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Mehta VC, Chandrasekhar SA, Quimby DL, Bhandari A, Mazo V, Glaser AD, Rose DZ, Mohanty BD. Cerebral Protection in Trans-Catheter Aortic Valve Replacement: Review and Contemporary Assessment of Randomized Trial Data. Neurohospitalist 2024; 14:157-165. [PMID: 38666284 PMCID: PMC11040624 DOI: 10.1177/19418744231225680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/28/2024] Open
Abstract
As the population has aged and as aortic valve therapies have evolved, the use of trans-catheter aortic valve replacement (TAVR) has grown dramatically over the past decade. A well-known complication of percutaneous cardiac intervention is embolic phenomena, and TAVR is among the highest risk procedures for clinical and subclinical stroke. As indications for TAVR expand to lower-risk and ultimately younger patients, the long-term consequences of stroke are amplified. Cerebral embolic protection (CEP) devices have taken a on unique preventative role following the Food and Drug Administration approval of the SentinelTM Cerebral Protection System (CPS). More recently, the PROTECTED TAVR study has spurred extensive debate in the neuro-cardiac community. In this review we describe the contemporary literature regarding stroke risk associated with TAVR, the history and role of CEP devices, a PROTECTED TAVR sub-group analysis, and implications for next steps in the field. Lastly, we explore the unique need for CEP in a younger TAVR population, as well as directions for future research.
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Affiliation(s)
- Vivek C. Mehta
- Division of Cardiology, Department of Medicine, University of South Florida, Morsani College of Medicine, Tampa, FL, USA
| | - Sanjay A. Chandrasekhar
- Division of Cardiology, Department of Medicine, University of South Florida, Morsani College of Medicine, Tampa, FL, USA
| | - Donald L. Quimby
- Division of Cardiology, Department of Medicine, University of South Florida, Morsani College of Medicine, Tampa, FL, USA
| | - Ajay Bhandari
- Division of Cardiology, Department of Medicine, University of South Florida, Morsani College of Medicine, Tampa, FL, USA
| | - Victoria Mazo
- Division of Vascular Neurology, Department of Neurology, University of South Florida, Morsani College of Medicine, Tampa, FL, USA
| | - Alexander D. Glaser
- Section of Cardiology, Department of Internal Medicine, Louisiana State University, New Orleans, LA, USA
| | - David Z. Rose
- Division of Vascular Neurology, Department of Neurology, University of South Florida, Morsani College of Medicine, Tampa, FL, USA
| | - Bibhu D. Mohanty
- Division of Cardiology, Department of Medicine, University of South Florida, Morsani College of Medicine, Tampa, FL, USA
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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] [What about the content of this article? (0)] [Affiliation(s)] [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.
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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
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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] [What about the content of this article? (0)] [Affiliation(s)] [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.
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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
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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] [What about the content of this article? (0)] [Affiliation(s)] [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.
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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
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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] [What about the content of this article? (0)] [Affiliation(s)] [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.
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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
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6
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Omi H, Yokoyama T, Naraoka T, Omi S, Takeuchi K. Prevalence of Cervical Canal Stenosis in Patients with Femoral Fracture: A Retrospective Single-Center Study. Spine Surg Relat Res 2022; 6:631-637. [PMID: 36561151 PMCID: PMC9747213 DOI: 10.22603/ssrr.2022-0014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Accepted: 04/17/2022] [Indexed: 12/25/2022] Open
Abstract
Introduction Cervical spine surgery reduces falls and subsequent femoral fractures. Nonetheless, current evidence on the prevalence of cervical cord compression (CCC) and increased signal intensity (ISI) in patients with femoral fractures is limited. We aimed to determine the prevalence of CCC and ISI and characterize the physical status and imaging findings using cervical spine magnetic resonance imaging (MRI) and brain computed tomography (CT) in patients with femoral fractures. Methods This study included 173 patients (140 women, 33 men) with femoral fractures caused by falling, who underwent both cervical spine MRI and brain CT. CCC cases classified as grade 2 (compression of less than one-third of the spinal cord) or higher were investigated. The ISI of the severely affected intervertebral disc level was evaluated using T2-weighted MRI. Hand grip strength and myelopathic signs were also evaluated. Data analysis was performed using the χ2 test, Fisher's exact test, and Student's t-test. Results Among the 173 patients, 83 (48.0%) had CCC, 29 (16.8%) had ISI, and 68 (39.3%) had abnormal brain CT findings. There was no ISI in patients in the non-CCC group. The patients' average age in the CCC group was significantly higher than that in the non-CCC group. There was no significant difference in the proportion of myelopathic sign and abnormal brain CT findings between the CCC and non-CCC groups or between the ISI and non-ISI groups. Bilateral hand grip strength was significantly negatively correlated with the stenosis rate (right, p=0.047; left, p=0.0018). Conclusions In conclusion, our study showed that patients with femoral fractures had a high frequency of cervical canal stenosis and intracranial lesions using cervical spine MRI and brain CT.
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Affiliation(s)
- Hirotsugu Omi
- Department of Orthopaedic Surgery, Omi Orthopaedic Clinic, Hirosaki, Aomori, Japan
| | - Toru Yokoyama
- Department of Orthopaedic Surgery, Odate Municipal General Hospital, Odate, Akita, Japan
| | - Takuya Naraoka
- Department of Orthopaedic Surgery, Fujinomiya City General Hospital, Fujinomiya, Shizuoka, Japan
| | - Sanae Omi
- Department of Radiology, Kin-ikyo Chuo Hospital, Sapporo, Hokkaido, Japan
| | - Kazunari Takeuchi
- Department of Orthopaedic Surgery, Odate Municipal General Hospital, Odate, Akita, Japan
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Anand SS, Tu JV, Desai D, Awadalla P, Robson P, Jacquemont S, Dummer T, Le N, Parker L, Poirier P, Teo K, Lear SA, Yusuf S, Tardif JC, Marcotte F, Busseuil D, Després JP, Black SE, Kirpalani A, Parraga G, Noseworthy MD, Dick A, Leipsic J, Kelton D, Vena J, Thomas M, Schulze KM, Larose E, Moody AR, Smith EE, Friedrich MG. Cardiovascular risk scoring and magnetic resonance imaging detected subclinical cerebrovascular disease. Eur Heart J Cardiovasc Imaging 2021; 21:692-700. [PMID: 31565735 PMCID: PMC7237958 DOI: 10.1093/ehjci/jez226] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Revised: 06/26/2019] [Accepted: 08/21/2019] [Indexed: 12/04/2022] Open
Abstract
Aims Cardiovascular risk factors are used for risk stratification in primary prevention. We sought to determine if simple cardiac risk scores are associated with magnetic resonance imaging (MRI)-detected subclinical cerebrovascular disease including carotid wall volume (CWV), carotid intraplaque haemorrhage (IPH), and silent brain infarction (SBI). Methods and results A total of 7594 adults with no history of cardiovascular disease (CVD) underwent risk factor assessment and a non-contrast enhanced MRI of the carotid arteries and brain using a standardized protocol in a population-based cohort recruited between 2014 and 2018. The non-lab-based INTERHEART risk score (IHRS) was calculated in all participants; the Framingham Risk Score was calculated in a subset who provided blood samples (n = 3889). The association between these risk scores and MRI measures of CWV, carotid IPH, and SBI was determined. The mean age of the cohort was 58 (8.9) years, 55% were women. Each 5-point increase (∼1 SD) in the IHRS was associated with a 9 mm3 increase in CWV, adjusted for sex (P < 0.0001), a 23% increase in IPH [95% confidence interval (CI) 9–38%], and a 32% (95% CI 20–45%) increase in SBI. These associations were consistent for lacunar and non-lacunar brain infarction. The Framingham Risk Score was also significantly associated with CWV, IPH, and SBI. CWV was additive and independent to the risk scores in its association with IPH and SBI. Conclusion Simple cardiovascular risk scores are significantly associated with the presence of MRI-detected subclinical cerebrovascular disease, including CWV, IPH, and SBI in an adult population without known clinical CVD.
