Cerebrovascular Disease Patients Research Articles

Abstract 4134851: Demographic and regional disparities in cerebrovascular disease mortality among adult patients with pre-existing atherosclerosis in the United States from 1999-2020

Introduction: Atherosclerosis (ATH) is a major risk factor for cerebrovascular disease (CEVD), with persistent mortality disparities. Our study aims to identify vulnerable regions and demographics in the US adult population with pre-existing ATH at risk of CEVD. Methods: CDC Wide-ranging Online Data for Epidemiologic Research (CDC WONDER) was used to access National Vital Statistics System data from 1999 to 2020. ATH-related CEVD was identified using CEVD as the underlying cause of death and ATH as a contributing cause of death. Results were presented as age-adjusted mortality rates (AAMR) per 100,000 population. Joinpoint regression was used to examine changes in trend and annual percentage change (APC). Results: A total of 325,408 CEVD occurred in patients with ATH from 1999 to 2020 (AAMR = 6.9, 95% CI: 6.8-7). Increased mortality rates were observed in males (AAMR = 6.3) as compared to females (AAMR = 5.1) (Figure, Panel A). AAMRs were highest in Non-Hispanic Whites [NHW] (5.7, 95% CI: 5.7 - 5.8), followed by non-Hispanic blacks [NHB] (5.5, 95% CI: 5.4 - 5.5), Hispanics (4.1, 95% CI: 4.0 - 4.1) and non-Hispanic American Indian/Alaska Native [NH-AIAN] (3.6, 95% CI: 3.4 - 3.8). Non-Hispanic Asian/Pacific Islander [NH-API] had the lowest mortality rates (3.4, 95% CI: 3.4 - 3.5). Region-wise analysis revealed that mortality rates were highest in the West (6.4, 95% CI: 6.3-6.4) and Midwest (6.2, 95% CI: 6.1-6.2). The South reported the rate of 5.5 (95% CI: 5.5-5.6), while the Northeast had the lowest rate (4.4, 95% CI: 4.3-4.4). Mortality rates were consistently higher in rural areas (6.1, 95% CI: 6.0-6.1) compared to urban areas (5.3, 95% CI: 5.3-5.4) throughout the study period. Overall AAMR rose from 9.0 in 1999 to 10.4 in 2001, then steadily declined before increasing to 3.6 from 2016 to 2020 (APC: 0.41). After an initial decline, AAMR increased in men (APC: 1.09) from 2016 and in women (APC: 5.09) from 2018. AAMR also increased among NH-API (APC: 8.9) and NHB (APC: 8.3) from 2018 onwards, and NHW (APC: 0.1) from 2016 (Figure, Panel B). Conclusions: Our study reveals significant mortality disparities from CEVD in patients with ATH, identifying males, NHW, and residents in the West and Midwest as particularly at increased risk. Rural areas consistently show higher mortality rates than urban areas. These findings highlight the need for targeted interventions and strategic provision of healthcare resources to improve outcomes for vulnerable populations.

Association between neutrophil-to-lymphocyte ratio and short-term all-cause mortality in patients with cerebrovascular disease admitted to the intensive care unit-a study based on the MIMIC-IV database.

Inflammation plays a crucial role in cerebrovascular disease (CVD) progression. Neutrophil-to-lymphocyte ratio (NLR) is an important inflammatory marker, though its diagnostic role in CVD is still under investigation. This study evaluates the relationship between NLR and short-term all-cause mortality in patients with CVD admitted to the intensive care unit (ICU). We conducted a retrospective study using data from the Medical Information Mart for Intensive Care (MIMIC-IV) (v2.2) database, including 4,327 adult ICU-admitted CVD patients. NLR values at admission were analyzed alongside various mortality variables. Multivariate Cox proportional hazards regression models and Kaplan-Meier (K-M) survival curves assessed the relationship between NLR and short-term all-cause mortality. Predictive power, sensitivity, specificity, and area under the curve (AUC) of NLR for short-term mortality were investigated using Receiver Operating Characteristic (ROC) analysis. Additionally, restricted cubic spline (RCS) curves and subgroup analyses were conducted. Among the 4,327 patients, 3,600 survived (survival group) and 727 died (non-survival group) within 28 days of admission (mortality rate: 16.8%). A multivariate Cox regression analysis identified NLR as an independent predictor of 28-day all-cause mortality (hazard ratio: 1.013; 95% confidence interval: 1.0086-1.0188; p < 0.001). The predictive model, incorporating NLR, age, gender, BMI, Charlson comorbidity index (CCI), WBC counts, Platelet, INR, and CRP, achieved an AUC of 0.686 (95% confidence interval: 0.665-0.70). While platelet-to-lymphocyte ratio was also analyzed, its predictive efficiency was less pronounced compared to NLR. A best NLR threshold of 6.19 was determined, distinguishing survivors from non-survivors. Kaplan-Meier survival curves showed that patients with NLR ≥ 6.19 had significantly lower survival rates at 7-, 14-, 21-, and 28-days. Subgroup analyses indicated that NLR did not significantly interact with most subgroups. NLR may serve as an independent predictor for short-term all-cause mortality in ICU-admitted CVD patients, enhancing our understanding of the association between inflammatory biomarkers and CVD prognosis.

