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Ambatipudi A, Daniel AR, Mangal R, Banerjee PR, Ganti L. Acute Cardioembolic Stroke in the Setting of Subtherapeutic Anticoagulation. Cureus 2023; 15:e44925. [PMID: 37818492 PMCID: PMC10561528 DOI: 10.7759/cureus.44925] [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] [Accepted: 09/08/2023] [Indexed: 10/12/2023] Open
Abstract
Acute ischemic stroke is a sudden neurological deficit secondary to decreased or lack of blood flow (perfusion) due to a thrombus or an embolus. Embolic strokes are ischemic strokes that occur due to a distal clot that results in hypoperfusion upstream. Cardioembolic strokes are embolic strokes due to a cardiac origin. Almost a quarter of ischemic strokes are of cardioembolic etiology. Here, we present the case of an 83-year-old female presenting with right-side weakness and aphasia who arrived 45 minutes after symptom onset. Cardioembolic stroke symptoms, diagnosis, treatment, and risk factors are discussed.
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Affiliation(s)
- Ankit Ambatipudi
- Biomedical Sciences, University of Central Florida, Orlando, USA
| | | | - Rohan Mangal
- Medicine, University of Miami Miller School of Medicine, Miami, USA
| | - Paul R Banerjee
- Emergency Medicine, Lakeland Regional Medical Center, Lakeland, USA
- Emergency Medicine, Mercer University School of Medicine, Macon, USA
| | - Latha Ganti
- Medical Sciences, The Warren Alpert Medical School of Brown University, Providence, USA
- Emergency Medicine, University of Central Florida College of Medicine, Orlando, USA
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Ganguly SS, Gujjar AR, Al Harthi H, Al Hashmi A, Jaju S, Al-Mahrezi A, Al-Asmi AR. Risk Factors for Ischaemic Stroke in an Omani Community: A case-control study. Sultan Qaboos Univ Med J 2021; 21:585-590. [PMID: 34888078 PMCID: PMC8631205 DOI: 10.18295/squmj.4.2021.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Revised: 11/03/2020] [Accepted: 11/28/2020] [Indexed: 11/17/2022] Open
Abstract
Objectives Stroke is recognised as the third most common cause of mortality and it has an increasing incidence in developing countries. Recognition and control of risk factors are of prime importance in the prevention of stroke. This study aimed to examine the characteristics of ischaemic stroke (IS) patients in Oman and quantify its various risk factors using a case-control model. Methods This case-control study was conducted from January 2012 to March 2013 at Sultan Qaboos University Hospital and Royal Hospital, Muscat. Adult Omani patients with IS who were admitted to either hospital were compared to age- and gender-matched controls. Demographic factors and frequency of various conventional risk factors were documented. Univariate and stepwise multivariate logistic regression analyses were performed to evaluate the risk factors associated with IS. Results A total of 255 patients and age-and gender-matched controls were included in this study. The mean age was 62.2 ± 13.2 years and 63.14% were male. Most cases (89.02%) were above 45 years of age. Cardio-embolism (31.76%) was the commonest mechanism of IS. Stepwise multiple logistic regression model revealed that family history of stroke was the strongest independent risk factor, followed by hypertension and high-density lipoprotein levels (odds ratio: 10.10, 5.17 and 3.34, respectively; P <0.01 each). Conclusion Cardio-embolism was the predominant mechanism of IS in this study. Family history of stroke, hypertension and reduced high-density lipoprotein were the leading independent risk factors. Strong emphasis on screening for risk factors, control of hypertension and lifestyle modification for those with a family history of stroke would be expected to emerge as the major stroke-preventive measures in Oman.