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Affiliation(s)
- Sonia S Anand
- Population Health Research Institute, Hamilton Health Sciences, McMaster University, 237 Barton St East, Hamilton, Ontario L8L 2X2, Canada.,Department of Medicine, McMaster University, 1280 Main Street West, Hamilton, Ontario L8S 4K1, Canada
| | - Jack V Tu
- Department of Medicine, University of Toronto, ICES, Sunnybrook Schulich Heart Centre; 2075 Bayview Ave, Toronto, Ontario M4N 3M5, Canada
| | - Dipika Desai
- Population Health Research Institute, Hamilton Health Sciences, McMaster University, 237 Barton St East, Hamilton, Ontario L8L 2X2, Canada
| | - Phillip Awadalla
- Department of Molecular Genetics, Ontario Institute for Cancer Research, University of Toronto, 661 University Avenue Suite 510, Toronto, Ontario M5G 0A3, Canada
| | - Paula Robson
- Cancer Research and Analytics, Cancer Control Alberta, Alberta Health Services, Suite 1500 Sun Life Place, 10123 99th Street NW, Edmonton, Alberta T5J 3H1, Canada
| | - Sébastien Jacquemont
- Department of Medicine, Université de Montréal, CHU Sainte Justine; 3175 Chemin de la Cote-Sainte-Catherine, Montreal, Quebec H3T 1C5, Canada.,Department of Pediatrics, Université de Montréal, CHU Sainte Justine, 3175 Chemin de la Cote-Sainte-Catherine, Montreal, Quebec H3T 1C5, Canada
| | - Trevor Dummer
- School of Population and Public Health, University of British Columbia, 675 W 10th Avenue, Vancouver, British Columbia V5Z 1L3, Canada
| | - Nhu Le
- Department of Statistics, BC Cancer Agency, University of British Columbia, 675 W 10th Avenue, Vancouver, British Columbia V5Z 1L3, Canada
| | - Louise Parker
- Department of Medicine, Dalhousie University; 1494 Carlton Street, P.O. Box 15000, Halifax, Nova Scotia B3H 4R2, Canada
| | - Paul Poirier
- Institut universitaire de cardiologie et de pneumologie de Québec - Université Laval, 2725 chemin Sainte-Foy, Québec G1V 4G5, Canada
| | - Koon Teo
- Population Health Research Institute, Hamilton Health Sciences, McMaster University, 237 Barton St East, Hamilton, Ontario L8L 2X2, Canada.,Department of Medicine, McMaster University, 1280 Main Street West, Hamilton, Ontario L8S 4K1, Canada
| | - Scott A Lear
- Faculty of Health Sciences, Simon Fraser University, 8888 University Drive, Burnaby, British Columbia V5A 1S6, Canada
| | - Salim Yusuf
- Population Health Research Institute, Hamilton Health Sciences, McMaster University, 237 Barton St East, Hamilton, Ontario L8L 2X2, Canada.,Department of Medicine, McMaster University, 1280 Main Street West, Hamilton, Ontario L8S 4K1, Canada
| | - Jean-Claude Tardif
- Research Centre, Montreal Heart Institute, Université de Montréal, 5000 Belanger Street, Montreal H1T 1C8, Quebec, Canada
| | - Francois Marcotte
- Research Centre, Montreal Heart Institute, Université de Montréal, 5000 Belanger Street, Montreal H1T 1C8, Quebec, Canada
| | - David Busseuil
- Research Centre, Montreal Heart Institute, Université de Montréal, 5000 Belanger Street, Montreal H1T 1C8, Quebec, Canada
| | - Jean-Pierre Després
- Department of Kinesiology, Université Laval, 2325 rue de l'Université, Québec, Québec G1V 0A6, Canada
| | - Sandra E Black
- Department of Medicine (Neurology), Sunnybrook Health Sciences Centre, University of Toronto, 2075 Bayview Avenue, Toronto, Ontario M4N 3M5, Canada.,Hurvitz Brain Sciences Research Program Director, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, University of Toronto, 2075 Bayview Avenue, Toronto, Ontario M4N 3M5, Canada
| | - Anish Kirpalani
- Department of Medical Imaging, St. Michael's Hospital, University of Toronto, 30 Bond Street, Toronto, Ontario M5B 1W8, Canada
| | - Grace Parraga
- Department of Medical Biophysics, Western University, 1151 Richmond Street North, London, Ontario N6A 5C1, Canada.,Robarts Research Institute, Western University, 1151 Richmond Street North, London, Ontario N6A 5B7, Canada
| | - Michael D Noseworthy
- Department of Electrical and Computer Engineering, School of Biomedical Engineering, McMaster University, 1280 Main Street West, Hamilton, Ontario L8S 4K1, Canada.,Diagnostic Imaging, St. Joseph's Health Care, 50 Charlton Avenue East, Hamilton, Ontario L8N 4A6, Canada
| | - Alexander Dick
- Division of Cardiology, University of Ottawa Heart Institute, University of Ottawa, 40 Ruskin Street, Ottawa, Ontario K1Y 4W7, Canada
| | - Jonathan Leipsic
- Department of Radiology, University of British Columbia, St. Paul's Hospital, 1081 Burrard Street, Vancouver, British Columbia V6Z 1Y6, Canada
| | - David Kelton
- Diagnostic Imaging, Brampton Civic Hospital, William Osler Health System, 2100 Bovaird Street East, Brampton, Ontario L6R 3J7, Canada
| | - Jennifer Vena
- Cancer Research and Analytics, Cancer Control Alberta, Alberta Health Services, Richmond Road Diagnostic and Treatment Centre, 1820 Richmond Road SW Calgary, Alberta T2T 5C7, Canada
| | - Melissa Thomas
- Population Health Research Institute, Hamilton Health Sciences, McMaster University, 237 Barton St East, Hamilton, Ontario L8L 2X2, Canada
| | - Karleen M Schulze
- Population Health Research Institute, Hamilton Health Sciences, McMaster University, 237 Barton St East, Hamilton, Ontario L8L 2X2, Canada.,Department of Medicine, McMaster University, 1280 Main Street West, Hamilton, Ontario L8S 4K1, Canada
| | - Eric Larose
- Institut universitaire de cardiologie et de pneumologie de Québec - Université Laval, 2725 chemin Sainte-Foy, Québec G1V 4G5, Canada
| | - Alan R Moody
- Department of Medical Imaging, Sunnybrook Health Sciences Centre, University of Toronto, 2075 Bayview Avenue, Toronto, Ontario M4N 3M5, Canada
| | - Eric E Smith
- Department of Clinical Neurosciences, Hotchkiss Brain Institute, University of Calgary, 3330 Hospital Drive NW, Calgary, Alberta T2N 4N1, Canada
| | - Matthias G Friedrich
- Department of Medicine and Diagnostic Radiology, McGill University, 1001 Decarie Boulevard, Montreal, Quebec H4A 3J1, Canada
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Forés R, Manresa JM, López-Lifante VM, Heras A, Delgado P, Vázquez X, Ruiz S, Alzamora MT, Toran P. Relationship between Retinal Microvasculature, Cardiovascular Risk and Silent Brain Infarction in Hypertensive Patients. Diagnostics (Basel) 2021; 11:diagnostics11060937. [PMID: 34073652 PMCID: PMC8224683 DOI: 10.3390/diagnostics11060937] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 05/21/2021] [Accepted: 05/21/2021] [Indexed: 11/16/2022] Open
Abstract
Objective: The aims of this study are to analyze the role of artery-vein ratio AVR assessment using VesselMap 2 software (Imedos Systems) and cardiovascular risk evaluation by means of REGICOR in the prediction of silent brain infarction (SBI) in middle-age hypertensive patients from the ISSYS study. Material and Methods: A cross-sectional study with 695 patients with hypertension aged 50 to 70 years who participated in the project Investigating Silent Strokes in HYpertensives: a Magnetic Resonance Imaging Study (ISSYS), was conducted in two Primary Care Centres of Barcelona. Participants agreed to a retinography and an MRI to detect silent brain infarction (SBI). The IMEDOS software was used for the semiautomatic caliber measurement of retinal arteries and veins, and the AVR was considered abnormal when <0.66. The REGICOR score was calculated for all patients. Results: Multivariate logistic regression analysis was used to evaluate the impact of AVR and REGICOR scores on SBI. The OR (odds ratio) for a high REGICOR score and an abnormal AVR were 3.16 and 4.45, respectively. When analysing the interaction of both factors, the OR of an abnormal AVR and moderate REGICOR score was 3.27, whereas with a high REGICOR score it reached 13.07. Conclusions: The measurement of AVR in patients with hypertension and with a high REGICOR score can contribute to the detection of silent brain infarction.