Associations between amyloid-β load and cognition in cerebrovascular disease beyond cerebral amyloid angiopathy: a systematic review and meta-analysis of positron emission tomography studies.

There is growing interest in the comorbidity of vascular and neurodegenerative pathologies in patients with cerebrovascular disease (CVD) beyond cerebral amyloid angiopathy (CAA). However, the relationship between amyloid-β and vascular cognitive impairment (VCI) remains debated. To investigate the association between VCI and amyloid-β deposition in non-CAA CVD patients. PubMed, Embase, Web of Science, PsycINFO and CENTRAL databases were systematically searched. Observational studies, including case-control and cohort studies, associating cognitive scores with amyloid load measured by positron emission tomography were selected. Meta-analyses were performed to assess the strength of amyloid-cognition associations across CVD subtypes and cognitive domains. A random-effects model using the inverse variance method was used, with heterogeneity evaluated by Q-statistics and I2 statistics. Meta-regression analyses were conducted to examine the influence of moderators, and publication bias was assessed using funnel plots and Egger's test. All statistical analyses were performed using StataMP 18. Twenty-seven eligible studies encompassing 2894 participants were included. Among non-CAA CVD patients, global cognitive performance was significantly lower in those with higher amyloid-β deposition (standardized mean difference = -0.43, P < 0.001). The correlation strength varied across cognitive domains (executive function: r = -0.41; language: r = -0.36; memory: r = -0.29; all P < 0.001). The correlation was significant in patients with subcortical vascular disease (r = -0.43, P < 0.001) but not post-stroke patients (r = -0.19, P > 0.05). Amyloid-β load is associated with cognitive decline in non-CAA CVD patients. This is more pronounced in patients with subcortical vascular disease than in post-stroke patients. Executive function is the most susceptible domain in VCI when the level of amyloid-β increases.

Characteristics of stroke inpatients in a single- center in Kunming: A multi-ethnic settlement with a northern sub-tropical low-latitude plateau mountain monsoon climate

Objective: This study aimed to evaluate the characteristics of stroke inpatients in Kunming in southwest China. Methods: Basic demographic information and risk factors of stroke inpatients admitted to a first-rate tertiary referral hospital in Kunming from January 1, 2015, to September 15, 2022, were retrospectively analysed. In total, 7,108 stroke inpatients with ischemic stroke (IS), primary intracerebral hemorrhage (ICH), and subarachnoid hemorrhage (SAH) were included. Results: IS was the most common type of stroke (75.97%), followed by ICH (13.45%) and SAH (10.58%). There were significant differences among the three groups in sex, age, ethnic, residence, occupation, and medical expenses (P&lt;0.05). There was also a statistically significant difference in the proportion of inpatients between the four seasons (P&lt;0.05). Hypertension, dyslipidemia, and diabetes were common risk factors for stroke. There were significant differences in the incidence of smoking, alcohol use, hypertension, dyslipidemia, diabetes, atrial fibrillation, and pulmonary infection among the three stroke subtypes (P&lt;0.05). Conclusion: Demographic information and risk factors were different among the three stroke subtypes. The number of hospitalized patients from all three groups varied slightly in different seasons in Kunming. Different types of cerebrovascular disease patients in the region have different characteristics from demographic information to risk factors.

