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Muthalaly RG, Abrahams TB, Nerlekar N, Nelson AJ, Tan S, Chan J, Phan T, Ma H, Nicholls SJ. Asymptomatic coronary artery disease in ischaemic stroke survivors: A systematic review and meta-analysis. Eur Stroke J 2024:23969873241231702. [PMID: 38357886 DOI: 10.1177/23969873241231702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2024] Open
Abstract
BACKGROUND Ischaemic stroke and coronary artery disease share risk factors and stroke survivors experience a high rate of cardiac events. Recent work suggests a high burden of asymptomatic coronary artery disease (CAD) in ischaemic stroke survivors. Thus, we performed this systematic review and meta-analysis to A) estimate the prevalence of CAD in ischaemic stroke survivors without known CAD and B) evaluate the association between coronary atherosclerosis and future major adverse cardiovascular events (MACE) in stroke survivors. PATIENTS AND METHODS We conducted a systematic review and meta-analysis according to the PRISMA statement. We included studies investigating acute ischaemic stroke or transient ischaemic attack where participants underwent anatomical assessment of all coronary arteries. For objective B) we included studies that reported an association between coronary atherosclerosis and MACE. Two reviewers used the Newcastle-Ottawa Scale to assess risk of bias. We used random-effects modelling for our analyses. RESULTS We identified 2983 studies of which 17 were included. These studies had a total of 6862 participants between 2008 and 2022. The pooled prevalence of any coronary atherosclerosis was 66.8% (95% CI 57.2%-75.1%) with substantial heterogeneity (I2 = 95.2%). The pooled prevalence of obstructive (>50%) stenosis was 29.3% with substantial heterogeneity (I2 = 91%). High-risk coronary anatomy (triple vessel disease or left main stenosis) was found in 7.0% (95% CI 4%-12%) with high heterogeneity I2 = 72%. One study examined high-risk plaques and found a prevalence of 5.9%. Five studies reported the association of coronary atherosclerosis with future MACE. The presence of obstructive CAD confers a HR of 8.0 (95% CI 1.7-37.1, p = 0.007) for future MACE. DISCUSSION AND CONCLUSIONS Asymptomatic CAD is common in ischaemic stroke survivors. The presence and severity of asymptomatic CAD strongly associates with the risk of future MACE. Further evaluation of the benefits of routine coronary assessment in ischaemic stroke is warranted.
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Affiliation(s)
- Rahul G Muthalaly
- Victorian Heart Institute, Monash University, Clayton, VIC, Australia
| | | | - Nitesh Nerlekar
- Victorian Heart Institute, Monash University, Clayton, VIC, Australia
| | - Adam J Nelson
- Victorian Heart Institute, Monash University, Clayton, VIC, Australia
| | - Sean Tan
- Victorian Heart Institute, Monash University, Clayton, VIC, Australia
| | - Jasmine Chan
- Victorian Heart Institute, Monash University, Clayton, VIC, Australia
| | - Thanh Phan
- Victorian Heart Institute, Monash University, Clayton, VIC, Australia
| | - Henry Ma
- Victorian Heart Institute, Monash University, Clayton, VIC, Australia
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Pinto CS, Ferreira F, Margarido I, Neves AL, Nunes JPL. Alkaline phosphatase and mortality in stroke patients: a systematic review. ANNALS OF TRANSLATIONAL MEDICINE 2023; 11:412. [PMID: 38213797 PMCID: PMC10777210 DOI: 10.21037/atm-23-1627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 07/18/2023] [Indexed: 01/13/2024]
Abstract
Background Increased plasma levels of alkaline phosphatase (ALP) have been associated to a worse prognosis in several types of diseases. In the present review, the authors aimed to study the relationship between plasma levels of ALP and overall mortality in patients with stroke. Methods A systematic review was carried out, searching two databases: Web of Science and Medline/PubMed. Results A total of nine studies that included data on overall mortality in stroke patients were selected. The selected studies were published between 2010 and 2022 and were predominantly from Asia. The articles reviewed quantified ALP levels through different methods: highest versus lowest quintiles of plasma ALP (three reports); highest versus lowest quartiles of plasma ALP (four reports); and plasma ALP levels in deceased versus in surviving patients (two reports). All selected studies showed an increased mortality associated to elevated ALP levels, irrespective of stroke type and length of follow-up, from a mean of 10 days to 2.5 years. The studies comparing the highest to the lowest ALP quintiles showed an aggregate value of 1.8 times greater risk of mortality for the former, when compared to the latter. Whereas, the studies comparing the highest to the lowest ALP quartiles showed an aggregate value of 2.4 times greater risk of mortality for the former, when compared to the latter. Conclusions Elevated ALP levels are associated with increased mortality in stroke patients and provide cost effective prognostic indicators of mortality in stroke.
