1
|
Nam KW, Kim CK, Yu S, Oh K, Chung JW, Oh YB, Kim GM, Jung JM, Song TJ, Kim YJ, Kim BJ, Heo SH, Park KY, Kim JM, Park JH, Choi JC, Park MS, Kim JT, Choi KH, Hwang YH, Seo WK. Corrigendum to "D-dimer to fibrinogen ratio predicts early neurological deterioration in ischemic stroke with atrial fibrillation" [Thromb. Res. 229 (2023) 219-224]. Thromb Res 2024; 233:173. [PMID: 38070220 DOI: 10.1016/j.thromres.2023.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2024]
Affiliation(s)
- Ki-Woong Nam
- Department of Neurology, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, South Korea
| | - Chi Kyung Kim
- Department of Neurology, Korea University Guro Hospital, Korea University College of Medicine, Seoul, South Korea.
| | - Sungwook Yu
- Department of Neurology, Korea University Anam Hospital, Korea University College of Medicine, Seoul, South Korea
| | - Kyungmi Oh
- Department of Neurology, Korea University Guro Hospital, Korea University College of Medicine, Seoul, South Korea
| | - Jong-Won Chung
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Young Bang Oh
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Gyeong-Moon Kim
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Jin-Man Jung
- Department of Neurology, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, South Korea
| | - Tae-Jin Song
- Department of Neurology, Ewha Womans University, School of Medicine, Seoul, South Korea
| | - Yong-Jae Kim
- Department of Neurology, the Catholic University of Korea, Seoul, South Korea
| | - Bum Joon Kim
- Department of Neurology, Asan Medical Center, Seoul, South Korea
| | - Sung Hyuk Heo
- Department of Neurology, Kyung Hee University College of Medicine, Seoul, South Korea
| | - Kwang-Yeol Park
- Department of Neurology, Chung-Ang University College of Medicine, Chung-Ang University Hospital, Seoul, South Korea
| | - Jeong-Min Kim
- Department of Neurology, Seoul National University Hospital, Seoul, South Korea
| | - Jong-Ho Park
- Department of Neurology, Myongji Hospital, Hanyang University College of medicine, Seoul, South Korea
| | - Jay Chol Choi
- Department of Neurology, Jeju National University, Jeju, South Korea
| | - Man-Seok Park
- Department of Neurology, Chonnam National University Hospital, Chonnam, South Korea
| | - Joon-Tae Kim
- Department of Neurology, Chonnam National University Hospital, Chonnam, South Korea
| | - Kang-Ho Choi
- Department of Neurology, Chonnam National University Hospital, Chonnam, South Korea
| | - Yang Ha Hwang
- Department of Neurology, Kyungpook National University Hospital, Dae-gu, South Korea
| | - Woo-Keun Seo
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea; Department of Digital Health, SHAIST, Sungkyunkwan University, Seoul, South Korea
| |
Collapse
|
2
|
Park S, Ha SH, Song B, Woo HG, Heo SH, Chang DI. An interesting case of crossed syndrome: ipsilateral facial paralysis with contralateral glossoplegia. BMC Neurol 2023; 23:370. [PMID: 37848830 PMCID: PMC10580508 DOI: 10.1186/s12883-023-03363-8] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2023] [Accepted: 08/17/2023] [Indexed: 10/19/2023] Open
Abstract
BACKGROUND Stroke is rarely accompanied with peripheral facial paralysis and supranuclear palsy of the hypoglossal nerve. Both sides of the motor cortex innervate the hypoglossal nucleus; therefore, unilateral lesions of the upper motor neurons rarely result in contralateral lingual paresis. We report a rare case of crossed syndrome with associated hyperacute peripheral hemifacial paralysis and contralateral lingual paresis after a lower pontine tegmentum ischemic stroke. CASE PRESENTATION A 73-year-old man presented with symptoms of hyperacute peripheral hemifacial paralysis. Upon protrusion, the patient's tongue deviated to the contralateral side, without fasciculation or atrophy. Brain imaging showed focal ischemic stroke in the pontine tegmentum. However, lingual hemiparesis and multimodal neuroimaging findings differed. CONCLUSIONS We suggest that cortico-hypoglossal fibers pass through the dorsal pontine. This case of crossed syndrome is a rare report of a lower pontine tegmentum ischemic stroke resembling an upper motor neuron lesion of the contralateral hypoglossal nerve.
Collapse
Affiliation(s)
- Sangil Park
- Department of Neurology, Kyung Hee University Hospital, #23 Kyunghee-daero, Dongdaemun-gu, Seoul, 02447, Republic of Korea
| | - Su Hyeon Ha
- Department of Neurology, Kyung Hee University Hospital, #23 Kyunghee-daero, Dongdaemun-gu, Seoul, 02447, Republic of Korea
| | - Baeseoup Song
- Department of Neurology, Kyung Hee University Hospital, #23 Kyunghee-daero, Dongdaemun-gu, Seoul, 02447, Republic of Korea
| | - Ho Geol Woo
- Department of Neurology, Kyung Hee University Hospital, #23 Kyunghee-daero, Dongdaemun-gu, Seoul, 02447, Republic of Korea
| | - Sung Hyuk Heo
- Department of Neurology, Kyung Hee University Hospital, #23 Kyunghee-daero, Dongdaemun-gu, Seoul, 02447, Republic of Korea
| | - Dae-Il Chang
- Department of Neurology, Kyung Hee University Hospital, #23 Kyunghee-daero, Dongdaemun-gu, Seoul, 02447, Republic of Korea.
| |
Collapse
|
3
|
Chung D, Song TJ, Kim BJ, Heo SH, Jung JM, Oh K, Kim CK, Yu S, Park KY, Kim JM, Park JH, Park MS, Kim JT, Hwang YH, Kim YJ, Chung JW, Bang OY, Kim GM, Seo WK, Choi JC. Stroke-Specific Predictors of Major Bleeding in Anticoagulated Patients With Stroke and Atrial Fibrillation: A Nationwide Multicenter Registry-Based Study. J Clin Neurol 2023; 19:429-437. [PMID: 37455504 PMCID: PMC10471546 DOI: 10.3988/jcn.2022.0289] [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: 08/07/2022] [Revised: 12/26/2022] [Accepted: 12/30/2022] [Indexed: 07/18/2023] Open
Abstract
BACKGROUND AND PURPOSE The congestive heart failure, hypertension, age, diabetes, previous stroke/transient ischemic attack (CHA2DS2-VASc) and hypertension, abnormal renal/liver function, stroke, bleeding history or predisposition, labile international normalized ratio, elderly, drugs/alcohol (HAS-BLED) scores have been validated in estimating the risks of ischemic stroke and major bleeding, respectively, in patients with atrial fibrillation (AF). This study investigated stroke-specific predictors of major bleeding in patients with stroke and AF who were taking oral anticoagulants (OACs). METHODS Subjects were selected from patients enrolled in the Korean ATrial fibrillaTion EvaluatioN regisTry in Ischemic strOke patieNts (K-ATTENTION) nationwide multicenter registry between 2013 and 2015. Patients were excluded if they were not taking OACs, had no brain imaging data, or had intracranial bleeding directly related to the index stroke. Major bleeding was defined according to International Society of Thrombosis and Haemostasis criteria. Cox regression analyses were performed to assess the associations between clinical variables and major bleeding and Kaplan-Meier estimates were performed to analyze event-free survival. RESULTS Of a total of 3,213 patients, 1,414 subjects (mean age of 72.6 years, 52.5% males) were enrolled in this study. Major bleeding was reported in 34 patients during the median follow-up period of 1.73 years. Multivariable analysis demonstrated that initial National Institutes of Health Stroke Scale scores (hazard ratio [HR] 1.07, p=0.006), hypertension (HR 3.18, p=0.030), persistent AF type (HR 2.51, p=0.016), and initial hemoglobin level (HR 0.74, p=0.001) were independently associated with major bleeding risk. Except for hypertension, these associations remained significant after adjusting for the HAS-BLED score. Intracranial atherosclerosis presented a trend of association without statistical significance (HR 2.21, p=0.050). CONCLUSIONS This study found that major bleeding risk was independently associated with stroke-specific factors in anticoagulated patients with stroke and AF. This has the clinical implication that baseline characteristics of patients with stroke and AF should be considered in secondary prevention, which would bring the net clinical benefit of balancing recurrent stroke prevention with minimal bleeding complications.
Collapse
Affiliation(s)
- Darda Chung
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Tae-Jin Song
- Department of Neurology, Ewha Womans University Seoul Hospital, Ewha Womans University College of Medicine, Seoul, Korea
| | - Bum Joon Kim
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Sung Hyuk Heo
- Department of Neurology, Kyung Hee University College of Medicine, Seoul, Korea
| | - Jin-Man Jung
- Department of Neurology, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, Korea
| | - Kyungmi Oh
- Department of Neurology, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Chi Kyung Kim
- Department of Neurology, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Sungwook Yu
- Department of Neurology, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea
| | - Kwang Yeol Park
- Department of Neurology, Chung-Ang University College of Medicine, Seoul, Korea
| | - Jeong-Min Kim
- Department of Neurology, Seoul National University Hospital, Seoul, Korea
| | - Jong-Ho Park
- Department of Neurology, Myongji Hospital, Hanyang University College of Medicine, Goyang, Korea
| | - Man-Seok Park
- Department of Neurology, Chonnam National University Hospital, Gwangju, Korea
| | - Joon-Tae Kim
- Department of Neurology, Chonnam National University Hospital, Gwangju, Korea
| | - Yang-Ha Hwang
- Department of Neurology, Kyungpook National University Hospital, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Yong-Jae Kim
- Department of Neurology, Eunpyeong St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea
| | - Jong-Won Chung
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Oh Young Bang
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Gyeong-Moon Kim
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Woo-Keun Seo
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
| | - Jay Chol Choi
- Department of Neurology, Jeju National University Hospital, Jeju, Korea.
| |
Collapse
|
4
|
Nam KW, Kim CK, Yu S, Oh K, Chung JW, Bang OY, Kim GM, Jung JM, Song TJ, Kim YJ, Kim BJ, Heo SH, Park KY, Kim JM, Park JH, Choi JC, Park MS, Kim JT, Choi KH, Hwang YH, Seo WK. D-dimer to fibrinogen ratio predicts early neurological deterioration in ischemic stroke with atrial fibrillation. Thromb Res 2023; 229:219-224. [PMID: 37562164 DOI: 10.1016/j.thromres.2023.07.014] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 07/19/2023] [Accepted: 07/28/2023] [Indexed: 08/12/2023]
Abstract
INTRODUCTION The D-dimer to fibrinogen ratio (DFR) is a good indicator of clot-producing activity in thrombotic disease, but its clinical usefulness in stroke patients with nonvalvular atrial fibrillation (NVAF) has not been studied. We evaluated the association between the DFR and early neurological deterioration (END) in acute ischemic stroke (AIS) patients with NVAF. METHODS We included consecutive AIS patients with NVAF between 2013 and 2015 from the registry of a real-world prospective cohort from 11 large centers in South Korea. END was defined as an increase ≥2 in the total NIHSS score or ≥ 1 in the motor NIHSS score within the first 72 h of admission. The DFR was calculated as follows: DFR = D-dimer (mg/L)/fibrinogen (mg/dL) x 100. RESULTS A total of 1018 AIS patients with NVAF were evaluated. In multivariable logistic regression analysis, the highest DFR tertile was closely associated with END (adjusted odds ratio [aOR] = 2.14, 95 % confidence interval [CI]: 1.24-3.69). Hypertension (aOR = 1.71, 95 % CI: 1.09-2.70), initial NIHSS score (aOR = 1.05, 95 % CI: 1.02-1.07) and use of anticoagulants (aOR = 0.41, 95 % CI: 0.28-0.60) were also correlated with END. In addition to END, the DFR was correlated with discharge NIHSS and modified Rankin Scale (mRS) scores and the 3-month mRS score. CONCLUSIONS High DFR values were associated with END in AIS patients with NVAF. As the DFR is an indicator directly related to the main pathological mechanism of NVAF patients (fibrinolysis and coagulation), it may be useful in predicting their prognosis.
Collapse
Affiliation(s)
- Ki-Woong Nam
- Department of Neurology, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, South Korea
| | - Chi Kyung Kim
- Department of Neurology, Korea University Guro Hospital, Korea University College of Medicine, Seoul, South Korea.
| | - Sungwook Yu
- Department of Neurology, Korea University Anam Hospital, Korea University College of Medicine, Seoul, South Korea
| | - Kyungmi Oh
- Department of Neurology, Korea University Guro Hospital, Korea University College of Medicine, Seoul, South Korea
| | - Jong-Won Chung
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Oh Young Bang
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Gyeong-Moon Kim
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Jin-Man Jung
- Department of Neurology, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, South Korea
| | - Tae-Jin Song
- Department of Neurology, Ewha Womans University, School of Medicine, Seoul, South Korea
| | - Yong-Jae Kim
- Department of Neurology, the Catholic University of Korea, Seoul, South Korea
| | - Bum Joon Kim
- Department of Neurology, Asan Medical Center, Seoul, South Korea
| | - Sung Hyuk Heo
- Department of Neurology, Kyung Hee University College of Medicine, Seoul, South Korea
| | - Kwang-Yeol Park
- Department of Neurology, Chung-Ang University College of Medicine, Chung-Ang University Hospital, Seoul, South Korea
| | - Jeong-Min Kim
- Department of Neurology, Seoul National University Hospital, Seoul, South Korea
| | - Jong-Ho Park
- Department of Neurology, Myongji Hospital, Hanyang University College of medicine, Seoul, South Korea
| | - Jay Chol Choi
- Department of Neurology, Jeju National University, Jeju, South Korea
| | - Man-Seok Park
- Department of Neurology, Chonnam National University Hospital, Chonnam, South Korea
| | - Joon-Tae Kim
- Department of Neurology, Chonnam National University Hospital, Chonnam, South Korea
| | - Kang-Ho Choi
- Department of Neurology, Chonnam National University Hospital, Chonnam, South Korea
| | - Yang Ha Hwang
- Department of Neurology, Kyungpook National University Hospital, Dae-gu, South Korea
| | - Woo-Keun Seo
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea; Departement of Digital Health, SHAIST, Sungkyunkwan University, Seoul, South Korea
| |
Collapse
|
5
|
Woo HG, Kim HG, Lee KM, Ha SH, Jo H, Heo SH, Chang DI, Kim BJ. Blood viscosity associated with stroke mechanism and early neurological deterioration in middle cerebral artery atherosclerosis. Sci Rep 2023; 13:9384. [PMID: 37296267 PMCID: PMC10256783 DOI: 10.1038/s41598-023-36633-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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: 02/18/2023] [Accepted: 06/07/2023] [Indexed: 06/12/2023] Open
Abstract
Blood viscosity may affect the mechanisms of stroke and early neurological deterioration (END). We aimed to investigate the relationship between blood viscosity, stroke mechanisms, and END in patients with middle cerebral artery (MCA) infarction. Patients with symptomatic MCA atherosclerosis (≥ 50% stenosis) were recruited. Blood viscosity was compared across patients with different mechanisms of symptomatic MCA disease: in situ thrombo-occlusion (sMCA-IST), artery-to-artery embolism (sMCA-AAE), and local branch occlusion (sMCA-LBO). END was defined as four points increase in the National Institutes of Health Stroke Scale score from baseline during the first week. The association between blood viscosity and END was also evaluated. A total of 360 patients (76 with sMCA-IST, 216 with sMCA-AAE, and 68 with sMCA-LBO) were investigated. Blood viscosity was highest in patients with sMCA-IST, followed by sMCA-AAE and sMCA-LBO (P < 0.001). Blood viscosity was associated with END in patients with MCA disease. Low shear viscosity was associated with END in patients with sMCA- LBO (adjusted odds ratio, aOR 1.524; 95% confidence interval, CI 1.035-2.246), sMCA- IST (aOR 1.365; 95% CI 1.013-1.839), and sMCA- AAE (aOR 1.285; 95% CI 1.010-1.634). Blood viscosity was related to END in patients with stroke caused by MCA disease.
Collapse
Affiliation(s)
- Ho Geol Woo
- Department of Neurology, Kyung Hee University College of Medicine, Kyung Hee University Hospital, Seoul, Korea
| | - Hyug-Gi Kim
- Department of Radiology, Kyung Hee University College of Medicine, Kyung Hee University Hospital, Seoul, Korea
| | - Kyung Mi Lee
- Department of Radiology, Kyung Hee University College of Medicine, Kyung Hee University Hospital, Seoul, Korea
| | - Sang Hee Ha
- Department of Neurology, Gil Medical Center, Gachon University, Incheon, Korea
| | - HangJin Jo
- Department of Mechanical Engineering and Division of Advanced Nuclear Engineering, POSTECH, Pohang, Gyeongbuk, Korea
| | - Sung Hyuk Heo
- Department of Neurology, Kyung Hee University College of Medicine, Kyung Hee University Hospital, Seoul, Korea
| | - Dae-Il Chang
- Department of Neurology, Kyung Hee University College of Medicine, Kyung Hee University Hospital, Seoul, Korea
| | - Bum Joon Kim
- Department of Neurology, Asan Medical Center, University of Ulsan, College of Medicine, Song-Pa, PO Box 145, Seoul, 138-600, Korea.
| |
Collapse
|
6
|
Hong KS, Bang OY, Park JH, Jung JM, Lee SH, Song TJ, Nam HS, Park HK, Jung KH, Heo SH, Koo J, Yu KH, Park KY, Kim CK, Park HK, Lee J, Lee J, Seo WK. Moderate-Intensity Rosuvastatin Plus Ezetimibe Versus High-Intensity Rosuvastatin for Target Low-Density Lipoprotein Cholesterol Goal Achievement in Patients With Recent Ischemic Stroke: A Randomized Controlled Trial. J Stroke 2023:jos.2022.02957. [PMID: 37032475 DOI: 10.5853/jos.2022.02957] [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] [Received: 09/15/2022] [Accepted: 02/14/2023] [Indexed: 04/11/2023] Open
Abstract
Background and Purpose Moderate-intensity statin plus ezetimibe versus high-intensity statin alone may provide a greater low-density lipoprotein cholesterol (LDL-C) reduction in patients with recent ischemic stroke. Methods This randomized, open-label, controlled trial assigned patients with recent ischemic stroke <90 days to rosuvastatin/ezetimibe 10/10 mg once daily (ROS10/EZT10) or to rosuvastatin 20 mg once daily (ROS20). The primary endpoint was LDL-C reduction ≥50% from baseline at 90 days. Key secondary endpoints were LDL-C <70 mg/dL and multiple lipid goal achievement, and composite of major vascular events. Results Of 584 randomized, 530 were included in the modified intention-to-treat analysis. The baseline LDL-C level was 130.2±34.7 mg/dL in the ROS10/EZT10 group and 131.0±33.9 mg/dL in the ROS20 group. The primary endpoint was achieved in 198 patients (72.5%) in the ROS10/EZT10 group and 148 (57.6%) in the ROS20 group (odds ratio [95% confidence interval], 1.944 [1.352-2.795]; P= 0.0003). LDL-C level <70 mg/dL was achieved in 80.2% and 65.4% in the ROS10/EZT10 and ROS20 groups (P=0.0001). Multiple lipid goal achievement rate was 71.1% and 53.7% in the ROS10/EZT10 and ROS20 groups (P<0.0001). Major vascular events occurred in 1 patient in the ROS10/EZT10 group and 9 in the ROS20 group (P=0.0091). The adverse event rates did not differ between the two groups. Conclusion Moderate-intensity rosuvastatin plus ezetimibe was superior to high-intensity rosuvastatin alone for intensive LDL-C reduction in patients with recent ischemic stroke. With the combination therapy, more than 70% of patients achieved LDL-C reduction ≥50% and 80% had an LDL-C <70 mg/dL at 90 days.
Collapse
Affiliation(s)
- Keun-Sik Hong
- Department of Neurology, Ilsan Paik Hospital, Inje University, Goyang, Korea
| | - Oh Young Bang
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jong-Ho Park
- Department of Neurology, Myongji Hospital, Hanyang University College of Medicine, Goyang, Korea
| | - Jin-Man Jung
- Department of Neurology, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, Korea
| | - Sang-Hun Lee
- Department of Neurology, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, Korea
| | - Tae-Jin Song
- Department of Neurology, Seoul Hospital, Ewha Women's University College of Medicine, Seoul, Korea
| | - Hyo Suk Nam
- Department of Neurology, Yonsei University College of Medicine, Seoul, Korea
| | - Hee-Kwon Park
- Department of Neurology, Inha University Hospital, Incheon, Korea
| | - Keun-Hwa Jung
- Department of Neurology, Seoul National University College of Medicine, Seoul, Korea
| | - Sung Hyuk Heo
- Department of Neurology, Kyung Hee University Medical Center, Seoul, Korea
| | - Jaseong Koo
- Department of Neurology, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea
| | - Kyung-Ho Yu
- Department of Neurology, Hallym University Sacred Heart Hospital, Anyang, Korea
| | - Kwang-Yeol Park
- Department of Neurology, Chung-Ang University Hospital, Seoul, Korea
| | - Chi Kyung Kim
- Department of Neurology, Korea University Guro Hospital, Seoul, Korea
| | - Hong-Kyun Park
- Department of Neurology, Ilsan Paik Hospital, Inje University, Goyang, Korea
| | - Jiyoon Lee
- Department of Biostatistics, Korea University College of Medicine, Seoul, Korea
| | - Juneyoung Lee
- Department of Biostatistics, Korea University College of Medicine, Seoul, Korea
| | - Woo-Keun Seo
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| |
Collapse
|
7
|
Kwon HS, Kim C, Kim YS, Koh SH, Kim HY, Lee SH, Jung KH, Kim JM, Kim YD, Kwon HM, Koo DL, Kim BJ, Kim BJ, Heo SH, Chang DI, Bushnell CD. Long Sleep Duration and Dissatisfaction with Sleep Quality Are Associated with Ischemic Stroke in Young Patients. Cerebrovasc Dis 2023; 52:671-678. [PMID: 36944320 DOI: 10.1159/000530003] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Accepted: 03/01/2023] [Indexed: 03/23/2023] Open
Abstract
INTRODUCTION Suboptimal sleep duration and poor sleep quality have been proposed to increase stroke risk. However, their significance in young ischemic stroke is unclear. We aimed to investigate the importance of sleep duration and quality on young ischemic stroke patients. METHODS A multicenter matched case-control study was performed to evaluate under-recognized risk factors in young (<45 years) ischemic stroke patients in 8 tertiary hospitals in Korea. A total of 225 patients and 225 age- and sex-matched controls were enrolled in the same period. Detailed information about patients' demographics, socioeconomic state, and traditional and nontraditional risk factors including sleep-related factors were obtained using structured questionnaires. Risk of ischemic stroke was estimated using conditional logistic regression analysis. RESULTS Although average sleep duration was similar in patients and controls, patients were more likely to have long (≥9 h) or extremely short (<5 h) sleep durations. In addition, the proportion of subjects with dissatisfaction with sleep quality was higher in patients than controls (66.2 vs. 49.3%, p < 0.001). In multivariable conditional logistic regression analysis, long sleep duration (OR: 11.076, 95% CI: 1.819-67.446, p = 0.009) and dissatisfaction with sleep quality (OR: 2.116, 95% CI: 1.168-3.833, p = 0.013) were independently associated with risk of ischemic stroke. CONCLUSIONS Long sleep duration and dissatisfaction with sleep quality may be associated with increased risk of ischemic stroke in young adults. Improving sleep habit or quality could be important for reducing the risk of ischemic stroke.
Collapse
Affiliation(s)
- Hyuk Sung Kwon
- Department of Neurology, Hanyang University College of Medicine, Seoul, Republic of Korea,
| | - Chulho Kim
- Department of Neurology, Hallym University Sacred Heart Hospital, Chuncheon, Republic of Korea
| | - Young Seo Kim
- Department of Neurology, Hanyang University College of Medicine, Seoul, Republic of Korea
| | - Seong-Ho Koh
- Department of Neurology, Hanyang University College of Medicine, Seoul, Republic of Korea
| | - Hyun Young Kim
- Department of Neurology, Hanyang University College of Medicine, Seoul, Republic of Korea
| | - Seung-Hoon Lee
- Department of Neurology, Seoul National University Hospital, Seoul, Republic of Korea
| | - Keun-Hwa Jung
- Department of Neurology, Seoul National University Hospital, Seoul, Republic of Korea
| | - Jeong-Min Kim
- Department of Neurology, Seoul National University Hospital, Seoul, Republic of Korea
| | - Young Dae Kim
- Department of Neurology, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Hyung-Min Kwon
- Department of Neurology, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Dae Lim Koo
- Department of Neurology, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Beom Joon Kim
- Department of Neurology and Cerebrovascular Center, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Bum Joon Kim
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Sung Hyuk Heo
- Department of Neurology, Kyung Hee University College of Medicine, Seoul, Republic of Korea
| | - Dae-Il Chang
- Department of Neurology, Kyung Hee University College of Medicine, Seoul, Republic of Korea
| | - Cheryl D Bushnell
- Department of Neurology, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| |
Collapse
|
8
|
Lim JS, Lee J, Kang Y, Park HT, Kim DE, Cha JK, Park TH, Heo JH, Lee KB, Park JM, Oh MS, Kim EG, Chang DI, Heo SH, Park MS, Park H, Yi S, Lee YB, Park KY, Lee SJ, Kim JG, Lee J, Cho KH, Rha JH, Kim YI, Lee JH, Choi JC, Oh KM, Kwon JH, Kim C, Park JH, Jung KH, Sung SM, Chung JW, Lee YS, Kim HY, Cho HJ, Park JW, Moon WJ, Bae HJ. Efficacy and safety of oxiracetam in patients with vascular cognitive impairment: A multicenter, randomized, double-blinded, placebo-controlled, phase IV clinical trial. Contemp Clin Trials 2023; 126:107108. [PMID: 36724841 DOI: 10.1016/j.cct.2023.107108] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Revised: 01/23/2023] [Accepted: 01/25/2023] [Indexed: 01/30/2023]
Abstract
BACKGROUND Oxiracetam may have a modest effect on preventing cognitive decline. Exercise can also enhance cognitive function. This trial aims to investigate the effect of oxiracetam on post-stroke cognitive impairment and explore whether this effect is modified by exercise. Furthermore, the mechanisms that mediate this effect will be investigated through a neural network analysis. METHODS This is a multicenter, randomized, double-blind, placebo-controlled phase IV trial. Patients who complained of cognitive decline 3 months after stroke and had a high risk of cognitive decline were eligible. Patients were randomly assigned to receive either 800 mg of oxiracetam or placebo twice daily for 36 weeks. After randomization, a predetermined exercise protocol was provided to each participant, and the degree of physical activity was assessed using wrist actigraphy at 4, 12, 24, and 36 weeks. Resting-state functional MRI was obtained in baseline and 36-week follow-up. Co-primary endpoints are changes in the Mini-Mental State Examination and Clinical Dementia Rating-Sum of Boxes. Secondary endpoints include changes in the NINDS-CSN VCIHS-Neuropsychology Protocol, Euro QoL, patient's global assessment, and functional network connectivity. If there is a significant difference in physical activity between the two groups, the interaction effect between physical activity and the treatment group will be examined. A total of 500 patients were enrolled from February 2018, and the last patient's final follow-up was completed in September 2022. CONCLUSION This trial is meaningful not only to prove the efficacy of oxiracetam, but also evaluate whether exercise can modify the effects of medication and how cognitive function can be restored. Trial registrationhttp://cris.nih.go.kr (KCT0005137).