Perfusion parameter map generation from TOF-MRA in stroke using generative adversarial networks

PurposeTo generate perfusion parameter maps from Time-of-flight magnetic resonance angiography (TOF-MRA) images using artificial intelligence to provide an alternative to traditional perfusion imaging techniques. Materials and methodsThis retrospective study included a total of 272 patients with cerebrovascular diseases; 200 with acute stroke (from 2010 to 2018), and 72 with steno-occlusive disease (from 2011 to 2014). For each patient the TOF MRA image and the corresponding Dynamic susceptibility contrast magnetic resonance imaging (DSC-MRI) were retrieved from the datasets. The authors propose an adapted generative adversarial network (GAN) architecture, 3D pix2pix GAN, that generates common perfusion maps (CBF, CBV, MTT, TTP, Tmax) from TOF-MRA images. The performance was evaluated by the structural similarity index measure (SSIM). For a subset of 20 patients from the acute stroke dataset, the Dice coefficient was calculated to measure the overlap between the generated and real hypoperfused lesions with a time-to-maximum (Tmax) > 6 s. ResultsThe GAN model exhibited high visual overlap and performance for all perfusion maps in both datasets: acute stroke (mean SSIM 0.88–0.92, mean PSNR 28.48–30.89, mean MAE 0.02–0.04 and mean NRMSE 0.14–0.37) and steno-occlusive disease patients (mean SSIM 0.83–0.98, mean PSNR 23.62–38.21, mean MAE 0.01–0.05 and mean NRMSE 0.03–0.15). For the overlap analysis for lesions with Tmax>6 s, the median Dice coefficient was 0.49. ConclusionOur AI model can successfully generate perfusion parameter maps from TOF-MRA images, paving the way for a non-invasive alternative for assessing cerebral hemodynamics in cerebrovascular disease patients. This method could impact the stratification of patients with cerebrovascular diseases. Our results warrant more extensive refinement and validation of the method.

Modified Rankin Scale disability status at day 4 poststroke is an informative predictor of long-term day 90 outcome

BackgroundLong-term disability after stroke is standardly assessed 3 months post-onset, using the modified Rankin Scale (mRS). The value of an early, day 4 mRS assessment for projecting the 3-month disability outcome has not been formally investigated. MethodsIn this cohort of patients with acute cerebral ischemia and intracranial hemorrhage, we analyzed day 4 and day 90 mRS assessments in the NIH Field Administration of Stroke Therapy– Magnesium (FAST-MAG) Phase 3 trial. The performance of day 4 mRS, alone and as part of multivariate models, in predicting day 90 mRS was assessed using correlation coefficients, percent agreement, and the kappa statistics. ResultsAmong the 1573 acute cerebrovascular disease (ACVD) patients, 1206 (76.7%) had acute cerebral ischemia (ACI), while 367 (23.3%) had intracranial hemorrhage. Among all 1573 ACVD patients, day 4 mRS and day 90 mRS correlated strongly, Spearman's rho=0.79, in unadjusted analysis with weighted kappa of 0.59. For dichotomized outcomes, simple carry-forward of the day 4 mRS performed fairly well in agreeing with day 90 mRS: mRS 0-1 (kappa=0.67), 85.4%; mRS 0-2 (k=0.59), 79.5%; fatal outcome, 88% (k=0.33). Correlations of 4d and 90d mRS were stronger for ACI than ICH patients, 0.76 vs 0.71. ConclusionsIn this acute cerebrovascular disease patient cohort, assessment of global disability performed on day 4 is highly informative regarding long-term, 3-month mRS disability outcome, alone, and even more strongly in combination with baseline prognostic variables. The day 4 mRS is a useful measure for imputing the final patient disability outcome in clinical trials and quality improvement programs.

The Burden of Inpatient Hospitalizations with Cardiac and Cerebrovascular Diseases in Patients with Type 1 Diabetes: Insights from the National Inpatient Sample in the US.

