disease risk-factors such as hypertension and diabetes. Risk for cortical infarcts tends to increase with atherosclerotic/coronary processes and risk for cerebellar infarcts with a more mixed profile of factors. Assessment of risk-factors by location of asymptomatic infarcts found on magnetic resonance imaging may improve the ability to target and optimize preventive therapeutic approaches to prevent stroke.
Collapse
Affiliation(s)
- Sigurdur Sigurdsson
- The Icelandic Heart Association, Kopavogur, Iceland (S.S., T.A., O.K., E.G., V.G.)
| | - Thor Aspelund
- The Icelandic Heart Association, Kopavogur, Iceland (S.S., T.A., O.K., E.G., V.G.).,The University of Iceland, Reykjavik (T.A., P.V.J., V.G.)
| | - Olafur Kjartansson
- The Icelandic Heart Association, Kopavogur, Iceland (S.S., T.A., O.K., E.G., V.G.)
| | - Elias Gudmundsson
- The Icelandic Heart Association, Kopavogur, Iceland (S.S., T.A., O.K., E.G., V.G.)
| | | | - Mark A van Buchem
- Department of Radiology, Leiden University Medical Center, the Netherlands (M.A.v.B.)
| | - Vilmundur Gudnason
- The Icelandic Heart Association, Kopavogur, Iceland (S.S., T.A., O.K., E.G., V.G.).,The University of Iceland, Reykjavik (T.A., P.V.J., V.G.)
| | - Lenore J Launer
- Laboratory of Epidemiology, Demography, and Biometry, National Institute on Aging, National Institutes of Health, Bethesda, MD (L.J.L.)
| |
Collapse
|
47
|
Qin H, Turnbull I, Chen Y, Wright N, Liu L, Pei P, Tang W, Xiang S, Guo Y, Zhao X, Clarke R, Li L, Wang Y, Chen Z. Hospital management of major stroke types in Chinese adults: a population-based study of 20 000 hospitalised stroke cases. BMJ Open 2021; 11:e054265. [PMID: 34785558 PMCID: PMC8596044 DOI: 10.1136/bmjopen-2021-054265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Accepted: 10/21/2021] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVES To compare hospital treatments for major stroke types in Chinese adults by stroke pathological types, sex, age, calendar year, hospital tier, region and other factors. DESIGN Cross-sectional analysis of medical records retrieved from 20 229 stroke cases in the China Kadoorie Biobank. SETTING Ten diverse areas (five urban, five rural) in China. PARTICIPANTS First-incident stroke cases who were recruited during an 11-year follow-up of 0.5M participants in the China Kadoorie Biobank. METHODS Electronic copies of medical records of stroke cases were retrieved for clinical adjudication by local neurologists. Stroke cases were classified as ischaemic stroke (IS) (including lacunar infarction (LACI) and non-LACI (non-LACI)), intracerebral haemorrhage (ICH), subarachnoid haemorrhage (SAH) and unspecified stroke types. RESULTS Among 20 299 first-ever stroke cases, 17 306 (85%) had IS, 7123 had non-LACI, 6690 had LACI, 3493 had silent LACI, 2623 (13%) had ICH and 370 (2%) had SAH. Among IS cases, antiplatelet treatment was used by 64% (65% non-LACI, 66% LACI, 56% silent LACI), lipid-lowering by 50% (52% non-LACI, 53% LACI, 43% silent LACI) and blood pressure-lowering by ~42% of all IS types, with positive trends in the use of these treatments by calendar year and hospital tier. Among ICH cases, 53% used blood pressure-lowering and 10% used lipid-lowering treatments, respectively. In contrast, traditional Chinese medicines (TCMs) were used by 59% of IS (50% non-LACI, 62% LACI, 74% silent LACI), 38% of ICH and 30% of SAH cases, with positive trends by calendar year and by hospital tier. CONCLUSIONS Among IS cases, use of antiplatelet and lipid-lowering medications increased in recent years, but use of TCM still exceeded use of blood pressure-lowering treatment. In contrast, blood pressure-lowering treatment was widely used for ICH, but only half of all ICH cases used blood pressure-lowering treatment.