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Affiliation(s)
- Rosa Forés
- Unitat de Suport a la Recerca Metropolitana Nord, Institut Universitari d’Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), 08303 Mataró, Spain; (J.M.M.); (V.M.L.-L.); (A.H.); (M.T.A.); (P.T.)
- Riu Nord-Riu Sud Primary Healthcare Centre, Santa Coloma de Gramenet, Gerència d’Àmbit d’Atenció Primària Metropolitana Nord, Institut Català de la Salut, 08921 Barcelona, Spain
- Correspondence: ; Tel.: +34-934662096
| | - Josep M. Manresa
- Unitat de Suport a la Recerca Metropolitana Nord, Institut Universitari d’Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), 08303 Mataró, Spain; (J.M.M.); (V.M.L.-L.); (A.H.); (M.T.A.); (P.T.)
| | - Victor M. López-Lifante
- Unitat de Suport a la Recerca Metropolitana Nord, Institut Universitari d’Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), 08303 Mataró, Spain; (J.M.M.); (V.M.L.-L.); (A.H.); (M.T.A.); (P.T.)
- Palau Healthcare Centre, Palau-Solità Plegamans, Gerència d’Àmbit d’Atenció Primària Metropolitana Nord, Institut Català de la Salut, 08124 Barcelona, Spain
| | - Antonio Heras
- Unitat de Suport a la Recerca Metropolitana Nord, Institut Universitari d’Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), 08303 Mataró, Spain; (J.M.M.); (V.M.L.-L.); (A.H.); (M.T.A.); (P.T.)
- Riu Nord-Riu Sud Primary Healthcare Centre, Santa Coloma de Gramenet, Gerència d’Àmbit d’Atenció Primària Metropolitana Nord, Institut Català de la Salut, 08921 Barcelona, Spain
| | - Pilar Delgado
- Neurovascular Research Lab, Vall D’Hebron Research Institute, Universitat Autònoma de Barcelona, 08035 Barcelona, Spain;
- Dementia Unit, Neurology Service, Vall D’Hebron University Hospital, Universitat Autònoma de Barcelona, 08035 Barcelona, Spain
| | - Xose Vázquez
- Hospital Municipal de Badalona, Badalona Serveis Assistencials, Secció d’Oftalmologia, Badalona, 08911 Barcelona, Spain;
| | - Susana Ruiz
- Germans Trias i Pujol University Hospital, Badalona, 08916 Barcelona, Spain;
| | - Maria Teresa Alzamora
- Unitat de Suport a la Recerca Metropolitana Nord, Institut Universitari d’Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), 08303 Mataró, Spain; (J.M.M.); (V.M.L.-L.); (A.H.); (M.T.A.); (P.T.)
- Riu Nord-Riu Sud Primary Healthcare Centre, Santa Coloma de Gramenet, Gerència d’Àmbit d’Atenció Primària Metropolitana Nord, Institut Català de la Salut, 08921 Barcelona, Spain
| | - Pere Toran
- Unitat de Suport a la Recerca Metropolitana Nord, Institut Universitari d’Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), 08303 Mataró, Spain; (J.M.M.); (V.M.L.-L.); (A.H.); (M.T.A.); (P.T.)
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9
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Abstract
Silent brain infarction (SBI) has been considered as a subclinical risk factor for symptomatic possible future stroke. We investigated the association between serum inflammatory markers and SBI. Patients (n = 54) diagnosed with SBI as the study group and 52 individuals as the control group were included in this study. Silent brain infarction is defined as a hyperintense lesion that was ≥3 mm in 1 dimension on fluid-attenuated inversion recovery T2-weighted magnetic resonance image, if the patient had normal neurological examination or had an abnormality that was not consistent with the brain lesion locations, after being evaluated by a neurologist. Serum endocan levels (P = .036) and high-sensitivity C-reactive protein (hsCRP; P = .022) were significantly higher in patients with SBI than the controls. Pentraxin 3, erythrocyte sedimentation rate, white blood count, lymphocyte, monocyte, neutrophil, low-density lipoprotein, and triglyceride levels were not significantly different when comparing the groups with and without SBI. There was a significant correlation (r = -0.196; P = .16) between hsCRP and endocan levels in the SBI group. Endocan, a novel biomarker of endothelial pathology, was significantly increased in patients with SBI and may be useful to predict the future risk of stroke.
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Affiliation(s)
- Yuksel Erdal
- Department of Neurology, Health Sciences University, Istanbul Training and Research Hospital, Istanbul, Turkey
| | - Nurettin Yavuz
- Department of Neurology, Health Sciences University, Istanbul Training and Research Hospital, Istanbul, Turkey
| | - Osman Oguz
- Department of Biochemistry, Health Sciences University, Istanbul Training and Research Hospital, Istanbul, Turkey
| | - Abdullah Soydan Mahmutoglu
- Department of Radiology, Health Sciences University, Istanbul Training and Research Hospital, Istanbul, Turkey
| | - Ufuk Emre
- Department of Neurology, Health Sciences University, Istanbul Training and Research Hospital, Istanbul, Turkey
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10
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Raghavan S, Graff-Radford J, Scharf E, Przybelski SA, Lesnick TG, Gregg B, Schwarz CG, Gunter JL, Zuk SM, Rabinstein A, Mielke MM, Petersen RC, Knopman DS, Kantarci K, Jack CR, Vemuri P. Study of Symptomatic vs. Silent Brain Infarctions on MRI in Elderly Subjects. Front Neurol 2021; 12:615024. [PMID: 33679582 PMCID: PMC7925615 DOI: 10.3389/fneur.2021.615024] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Accepted: 02/01/2021] [Indexed: 12/16/2022] Open
Abstract
Brain infarctions are closely associated with future risk of stroke and dementia. Our goal was to report (i) frequency and characteristics that differentiate symptomatic vs. silent brain infarctions (SBI) on MRI and (ii) frequency and location by vascular distribution (location of stroke by major vascular territories) in a population based sample. From Mayo Clinic Study of Aging, 347 participants (≥50 years) with infarcts detected on their first MRI were included. Infarct information was identified visually on a FLAIR MRI image and a vascular territory atlas was registered to the FLAIR image data in order to identify the arterial territory of infarction. We identified the subset with a clinical history of stroke based on medical chart review and used a logistic regression to evaluate the risk factors associated with greater probability of a symptomatic stroke vs. SBI. We found that 14% of all individuals with infarctions had a history of symptomatic stroke (Silent: n = 300, symptomatic: n = 47). Factors associated with a symptomatic vs. SBI were size which had an odds ratio of 3.07 (p < 0.001), greater frequency of hypertension (odds ratio of 4.12, p = 0.025) and alcohol history (odds ratio of 4.58, p = 0.012). The frequency of infarcts was greater in right hemisphere compared to the left for SBI. This was primarily driven by middle cerebral artery (MCA) infarcts (right = 60%, left = 40%, p = 0.005). While left hemisphere strokes are more common for symptomatic carotid disease and in clinical trials, right hemispheric infarcts may be more frequent in the SBI group.