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Affiliation(s)
| | - Francisca Ferreira
- Faculty of Medicine, University of Porto, Porto, Portugal
- Department of Neurology, University Hospital Center of São João, Porto, Portugal
| | - Inês Margarido
- Faculty of Medicine, University of Porto, Porto, Portugal
- Department of Neurology, University Hospital Center of São João, Porto, Portugal
| | - Ana Lídia Neves
- Faculty of Medicine, University of Porto, Porto, Portugal
- Department of Neurology, University Hospital Center of São João, Porto, Portugal
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Hua M, Chen WY, Wang LH, Zou XH, Mao LL. The value of serum Lp-PLA2 combined with MPO in the diagnosis of cerebral infarction caused by large artery atherosclerosis. Clin Neurol Neurosurg 2023; 232:107899. [PMID: 37467579 DOI: 10.1016/j.clineuro.2023.107899] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 06/25/2023] [Accepted: 07/15/2023] [Indexed: 07/21/2023]
Abstract
OBJECTIVE To explore the value of serum lipoprotein-associated phospholipase A2(Lp-PLA2)combined with myeloperoxidase(MPO)for the diagnosis of large artery atherosclerosis(LAA) cerebral infarction. METHODS Baseline data were collected from patients with first-ever acute cerebral infarction, serum Lp-PLA2 and MPO levels were measured. The etiology of cerebral infarction was classified according to the Chinese Ischemic Stroke Subtype Classification Standard. The risk factors associated with LAA cerebral infarction were identified by univariate and multivariate regression analysis. The diagnostic value of serum Lp-PLA2 and MPO for LAA cerebral infarction was assessed by the area under the receiver-operating characteristic (ROC) curve. RESULTS Overall 368 patients were involved, 148 patients (40.22 %) were LAA. The serum La-PLA2 and MPO levels were higher in the LAA group than those in non-LAA group (23.06 ± 3.39 ng/mL versus 17.48 ± 3.26 ng/mL; 93.60 ± 9.58 ng/mL versus 75.98 ± 15.53 ng/mL; P < 0.001 for both). Multivariate analysis showed that elevated levels of serum Lp-PLA2 (OR 1.742, 95 %CI 1.499-2.025; P < 0.001) and MPO (OR 1.060, 95 % CI 1.026-1.096; P = 0.001) were the independent risk factors of LAA cerebral infarction. The area under curve of the serum Lp-PLA2 combined with MPO for the diagnosis of LAA cerebral infarction was 0.896 [0.866 ∼ 0.927] (P < 0.001). CONCLUSION Serum Lp-PLA2 combined with MPO could be valued as a predictor of acute cerebral infarction caused by large artery atherosclerosis.
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Affiliation(s)
- Min Hua
- Department of Neurology, Wujin Hospital Affiliated with Jiangsu University, The Wujin Clinical College of Xuzhou Medical University, Changzhou 213002, Jiangsu Province, China
| | - Wen-Ya Chen
- Department of Neurology, Wujin Hospital Affiliated with Jiangsu University, The Wujin Clinical College of Xuzhou Medical University, Changzhou 213002, Jiangsu Province, China
| | - Li-Hui Wang
- Department of Neurology, Wujin Hospital Affiliated with Jiangsu University, The Wujin Clinical College of Xuzhou Medical University, Changzhou 213002, Jiangsu Province, China
| | - Xiao-Hua Zou
- Department of Neurology, Wujin Hospital Affiliated with Jiangsu University, The Wujin Clinical College of Xuzhou Medical University, Changzhou 213002, Jiangsu Province, China
| | - Lun-Lin Mao
- Department of Neurology, Wujin Hospital Affiliated with Jiangsu University, The Wujin Clinical College of Xuzhou Medical University, Changzhou 213002, Jiangsu Province, China.