Collapse
Affiliation(s)
- Jae-Sung Lim
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Juneyoung Lee
- Department of Biostatistics, Korea University, Seoul, Republic of Korea
| | - Yeonwook Kang
- Department of Psychology, Hallym University, Chuncheon, Republic of Korea
| | - Hyun-Tae Park
- Department of Health Sciences, Graduate School, Dong-A University, Busan, Republic of Korea
| | - Dong-Eog Kim
- Department of Neurology, Dongguk University Ilsan Hospital, Dongguk University College of Medicine, Ilsan, Republic of Korea
| | - Jae-Kwan Cha
- Department of Neurology, Dong-A University Hospital, Busan, Republic of Korea
| | - Tai Hwan Park
- Department of Neurology, Seoul Medical Center, Seoul, Republic of Korea
| | - Jae-Hyuk Heo
- Department of Neurology, Seoul Medical Center, Seoul, Republic of Korea
| | - Kyung Bok Lee
- Department of Neurology, Soonchunhyang University Hospital, Seoul, Republic of Korea
| | - Jong-Moo Park
- Department of Neurology, Uijeongbu Eulji Medical Center, Eulji University, Uijeongbu, Republic of Korea
| | - Mi Sun Oh
- Department of Neurology, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Republic of Korea
| | - Eung-Gyu Kim
- Department of Neurology, Inje University Busan Paik Hospital, Inje University, Busan, Republic of Korea
| | - Dae-Il Chang
- Department of Neurology, Kyung Hee University Hospital, Seoul, Republic of Korea
| | - Sung Hyuk Heo
- Department of Neurology, Kyung Hee University Hospital, Seoul, Republic of Korea
| | - Man-Seok Park
- Department of Neurology, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - HyunYoung Park
- Department of Neurology, Wonkwang University Hospital, Wonkwang University School of Medicine, Iksan, Republic of Korea
| | - SangHak Yi
- Department of Neurology, Wonkwang University Hospital, Wonkwang University School of Medicine, Iksan, Republic of Korea
| | - Yeong Bae Lee
- Department of Neurology, Gil Medical Center, Gachon University College of Medicine, Incheon, Republic of Korea
| | - Kwang-Yeol Park
- Department of Neurology, Chung-Ang University Medical Center, Chung-Ang University College of Medicine, Republic of Korea
| | - Soo Joo Lee
- Department of Neurology, Daejeon Eulji Medical Center, Eulji University, School of Medicine, Daejeon, Republic of Korea
| | - Jae Guk Kim
- Department of Neurology, Daejeon Eulji Medical Center, Eulji University, School of Medicine, Daejeon, Republic of Korea
| | - Jun Lee
- Department of Neurology, Yeungnam University Hospital, Yeungnam University School of Medicine, Daegu, Republic of Korea
| | - Kyung-Hee Cho
- Department of Neurology, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Joung-Ho Rha
- Department of Neurology, Inha University Hospital, Inha University College of Medicine, Incheon, Republic of Korea
| | - Yeong-In Kim
- Department of Neurology, Catholic Kwandong University International St. Mary's Hospital, Incheon, Republic of Korea
| | - Jun Hong Lee
- Department of Neurology, National Health Insurance Service Ilsan Hospital, Ilsan, Republic of Korea
| | - Jay Chol Choi
- Department of Neurology, Jeju National University Hospital, Jeju National University School of Medicine, Jeju, Republic of Korea
| | - Kyung-Mi Oh
- Department of Neurology, Korea Univeristy Guro Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Jee-Hyun Kwon
- Department of Neurology, Ulsan University Hospital, Ulsan University College of Medicine, Ulsan, Republic of Korea
| | - Chulho Kim
- Department of Neurology, Hallym University Chuncheon Sacred Heart Hospital, Hallym University College of Medicine, Chuncheon, Republic of Korea
| | - Jong-Ho Park
- Department of Neurology, Myongji Hospital, Hanyang University College of Medicine, Goyang, Republic of Korea
| | - Keun-Hwa Jung
- Department of Neurology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Sang Min Sung
- Department of Neurology, Pusan National University Hospital, Pusan National University School of Medicine and Biomedical Research Institute, Busan, Republic of Korea
| | - Jong-Won Chung
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Yong-Seok Lee
- Department of Neurology, Seoul National University Boramae Medical Center, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Hahn Young Kim
- Department of Neurology, Konkuk University Hospital, Konkuk University, Seoul, Republic of Korea
| | - Hyun-Ji Cho
- Department of Neurology, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Incheon, Republic of Korea
| | - Jeong Wook Park
- Department of Neurology, Uijeongbu St. Mary's Hospital, Catholic University of Korea, Uijeongbu, Republic of Korea
| | - Won-Jin Moon
- Department of Radiology, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Republic of Korea
| | - Hee-Joon Bae
- Department of Neurology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Republic of Korea.
| |
Collapse
|
9
|
Jung S, Lee HA, Kang IS, Shin SH, Chang Y, Shin DW, Park M, Kim YD, Nam HS, Heo JH, Kim TH, Yu HT, Lee JM, Heo SH, Woo HG, Park JK, Ro SY, Kim CK, Lee YS, Do JK, Kim DH, Song TJ, Park J. Corrigendum: Clinical implications of atrial fibrillatioN detection using wearabLE devices in patients with cryptogenic stroke (CANDLE-AF) trial: Design and rationale. Front Cardiovasc Med 2023; 10:1199185. [PMID: 37153467 PMCID: PMC10155058 DOI: 10.3389/fcvm.2023.1199185] [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] [Received: 04/03/2023] [Accepted: 04/04/2023] [Indexed: 05/09/2023] Open
Abstract
[This corrects the article DOI: 10.3389/fcvm.2022.837958.].
Collapse
Affiliation(s)
- Sodam Jung
- Mokdong Hospital, Ewha Womans University School of Medicine, Seoul, South Korea
| | - Hye Ah Lee
- Mokdong Hospital, Ewha Womans University School of Medicine, Seoul, South Korea
| | - In Sook Kang
- Mokdong Hospital, Ewha Womans University School of Medicine, Seoul, South Korea
| | - Sang Hoon Shin
- Ewha Womans University Seoul Hospital, Seoul, South Korea
| | - Yoonkyung Chang
- Mokdong Hospital, Ewha Womans University School of Medicine, Seoul, South Korea
| | - Dong Woo Shin
- Mokdong Hospital, Ewha Womans University School of Medicine, Seoul, South Korea
| | - Mooseok Park
- Ewha Womans University Seoul Hospital, Seoul, South Korea
| | - Young Dae Kim
- College of Medicine, Yonsei University, Seoul, South Korea
| | - Hyo Suk Nam
- College of Medicine, Yonsei University, Seoul, South Korea
| | - Ji Hoe Heo
- College of Medicine, Yonsei University, Seoul, South Korea
| | - Tae-Hoon Kim
- Severance Cardiovascular Hospital, Seoul, South Korea
| | - Hee Tae Yu
- Severance Cardiovascular Hospital, Seoul, South Korea
| | | | - Sung Hyuk Heo
- Kyung Hee University Medical Center, Seoul, South Korea
| | - Ho Geol Woo
- Kyung Hee University Medical Center, Seoul, South Korea
| | - Jin-Kyu Park
- Hanyang University Seoul Hospital, Seoul, South Korea
| | - Seung-Y. Ro
- Korea University Guro Hospital, Seoul, South Korea
| | | | - Young-Soo Lee
- Daegu Catholic University Medical Center, Daegu, North Gyeongsang, South Korea
| | - Jin Kuk Do
- Daegu Catholic University Medical Center, Daegu, North Gyeongsang, South Korea
| | - Dong-Hyeok Kim
- Ewha Womans University Seoul Hospital, Seoul, South Korea
| | - Tae-Jin Song
- Ewha Womans University Seoul Hospital, Seoul, South Korea
| | - Junbeom Park
- Mokdong Hospital, Ewha Womans University School of Medicine, Seoul, South Korea
- Correspondence: Junbeom Park
| |
Collapse
|
10
|
Woo HG, Kim HG, Lee KM, Ha SH, Jo H, Heo SH, Chang DI, Liebeskind DS, Kim BJ. Wall Shear Stress Associated with Stroke Occurrence and Mechanisms in Middle Cerebral Artery Atherosclerosis. J Stroke 2023; 25:132-140. [PMID: 36746383 PMCID: PMC9911838 DOI: 10.5853/jos.2022.02754] [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: 08/26/2022] [Accepted: 12/08/2022] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND AND PURPOSE Various mechanisms are involved in the etiology of stroke caused by atherosclerosis of the middle cerebral artery (MCA). Here, we compared differences in plaque nature and hemodynamic parameters according to stroke mechanism in patients with MCA atherosclerosis. METHODS Consecutive patients with asymptomatic and symptomatic MCA atherosclerosis (≥50% stenosis) were enrolled. MCA plaque characteristics (location and plaque enhancement) and wall shear stress (WSS) were measured using high-resolution vessel wall and four-dimensional flow magnetic resonance imaging, respectively, at five points (initial, upstream, minimal lumen, downstream, and terminal). These parameters were compared between patients with asymptomatic and symptomatic MCA atherosclerosis with infarctions of different mechanisms (artery-to-artery embolism vs. local branch occlusion). RESULTS In total, 110 patients (46 asymptomatic, 32 artery-to-artery embolisms, and 32 local branch occlusions) were investigated. Plaques were evenly distributed in the MCA of patients with asymptomatic MCA atherosclerosis, more commonly observed in the distal MCA of patients with artery-to-artery embolism, and in the middle MCA of patients with local branch occlusion. Maximum WSS and plaque enhancement were more prominent in the minimum lumen area of patients with asymptomatic MCA atherosclerosis or those with local branch occlusion, and were more prominent in the upstream area in those with artery-to-artery embolism. The elevated variability in the maximum WSS was related to stroke caused by artery-to-artery embolism. CONCLUSION Stroke caused by artery-to-artery embolism was related to plaque enhancement and the highest maximum WSS at the upstream point of the plaque, and was associated with elevated variability of maximum WSS.
Collapse
Affiliation(s)
- Ho Geol Woo
- Department of Neurology, Kyung Hee University Hospital, Kyung Hee University College of Medicine, Seoul, Korea
| | - Hyug-Gi Kim
- Department of Radiology, Kyung Hee University Hospital, Kyung Hee University College of Medicine, Seoul, Korea
| | - Kyung Mi Lee
- Department of Radiology, Kyung Hee University Hospital, Kyung Hee University College of Medicine, Seoul, Korea
| | - Sang Hee Ha
- Department of Neurology, Asan Medical Center, Seoul, Korea
| | - HangJin Jo
- Department of Mechanical Engineering & Division of Advanced Nuclear Engineering, POSTECH, Pohang, Korea
| | - Sung Hyuk Heo
- Department of Neurology, Kyung Hee University Hospital, Kyung Hee University College of Medicine, Seoul, Korea
| | - Dae-il Chang
- Department of Neurology, Kyung Hee University Hospital, Kyung Hee University College of Medicine, Seoul, Korea
| | - David S. Liebeskind
- Department of Neurology, University of California in Los Angeles, Los Angeles, CA, USA
| | - Bum Joon Kim
- Department of Neurology, Asan Medical Center, Seoul, Korea,Correspondence: Bum Joon Kim Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Korea Tel: +82-2-958-8499 E-mail:
| |
Collapse
|
11
|
Ku BD, Yoon SS, Heo SH. Haemodynamic compensation in a patient with bilateral vertebral artery. Hong Kong Med J 2022; 28:410.e1-410.e2. [PMID: 38232969 DOI: 10.12809/hkmj219536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2024] Open
Affiliation(s)
- B D Ku
- Department of Neurology, International St Mary's Hospital, Catholic Kwandong University College of Medicine, Incheon, South Korea
| | - S S Yoon
- Department of Neurology, Kyung Hee University School of Medicine, Seoul, South Korea
| | - S H Heo
- Department of Neurology, Kyung Hee University School of Medicine, Seoul, South Korea
| |
Collapse
|
12
|
Noh KC, Choi HY, Woo HG, Chang JY, Heo SH, Chang DI, Kim BJ. High-on-Aspirin Platelet Reactivity Differs Between Recurrent Ischemic Stroke Associated With Extracranial and Intracranial Atherosclerosis. J Clin Neurol 2022; 18:421-427. [PMID: 35796267 PMCID: PMC9262451 DOI: 10.3988/jcn.2022.18.4.421] [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: 07/27/2021] [Revised: 12/10/2021] [Accepted: 12/10/2021] [Indexed: 11/19/2022] Open
Abstract
Background and Purpose Ischemic stroke recurs despite the use of antiplatelet agents. Various mechanisms are involved in recurrence due to intracranial atherosclerosis (ICAS) and extracranial atherosclerosis (ECAS). High-on-aspirin platelet reactivity (HAPR) may differ between recurrent stroke due to ICAS and ECAS. Methods Patients with recurrent ischemic stroke as a result of large-artery atherosclerosis despite taking aspirin were enrolled consecutively. Ischemic stroke was classified as stroke due to ICAS or ECAS according to the location of the culprit stenosis. An aspirin reaction units (ARU) value of >550 IU was defined as HAPR. HAPR and its associated factors were compared between the two groups and also considering the mechanism of stroke. Results Among the 190 patients with recurrent stroke (111 with ICAS and 79 with ECAS), 36 (18.3%) showed HAPR. The ARU value was higher in the ECAS than the ICAS group (492±83 vs. 465±78, mean±standard deviation; p=0.028), as was the proportion of patients with HAPR (27.8% vs. 12.6%, p=0.008). Being male and having stroke due to ECAS (reference=stroke due to ICAS: odds ratio=5.760; 95% confidence interval=2.154–15.403; p<0.001) was independently associated with HAPR. The ARU value differed according to the stroke mechanism, and was highest in those with artery-to-artery embolism. Artery-to-artery embolism was independently associated with HAPR in both the ICAS and ECAS groups. Conclusions Recurrent stroke due to ECAS was more strongly associated with HAPR and insufficient antiplatelet inhibition than was that due to ICAS. Artery-to-artery embolism was associated with HAPR in recurrent ischemic stroke as a result of ICAS or ECAS.
Collapse
Affiliation(s)
- Kyung Chul Noh
- Department of Neurology, Kyung Hee University Hospital at Gangdong, Seoul, Korea.,Department of Medicine, Graduate School, Kyung Hee University, Seoul, Korea
| | - Hye-Yeon Choi
- Department of Neurology, Kyung Hee University Hospital at Gangdong, Seoul, Korea
| | - Ho Geol Woo
- Department of Neurology, Kyung Hee University Hospital, Seoul, Korea
| | - Jun Young Chang
- Department of Neurology, Asan Medical Center, University of Ulsan, College of Medicine, Seoul, Korea
| | - Sung Hyuk Heo
- Department of Neurology, Kyung Hee University Hospital, Seoul, Korea
| | - Dae-Il Chang
- Department of Neurology, Kyung Hee University Hospital, Seoul, Korea
| | - Bum Joon Kim
- Department of Neurology, Asan Medical Center, University of Ulsan, College of Medicine, Seoul, Korea.
| |
Collapse
|
13
|
Nam KW, Kim CK, Yu S, Oh K, Chung JW, Bang OY, Kim GM, Jung JM, Song TJ, Kim YJ, Kim BJ, Heo SH, Park KY, Kim JM, Park JH, Choi JC, Park MS, Kim JT, Choi KH, Hwang YH, Seo WK. Plasma Total Homocysteine Level Is Related to Unfavorable Outcomes in Ischemic Stroke With Atrial Fibrillation. J Am Heart Assoc 2022; 11:e022138. [PMID: 35470699 PMCID: PMC9238578 DOI: 10.1161/jaha.121.022138] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Background Unlike patients with stroke caused by other mechanisms, the effect of elevated plasma total homocysteine (tHcy) on the prognosis of patients with both ischemic stroke and atrial fibrillation (AF) is unknown. This study aimed to evaluate the association between tHcy level and the functional outcome of patients with AF‐related stroke. Methods and Results We included consecutive patients with AF‐related stroke between 2013 and 2015 from the registry of a real‐world prospective cohort from 11 large centers in South Korea. A 3‐month modified Rankin Scale score ≥3 was considered an unfavorable outcome. Since tHcy is strongly affected by renal function, we performed a subgroup analysis according to the presence of renal dysfunction. A total of 910 patients with AF‐related stroke were evaluated (mean age, 73 years; male sex, 56.0%). The mean tHcy level was 11.98±8.81 μmol/L. In multivariable analysis, the tHcy level (adjusted odds ratio, 1.04; 95% CI, 1.01–1.07, per 1 μmol/L) remained significantly associated with unfavorable outcomes. In the subgroup analysis based on renal function, tHcy values above the cutoff point (≥14.60 μmol/L) showed a close association with the unfavorable outcome only in the normal renal function group (adjusted odds ratio, 3.10; 95% CI, 1.60–6.01). In patients with renal dysfunction, tHcy was not significantly associated with the prognosis of AF‐related stroke. Conclusions A higher plasma tHcy level was associated with unfavorable outcomes in patients with AF‐related stroke. This positive association may vary according to renal function but needs to be verified in further studies.
Collapse
Affiliation(s)
- Ki-Woong Nam
- Department of Neurology Seoul Metropolitan Government-Seoul National University Boramae Medical Center Seoul South Korea
| | - Chi Kyung Kim
- Department of Neurology Korea University Guro HospitalKorea University College of Medicine Seoul South Korea
| | - Sungwook Yu
- Department of Neurology Korea University Anam HospitalKorea University College of Medicine Seoul South Korea
| | - Kyungmi Oh
- Department of Neurology Korea University Guro HospitalKorea University College of Medicine Seoul South Korea
| | - Jong-Won Chung
- Department of Neurology Samsung Medical CenterSungkyunkwan University School of Medicine Seoul South Korea
| | - Oh Young Bang
- Department of Neurology Samsung Medical CenterSungkyunkwan University School of Medicine Seoul South Korea
| | - Gyeong-Moon Kim
- Department of Neurology Samsung Medical CenterSungkyunkwan University School of Medicine Seoul South Korea
| | - Jin-Man Jung
- Department of Neurology Korea University Ansan HospitalKorea University College of Medicine Ansan South Korea
| | - Tae-Jin Song
- Department of Neurology Ewha Womans UniversitySchool of Medicine Seoul South Korea
| | - Yong-Jae Kim
- Department of Neurology The Catholic University of Korea Seoul South Korea
| | - Bum Joon Kim
- Department of Neurology Asan Medical Center Seoul South Korea
| | - Sung Hyuk Heo
- Department of Neurology Kyung Hee University College of Medicine Seoul South Korea
| | - Kwang-Yeol Park
- Department of Neurology Chung-Ang University College of MedicineChung-Ang University Hospital Seoul South Korea
| | - Jeong-Min Kim
- Department of Neurology Seoul National University Hospital Seoul South Korea
| | - Jong-Ho Park
- Department of Neurology Myongji HospitalHanyang University College of medicine Seoul South Korea
| | - Jay Chol Choi
- Department of Neurology Jeju National University Jeju South Korea
| | - Man-Seok Park
- Department of Neurology Chonnam National University Hospital Chonnam South Korea
| | - Joon-Tae Kim
- Department of Neurology Chonnam National University Hospital Chonnam South Korea
| | - Kang-Ho Choi
- Department of Neurology Chonnam National University Hospital Chonnam South Korea
| | - Yang Ha Hwang
- Department of Neurology Kyungpook National University Hospital Dae-gu South Korea
| | - Woo-Keun Seo
- Department of Neurology Samsung Medical CenterSungkyunkwan University School of Medicine Seoul South Korea.,Departement of Digital Health SHAISTSungkyunkwan University Seoul South Korea
| |
Collapse
|
14
|
Jung S, Lee HA, Kang IS, Shin SH, Chang Y, Woo Shin D, Park MS, Kim YD, Nam HS, Heo JH, Kim TH, Yu HT, Lee JM, Heo SH, Woo HG, Park JK, Roh SY, Kim CK, Lee YS, Do JK, Kim DH, Song TJ, Park J. Clinical Implications of Atrial Fibrillation Detection Using Wearable Devices in Patients With Cryptogenic Stroke (CANDLE-AF) Trial: Design and Rationale. Front Cardiovasc Med 2022; 9:837958. [PMID: 35445088 PMCID: PMC9013795 DOI: 10.3389/fcvm.2022.837958] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Accepted: 02/28/2022] [Indexed: 11/14/2022] Open
Abstract
Background Although many electrocardiography wearable devices have been released recently for the detection of atrial fibrillation (AF), there are few studies reporting prospective data for wearable devices compared to the strategy of the existing guidelines in the detection of atrial fibrillation (AF) after cryptogenic stroke. A tiny single-patch monitor is more convenient than a conventional Holter monitor recording device and, therefore, longer duration of monitoring may be acceptable. Methods and Design The CANDLE-AF study is a multicenter, prospective, randomized controlled trial. Patients with transient ischemic attack or ischemic stroke without any history of AF will be enrolled. The superiority of the 72-h single-patch monitor to standard strategy and non-inferiority of the 72-h single-patch monitor to an event-recorder-type device will be investigated. Single-patch monitor arm will repeat monitoring at 1, 3, 6, and 12 months, event-recorder-type arm will repeat monitoring twice daily for 12 months. The enrollment goal is a total of 600 patients, and the primary outcome is the detection of AF which continues at least 30 s during study period. The secondary outcome is the rate of changes from antiplatelet to anticoagulant and major adverse cardiac and cerebrovascular events within 1 year. Conclusions The results of CANDLE-AF will clarify the role of a single-lead patch ECG for the early detection of AF in patients with acute ischemic stroke. In addition, the secondary outcome will be analyzed to determine whether more sensitive AF detection can affect the prognosis and if further device development is meaningful. (cris.nih.go.kr KCT0005592).
Collapse
Affiliation(s)
- Sodam Jung
- Division of Cardiology, Ewha Womans University Mokdong Hospital, Seoul, South Korea
| | - Hye Ah Lee
- Clinical Trial Center, Ewha Womans University Mokdong Hospital, Seoul, South Korea
| | - In Sook Kang
- Division of Cardiology, Ewha Womans University Mokdong Hospital, Seoul, South Korea
| | - Sang Hoon Shin
- Division of Cardiology, Ewha Womans University Seoul Hospital, Seoul, South Korea
| | - Yoonkyung Chang
- Division of Cardiology, Ewha Womans University Mokdong Hospital, Seoul, South Korea
| | - Dong Woo Shin
- Department of Neurology, Ewha Womans University Mokdong Hospital, Seoul, South Korea
| | - Moo-Seok Park
- Department of Neurology, Ewha Womans University Seoul Hospital, Seoul, South Korea
| | - Young Dae Kim
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea
| | - Hyo Suk Nam
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea
| | - Ji Hoe Heo
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea
| | - Tae-Hoon Kim
- Division of Cardiology, Severance Cardiovascular Hospital, Seoul, South Korea
| | - Hee Tae Yu
- Division of Cardiology, Severance Cardiovascular Hospital, Seoul, South Korea
| | - Jung Myung Lee
- Division of Cardiology, Kyung Hee University Hospital, Seoul, South Korea
| | - Sung Hyuk Heo
- Department of Neurology, Kyung Hee University Hospital, Seoul, South Korea
| | - Ho Geol Woo
- Department of Neurology, Kyung Hee University Hospital, Seoul, South Korea
| | - Jin-Kyu Park
- Division of Cardiology, Hanyang University Seoul Hospital, Seoul, South Korea
| | - Seung-Young Roh
- Devision of Cardiology, Korea University Guro Hospital, Seoul, South Korea
| | - Chi Kyung Kim
- Department of Neurology, Korea University Guro Hospital, Seoul, South Korea
| | - Young-Soo Lee
- Division of Cardiology, Daegu Catholic University Medical Center, Daegu, South Korea
| | - Jin Kuk Do
- Department of Neurology, Daegu Catholic University Medical Center, Daegu, South Korea
| | - Dong-Hyeok Kim
- Division of Cardiology, Ewha Womans University Seoul Hospital, Seoul, South Korea
- *Correspondence: Dong-Hyeok Kim
| | - Tae-Jin Song
- Department of Neurology, Ewha Womans University Seoul Hospital, Seoul, South Korea
- Tae-Jin Song
| | - Junbeom Park
- Division of Cardiology, Ewha Womans University Mokdong Hospital, Seoul, South Korea
- Junbeom Park
| | | |
Collapse
|
15
|
Cho AH, Kwon HS, Lee MH, Park JH, Heo SH, Yu S, Kwon SU. Hemorrhagic Focus Within the Recent Small Subcortical Infarcts on Long-Term Follow-Up Magnetic Resonance Imaging. Stroke 2022; 53:e139-e140. [PMID: 35236087 DOI: 10.1161/strokeaha.121.037939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- A-Hyun Cho
- Department of Neurology, Catholic University of Korea (A.-H.C., M.H.L.)
| | - Hyuk Sung Kwon
- Hanyang University, College of Medicine, Seoul, Republic of Korea. (H.S.K., J.-H.P.)
| | - Min Hwan Lee
- Department of Neurology, Catholic University of Korea (A.-H.C., M.H.L.)
| | - Jong-Ho Park
- Hanyang University, College of Medicine, Seoul, Republic of Korea. (H.S.K., J.-H.P.)
| | - Sung Hyuk Heo
- Kyung Hee University, College of Medicine, Seoul, Republic of Korea. (S.H.H.)
| | - Sungwook Yu
- Korea University, College of Medicine, Seoul, Republic of Korea. (S.Y.)
| | - Sun U Kwon
- Asan Medical Center University of Ulsan, College of Medicine, Seoul, Republic of Korea. (S.U.K.)
| |
Collapse
|
16
|
Kim BJ, Hwang YH, Park MS, Kim JT, Choi KH, Jung JM, Yu S, Kim CK, Oh K, Song TJ, Kim YJ, Park KY, Kim JM, Park JH, Choi JC, Chung JW, Bang OY, Kim GM, Heo SH, Seo WK. Atrial Fibrillation Related and Unrelated Stroke Recurrence Among Ischemic Stroke Patients With Atrial Fibrillation. Front Neurol 2021; 12:744607. [PMID: 34744981 PMCID: PMC8566747 DOI: 10.3389/fneur.2021.744607] [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: 07/20/2021] [Accepted: 09/21/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Ischemic stroke with atrial fibrillation (AF) may recur despite appropriate treatment. It may be AF-related or AF-unrelated. We compared the factors associated with AF-related and AF-unrelated recurrences among ischemic stroke patients with AF. Methods: Patients with ischemic stroke and AF were enrolled from 11 centers in Korea. Ischemic stroke recurrence was classified as AF-related if the lesion pattern was compatible with cardioembolism without significant stenosis or as AF-unrelated if the lesion was more likely due to small vessel disease or arterial stenosis. Factors associated with stroke recurrence (AF-related and AF-unrelated) were investigated. Results: Among the 2,239 patients, 115 (5.1%) experienced recurrence (75 AF-related and 40 AF-unrelated). Factors independently associated with any stroke recurrence included AF diagnosed before stroke, small subcortical infarctions, and small scattered lesions in a single vascular territory. Type of AF was associated with the type of stroke recurrence, with persistent AF being associated with AF-related stroke [hazard ratio (HR) = 2.94, 95% confidence interval (CI) 1.69-5.26; p < 0.001]. By contrast, paroxysmal AF (HR = 3.76, 95% CI 1.56-9.04; p = 0.003), AF diagnosed before stroke (HR = 2.38, 95% CI 1.19-4.55; p = 0.014), small scattered lesions in a single vascular territory (reference: corticosubcortical lesion, HR = 3.19, 95% CI 1.18-8.63; p = 0.022), and the use of antiplatelet agents (HR = 2.11, 95% CI 1.11-4.03; p = 0.024) were independently associated with AF-unrelated stroke. Conclusion: Persistent AF was more associated with AF-related stroke recurrence, whereas paroxysmal AF was more associated with AF-unrelated stroke recurrence. A scattered lesion in a single vascular territory may predict AF-unrelated stroke recurrence.