This study aimed to evaluate the burden and impact of cardiac and cerebrovascular disease (CCD) on hospital inpatients with type 1 diabetes mellitus (T1DM). This is a retrospective nationwide cohort study of people with T1DM with or without CCD in the US National Inpatient Sample between 2016 and 2019. The in-hospital mortality rates, length of stay (LoS), and healthcare costs were determined. A total of 59,860 T1DM patients had a primary diagnosis of CCD and 1,382,934 did not. The median LoS was longer for patients with CCD compared to no CCD (4.6 vs. 3 days). Patients with T1DM and CCD had greater in-hospital mortality compared to those without CCD (4.1% vs. 1.1%, p < 0.001). The estimated total care cost for all patients with T1DM with CCD was approximately USD 326 million. The adjusted odds of mortality compared to patients with non-CCD admission was greatest for intracranial hemorrhage (OR 17.37, 95%CI 12.68-23.79), pulmonary embolism (OR 4.39, 95%CI 2.70-7.13), endocarditis (OR 3.46, 95%CI 1.22-9.84), acute myocardial infarction (OR 2.31, 95%CI 1.92-2.77), and stroke (OR 1.47, 95%CI 1.04-2.09). The burden of CCD in patients with T1DM is substantial and significantly associated with increased hospital mortality and high healthcare expenditures.

Investigation of thyroid function tests and lipid levels in cerebrovascular patients

Worldwide, cerebrovascular diseases rank third as the cause of death after heart diseases and cancer, and ranks first as the cause of handicap and disability. It is a disease that needs to be well known and recognized, especially due to the high risk of mortality in the acute period and the severe loss of function in the majority of surviving patients, requiring long-term care and assistance. In this study, it is aimed to contribute to the literature and to examine the relationship between thyroid dysfunction and cerebrovascular diseases in patients with hyperlipidemia. When the patient and control groups were evaluated in terms of blood lipid levels, HDL levels were found to be significantly lower in the patient group compared to the control group. VLDL, TG and cholesterol levels were found to be significantly higher in the patient group compared to the control group. The T3 value was found to be statistically significantly lower in the patient group. In some cases such as hyperthyroidism, hypothyroidism and hyperlipidemia, it may not show serious clinical symptoms, which increases the importance of these investigations. We believe that the detected thyroid dysfunction and dyslipidemia treatments will decrease the acute stroke prevalence and improve the prognosis.

Cerebrovascular disease in patients with antiphospholipid antibody syndrome: a transcranial Doppler and magnetic resonance imaging study.

Transcranial Doppler (TCD) and brain MRI may be useful in evaluating patients with APS, helping to stratify the risk of cerebrovascular ischaemic events in this population. This study aimed to assess the frequency of brain MRI abnormalities in patients with primary antiphospholipid syndrome, secondary antiphospholipid syndrome and SLE and correlate to TCD findings. The study, conducted over four years at two autoimmune disease referral centres, included 22 primary antiphospholipid syndrome patients, 24 secondary antiphospholipid syndrome patients, 27 SLE patients without APS and 21 healthy controls. All participants underwent TCD to assess cerebral haemodynamics, detect microembolic signals and evaluate right-to-left shunts, followed by brain MRI and magnetic resonance angiography. MRI scans were reviewed for acute microembolism, localized cortical infarctions, border infarctions, lacunar infarctions, ischaemic lesions, white matter hyperintensity, micro and macro haemorrhages and arterial stenosis ≥50% of the cervical carotid artery, by two neuroradiologists blinded to the clinical data. Brain MRI findings were similar between the groups, except for lacunar infarction, more frequent in patients with secondary antiphospholipid syndrome (P = 0.022). Patients with intracranial stenosis detected by TCD had a higher frequency of territorial infarction (40% vs 7.5%, P = 0.02), lacunar (40% vs 11.3%, P = 0.075) and border zone infarcts (20% vs 1.9%, P = 0.034). Patients with intracranial stenosis presented a higher frequency of territorial, lacunar and border zone infarcts, suggesting that evaluating the intracranial vasculature should not be neglected in patients with APS and stroke.

The Diagnostic Accuracy of Transcranial Color-Coded Doppler Ultrasound Technique in Stratifying Intracranial Cerebral Artery Stenoses in Cerebrovascular Disease Patients: A Systematic Review and Meta-Analysis.