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Anterior wall STEMI in a patient with paroxysmal atrial fibrillation due to coronary embolism: A case report. Ann Med Surg (Lond) 2022; 82:104602. [PMID: 36268397 PMCID: PMC9577526 DOI: 10.1016/j.amsu.2022.104602] [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: 07/09/2022] [Revised: 09/02/2022] [Accepted: 09/04/2022] [Indexed: 11/22/2022] Open
Abstract
Introduction Coronary embolism (CE) is a rare cause of acute ST-elevation myocardial infarction (STEMI). Atrial fibrillation (AF), left ventricular thrombus, septic emboli from infective endocarditis, myxoma, and paradoxical embolism can induce emboli in coronary arteries. Case presentation Here we present a case of anterior wall STEMI secondary to paroxysmal AF in a 60-years-old female with a previous history of right-sided ischemic stroke. Discussion The major criteria for diagnosis of coronary embolism include (1) non-atherosclerotic wall of coronary vessels under angiography; (2) concomitant involvement of multiple sites; (3) histological proof of venous thrombus; (4) imaging by echocardiography/CT/MRI showing intra-cardiac thrombus. The minor criteria include (1) <25% stenosis of other vessels supplying to infarct-free myocardium; (2) atrial fibrillation history; (3) risk factors like (prosthetic valve, bacterial endocarditis, patent foramen ovale, atrial septal defect, dilated cardiomyopathy). Conclusion Our case highlights the importance of cardiac embolus as a diagnosis in a patient with a history of stroke secondary to atrial fibrillation as a cause of acute STEMI and its management. Cardioembolism is an underappreciated etiology of the acute coronary syndrome in the patient with atrial fibrillation. Cardiac embolus may be in a patient with the history of stroke secondary to atrial fibrillation as a cause of acute STEMI.
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Scalco A, Moro N, Mongillo M, Zaglia T. Neurohumoral Cardiac Regulation: Optogenetics Gets Into the Groove. Front Physiol 2021; 12:726895. [PMID: 34531763 PMCID: PMC8438220 DOI: 10.3389/fphys.2021.726895] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Accepted: 07/27/2021] [Indexed: 12/25/2022] Open
Abstract
The cardiac autonomic nervous system (ANS) is the main modulator of heart function, adapting contraction force, and rate to the continuous variations of intrinsic and extrinsic environmental conditions. While the parasympathetic branch dominates during rest-and-digest sympathetic neuron (SN) activation ensures the rapid, efficient, and repeatable increase of heart performance, e.g., during the "fight-or-flight response." Although the key role of the nervous system in cardiac homeostasis was evident to the eyes of physiologists and cardiologists, the degree of cardiac innervation, and the complexity of its circuits has remained underestimated for too long. In addition, the mechanisms allowing elevated efficiency and precision of neurogenic control of heart function have somehow lingered in the dark. This can be ascribed to the absence of methods adequate to study complex cardiac electric circuits in the unceasingly moving heart. An increasing number of studies adds to the scenario the evidence of an intracardiac neuron system, which, together with the autonomic components, define a little brain inside the heart, in fervent dialogue with the central nervous system (CNS). The advent of optogenetics, allowing control the activity of excitable cells with cell specificity, spatial selectivity, and temporal resolution, has allowed to shed light on basic neuro-cardiology. This review describes how optogenetics, which has extensively been used to interrogate the circuits of the CNS, has been applied to untangle the knots of heart innervation, unveiling the cellular mechanisms of neurogenic control of heart function, in physiology and pathology, as well as those participating to brain-heart communication, back and forth. We discuss existing literature, providing a comprehensive view of the advancement in the understanding of the mechanisms of neurogenic heart control. In addition, we weigh the limits and potential of optogenetics in basic and applied research in neuro-cardiology.