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Affiliation(s)
| | | | - Eugene Scharf
- Neurology, Mayo Clinic, Rochester, MN, United States
| | | | | | - Brian Gregg
- Departments of Radiology, Mayo Clinic, Rochester, MN, United States
| | | | - Jeffrey L Gunter
- Information Technology, Mayo Clinic, Rochester, MN, United States
| | - Samantha M Zuk
- Departments of Radiology, Mayo Clinic, Rochester, MN, United States
| | | | - Michelle M Mielke
- Neurology, Mayo Clinic, Rochester, MN, United States.,Health Sciences Research, Mayo Clinic, Rochester, MN, United States
| | | | | | - Kejal Kantarci
- Departments of Radiology, Mayo Clinic, Rochester, MN, United States
| | - Clifford R Jack
- Departments of Radiology, Mayo Clinic, Rochester, MN, United States
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11
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Abstract
Background Silent brain infarcts (SBI) are increasingly being recognized as an important complication of cardiac procedures as well as a potential surrogate marker for studies on brain injury. The extent of subclinical brain injury is poorly defined. Methods and Results We conducted a systematic review and meta‐analysis utilizing studies of SBIs and focal neurologic deficits following cardiac procedures. Our final analysis included 42 studies with 49 separate intervention groups for a total of 2632 patients. The prevalence of SBIs following transcatheter aortic valve implantation was 0.71 (95% CI 0.64‐0.77); following aortic valve replacement 0.44 (95% CI 0.31‐0.57); in a mixed cardiothoracic surgery group 0.39 (95% CI 0.28‐0.49); coronary artery bypass graft 0.25 (95% CI 0.15‐0.35); percutaneous coronary intervention 0.14 (95% CI 0.10‐0.19); and off‐pump coronary artery bypass 0.14 (0.00‐0.58). The risk ratio of focal neurologic deficits to SBI in aortic valve replacement was 0.22 (95% CI 0.15‐0.32); in off‐pump coronary artery bypass 0.21 (95% CI 0.02‐2.04); with mixed cardiothoracic surgery 0.15 (95% CI 0.07‐0.33); coronary artery bypass graft 0.10 (95% CI 0.05‐0.18); transcatheter aortic valve implantation 0.10 (95% CI 0.07‐0.14); and percutaneous coronary intervention 0.06 (95% CI 0.03‐0.14). The mean number of SBIs per patient was significantly higher in the transcatheter aortic valve implantation group (4.58 ± 2.09) compared with both the aortic valve replacement group (2.16 ± 1.62, P=0.03) and the percutaneous coronary intervention group (1.88 ± 1.02, P=0.03). Conclusions SBIs are a very common complication following cardiac procedures, particularly those involving the aortic valve. The high frequency of SBIs compared with strokes highlights the importance of recording this surrogate measure in cardiac interventional studies. We suggest that further work is required to standardize reporting in order to facilitate the use of SBIs as a routine outcome measure.
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Affiliation(s)
- Ben Indja
- 1 Sydney Translational Imaging Laboratory Heart Research Institute Charles Perkins Centre The University of Sydney Camperdown Sydney NSW Australia.,2 Sydney Medical School The University of Sydney Camperdown Sydney NSW Australia
| | - Kei Woldendorp
- 2 Sydney Medical School The University of Sydney Camperdown Sydney NSW Australia.,4 Department of Cardiothoracic Surgery Royal Prince Alfred Hospital Camperdown Sydney NSW Australia
| | - Michael P Vallely
- 2 Sydney Medical School The University of Sydney Camperdown Sydney NSW Australia.,3 Sydney Heart and Lung Surgeons Camperdown Sydney NSW Australia
| | - Stuart M Grieve
- 1 Sydney Translational Imaging Laboratory Heart Research Institute Charles Perkins Centre The University of Sydney Camperdown Sydney NSW Australia.,2 Sydney Medical School The University of Sydney Camperdown Sydney NSW Australia.,5 Department of Radiology Royal Prince Alfred Hospital Camperdown Sydney NSW Australia
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12
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Harada M, Motoike Y, Nomura Y, Nishimura A, Koshikawa M, Murayama K, Ohno Y, Watanabe E, Ozaki Y, Izawa H. Factors associated with silent cerebral events during atrial fibrillation ablation in patients on uninterrupted oral anticoagulation. J Cardiovasc Electrophysiol 2020; 31:2889-2897. [PMID: 32786019 DOI: 10.1111/jce.14716] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 07/29/2020] [Accepted: 08/08/2020] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Silent cerebral events (SCEs) are related to the potential thromboembolic risk in atrial fibrillation (AF) ablation. Periprocedural uninterrupted oral anticoagulation (OAC) reportedly reduced the risk of SCEs, but the incidence still remains. METHODS AND RESULTS AF patients undergoing catheter ablation were eligible. All patients took non-vitamin K antagonist oral anticoagulants (NOACs; n = 248) or vitamin K antagonist (VKA; n = 37) for periprocedural OAC (>4 weeks) without interruption during the procedure. Brain magnetic resonance imaging was performed within 2 days after the procedure to detect SCEs. Clinical characteristics and procedure-related parameters were compared between patients with and without SCEs. SCEs were detected in 66 patients (23.1%; SCE[+]) but were not detected in 219 patients (SCE[-]). Age was higher in SCE[+] than in SCE[-] (66 ± 10 vs. 62 ± 12 years; p < .05). Persistent AF prevalence, CHADS2 /CHA2 DS2 -VASc scores, serum NT-ProBNP levels, left atrial dimension (LAD), and spontaneous echo contrast prevalence in transesophageal echocardiography significantly increased in SCE[+] versus SCE[-]. SCE[+] had lower baseline activated clotting time (ACT) before heparin injection and longer time to reach optimal ACT (>300 s) than SCE[-] (146 ± 27 vs. 156 ± 29 s and 44 ± 30 vs. 35 ± 25 min; p < .05, respectively). In multivariate analysis, age, LAD, baseline ACT, and time to reach the optimal ACT were predictors for SCEs. The average values of the ACT parameters were significantly different among NOACs/VKA. CONCLUSION Age, LAD, and intraprocedural ACT kinetics significantly affect SCEs during AF ablation. Different anticoagulants have different impacts on ACT during the procedure, which should be considered when estimating the risk of SCEs.