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Affiliation(s)
| | - Arunodaya R Gujjar
- Medicine, College of Medicine & Health Sciences, Sultan Qaboos University, Muscat, Oman
| | | | | | - Sanjay Jaju
- Departments of Family Medicine & Public Health
| | | | - Abdullah R Al-Asmi
- Medicine, College of Medicine & Health Sciences, Sultan Qaboos University, Muscat, Oman
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Nakajima M, Inatomi Y, Ueda A, Ito Y, Kouzaki Y, Takita T, Wada K, Yonehara T, Terasaki T, Hashimoto Y, Ando Y. Preceding direct oral anticoagulant administration reduces the severity of stroke in patients with atrial fibrillation - K-PLUS registry. J Clin Neurosci 2021; 89:106-112. [PMID: 34119252 DOI: 10.1016/j.jocn.2021.04.027] [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: 09/06/2020] [Revised: 02/17/2021] [Accepted: 04/25/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Stroke severity can be mitigated by preceding anticoagulant administration in acute ischemic stroke patients with atrial fibrillation (AF). We investigated if such mitigative effects are different between warfarin and direct oral anticoagulants (DOACs). MATERIAL AND METHODS We collected data from a regional multicenter stroke registry. Ischemic stroke or transient ischemic attack patients with AF were included. Background characteristics, National Institutes of Health Stroke Scale (NIHSS) score on admission, lesion characteristics, and in-hospital death were analyzed according to preceding antithrombotic agents at onset. RESULTS A total of 2173 patients had AF; 628 were prescribed warfarin, 272 DOACs, 429 antiplatelets alone, and 844 no antithrombotics. The NIHSS score on admission was lowest in the DOACs group compared to the other groups. In neuroimaging analysis, small ischemic lesions were observed more frequently in the DOACs group, while large ischemic lesions were less frequent in this group. When the no antithrombotics group was used as a reference, the adjusted odds ratio for moderate to severe stroke was 0.56 (95% confidence interval, 0.40-0.78) in the DOACs group, while it was 0.98 (0.77-1.24) in the warfarin group and 0.94 (0.72-1.22) in the antiplatelets group. In-hospital mortality was lowest in the DOACs group compared to the other groups. CONCLUSION Preceding DOAC administration might mitigate the severity of stroke in AF patients more strongly than other antithrombotics, possibly leading to a better outcome in patients with stroke.
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Affiliation(s)
- Makoto Nakajima
- Department of Neurology, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan.
| | | | - Akihiko Ueda
- Department of Neurology, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan.
| | - Yasuyuki Ito
- Department of Neurology, Minamata City General Hospital & Medical Center, Minamata, Japan
| | - Yanosuke Kouzaki
- Department of Neurology, National Hospital Organization Kumamoto Medical Center, Kumamoto, Japan
| | - Tomohiro Takita
- Department of Neurology, Japanese Red Cross Kumamoto Hospital, Kumamoto, Japan
| | - Kuniyasu Wada
- Department of Neurology, Kumamoto City Hospital, Kumamoto, Japan.
| | | | - Tadashi Terasaki
- Department of Neurology, Japanese Red Cross Kumamoto Hospital, Kumamoto, Japan.
| | | | - Yukio Ando
- Department of Neurology, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan; Department of Amyloidosis, Nagasaki International University, Sasebo, Japan.