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Affiliation(s)
- Arianna Scalco
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Padova, Italy
- Veneto Institute of Molecular Medicine, Padova, Italy
| | - Nicola Moro
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Padova, Italy
- Veneto Institute of Molecular Medicine, Padova, Italy
| | - Marco Mongillo
- Veneto Institute of Molecular Medicine, Padova, Italy
- Department of Biomedical Sciences, University of Padova, Padova, Italy
| | - Tania Zaglia
- Veneto Institute of Molecular Medicine, Padova, Italy
- Department of Biomedical Sciences, University of Padova, Padova, Italy
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Lee S, Kim IC, Kim YD, Nam HS, Kim SY, Choi SM, Chang HJ. The role of cardiac CT throughout the full cardiac cycle in diagnosing patent foramen ovale in patients with acute stroke. Eur Radiol 2021; 31:8983-8990. [PMID: 34075451 DOI: 10.1007/s00330-021-08037-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 04/24/2021] [Accepted: 05/03/2021] [Indexed: 11/25/2022]
Abstract
OBJECTIVES We explored the hypothesis that the diagnostic performance of cardiac computed tomography (CT) throughout the full cardiac cycle would be superior to single-phase CT and comparable to transesophageal echocardiography (TEE) in diagnosing patent foramen ovale (PFO). METHODS AND RESULTS From May 2011 to April 2015, 978 patients with stroke were diagnosed with PFO by TEE. In patients with stroke, cardiac CT was performed if the patients had more than two cardiovascular risk factors. We prospectively enrolled 70 patients with an indication for cardiac CT. Cardiac CT images were reconstructed at 10% increments of the R-R interval. The sensitivity of cardiac CT throughout the full cardiac cycle in diagnosing PFO was compared to that for TEE and single-phase cardiac CT. To evaluate the specificity of cardiac CT, we analyzed patients without PFO confirmed by TEE who underwent cardiac CT within 1 month of pre-cardiac surgery. Sixty-six patients with cardiac CT and TEE were included in the final analysis. Throughout the full cardiac cycle, cardiac CT had a sensitivity of 89.4% and a specificity of 92.3% in diagnosing PFO, compared to TEE as a reference. PFO was primarily detected in the 60% and 70% intervals in 10-phase reconstructed images. The sensitivity of PFO diagnosis with cardiac CT was 81.8% when analyzing both the 60% and 70% intervals instead of the full cardiac cycle. CONCLUSION Cardiac CT throughout the full cardiac cycle outperforms single-phase cardiac CT in detecting PFO. Cardiac CT can be used as an alternative method to TEE for detecting PFO in stroke patients. KEY POINTS • Throughout the full cardiac cycle, cardiac computed tomography (CT) had a sensitivity of 89.4% and a specificity of 92.3% in diagnosing patent foramen ovale (PFO), compared to transesophageal echocardiography. • The sensitivity of diagnosing patent foramen ovale with cardiac CT was 81.8% when analyzing 60% and 70% R-R intervals instead of the full cardiac cycle. • Cardiac CT with retrospective electrocardiographic gating throughout the full cardiac cycle can increase the detectability of PFO, compared to single-phase cardiac CT.
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Affiliation(s)
- Seonhwa Lee
- Division of Cardiology, Department of Internal Medicine, Severance Cardiovascular Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, South Korea
| | - In-Cheol Kim
- Department of Cardiology, Cardiovascular Center, Keimyung University Dongsan Hospital, Keimyung University School of Medicine, Daegu, Korea
| | - Young Dae Kim
- Department of Neurology, Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Hyo Suk Nam
- Department of Neurology, Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - So Yeon Kim
- CONNECT-AI Research Center, Yonsei University College of Medicine, Seoul, South Korea
| | - Seon Mi Choi
- CONNECT-AI Research Center, Yonsei University College of Medicine, Seoul, South Korea
| | - Hyuk-Jae Chang
- Division of Cardiology, Department of Internal Medicine, Severance Cardiovascular Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, South Korea.