Collapse
Affiliation(s)
- Bum Joon Kim
- Department of Neurology, Asan Medical Center, Seoul, South Korea
| | - Yang-Ha Hwang
- Department of Neurology, Kyungpook National University Hospital, Daegu, South Korea
| | - Man-Seok Park
- Department of Neurology, Chonnam National University Hospital, Gwangju, South Korea
| | - Joon-Tae Kim
- Department of Neurology, Chonnam National University Hospital, Gwangju, South Korea
| | - Kang-Ho Choi
- Department of Neurology, Chonnam National University Hospital, Gwangju, South Korea
| | - Jin-Man Jung
- Department of Neurology, Korea University Ansan Hospital, Ansan, South Korea
| | - Sungwook Yu
- Department of Neurology, Korea University Anam Hospital, Seoul, South Korea
| | - Chi Kyung Kim
- Department of Neurology, Korea University Guro Hospital, Seoul, South Korea
| | - Kyungmi Oh
- Department of Neurology, Korea University Guro Hospital, Seoul, South Korea
| | - Tae-Jin Song
- Department of Neurology, Ewha Womans University Seoul Hospital, Seoul, South Korea
| | - Yong-Jae Kim
- Department of Neurology, Eunpyeong St. Mary's Hospital, The Catholic University of Korea, Seoul, South Korea
| | - Kwang-Yeol Park
- Department of Neurology, Chung-Ang University Hospital, Seoul, South Korea
| | - Jeong-Min Kim
- Department of Neurology, Seoul National University Hospital, Seoul, South Korea
| | - Jong-Ho Park
- Department of Neurology, Myongji Hospital, Hanyang University College of Medicine, Goyang, South Korea
| | - Jay Chol Choi
- Department of Neurology, Jeju National University Hospital, Jeju, South Korea
| | - Jong-Won Chung
- Department of Neurology, Samsung Medical Center, Seoul, South Korea
| | - Oh Young Bang
- Department of Neurology, Samsung Medical Center, Seoul, South Korea
| | - Gyeong-Moon Kim
- Department of Neurology, Samsung Medical Center, Seoul, South Korea
| | - Sung Hyuk Heo
- Department of Neurology, Kyung Hee University Hospital, Seoul, South Korea
| | - Woo-Keun Seo
- Department of Neurology, Samsung Medical Center, Seoul, South Korea
| |
Collapse
|
17
|
Kwon YN, Kim B, Kim JS, Mo H, Choi K, Oh SI, Kim JE, Nam TS, Sohn EH, Heo SH, Kim SB, Park KC, Yoon SS, Oh J, Baek SH, Kim BJ, Park KS, Sung JJ, Jung JH, Kim SJ, Park SH, Waters P, Kim SM. Myelin Oligodendrocyte Glycoprotein-Immunoglobulin G in the CSF: Clinical Implication of Testing and Association With Disability. Neurol Neuroimmunol Neuroinflamm 2021; 9:9/1/e1095. [PMID: 34711644 PMCID: PMC8554713 DOI: 10.1212/nxi.0000000000001095] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Accepted: 09/08/2021] [Indexed: 11/29/2022]
Abstract
Background and Objective To investigate the clinical relevance of CSF myelin oligodendrocyte glycoprotein-immunoglobulin G (MOG-IgG) testing in a large multicenter cohort. Methods In this multicenter cohort study, paired serum-CSF samples from 474 patients with suspected inflammatory demyelinating disease (IDD) from 11 referral hospitals were included. After serum screening, patients were grouped into seropositive myelin oligodendrocyte glycoprotein antibody associated disease (MOGAD, 31), aquaporin-4-IgG-positive neuromyelitis optica spectrum disorder (AQP4-IgG + NMOSD, 60), other IDDs (217), multiple sclerosis (MS, 45), and non-IDDs (121). We then screened CSF for MOG-IgG and compared the clinical and serologic characteristics of patients uniquely positive for MOG-IgG in the CSF to seropositive patients with MOGAD. Results Nineteen patients with seropositive MOGAD (61.3%), 9 with other IDDs (CSF MOG + IDD, 4.1%), 4 with MS (8.9%), but none with AQP4-IgG + NMOSD nor with non-IDDs tested positive in the CSF for MOG-IgG. The clinical, pathologic, and prognostic features of patients uniquely positive for CSF MOG-IgG, with a non-MS phenotype, were comparable with those of seropositive MOGAD. Intrathecal MOG-IgG synthesis, observed from the onset of disease, was shown in 12 patients: 4 of 28 who were seropositive and 8 who were uniquely CSF positive, all of whom had involvement of either brain or spinal cord. Both CSF MOG-IgG titer and corrected CSF/serum MOG-IgG index, but not serum MOG-IgG titer, were associated with disability, CSF pleocytosis, and level of CSF proteins. Discussion CSF MOG-IgG is found in IDD other than MS and also in MS. In IDD other than MS, the CSF MOG-IgG positivity can support the diagnosis of MOGAD. The synthesis of MOG-IgG in the CNS of patients with MOGAD can be detected from the onset of the disease and is associated with the severity of the disease. Classification of Evidence This study provides Class II evidence that the presence of CSF MOG-IgG can improve the diagnosis of MOGAD in the absence of an MS phenotype, and intrathecal synthesis of MOG-IgG was associated with increased disability.
Collapse
Affiliation(s)
- Young Nam Kwon
- From the Department of Neurology, Seoul National University Hospital (Y.N.K., J.J.S., S.M.K); Department of Neurology, Neuroscience Research Institute, Seoul National University College of Medicine (B.K., J.J.S., S.M.K); Department of Neurology (J.S.K.), Seoul National University Bundang Hospital, Seongnam; Department of Neurology (H.M.), Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong; Department of Neurology (K.C.), Konkuk University School of Medicine, Konkuk University Medical Center; Department of Neurology (S-.i.O.), Busan Paik Hospital, Inje University College of Medicine, Busan; Department of Neurology (J.-E.K.), Seoul Hospital, Ewha Womans University College of Medicine; Department of Neurology (T.-S.N.), Chonnam National University Medical School, Gwangju; Department of Neurology (E.H.S.), Chungnam National University College of Medicine, Chungnam National University Hospital, Daejeon; Department of Neurology (S.H.H., K-C.P., S.S.Y.), Kyung Hee University Hospital, Kyung Hee University School of Medicine; Department of Neurology (S.B.K.), Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine; Department of Neurology (S-H.B., B.-J.K.), Korea University College of Medicine, Korea University Anam Hospital; Department of Ophthalmology (J.H.J., S.-J.K.), Seoul National University College of Medicine; Department of Pathology (S.-H.P.), Seoul National University Hospital, Seoul National University, College of Medicine, Seoul; Autoimmune Neurology Group (P.W.), Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, Oxford, UK
| | - Boram Kim
- From the Department of Neurology, Seoul National University Hospital (Y.N.K., J.J.S., S.M.K); Department of Neurology, Neuroscience Research Institute, Seoul National University College of Medicine (B.K., J.J.S., S.M.K); Department of Neurology (J.S.K.), Seoul National University Bundang Hospital, Seongnam; Department of Neurology (H.M.), Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong; Department of Neurology (K.C.), Konkuk University School of Medicine, Konkuk University Medical Center; Department of Neurology (S-.i.O.), Busan Paik Hospital, Inje University College of Medicine, Busan; Department of Neurology (J.-E.K.), Seoul Hospital, Ewha Womans University College of Medicine; Department of Neurology (T.-S.N.), Chonnam National University Medical School, Gwangju; Department of Neurology (E.H.S.), Chungnam National University College of Medicine, Chungnam National University Hospital, Daejeon; Department of Neurology (S.H.H., K-C.P., S.S.Y.), Kyung Hee University Hospital, Kyung Hee University School of Medicine; Department of Neurology (S.B.K.), Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine; Department of Neurology (S-H.B., B.-J.K.), Korea University College of Medicine, Korea University Anam Hospital; Department of Ophthalmology (J.H.J., S.-J.K.), Seoul National University College of Medicine; Department of Pathology (S.-H.P.), Seoul National University Hospital, Seoul National University, College of Medicine, Seoul; Autoimmune Neurology Group (P.W.), Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, Oxford, UK.
| | - Jun-Soon Kim
- From the Department of Neurology, Seoul National University Hospital (Y.N.K., J.J.S., S.M.K); Department of Neurology, Neuroscience Research Institute, Seoul National University College of Medicine (B.K., J.J.S., S.M.K); Department of Neurology (J.S.K.), Seoul National University Bundang Hospital, Seongnam; Department of Neurology (H.M.), Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong; Department of Neurology (K.C.), Konkuk University School of Medicine, Konkuk University Medical Center; Department of Neurology (S-.i.O.), Busan Paik Hospital, Inje University College of Medicine, Busan; Department of Neurology (J.-E.K.), Seoul Hospital, Ewha Womans University College of Medicine; Department of Neurology (T.-S.N.), Chonnam National University Medical School, Gwangju; Department of Neurology (E.H.S.), Chungnam National University College of Medicine, Chungnam National University Hospital, Daejeon; Department of Neurology (S.H.H., K-C.P., S.S.Y.), Kyung Hee University Hospital, Kyung Hee University School of Medicine; Department of Neurology (S.B.K.), Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine; Department of Neurology (S-H.B., B.-J.K.), Korea University College of Medicine, Korea University Anam Hospital; Department of Ophthalmology (J.H.J., S.-J.K.), Seoul National University College of Medicine; Department of Pathology (S.-H.P.), Seoul National University Hospital, Seoul National University, College of Medicine, Seoul; Autoimmune Neurology Group (P.W.), Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, Oxford, UK.
| | - Heejung Mo
- From the Department of Neurology, Seoul National University Hospital (Y.N.K., J.J.S., S.M.K); Department of Neurology, Neuroscience Research Institute, Seoul National University College of Medicine (B.K., J.J.S., S.M.K); Department of Neurology (J.S.K.), Seoul National University Bundang Hospital, Seongnam; Department of Neurology (H.M.), Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong; Department of Neurology (K.C.), Konkuk University School of Medicine, Konkuk University Medical Center; Department of Neurology (S-.i.O.), Busan Paik Hospital, Inje University College of Medicine, Busan; Department of Neurology (J.-E.K.), Seoul Hospital, Ewha Womans University College of Medicine; Department of Neurology (T.-S.N.), Chonnam National University Medical School, Gwangju; Department of Neurology (E.H.S.), Chungnam National University College of Medicine, Chungnam National University Hospital, Daejeon; Department of Neurology (S.H.H., K-C.P., S.S.Y.), Kyung Hee University Hospital, Kyung Hee University School of Medicine; Department of Neurology (S.B.K.), Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine; Department of Neurology (S-H.B., B.-J.K.), Korea University College of Medicine, Korea University Anam Hospital; Department of Ophthalmology (J.H.J., S.-J.K.), Seoul National University College of Medicine; Department of Pathology (S.-H.P.), Seoul National University Hospital, Seoul National University, College of Medicine, Seoul; Autoimmune Neurology Group (P.W.), Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, Oxford, UK
| | - Kyomin Choi
- From the Department of Neurology, Seoul National University Hospital (Y.N.K., J.J.S., S.M.K); Department of Neurology, Neuroscience Research Institute, Seoul National University College of Medicine (B.K., J.J.S., S.M.K); Department of Neurology (J.S.K.), Seoul National University Bundang Hospital, Seongnam; Department of Neurology (H.M.), Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong; Department of Neurology (K.C.), Konkuk University School of Medicine, Konkuk University Medical Center; Department of Neurology (S-.i.O.), Busan Paik Hospital, Inje University College of Medicine, Busan; Department of Neurology (J.-E.K.), Seoul Hospital, Ewha Womans University College of Medicine; Department of Neurology (T.-S.N.), Chonnam National University Medical School, Gwangju; Department of Neurology (E.H.S.), Chungnam National University College of Medicine, Chungnam National University Hospital, Daejeon; Department of Neurology (S.H.H., K-C.P., S.S.Y.), Kyung Hee University Hospital, Kyung Hee University School of Medicine; Department of Neurology (S.B.K.), Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine; Department of Neurology (S-H.B., B.-J.K.), Korea University College of Medicine, Korea University Anam Hospital; Department of Ophthalmology (J.H.J., S.-J.K.), Seoul National University College of Medicine; Department of Pathology (S.-H.P.), Seoul National University Hospital, Seoul National University, College of Medicine, Seoul; Autoimmune Neurology Group (P.W.), Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, Oxford, UK
| | - Seong-Il Oh
- From the Department of Neurology, Seoul National University Hospital (Y.N.K., J.J.S., S.M.K); Department of Neurology, Neuroscience Research Institute, Seoul National University College of Medicine (B.K., J.J.S., S.M.K); Department of Neurology (J.S.K.), Seoul National University Bundang Hospital, Seongnam; Department of Neurology (H.M.), Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong; Department of Neurology (K.C.), Konkuk University School of Medicine, Konkuk University Medical Center; Department of Neurology (S-.i.O.), Busan Paik Hospital, Inje University College of Medicine, Busan; Department of Neurology (J.-E.K.), Seoul Hospital, Ewha Womans University College of Medicine; Department of Neurology (T.-S.N.), Chonnam National University Medical School, Gwangju; Department of Neurology (E.H.S.), Chungnam National University College of Medicine, Chungnam National University Hospital, Daejeon; Department of Neurology (S.H.H., K-C.P., S.S.Y.), Kyung Hee University Hospital, Kyung Hee University School of Medicine; Department of Neurology (S.B.K.), Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine; Department of Neurology (S-H.B., B.-J.K.), Korea University College of Medicine, Korea University Anam Hospital; Department of Ophthalmology (J.H.J., S.-J.K.), Seoul National University College of Medicine; Department of Pathology (S.-H.P.), Seoul National University Hospital, Seoul National University, College of Medicine, Seoul; Autoimmune Neurology Group (P.W.), Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, Oxford, UK
| | - Jee-Eun Kim
- From the Department of Neurology, Seoul National University Hospital (Y.N.K., J.J.S., S.M.K); Department of Neurology, Neuroscience Research Institute, Seoul National University College of Medicine (B.K., J.J.S., S.M.K); Department of Neurology (J.S.K.), Seoul National University Bundang Hospital, Seongnam; Department of Neurology (H.M.), Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong; Department of Neurology (K.C.), Konkuk University School of Medicine, Konkuk University Medical Center; Department of Neurology (S-.i.O.), Busan Paik Hospital, Inje University College of Medicine, Busan; Department of Neurology (J.-E.K.), Seoul Hospital, Ewha Womans University College of Medicine; Department of Neurology (T.-S.N.), Chonnam National University Medical School, Gwangju; Department of Neurology (E.H.S.), Chungnam National University College of Medicine, Chungnam National University Hospital, Daejeon; Department of Neurology (S.H.H., K-C.P., S.S.Y.), Kyung Hee University Hospital, Kyung Hee University School of Medicine; Department of Neurology (S.B.K.), Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine; Department of Neurology (S-H.B., B.-J.K.), Korea University College of Medicine, Korea University Anam Hospital; Department of Ophthalmology (J.H.J., S.-J.K.), Seoul National University College of Medicine; Department of Pathology (S.-H.P.), Seoul National University Hospital, Seoul National University, College of Medicine, Seoul; Autoimmune Neurology Group (P.W.), Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, Oxford, UK.
| | - Tai-Seung Nam
- From the Department of Neurology, Seoul National University Hospital (Y.N.K., J.J.S., S.M.K); Department of Neurology, Neuroscience Research Institute, Seoul National University College of Medicine (B.K., J.J.S., S.M.K); Department of Neurology (J.S.K.), Seoul National University Bundang Hospital, Seongnam; Department of Neurology (H.M.), Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong; Department of Neurology (K.C.), Konkuk University School of Medicine, Konkuk University Medical Center; Department of Neurology (S-.i.O.), Busan Paik Hospital, Inje University College of Medicine, Busan; Department of Neurology (J.-E.K.), Seoul Hospital, Ewha Womans University College of Medicine; Department of Neurology (T.-S.N.), Chonnam National University Medical School, Gwangju; Department of Neurology (E.H.S.), Chungnam National University College of Medicine, Chungnam National University Hospital, Daejeon; Department of Neurology (S.H.H., K-C.P., S.S.Y.), Kyung Hee University Hospital, Kyung Hee University School of Medicine; Department of Neurology (S.B.K.), Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine; Department of Neurology (S-H.B., B.-J.K.), Korea University College of Medicine, Korea University Anam Hospital; Department of Ophthalmology (J.H.J., S.-J.K.), Seoul National University College of Medicine; Department of Pathology (S.-H.P.), Seoul National University Hospital, Seoul National University, College of Medicine, Seoul; Autoimmune Neurology Group (P.W.), Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, Oxford, UK
| | - Eun Hee Sohn
- From the Department of Neurology, Seoul National University Hospital (Y.N.K., J.J.S., S.M.K); Department of Neurology, Neuroscience Research Institute, Seoul National University College of Medicine (B.K., J.J.S., S.M.K); Department of Neurology (J.S.K.), Seoul National University Bundang Hospital, Seongnam; Department of Neurology (H.M.), Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong; Department of Neurology (K.C.), Konkuk University School of Medicine, Konkuk University Medical Center; Department of Neurology (S-.i.O.), Busan Paik Hospital, Inje University College of Medicine, Busan; Department of Neurology (J.-E.K.), Seoul Hospital, Ewha Womans University College of Medicine; Department of Neurology (T.-S.N.), Chonnam National University Medical School, Gwangju; Department of Neurology (E.H.S.), Chungnam National University College of Medicine, Chungnam National University Hospital, Daejeon; Department of Neurology (S.H.H., K-C.P., S.S.Y.), Kyung Hee University Hospital, Kyung Hee University School of Medicine; Department of Neurology (S.B.K.), Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine; Department of Neurology (S-H.B., B.-J.K.), Korea University College of Medicine, Korea University Anam Hospital; Department of Ophthalmology (J.H.J., S.-J.K.), Seoul National University College of Medicine; Department of Pathology (S.-H.P.), Seoul National University Hospital, Seoul National University, College of Medicine, Seoul; Autoimmune Neurology Group (P.W.), Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, Oxford, UK
| | - Sung Hyuk Heo
- From the Department of Neurology, Seoul National University Hospital (Y.N.K., J.J.S., S.M.K); Department of Neurology, Neuroscience Research Institute, Seoul National University College of Medicine (B.K., J.J.S., S.M.K); Department of Neurology (J.S.K.), Seoul National University Bundang Hospital, Seongnam; Department of Neurology (H.M.), Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong; Department of Neurology (K.C.), Konkuk University School of Medicine, Konkuk University Medical Center; Department of Neurology (S-.i.O.), Busan Paik Hospital, Inje University College of Medicine, Busan; Department of Neurology (J.-E.K.), Seoul Hospital, Ewha Womans University College of Medicine; Department of Neurology (T.-S.N.), Chonnam National University Medical School, Gwangju; Department of Neurology (E.H.S.), Chungnam National University College of Medicine, Chungnam National University Hospital, Daejeon; Department of Neurology (S.H.H., K-C.P., S.S.Y.), Kyung Hee University Hospital, Kyung Hee University School of Medicine; Department of Neurology (S.B.K.), Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine; Department of Neurology (S-H.B., B.-J.K.), Korea University College of Medicine, Korea University Anam Hospital; Department of Ophthalmology (J.H.J., S.-J.K.), Seoul National University College of Medicine; Department of Pathology (S.-H.P.), Seoul National University Hospital, Seoul National University, College of Medicine, Seoul; Autoimmune Neurology Group (P.W.), Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, Oxford, UK
| | - Sang Beom Kim
- From the Department of Neurology, Seoul National University Hospital (Y.N.K., J.J.S., S.M.K); Department of Neurology, Neuroscience Research Institute, Seoul National University College of Medicine (B.K., J.J.S., S.M.K); Department of Neurology (J.S.K.), Seoul National University Bundang Hospital, Seongnam; Department of Neurology (H.M.), Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong; Department of Neurology (K.C.), Konkuk University School of Medicine, Konkuk University Medical Center; Department of Neurology (S-.i.O.), Busan Paik Hospital, Inje University College of Medicine, Busan; Department of Neurology (J.-E.K.), Seoul Hospital, Ewha Womans University College of Medicine; Department of Neurology (T.-S.N.), Chonnam National University Medical School, Gwangju; Department of Neurology (E.H.S.), Chungnam National University College of Medicine, Chungnam National University Hospital, Daejeon; Department of Neurology (S.H.H., K-C.P., S.S.Y.), Kyung Hee University Hospital, Kyung Hee University School of Medicine; Department of Neurology (S.B.K.), Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine; Department of Neurology (S-H.B., B.-J.K.), Korea University College of Medicine, Korea University Anam Hospital; Department of Ophthalmology (J.H.J., S.-J.K.), Seoul National University College of Medicine; Department of Pathology (S.-H.P.), Seoul National University Hospital, Seoul National University, College of Medicine, Seoul; Autoimmune Neurology Group (P.W.), Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, Oxford, UK.