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Gutiérrez OM, Irvin MR, Chaudhary NS, Cushman M, Zakai NA, David VA, Limou S, Pamir N, Reiner AP, Naik RP, Sale MM, Safford MM, Hyacinth HI, Judd SE, Kopp JB, Winkler CA. APOL1 Nephropathy Risk Variants and Incident Cardiovascular Disease Events in Community-Dwelling Black Adults. CIRCULATION. GENOMIC AND PRECISION MEDICINE 2018; 11:e002098. [PMID: 29899045 PMCID: PMC6339526 DOI: 10.1161/circgen.117.002098] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/07/2017] [Accepted: 04/04/2018] [Indexed: 02/06/2023]
Abstract
BACKGROUND APOL1 renal risk variants are strongly associated with chronic kidney disease in Black adults, but reported associations with cardiovascular disease (CVD) have been conflicting. METHODS We examined associations of APOL1 with incident coronary heart disease (n=323), ischemic stroke (n=331), and the composite CVD outcome (n=500) in 10 605 Black participants of the REGARDS study (Reasons for Geographic and Racial Differences in Stroke). Primary analyses compared individuals with APOL1 high-risk genotypes to APOL1 low-risk genotypes in Cox proportional hazards models adjusted for CVD risk factors and African ancestry. RESULTS APOL1 high-risk participants were younger and more likely to have albuminuria at baseline than APOL1 low-risk participants. The risk of incident stroke, coronary heart disease, or composite CVD end point did not significantly differ by APOL1 genotype status in multivariable models. The association of APOL1 genotype with incident composite CVD differed by diabetes mellitus status (Pinteraction=0.004). In those without diabetes mellitus, APOL1 high-risk genotypes associated with greater risk of incident composite CVD (hazard ratio, 1.67; 95% confidence interval, 1.12-2.47) compared with those with APOL1 low-risk genotypes in multivariable adjusted models. This latter association was driven by ischemic strokes (hazard ratio, 2.32; 95% confidence interval, 1.33-4.07), in particular, those related to small vessel disease (hazard ratio, 5.10; 95% confidence interval, 1.55-16.56). There was no statistically significant association of APOL1 genotypes with incident CVD in subjects with diabetes mellitus. The APOL1 high-risk genotype was associated with higher stroke risk in individuals without but not those with chronic kidney disease in fully adjusted models. CONCLUSIONS APOL1 high-risk status is associated with CVD events in community-dwelling Black adults without diabetes mellitus.
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Affiliation(s)
- Orlando M Gutiérrez
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL (O.M.G.)
| | - Marguerite R Irvin
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL (M.R.I., N.S.C.)
| | - Ninad S Chaudhary
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL (M.R.I., N.S.C.)
| | - Mary Cushman
- Division of Hematology and Oncology, University of Vermont, Burlington, VT (M.C., N.A.Z.)
| | - Neil A Zakai
- Division of Hematology and Oncology, University of Vermont, Burlington, VT (M.C., N.A.Z.)
| | - Victor A David
- Basic Research Laboratory, Center for Cancer Research, National Cancer Institute, Frederick, MD (V.A.D.)
| | - Sophie Limou
- Basic Research Laboratory, National Cancer Institute, National Institutes of Health, Leidos Biomedical Research, Frederick National Laboratory, Frederick, MD (S.L., C.A.W.)
- Center for Research in Immunology and Transplantation, University of Nantes, Nantes, France (S.L.)
| | - Nathalie Pamir
- Knight Cardiovascular Institute, Oregon Health and Science University, Portland, OR (N.P.)
| | - Alex P Reiner
- Department of Epidemiology, University of Washington, Seattle, WA (A.P.R.)
| | - Rakhi P Naik
- Department of Medicine, Johns Hopkins School of Medicine, Johns Hopkins University, Baltimore, MD (R.P.N.)
| | - Michele M Sale
- Center for Public Health Genomics, University of Virginia, Charlottesville, VA (M.M. Sale)
| | - Monika M Safford
- Division of General Internal Medicine, Weill Cornell Medicine, New York, NY (M.M. Safford)
| | - Hyacinth I Hyacinth
- Department of Pediatrics, Aflac Cancer and Blood Disorder Center, Children's Healthcare of Atlanta, Emory University, Atlanta, GA (H.I.H.)
| | - Suzanne E Judd
- Department of Biostatistics, University of Alabama at Birmingham, Birmingham, AL (S.E.J.)
| | - Jeffrey B Kopp
- Kidney Diseases Branch, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD (J.B.K.).
| | - Cheryl A Winkler
- Basic Research Laboratory, National Cancer Institute, National Institutes of Health, Leidos Biomedical Research, Frederick National Laboratory, Frederick, MD (S.L., C.A.W.)