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Cho KH, Lee DH, Kim KM, Choi YH, Nam HS, Heo JH, Heo K, Kim YD. Relationship Between Sleep Apnea and Coronary Artery Calcium in Patients With Ischemic Stroke. Front Neurol 2019; 10:819. [PMID: 31417490 PMCID: PMC6684953 DOI: 10.3389/fneur.2019.00819] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Accepted: 07/16/2019] [Indexed: 12/20/2022] Open
Abstract
Study Objectives: Coronary artery disease is considered to be the major cause of death amongst patients with ischemic stroke. The coronary artery calcium (CAC) score is related not only to sleep-disordered breathing, but also with future risk of cardiovascular mortality. We investigated the association between the severity of sleep-disordered breathing and CAC score in patients with ischemic stroke. Methods: We included 32 patients who underwent coronary multichannel computed tomography and polysomnography (within 2 years of the stroke event) amongst the patients admitted to our clinic due to acute ischemic stroke. We investigated vascular risk factors, polysomnography findings, and sleep questionnaire scores, and their relationships with the CAC score. Results: All patients were found to have sleep apnea of any degree, and 23 (72%) had severe sleep apnea. Twenty-three (72%) patients had a positive CAC score. Higher CAC scores were associated with elevated respiratory disturbance index (RDI), apnea index, oxygen desaturation index, and STOP-BANG test scores. Multivariate analysis after adjusting for potential confounding factors revealed independent relationships between the CAC score and the RDI (ß [SE] = 5.3 [2.1], p = 0.01), oxygen desaturation index (ß [SE] = 6.8 [2.8], p = 0.02), and STOP-BANG test score (ß [SE] = 90.3 [37.7], p = 0.02). Conclusion: Our findings indicate a relationship between coronary atherosclerotic burden measured by the CAC score and the severity of sleep apnea. Performing polysomnography could be useful for investigating the severity of hidden coronary artery disease among these patients.
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Affiliation(s)
- Kyoo Ho Cho
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea
| | - Dong Hyun Lee
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea
| | - Kyung Min Kim
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea
| | - Yun Ho Choi
- Department of Neurology, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Incheon, South Korea
| | - Hyo Suk Nam
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea
| | - Ji Hoe Heo
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea
| | - Kyoung Heo
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea
| | - Young Dae Kim
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea
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戴 颖, 黄 志, 刘 新, 王 启. [Risk factors for recurrence of large atherosclerotic cerebral infarction]. NAN FANG YI KE DA XUE XUE BAO = JOURNAL OF SOUTHERN MEDICAL UNIVERSITY 2017; 37:1678-1682. [PMID: 29292265 PMCID: PMC6744025 DOI: 10.3969/j.issn.1673-4254.2017.12.20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 11/02/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVE To explore the risk factors for recurrence of large atherosclerotic cerebral infarction in first?episode patients. METHODS The consecutive patients with acute cerebral infarction diagnosed in the Department of Neurology were screened for large atherosclerotic cerebral infarction by CTA/MRA examination, and all the confirmed patients were followed up for 1 year. The patients were divided into recurrent ischemic stroke group and non?recurrent group according to occurrence of cerebrovascular events during the follow?up. RESULTS A total of 256 eligible patients were included in this study, and all of them completed the follow?up. During the 1?year follow?up, 30 (11.7%) patients had ischemic cerebrovascular stroke events. Univariate analysis showed significant differences in alcohol drinking (P=0.028), smoking (P=0.007), high?density lipoprotein cholesterol (HDL; P=0.045), ischemic heart disease (P=0.002), antihypertensive agents (P=0.036) and statin use (P=0.016) between the recurrent group and non?recurrent group. Cox regression analysis showed that irregular use of statins (RR=0.410, P=0.043), smoking (RR=2.253, P=0.043), HDL (RR=0.327, P=0.029), and ischemic heart disease (RR=8.566, P<0.001) were correlated with recurrent ischemic stroke. CONCLUSION The first?episode patients with irregular use of statins, low HDL levels, smoking and ischemic heart disease are at higher risks for having ischemic stroke recurrence.