| | - Key-Chung Park
- From the Department of Neurology, Seoul National University Hospital (Y.N.K., J.J.S., S.M.K); Department of Neurology, Neuroscience Research Institute, Seoul National University College of Medicine (B.K., J.J.S., S.M.K); Department of Neurology (J.S.K.), Seoul National University Bundang Hospital, Seongnam; Department of Neurology (H.M.), Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong; Department of Neurology (K.C.), Konkuk University School of Medicine, Konkuk University Medical Center; Department of Neurology (S-.i.O.), Busan Paik Hospital, Inje University College of Medicine, Busan; Department of Neurology (J.-E.K.), Seoul Hospital, Ewha Womans University College of Medicine; Department of Neurology (T.-S.N.), Chonnam National University Medical School, Gwangju; Department of Neurology (E.H.S.), Chungnam National University College of Medicine, Chungnam National University Hospital, Daejeon; Department of Neurology (S.H.H., K-C.P., S.S.Y.), Kyung Hee University Hospital, Kyung Hee University School of Medicine; Department of Neurology (S.B.K.), Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine; Department of Neurology (S-H.B., B.-J.K.), Korea University College of Medicine, Korea University Anam Hospital; Department of Ophthalmology (J.H.J., S.-J.K.), Seoul National University College of Medicine; Department of Pathology (S.-H.P.), Seoul National University Hospital, Seoul National University, College of Medicine, Seoul; Autoimmune Neurology Group (P.W.), Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, Oxford, UK
| | - Sung Sang Yoon
- From the Department of Neurology, Seoul National University Hospital (Y.N.K., J.J.S., S.M.K); Department of Neurology, Neuroscience Research Institute, Seoul National University College of Medicine (B.K., J.J.S., S.M.K); Department of Neurology (J.S.K.), Seoul National University Bundang Hospital, Seongnam; Department of Neurology (H.M.), Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong; Department of Neurology (K.C.), Konkuk University School of Medicine, Konkuk University Medical Center; Department of Neurology (S-.i.O.), Busan Paik Hospital, Inje University College of Medicine, Busan; Department of Neurology (J.-E.K.), Seoul Hospital, Ewha Womans University College of Medicine; Department of Neurology (T.-S.N.), Chonnam National University Medical School, Gwangju; Department of Neurology (E.H.S.), Chungnam National University College of Medicine, Chungnam National University Hospital, Daejeon; Department of Neurology (S.H.H., K-C.P., S.S.Y.), Kyung Hee University Hospital, Kyung Hee University School of Medicine; Department of Neurology (S.B.K.), Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine; Department of Neurology (S-H.B., B.-J.K.), Korea University College of Medicine, Korea University Anam Hospital; Department of Ophthalmology (J.H.J., S.-J.K.), Seoul National University College of Medicine; Department of Pathology (S.-H.P.), Seoul National University Hospital, Seoul National University, College of Medicine, Seoul; Autoimmune Neurology Group (P.W.), Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, Oxford, UK
| | - Jeeyoung Oh
- From the Department of Neurology, Seoul National University Hospital (Y.N.K., J.J.S., S.M.K); Department of Neurology, Neuroscience Research Institute, Seoul National University College of Medicine (B.K., J.J.S., S.M.K); Department of Neurology (J.S.K.), Seoul National University Bundang Hospital, Seongnam; Department of Neurology (H.M.), Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong; Department of Neurology (K.C.), Konkuk University School of Medicine, Konkuk University Medical Center; Department of Neurology (S-.i.O.), Busan Paik Hospital, Inje University College of Medicine, Busan; Department of Neurology (J.-E.K.), Seoul Hospital, Ewha Womans University College of Medicine; Department of Neurology (T.-S.N.), Chonnam National University Medical School, Gwangju; Department of Neurology (E.H.S.), Chungnam National University College of Medicine, Chungnam National University Hospital, Daejeon; Department of Neurology (S.H.H., K-C.P., S.S.Y.), Kyung Hee University Hospital, Kyung Hee University School of Medicine; Department of Neurology (S.B.K.), Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine; Department of Neurology (S-H.B., B.-J.K.), Korea University College of Medicine, Korea University Anam Hospital; Department of Ophthalmology (J.H.J., S.-J.K.), Seoul National University College of Medicine; Department of Pathology (S.-H.P.), Seoul National University Hospital, Seoul National University, College of Medicine, Seoul; Autoimmune Neurology Group (P.W.), Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, Oxford, UK
| | - Seol-Hee Baek
- From the Department of Neurology, Seoul National University Hospital (Y.N.K., J.J.S., S.M.K); Department of Neurology, Neuroscience Research Institute, Seoul National University College of Medicine (B.K., J.J.S., S.M.K); Department of Neurology (J.S.K.), Seoul National University Bundang Hospital, Seongnam; Department of Neurology (H.M.), Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong; Department of Neurology (K.C.), Konkuk University School of Medicine, Konkuk University Medical Center; Department of Neurology (S-.i.O.), Busan Paik Hospital, Inje University College of Medicine, Busan; Department of Neurology (J.-E.K.), Seoul Hospital, Ewha Womans University College of Medicine; Department of Neurology (T.-S.N.), Chonnam National University Medical School, Gwangju; Department of Neurology (E.H.S.), Chungnam National University College of Medicine, Chungnam National University Hospital, Daejeon; Department of Neurology (S.H.H., K-C.P., S.S.Y.), Kyung Hee University Hospital, Kyung Hee University School of Medicine; Department of Neurology (S.B.K.), Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine; Department of Neurology (S-H.B., B.-J.K.), Korea University College of Medicine, Korea University Anam Hospital; Department of Ophthalmology (J.H.J., S.-J.K.), Seoul National University College of Medicine; Department of Pathology (S.-H.P.), Seoul National University Hospital, Seoul National University, College of Medicine, Seoul; Autoimmune Neurology Group (P.W.), Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, Oxford, UK
| | - Byung-Jo Kim
- From the Department of Neurology, Seoul National University Hospital (Y.N.K., J.J.S., S.M.K); Department of Neurology, Neuroscience Research Institute, Seoul National University College of Medicine (B.K., J.J.S., S.M.K); Department of Neurology (J.S.K.), Seoul National University Bundang Hospital, Seongnam; Department of Neurology (H.M.), Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong; Department of Neurology (K.C.), Konkuk University School of Medicine, Konkuk University Medical Center; Department of Neurology (S-.i.O.), Busan Paik Hospital, Inje University College of Medicine, Busan; Department of Neurology (J.-E.K.), Seoul Hospital, Ewha Womans University College of Medicine; Department of Neurology (T.-S.N.), Chonnam National University Medical School, Gwangju; Department of Neurology (E.H.S.), Chungnam National University College of Medicine, Chungnam National University Hospital, Daejeon; Department of Neurology (S.H.H., K-C.P., S.S.Y.), Kyung Hee University Hospital, Kyung Hee University School of Medicine; Department of Neurology (S.B.K.), Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine; Department of Neurology (S-H.B., B.-J.K.), Korea University College of Medicine, Korea University Anam Hospital; Department of Ophthalmology (J.H.J., S.-J.K.), Seoul National University College of Medicine; Department of Pathology (S.-H.P.), Seoul National University Hospital, Seoul National University, College of Medicine, Seoul; Autoimmune Neurology Group (P.W.), Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, Oxford, UK.
| | - Kyung Seok Park
- From the Department of Neurology, Seoul National University Hospital (Y.N.K., J.J.S., S.M.K); Department of Neurology, Neuroscience Research Institute, Seoul National University College of Medicine (B.K., J.J.S., S.M.K); Department of Neurology (J.S.K.), Seoul National University Bundang Hospital, Seongnam; Department of Neurology (H.M.), Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong; Department of Neurology (K.C.), Konkuk University School of Medicine, Konkuk University Medical Center; Department of Neurology (S-.i.O.), Busan Paik Hospital, Inje University College of Medicine, Busan; Department of Neurology (J.-E.K.), Seoul Hospital, Ewha Womans University College of Medicine; Department of Neurology (T.-S.N.), Chonnam National University Medical School, Gwangju; Department of Neurology (E.H.S.), Chungnam National University College of Medicine, Chungnam National University Hospital, Daejeon; Department of Neurology (S.H.H., K-C.P., S.S.Y.), Kyung Hee University Hospital, Kyung Hee University School of Medicine; Department of Neurology (S.B.K.), Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine; Department of Neurology (S-H.B., B.-J.K.), Korea University College of Medicine, Korea University Anam Hospital; Department of Ophthalmology (J.H.J., S.-J.K.), Seoul National University College of Medicine; Department of Pathology (S.-H.P.), Seoul National University Hospital, Seoul National University, College of Medicine, Seoul; Autoimmune Neurology Group (P.W.), Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, Oxford, UK
| | - Jung-Joon Sung
- From the Department of Neurology, Seoul National University Hospital (Y.N.K., J.J.S., S.M.K); Department of Neurology, Neuroscience Research Institute, Seoul National University College of Medicine (B.K., J.J.S., S.M.K); Department of Neurology (J.S.K.), Seoul National University Bundang Hospital, Seongnam; Department of Neurology (H.M.), Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong; Department of Neurology (K.C.), Konkuk University School of Medicine, Konkuk University Medical Center; Department of Neurology (S-.i.O.), Busan Paik Hospital, Inje University College of Medicine, Busan; Department of Neurology (J.-E.K.), Seoul Hospital, Ewha Womans University College of Medicine; Department of Neurology (T.-S.N.), Chonnam National University Medical School, Gwangju; Department of Neurology (E.H.S.), Chungnam National University College of Medicine, Chungnam National University Hospital, Daejeon; Department of Neurology (S.H.H., K-C.P., S.S.Y.), Kyung Hee University Hospital, Kyung Hee University School of Medicine; Department of Neurology (S.B.K.), Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine; Department of Neurology (S-H.B., B.-J.K.), Korea University College of Medicine, Korea University Anam Hospital; Department of Ophthalmology (J.H.J., S.-J.K.), Seoul National University College of Medicine; Department of Pathology (S.-H.P.), Seoul National University Hospital, Seoul National University, College of Medicine, Seoul; Autoimmune Neurology Group (P.W.), Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, Oxford, UK
| | - Jae Ho Jung
- From the Department of Neurology, Seoul National University Hospital (Y.N.K., J.J.S., S.M.K); Department of Neurology, Neuroscience Research Institute, Seoul National University College of Medicine (B.K., J.J.S., S.M.K); Department of Neurology (J.S.K.), Seoul National University Bundang Hospital, Seongnam; Department of Neurology (H.M.), Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong; Department of Neurology (K.C.), Konkuk University School of Medicine, Konkuk University Medical Center; Department of Neurology (S-.i.O.), Busan Paik Hospital, Inje University College of Medicine, Busan; Department of Neurology (J.-E.K.), Seoul Hospital, Ewha Womans University College of Medicine; Department of Neurology (T.-S.N.), Chonnam National University Medical School, Gwangju; Department of Neurology (E.H.S.), Chungnam National University College of Medicine, Chungnam National University Hospital, Daejeon; Department of Neurology (S.H.H., K-C.P., S.S.Y.), Kyung Hee University Hospital, Kyung Hee University School of Medicine; Department of Neurology (S.B.K.), Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine; Department of Neurology (S-H.B., B.-J.K.), Korea University College of Medicine, Korea University Anam Hospital; Department of Ophthalmology (J.H.J., S.-J.K.), Seoul National University College of Medicine; Department of Pathology (S.-H.P.), Seoul National University Hospital, Seoul National University, College of Medicine, Seoul; Autoimmune Neurology Group (P.W.), Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, Oxford, UK
| | - Seong-Joon Kim
- From the Department of Neurology, Seoul National University Hospital (Y.N.K., J.J.S., S.M.K); Department of Neurology, Neuroscience Research Institute, Seoul National University College of Medicine (B.K., J.J.S., S.M.K); Department of Neurology (J.S.K.), Seoul National University Bundang Hospital, Seongnam; Department of Neurology (H.M.), Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong; Department of Neurology (K.C.), Konkuk University School of Medicine, Konkuk University Medical Center; Department of Neurology (S-.i.O.), Busan Paik Hospital, Inje University College of Medicine, Busan; Department of Neurology (J.-E.K.), Seoul Hospital, Ewha Womans University College of Medicine; Department of Neurology (T.-S.N.), Chonnam National University Medical School, Gwangju; Department of Neurology (E.H.S.), Chungnam National University College of Medicine, Chungnam National University Hospital, Daejeon; Department of Neurology (S.H.H., K-C.P., S.S.Y.), Kyung Hee University Hospital, Kyung Hee University School of Medicine; Department of Neurology (S.B.K.), Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine; Department of Neurology (S-H.B., B.-J.K.), Korea University College of Medicine, Korea University Anam Hospital; Department of Ophthalmology (J.H.J., S.-J.K.), Seoul National University College of Medicine; Department of Pathology (S.-H.P.), Seoul National University Hospital, Seoul National University, College of Medicine, Seoul; Autoimmune Neurology Group (P.W.), Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, Oxford, UK.
| | - Sung-Hye Park
- From the Department of Neurology, Seoul National University Hospital (Y.N.K., J.J.S., S.M.K); Department of Neurology, Neuroscience Research Institute, Seoul National University College of Medicine (B.K., J.J.S., S.M.K); Department of Neurology (J.S.K.), Seoul National University Bundang Hospital, Seongnam; Department of Neurology (H.M.), Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong; Department of Neurology (K.C.), Konkuk University School of Medicine, Konkuk University Medical Center; Department of Neurology (S-.i.O.), Busan Paik Hospital, Inje University College of Medicine, Busan; Department of Neurology (J.-E.K.), Seoul Hospital, Ewha Womans University College of Medicine; Department of Neurology (T.-S.N.), Chonnam National University Medical School, Gwangju; Department of Neurology (E.H.S.), Chungnam National University College of Medicine, Chungnam National University Hospital, Daejeon; Department of Neurology (S.H.H., K-C.P., S.S.Y.), Kyung Hee University Hospital, Kyung Hee University School of Medicine; Department of Neurology (S.B.K.), Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine; Department of Neurology (S-H.B., B.-J.K.), Korea University College of Medicine, Korea University Anam Hospital; Department of Ophthalmology (J.H.J., S.-J.K.), Seoul National University College of Medicine; Department of Pathology (S.-H.P.), Seoul National University Hospital, Seoul National University, College of Medicine, Seoul; Autoimmune Neurology Group (P.W.), Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, Oxford, UK
| | - Patrick Waters
- From the Department of Neurology, Seoul National University Hospital (Y.N.K., J.J.S., S.M.K); Department of Neurology, Neuroscience Research Institute, Seoul National University College of Medicine (B.K., J.J.S., S.M.K); Department of Neurology (J.S.K.), Seoul National University Bundang Hospital, Seongnam; Department of Neurology (H.M.), Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong; Department of Neurology (K.C.), Konkuk University School of Medicine, Konkuk University Medical Center; Department of Neurology (S-.i.O.), Busan Paik Hospital, Inje University College of Medicine, Busan; Department of Neurology (J.-E.K.), Seoul Hospital, Ewha Womans University College of Medicine; Department of Neurology (T.-S.N.), Chonnam National University Medical School, Gwangju; Department of Neurology (E.H.S.), Chungnam National University College of Medicine, Chungnam National University Hospital, Daejeon; Department of Neurology (S.H.H., K-C.P., S.S.Y.), Kyung Hee University Hospital, Kyung Hee University School of Medicine; Department of Neurology (S.B.K.), Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine; Department of Neurology (S-H.B., B.-J.K.), Korea University College of Medicine, Korea University Anam Hospital; Department of Ophthalmology (J.H.J., S.-J.K.), Seoul National University College of Medicine; Department of Pathology (S.-H.P.), Seoul National University Hospital, Seoul National University, College of Medicine, Seoul; Autoimmune Neurology Group (P.W.), Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, Oxford, UK
| | - Sung-Min Kim
- From the Department of Neurology, Seoul National University Hospital (Y.N.K., J.J.S., S.M.K); Department of Neurology, Neuroscience Research Institute, Seoul National University College of Medicine (B.K., J.J.S., S.M.K); Department of Neurology (J.S.K.), Seoul National University Bundang Hospital, Seongnam; Department of Neurology (H.M.), Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong; Department of Neurology (K.C.), Konkuk University School of Medicine, Konkuk University Medical Center; Department of Neurology (S-.i.O.), Busan Paik Hospital, Inje University College of Medicine, Busan; Department of Neurology (J.-E.K.), Seoul Hospital, Ewha Womans University College of Medicine; Department of Neurology (T.-S.N.), Chonnam National University Medical School, Gwangju; Department of Neurology (E.H.S.), Chungnam National University College of Medicine, Chungnam National University Hospital, Daejeon; Department of Neurology (S.H.H., K-C.P., S.S.Y.), Kyung Hee University Hospital, Kyung Hee University School of Medicine; Department of Neurology (S.B.K.), Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine; Department of Neurology (S-H.B., B.-J.K.), Korea University College of Medicine, Korea University Anam Hospital; Department of Ophthalmology (J.H.J., S.-J.K.), Seoul National University College of Medicine; Department of Pathology (S.-H.P.), Seoul National University Hospital, Seoul National University, College of Medicine, Seoul; Autoimmune Neurology Group (P.W.), Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, Oxford, UK.
| |
Collapse
|
18
|
Kim SH, Jeon ET, Yu S, Kyungmi O, Kim CK, Song TJ, Kim YJ, Heo SH, Park KY, Kim JM, Park JH, Choi JC, Park MS, Kim JT, Choi KH, Hwang YH, Kim BJ, Chung JW, Bang OY, Kim G, Seo WK, Jung JM. Interpretable machine learning for early neurological deterioration prediction in atrial fibrillation-related stroke. J Neurol Sci 2021. [DOI: 10.1016/j.jns.2021.118754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
19
|
Park JH, Kwon SU, Kwon HS, Heo SH. Prior intracerebral hemorrhage and white matter hyperintensity burden on recurrent stroke risk. Sci Rep 2021; 11:17406. [PMID: 34465828 PMCID: PMC8408204 DOI: 10.1038/s41598-021-96809-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 08/09/2021] [Indexed: 11/23/2022] Open
Abstract
Prior intracerebral hemorrhage (ICH) is associated with increased risk of ischemic stroke. Since white matter hyperintensity (WMH) is associated with ischemic stroke and ICH, this study aimed to evaluate the relationship between ICH and the risk of recurrent stroke by WMH severity. From a prospective multicenter database comprising 1454 noncardioembolic stroke patients with cerebral small-vessel disease, patients were categorized by presence or absence of prior ICH and WMH severity: mild-moderate WMH (reference); advanced WMH; ICH with mild-moderate WMH; and ICH with advanced WMH. Among patients with ICH, the association with stroke outcomes by WMH burden was further assessed. The primary endpoint was ischemic stroke and hemorrhagic stroke. The secondary endpoint was major adverse cardiovascular events (MACE): stroke/coronary heart disease/vascular death. During the mean 1.9-year follow-up period, the ischemic stroke incidence rate per 100 person-years was 2.7, 4.0, 2.5, and 8.1 in increasing severity, and the rate of hemorrhagic stroke was 0.7, 1.3, 0.6, and 2.1, respectively. The risk of ischemic stroke was higher in ICH with advanced WMH (adjusted HR 2.62; 95% CI 1.22−5.60) than the reference group, while the risk of hemorrhagic stroke trended higher (3.75, 0.85–16.53). The risk of MACE showed a similar pattern in ICH with advanced WMH. Among ICH patients, compared with mild WMH, the risk of ischemic stroke trended to be higher in advanced WMH (HR 3.37; 95% CI 0.90‒12.61). Advanced WMH was independently associated with an increased risk of hemorrhagic stroke (HR 33.96; 95% CI 1.52−760.95). Given the fewer rate of hemorrhagic stroke, the risk of hemorrhagic stroke might not outweigh the benefits of antiplatelet therapy for secondary prevention.
Collapse
Affiliation(s)
- Jong-Ho Park
- Department of Neurology, Myongji Hospital, Hanyang University College of Medicine, Goyang, Korea.
| | - Sun U Kwon
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
| | - Hyuk Sung Kwon
- Department of Neurology, Hanyang University College of Medicine, Seoul, Korea
| | - Sung Hyuk Heo
- Department of Neurology, Kyung Hee University Hospital, Seoul, Korea
| |
Collapse
|
20
|
Kang HG, Lee SJ, Heo SH, Chang DI, Kim BJ. Clopidogrel Resistance in Patients With Stroke Recurrence Under Single or Dual Antiplatelet Treatment. Front Neurol 2021; 12:652416. [PMID: 34447343 PMCID: PMC8383201 DOI: 10.3389/fneur.2021.652416] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 07/19/2021] [Indexed: 01/01/2023] Open
Abstract
Background: The factors associated with clopidogrel resistance in patients with stroke recurrence receiving single or dual antiplatelet treatment (SAPT or DAPT) may differ. This study compared the high on-treatment platelet reactivities (HPRs) and the factors associated with clopidogrel resistance in recurrent ischemic stroke patients receiving clopidogrel or aspirin and clopidogrel. Methods: We enrolled and allocated 275 recurrent ischemic stroke patients to the clopidogrel and DAPT groups and compared their demographics, conventional risk factors, and P2Y12 reaction units (PRUs). Clopidogrel resistance was categorized as PRU higher than 275. We performed a multivariate logistic regression analysis to determine the factors underlying clopidogrel resistance during SAPT and DAPT. Results: In total, 145 (52.7%) and 130 (47.3%) patients received clopidogrel and DAPT, respectively at recurrence. The risk factors of the two groups were not significantly different, except that coronary artery disease was more frequent in the DAPT group. The PRU was higher (255 ± 91 vs. 221 ± 84; p = 0.002) and clopidogrel resistance was more frequent (45.5 vs. 31.5%; p = 0.018) in the SAPT than in the DAPT group. Hyperlipidemia was associated with clopidogrel resistance during SAPT, and smoking (Odds ratio = 0.426, 95% confidence interval 0.210–0.861; p = 0.018) had a protective effect against clopidogrel resistance. For those receiving DAPT, old age, female, low hemoglobin A1c level, and high ARU were associated with clopidogrel resistance. Conclusions: HPR and clopidogrel resistance were more frequent in recurrent ischemic stroke patients receiving clopidogrel than in those receiving DAPT. Smoking was independently associated with less clopidogrel resistance among those receiving clopidogrel SAPT but not in those receiving DAPT.
Collapse
Affiliation(s)
- Hyun Goo Kang
- Department of Neurology, Research Institute of Clinical Medicine of Jeonbuk National University - Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, South Korea
| | - Seung Jae Lee
- Institute for Molecular Biology and Genetics and Department of Chemistry, Jeonbuk National University, Jeonju, South Korea
| | - Sung Hyuk Heo
- Department of Neurology, Kyung Hee University School of Medicine, Seoul, South Korea
| | - Dae-Il Chang
- Department of Neurology, Kyung Hee University School of Medicine, Seoul, South Korea
| | - Bum Joon Kim
- Department of Neurology, Asan Medical Center, University of Ulsan, School of Medicine, Seoul, South Korea
| |
Collapse
|
21
|
Park JH, Chung JW, Bang OY, Kim GM, Choi KH, Park MS, Kim JT, Hwang YH, Song TJ, Kim YJ, Kim BJ, Heo SH, Jung JM, Oh K, Kim CK, Yu S, Park KY, Kim JM, Choi JC, Seo WK. Atherosclerotic Burden and Vascular Risk in Stroke Patients With Atrial Fibrillation. Stroke 2021; 52:1662-1672. [PMID: 33794654 DOI: 10.1161/strokeaha.120.032232] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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
[Figure: see text].
Collapse
Affiliation(s)
- Jong-Ho Park
- Department of Neurology, Myongji Hospital, Hanyang University College of Medicine, Goyang, Korea (J.-H.P.)
| | - Jong-Won Chung
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea (J.-W.C., O.Y.B., G.-M.K., W.-K.S.)
| | - Oh Young Bang
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea (J.-W.C., O.Y.B., G.-M.K., W.-K.S.)
| | - Gyeong-Moon Kim
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea (J.-W.C., O.Y.B., G.-M.K., W.-K.S.)
| | - Kang-Ho Choi
- Department of Neurology, Chonnam National University Hospital, Gwangju, Korea (K.-H.C., M.-S.P., J.-T.K.)
| | - Man-Seok Park
- Department of Neurology, Chonnam National University Hospital, Gwangju, Korea (K.-H.C., M.-S.P., J.-T.K.)
| | - Joon-Tae Kim
- Department of Neurology, Chonnam National University Hospital, Gwangju, Korea (K.-H.C., M.-S.P., J.-T.K.)
| | - Yang-Ha Hwang
- Department of Neurology, Kyungpook National University Hospital, School of Medicine, Kyungpook National University, Daegu, Korea (Y.-H.H.)
| | - Tae-Jin Song
- Department of Neurology, Ewha Womans University Seoul Hospital, Ewha Womans University College of Medicine, Seoul, Korea (T.-J.S.)
| | - Yong-Jae Kim
- Department of Neurology, Eunpyeong St. Mary's Hospital, The Catholic University of Korea, Seoul (Y.-J.K.)
| | - Bum Joon Kim
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea (B.J.K.)
| | - Sung Hyuk Heo
- Department of Neurology, Kyung Hee University College of Medicine, Seoul, Korea (S.H.H.)
| | - Jin-Man Jung
- Department of Neurology, Korea University Ansan Hospital (J.-M.J.), Korea University College of Medicine
| | - Kyungmi Oh
- Department of Neurology, Korea University Guro Hospital (K.O., C.K.K.), Korea University College of Medicine
| | - Chi Kyung Kim
- Department of Neurology, Korea University Guro Hospital (K.O., C.K.K.), Korea University College of Medicine
| | - Sungwook Yu
- Department of Neurology, Korea University Anam Hospital (S.Y.), Korea University College of Medicine
| | - Kwang Yeol Park
- Department of Neurology, Chung-Ang University College of Medicine, Seoul, Korea (K.Y.P.)
| | - Jeong-Min Kim
- Department of Neurology, Seoul National University Hospital, Korea (J.-M.K.)
| | - Jay Chol Choi
- Department of Neurology, Jeju National University, Korea (J.C.C.)
| | - Woo-Keun Seo
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea (J.-W.C., O.Y.B., G.-M.K., W.-K.S.)
| |
Collapse
|
22
|
Kim Y, Lim JS, Oh MS, Yu KH, Lee JS, Park JH, Kim YJ, Rha JH, Hwang YH, Heo SH, Ahn SH, Lee JH, Kwon SU. Blood pressure variability is related to faster cognitive decline in ischemic stroke patients: PICASSO subanalysis. Sci Rep 2021; 11:5049. [PMID: 33658545 PMCID: PMC7930263 DOI: 10.1038/s41598-021-83945-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Accepted: 01/18/2021] [Indexed: 12/27/2022] Open
Abstract
Blood pressure variability (BPV) is associated with higher cardiovascular morbidity risks; however, its association with cognitive decline remains unclear. We investigated whether higher BPV is associated with faster declines in cognitive function in ischemic stroke (IS) patients. Cognitive function was evaluated between April 2010 and August 2015 using the Mini-mental State Examination (MMSE) and Montreal Cognitive Assessment in 1,240 Korean PICASSO participants. Patients for whom baseline and follow-up cognitive test results and at least five valid BP readings were available were included. A restricted maximum likelihood–based Mixed Model for Repeated Measures was used to compare changes in cognitive function over time. Among a total of 746 participants (64.6 ± 10.8 years; 35.9% female). Baseline mean-MMSE score was 24.9 ± 4.7. The median number of BP readings was 11. During a mean follow-up of 2.6 years, mean baseline and last follow-up MMSE scores were 25.4 ± 4.8 vs. 27.8 ± 4.4 (the lowest BPV group) and 23.9 ± 5.2 vs. 23.2 ± 5.9 (the highest BPV group). After adjusting for multiple variables, higher BPV was independently associated with faster cognitive decline over time. However, no significant intergroup difference in cognitive changes associated with mean systolic BP was observed. Further research is needed to elucidate how BPV might affect cognitive function.