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Wu FF, Hung YC, Tsai YH, Yang JT, Lee TH, Liow CW, Lee JD, Lin CJ, Peng TI, Lin LC. The influence of dehydration on the prognosis of acute ischemic stroke for patients treated with tissue plasminogen activator. BMC Cardiovasc Disord 2017; 17:154. [PMID: 28610565 PMCID: PMC5470225 DOI: 10.1186/s12872-017-0590-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2016] [Accepted: 06/05/2017] [Indexed: 02/06/2023] Open
Abstract
Background Many studies have determined that dehydration is an independent predictor of outcome after ischemic stroke (IS); however, none have determined if the use of thrombolytic therapy modifies the negative impact of poor hydration. To inform the stroke registry established at our institution, we conducted a retrospective study to determine if dehydration remains a negative prognostic factor after IS patients treated with tissue plasminogen activator (tPA). Methods Between 2007 and 2012, we recruited 382 subjects; 346 had data available and were divided into 2 groups on the basis of their blood urea nitrogen/creatinine (BUN/Cr) ratio. Dehydrated subjects had a BUN/Cr ratio ≥ 15; hydrated subjects had a BUN/Cr < 15. The primary outcome was impairment at discharge as graded by the Barthel Index (BI) and the modified Rankin Scale (mRS). Results The dehydration group had a greater mean age; more women; lower mean levels of hemoglobin, triglycerides, and sodium; and higher mean potassium and glucose levels. A favorable outcome as assessed by the mRS (≤2) was significantly less frequent among dehydrated subjects, but a favorable outcome by the BI (≥60) was not. Logistic regression and multivariate models confirmed that dehydration is an independent predictor of poor outcome by both the mRS and the BI; however, it was not predictive when patients were stratified by Trial of Org 10,172 in Acute Stroke Treatment subtype. Conclusions Our findings indicate that use of thrombolytic therapy does not eliminate the need to closely monitor hydration status in patients with IS.
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Affiliation(s)
- Fei-Fan Wu
- Department of Emergency Medicine, Chang Gung Memorial Hospital, No. 6, W. Sec., Jiapu Rd., Puzih City, Chiayi County, 613, Taiwan, ROC
| | - Yen-Chu Hung
- Department of Neurology, Chang Gung University, Taoyuan, Taiwan.,Department of Nursing, Chang Gung University of Science and Technology, Chiayi Campus, Chiayi, Taiwan
| | - Y H Tsai
- Department of Diagnostic Radiology, Chang Gung University, Taoyuan, Taiwan.,Department of Nursing, Chang Gung University of Science and Technology, Chiayi Campus, Chiayi, Taiwan
| | - Jen-Tsung Yang
- Division of Neurosurgery, Department of Surgery, Chang Gung Memorial Hospital, Chiayi, and College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Tsong-Hai Lee
- Stroke Center and Department of Neurology, Linkou Chang Gung Memorial Hospital, and College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Chia-Wei Liow
- Department of Neurology, Kaohsiung Chang Gung Memorial Hospital, and College of Medicine, Chang Gung University, Kaohsiung, Taiwan
| | - Jiann-Der Lee
- Department of Neurology, Chang Gung University, Taoyuan, Taiwan
| | - Chung-Jen Lin
- Department of Emergency Medicine, Chang Gung Memorial Hospital, No. 6, W. Sec., Jiapu Rd., Puzih City, Chiayi County, 613, Taiwan, ROC
| | - Tsung-I Peng
- Department of Neurology, Keelung Chang Gung Memorial Hospital, and College of Medicine, Chang Gung University, Keelung, Taiwan
| | - Leng-Chieh Lin
- Department of Emergency Medicine, Chang Gung Memorial Hospital, No. 6, W. Sec., Jiapu Rd., Puzih City, Chiayi County, 613, Taiwan, ROC. .,Department of Nursing, Chang Gung University of Science and Technology, Chiayi Campus, Chiayi, Taiwan.