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Affiliation(s)
- 颖仪 戴
- 南方医科大学,广东 广州 510515Southern Medical University, Guangzhou 510515, China
- 广东省第二人民医院神经内科,广东 广州 510317Department of Neurology, Guangdong Second Provincial General Hospital, Guangzhou 510317, China
| | - 志新 黄
- 广东省第二人民医院神经内科,广东 广州 510317Department of Neurology, Guangdong Second Provincial General Hospital, Guangzhou 510317, China
| | - 新通 刘
- 南方医科大学,广东 广州 510515Southern Medical University, Guangzhou 510515, China
- 广东省第二人民医院神经内科,广东 广州 510317Department of Neurology, Guangdong Second Provincial General Hospital, Guangzhou 510317, China
| | - 启章 王
- 广州医科大学附属深圳沙井医院,广东 深圳 518104Shenzhen Shajing Hospital Affiliated to Guangzhou Medical University, Shenzhen 518104, China
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Yoo J, Song D, Baek JH, Kim K, Kim J, Song TJ, Lee HS, Choi D, Kim YD, Nam HS, Heo JH. Poor long-term outcomes in stroke patients with asymptomatic coronary artery disease in heart CT. Atherosclerosis 2017; 265:7-13. [PMID: 28825975 DOI: 10.1016/j.atherosclerosis.2017.07.029] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2017] [Revised: 07/08/2017] [Accepted: 07/27/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND AND AIMS Although stroke patients have a high risk of ischemic heart disease, little information is available on the risk of coronary events in stroke patients with asymptomatic coronary artery disease (CAD). We investigated the long-term vascular outcomes in stroke patients with asymptomatic CAD diagnosed with multi-detector coronary computed tomography (MDCT). METHODS This study was a retrospective analysis using a prospective cohort of ischemic stroke patients. We included consecutive stroke patients without history or symptoms of CAD who underwent MDCT. We investigated the long-term risk of major adverse cardiovascular events (MACE: cardiovascular mortality, ischemic stroke, myocardial infarction, unstable angina, and urgent coronary revascularization) and composite of MACE/all-cause mortality/elective coronary revascularization. We further investigated the value of MDCT for MACE prediction. RESULTS Among the 1893 included patients, 1349 (71.3%) patients had some degree of CAD and 654 patients (34.5%) had significant (≥50%) CAD. At follow-up (median, 4.4 years), MACE occurred in 230 patients (12.2%). Event rates of MACE increased with the increasing extent of CAD. After adjustment for age, sex, and risk factors, the hazard ratios for MACE in mild CAD, 1-VD, 2-VD, and 3-VD or left main coronary disease were 1.28 (95% confidence interval [CI]: 0.88-1.87), 1.39 (95% CI: 0.90-2.16), 2.22 (95% CI: 1.39-3.55), and 2.91 (95% CI: 1.82-4.65), respectively (no CAD as a reference). Diagnosis of asymptomatic CAD significantly improved the prediction of MACE. CONCLUSIONS Asymptomatic CAD detected on MDCT was associated with increased risks of vascular events or deaths in acute stroke patients.
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Affiliation(s)
- Joonsang Yoo
- Department of Neurology, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemoon-gu, Seoul, Republic of Korea; Department of Neurology, Keimyung University College of Medicine, 56 Dalseong-ro, Jung-gu, Daegu, Republic of Korea
| | - Dongbeom Song
- Department of Neurology, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemoon-gu, Seoul, Republic of Korea
| | - Jang-Hyun Baek
- Department of Neurology, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemoon-gu, Seoul, Republic of Korea; Department of Neurology, National Medical Center, 246 Cheonggyecheon-ro, Jung-gu, Seoul, Republic of Korea
| | - Kyoungsub Kim
- Department of Neurology, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemoon-gu, Seoul, Republic of Korea
| | - Jinkwon Kim
- Department of Neurology, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemoon-gu, Seoul, Republic of Korea; Department of Neurology, CHA Bundang Medical Center, CHA University, 59 Yatap-ro, Bundang-gu, Seongnam, Republic of Korea
| | - Tae-Jin Song
- Department of Neurology, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemoon-gu, Seoul, Republic of Korea; Department of Neurology, Ewha Womans University School of Medicine, 1071 Anyangcheon-ro, Yangcheon-gu, Seoul, Republic of Korea
| | - Hye Sun Lee
- Biostatistics Collaboration Unit, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemoon-gu, Seoul, Republic of Korea
| | - Donghoon Choi
- Division of Cardiology, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemoon-gu, Seoul, Republic of Korea
| | - Young Dae Kim
- Department of Neurology, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemoon-gu, Seoul, Republic of Korea
| | - Hyo Suk Nam
- Department of Neurology, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemoon-gu, Seoul, Republic of Korea.