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Affiliation(s)
- Masahide Harada
- Department of Cardiology, Fujita Health University, Toyoake, Aichi, Japan
| | - Yuji Motoike
- Department of Cardiology, Fujita Health University, Toyoake, Aichi, Japan
| | - Yoshihiro Nomura
- Department of Cardiology, Fujita Health University, Toyoake, Aichi, Japan
| | - Asuka Nishimura
- Department of Cardiology, Fujita Health University, Toyoake, Aichi, Japan
| | - Masayuki Koshikawa
- Department of Cardiology, Fujita Health University, Toyoake, Aichi, Japan
| | - Kazuhiro Murayama
- Joint Research Laboratory of Advanced Medical Imaging, Fujita Health University, Toyoake, Aichi, Japan
| | - Yoshiharu Ohno
- Joint Research Laboratory of Advanced Medical Imaging, Fujita Health University, Toyoake, Aichi, Japan
| | - Eiichi Watanabe
- Department of Cardiology, Fujita Health University, Toyoake, Aichi, Japan
| | - Yukio Ozaki
- Department of Cardiology, Fujita Health University, Toyoake, Aichi, Japan
| | - Hideo Izawa
- Department of Cardiology, Fujita Health University, Toyoake, Aichi, Japan
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13
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Harada M, Motoike Y, Nomura Y, Nishimura A, Koshikawa M, Murayama K, Ohno Y, Watanabe E, Izawa H, Ozaki Y. Comparison of effectiveness and safety between uninterrupted direct oral anticoagulants with and without switching to dabigatran in atrial fibrillation ablation. J Arrhythm 2020; 36:417-424. [PMID: 32528566 PMCID: PMC7280006 DOI: 10.1002/joa3.12333] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Revised: 02/15/2020] [Accepted: 03/01/2020] [Indexed: 11/10/2022] Open
Abstract
Introduction Recent studies have demonstrated the feasibility of uninterrupted direct oral anticoagulants (DOACs) with a temporary switch to dabigatran (“dabigatran bridge”) for atrial fibrillation (AF) ablation. We compared the effectiveness and safety between uninterrupted DOACs with and without the “dabigatran bridge” in patients taking factor Xa inhibitors. Methods AF patients on factor Xa inhibitors (rivaroxaban/apixaban/edoxaban) undergoing catheter ablation were eligible (n = 348). Brain MRI was performed within 2 days after the procedure to detect silent cerebral events (SCEs). Rivaroxaban/apixaban/edoxaban were uninterruptedly used in 153 patients (Group 1); these DOACs were switched to dabigatran on the day of AF ablation in 195 patients (Group 2). After propensity score matching, the unfractionated heparin (UFH) amount and the activated clotting time (ACT) kinetics during the procedure, the SCE incidence, and the follow‐up complications (30 days, thromboembolism and major/minor bleeding) in the two groups were compared. Results Group 2 had higher initial ACT value and shorter time to optimal ACT (>300 seconds) than Group 1 (184 ± 36 s vs 145 ± 22 s, and 34 ± 29 s vs 43 ± 34 s, P < .05, respectively). Group 2 tended to require less amount of UFH to achieve optimal ACT than Group 1, but the total amount of UFH for the procedure was comparable. Group 2 had lower SCE incidence than Group 1 (16.2% vs 26.4%, P < .05). The prevalence of follow‐up complications was unchanged between the two groups. Conclusions Switching to dabigatran on the day of AF ablation decreases preclinical thromboembolic events with similar bleeding risk to uninterrupted factor Xa inhibitors.
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Affiliation(s)
- Masahide Harada
- Department of Cardiology Fujita Health University Toyoake Japan
| | - Yuji Motoike
- Department of Cardiology Fujita Health University Toyoake Japan
| | | | - Asuka Nishimura
- Department of Cardiology Fujita Health University Toyoake Japan
| | | | - Kazuhiro Murayama
- Joint Research Laboratory of Advanced Medical Imaging Fujita Health University Toyoake Japan
| | - Yoshiharu Ohno
- Joint Research Laboratory of Advanced Medical Imaging Fujita Health University Toyoake Japan
| | - Eiichi Watanabe
- Department of Cardiology Fujita Health University Toyoake Japan
| | - Hideo Izawa
- Department of Cardiology Fujita Health University Toyoake Japan
| | - Yukio Ozaki
- Department of Cardiology Fujita Health University Toyoake Japan
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14
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Caughey MC, Qiao Y, Windham BG, Gottesman RF, Mosley TH, Wasserman BA. Carotid Intima-Media Thickness and Silent Brain Infarctions in a Biracial Cohort: The Atherosclerosis Risk in Communities (ARIC) Study. Am J Hypertens 2018; 31:869-875. [PMID: 29425278 PMCID: PMC6049000 DOI: 10.1093/ajh/hpy022] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Revised: 01/19/2018] [Accepted: 02/06/2018] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Both hypertensive and atherosclerotic processes contribute to common carotid artery intima-media thickness (CCA-IMT). Elevated CCA-IMT may be indicative of subclinical cerebrovascular disease; however, its role in the absence of concomitant carotid artery plaque is uncertain, and few studies have examined associations in Black populations. MATERIALS AND METHODS At cohort visit 3 (1993-1995) a subset of stroke-free participants (641 Blacks and 702 Whites, mean age 63) from the Atherosclerosis Risk in Communities (ARIC) study was imaged by brain MRI and carotid ultrasound. A CCA-IMT >0.9 mm was considered elevated. Asymptomatic brain lesions ≥3 mm were considered silent brain infarctions (SBI). Subcortical SBI measuring 3 to <20 mm were considered lacunes. Associations between elevated CCA-IMT and SBI were analyzed with Poisson regression. RESULTS Elevated CCA-IMT was identified in 168 participants (16% of Blacks, 10% of Whites), and SBI were observed in 156 (15% of Blacks, 8% of Whites). Elevated CCA-IMT was strongly related to anterior circulation SBI, posterior circulation SBI, and lacunes. After adjustments, elevated CCA-IMT remained associated with greater number of lacunes in Blacks ([prevalence ratio, PR] = 1.60; 95% confidence interval [CI]: 1.02-2.51), but not Whites (PR = 0.85; 95% CI: 0.35-2.04); P value for interaction = 0.12. Among Black participants without concomitant carotid plaque, elevated CCA-IMT was associated with twice the number of lacunes (PR = 2.00; 95% CI: 1.05-3.82). CONCLUSIONS In older Black adults, elevated CCA-IMT is independently associated with lipohyalinosis of the cerebral small vessels, irrespective of concomitant carotid plaque and vascular risk factors.
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Affiliation(s)
- Melissa C Caughey
- Department of Medicine, Division of Cardiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Ye Qiao
- Department of Radiology, Johns Hopkins Medicine, Baltimore, Maryland, USA
| | - Beverly Gwen Windham
- Department of Medicine, Division of Geriatrics, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | | | - Thomas H Mosley
- Department of Medicine, Division of Geriatrics, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Bruce A Wasserman
- Department of Radiology, Johns Hopkins Medicine, Baltimore, Maryland, USA
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15
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Squarzoni P, Tamashiro-Duran JH, Duran FLS, Leite CC, Wajngarten M, Scazufca M, Menezes PR, Lotufo PA, Alves TCTF, Busatto GF. High frequency of silent brain infarcts associated with cognitive deficits in an economically disadvantaged population. Clinics (Sao Paulo) 2017; 72:474-480. [PMID: 28954006 PMCID: PMC5577623 DOI: 10.6061/clinics/2017(08)04] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2017] [Accepted: 04/10/2017] [Indexed: 01/31/2023] Open
Abstract
OBJECTIVE: Using magnetic resonance imaging, we aimed to assess the presence of silent brain vascular lesions in a sample of apparently healthy elderly individuals who were recruited from an economically disadvantaged urban region (São Paulo, Brazil). We also wished to investigate whether the findings were associated with worse cognitive performance. METHODS: A sample of 250 elderly subjects (66-75 years) without dementia or neuropsychiatric disorders were recruited from predefined census sectors of an economically disadvantaged area of Sao Paulo and received structural magnetic resonance imaging scans and cognitive testing. A high proportion of individuals had very low levels of education (4 years or less, n=185; 21 with no formal education). RESULTS: The prevalence of at least one silent vascular-related cortical or subcortical lesion was 22.8% (95% confidence interval, 17.7-28.5), and the basal ganglia was the most frequently affected site (63.14% of cases). The subgroup with brain infarcts presented significantly lower levels of education than the subgroup with no brain lesions as well as significantly worse current performance in cognitive test domains, including memory and attention (p<0.002). CONCLUSIONS: Silent brain infarcts were present at a substantially high frequency in our elderly sample from an economically disadvantaged urban region and were significantly more prevalent in subjects with lower levels of education. Covert cerebrovascular disease significantly contributes to cognitive deficits, and in the absence of magnetic resonance imaging data, this cognitive impairment may be considered simply related to ageing. Emphatic attention should be paid to potentially deleterious effects of vascular brain lesions in poorly educated elderly individuals from economically disadvantaged environments.