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Ducci RDP, Lange MC, Zétola VDHF, Rundek T. Factors Related to Cardioembolism as Major Predictors of Poor Survival after First-Ever Middle Cerebral Artery Stroke Treated with Thrombolysis. Cerebrovasc Dis 2017; 43:178-185. [DOI: 10.1159/000455723] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2016] [Accepted: 12/30/2016] [Indexed: 12/27/2022] Open
Abstract
<b><i>Background and Purpose:</i></b> Prognostic factors related to mortality rates after stroke have been reported; however, most studies included different treatments and did not focus solely on ischemic stroke. The study aimed to report the short- and long-term survival and predictors of death in patients with first-ever ischemic stroke in the middle cerebral artery (MCA) territory, submitted to intravenous thrombolysis (IVT). <b><i>Methods:</i></b> A prospective observational cohort study of patients with first-ever ischemic stroke in the MCA territory treated with IVT from March 2010 to February 2015 was conducted, and patients were followed up until May 2015. The Kaplan-Meier method was used to estimate the cumulative case fatality rates. The potential prognostic factors were identified using Cox proportional hazards regression analysis. <b><i>Results:</i></b> A total of 169 patients, 51% women of mean age of 64.1 ± 12.9 years were followed up for a median time of 23.6 (8.1-36.2) months. At the end of the study, 53 (31.4%) patients had died. The estimated cumulative case fatality rate was 41.8% for 5 years. Chronic heart failure (hazards ratio [HR] 2.89, 95% CI 1.43-5.84, <i>p</i> = 0.003), atrial fibrillation (HR 3.88, 95% CI 1.30-11.57, <i>p</i> = 0.015), and symptomatic intracerebral hemorrhage (SICH; HR 7.83, 95% CI 3.43-17.92, <i>p</i> < 0.001) were significant unfavorable independent outcome predictors. The most frequent cause of death was infection (46%). <b><i>Conclusions:</i></b> Stroke in the MCA territory has a high mortality rate, even in patients treated with IVT. SICH, atrial fibrillation, and chronic heart failure are modifiable factors related to cardioembolism that need to be aggressively targeted for improved outcomes after stroke.
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Judd SE, Morgan CJ, Panwar B, Howard VJ, Wadley VG, Jenny NS, Kissela BM, Gutiérrez OM. Vitamin D deficiency and incident stroke risk in community-living black and white adults. Int J Stroke 2016; 11:93-102. [PMID: 26763025 DOI: 10.1177/1747493015607515] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Black individuals are at greater risk of stroke and vitamin D deficiency than white individuals. Epidemiologic studies have shown that low 25-hydroxyvitamin D concentrations are associated with increased risk of stroke, but these studies had limited representation of black individuals. METHODS We examined the association of 25-hydroxyvitamin D with incident stroke in the Reasons for Geographic and Racial Differences in Stroke (REGARDS) study, a cohort of black and white adults ≥45 years of age. Using a case-cohort study design, plasma 25-hydroxyvitamin D was measured in 610 participants who developed incident stroke (cases) and in 937 stroke-free individuals from a stratified cohort random sample of REGARDS participants (comparison cohort). RESULTS In multivariable models adjusted for socio-demographic factors, co-morbidities and laboratory values including parathyroid hormone, lower 25-hydroxyvitamin D concentrations were associated with higher risk of stroke (25-hydroxyvitamin D >30 ng/mL reference; 25-hydroxyvitamin D concentrations 20-30 ng/mL, hazard ratio 1.33, 95% confidence interval (95% CI) 0.89,1.96; 25-hydroxyvitamin D <20 ng/mL, hazard ratio 1.85, 95% CI 1.17, 2.93). There were no statistically significant differences in the association of lower 25-hydroxyvitamin D with higher risk of stroke in black vs. white participants in fully adjusted models (hazard ratio comparing lowest vs. highest 25-hydroxyvitamin D category 2.62, 95% CI 1.18, 5.83 in blacks vs. 1.64, 95% CI 0.83, 3.24 in whites, P(interaction) = 0.82). The associations were qualitatively unchanged when restricted to ischemic or hemorrhagic stroke subtypes or when using race-specific cut-offs for 25-hydroxyvitamin D categories. CONCLUSIONS Vitamin D deficiency is a risk factor for incident stroke and the strength of this association does not appear to differ by race.