| | - Ji Hoe Heo
- Department of Neurology, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemoon-gu, Seoul, Republic of Korea.
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Song TJ, Kim J, Song D, Yoo J, Lee HS, Kim YJ, Nam HS, Heo JH, Kim YD. Total Cerebral Small-Vessel Disease Score is Associated with Mortality during Follow-Up after Acute Ischemic Stroke. J Clin Neurol 2017; 13:187-195. [PMID: 28406586 PMCID: PMC5392462 DOI: 10.3988/jcn.2017.13.2.187] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2016] [Revised: 01/15/2017] [Accepted: 01/18/2017] [Indexed: 12/15/2022] Open
Abstract
Background and Purpose The recently developed total cerebral small-vessel disease (CSVD) score might appropriately reflect the total burden or severity of CSVD. We investigated whether the total CSVD score is associated with long-term outcomes during follow-up in patients with acute ischemic stroke. Methods In total, 1,096 consecutive patients with acute ischemic stroke who underwent brain magnetic resonance imaging were enrolled. We calculated the total CSVD score for each patient after determining the burden of cerebral microbleeds (CMBs), high-grade white-matter hyperintensities (HWHs), high-grade perivascular spaces (HPVSs), and asymptomatic lacunar infarctions (ALIs). We recorded the date and cause of death for all of the patients using data from the Korean National Statistical Office. We compared the long-term mortality rate with the total CSVD score using Cox proportional-hazards models. Results CMBs were found in 26.8% of the subjects (294/1,096), HWHs in 16.4% (180/1,096), HPVSs in 19.3% (211/1,096), and ALIs in 38.0% (416/1,096). After adjusting for age, sex, and variables that were significant at p<0.1 in the univariate analysis, the total CSVD score was independently associated with long-term death from all causes [hazard ratio (HR)=1.18 per point, 95% confidence interval (CI)=1.07–1.30], ischemic stroke (HR=1.20 per point, 95% CI=1.01–1.42), and hemorrhagic stroke (HR=2.05 per point, 95% CI=1.30–3.22), but not with fatal cardiovascular events (HR=1.17 per point, 95% CI=0.82–1.67). Conclusions The total CSVD score is a potential imaging biomarker for predicting mortality during follow-up in patients with acute ischemic stroke.
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Affiliation(s)
- Tae Jin Song
- Department of Neurology, Yonsei University College of Medicine, Seoul, Korea.,Department of Neurology, Ewha Womans University School of Medicine, Seoul, Korea
| | - Jinkwon Kim
- Department of Neurology, CHA Bundang Medical Center, CHA University, Seongnam, Korea
| | - Dongbeom Song
- Department of Neurology, Yonsei University College of Medicine, Seoul, Korea
| | - Joonsang Yoo
- Department of Neurology, Yonsei University College of Medicine, Seoul, Korea
| | - Hye Sun Lee
- Department of Biostatistics, Yonsei University College of Medicine, Seoul, Korea
| | - Yong Jae Kim
- Department of Neurology, Ewha Womans University School of Medicine, Seoul, Korea
| | - Hyo Suk Nam
- Department of Neurology, Yonsei University College of Medicine, Seoul, Korea
| | - Ji Hoe Heo
- Department of Neurology, Yonsei University College of Medicine, Seoul, Korea
| | - Young Dae Kim
- Department of Neurology, Yonsei University College of Medicine, Seoul, Korea.
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