The early and accurate stratification of intracranial cerebral artery stenosis (ICAS) is critical to inform treatment management and enhance the prognostic outcomes in patients with cerebrovascular disease (CVD). Digital subtraction angiography (DSA) is an invasive and expensive procedure but is the gold standard for the diagnosis of ICAS. Over recent years, transcranial color-coded Doppler ultrasound (TCCD) has been suggested to be a useful imaging method for accurately diagnosing ICAS. However, the diagnostic accuracy of TCCD in stratifying ICASs among patients with CVD remains unclear. Therefore, this systematic review and meta-analysis aimed at evaluating the diagnostic accuracy of TCCD in the stratification of intracranial steno-occlusions among CVD patients. A total of six databases-Embase, CINAHL, Medline, PubMed, Google Scholar, and Web of Science (core collection)-were searched for studies that assessed the diagnostic accuracy of TCCD in stratifying ICASs. The meta-analysis was performed using Meta-DiSc 1.4. The Quality Assessment of Diagnostic Accuracy Studies tool version 2 (QUADAS-2) assessed the risk of bias. Eighteen studies met all of the eligibility criteria. TCCD exhibited a high pooled diagnostic accuracy in stratifying intracranial steno-occlusions in patients presenting with CVD when compared to DSA as a reference standard (sensitivity = 90%; specificity = 87%; AUC = 97%). Additionally, the ultrasound parameters peak systolic velocity (PSV) and mean flow velocity (MFV) yielded a comparable diagnostic accuracy of "AUC = 0.96". In conclusion, TCCD could be a noble, safe, and accurate alternative imaging technique to DSA that can provide useful diagnostic information in stratifying intracranial steno-occlusions in patients presenting with CVD. TCCD should be considered in clinical cases where access to DSA is limited.

PFO-spectrum disorder: two different cerebrovascular diseases in patients with PFO as detected by AI brain imaging software.

Patent foramen ovale (PFO) is a prevalent cardiac remnant of fetal anatomy that may pose a risk factor for stroke in some patients, while others can present with asymptomatic white matter (WM) lesions. The current study aimed to test the hypothesis that patients with a PFO who have a history of stroke or transient ischemic attack, compared to those without such a history, have a different burden and distribution of cerebral WM hyperintensities. Additionally, we tested the association between PFO morphological characteristics and severity of shunt, and their impact on the occurrence of ischemic cerebral vascular events and on the burden of cerebral WM lesions. Retrospective, case-control study that included patients with PFO confirmed by transesophageal echocardiography. Right-to-left shunt size was assessed using transcranial Doppler ultrasound. Cerebral MRIs were analyzed for all participants using the semi-automated Quantib NDTM software for the objective quantification of WM lesions. WM lesions volume was compared between patients with and without a history of stroke. Additionally, the anatomical characteristics of PFOs were assessed to explore their relation to stroke occurrence and WM lesions volume. Of the initial 264 patients diagnosed with PFO, 67 met the inclusion criteria and were included in the analysis. Of them, 62% had a history of PFO-related stroke/TIA. Overall burden of WM lesions, including stroke volume, was not significantly different (p = 0.103). However, after excluding stroke volume, WM lesions volume was significantly higher in patients without stroke (0.27 cm3, IQR 0.03-0.60) compared to those with stroke/TIA (0.08 cm3, IQR 0.02-0.18), p = 0.019. Patients with a history of PFO-related stroke/TIA had a tendency to larger PFO sizes by comparison to those without, in terms of length and height, and exhibited greater right-to-left shunt volumes. We suggest that PFO may be associated with the development of two distinct cerebrovascular conditions (stroke and "silent" WM lesions), each characterized by unique imaging patterns. Further studies are needed to identify better the "at-risk" PFOs and gain deeper insights into their clinical implications.

Turning brain MRI into diagnostic PET: 15O-water PET CBF synthesis from multi-contrast MRI via attention-based encoder–decoder networks

Accurate quantification of cerebral blood flow (CBF) is essential for the diagnosis and assessment of a wide range of neurological diseases. Positron emission tomography (PET) with radiolabeled water (15O-water) is the gold-standard for the measurement of CBF in humans, however, it is not widely available due to its prohibitive costs and the use of short-lived radiopharmaceutical tracers that require onsite cyclotron production. Magnetic resonance imaging (MRI), in contrast, is more accessible and does not involve ionizing radiation. This study presents a convolutional encoder–decoder network with attention mechanisms to predict the gold-standard 15O-water PET CBF from multi-contrast MRI scans, thus eliminating the need for radioactive tracers. The model was trained and validated using 5-fold cross-validation in a group of 126 subjects consisting of healthy controls and cerebrovascular disease patients, all of whom underwent simultaneous 15O-water PET/MRI. The results demonstrate that the model can successfully synthesize high-quality PET CBF measurements (with an average SSIM of 0.924 and PSNR of 38.8 dB) and is more accurate compared to concurrent and previous PET synthesis methods. We also demonstrate the clinical significance of the proposed algorithm by evaluating the agreement for identifying the vascular territories with impaired CBF. Such methods may enable more widespread and accurate CBF evaluation in larger cohorts who cannot undergo PET imaging due to radiation concerns, lack of access, or logistic challenges.