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Affiliation(s)
- Suzanne E Judd
- Department of Biostatistics, University of Alabama at Birmingham, Birmingham, USA
| | - Charity J Morgan
- Department of Biostatistics, University of Alabama at Birmingham, Birmingham, USA
| | - Bhupesh Panwar
- Division of Nephrology, Department of Medicine, University of Alabama at Birmingham, Birmingham, USA
| | - Virginia J Howard
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, USA
| | - Virginia G Wadley
- Division of Gerontology, Geriatrics and Palliative Care, Department of Medicine, University of Alabama at Birmingham, Birmingham, USA
| | - Nancy S Jenny
- Departments of Medicine and Pathology, University of Vermont, Burlington, USA
| | - Brett M Kissela
- Department of Neurology, University of Cincinnati, Cincinnati, USA
| | - Orlando M Gutiérrez
- Division of Nephrology, Department of Medicine, University of Alabama at Birmingham, Birmingham, USA Department of Epidemiology, University of Alabama at Birmingham, Birmingham, USA
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Panwar B, Jenny NS, Howard VJ, Wadley VG, Muntner P, Kissela BM, Judd SE, Gutiérrez OM. Fibroblast growth factor 23 and risk of incident stroke in community-living adults. Stroke 2015; 46:322-8. [PMID: 25563643 PMCID: PMC4308535 DOI: 10.1161/strokeaha.114.007489] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2014] [Accepted: 12/04/2014] [Indexed: 12/21/2022]
Abstract
BACKGROUND AND PURPOSE Fibroblast growth factor 23 (FGF23) is a hormone that regulates phosphorus and vitamin D metabolism. Elevated FGF23 concentrations are associated with excess risk of cardiovascular disease. Associations of FGF23 with stroke outcomes are less clear. METHODS Using a case-cohort study design, we examined the association of baseline plasma FGF23 concentrations with incident stroke in the Reasons for Geographic and Racial Differences in Stroke (REGARDS) study, a cohort of black and white adults aged ≥45 years. FGF23 was measured in 615 participants who developed incident stroke (cases) and in 936 participants randomly selected from the REGARDS cohort (comparison subcohort). RESULTS In multivariable-adjusted models, higher calcium and phosphorus concentrations, lower estimated glomerular filtration rate and higher urine albumin excretion were independently associated with higher FGF23. There was no statistically significant association of FGF23 with risk of all-cause stroke in Cox models adjusted for demographic factors and established stroke risk factors (hazard ratio comparing fourth with first quartile 1.19; 95% confidence interval, 0.78-1.82). In prespecified models stratified by stroke subtypes, there was a graded association of FGF23 with risk of cardioembolic stroke in fully adjusted models (quartile 1, reference; quartile 2 hazard ratio, 1.48; 95% confidence interval, 0.63-3.47; quartile 3 hazard ratio, 1.99; 95% confidence interval, 0.89-4.44; quartile 4 hazard ratio, 2.52; 95% confidence interval, 1.08-5.91). There were no statistically significant associations of FGF23 with other ischemic stroke subtypes or with hemorrhagic strokes. CONCLUSIONS Higher FGF23 concentrations were associated with higher risk of cardioembolic but not with other stroke subtypes in community-dwelling adults. Additional studies should delineate reasons for these findings.