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Affiliation(s)
- Paula Squarzoni
- Departamento de Psiquiatria, Instituto de Psiquiatria (IPQ), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Jaqueline H Tamashiro-Duran
- Departamento de Psiquiatria, Instituto de Psiquiatria (IPQ), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Fabio L S Duran
- Departamento de Psiquiatria, Instituto de Psiquiatria (IPQ), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Claudia C Leite
- Departamento de Radiologia e Oncologia, Faculdade Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Mauricio Wajngarten
- Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Marcia Scazufca
- Departamento de Psiquiatria, Instituto de Psiquiatria (IPQ), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Paulo R Menezes
- Departamento de Medicina Preventiva, Faculdade de Medicina FMUSP, Universidade of Sao Paulo, Sao Paulo, SP, BR
| | - Paulo A Lotufo
- Centro de Pesquisa Clinica e Epidemiologica, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Tania C T F Alves
- Departamento de Psiquiatria, Instituto de Psiquiatria (IPQ), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Geraldo F Busatto
- Departamento de Psiquiatria, Instituto de Psiquiatria (IPQ), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
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16
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Nakanishi K, Jin Z, Homma S, Elkind MSV, Rundek T, Tugcu A, Sacco RL, Di Tullio MR. Association of Blood Pressure Control Level With Left Ventricular Morphology and Function and With Subclinical Cerebrovascular Disease. J Am Heart Assoc 2017; 6:JAHA.117.006246. [PMID: 28757483 PMCID: PMC5586460 DOI: 10.1161/jaha.117.006246] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Background Left ventricular (LV) hypertrophy and subclinical cerebrovascular disease are early manifestations of cardiac and brain target organ damage caused by hypertension. This study aimed to investigate whether intensive office systolic blood pressure (SBP) control has beneficial effects on LV morphology and function and subclinical cerebrovascular disease in elderly patients with hypertension. Methods and Results We examined 420 patients treated for hypertension without history of heart failure and stroke from the CABL (Cardiovascular Abnormalities and Brain Lesions) study. All patients underwent 2‐dimensional echocardiographic examination and brain magnetic resonance imaging. Subclinical cerebrovascular disease was defined as silent brain infarcts and white matter hyperintensity volume. Patients were divided into 3 groups: SBP <120 mm Hg (intensive control); SBP 120 to 139 mm Hg (less intensive control); and SBP ≥140 mm Hg (uncontrolled). Prevalence of LV hypertrophy and diastolic dysfunction were lowest in the intensive control, intermediate in the less intensive control, and highest in the uncontrolled groups (12.8%, 31.8%, and 44.7%, respectively [P<0.001], for LV hypertrophy; 46.8%, 61.7%, and 72.6%, respectively [P=0.003], for diastolic dysfunction). Patients with less intensive SBP control had greater risk of LV hypertrophy than those with intensive control (adjusted odds ratio, 3.26; P=0.013). A similar trend was observed for LV diastolic dysfunction but did not reach statistical significance (adjusted odds ratio, 1.65; P=0.144). Conversely, intensive SBP control was not significantly associated with reduced risk of silent brain infarcts and white matter hyperintensity volume compared with less intensive control. Conclusions Compared with less intensive control, intensive SBP control may have a stronger beneficial effect on cardiac than cerebral subclinical disease.
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Affiliation(s)
- Koki Nakanishi
- Department of Medicine, Columbia University, New York, NY
| | - Zhezhen Jin
- Department of Biostatistics, Columbia University, New York, NY
| | - Shunichi Homma
- Department of Medicine, Columbia University, New York, NY
| | - Mitchell S V Elkind
- Departments of Neurology and Epidemiology, Columbia University, New York, NY
| | - Tatjana Rundek
- Department of Neurology, Miller School of Medicine, University of Miami, FL.,Department of Public Health Sciences, Miller School of Medicine, University of Miami, FL
| | - Aylin Tugcu
- Department of Medicine, Columbia University, New York, NY
| | - Ralph L Sacco
- Department of Neurology, Miller School of Medicine, University of Miami, FL.,Department of Public Health Sciences, Miller School of Medicine, University of Miami, FL.,Department of Human Genetics, Miller School of Medicine, University of Miami, FL
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17
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Yang K, Feng Y, Mu J, Fu N, Chen S, Fu Y. The Presence of Previous Cerebral Microbleeds Has a Negative Effect on Hypertensive Intracerebral Hemorrhage Recovery. Front Aging Neurosci 2017; 9:49. [PMID: 28326034 PMCID: PMC5339337 DOI: 10.3389/fnagi.2017.00049] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2016] [Accepted: 02/20/2017] [Indexed: 11/13/2022] Open
Abstract
Background and Purpose: Cerebral microbleeds are an intracerebral microangiopathy with bleeding tendency found in intracerebral hemorrhage patients. However, studies about cerebral microbleed effects on the prognosis of hypertensive intracerebral hemorrhage patients are rare. We performed a prospective study to discuss not only the risk factors of cerebral microbleed incidence in hypertensive intracerebral hemorrhage patients but also the relevance of cerebral microbleeds with silent brain infarction, hemorrhage and prognosis. Methods: This study enrolled 100 patients diagnosed with hypertensive intracerebral hemorrhage within 3 days after onset. Magnetic resonance imaging including susceptibility-weighted imaging and diffusion-weighted imaging (DWI) were utilized to examine patients on the fifth day after onset. Regular follow-ups were performed to examine the following clinical cerebrovascular events and vascular deaths in 1 year. Results: Cerebral microbleeds were observed in 55 (55%) patients. Multiple logistic regression analysis showed that over-aging, elevation of serum creatinine, and leukoaraiosis were independently associated with cerebral microbleeds. In addition, higher silent brain infarction prevalence was observed in patients with cerebral microbleeds. In contrast, none of the cerebral microbleed patients exhibited cerebral microbleeds ≥5, which is an independent risk factor of poor 3-month neurological function recovery. During the 1-year follow-up, 14 subjects presented clinical cerebrovascular events or vascular death. The Cox proportional hazards model implicated that atrial fibrillation, cerebral microbleeds ≥5 and silent brain infarction were independent predictive factors for these events. Conclusions: Over-aging combined with an elevation of serum creatinine and leukoaraiosis were independent risk factors of cerebral microbleeds. Patients with cerebral microbleeds were more likely to exhibit silent brain infarction. Poor recovery of 3-month neurological function was observed in hypertensive intracerebral hemorrhage patients with cerebral microbleeds ≥5. Cerebral microbleeds ≥5 or silent brain infarction might also indicate an elevated risk of future cerebrovascular events and vascular death.