Collapse
Affiliation(s)
- Yerim Kim
- Department of Neurology, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Republic of Korea
| | - Jae-Sung Lim
- Department of Neurology, University of Ulsan, Asan Medical Center, Seoul, Republic of Korea
| | - Mi Sun Oh
- Department of Neurology, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Republic of Korea
| | - Kyung-Ho Yu
- Department of Neurology, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Republic of Korea
| | - Ji Sung Lee
- Clinical Research Center, Asan Institute for Life Sciences, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Jong-Ho Park
- Department of Neurology, Myongji Hospital, Hanyang University College of Medicine, Goyang, Republic of Korea
| | - Yong-Jae Kim
- Department of Neurology, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Joung-Ho Rha
- Department of Neurology, Inha University Hospital, Incheon, Republic of Korea
| | - Yang-Ha Hwang
- Department of Neurology, Kyungpook National University Hospital, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
| | - Sung Hyuk Heo
- Department of Neurology, Kyung Hee University Medical Center, Seoul, Republic of Korea
| | - Seong Hwan Ahn
- Department of Neurology, Chosun University Hospital, Gwangju, Republic of Korea
| | - Ju-Hun Lee
- Department of Neurology, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Republic of Korea.
| | - Sun U Kwon
- Department of Neurology, University of Ulsan, Asan Medical Center, Seoul, Republic of Korea.
| |
Collapse
|
23
|
Nam KW, Kim CK, Yu S, Chung JW, Bang OY, Kim GM, Jung JM, Song TJ, Kim YJ, Kim BJ, Heo SH, Park KY, Kim JM, Park JH, Choi JC, Park MS, Kim JT, Choi KH, Hwang YH, Oh K, Seo WK. Pre-Admission CHADS2 and CHA2DS2-VASc Scores on Early Neurological Worsening. Cerebrovasc Dis 2021; 50:288-295. [PMID: 33588410 DOI: 10.1159/000513396] [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] [Received: 08/28/2020] [Accepted: 11/19/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Stroke risk scores (CHADS2 and CHA2DS2-VASc) not only predict the risk of stroke in atrial fibrillation (AF) patients, but have also been associated with prognosis after stroke. OBJECTIVE The aim of this study was to evaluate the relationship between stroke risk scores and early neurological deterioration (END) in ischemic stroke patients with AF. METHODS We included consecutive ischemic stroke patients with AF admitted between January 2013 and December 2015. CHADS2 and CHA2DS2-VASc scores were calculated using the established scoring system. END was defined as an increase ≥2 on the total National Institutes of Health Stroke Scale (NIHSS) score or ≥1 on the motor NIHSS score within the first 72 h of admission. RESULTS A total of 2,099 ischemic stroke patients with AF were included. In multivariable analysis, CHA2DS2-VASc score (adjusted odds ratio [aOR] = 1.17, 95% confidence interval [CI] = 1.04-1.31) was significantly associated with END after adjusting for confounders. Initial NIHSS score, use of anticoagulants, and intracranial atherosclerosis (ICAS) were also found to be closely associated with END, independent of the CHA2DS2-VASc score. Multivariable analysis stratified by the presence of ICAS demonstrated that both CHA2DS2-VASc (aOR = 1.20, 95% CI = 1.04-1.38) and CHADS2 scores (aOR = 1.24, 95% CI = 1.01-1.52) were closely related to END in only patients with ICAS. In patients without ICAS, neither of the risk scores were associated with END. CONCLUSIONS High CHA2DS2-VASc score was associated with END in ischemic stroke patients with AF. This close relationship is more pronounced in patients with ICAS.
Collapse
Affiliation(s)
- Ki-Woong Nam
- Department of Neurology, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Chi Kyung Kim
- Department of Neurology, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Sungwook Yu
- Department of Neurology, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Jong-Won Chung
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Oh Young Bang
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Gyeong-Moon Kim
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Jin-Man Jung
- Department of Neurology, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, Republic of Korea
| | - Tae-Jin Song
- Department of Neurology, Ewha Womans University, School of Medicine, Seoul, Republic of Korea
| | - Yong-Jae Kim
- Department of Neurology, The Catholic University of Korea, Seoul, Republic of Korea
| | - Bum Joon Kim
- Department of Neurology, Kyung Hee University College of Medicine, Seoul, Republic of Korea
| | - Sung Hyuk Heo
- Department of Neurology, Kyung Hee University College of Medicine, Seoul, Republic of Korea
| | - Kwang-Yeol Park
- Department of Neurology, Chung-Ang University College of Medicine, Chung-Ang University Hospital, Seoul, Republic of Korea
| | - Jeong-Min Kim
- Department of Neurology, Chung-Ang University College of Medicine, Chung-Ang University Hospital, Seoul, Republic of Korea
| | - Jong-Ho Park
- Department of Neurology, Myongji Hospital, Hanyang University College of Medicine, Seoul, Republic of Korea
| | - Jay Chol Choi
- Department of Neurology, Jeju National University, Jeju, Republic of Korea
| | - Man-Seok Park
- Department of Neurology, Chonnam National University Hospital, Chonnam, Chonnam, Republic of Korea
| | - Joon-Tae Kim
- Department of Neurology, Chonnam National University Hospital, Chonnam, Chonnam, Republic of Korea
| | - Kang-Ho Choi
- Department of Neurology, Chonnam National University Hwasun Hospital, Hwasun, Republic of Korea
| | - Yang Ha Hwang
- Department of Neurology, Kyungpook National University Hospital, Dae-gu, Dae-gu, Republic of Korea
| | - Kyungmi Oh
- Department of Neurology, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Woo-Keun Seo
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea, .,Department of Digital Health, SHAIST, Sungkyunkwan University, Seoul, Republic of Korea,
| |
Collapse
|
24
|
Lim JS, Kwon SU, Yu KH, Yu S, Park JH, Lee BC, Oh MS, Kim YJ, Rha JH, Hwang YH, Lee JS, Heo SH, Ahn SH, Seo WK, Park JM, Lee JH, Kwon JH, Sohn SI, Jung JM, Kim HY, Kim EG, Cha JK, Park MS, Nam HS, Bae HJ, Kim DE, Park J, Kang Y, Choi J, Lee J. Cilostazol and Probucol for Cognitive Decline after Stroke: A Cognitive Outcome Substudy of the PICASSO Trial. J Stroke 2021; 23:128-131. [PMID: 33600710 PMCID: PMC7900397 DOI: 10.5853/jos.2020.03650] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Accepted: 11/18/2020] [Indexed: 12/13/2022] Open
Affiliation(s)
- Jae-Sung Lim
- Department of Neurology, Hallym University Sacred Heart Hospital, Hallym Neurological Institute, Hallym University College of Medicine, Anyang, Korea
| | - Sun U Kwon
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Kyung-Ho Yu
- Department of Neurology, Hallym University Sacred Heart Hospital, Hallym Neurological Institute, Hallym University College of Medicine, Anyang, Korea
| | - Sungwook Yu
- Department of Neurology, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea
| | - Jong-Ho Park
- Department of Neurology, Myongji Hospital, Hanyang University College of Medicine, Goyang, Korea
| | - Byung-Chul Lee
- Department of Neurology, Hallym University Sacred Heart Hospital, Hallym Neurological Institute, Hallym University College of Medicine, Anyang, Korea
| | - Mi Sun Oh
- Department of Neurology, Hallym University Sacred Heart Hospital, Hallym Neurological Institute, Hallym University College of Medicine, Anyang, Korea
| | - Yong-Jae Kim
- Department of Neurology, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Joung-Ho Rha
- Department of Neurology, Inha University Hospital, Incheon, Korea
| | - Yang-Ha Hwang
- Department of Neurology, Kyungpook National University Hospital, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Ji Sung Lee
- Clinical Research Center, Asan Institute for Life Sciences, Asan Medical Center, Seoul, Korea
| | - Sung Hyuk Heo
- Department of Neurology, Kyung Hee University Medical Center, Seoul, Korea
| | - Seong Hwan Ahn
- Department of Neurology, Chosun University Hospital, Gwangju, Korea
| | - Woo-Keun Seo
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jong-Moo Park
- Department of Neurology, Nowon Eulji Medical Center, Eulji University, Seoul, Korea
| | - Ju-Hun Lee
- Department of Neurology, Hallym University Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
| | - Jee-Hyun Kwon
- Department of Neurology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Sung-Il Sohn
- Department of Neurology, Keimyung University Dongsan Hospital, Keimyung University School of Medicine, Daegu, Korea
| | - Jin-Man Jung
- Department of Neurology, Korea University Ansan Hospital, Ansan, Korea
| | - Hahn Young Kim
- Department of Neurology, Konkuk University School of Medicine, Seoul, Korea
| | - Eung-Gyu Kim
- Department of Neurology, Inje University Busan Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Jae-Kwan Cha
- Department of Neurology, Dong-A University Hospital, Busan, Korea
| | - Man-Seok Park
- Department of Neurology, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Korea
| | - Hyo Suk Nam
- Department of Neurology, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Hee-Joon Bae
- Department of Neurology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Dong-Eog Kim
- Department of Neurology, Dongguk University Ilsan Hospital, Goyang, Korea
| | - Jaeseol Park
- Department of Neurology, Hallym University Sacred Heart Hospital, Hallym Neurological Institute, Hallym University College of Medicine, Anyang, Korea
| | - Yeonwook Kang
- Department of Psychology, Hallym University, Chuncheon, Korea
| | - Jimi Choi
- Department of Biostatistics, Korea University College of Medicine, Seoul, Korea
| | - Juneyoung Lee
- Department of Biostatistics, Korea University College of Medicine, Seoul, Korea.,BK21 FOUR R&E Center for Learning Health Systems, Korea University, Seoul, Korea
| |
Collapse
|
25
|
Eun MY, Kim JY, Hwang YH, Park MS, Kim JT, Choi KH, Jung JM, Yu S, Kim CK, Oh K, Song TJ, Kim YJ, Kim BJ, Heo SH, Park KY, Kim JM, Park JH, Choi JC, Chung JW, Bang OY, Kim GM, Seo WK. Initiation of Guideline-Matched Oral Anticoagulant in Atrial Fibrillation-Related Stroke. J Stroke 2021; 23:113-123. [PMID: 33600708 PMCID: PMC7900398 DOI: 10.5853/jos.2020.03440] [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: 08/14/2020] [Accepted: 11/19/2020] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND AND PURPOSE To evaluate the outcome events and bleeding complications of the European Society of Cardiology (ESC) guideline-matched oral anticoagulant therapy for patients with acute ischemic stroke and atrial fibrillation (AF). METHODS Patients with acute ischemic stroke and AF from a nationwide multicenter registry (Korean ATrial fibrillaTion EvaluatioN regisTry in Ischemic strOke patieNts [K-ATTENTION]) between January 2013 and December 2015 were included in the study. Patients were divided into the ESC guideline-matched and the non-matched groups. The primary outcome was recurrence of any stroke during the 90-day follow-up period. Secondary outcomes were major adverse cerebrovascular and cardiovascular events, ischemic stroke, intracranial hemorrhage, acute coronary syndrome, allcause mortality, and major hemorrhage. Propensity score matching and logistic regression analyses were performed to assess the effect of the treatments administered. RESULTS Among 2,321 eligible patients, 1,126 patients were 1:1 matched to the ESC guidelinematched and the non-matched groups. As compared with the non-matched group, the ESC guideline-matched group had a lower risk of any recurrent stroke (1.4% vs. 3.4%; odds ratio [OR], 0.41; 95% confidence interval [CI], 0.18 to 0.95). The risk of recurrent ischemic stroke was lower in the ESC guideline-matched group than in the non-matched group (0.9% vs. 2.7%; OR, 0.32; 95% CI, 0.11 to 0.88). There was no significant difference in the other secondary outcomes between the two groups. CONCLUSIONS ESC guideline-matched oral anticoagulant therapy was associated with reduced risks of any stroke and ischemic stroke as compared with the non-matched therapy.
Collapse
Affiliation(s)
- Mi-Yeon Eun
- Department of Neurology, Kyungpook National University Chilgok Hospital, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Jae-Young Kim
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.,Department of Digital Health, Samsung Advanced Institute for Health Sciences & Technology, Sungkyunkwan University, Seoul, Korea
| | - Yang-Ha Hwang
- Department of Neurology, Kyungpook National University Hospital, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Man-Seok Park
- Department of Neurology, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Korea
| | - Joon-Tae Kim
- Department of Neurology, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Korea
| | - Kang-Ho Choi
- Department of Neurology, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Korea
| | - Jin-Man Jung
- Department of Neurology, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, Korea
| | - Sungwook Yu
- Department of Neurology, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea
| | - Chi Kyung Kim
- Department of Neurology, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Kyungmi Oh
- Department of Neurology, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Tae-Jin Song
- Department of Neurology, Ewha Womans University Seoul Hospital, Ewha Womans University School of Medicine, Seoul, Korea
| | - Yong-Jae Kim
- Department of Neurology, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Kore, Seoul, Korea
| | - Bum Joon Kim
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Sung Hyuk Heo
- Department of Neurology, Kyung Hee University Hospital, Kyung Hee University School of Medicine, Seoul, Korea
| | - Kwang-Yeol Park
- Department of Neurology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea
| | - Jeong-Min Kim
- Department of Neurology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea
| | - Jong-Ho Park
- Department of Neurology, Myongji Hospital, Hanyang University College of Medicine, Goyang, Korea
| | - Jay Chol Choi
- Department of Neurology, Jeju National University Hospital, Jeju National University College of Medicine, Jeju, Korea
| | - Jong-Won Chung
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Oh Young Bang
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Gyeong-Moon Kim
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Woo-Keun Seo
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.,Department of Digital Health, Samsung Advanced Institute for Health Sciences & Technology, Sungkyunkwan University, Seoul, Korea
| |
Collapse
|
26
|
Yu I, Song TJ, Kim BJ, Heo SH, Jung JM, Oh KM, Kim CK, Yu S, Park KY, Kim JM, Park JH, Choi JC, Park MS, Kim JT, Hwang YH, Chung JW, Bang OY, Kim GM, Kim YJ, Kim S, Woo SY, Cho H, Seo WK. CHADS2, CHA2DS2-VASc, ATRIA, and Essen stroke risk scores in stroke with atrial fibrillation: A nationwide multicenter registry study. Medicine (Baltimore) 2021; 100:e24000. [PMID: 33545993 PMCID: PMC7837865 DOI: 10.1097/md.0000000000024000] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [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: 06/26/2020] [Accepted: 11/25/2020] [Indexed: 11/27/2022] Open
Abstract
The performance of scoring systems for risk stratification in patients with atrial fibrillation (AF) was not validated well in patients with stroke. The purpose of this study was to evaluate whether the risk scoring systems predict vascular outcomes in stroke patients with AF.Data were obtained from a nationwide multicenter registry for acute stroke with AF from January 1, 2013, to December 31, 2015. We investigated the predictive power of the CHADS2, CHA2DS2-VASc, ATRIA, and Essen stroke scores in stroke patients with AF. The subjects were further stratified into groups according to treatment with or without oral anticoagulants (OACs).A total of 3112 stroke with AF subjects were included. The rate of recurrent ischemic stroke and any stroke were not associated with the CHADS2, CHA2DS2-VASc, ATRIA, and Essen stroke risk scores. The risks of death and major adverse cerebrovascular and cardiovascular events (MACEs) increased sequentially with the increase of each risk score in OAC group. (the range of C-index 0.544-0.558 for recurrent ischemic stroke; 0.523-0.537 for any stroke; 0.580-0.597 for death; 0.564-0.583 for MACEs). However, in the group treated with OACs, all risk scores were significantly associated with the risk of MACEs. The C-statistics of the 4 scoring systems were 0.544 to 0.558, 0.523 to 0.537, 0.580 to 0.597, 0.564 to 0.583, respectively, for recurrent ischemic stroke, any stroke, death, and MACEs.The performance of the CHADS2, CHA2DS2-VASc, ATRIA, and Essen stroke risk scores for the prediction of recurrent stroke was unsatisfactory in stroke patients with AF whereas the performance for the prediction of recurrent stroke was not MACEs or death was good. A new risk stratification scheme that is specific for secondary stroke prevention in the AF population is needed.
Collapse
Affiliation(s)
- Inwu Yu
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine
| | - Tae-Jin Song
- Department of Neurology, Seoul Hospital Ewha Womans University College of Medicine
| | - Bum Joon Kim
- Department of Neurology, Stroke Center, Asan Medical Center
| | - Sung Hyuk Heo
- Department of Neurology, Kyung Hee University College of Medicine, Seoul
| | - Jin-Man Jung
- Department of Neurology, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, Kyungki-Do
| | - Kyung-Mi Oh
- Department of Neurology, Korea University Guro Hospital
| | - Chi Kyung Kim
- Department of Neurology, Korea University Guro Hospital
| | - Sungwook Yu
- Department of Neurology, Korea University Anam Hospital, Korea University College of Medicine
| | - Kwang Yeol Park
- Department of Neurology, Chung-Ang University College of Medicine
| | - Jeong-Min Kim
- Department of Neurology, Seoul National University Hospital, Seoul
| | - Jong-Ho Park
- Department of Neurology, Myongji Hospital, Hanyang University College of Medicine, Goyang
| | - Jay Chol Choi
- Department of Neurology, Jeju National University, Jeju
| | - Man-Seok Park
- Department of Neurology, Chonnam National University Hospital, Gwangju
| | - Joon-Tae Kim
- Department of Neurology, Chonnam National University Hospital, Gwangju
| | - Yang-Ha Hwang
- Department of Neurology, Cerebrovascular Center, Kyungpook National University School of Medicine and Hospital, Daegu
| | - Jong-Won Chung
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine
| | - Oh Young Bang
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine
| | - Geong-Moon Kim
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine
| | - Yong-Jae Kim
- Department of Neurology, Eunpyeong St. Mary's Hospital, the Catholic University of Korea
| | - Seonwoo Kim
- Statistics and Data Center, Samsung Medical Center, Seoul, Republic of Korea
| | - Sook young Woo
- Statistics and Data Center, Samsung Medical Center, Seoul, Republic of Korea
| | - Hyun Cho
- Statistics and Data Center, Samsung Medical Center, Seoul, Republic of Korea
| | - Woo-Keun Seo
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine
| |
Collapse
|
27
|
Woo HG, Chung H, Lee JS, Heo SH. Double-Chamber Left Ventricle as a Potential Cardioembolic Source in Acute Ischemic Stroke. J Clin Neurol 2021; 17:470-472. [PMID: 34184456 PMCID: PMC8242305 DOI: 10.3988/jcn.2021.17.3.470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2020] [Revised: 02/22/2021] [Accepted: 02/22/2021] [Indexed: 11/21/2022] Open
Affiliation(s)
- Ho Geol Woo
- Department of Neurology, Kyung Hee University College of Medicine, Seoul, Korea
| | - Hyemoon Chung
- Division of Cardiology, Department of Internal Medicine, Kyung Hee University College of Medicine, Seoul, Korea
| | - Jin San Lee
- Department of Neurology, Kyung Hee University College of Medicine, Seoul, Korea
| | - Sung Hyuk Heo
- Department of Neurology, Kyung Hee University College of Medicine, Seoul, Korea.
| |
Collapse
|
28
|
Ha SH, Chang JY, Lee SH, Lee KM, Heo SH, Chang DI, Kim BJ. Mechanism of Stroke According to the Severity and Location of Atherosclerotic Middle Cerebral Artery Disease. J Stroke Cerebrovasc Dis 2020; 30:105503. [PMID: 33271485 DOI: 10.1016/j.jstrokecerebrovasdis.2020.105503] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [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: 09/02/2020] [Revised: 11/12/2020] [Accepted: 11/22/2020] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND AND PURPOSE Strategy for secondary prevention of ischemic stroke depends on the mechanism of stroke. The aim of this study was to compare the stroke mechanism according to the location and severity of middle cerebral artery (MCA) disease. METHODS We analyzed acute ischemic stroke patients within 7 days of onset with symptomatic MCA disease. The location of MCA disease was classified into proximal MCA M1 (pMCA) and distal MCA M1/proximal M2 (dMCA). The mechanism of stroke was categorized according to the pattern of ischemic lesion: local branch occlusion, artery-to-artery embolism/hemodynamic infarction, in situ-thrombosis, or a combined mechanism. The mechanism and imaging characteristics of stroke were compared according to the location and severity. The factors associated with the stroke mechanism were also investigated. RESULTS A symptomatic MCA disease was observed in 126 patients (74 pMCA and 52 dMCA). The mechanism of stroke differed according to the location (p < 0.001); the combined mechanism was most common in pMCA disease (54.1%), especially in those who presented with MCA occlusion and with a susceptible vessel sign. Artery-to-artery embolism/hemodynamic infarction was most common in dMCA disease (46.2%). A longer length of stenosis was observed in local branch occlusion than in other mechanisms (p = 0.04) and was an independent factor associated with local branch occlusion (OR=1.631, 95% CI=1.161-2.292; p = 0.005). CONCLUSIONS The mechanism of stroke differed according to the location of MCA disease: occlusion caused by plaque rupture with combined mechanism of stroke type was predominant in pMCA. Longer length of stenosis was associated with local branch occlusion.
Collapse
Affiliation(s)
- Sang Hee Ha
- Department of Neurology, Kyung Hee University Hospital, Seoul, Korea
| | | | - Sang Hun Lee
- Department of Neurology, Korea University Ansan Hospital, Ansan, Korea
| | - Kyung Mi Lee
- Department of Neurology and Radiology, Kyung Hee University Hospital, Seoul, Korea
| | - Sung Hyuk Heo
- Department of Neurology, Kyung Hee University Hospital, Seoul, Korea
| | - Dae-Il Chang
- Department of Neurology, Kyung Hee University Hospital, Seoul, Korea
| | - Bum Joon Kim
- Department of Neurology, Asan Medical Center, Seoul, Korea.
| |
Collapse
|
29
|
Kwon HS, Kim YS, Lee JM, Koh SH, Kim HY, Kim C, Lee SH, Jung KH, Kim YD, Kwon HM, Kim BJ, Kim JM, Kim BJ, Heo SH, Chang DI. Causes, Risk Factors, and Clinical Outcomes of Stroke in Korean Young Adults: Systemic Lupus Erythematosus is Associated with Unfavorable Outcomes. J Clin Neurol 2020; 16:605-611. [PMID: 33029967 PMCID: PMC7541989 DOI: 10.3988/jcn.2020.16.4.605] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [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: 02/04/2020] [Revised: 06/01/2020] [Accepted: 06/02/2020] [Indexed: 01/01/2023] Open
Abstract
Background and Purpose The incidence of ischemic stroke (IS) in young adults is increasing, and the associated large socioeconomic impact makes understanding IS in young adults important. We investigated the causes of and risk factors for IS in young adults, and their impact on outcomes. Methods The Stroke in Korean Young Adults (SKY) study is a standardized multicenter prospective study involving eight medical centers of the Republic of Korea. First-ever IS patients aged 18 years to 44 years were prospectively included in this study within 7 days of stroke onset. Their outcomes at 3 months were analyzed. Results This study enrolled 270 patients from April 2014 to December 2018, most (67.8%) of whom were male. About 41.5% of the patients had one or more vascular risk factors from among hypertension, diabetes mellitus, and dyslipidemia. However, only half of them had received regular treatment. Arterial dissection was more common in males, and systemic lupus erythematosus (SLE) and Moyamoya disease were more common in females. The outcome was favorable (modified Rankin Scale score of 0 or 1) in 81.9% of the patients at 3 months after stroke onset. More severe initial symptoms, higher initial glucose level, and SLE as a comorbidity were associated with unfavorable outcomes. Conclusions Young adult IS patients in Korea exhibit low awareness and poor management of their risk factors. Although the short-term outcome was relatively favorable in those patients, having SLE was associated with unfavorable outcomes. More attention needs to be paid for improving awareness and controlling risk factors in this population.
Collapse
Affiliation(s)
- Hyuk Sung Kwon
- Department of Neurology, Hanyang University College of Medicine, Seoul, Korea
| | - Young Seo Kim
- Department of Neurology, Hanyang University College of Medicine, Seoul, Korea.
| | - Jong Min Lee
- Department of Neurology, Hanyang University College of Medicine, Seoul, Korea
| | - Seong Ho Koh
- Department of Neurology, Hanyang University College of Medicine, Seoul, Korea
| | - Hyun Young Kim
- Department of Neurology, Hanyang University College of Medicine, Seoul, Korea
| | - Chulho Kim
- Department of Neurology, Hallym University Sacred Heart Hospital, Chuncheon, Korea
| | - Seung Hoon Lee
- Department of Neurology, Seoul National University Hospital, Seoul, Korea
| | - Keun Hwa Jung
- Department of Neurology, Seoul National University Hospital, Seoul, Korea
| | - Young Dae Kim
- Department of Neurology, Yonsei University College of Medicine, Seoul, Korea
| | - Hyung Min Kwon
- Department of Neurology, Seoul National University College of Medicine, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, Korea
| | - Beom Joon Kim
- Department of Neurology and Cerebrovascular Center, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Jeong Min Kim
- Department of Neurology, Chung-Ang University Hospital, Seoul, Korea
| | - Bum Joon Kim
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Sung Hyuk Heo
- Department of Neurology, Kyung Hee University College of Medicine, Seoul, Korea
| | - Dae Il Chang
- Department of Neurology, Kyung Hee University College of Medicine, Seoul, Korea
| | | |
Collapse
|
30
|
Woo HG, Heo SH, Kim EJ, Chang DI, Song TJ, Kim BJ. Atherosclerotic plaque locations may be related to different ischemic lesion patterns. BMC Neurol 2020; 20:288. [PMID: 32731859 PMCID: PMC7391573 DOI: 10.1186/s12883-020-01868-0] [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: 04/29/2020] [Accepted: 07/22/2020] [Indexed: 11/16/2022] Open
Abstract
Background Atherosclerosis of the internal carotid artery (ICA) is an important cause of ischemic stroke. Artery-to-artery embolism is the major stroke mechanism in patients with atherosclerotic carotid disease. This study hypothesized that the atherosclerotic ICA geometry and plaque location would be associated with lesion pattern in patients with acute ischemic stroke. Methods Ischemic stroke patients with symptomatic proximal ICA disease (> 50% diameter stenosis) were enrolled. The carotid plaque location was divided into high-apical and low-body types. The geometric parameters of the ICA (angles between arteries) were measured, and ischemic lesion patterns were classified according to the number, location, and size of the lesions. Factors associated with plaque location and lesion pattern, dichotomized by size, were investigated. Results Of the 93 acute ischemic stroke patients enrolled, 31 had high-apical and 62 had low-body plaques. Hyperlipidemia was more prevalent and the common carotid artery (CCA)-ICA angle was wider (167.7 ± 10.4° vs 162.3 ± 9.8°, p = 0.019) in patients with low-body than high-apical plaques. Low-body plaques were more frequently associated with small scattered or cortical lesions (54.8% vs. 32.3%, p = 0.040), whereas high-apical plaques were more frequently associated with large lesions having additional lesions (38.7% vs. 11.3%, p = 0.002). The presence of low-body plaques (odds ratio: 3.106, 95% confidence interval: 1.105–8.728, p = 0.032) was independently associated with the small lesion-only pattern. Conclusions Low-body plaques are more frequently associated with small scattered lesions, whereas high-apical plaques are more frequently associated with large lesions having additional lesions. A wide CCA-ICA angle is associated with low-body plaque of the carotid artery.