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Affiliation(s)
- Bhupesh Panwar
- From the Departments of Medicine (B.P., V.G.W., P.M., O.M.G.), Epidemiology (V.J.H., P.M., O.M.G.), and Biostatistics (S.E.J.), University of Alabama at Birmingham; Department of Pathology, University of Vermont, Burlington (N.S.J.); and Department of Neurology, University of Cincinnati, OH (B.M.K.)
| | - Nancy S Jenny
- From the Departments of Medicine (B.P., V.G.W., P.M., O.M.G.), Epidemiology (V.J.H., P.M., O.M.G.), and Biostatistics (S.E.J.), University of Alabama at Birmingham; Department of Pathology, University of Vermont, Burlington (N.S.J.); and Department of Neurology, University of Cincinnati, OH (B.M.K.)
| | - Virginia J Howard
- From the Departments of Medicine (B.P., V.G.W., P.M., O.M.G.), Epidemiology (V.J.H., P.M., O.M.G.), and Biostatistics (S.E.J.), University of Alabama at Birmingham; Department of Pathology, University of Vermont, Burlington (N.S.J.); and Department of Neurology, University of Cincinnati, OH (B.M.K.)
| | - Virginia G Wadley
- From the Departments of Medicine (B.P., V.G.W., P.M., O.M.G.), Epidemiology (V.J.H., P.M., O.M.G.), and Biostatistics (S.E.J.), University of Alabama at Birmingham; Department of Pathology, University of Vermont, Burlington (N.S.J.); and Department of Neurology, University of Cincinnati, OH (B.M.K.)
| | - Paul Muntner
- From the Departments of Medicine (B.P., V.G.W., P.M., O.M.G.), Epidemiology (V.J.H., P.M., O.M.G.), and Biostatistics (S.E.J.), University of Alabama at Birmingham; Department of Pathology, University of Vermont, Burlington (N.S.J.); and Department of Neurology, University of Cincinnati, OH (B.M.K.)
| | - Brett M Kissela
- From the Departments of Medicine (B.P., V.G.W., P.M., O.M.G.), Epidemiology (V.J.H., P.M., O.M.G.), and Biostatistics (S.E.J.), University of Alabama at Birmingham; Department of Pathology, University of Vermont, Burlington (N.S.J.); and Department of Neurology, University of Cincinnati, OH (B.M.K.)
| | - Suzanne E Judd
- From the Departments of Medicine (B.P., V.G.W., P.M., O.M.G.), Epidemiology (V.J.H., P.M., O.M.G.), and Biostatistics (S.E.J.), University of Alabama at Birmingham; Department of Pathology, University of Vermont, Burlington (N.S.J.); and Department of Neurology, University of Cincinnati, OH (B.M.K.)
| | - Orlando M Gutiérrez
- From the Departments of Medicine (B.P., V.G.W., P.M., O.M.G.), Epidemiology (V.J.H., P.M., O.M.G.), and Biostatistics (S.E.J.), University of Alabama at Birmingham; Department of Pathology, University of Vermont, Burlington (N.S.J.); and Department of Neurology, University of Cincinnati, OH (B.M.K.).
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Cardioembolic sources in stroke patients in South of Brazil. THROMBOSIS 2014; 2014:753780. [PMID: 25349734 PMCID: PMC4198824 DOI: 10.1155/2014/753780] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/30/2014] [Revised: 09/24/2014] [Accepted: 09/24/2014] [Indexed: 11/17/2022]
Abstract
Background. Stroke is a leading cause of mortality and disability in Brazil and around the world. Cardioembolism is responsible for nearly 30% of the origins of ischemic stroke. Methods. We analyzed data of 256 patients with cardioembolic ischemic stroke (according to TOAST classification) who were admitted into the Hospital São Lucas-PUCRS from October 2011 to January 2014. The cardioembolic subtype was divided into six subgroups: arrhythmias, valvular heart disease, coronary artery disease, cardiomyopathy, septal abnormalities, and intracardiac injuries. The prevalence of the most important cardiovascular risk factors and medications in use for prevention of systemic embolism by the time of hospital admission was analyzed in each patient. Results. Among 256 patients aged 60.2 +/− 6.9 years, 132 males, arrhythmias were the most common cause of cardioembolism corresponding to 50.7%, followed by valvular heart disease (17.5%) and coronary artery disease (16%). Hypertension (61.7%) and dyslipidemia (43.7%) were the most common risk factors. Less than 50% of patients with arrhythmias were using oral anticoagulants. Conclusions. Identifying the prevalence of cardioembolic stroke sources subgroups has become an increasingly important role since the introduction of new oral anticoagulants. In this study, arrhythmias (especially atrial fibrillation) were the main cause of cardioembolism.