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Affiliation(s)
- Kang Yang
- Department of Neurology and Institute of Neurology, Rui Jin Hospital, School of Medicine, Shanghai Jiao Tong University Shanghai, China
| | - Yulan Feng
- Department of Neurology, Min Hang Hospital, Fudan University Shanghai, China
| | - JinJin Mu
- Department of Neurology and Institute of Neurology, Rui Jin Hospital, School of Medicine, Shanghai Jiao Tong University Shanghai, China
| | - Ningzhen Fu
- School of Medicine, Shanghai Jiao Tong University Shanghai, China
| | - Shufen Chen
- Department of Neurology and Institute of Neurology, Rui Jin Hospital, School of Medicine, Shanghai Jiao Tong University Shanghai, China
| | - Yi Fu
- Department of Neurology and Institute of Neurology, Rui Jin Hospital, School of Medicine, Shanghai Jiao Tong University Shanghai, China
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18
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Finn C, Giambrone AE, Gialdini G, Delgado D, Baradaran H, Kamel H, Gupta A. The Association between Carotid Artery Atherosclerosis and Silent Brain Infarction: A Systematic Review and Meta-analysis. J Stroke Cerebrovasc Dis 2017; 26:1594-1601. [PMID: 28318958 DOI: 10.1016/j.jstrokecerebrovasdis.2017.02.028] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2016] [Revised: 02/03/2017] [Accepted: 02/20/2017] [Indexed: 10/19/2022] Open
Abstract
BACKGROUND Carotid atherosclerosis is responsible for ~20% of ischemic strokes, but it is unclear whether carotid disease is associated with the presence of downstream silent brain infarction (SBI). We performed a systematic review and meta-analysis to study the relationship between SBI and 2 separate manifestations of carotid atherosclerosis, carotid intima-media thickening (IMT) and luminal stenosis. METHODS Ovid MEDLINE, Ovid Embase, and the Cochrane Library Database were searched with an additional search of references and citing articles of target studies. Articles were included if they reported an association between carotid IMT or stenosis and magnetic resonance imaging-defined SBI, excluding SBIs found after carotid intervention. RESULTS We pooled 7 studies of carotid IMT reporting on 1469 subjects with SBI and 5102 subjects without SBI. Subjects with SBI had a larger mean IMT than subjects without SBI (pooled standardized mean difference, .37; 95% confidence interval [CI], .23-.51; P < .0001). We pooled 11 studies of carotid stenosis reporting on 12,347 subjects (2110 subjects with carotid stenosis and 10,237 subjects without carotid stenosis). We found a higher prevalence of SBI among subjects with carotid stenosis (30.4% versus 17.4%). Our pooled random-effects analysis showed a significant positive relationship between carotid stenosis and SBI (odds ratio, 2.78; 95% CI, 2.19-3.52; P < .0001). CONCLUSIONS Two forms of atherosclerotic disease, carotid IMT and stenosis, are both significantly associated with SBI. This review highlights a lack of consistent definitions for carotid disease measures and little evidence evaluating SBI prevalence downstream from carotid stenosis.
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Affiliation(s)
- Caitlin Finn
- Department of Radiology, Weill Cornell Medical College (WCMC), New York, New York
| | | | - Gino Gialdini
- Feil Family Brain and Mind Research Institute, WCMC, New York, New York
| | - Diana Delgado
- Samuel J. Wood Library and C.V. Starr Biomedical Information Center, WCMC, New York, New York
| | - Hediyeh Baradaran
- Department of Radiology, Weill Cornell Medical College (WCMC), New York, New York
| | - Hooman Kamel
- Feil Family Brain and Mind Research Institute, WCMC, New York, New York; Department of Neurology, WCMC, New York, New York
| | - Ajay Gupta
- Department of Radiology, Weill Cornell Medical College (WCMC), New York, New York; Feil Family Brain and Mind Research Institute, WCMC, New York, New York.
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19
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Laible M, Möhlenbruch M, Horstmann S, Pfaff J, Geis NA, Pleger S, Schüler S, Rizos T, Bendszus M, Veltkamp R. Peri-procedural silent cerebral infarcts after left atrial appendage occlusion. Eur J Neurol 2016; 24:53-57. [PMID: 27647674 DOI: 10.1111/ene.13129] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2016] [Accepted: 08/09/2016] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND PURPOSE To determine the rate of peri-interventional silent brain infarcts after left atrial appendage occlusion (LAAO). METHODS In this prospective, uncontrolled single-center pilot study, consecutive patients with atrial fibrillation undergoing LAAO between July 2013 and January 2016 were included. The Amplatzer Cardiac Plug, WATCHMAN or Amulet device was used. A neurological examination and cranial magnetic resonance imaging (MRI) were performed within 48 h before and after the procedure. MRI was evaluated for new diffusion-weighted imaging (DWI) hyperintensities, cerebral microbleeds (CMBs) and white-matter lesions (WMLs). RESULTS Left atrial appendage occlusion was performed in 21 patients (mean age, 73.2 ± 9.5 years). Main reasons for LAAO were previous intracerebral hemorrhage (n = 11) and major systemic bleeding (n = 6). No clinically overt stroke occurred peri-interventionally. After the intervention, one patient had a small cerebellar hyperintensity on DWI (4.8%; 95% confidence interval, 0.0-14.3) that was not present on the MRI 1 day before the procedure. Among 11 patients with available MRI just before LAAO, there were no significant changes in the number of CMBs and the severity of WMLs after LAAO. CONCLUSIONS This study of peri-interventional MRI in LAAO suggests a low rate of silent peri-procedural infarcts in this elderly population. Confirmation in larger studies is needed.
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Affiliation(s)
- M Laible
- Department of Neurology, Heidelberg University Hospital, Heidelberg, Germany
| | - M Möhlenbruch
- Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany
| | - S Horstmann
- Department of Neurology, Heidelberg University Hospital, Heidelberg, Germany
| | - J Pfaff
- Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany
| | - N A Geis
- Department of Internal Medicine III, Heidelberg University Hospital, Heidelberg, Germany
| | - S Pleger
- Department of Internal Medicine III, Heidelberg University Hospital, Heidelberg, Germany
| | - S Schüler
- Institute of Medical Biometry and Informatics, University of Heidelberg, Heidelberg, Germany
| | - T Rizos
- Department of Neurology, Heidelberg University Hospital, Heidelberg, Germany
| | - M Bendszus
- Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany
| | - R Veltkamp
- Department of Neurology, Heidelberg University Hospital, Heidelberg, Germany.,Department of Stroke Medicine, Imperial College London, London, UK
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20
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Affiliation(s)
- Lin Cao
- North Carolina School of Science and Mathematics, Durham, NC (L.C.)
| | - Sean D Pokorney
- Duke Clinical Research Institute, Duke University Medical Center, Durham, NC (S.D.P., K.N.) Duke University School of Medicine, Durham, NC (S.D.P., K.H., K.W.B., K.N.)
| | - Kathleen Hayden
- Duke University School of Medicine, Durham, NC (S.D.P., K.H., K.W.B., K.N.)
| | | | - L Kristin Newby
- Duke Clinical Research Institute, Duke University Medical Center, Durham, NC (S.D.P., K.N.) Duke University School of Medicine, Durham, NC (S.D.P., K.H., K.W.B., K.N.)