Clinical, neurological, laboratory and neuropsychological features of the course of cerebrovascular diseases in patients infected with SARS-CoV-2

The rapid global spread of the COVID-19 virus has caused an unprecedented pandemic, in the conditions of which a significant number of pathological consequences of this disease have appeared. In particular, COVID-19 affected the course of cerebrovascular disease, the consequences of which cause disorders of the normal functioning of the brain. Therefore, the aim of the study was to improve the diagnosis of cerebrovascular disease in patients infected with SARS-CoV-2 by studying clinical, neurological, laboratory and neuropsychological indicators. The trial uses Beck's Anxiety Inventory, Hamilton Depression Rating Scale; neuropsychological tests – Mina Mental State Examination, Montreal Cognitive Assessment; clinical – neuro­logical status; laboratory – complete blood count, erythrocyte sedimentation rate), C-reactive protein, D-dimer, indi­cators of the blood coagulation system, procalcitonin; polymerase chain reaction, a test for the detection of ribonucleic acid of the COVID-19 virus; statistical. The revealed results indicate deviations from the norm of most indicators in patients infected with SARS-CoV-2 in particular such as leukocytes (t=3.18, p≤0.01), lymphocytes (t=3.83, p≤0.01), band neutrophils (t=2.33, p≤0.05), segmented neutrophils (t=2.29, p≤0.05), erythrocyte sedimentation rate (t=2.17, p≤0.05), platelets (t =2.86, p≤0.01), prothrombin index (t=3.17, p≤0.01), D-dimer (t=2.11, p≤0.05), fibrinogen (t=2 .53, p≤0.05), C-reactive protein (t=2.97, p≤0.01), procalcitonin (t=2.64, p≤0.05). Patients with a history of SARS-CoV-2 had significantly lower indicators of cognitive (t=-2.17, p≤0.05), visuospatial function (t=-2.84, p≤0.01), as well as a higher level of depression (t=2.87, p≤0.01) than patients who did not suffer from COVID-19. No statistical differences were found in terms of anxiety in both groups. A direct correlation was established between the level of leukocytes and cognitive functions (r=0.477, p≤0.01) and also visuospatial function (r=0.591, p≤0.05). An inverse correlation between procalcitonin level and mental status was also established (r=-0.622, p≤0.01). The conducted study proved the statistical significance of clinical-neurological, laboratory and neuropsychological indicators of patients with cerebrovascular disease infected with SARS-CoV-2.

Acute Effect of Positive Airway Pressure on Heart Rate Variability in Obstructive Sleep Apnea.

Autonomic dysregulation is associated with cardiovascular consequences in obstructive sleep apnea (OSA). This study aimed to investigate the effect of acute continuous positive airway pressure (CPAP) treatment on autonomic activity and to identify factors contributing to heart rate variability (HRV) changes in OSA. Frequency domain HRV parameters were calculated and compared between the baseline polysomnography and during the CPAP titration in 402 patients with moderate to severe OSA. There were significant reductions in total power, very low-frequency band power, low-frequency band power, and high-frequency band power during the CPAP titration as compared to the baseline polysomnography. This tendency was pronounced in male patients with severe OSA. Multivariate analysis found that changes in the apnea-hypopnea index and oxygen saturation were significantly associated with changes in sympathetic and parasympathetic activity, respectively. This study demonstrated that HRV parameters significantly changed during the CPAP titration, indicating a beneficial effect of CPAP in the restoration of sympathetic and parasympathetic hyperactivity in OSA. Prospective longitudinal studies should determine whether long-term CPAP treatment aids in maintaining the long-lasting improvement of the autonomic functions, thereby contributing to the prevention of cardiovascular and cerebrovascular diseases in patients with OSA.