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Cardiac function and outcome in patients with cardio-embolic stroke. PLoS One 2014; 9:e95277. [PMID: 24760037 PMCID: PMC3997393 DOI: 10.1371/journal.pone.0095277] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2013] [Accepted: 03/26/2014] [Indexed: 11/25/2022] Open
Abstract
Background The relationship between whole spectrum of Ejection fraction (EF) and cardioembolic stroke (CES) outcome has not been fully described yet. Notably, it remains unclear whether borderline EF (41∼49%) is related with poor outcome after CES. We sought to evaluate whether lower ejection fraction and borderline EF could predict the outcome in patients with CES. Method and Results We evaluated the relationship between EF and functional outcome in 437 consecutive patients with CES. EF was introduced as continuous and categorical (EF≤40%, EF 41∼49%, EF≥50%) variable. Patients with CES and the subgroup with AF were evaluated separately. Poor short-term outcome (modified Rankin Score≥3at discharge or death within 90 days after stroke onset) and long-term mortality were evaluated. A total of 165 patients (37.8%) had poor short-term outcomes. EF tends to be lower in patients with poor short-term outcome (56.8±11.0 vs. 54.8±12.0, p-value 0.086). Overall cumulative death was136 (31.1%) in all CES patients and 106 (31.7%) in the AF subgroup. In a multivariable model adjusted for possible covariates, the hazard ratio for mortality significantly decreased by 3% for every 1% increase in ejection fraction in CES patients and 2% for every 1% increase in the AF subgroup. Reduced EF (EF≤40%) showed higher mortality (HR 2.61), and those with borderline EF (41∼49%) had a tendency of higher mortality (HR 1.65, p-value 0.067)compared with those with normal EF. Conclusion We found a strong association between lower EF and CES outcome. Echocardiographic evaluation helps to better determine the prognosis in CES patients, even in subgroup of patients with AF.
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Medic S, Beslac-Bumbasirevic L, Kisic-Tepavcevic D, Pekmezovic T. Short-term and long-term stroke survival: the belgrade prognostic study. J Clin Neurol 2013; 9:14-20. [PMID: 23346155 PMCID: PMC3543904 DOI: 10.3988/jcn.2013.9.1.14] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2012] [Revised: 08/20/2012] [Accepted: 08/20/2012] [Indexed: 12/19/2022] Open
Abstract
Background and Purpose The aims of this study were to determine the 28-day and 1-year survival rates after first-ever ischemic stroke and to identify their baseline predictors. Methods We prospectively and consecutively collected data on 300 patients with first-ever acute ischemic stroke admitted to 2 major neurological institutions for cerebrovascular diseases in Belgrade during March 2008. The Kaplan-Meier method was used to estimate the cumulative 28-day and 1-year survival rates, and the predictive values of different variables were assessed by Cox proportional-hazards regression model. Results The cumulative 28-day and 1-year survival rates of ischemic stroke patients in the cohort were 81.0% and 78.3%, respectively. The multivariate predictive model revealed that hypertension (p=0.017), National Institutes of Health Stroke Scale score (p=0.001), and in-hospital medical complications (p=0.029) were significant unfavorable independent outcome predictors, while early physical therapy (p=0.001) was a significant favorable prognostic factor for the 28-day mortality in our patients. Multivariate Cox regression analysis showed that age (p=0.001), National Institutes of Health Stroke Scale score (p=0.001), and in-hospital complications (p=0.008) remained significant predictors of 1-year mortality. Conclusions The findings support the need for optimal control of vascular risk factors and treatment of atherosclerotic disease as well as appropriate prevention and management of in-hospital complications of stroke.
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Affiliation(s)
- Sanja Medic
- Department of Neurology, Clinical Center Dr Dragisa Misovic, Belgrade, Serbia
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