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21
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Abstract
The association between cerebral small vessel disease (SVD) - in the form of white matter lesions, infarctions, and hemorrhages - with vascular cognitive impairment (VCI), has mostly been deduced from observational studies. Pathological conditions affecting the small vessels of the brain and leading to SVD have suggested plausible molecular mechanisms involved in vascular damage and their impact on brain function. However, much still needs to be clarified in understanding the pathophysiology of VCI, the role of neurodegenerative processes such as Alzheimer's disease, and the impact of aging itself. In addition, both genetic predispositions and environmental exposures may potentiate the development of SVD and interact with normal aging to impact cognitive function and require further study. Advances in technology, in the analysis of genetic and epigenetic data, neuroimaging such as magnetic resonance imaging, and new biomarkers will help to clarify the complex factors leading to SVD and the expression of VCI.
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Affiliation(s)
- Fred Rincon
- Department of Neurology, Thomas Jefferson University Philadelphia, PA, USA
| | - Clinton B Wright
- Department of Neurosurgery, Thomas Jefferson University Philadelphia, PA, USA ; Evelyn F. McKnight Brain Institute, Department of Neurology, University of Miami Miami, FL, USA ; Department of Epidemiology and Public Health, University of Miami Miami, FL, USA ; Neuroscience Program, University of Miami Miami, FL, USA
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22
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Koton S, Tsabari R, Molshazki N, Kushnir M, Shaien R, Eilam A, Tanne D. Burden and outcome of prevalent ischemic brain disease in a national acute stroke registry. Stroke 2013; 44:3293-7. [PMID: 24065711 DOI: 10.1161/strokeaha.113.002174] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Previous overt stroke and subclinical stroke are frequent in patients with stroke; yet, their clinical significance and effects on stroke outcome are not clear. We studied the burden and outcome after acute ischemic stroke by prevalent ischemic brain disease in a national registry of hospitalized patients with acute stroke. METHODS Patients with ischemic stroke in the National Acute Stroke Israeli prospective hospital-based registry (February to March 2004, March to April 2007, and April to May 2010) with information on previous overt stroke and subclinical stroke per computed tomography/MRI (n=3757) were included. Of them, a subsample (n=787) was followed up at 3 months. Logistic regression models were computed for outcomes in patients with prior overt stroke or subclinical stroke, compared with patients with first stroke, adjusting for age, sex, vascular risk factors, stroke severity, and clinical classification. RESULTS Two-thirds of patients had a prior overt stroke or subclinical stroke. Death rates were similar for patients with and without prior stroke. Adjusted odds ratios (OR; 95% confidence interval [CI]) for disability were increased for patients with prior overt stroke (OR, 1.31; 95% CI, 1.03-1.66) and subclinical stroke (OR, 1.45; 95% CI, 1.16-1.82). Relative odds of Barthel Index≤60 for patients with prior overt stroke (OR, 2.04; 95% CI, 1.14-3.68) and with prior subclinical stroke (OR, 2.04; 95% CI, 1.15-3.64) were twice higher than for patients with a first stroke. ORs for dependency were significantly increased for patients with prior overt stroke (OR, 1.95; 95% CI, 1.19-3.20) but not for those with subclinical stroke (OR, 1.36; 95% CI, 0.84-2.19). CONCLUSIONS In our national cohort of patients with acute ischemic stroke, nearly two thirds had a prior overt stroke or subclinical stroke. Risk of poor functional outcomes was increased for patients with prior stroke, both overt and subclinical.
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Affiliation(s)
- Silvia Koton
- From the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel (S.K., D.T.); Department of Neurology, Chaim Sheba Medical Center, Tel-Hashomer, Israel (R.T., N.M., D.T.); Department of Neurology, Kaplan Medical Center, Rechovot, Israel (M.K., A.E.); and Department of Neurology, Rivka Ziv Medical Center, Zefat, Israel (R.S.)
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23
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Abstract
With the increasing size of the elderly population and evolving imaging technology, silent brain infarction (SBI) has garnered attention from both the public and the physicians. Over 20% of the elderly exhibit SBI, and the prevalence of SBI increases steadily with age, ie, 30%–40% in those older than 70 years. Well-known cardiovascular risk factors such as hypertension has been identified as a risk factor of SBI (odds ratio [OR] = 3.47) Besides this, blood pressure (BP) reactivity to mental stress, morning BP surges, and orthostatic BP changes have been demonstrated to contribute to the presence of SBI. Further, a metabolic syndrome not only as a whole syndrome (OR =2.18) but also as individual components could have an influence on SBI. Increased C-reactive protein and interleukin-6, coronary artery disease, body mass index, and alcohol consumption have also been associated with SBI. The ORs and possible mechanisms have been discussed in this article. Overt stroke, dementia, depression, and aspiration pneumonia were all associated with SBI. (overt stroke: hazard ratio [HR] =1.9, 95% confidence interval [CI]: 1.2–2.8; dementia: HR =2.26, 95% CI: 1.09–4.70). We also looked into their close relationship with SBI in this review.
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Affiliation(s)
- Jae-Sung Lim
- Department of Neurology, Armed Forces Seoul Hospital, Seoul, Republic of Korea
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24
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Han IB, Kim OJ, Ahn JY, Oh D, Hong SP, Huh R, Chung SS, Kim NK. Association of methylenetetrahydrofolate reductase (MTHFR 677C>T and 1298A>C) polymorphisms and haplotypes with silent brain infarction and homocysteine levels in a Korean population. Yonsei Med J 2010; 51:253-60. [PMID: 20191019 PMCID: PMC2824873 DOI: 10.3349/ymj.2010.51.2.253] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2009] [Revised: 06/08/2009] [Accepted: 07/01/2009] [Indexed: 01/08/2023] Open
Abstract
PURPOSE Methylenetetrahydrofolate reductase (MTHFR) is the main regulatory enzyme for homocysteine metabolism. In the present study, we evaluated whether the MTHFR 677C>T and 1298A>C gene polymorphisms are associated with SBI and plasma homocysteine concentration in a Korean population. MATERIALS AND METHODS We enrolled 264 patients with SBI and 234 healthy controls in South Korea. Fasting plasma total homocysteine (tHcy) concentrations were measured, and genotype analysis of the MTHFR gene was carried out. RESULTS The plasma tHcy levels were significantly higher in patients with SBI than in healthy controls. Despite a significant association between the MTHFR 677TT genotype and hyperhomocysteinemia, the MTHFR 677C>T genotypes did not appear to influence susceptibility to SBI. However, odds ratios of the 1298AC and 1298AC + CC genotypes for the 1298AA genotype were significantly different between SBI patients and normal controls. The frequencies of 677C-1298A and 677C-1298C haplotypes were significantly higher in the SBI group than in the control group. CONCLUSION This study demonstrates that the MTHFR 1298A>C polymorphism is a risk factor for SBI in a Korean population. The genotypes of 677C>T and 1298A>C polymorphisms interact additively, and increase the risk of SBI in Korean subjects.
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Affiliation(s)
- In Bo Han
- Department of Neurosurgery, School of Medicine, CHA University, Seongnam, Korea
- Institute for Clinical Research, School of Medicine, CHA University, Seongnam, Korea
| | - Ok Joon Kim
- Department of Neurology, School of Medicine, CHA University, Seongnam, Korea
| | - Jung Yong Ahn
- Department of Neurosurgery, Yonsei University College of Medicine, Seoul, Korea
| | - Doyeun Oh
- Institute for Clinical Research, School of Medicine, CHA University, Seongnam, Korea
| | | | - Ryoong Huh
- Department of Neurosurgery, School of Medicine, CHA University, Seongnam, Korea
| | - Sang Sup Chung
- Department of Neurosurgery, School of Medicine, CHA University, Seongnam, Korea
| | - Nam Keun Kim
- Institute for Clinical Research, School of Medicine, CHA University, Seongnam, Korea
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