Abstract 16971: Unraveling the Burden of Cerebrovascular Disease: Exploring the Role of Peripheral Vascular Disease and Kidney Transplant in End-Stage Renal Disease Hospitalization Rates (Insights From the National Inpatient Sample, 2005 to 2019)

Background: Patients with end-stage renal disease (ESRD) face a higher risk of cerebrovascular disease, but the impact of peripheral vascular disease (PVD) and a kidney transplant (KiTx) on hospitalization rates for cerebrovascular conditions remains uncertain. This study aimed to investigate the rates of hospitalization for cerebrovascular disease in patients with ESRD, PVD, KiTx, or a combination. Methods: Using the National Inpatient Sample (NIS), 2,713,194 ESRD hospitalizations (2005-2019) were analyzed. We focused on two cerebrovascular conditions of interest: 1) cerebral infarction due to thrombosis, embolism, and occlusion (CITO) and 2) artery occlusion resulting in cerebral ischemia (AOSI). Comparative analysis utilized t-tests and odds ratios. Results: Among ESRD hospitalizations, 66,927 (2.47%) had KiTx, 63,411 (2.34%) had PVD, and 1,406 (0.05%) had both. Key findings included: 1) ESRD patients with PVD had higher odds of hospitalization for CITO (OR 1.33, CI 1.1-1.8, p=0.009) or AOSI (OR 2.63, CI 2.5-2.8, p&lt;0.001) compared to those without PVD (Fig. 1AB); 2) ESRD patients hospitalized with CITO had higher odds of having KiTx and PVD compared to those without KiTx or PVD (OR 3.17, CI 1.0-9.3, p=0.035, Fig. 1AB); 3) ESRD patients with PVD had higher rates of being hospitalized with AOSI (7.29%) than those without AOSI (2.29%, p&lt;0.001); 4) ESRD patients hospitalized with CITO had higher odds of having KiTx and PVD compared to those without KiTx or PVD (OR 3.17, CI 1.0-9.3, p=0.035, Fig. 1AB) and 5) ESRD patients hospitalized with AOSI demonstrated a higher rate of having KiTx and PVD (0.09%) compared to those without AOSI (0.05%, p=0.002). Conclusion: This nationwide analysis reveals that the presence of PVD and KiTx is associated with increased rates of hospitalization for cerebrovascular conditions. These findings underscore the importance of proactive management to mitigate the risk of cerebrovascular disease in this vulnerable patient population.

Neuropathologic evaluation of cerebrovascular disease in patients with rheumatoid arthritis.

Active RA has been associated with an increased risk of both cardiovascular and peripheral vascular disease. We aimed to compare cerebrovascular changes in patients with and without RA, both with and without a neuropathologic diagnosis of neurodegenerative disease. Patients with RA (n = 32) who died and underwent autopsy between 1994 and 2021 were matched to non-RA controls (n = 32) on age, sex and level of neurodegenerative proteinopathy. Routine neuropathologic examination was performed at the time of autopsy. Cerebrovascular disease severity was evaluated using modified Kalaria and Strozyk scales. Clinical dementia diagnoses were manually collected from patients' medical records. Prior to death, 15 (47%) RA patients and 14 (44%) controls were diagnosed with dementia; 9 patients in each group (60% and 64%, respectively) had Alzheimer's disease. The prevalence of cerebral amyloid angiopathy, microinfarcts, infarcts or strokes was found to be similar between groups. Patients with RA were more likely to have more severe vascular changes in the basal ganglia by Kalaria scale (P = 0.04), but not in other brain areas. There were no significant differences in the presence of large infarcts, lacunar infarcts or leukoencephalopathy by Strozyk scale. Among patients with RA and no clinical diagnosis of dementia, the majority had mild-moderate cerebrovascular abnormalities, and a subset of patients had Alzheimer's disease neuropathologic changes. In this small series of autopsies, patients with and without RA had largely similar cerebrovascular pathology when controlling for neurodegenerative proteinopathies, although patients with RA exhibited more pronounced cerebrovascular disease in the basal ganglia.