Collapse
Affiliation(s)
- Haiqiang Qin
- Department of Neurology, Beijing Tiantian Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Centre for Neurological Diseases, Beijing, China
| | - Iain Turnbull
- Clinical Trial Service Unit and Epidemiological Studies, NDPH, University of Oxford, Oxford, UK
| | - Yiping Chen
- Clinical Trial Service Unit and Epidemiological Studies, NDPH, University of Oxford, Oxford, UK
- Medical Research Council Population Health Research Unit (PHRU), Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Neil Wright
- Clinical Trial Service Unit and Epidemiological Studies, NDPH, University of Oxford, Oxford, UK
| | - Liping Liu
- Department of Neurology, Beijing Tiantian Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Centre for Neurological Diseases, Beijing, China
| | - Pei Pei
- Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, Beijing, China
| | - Wei Tang
- Emergency Department, Pengzhou Traditional Chinese Medical Hospital, Sichuan, China
| | | | - Yu Guo
- Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, Beijing, China
| | - Xingquan Zhao
- Department of Neurology, Beijing Tiantian Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Centre for Neurological Diseases, Beijing, China
| | - Robert Clarke
- Clinical Trial Service Unit and Epidemiological Studies, NDPH, University of Oxford, Oxford, UK
| | - Liming Li
- Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, Beijing, China
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Centre, Beijing, China
| | - Yongjun Wang
- Department of Neurology, Beijing Tiantian Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Centre for Neurological Diseases, Beijing, China
| | - Zhengming Chen
- Clinical Trial Service Unit and Epidemiological Studies, NDPH, University of Oxford, Oxford, UK
| |
Collapse
|
48
|
The Role of Thromboxane in the Course and Treatment of Ischemic Stroke: Review. Int J Mol Sci 2021; 22:ijms222111644. [PMID: 34769074 PMCID: PMC8584264 DOI: 10.3390/ijms222111644] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Revised: 10/25/2021] [Accepted: 10/26/2021] [Indexed: 12/13/2022] Open
Abstract
Cardiovascular diseases are currently among the leading causes of morbidity and mortality in many developed countries. They are distinguished by chronic and latent development, a course with stages of worsening of symptoms and a period of improvement, and a constant potential threat to life. One of the most important disorders in cardiovascular disease is ischemic stroke. The causes of ischemic stroke can be divided into non-modifiable and modifiable causes. One treatment modality from a neurological point of view is acetylsalicylic acid (ASA), which blocks cyclooxygenase and, thus, thromboxane synthesis. The legitimacy of its administration does not raise any doubts in the case of the acute phase of stroke in patients in whom thrombolytic treatment cannot be initiated. The measurement of thromboxane B2 (TxB2) in serum (a stable metabolic product of TxA2) is the only test that measures the effect of aspirin on the activity of COX-1 in platelets. Measurement of thromboxane B2 may be a potential biomarker of vascular disease risk in patients treated with aspirin. The aim of this study is to present the role of thromboxane B2 in ischemic stroke and to present effective therapies for the treatment of ischemic stroke. Scientific articles from the PubMed database were used for the work, which were selected on the basis of a search for “thromboxane and stroke”. Subsequently, a restriction was introduced for works older than 10 years, those concerning animals, and those without full text access. Ultimately, 58 articles were selected. It was shown that a high concentration of TXB2 may be a risk factor for ischemic stroke or ischemic heart disease. However, there is insufficient evidence to suggest that thromboxane could be used in clinical practice as a marker of ischemic stroke. The inclusion of ASA in the prevention of stroke has a beneficial effect that is associated with the effect on thromboxane. However, its insufficient power in 25% or even 50% of the population should be taken into account. An alternative and/or additional therapy could be a selective antagonist of the thromboxane receptor. Thromboxane A2 production is inhibited by estrogen; therefore, the risk of CVD after the menopause and among men is higher. More research is needed in this area.