Collapse
Affiliation(s)
- Ho Geol Woo
- Departments of Neurology, Kyung Hee University College of Medicine, Seoul, South Korea
| | - Sung Hyuk Heo
- Departments of Neurology, Kyung Hee University College of Medicine, Seoul, South Korea
| | - Eui Jong Kim
- Departments of Radiology, Kyung Hee University College of Medicine, Seoul, South Korea
| | - Dae-Il Chang
- Departments of Neurology, Kyung Hee University College of Medicine, Seoul, South Korea
| | - Tae Jin Song
- Department of Neurology, Seoul Hospital Ewha Womans University College of Medicine, Seoul, South Korea
| | - Bum Joon Kim
- Department of Neurology, Asan Medical Center, University of Ulsan, Song-Pa, PO Box 145, Seoul, 138-600, South Korea.
| |
Collapse
|
31
|
Park HK, Lee JS, Kim BJ, Park JH, Kim YJ, Yu S, Hwang YH, Rha JH, Heo SH, Ahn SH, Seo WK, Park JM, Lee JH, Kwon JH, Sohn SI, Jung JM, Kwon SU, Hong KS. Cilostazol versus aspirin in ischemic stroke with cerebral microbleeds versus prior intracerebral hemorrhage. Int J Stroke 2020; 16:1019-1030. [PMID: 32664827 DOI: 10.1177/1747493020941273] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [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: 11/17/2022]
Abstract
BACKGROUND In PreventIon of CArdiovascular Events in Ischaemic Stroke Patients with High Risk of Cerebral HaemOrrhage (PICASSO), cilostazol versus aspirin was comparable for the end points of cerebral hemorrhage and major vascular events. However, underlying hemorrhage-prone lesions could modify the treatment effect. AIMS We explored whether the safety and efficacy of cilostazol versus aspirin would differ between hemorrhage-prone lesions (multiple cerebral microbleeds vs. prior intracerebral hemorrhage). METHODS In this post hoc analysis of PICASSO, we divided patients into the cerebral microbleeds and prior intracerebral hemorrhage subgroups. The primary safety end point was the first occurrence of cerebral hemorrhage. The primary efficacy end point was the composite of stroke, myocardial infarction, or vascular death. RESULTS Of 1512 patients, 903 (59.7%) had multiple cerebral microbleeds and 609 (40.3%) had prior intracerebral hemorrhage. The cerebral hemorrhage risk was lower with cilostazol versus aspirin (0.12%/year vs. 1.49%/year; hazard ratio, 0.08 [95% confidence interval 0.01-0.60]; p = 0.015) in the cerebral microbleeds subgroup, but was not different (1.26%/year vs. 0.79%/year; hazards ratio 1.60 [0.52-4.90]; p = 0.408) in the prior intracerebral hemorrhage subgroup. The interaction of treatment-by-subgroup was significant (pinteraction = 0.011). For the composite of major vascular events, there was a trend toward a lower risk with cilostazol versus aspirin (3.56%/year vs. 5.53%/year; hazards ratio 0.64 [0.41-1.01]; p = 0.056) in the cerebral microbleeds subgroup, but was comparable (5.21%/year vs. 5.05%/year; hazards ratio 1.03 [0.63-1.67]; p = 0.913) in the prior intracerebral hemorrhage subgroup without a significant treatment-by-subgroup interaction (pinteraction = 0.165). CONCLUSIONS Cilostazol versus aspirin might be a better option in ischemic stroke with multiple cerebral microbleeds, but confirmatory trials are needed. CLINICAL TRIAL REGISTRATION URL:http://www.clinicaltrials.gov. NCT01013532.
Collapse
Affiliation(s)
- Hong-Kyun Park
- Department of Neurology, Inje University Ilsan Paik Hospital, Goyang, Korea
| | - Ji Sung Lee
- Clinical Research Center, Asan Institute for Life Sciences, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Bum Joon Kim
- Department of Neurology, Kyung Hee University Medical Center, Seoul, Korea
| | - Jong-Ho Park
- Department of Neurology, Myungji Hospital, Hanyang University College of Medicine, Goyang, Korea
| | - Yong-Jae Kim
- Department of Neurology, Eunpyeong St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea
| | - Sungwook Yu
- Department of Neurology, Anam Hospital, Korea University, Seoul, Korea
| | - Yang-Ha Hwang
- Department of Neurology, Kyungpook National University Hospital, Daegu, Korea
| | - Joung-Ho Rha
- Department of Neurology, Inha University Hospital, Incheon, Korea
| | - Sung Hyuk Heo
- Department of Neurology, Kyung Hee University Medical Center, Seoul, Korea
| | - Seong Hwan Ahn
- Department of Neurology, Chosun University School of Medicine and Hospital, Gwangju, Korea
| | - Woo-Keun Seo
- Department of Neurology, Samsung Medical Center, Sunkyunkwan University, Seoul, Korea
| | - Jong-Moo Park
- Department of Neurology, Nowon Eulji Medical Center, Eulji University, Seoul, Korea
| | - Ju-Hun Lee
- Department of Neurology, Kangdong Sacred Heart Hospital, Hallym University, Seoul, Korea
| | - Jee-Hyun Kwon
- Department of Neurology, Ulsan University Hospital, Ulsan University, Ulsan, Korea
| | - Sung-Il Sohn
- Department of Neurology, Dongsan Medical Center, Keimyung University, Daegu, Korea
| | - Jin-Man Jung
- Department of Neurology, Ansan Hospital, Korea University, Seoul, Korea
| | - Sun U Kwon
- Department of Neurology, Asan Medical Center, Ulsan University, Seoul, Korea
| | - Keun-Sik Hong
- Department of Neurology, Inje University Ilsan Paik Hospital, Goyang, Korea
| | | |
Collapse
|
32
|
Ha SH, Kim YJ, Heo SH, Chang DI, Kim BJ. Prediction of deep vein thrombosis by ultrasonography and D-dimer in Asian patients with ischemic stroke. BMC Neurol 2020; 20:257. [PMID: 32593290 PMCID: PMC7320547 DOI: 10.1186/s12883-020-01842-w] [Citation(s) in RCA: 4] [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] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Accepted: 06/24/2020] [Indexed: 01/10/2023] Open
Abstract
Background Deep vein thrombosis (DVT) is an important complication of ischemic stroke, although the incidence of DVT is regarded as being lower in Asian than in non-Asian patients. Here, we investigated the incidence and factors associated with DVT in Asian patients with ischemic stroke. Methods Acute ischemic stroke patients received lower extremity ultrasonography (LEUS) to diagnose the presence of DVT. Clinical characteristics and laboratory results, including D-dimer level, were compared between patients with and without DVT. Independent risk factors for DVT were investigated using multivariable analysis. Similar analysis was performed to identify factors associated with elevated D-dimer level (> 0.5 mg/dl) in acute ischemic stroke patients. Results During the study period, 289 patients were enrolled, and 38 (13.1%) showed DVT. Female sex (OR = 2.579, 95% CI = 1.224–5.432; p = 0.013) and a high National Institutes of Health Stroke Scale (NIHSS) score (OR = 1.191 95% CI = 1.095–1.294; p = 0.005) were independently associated with the presence of DVT, although D-dimer level was not. Stroke mechanism, especially cardioembolic stroke (OR = 3.777, 95% CI = 1.532–9.313; p = 0.004; reference: large artery atherosclerosis), NIHSS score (OR = 1.087, 95% CI = 1.002–1.179; p = 0.001) and thrombolysis (OR = 12.360, 95% CI 2.456–62.213; p = 0.002) were independently associated with elevated abnormal D-dimer levels. Conclusion The severity of ischemic stroke, but not the D-dimer level, was associated with the presence of DVT in Asian ischemic stroke patients. D-dimer level was influenced by the stroke mechanism. LEUS in patients with severe neurological deficit, rather than screening with D-dimer, may be more beneficial for diagnosing DVT in Asian patients with acute ischemic stroke.
Collapse
Affiliation(s)
- Sang Hee Ha
- Department of Neurology, Kyung Hee University Hospital, Seoul, Republic of Korea
| | - Yeon-Jung Kim
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpagu, Seoul, 138-736, Republic of Korea
| | - Sung Hyuk Heo
- Department of Neurology, Kyung Hee University Hospital, Seoul, Republic of Korea
| | - Dae-Il Chang
- Department of Neurology, Kyung Hee University Hospital, Seoul, Republic of Korea
| | - Bum Joon Kim
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpagu, Seoul, 138-736, Republic of Korea.
| |
Collapse
|
33
|
Kim JM, Park KY, Yu IW, Song TJ, Kim YJ, Kim BJ, Heo SH, Jung JM, Oh KM, Kim CK, Yu S, Park JH, Choi JC, Park MS, Kim JT, Choi KH, Hwang YH, Chung JW, Bang OY, Kim GM, Seo WK. Incidence of oral anticoagulant interruption among stroke patients with atrial fibrillation and subsequent stroke. Eur J Neurol 2020; 27:900-902. [PMID: 32064742 DOI: 10.1111/ene.14175] [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] [Subscribe] [Scholar Register] [Received: 08/24/2019] [Accepted: 02/10/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND PURPOSE We analyzed the incidence and causes of oral anticoagulant (OAC) cessation and subsequent stroke after OAC withdrawal in a cohort of Korean stroke patients with atrial fibrillation. METHODS The Korean Atrial Fibrillation Evaluation Registry in Ischemic Stroke patients (K-ATTENTION) is a multicenter cohort study, merging stroke registries from 11 tertiary centers in Korea. The number of OAC interruption episodes and the reasons were reviewed from hospital records. Stroke after OAC withdrawal was defined when a patient experienced ischaemic stroke within 31 days after OAC withdrawal. Clinical variables were compared between patients who experienced stroke recurrence during OAC interruption and those who did not experience recurrence. RESULTS Among 3213 stroke patients with atrial fibrillation, a total of 329 episodes of OAC interruption were detected in 229 patients after index stroke (mean age 72.9 ± 8.3 years, 113 female patients). The most frequent reason for OAC withdrawal was poor compliance [103 episodes (31.3%)] followed by extracranial bleeding [96 episodes (29.2%)]. Stroke after OAC withdrawal was noted in 13 patients. Mean age, vascular risk factor profile and mean CHA2 DS2 -VASc score were not significantly different between patients with and without recurrent stroke. CONCLUSIONS A considerable number of stroke patients with atrial fibrillation experienced temporary interruption of OAC after index stroke, which was associated with stroke recurrence of 4.0 cases per 100 interruption episodes.
Collapse
Affiliation(s)
- J-M Kim
- Department of Neurology, Chung-Ang University College of Medicine, Seoul, Korea
| | - K-Y Park
- Department of Neurology, Chung-Ang University College of Medicine, Seoul, Korea
| | - I-W Yu
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - T-J Song
- Department of Neurology, Seoul Hospital, Ewha Womans University College of Medicine, Seoul, Korea
| | - Y-J Kim
- Department of Neurology, Eunpyeong St Mary's Hospital, The Catholic University of Korea, Seoul, Korea
| | - B J Kim
- Department of Neurology, Asan Medical Center, University of Ulsan, College of Medicine, Seoul, Korea
| | - S H Heo
- Department of Neurology, Kyung Hee University College of Medicine, Seoul, Korea
| | - J-M Jung
- Department of Neurology, Korea University Ansan Hospital, Korea University College of Medicine, Kyungki-Do, Korea
| | - K-M Oh
- Department of Neurology, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - C K Kim
- Department of Neurology, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - S Yu
- Department of Neurology, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea
| | - J-H Park
- Department of Neurology, Myongji Hospital, Hanyang University College of Medicine, Goyang, South Korea
| | - J C Choi
- Department of Neurology, Jeju National University, Jeju, Korea
| | - M-S Park
- Department of Neurology, Chonnam National University Hospital, Gwangju, Korea
| | - J-T Kim
- Department of Neurology, Chonnam National University Hospital, Gwangju, Korea
| | - K-H Choi
- Department of Neurology, Chonnam National University Hospital, Gwangju, Korea
| | - Y-H Hwang
- Department of Neurology, Kyungpook National University School of Medicine and Hospital, Daegu, Korea
| | - J-W Chung
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - O Y Bang
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - G-M Kim
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - W-K Seo
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| |
Collapse
|
34
|
Kwon HS, Lee EH, Park HH, Jin JH, Choi H, Lee KY, Lee YJ, Lee JH, de Oliveira FMS, Kim HY, Seo Kim Y, Kim BJ, Heo SH, Chang DI, Kamali-Moghaddam M, Koh SH. Early increment of soluble triggering receptor expressed on myeloid cells 2 in plasma might be a predictor of poor outcome after ischemic stroke. J Clin Neurosci 2020; 73:215-218. [PMID: 32067825 DOI: 10.1016/j.jocn.2020.02.016] [Citation(s) in RCA: 9] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Accepted: 02/08/2020] [Indexed: 01/02/2023]
Abstract
Soluble triggering receptor expressed on myeloid cells 2 (sTREM2) is derived from cleavage of TREM2, which is expressed on the cell surface of microlgia and other tissue-specific macrophages. In the present study, the changes in the sTREM2 levels after ischemic stroke (IS) and their association with clinical outcomes were evaluated. A total of 43 patients diagnosed with non-cardioembolic IS between June 2011 and May 2014 were consecutively included in this study. Patients treated with intravenous thrombolysis or intra-arterial thrombectomy were excluded. Plasma samples were collected three times (days 1, 7, and 90) after ictus. The sTREM2 level was measured in the samples using the highly sensitive solid-phase proximity ligation assay (SP-PLA). Among the 43 subjects, higher initial NIH stroke scale (NIHSS) score (P = 0.005), early increment of sTREM2 (P < 0.001), and late decrement of sTREM2 (P = 0.002), were more common in patients with poor outcome. Based on multivariate analysis, initial NIHSS score (P = 0.015) and early increment of sTREM2 (P = 0.032) were independently associated with poor outcome. The results from the present study indicate that increment of sTREM2 level at the early phase was a predictor of poor outcome. Serial follow-up of sTREM2 may aid prognosis after stroke.
Collapse
Affiliation(s)
- Hyuk Sung Kwon
- Department of Neurology, Hanyang University College of Medicine, Seoul, Republic of Korea
| | - Eun-Hye Lee
- Department of Neurology, Hanyang University College of Medicine, Seoul, Republic of Korea; Department of Translational Medicine, Hanyang University Graduate School of Biomedical Science & Engineering, Seoul, Republic of Korea
| | - Hyun-Hee Park
- Department of Neurology, Hanyang University College of Medicine, Seoul, Republic of Korea
| | - Jeong-Hwa Jin
- Department of Neurology, Hanyang University College of Medicine, Seoul, Republic of Korea
| | - Hojin Choi
- Department of Neurology, Hanyang University College of Medicine, Seoul, Republic of Korea
| | - Kyu-Yong Lee
- Department of Neurology, Hanyang University College of Medicine, Seoul, Republic of Korea
| | - Young Joo Lee
- Department of Neurology, Hanyang University College of Medicine, Seoul, Republic of Korea
| | - Jae-Hong Lee
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | | | - Hyun Young Kim
- Department of Neurology, Hanyang University College of Medicine, Seoul, Republic of Korea
| | - Young Seo Kim
- Department of Neurology, Hanyang University College of Medicine, Seoul, Republic of Korea
| | - Bum Joon Kim
- Department of Neurology, Kyung Hee University College of Medicine, Seoul, Republic of Korea
| | - Sung Hyuk Heo
- Department of Neurology, Kyung Hee University College of Medicine, Seoul, Republic of Korea
| | - Dae-Il Chang
- Department of Neurology, Kyung Hee University College of Medicine, Seoul, Republic of Korea
| | - Masood Kamali-Moghaddam
- Department of Immunology, Genetics, and Pathology, Science for Life Laboratory, Uppsala University, Uppsala, Sweden.
| | - Seong-Ho Koh
- Department of Neurology, Hanyang University College of Medicine, Seoul, Republic of Korea; Department of Translational Medicine, Hanyang University Graduate School of Biomedical Science & Engineering, Seoul, Republic of Korea.
| |
Collapse
|
35
|
Lee EJ, Kwon SU, Park JH, Kim YJ, Hong KS, Yu S, Hwang YH, Lee JS, Lee J, Rha JH, Heo SH, Ahn SH, Seo WK, Park JM, Lee JH, Kwon JH, Sohn SI, Jung JM, Kim HY, Kim EG, Kim SH, Cha JK, Park MS, Nam HS, Kang DW. Changes in High-Density Lipoprotein Cholesterol and Risks of Cardiovascular Events: A Post Hoc Analysis from the PICASSO Trial. J Stroke 2020; 22:108-118. [PMID: 32027796 PMCID: PMC7005357 DOI: 10.5853/jos.2019.02551] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Accepted: 12/11/2019] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND AND PURPOSE Whether pharmacologically altered high-density lipoprotein cholesterol (HDL-C) affects the risk of cardiovascular events is unknown. Recently, we have reported the Prevention of Cardiovascular Events in Asian Patients with Ischaemic Stroke at High Risk of Cerebral Haemorrhage (PICASSO) trial that demonstrated the non-inferiority of cilostazol to aspirin and superiority of probucol to non-probucol for cardiovascular prevention in ischemic stroke patients (clinicaltrials.gov: NCT01013532). We aimed to determine whether on-treatment HDL-C changes by cilostazol and probucol influence the treatment effect of each study medication during the PICASSO study. METHODS Of the 1,534 randomized patients, 1,373 (89.5%) with baseline cholesterol parameters were analyzed. Efficacy endpoint was the composite of stroke, myocardial infarction, and cardiovascular death. Cox proportional hazards regression analysis examined an interaction between the treatment effect and changes in HDL-C levels from randomization to 1 month for each study arm. RESULTS One-month post-randomization mean HDL-C level was significantly higher in the cilostazol group than in the aspirin group (1.08 mmol/L vs. 1.00 mmol/L, P<0.001). The mean HDL-C level was significantly lower in the probucol group than in the non-probucol group (0.86 mmol/L vs. 1.22 mmol/L, P<0.001). These trends persisted throughout the study. In both study arms, no significant interaction was observed between HDL-C changes and the assigned treatment regarding the risk of the efficacy endpoint. CONCLUSIONS Despite significant HDL-C changes, the effects of cilostazol and probucol treatment on the risk of cardiovascular events were insignificant. Pharmacologically altered HDL-C levels may not be reliable prognostic markers for cardiovascular risk.
Collapse
Affiliation(s)
- Eun-Jae Lee
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Sun U Kwon
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jong-Ho Park
- Department of Neurology, Myongji Hospital, Hanyang University College of Medicine, Goyang, Korea
| | - Yong-Jae Kim
- Department of Neurology, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Keun-Sik Hong
- Department of Neurology, Inje University Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Korea
| | - Sungwook Yu
- Department of Neurology, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea
| | - Yang-Ha Hwang
- Department of Neurology, Kyungpook National University Hospital, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Ji Sung Lee
- Clinical Research Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Juneyoung Lee
- Department of Biostatistics, Korea University, Seoul, Korea
| | - Joung-Ho Rha
- Department of Neurology, Inha University Hospital, Incheon, Korea
| | - Sung Hyuk Heo
- Department of Neurology, Kyung Hee University Medical Center, Seoul, Korea
| | - Sung Hwan Ahn
- Department of Neurology, Chosun University Hospital, Chosun University College of Medicine, Gwangju, Korea
| | - Woo-Keun Seo
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jong-Moo Park
- Department of Neurology, Eulji General Hospital, Eulji University School of Medicine, Seoul, Korea
| | - Ju-Hun Lee
- Department of Neurology, Hallym University Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
| | - Jee-Hyun Kwon
- Department of Neurology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Sung-Il Sohn
- Department of Neurology, Keimyung University Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Korea
| | - Jin-Man Jung
- Department of Neurology, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, Korea
| | - Hahn Young Kim
- Department of Neurology, Konkuk University School of Medicine, Seoul, Korea
| | - Eung-Gyu Kim
- Department of Neurology, Inje University Busan Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Sung Hun Kim
- Department of Neurology, Kangwon National University Hospital, Kangwon National University School of Medicine, Chuncheon, Korea
| | - Jae-Kwan Cha
- Department of Neurology, Dong-A University Hospital, Dong-A University College of Medicine, Busan, Korea
| | - Man-Seok Park
- Department of Neurology, Chonnam National University Medical School, Gwangju, Korea
| | - Hyo Suk Nam
- Department of Neurology, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Dong-Wha Kang
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | | |
Collapse
|
36
|
Eun MY, Hwang YH, Park MS, Kim JT, Choi KH, Jung JM, Yu S, Oh K, Kim CK, Song TJ, Kim YJ, Kim BJ, Heo SH, Park KY, Kim JM, Park JH, Choi JC, Chung JW, Bang OY, Kim GM, Seo WK. Abstract TP435: Oral Anticoagulant Therapy Adherent to ESC Guidelines Reduces the Risk of Recurrent Stroke in Patients With Atrial Fibrillation. Stroke 2020. [DOI: 10.1161/str.51.suppl_1.tp435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction:
Oral anticoagulant therapy is the primary treatment for the prevention of recurrent ischemic stroke in patients with atrial fibrillation (AF). Early anticoagulant therapy can be beneficial for the prevention of recurrent ischemic stroke, however, also can provoke symptomatic intracranial hemorrhage. This study aims to evaluate the efficacy and safety of standard oral anticoagulant therapy adherent to the European Society of Cardiology (ESC) guidelines compared to early oral anticoagulant therapy.
Methods:
Acute ischemic stroke patients with AF were included from a nationwide multicenter registry (K-ATTENTION). The primary outcome was recurrent all-type stroke during 90 days of follow-up. Secondary outcomes were major adverse cardiovascular events (MACE), ischemic stroke, intracranial hemorrhage, acute coronary syndrome, all-cause death, and major hemorrhage. The propensity score was used to match the baseline characteristics between the two treatment groups.
Results:
Among 2,321 eligible patients, 532 patients with standard anticoagulation were matched to 532 patients with early anticoagulation. Eight participants (1.5%) with standard anticoagulation had recurrence of all-type stroke compared with 19 (3.5%) of participants with early anticoagulation (odds ratio [OR], 0.41; 95% confidence interval [CI], 0.18-0.95; P=0.038). Standard anticoagulation was also associated with reduced risk of recurrent ischemic stroke (OR, 0.30; 95% CI, 0.11-0.82; P=0.019). Other secondary outcomes, including intracranial hemorrhage and major hemorrhage, appeared not to be informative.
Conclusions:
In conclusion, standard oral anticoagulant therapy adherent to ESC guidelines reduces the risk of recurrent all-type stroke and ischemic stroke compared to early oral anticoagulant therapy.
Collapse
Affiliation(s)
- Mi-Yeon Eun
- Neurology, Kyungpook National Univ Chilgok Hosp, Sch of Medicine, Kyungpook National Univ, Daegu, Korea, Republic of
| | - Yang-Ha Hwang
- Neurology, Kyungpook National Univ Hosp, Sch of Medicine, Kyungpook National Univ, Daegu, Korea, Republic of
| | - Man-Seok Park
- Neurology, Chonnam National Univ Hosp, Gwangju, Korea, Republic of
| | - Joon-Tae Kim
- Neurology, Chonnam National Univ Hosp, Gwangju, Korea, Republic of
| | - Kang-Ho Choi
- Neurology, Chonnam National Univ Hosp, Gwangju, Korea, Republic of
| | - Jin-Man Jung
- Neurology, Korea Univ Ansan Hosp, Korea Univ College of Medicine, Ansan, Korea, Republic of
| | - Sungwook Yu
- Neurology, Korea Univ Anam Hosp, Korea Univ College of Medicine, Seoul, Korea, Republic of
| | - Kyungmi Oh
- Neurology, Korea Univ Guro Hosp, Korea Univ College of Medicine, Seoul, Korea, Republic of
| | - Chi Kyung Kim
- Neurology, Korea Univ Guro Hosp, Korea Univ College of Medicine, Seoul, Korea, Republic of
| | - Tae-Jin Song
- Neurology, Ewha Womans Mokdong’s Hosp, Ewha Womans Univ Sch of Medicine, Seoul, Korea, Republic of
| | - Yong-Jae Kim
- Neurology, Eunpyeong St. Mary’s Hosp, The Catholic Univ of Korea, Seoul, Korea, Republic of
| | - Bum Joon Kim
- Neurology, Kyung Hee Univ Hosp, Seoul, Korea, Republic of
| | - Sung Hyuk Heo
- Neurology, Kyung Hee Univ Hosp, Seoul, Korea, Republic of
| | - Kwang-Yeol Park
- Neurology, Chung-Ang Univ Hosp, Chung-Ang Univ College of Medicine, Seoul, Korea, Republic of
| | - Jeong-Min Kim
- Neurology, Chung-Ang Univ Hosp, Chung-Ang Univ College of Medicine, Seoul, Korea, Republic of
| | - Jong-Ho Park
- Neurology, Myongji Hosp, Hanyang Univ College of Medicine, Goyang, Korea, Republic of
| | - Jay Chol Choi
- Neurology, Jeju National Univ Hosp, Jeju National Univ College of Medicine, Jeju, Korea, Republic of
| | - Jong-Won Chung
- Neurology, Samsung Med Cntr, Sungkyunkwan Univ Sch of Medicine, Seoul, Korea, Republic of
| | - Oh Young Bang
- Neurology, Samsung Med Cntr, Sungkyunkwan Univ Sch of Medicine, Seoul, Korea, Republic of
| | - Gyeong-Moon Kim
- Neurology, Samsung Med Cntr, Sungkyunkwan Univ Sch of Medicine, Seoul, Korea, Republic of
| | - Woo-Keun Seo
- Neurology, Samsung Med Cntr, Sungkyunkwan Univ Sch of Medicine, Seoul, Korea, Republic of
| |
Collapse
|
37
|
Heo SH, Kim BJ, Chang DI, Choi HY, Kim YS, Koh SH, Park JH, Lee YB, Jang MU, Ahn SH, Song J, Kim H. Abstract WP96: The Efficacy and Safety of HT047 in Patients With Acute Ischemic Stroke: A Multi-Center, Randomized, Double-Blind, Placebo-Controlled, Parallel-Group, Phase II Trial. Stroke 2020. [DOI: 10.1161/str.51.suppl_1.wp96] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction:
HT047 is an herbal mixture extract of the
Scutellaria baicalensis
and
Pueraria lobata
plants, which have been widely used to treat ischemic stroke in traditional Korean medicine. The aims of this trial are to investigate whether HT047 can improve neurological status, particularly motor function, in acute ischemic stroke patients, and to determine the safety and tolerance of HT047.
Methods:
In this randomized, double-blind, placebo-controlled, parallel-group, phase II trial, we enrolled patients with acute ischemic stroke within the past 14 days from 8 centers in Korea. The participating patients must have a Fugl-Meyer Assessment (FMA) motor score ≤55 with arm or leg weakness, and Korean version of the National Institutes of Health Stroke Scale (K-NIHSS) score of ≥4 and ≤15. Seventy-eight participants will be randomized in a 1:1:1 ratio and given high-dose HT047 (750 mg three times a day), low-dose HT047 (500 mg three times a day), or a placebo for 12 weeks. The primary endpoint is the change in FMA motor score between baseline and week 12. The trial is registered with ClinicalTrials.gov, NCT02828540.
Results:
Between Aug, 2016, and Aug, 2018, we randomly assigned 78 patients to one of the three study groups, of whom 66 patients were assessed for the primary endpoint in full analysis set. The median (min, max) changes in FMA motor score of high-dose HT047 and low-dose HT047 were 24 (0, 63) and 43 (-2, 70) (placebo group=28 [0, 63], p=0.929 and p=0.705, respectively). The prevalence of favorable outcome defined as modified Rankin scale score of 0-2 were 47.6% (p=0.919) in high-dose HT047 group and 57.1% (p=0.106) in low-dose HT047 group (31.6% in placebo group). Adverse events were similar across the three study groups.
Conclusions:
This study is a first-in-human trial of HT047, and there were no between-group differences on the primary and secondary endpoints.
Collapse
Affiliation(s)
| | | | | | - Hye-Yeon Choi
- Kyung Hee Univ Hosp at Gangdong, Seoul, Korea, Republic of
| | | | - Seong-Ho Koh
- Hanyang Univ Guri Hosp, Guri, Korea, Republic of
| | - Jong-Ho Park
- Hanyang Univ Myongji Hosp, Goyang, Korea, Republic of
| | - Yeong-Bae Lee
- Gachon Univ Gil Med Cntr, Incheon, Korea, Republic of
| | - Min Uk Jang
- Hallym Univ Dongtan Sacred Heart Hosp, Dongtan, Korea, Republic of
| | | | - Jungbin Song
- Kyung Hee Univ College of Korean Medicine, Seoul, Korea, Republic of
| | - Hocheol Kim
- Kyung Hee Univ College of Korean Medicine, Seoul, Korea, Republic of
| |
Collapse
|
38
|
Kim BJ, Kwon SU, Park JH, Kim YJ, Hong KS, Wong LKS, Yu S, Hwang YH, Lee JS, Lee J, Rha JH, Heo SH, Ahn SH, Seo WK, Park JM, Lee JH, Kwon JH, Sohn SI, Jung JM, Navarro JC, Kim HY, Kim EG, Kim S, Cha JK, Park MS, Nam HS, Kang DW. Cilostazol Versus Aspirin in Ischemic Stroke Patients With High-Risk Cerebral Hemorrhage: Subgroup Analysis of the PICASSO Trial. Stroke 2019; 51:931-937. [PMID: 31856691 DOI: 10.1161/strokeaha.119.023855] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [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- Although cilostazol has shown less hemorrhagic events than aspirin, only marginal difference was observed in hemorrhagic stroke events among patients at high risk for cerebral hemorrhage. To identify patients who would most benefit from cilostazol, this study analyzed interactions between treatment and subgroups of the PICASSO trial (Prevention of Cardiovascular Events in Asian Ischemic Stroke Patients With High Risk of Cerebral Hemorrhage). Methods- Ischemic stroke patients with a previous intracerebral hemorrhage or multiple microbleeds were randomized to treatment with cilostazol or aspirin and followed up for a mean 1.8 years. Efficacy, defined as the composite of any stroke, myocardial infarction, and vascular death, and safety, defined as the incidence of hemorrhagic stroke, were analyzed in the 2 groups. Interactions between treatment and age, sex, presence of hypertension and diabetes mellitus, index of high-risk cerebral hemorrhage, and white matter lesion burden were analyzed for primary and key secondary outcomes. Changes in vital signs and laboratory results were compared in the 2 groups. Results- Among all 1534 patients enrolled, a significant interaction between treatment group and index of high risk for cerebral hemorrhage on hemorrhagic stroke (P for interaction, 0.03) was observed. Hemorrhagic stroke was less frequent in the cilostazol than in the aspirin group in patients with multiple microbleeds (1 versus 13 events; hazard ratio, 0.08 [95% CI, 0.01-0.61]; P=0.01). A marginal interaction between treatment group and white matter change on any stroke (P for interaction, 0.08) was observed. Cilostazol reduced any stroke significantly in patients with mild (5 versus 16 events; hazard ratio, 0.36 [95% CI, 0.13-0.97]; P=0.04)-to-moderate (16 versus 32 events; hazard ratio, 0.50 [95% CI, 0.29-0.92]; P=0.03) white matter changes. Heart rate and HDL (high-density lipoprotein) cholesterol level were significantly higher in the cilostazol group than in the aspirin group at follow-up. Conclusions- Cilostazol may be more beneficial for ischemic stroke patients with multiple cerebral microbleeds and before white matter changes are extensive. Registration- URL: https://www.clinicaltrials.gov. Unique identifier: NCT01013532.
Collapse
Affiliation(s)
- Bum Joon Kim
- From the Department of Neurology, Kyung Hee University Medical Center, Seoul, Korea (B.J.K., S.H.H.)
| | - Sun U Kwon
- Department of Neurology (S.U.K., D.-W.K.), Asan Medical Center, Ulsan University, Seoul, Korea
| | - Joung-Ho Park
- Department of Neurology, Hanyang University, Myongji Hospital, Seoul, Korea (J.-H.P.)
| | - Yong-Jae Kim
- Department of Neurology, Eunpyeong St. Mary's Hospital, The Catholic University of Korea, Seoul (Y.-J.K.)
| | - Keun-Sik Hong
- Department of Neurology, Ilsan Paik Hospital, Inje University, Goyang, Korea (K.-S.H.)
| | - Lawrence K S Wong
- Department of Medicine and Therapeutics, Chinese University of Hong Kong (L.K.S.W.)
| | - Sungwook Yu
- Department of Neurology, Anam Hospital (S.Y.), Korea University, Seoul
| | - Yang-Ha Hwang
- Department of Neurology, Kyungpook National University Hospital, Daegu, Korea (Y.-H.H.)
| | - Ji Sung Lee
- Clinical Research Center (J.S.L.), Asan Medical Center, Ulsan University, Seoul, Korea
| | - Juneyoung Lee
- Department of Biostatistics (J.L.), Korea University, Seoul
| | - Jong-Ho Rha
- Department of Neurology, Inha University Hospital, Incheon, Korea (J.-H.R.)
| | - Sung Hyuk Heo
- From the Department of Neurology, Kyung Hee University Medical Center, Seoul, Korea (B.J.K., S.H.H.)
| | - Seong Hwan Ahn
- Department of Neurology, Chosun University Hospital, Gwangju, Korea (S.H.A.)
| | - Woo-Keun Seo
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University, Seoul, Korea (W.-K.S.)
| | - Jong-Moo Park
- Department of Neurology, Eulji General Hospital, Eulji University, Seoul, Korea (J.-M.P.)
| | - Ju-Hun Lee
- Department of Neurology, Sacred Heart Hospital, Hallym University, Seoul, Korea (J.-H.L.)
| | - Jee-Hyun Kwon
- Department of Neurology, Ulsan University Hospital, Ulsan University, Korea (J.-H.K.)
| | - Sung-Il Sohn
- Department of Neurology, Dongsan Medical Center, Keimyung University, Daegu, Korea (S.-I.S.)
| | - Jin-Man Jung
- Department of Neurology, Ansan Hospital (J.-M.J.), Korea University, Seoul
| | - Jose C Navarro
- Department of Neurology and Psychiatry, University of Santo Tomas Hospital, Manila, Philippines (J.C.N.)
| | - Hahn Young Kim
- Department of Neurology, Konkuk University School of Medicine, Seoul, Korea (H.Y.K.)
| | - Eung-Gyu Kim
- Department of Neurology, Busan Paik Hospital, Inje University College of Medicine, Busan, Korea (E.-G.K.)
| | - Seongheon Kim
- Department of Neurology, Kangwon National University Hospital, Chuncheon, Korea (S.K.)
| | - Jae-Kwan Cha
- Department of Neurology, Dong-A University Hospital, Busan, Korea (J.-K.C.)
| | - Man-Seok Park
- Department of Neurology, Chonnam National University Medical School, Gwangju, Korea (M.-S.P.)
| | - Hyo Suk Nam
- Department of Neurology, Yonsei University Severance Hospital, Seoul, Korea (H.S.N.)
| | - Dong-Wha Kang
- Department of Neurology (S.U.K., D.-W.K.), Asan Medical Center, Ulsan University, Seoul, Korea
| | | |
Collapse
|
39
|
Choi KH, Seo WK, Park MS, Kim JT, Chung JW, Bang OY, Kim GM, Song TJ, Kim BJ, Heo SH, Jung JM, Oh KM, Kim CK, Yu S, Park KY, Kim JM, Park JH, Choi JC, Hwang YH, Kim YJ. Effect of Statin Therapy on Outcomes of Patients With Acute Ischemic Stroke and Atrial Fibrillation. J Am Heart Assoc 2019; 8:e013941. [PMID: 31826725 PMCID: PMC6951051 DOI: 10.1161/jaha.119.013941] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [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: 12/22/2022]
Abstract
Background There is insufficient evidence on the effect of statins, particularly high‐intensity statins, in patients with acute ischemic stroke and atrial fibrillation. We investigated the impact of statins on the outcomes in these patients, including those who might be vulnerable to statin therapy and those without clinical atherosclerotic cardiovascular diseases. Methods and Results A total of 2153 patients with acute ischemic stroke and atrial fibrillation were enrolled in the present nationwide, multicenter, cohort study. The primary composite end point was the occurrence of net adverse clinical and cerebral events (NACCE; death from any cause, stroke, acute coronary syndrome, or major bleeding) over a 3‐year period based on statin intensity. NACCE rates were lower in patients receiving low‐ to moderate‐intensity (adjusted hazard ratio 0.64; 95% CI: 0.52‐0.78) and high‐intensity statins (hazard ratio 0.51; 95% CI 0.40‐0.66) than in those not receiving statin therapy. High‐intensity statins were associated with a lower risk for NACCE than low‐ to moderate‐intensity statins (hazard ratio 0.76; 95% CI 0.59‐0.96). Subgroup analyses showed that the differences in hazard ratio for 3‐year NACCE favored statin use across all subgroups, including older patients, those with low cholesterol levels, patients receiving anticoagulants, and patients without clinical atherosclerotic cardiovascular diseases. Magnified benefits of high‐intensity statins compared with low‐ to moderate‐intensity statins were observed in patients who underwent revascularization therapy and those under 75 years of age. Conclusions Statins, particularly high‐intensity statins, could reduce the risk for NACCE in patients with acute ischemic stroke and atrial fibrillation; this needs to be further explored in randomized controlled trials.
Collapse
Affiliation(s)
- Kang-Ho Choi
- Department of Neurology Chonnam National University College of Medicine and Hospital Gwangju Korea
| | - Woo-Keun Seo
- Department of Neurology Samsung Medical Center and Department of Digital Health, SAHIST Sunkyunkwan University Seoul Korea
| | - Man-Seok Park
- Department of Neurology Chonnam National University College of Medicine and Hospital Gwangju Korea
| | - Joon-Tae Kim
- Department of Neurology Chonnam National University College of Medicine and Hospital Gwangju Korea
| | - Jong-Won Chung
- Department of Neurology Samsung Medical Center Sungkyunkwan University School of Medicine Seoul Korea
| | - Oh Young Bang
- Department of Neurology Samsung Medical Center Sungkyunkwan University School of Medicine Seoul Korea
| | - Gyeong-Moon Kim
- Department of Neurology Samsung Medical Center Sungkyunkwan University School of Medicine Seoul Korea
| | - Tae-Jin Song
- Department of Neurology Seoul Hospital Ewha Womans University College of Medicine Seoul Korea
| | - Bum Joon Kim
- Department of Neurology Kyung Hee University College of Medicine Seoul Korea
| | - Sung Hyuk Heo
- Department of Neurology Kyung Hee University College of Medicine Seoul Korea
| | - Jin-Man Jung
- Department of Neurology Korea University Ansan Hospital Korea University College of Medicine Seoul Korea
| | - Kyung-Mi Oh
- Department of Neurology Korea University Guro Hospital Korea University College of Medicine Seoul Korea
| | - Chi Kyung Kim
- Department of Neurology Korea University Guro Hospital Korea University College of Medicine Seoul Korea
| | - Sungwook Yu
- Department of Neurology Korea University Hospital Korea University College of Medicine Seoul Korea
| | - Kwang-Yeol Park
- Department of Neurology Chung-Ang University College of Medicine Seoul Korea
| | - Jeong-Min Kim
- Department of Neurology Chung-Ang University College of Medicine Seoul Korea
| | - Jong-Ho Park
- Department of Neurology Myongji Hospital Hanyang University College of Medicine Goyang Korea
| | - Jay Chol Choi
- Department of Neurology Jeju National University Jeju Korea
| | - Yang-Ha Hwang
- Department of Neurology Cerebrovascular Center Kyungpook National University School of Medicine and Hospital Daegu Korea
| | - Yong-Jae Kim
- Department of Neurology Eunpyeong St. Mary's Hospital The Catholic University of Korea Seoul Korea
| |
Collapse
|
40
|
Song TJ, Baek IY, Woo HG, Kim YJ, Chang Y, Kim BJ, Heo SH, Jung JM, Oh K, Kim CK, Yu S, Park KY, Kim JM, Park JH, Choi JC, Park MS, Kim JT, Choi KH, Hwang YH, Chung JW, Bang OY, Kim GM, Seo WK. Characteristics and Factors for Short-Term Functional Outcome in Stroke Patients With Atrial Fibrillation, Nationwide Retrospective Cohort Study. Front Neurol 2019; 10:1101. [PMID: 31681159 PMCID: PMC6813464 DOI: 10.3389/fneur.2019.01101] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [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: 04/12/2019] [Accepted: 10/01/2019] [Indexed: 01/07/2023] Open
Abstract
Background and aims: Atrial fibrillation (AF) is a major cause of ischemic stroke; however, detailed clinical data and prognostic factors for stroke patients with AF are lacking in Korea. We aimed to investigate clinical information and factors associated with functional outcomes of stroke patients with AF from the Korean nationwide ATrial fibrillaTion EvaluatioN regisTry in Ischemic strOke patieNts (K-ATTENTION) database. Methods: From January 2013 to December 2015, consecutive clinical information from acute stroke patients with AF or history of AF was collected from 11 centers in Korea. Collected data included demographics, risk factors, pre-stroke medication, stroke severity, stroke subtypes, concomitant cerebral atherosclerosis, brain image findings, recanalization therapy, discharge medication, and functional outcome at 3 months after index stroke. Results: A total of 3,213 stroke patients (mean age, 73.6 ± 9.8 years; female, 48.6%) were included. The mean CHA2DS2-VASc score was 4.9. Among the 1,849 (57.5%) patients who had brain image and functional outcome data, poor outcome (modified Rankin scale > 2) was noted in 53.1% (981/1,849) of patients. After adjusting for age, sex, and variables that had a p < 0.05 in univariate analysis or well-known factors for functional outcome, presence of asymptomatic extracranial cerebral atherosclerosis [odd ratio (OR): 1.96, 95% confidence interval (CI): 1.36–2.82, p = 0.001] and less frequent prior stroke statin intake (OR: 0.69, 95% CI: 0.49–0.98, p = 0.038) were associated with poor functional outcome. Conclusion: Our results suggest that presence of non-relevant extracranial cerebral atherosclerosis may affect poor functional outcome and prior stroke statin therapy may be feasible in Korean stroke patients with AF.
Collapse
Affiliation(s)
- Tae-Jin Song
- Department of Neurology, College of Medicine, Ewha Womans University Mokdong Hospital, Seoul, South Korea
| | - In-Young Baek
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.,Department of Digital Health, SAIHST, Sungkyunkwan University, Seoul, South Korea
| | - Ho Geol Woo
- Department of Neurology, College of Medicine, Ewha Womans University Mokdong Hospital, Seoul, South Korea
| | - Yong-Jae Kim
- Department of Neurology, Eunpyeong St.Mary's Hospital, The Catholic University of Korea, Seoul, South Korea
| | - Younkyung Chang
- Department of Neurology, College of Medicine, Ewha Womans University Mokdong Hospital, Seoul, South Korea
| | - Bum Joon Kim
- Department of Neurology, Kyung Hee University College of Medicine, Seoul, South Korea
| | - Sung Hyuk Heo
- Department of Neurology, Kyung Hee University College of Medicine, Seoul, South Korea
| | - Jin-Man Jung
- Department of Neurology, Korea University Ansan Hospital, Korea University College of Medicine, Seoul, South Korea
| | - Kyungmi Oh
- Department of Neurology, Korea University Guro Hospital, Korea University College of Medicine, Seoul, South Korea
| | - Chi Kyung Kim
- Department of Neurology, Korea University Guro Hospital, Korea University College of Medicine, Seoul, South Korea
| | - Sungwook Yu
- Department of Neurology, Korea University Anam Hospital, Korea University College of Medicine, Seoul, South Korea
| | - Kwang Yeol Park
- Department of Neurology, Chung-Ang University College of Medicine, Seoul, South Korea
| | - Jeong-Min Kim
- Department of Neurology, Chung-Ang University College of Medicine, Seoul, South Korea
| | - Jong-Ho Park
- Department of Neurology, MyongjiHospital, Hanyang University, College of Medicine, Goyang-si, South Korea
| | - Jay Chol Choi
- Department of Neurology, Jeju National University, Jeju-si, South Korea
| | - Man-Seok Park
- Department of Neurology, Chonnam National University Medical School and Hospital, Gwangju, South Korea
| | - Joon-Tae Kim
- Department of Neurology, Chonnam National University Medical School and Hospital, Gwangju, South Korea
| | - Kang-Ho Choi
- Department of Neurology, Chonnam National University Medical School and Hospital, Gwangju, South Korea
| | - Yang-Ha Hwang
- Department of Neurology, School of Medicine, Kyungpook National University, Daegu, South Korea
| | - Jong-Won Chung
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Oh Young Bang
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Gyeong-Moon Kim
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Woo-Keun Seo
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.,Department of Digital Health, SAIHST, Sungkyunkwan University, Seoul, South Korea
| |
Collapse
|
41
|
Jung JM, Kim YH, Yu S, O K, Kim CK, Song TJ, Kim YJ, Kim BJ, Heo SH, Park KY, Kim JM, Park JH, Choi JC, Park MS, Kim JT, Choi KH, Hwang YH, Chung JW, Bang OY, Kim GM, Seo WK. Long-Term Outcomes of Real-World Korean Patients with Atrial-Fibrillation-Related Stroke and Severely Decreased Ejection Fraction. J Clin Neurol 2019; 15:545-554. [PMID: 31591844 PMCID: PMC6785482 DOI: 10.3988/jcn.2019.15.4.545] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [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: 04/16/2019] [Revised: 07/29/2019] [Accepted: 07/29/2019] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND AND PURPOSE The clinical implications of echocardiography findings for long-term outcomes in atrial fibrillation (AF)-related stroke patients are unknown. METHODS This was a substudy of the Korean ATrial fibrillaTion EvaluatioN regisTry in Ischemic strOke patieNts (K-ATTENTION), which is a multicenter-based cohort comprising prospective stroke registries from 11 tertiary centers. Stroke survivors who underwent two-dimensional transthoracic echocardiography during hospitalization were enrolled. Echocardiography markers included the left-ventricle (LV) ejection fraction (LVEF), the left atrium diameter, and the ratio of the peak transmitral filling velocity to the mean mitral annular velocity during early diastole (E/e' ratio). LVEF was categorized into normal (≥55%), mildly decreased (>40% and <55%), and severely decreased (≤40%). The E/e' ratio associated with the LV filling pressure was categorized into normal (<8), borderline (≥8 and <15), and elevated (≥15). Kaplan-Meier and Cox regression analyses were performed for recurrent stroke, major adverse cardiac events, and all-cause death. RESULTS This study finally included 1,947 patients. Over a median follow-up of 1.65 years (interquartile range, 0.42-2.87 years), the rates of recurrent stroke, major adverse cardiac events, and all-cause death were 35.1, 10.8, and 69.6 cases per 1,000 person-years, respectively. Multivariable analyses demonstrated that severely decreased LVEF was associated with a higher risks of major adverse cardiac events [hazard ratio (HR), 3.91; 95% confidence interval (CI), 1.58-9.69] and all-cause death (HR, 1.95; 95% CI, 1.23-3.10). The multivariable fractional polynomial plot indicated that recurrent stroke might be associated with a lower LVEF. CONCLUSIONS Severe LV systolic dysfunction could be a determinant of long-term outcomes in AF-related stroke.
Collapse
Affiliation(s)
- Jin Man Jung
- Department of Neurology, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, Korea
| | - Yong Hyun Kim
- Department of Cardiology, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, Korea
| | - Sungwook Yu
- Department of Neurology, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea
| | - Kyungmi O
- Department of Neurology, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea
| | - Chi Kyung Kim
- Department of Neurology, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Tae Jin Song
- Department of Neurology, Mokdong Hospital, Ewha Womans University, College of Medicine, Seoul, Korea
| | - Yong Jae Kim
- Department of Neurology, Eunpyeong St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea
| | - Bum Joon Kim
- Department of Neurology, Kyung Hee University College of Medicine, Seoul, Korea
| | - Sung Hyuk Heo
- Department of Neurology, Kyung Hee University College of Medicine, Seoul, Korea
| | - Kwang Yeol Park
- Department of Neurology, Chung-Ang University College of Medicine, Chung-Ang University Hospital, Seoul, Korea
| | - Jeong Min Kim
- Department of Neurology, Chung-Ang University College of Medicine, Chung-Ang University Hospital, Seoul, Korea
| | - Jong Ho Park
- Department of Neurology, Myongji Hospital, Hanyang University College of Medicine, Goyang, Korea
| | - Jay Chol Choi
- Department of Neurology, Jeju National University, Jeju, Korea
| | - Man Seok Park
- Department of Neurology, Chonnam National University Hospital, Gwangju, Korea
| | - Joon Tae Kim
- Department of Neurology, Chonnam National University Hospital, Gwangju, Korea
| | - Kang Ho Choi
- Department of Neurology, Chonnam National University Hospital, Gwangju, Korea.,Department of Neurology, Chonnam National University Hwasun Hospital, Hwasun, Korea
| | - Yang Ha Hwang
- Department of Neurology, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Jong Won Chung
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Oh Young Bang
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Gyeong Moon Kim
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Woo Keun Seo
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
| |
Collapse
|
42
|
Heo SH, Song J, Kim BJ, Kim H, Chang DI. Rationale and design to assess the efficacy and safety of HT047 in patients with acute ischemic stroke: A multicenter, randomized, double-blind, placebo-controlled, parallel-group, phase II trial. Medicine (Baltimore) 2019; 98:e17655. [PMID: 31651889 PMCID: PMC6824685 DOI: 10.1097/md.0000000000017655] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Though several neuroprotective agents have been evaluated as potential treatments for acute ischemic stroke, none have demonstrated a definitive treatment efficacy, which remains elusive. HT047 is an herbal extract of Scutellaria baicalensis and Pueraria lobata, both of which have been widely used to treat ischemic stroke in traditional Korean medicine. The aims of this trial are to investigate whether HT047 can improve neurologic status, particularly motor function, in acute ischemic stroke patients, and to determine the safety of HT047. METHODS A multicenter, double-blind, randomized, placebo-controlled, 3-arm parallel group, phase II trial will be conducted in patients who have had an acute ischemic stroke within the past 14 days. The participating patients must have a Fugl-Meyer assessment (FMA) motor score ≤55, with arm or leg weakness, and Korean version of the National Institutes of Health Stroke scale (K-NIHSS) score of ≥4 and ≤15. Seventy-eight participants will be randomized in a 1:1:1 ratio and given high-dose HT047 (750 mg 3 times a day), low-dose HT047 (500 mg 3 times a day), or a placebo for 12 weeks. The primary endpoint is the change in FMA motor score between baseline and week 12. Secondary endpoints are as follows: the change in FMA motor score at weeks 4 and 8 from baseline; the change in FMA motor score at weeks 4, 8, and 12 from baseline according to the timing of treatment initiation (either within 1 week, or 1-2 weeks), or according to the presence of prognostic risk factors (hypertension, diabetes, dyslipidemia, etc); the change in K-NIHSS and Korean versions of the modified Rankin scale (K-mRS) and the modified Barthel index at weeks 4 and 12 from baseline; and the proportion of subjects at week 12 with a K-NIHSS score of 0 to 2, or with K-mRS scores of 0, ≤1, and ≤2. DISCUSSION This study is a 1st-in-human trial of HT047 to explore the efficacy and safety in acute ischemic stroke patients. The results will provide the appropriate dosage and evidence of therapeutic benefit of HT047 for stroke recovery. TRIAL REGISTRATION ClinicalTrials.gov (NCT02828540) Registered July 11, 2016.