Collapse
|
49
|
Insulin resistance and muscle weakness are synergistic risk factors for silent lacunar infarcts: the Bunkyo Health Study. Sci Rep 2021; 11:21093. [PMID: 34702849 PMCID: PMC8548532 DOI: 10.1038/s41598-021-00377-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Accepted: 10/05/2021] [Indexed: 11/19/2022] Open
Abstract
Insulin resistance and muscle weakness are risk factors for silent lacunar infarcts (SLI), but it is unclear whether they are still independent risk factors when adjusted for each other. In addition, the effect of their combination on SLI is completely unknown. We evaluated SLI, insulin sensitivity, and knee extensor muscle strength by magnetic resonance imaging, PREDIM, and dynamometer, respectively, in 1531 elderly people aged 65–84 years living in an urban area of Tokyo. Among the study subjects, 251 (16.4%) had SLI. Impaired insulin sensitivity (High; 1.00 [reference], Medium; 1.53 [95% confidence interval (CI) 0.94–2.48], Low; 1.86 [1.02–3.39], p for trend 0.047) and reduced muscle strength (High; 1.00 [reference], Medium; 1.40 [0.98–2.02], Low; 1.49 [1.04–2.15], p for trend 0.037) were independently associated with increased risk for SLI in the fully adjusted model. In terms of combined, subjects classified as having the lowest insulin sensitivity and lowest strength were 4.33 times (95% CI 1.64–11.45) more likely to have a SLI than those classified as having the highest insulin sensitivity and highest strength. Impaired insulin sensitivity and reduced muscle strength were independently associated with higher risk of SLI in elderly subjects, and their combination synergistically increased this risk.
Collapse
|
50
|
The risk factors of old silent brain infarctions in carotid artery stenosis. Neurol Sci 2021; 43:2397-2404. [PMID: 34586540 DOI: 10.1007/s10072-021-05638-9] [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: 03/07/2021] [Accepted: 09/25/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND AND PURPOSE This study aims to investigate the risk factors of old ipsilateral silent brain infarctions (iSBIs) in patients with internal carotid artery (ICA) stenosis. METHODS Consecutive patients with unilateral ICA stenosis ≥ 50% or occlusion were retrospectively enrolled. Old iSBIs were assessed on magnetic resonance imaging. Baseline characteristics and imaging features were compared between patients with and without iSBIs. Multivariable regression analysis was conducted to identify independent risk factors of iSBIs. RESULTS We enrolled 274 patients with unilateral ICA stenosis ≥ 50% or occlusion. One hundred thirty-three patients had iSBIs to stenosed ICA (48.54%). One hundred thirty-seven patients had recent brain infarction on either side (50.0%). The patients with iSBIs had a lower level of high-density lipoprotein [OR 0.60, 95% CI (0.36-0.96), P = 0.045], higher prevalence of irregular/ulcer plaque [OR 10.71, 95% CI (4.60-24.95), P < 0.0001], and incompleteness of circle of Willis [OR 0.27, 95% CI (0.16-0.45), P < 0.0001] in all enrolled patients. In the patients without recent infarction on either side, lower level of high-density lipoprotein [OR 0.42, 95% CI (0.27-0.88), P = 0.031], higher prevalence of irregular/ulcer plaque [OR 12.73, 95% CI (4.13-39.22), P < 0.0001] and incompleteness of circle of Willis [OR 0.24, 95% CI (0.11-0.50), P = 0.004] were independently associated with iSBIs. The results were similar in ICA stenosis patients with recent brain infarction on either side. CONCLUSION In patients with carotid stenosis, incompleteness of circle of Willis, irregular/ulcer plaque, and lower level of high-density lipoprotein were independently associated with old iSBIs.
Collapse
|