Collapse
Affiliation(s)
- Sung Hyuk Heo
- Department of Neurology, Kyung Hee University Hospital
| | - Jungbin Song
- Department of Herbal Pharmacology, Kyung Hee University College of Korean Medicine, Seoul, Republic of Korea
| | - Bum Joon Kim
- Department of Neurology, Kyung Hee University Hospital
| | - Hocheol Kim
- Department of Herbal Pharmacology, Kyung Hee University College of Korean Medicine, Seoul, Republic of Korea
| | - Dae-Il Chang
- Department of Neurology, Kyung Hee University Hospital
| |
Collapse
|
43
|
Shin YY, Ha SH, Woo HG, Heo SH, Chang DI, Kim BJ. Subclinical Peripheral Arterial Disease in Patients with Acute Ischemic Stroke: A Study with Ultrasonography. J Stroke Cerebrovasc Dis 2019; 28:104370. [PMID: 31522885 DOI: 10.1016/j.jstrokecerebrovasdis.2019.104370] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [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: 07/15/2019] [Revised: 08/14/2019] [Accepted: 08/25/2019] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Peripheral arterial disease (PAD) is an advanced form of atherosclerosis defined by an abnormal ankle-brachial index (ABI). However, the ABI provides no information about the location of atherosclerosis. We investigated the clinical implication of PAD confirmed using lower-extremity ultrasonography (LEUS), with consideration of the atherosclerosis location. METHODS Patients with acute ischemic stroke who underwent LEUS were enrolled. Patients with PAD were further divided into those with PAD at the proximal (above-popliteal artery, PADP) and distal (below-tibialis artery, PADD) segments. The clinical outcome was compared between patients with and without PAD, and between PADP and PADD. The atherosclerosis location in the cerebral artery was also compared between groups. RESULTS Among 289 patients, PAD was observed in 108 (37.4%) patients (43 had PADP and 65 had PADD). Patients with PAD were slightly older (P < .001) and had more significant carotid artery stenosis (30.6% versus 12.7%, P < .001) than those without. Patients with PAD had poor 3-month functional outcome than those without (modified-Rankin Scale score: 3 [interquartile range, 1-4] versus 2 [1-3], respectively, P = .003). Diabetes, high-stroke severity, and the presence of PADP (odds ratio, 3.893; 95% confidence interval, 1.454-10.425; P = .007) were independently associated with poor functional outcome at 3 months. Patients with PADP showed higher prevalence of extracranial stenosis than those with PADD (41.9% versus 23.1%; P = .038). CONCLUSIONS Our study suggests that subclinical PAD, especially PADP, is associated with poor functional outcome at 3 months after stroke onset. Interestingly, the location of cerebral atherosclerosis differed according to the location of PAD.
Collapse
Affiliation(s)
- Yu Yong Shin
- Department of Neurology, Kyung Hee University Hospital at Gangdong, Seoul, Republic of Korea; Department of Neurology, Naeun Hospital, Incheon, Republic of Korea
| | - Sang Hee Ha
- Department of Neurology, Kyung Hee University Hospital, Seoul, Republic of Korea
| | - Ho Geol Woo
- Department of Medicine, Graduate School, Kyung Hee University, Seoul, Republic of Korea
| | - Sung Hyuk Heo
- Department of Neurology, Kyung Hee University Hospital, Seoul, Republic of Korea
| | - Dae-Il Chang
- Department of Neurology, Kyung Hee University Hospital, Seoul, Republic of Korea
| | - Bum Joon Kim
- Department of Neurology, Kyung Hee University Hospital, Seoul, Republic of Korea.
| |
Collapse
|
44
|
Choi KH, Seo WK, Park MS, Kim JT, Chung JW, Bang OY, Kim GM, Song TJ, Kim BJ, Heo SH, Jung JM, Oh K, Kim CK, Yu S, Park KY, Kim JM, Park JH, Choi JC, Hwang YH, Kim YJ. Baseline D-Dimer Levels as a Risk Assessment Biomarker for Recurrent Stroke in Patients with Combined Atrial Fibrillation and Atherosclerosis. J Clin Med 2019; 8:jcm8091457. [PMID: 31540205 PMCID: PMC6780256 DOI: 10.3390/jcm8091457] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [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: 08/09/2019] [Revised: 09/08/2019] [Accepted: 09/10/2019] [Indexed: 02/06/2023] Open
Abstract
Background: We investigated the effect of D-dimer levels and efficacy of different antithrombotic therapies according to the baseline D-dimer levels on recurrent stroke in patients with atrial fibrillation (AF)-related stroke and atherosclerosis. Methods: We enrolled 1441 patients with AF-related stroke and atherosclerosis in this nationwide multicenter study. The primary outcome measure was the occurrence of recurrent ischemic stroke over a 3-year period. Results: High D-dimer levels (≥2 μg/mL) were significantly associated with higher risk of recurrent ischemic stroke (adjusted hazard ratio (HR), 1.80; 95% confidence interval (CI), 1.13–2.84; p = 0.012). The risk of recurrent stroke was similar between the anticoagulant and the antiplatelet groups in all subjects (adjusted HR, 0.78; 95% CI, 0.46–1.32; p = 0.369). However, in patients with high D-dimer levels (≥2 μg/mL), risk of recurrent stroke was significantly lower in the anticoagulant group than in the antiplatelet group (adjusted HR, 0.40; 95% CI, 0.18–0.87; p = 0.022). Conclusion: Our findings suggested that baseline D-dimer levels could be used as a risk assessment biomarker of recurrent stroke in patients with AF-related stroke and atherosclerosis. High D-dimer levels would facilitate the identification of patients who are more likely to benefit from anticoagulants to ensure secondary prevention of stroke.
Collapse
Affiliation(s)
- Kang-Ho Choi
- Department of Neurology, Chonnam National University School of Medicine and Hospital, Gwangju 61469, Korea.
| | - Woo-Keun Seo
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea.
| | - Man-Seok Park
- Department of Neurology, Chonnam National University School of Medicine and Hospital, Gwangju 61469, Korea.
| | - Joon-Tae Kim
- Department of Neurology, Chonnam National University School of Medicine and Hospital, Gwangju 61469, Korea.
| | - Jong-Won Chung
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea.
| | - Oh Young Bang
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea.
| | - Geong-Moon Kim
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea.
| | - Tae-Jin Song
- Department of Neurology, Ewha Womans University, Seoul 03760, Korea.
| | - Bum Joon Kim
- Department of Neurology, Kyung Hee University College of Medicine, Seoul 02447, Korea.
| | - Sung Hyuk Heo
- Department of Neurology, Kyung Hee University College of Medicine, Seoul 02447, Korea.
| | - Jin-Man Jung
- Department of Neurology, Korea University Ansan Hospital, Korea University College of Medicine, Kyungki-Do 15355, Korea.
| | - Kyungmi Oh
- Department of Neurology, Korea University Guro Hospital, Korea University College of Medicine, Seoul 08308, Korea.
| | - Chi Kyung Kim
- Department of Neurology, Korea University Guro Hospital, Korea University College of Medicine, Seoul 08308, Korea.
| | - Sungwook Yu
- Department of Neurology, Korea University Hospital, Korea University College of Medicine, Seoul 02841, Korea.
| | - Kwang Yeol Park
- Department of Neurology, Chung-Ang University College of Medicine, Seoul 06974, Korea.
| | - Jeong-Min Kim
- Department of Neurology, Chung-Ang University College of Medicine, Seoul 06974, Korea.
| | - Jong-Ho Park
- Department of Neurology, Myongji Hospital, Hanyang University College of Medicine, Goyang 10475, Korea.
| | - Jay Chol Choi
- Department of Neurology, Jeju National University, Jeju 63241, Korea.
| | - Yang-Ha Hwang
- Department of Neurology, Cerebrovascular Center Kyungpook National University School of Medicine and Hospital, Daegu 41944, Korea.
| | - Yong-Jae Kim
- Department of Neurology, Eunpyeong St. Mary's Hospital, The Catholic University of Korea, Seoul 03312, Korea.
| |
Collapse
|
45
|
Kim BJ, Kwon SU, Park JM, Hwang YH, Heo SH, Rha JH, Lee J, Park MS, Kim JT, Song HJ, Park JH, Yu S, Lee SJ, Park TH, Cha JK, Kwon HM, Kim EG, Lee SH, Lee JS, Lee J, Kang DW. Blood Pressure Variability Is Associated With White Matter Lesion Growth in Intracranial Atherosclerosis. Am J Hypertens 2019; 32:918-924. [PMID: 31044227 DOI: 10.1093/ajh/hpz068] [Citation(s) in RCA: 5] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2019] [Revised: 04/23/2019] [Accepted: 04/25/2019] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND High blood pressure variability (BPV) is associated with recurrent stroke. We investigated the association between BPV, new ischemic lesions (NILs), and white matter lesion (WML) growth in patients with ischemic stroke due to intracranial atherosclerosis (ICAS). METHODS This study was performed as a post-hoc analysis of the STABLE-ICAS trial, which enrolled subacute ischemic stroke patients with symptomatic ICAS (>50% stenosis) and hypertension. BPV was measured at the office (visit by visit) and at home (day by day). Patients were divided into 3 groups (tertiles) according to their home BPV. WML growth and the occurrence of NILs were compared among the 3 groups. Multivariable analyses were performed to identify the independent risk factors of WML growth and NILs. RESULTS Of the 111 enrolled patients, 69 patients (67.6%) demonstrated WML growth and 15 patients (13.7%) had NILs. Patients with higher BPV demonstrated a more WML growth (50% vs. 61.8% vs. 83.8; P = 0.02, by tertiles) and more NILs (5.4% vs. 5.4% vs. 29.7%; P = 0.002, by tertiles). In multivariable analyses, old age [odds ratio (OR) = 1.052 (95% confidence interval (CI) = 1.005-1.101); P = 0.03] and home BPV [OR = 1.149 (95% CI = 1.013-1.304); P = 0.02] were independently associated with WML growth. Low mean diastolic blood pressure [OR = 0.913 (95% CI = 0.874-0.984); P = 0.02] and high home BPV [OR = 1.287 (95% CI = 1.086-1.526); P = 0.004] were independently associated with NILs at follow-up. CONCLUSIONS High BPV is associated with WML growth and NIL in ischemic stroke patients with symptomatic ICAS. BPV monitoring at home may be helpful.
Collapse
Affiliation(s)
- Bum Joon Kim
- Department of Neurology, Kyung Hee University Hospital, Kyung Hee University, Seoul, South Korea
| | - Sun U Kwon
- Department of Neurology, Asan Medical Center, University of Ulsan, Seoul, South Korea
| | - Jong-Moo Park
- Department of Neurology, Eulji General Hospital, Eulji University, Seoul, South Korea
| | - Yang-Ha Hwang
- Department of Neurology, Kyungpook National University Hospital, Kyungpook National University, Daegu, South Korea
- Cerebrovascular Center, Kyungpook National University School of Medicine and Hospital, Daegu, South Korea
| | - Sung Hyuk Heo
- Department of Neurology, Kyung Hee University Hospital, Kyung Hee University, Seoul, South Korea
| | - Joung-Ho Rha
- Department of Neurology, Inha University Hospital, Inha University, Incheon, South Korea
| | - Jun Lee
- Department of Neurology, Yeungnam University Hospital, Yeungnam University, Daegu, South Korea
| | - Man-Seok Park
- Department of Neurology, Chonnam National University Hospital, Gwangju, South Korea
| | - Joon-Tae Kim
- Department of Neurology, Chonnam National University Hospital, Gwangju, South Korea
| | - Hee-Jung Song
- Department of Neurology, Chungnam National University Hospital, Daejeon, South Korea
| | - Jong-Ho Park
- Department of Neurology, Hanyang University, Seoul, South Korea
| | - Sungwook Yu
- Department of Neurology, Anam Hospital, Korea University, Seoul, South Korea
| | - Soo Joo Lee
- Department of Neurology, Eulji University Hospital, Eulji University, Daejeon, South Korea
| | - Tai Hwan Park
- Department of Neurology, Seoul Medical Center, Seoul, South Korea
| | - Jae-Kwan Cha
- Department of Neurology, Dong-A University Hospital, Busan, South Korea
| | - Hyung-Min Kwon
- Department of Neurology, SMG-SNU Boramae Medical Center, Seoul National University College of Medicine, Seoul, South Korea
| | - Eung-Gyu Kim
- Department of Neurology, Busan Paik Hospital, Inje University, Busan, South Korea
| | - Seung-Hoon Lee
- Department of Neurology, Seoul National University Hospital, Seoul, South Korea
| | - Ji Sung Lee
- Clinical Research Center, Asan Medical Center, Seoul, South Korea
| | - Juneyoung Lee
- Department of Biostatistics, Korea University, Seoul, South Korea
| | - Dong-Wha Kang
- Department of Neurology, Asan Medical Center, University of Ulsan, Seoul, South Korea
| |
Collapse
|
46
|
Chung SW, Lee KM, Heo SH, Ra R, Hong SJ, Yang HI, Lee SH, Song R, Lee YA. A systemic lupus erythematosus patient with thunderclap headache: reversible cerebral vasoconstriction syndrome. Lupus 2019; 28:898-902. [PMID: 31042127 DOI: 10.1177/0961203319845485] [Citation(s) in RCA: 5] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Headaches are common in patients with systemic lupus erythematosus (SLE). It is important to identify the exact cause of headaches in SLE to avoid unnecessary steroid or immunosuppressive therapy like in neuropsychiatric SLE. A 35-year-old woman with SLE suddenly developed severe headache. Magnetic resonance angiography showed multifocal segmental narrowing of cerebral arteries, suggestive of central nervous system vasculitis. However, lack of abnormal enhancement in vessel wall imaging indicated reversible cerebral vasoconstriction syndrome (RCVS) rather than central nervous system vasculitis. The patient was treated with oral nimodipine and she recovered over a period of two months. Following magnetic resonance angiography on day 90 was normal. Herein we report a case of reversible cerebral vasoconstriction syndrome in an SLE patient with literature review.
Collapse
Affiliation(s)
- S W Chung
- 1 Division of Rheumatology, Department of Internal Medicine, School of Medicine, Kyung Hee University, Seoul, South Korea
| | - K M Lee
- 2 Department of Radiology, School of Medicine, Kyung Hee University, Seoul, South Korea
| | - S H Heo
- 3 Department of Neurology, School of Medicine, Kyung Hee University, Seoul, South Korea
| | - R Ra
- 1 Division of Rheumatology, Department of Internal Medicine, School of Medicine, Kyung Hee University, Seoul, South Korea
| | - S-J Hong
- 1 Division of Rheumatology, Department of Internal Medicine, School of Medicine, Kyung Hee University, Seoul, South Korea
| | - H-I Yang
- 1 Division of Rheumatology, Department of Internal Medicine, School of Medicine, Kyung Hee University, Seoul, South Korea
| | - S-H Lee
- 1 Division of Rheumatology, Department of Internal Medicine, School of Medicine, Kyung Hee University, Seoul, South Korea
| | - R Song
- 1 Division of Rheumatology, Department of Internal Medicine, School of Medicine, Kyung Hee University, Seoul, South Korea
| | - Y-A Lee
- 1 Division of Rheumatology, Department of Internal Medicine, School of Medicine, Kyung Hee University, Seoul, South Korea
| |
Collapse
|
47
|
Kim BJ, Kim HY, Jho W, Kim YS, Koh SH, Heo SH, Chang DI, Lee YJ. Asymptomatic Basilar Artery Plaque Distribution and Vascular Geometry. J Atheroscler Thromb 2019; 26:1007-1014. [PMID: 30918163 PMCID: PMC6845693 DOI: 10.5551/jat.47365] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [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] [Indexed: 11/11/2022] Open
Abstract
AIM Development of atherosclerotic plaques is affected by vascular geometry and hemodynamics. Hemodynamics in the basilar artery (BA) is unique as the flow converges from vertebral arteries (VAs). Here, we investigated the characteristics of BA plaque based on VA and BA geometry. METHODS Consecutive patients evaluated using high-resolution magnetic resonance imaging (MRI) at a general health center were screened. Geometric characteristics of VA (VA dominancy and VA-BA angles) and BA (BA convexity and BA angles) were assessed. The burden of BA plaques was investigated in each wall (anterior, posterior, left, and right lateral). The characteristics of BA plaques were compared according to VA dominancy (right vs. left), BA angle of lateral view (lateral mid-BA angle; dichotomized), and total plaque burden (divided by tertiles). RESULTS Of the 1029 subjects, BA plaques were observed in 98 (9.5%) patients, and were more frequently located at the anterior wall (32.4%) and posterior wall (35.0%) than the right wall (15.3%) and left lateral wall (17.6%). Right and left lateral plaques were more frequent in the left and right convex BA, respectively (p=0.009 and p=0.024, respectively). Anterior plaques were more frequently observed in low lateral mid-BA angle (p= 0.043). BA plaques were predominant in anterior and posterior walls in patients with lower plaque burden, whereas they were predominant in right and left lateral walls in patients with higher plaque burden (p=0.001 and p=0.025, respectively). CONCLUSIONS Asymptomatic BA plaque location was associated with BA convexity and lateral mid-BA angle. The anteriorly and posteriorly located BA plaques may extend to the lateral walls as the plaque burden increases.
Collapse
Affiliation(s)
- Bum Joon Kim
- Department of Neurology, Kyung Hee University Hospital
| | | | - Wonho Jho
- Department of Neurology, Hanyang University Hospital
| | - Young Seo Kim
- Department of Neurology, Hanyang University Hospital
| | - Seong-Ho Koh
- Department of Neurology, Hanyang University Hospital
| | - Sung Hyuk Heo
- Department of Neurology, Kyung Hee University Hospital
| | - Dae-Il Chang
- Department of Neurology, Kyung Hee University Hospital
| | - Young-Jun Lee
- Department of Radiology, Hanyang University Hospital
| |
Collapse
|
48
|
Park JH, Heo SH, Lee MH, Kwon HS, Kwon SU, Lee JS. White matter hyperintensities and recurrent stroke risk in patients with stroke with small-vessel disease. Eur J Neurol 2019; 26:911-918. [PMID: 30637882 DOI: 10.1111/ene.13908] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Accepted: 01/08/2019] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND PURPOSE White matter hyperintensities (WMH) are a predictor of stroke among elderly individuals. This study aimed to evaluate the association between WMH severity and the risk of recurrent vascular events among Asian patients with ischaemic stroke with small-vessel disease (SVD) including micro/macrobleeds and lacunes. METHODS Data from participants (n = 1454) in the PICASSO (PreventIon of CArdiovascular Events in iSchemic Stroke Patients with High Risk of Cerebral HemOrrhage) trial were reviewed. The severity of WMH in baseline brain magnetic resonance imaging scans was assessed using the Fazekas scale. The association between WMH severity and stroke (ischaemic or hemorrhagic) and major vascular events (MVEs) (a composite of stroke/myocardial infarction/vascular death) was assessed. RESULTS Study patients had a significant burden of SVD: Fazekas score 0 (n = 2), 1 (n = 426), 2 (n = 650) and 3 (n = 376) [median Fazekas score 2 (mean follow-up, 1.9 ± 1.3 years)]. The stroke incidence rate per 100 personyears was 2.6 in the Fazekas 0-1 group, 3.6 in the Fazekas 2 group and 7.0 in the Fazekas 3 group, and the rates for MVEs were 3.3, 4.3 and 7.6, respectively. Compared with the Fazekas 0-1 group, the Fazekas 3 group was associated with a higher risk of stroke [adjusted hazard ratio (HR), 2.15; 95% confidence interval (CI), 1.19-3.88; P = 0.011], ischaemic stroke (adjusted HR, 2.11; 95% CI, 1.07-4.15; P = 0.031), hemorrhagic stroke (adjusted HR, 3.72; 95% CI, 1.09-12.70; P = 0.036) and MVEs (adjusted HR, 2.09; 95% CI, 1.20-3.66; P = 0.010). CONCLUSION Advanced WMH in Asian patients with ischaemic stroke with SVD burden was associated with an increased risk of recurrent vascular events. It may exert an effect as a prognostic indicator in high risk of recurrent vascular events.
Collapse
Affiliation(s)
- J-H Park
- Department of Neurology, Myongji Hospital, Hanyang University College of Medicine, Goyang
| | - S H Heo
- Department of Neurology, Kyung Hee University Hospital, Seoul
| | - M H Lee
- Department of Neurology, Myongji St Mary's Hospital, Seoul
| | - H S Kwon
- Department of Neurology, Hanyang University College of Medicine, Seoul
| | - S U Kwon
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul
| | - J S Lee
- Clinical Research Center, Asan Medical Center, Seoul, South Korea
| | | |
Collapse
|
49
|
Jung JM, Seo WK, Kim JM, Park KY, Song TJ, Kim YJ, Kim BJ, Heo SH, Oh KM, Kim CK, Yu S, Park JH, Choi JC, Park MS, Kim JT, Bang OY, Chung JW, Hwang YH, Kim GM. Abstract WP210: Transthoracic Echocardiographic Predictor for Long-Term Outcomes in Real-World Korean Patients With Atrial Fibrillation-Related Stroke: A Multi-Center Cohort Study. Stroke 2019. [DOI: 10.1161/str.50.suppl_1.wp210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background:
While transthoracic echocardiography (TTE) is performed to find out potential embolic sources and certain cardiac abnormalities as a routine workup of stroke, clinical implication of echocardiographic findings for long-term outcomes in atrial fibrillation (AF)-related stroke patients has been unknown.
Methods:
This was a sub-study of K-ATTENTION (Korean ATrial fibrillaTion EvaluatioN regisTry in Ischemic strOke patieNts), a multicenter-based cohort composed of prospective stroke registries from 11 tertiary centers. All stroke survivals enrolled in this study underwent TTE during hospitalization. Echocardiographic findings included left atrial (LA) diameter, left ventricular ejection fraction (LVEF), LV end-diastolic dimension (LVEDV), stenosis and regurgitation of mitral and aortic valves, and peak trans-mitral filling velocity/mean mitral annular velocity during early diastole (E/e’ ratio). Indexed-LA size was acquired as dividing LA size by body surface area. LV systolic function was grouped into normal (LVEF≥55%), mild (55%>LVEF>40%), and severe (LVEF≤40%). Level of E/e’ ratio associated with LV filling pressure was divided into normal (<8), borderline (8-15) and increased (≥15). Outcomes of interest were recurrent stroke, coronary artery disease, and vascular, and all-cause death. We used Cox regression multivariable analyses adjusted by confounding factors.
Results:
A total of 1952 patients were finally included. Over a mean follow-up of 1.72±1.31 years, 140 patients had recurrent stroke, 36 had coronary artery disease, and of 236 fatalities, 33 died of a vascular cause. Multivariable analyses demonstrated that severe LV systolic dysfunction was associated with a higher risk of coronary artery disease (hazard ratio [HR] 3.80, 95% confidence interval [CI] 1.53-9.41), vascular death (HR 3.59, 95% CI 1.42-9.10) and all-cause death (HR 2.29, 95% CI 1.47-3.56).
Conclusions:
LV ejection fraction could be important predictor for long-term outcomes in AF-related stroke.
Collapse
Affiliation(s)
- Jin-Man Jung
- Korea Univ Ansan Hosp, Ansan, Korea, Republic of
| | | | - Jeong-min Kim
- Chung-Ang Univ College of Medicine, Seoul, Korea, Republic of
| | - Kwang Yeol Park
- Chung-Ang Univ College of Medicine, Seoul, Korea, Republic of
| | | | | | - Bum Joon Kim
- Kyung Hee Univ College of Medicine, Seoul, Korea, Republic of
| | - Sung Hyuk Heo
- Kyung Hee Univ College of Medicine, Seoul, Korea, Republic of
| | - Kyung-mi Oh
- Korea Univ Guro Hosp, Seoul, Korea, Republic of
| | | | - Sungwook Yu
- Korea Univ Anam Hosp, Seoul, Korea, Republic of
| | | | | | - Man-seok Park
- Chonnam National Univ Hosp, Gwangju, Korea, Republic of
| | - Joon-tae Kim
- Chonnam National Univ Hosp, Gwangju, Korea, Republic of
| | | | | | - Yang-ha Hwang
- Kyungpook National Univ Sch of Medicine and Hosp, Dae-gu, Korea, Republic of
| | | |
Collapse
|
50
|
Seo WK, Kim JT, Chung JW, Song TJ, Kim YJ, Kim BJ, Heo SH, Jung JM, Oh K, Kim CK, Yu S, Park KY, Kim JM, Park JH, Choi JC, Park MS, Choi KH, Hwang YH, Bang OY, Kim GM. Abstract TP519: The Effect of Different Oral Anticoagulants on Vascular Outcomes in Stroke With Atrial Fibrillation: A Real-world Data. Stroke 2019. [DOI: 10.1161/str.50.suppl_1.tp519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background and Purpose:
Little is known about the different effect of outcomes and factors associated with vascular outcomes in stroke patients with atrial fibrillation in real world practice setting especially in Korea. In this study, we investigated the effect of each oral anticoagulants on vascular outcomes using K-ATTENTION (Korean ATrial fibrillaTion EvaluatioN regisTry in Ischemic strOke patieNts) study.
Methods:
Consecutive data of acute stroke patients with atrial fibrillation were collected from 11 centers in Korea from January 2013 to December 2015. Eligibility of inclusion was acute stroke within 7 days from the onset of stroke and diagnosis of non-valvular or valvular atrial fibrillation. Vascular outcomes included ischemic stroke, hemorrhagic stroke, death of any cause, and major adverse cerebro/cardiovascular events (MACE). To describe the effect of each oral anticoagulants on vascular outcomes, we performed time-dependent Cox’s regression analyses with the class of oral anticoagulant as a time dependent covariate. For stroke, hemorrhagic stroke, and any stroke, death was considered as competing risk.
Results:
Among 3213 stroke patients included in K-ATTENTION study, a total 3033 stroke patients (mean age 73.45 ± 9.93 years old, female 48.5%) were included. Mean CHA2DS2-VASc score was 4.89 ± 1.37. During the study period, a total of 161 ischemic strokes, 46 hemorrhagic strokes, 199 any strokes, 556 death and 720 MACE were captured. Time-dependent Cox’s regression analysis revealed that use of oral anticoagulants [vitamin K antagonist (VKA), dabigatran, rivaroxaban, or apixaban] was associated with significantly lower risk of death and MACE compared with no oral anticoagulants use. Although, there was no difference among oral anticoagulants for ischemic stroke, hemorrhagic stroke, or any stroke when compared with no oral anticoagulants, dabigatran showed a trend of reduced risk of any stroke (HR 0.48, 95%CI 0.23 - 1.01, p = 0.0545).
Conclusion:
This real-world data revealed that the use of oral anticoagulants was associated with the reduced risk of MACE and death. However, for ischemic stroke and hemorrhagic stroke, the results were not conclusive. Dabigatran showed a trend of reduced risk of any stroke.
Collapse
Affiliation(s)
| | - Joon-Tae Kim
- Chonnam National Univ Hosp, Kwonju, Korea, Republic of
| | | | | | | | | | | | | | | | | | | | | | | | | | | | - Man-Seok Park
- Chonnam National Univ Hosp, Seoul, Korea, Republic of
| | - Kang-Ho Choi
- Chonnam National Univ Hosp, Kwonju, Korea, Republic of
| | | | | | | |
Collapse
|