Clinical and radiological characteristics of Covid-19 patients with acute cerebrovascular vents: A meta-analysis

The Information on the 2019 coronavirus illness (COVID-19) in Egypt's severe cerebrovascular consequences is scant. In cases of acute cerebrovascular disease (CVD), this study aimed to examine the radiological and clinical characteristics of patients with and without COVID-19. Prospective research evaluated CVD patients with and without COVID-19 who were hospitalized at Qena University Hospital (QUH) before the global epidemic. Patients diagnosed with COVID-19 and able to be treated at either assist or Aswan University Hospitals (AAUH) for cardiovascular disease were compared. The data included patient demographics, medical history, risk factors, clinical presentation, comorbidities, and imaging results from CT and MRI scans of the chest and brain. In overall 439 individuals with COVID-19, 55 (12.5%) experienced acute CVD. Of these, 13 patients (2.9%) experienced hemorrhagic CVD, whereas 42 (9.6%) suffered an ischemic stroke. 180 of the 250 non-COVID-19 individuals suffered from ischemic stroke, and 70 from hemorrhagic stroke. Many COVID-19 patients had large vascular occlusions (LVO), which is a significant portion of individuals who had ischemic stroke symptoms (40 vs. 7.2%, P &lt;0.001) and was considerably more reciprocal than in CVD patients who were not COVID-19. Comorbidities were noted in 44 instances (80% of the total). Sufferers of ischemic stroke who had COVID-19 were much more likely to have dangerous elements such as hypertension and Ischemic Heart Disease (IHD) as well as concomitant conditions like hepatitis and kidney disease. Additionally, 6.5% of individuals with LVO had a hemorrhagic transition, and 23.5% had hemorrhagic CVD. In our research, individuals with COVID-19 often had severe CVD. The most typical LVO was. The most frequent risk factors, such as hypertension, IHD, and anemia, may make the clinical presentation worse. Patients with CVD often had comorbid conditions, but many also had high liver enzymes and creatinine levels that were partly brought on by the COVID-19 disease itself. The new findings start to describe the range of CVD linked to COVID-19 in patients from Upper Egypt.&#x0D;

Glial Fibrillary Acidic Protein Levels in Post-Stroke Depression: A Prospective Ischemic Stroke Cohort.

Increased glial fibrillary acidic protein (GFAP) levels were found in cerebrovascular disease patients. The pathogenesis of depression after ischemic stroke remains largely unknown. Here, we aim to determine whether GFAP concentrations were associated with post-stroke depression (PSD) at 3 months. From March 2022 to September 2022, patients with first-ever ischemic stroke were prospectively recruited. GFAP concentrations were detected within 24 h using an enzyme-linked immunosorbent assay. The PSD was defined as a Hamilton Depression Rating Scale 24-Item score ≥ 8. A total of 206 subjects with ischemic stroke (mean age: 63.6 years; 49.0% female) were enrolled. During the 90-day follow-up, 57 participants (27.7%) were observed in PSD. The median serum GFAP concentrations were 0.67 ng/mL. After adjustment for the covariates, higher increased GFAP levels were associated with increased risk of PSD (odds ratio [OR], 7.12; 95% confidence interval [CI], 3.29-15.44; P < 0.001). Also, the multivariate-adjusted OR of PSD associated with the fourth quartile of GFAP was 10.89 (95% CI, 3.53-33.60; P < 0.001) compared with the first quartile. Furthermore, the restricted cubic spline confirmed a linear association between GFAP and the risk of PSD (P for linearity < 0.001). Our results indicated that increased circulating GFAP concentrations were significantly correlated with the risk of PSD at 3 months. Measuring the GFAP levels after ischemic stroke may add some values for the risk stratifying of PSD.

Factor V Leiden, prothrombin, MTHFR, and PAI-1 gene polymorphisms in patients with arterial disease: A comprehensive systematic-review and meta-analysis

IntroductionThe role of inherited thrombophilia in arterial disease is uncertain. We performed a systematic-review and meta-analysis of inherited thrombophilia in cerebrovascular (CVD), coronary heart (CHD), and peripheral artery disease (PAD) patients. Materials and methodsMEDLINE and EMBASE were searched up to February 2022. Pooled prevalences (PPs) and odds ratios (ORs) with 95 % confidence intervals (95%CI) were calculated in a random-effects model. Factor V Leiden (G1691A), prothrombin (G20210A), MTHFR C677T/A1298C and PAI-1 4G/5G were evaluated. Results377 studies for 98,186 patients (32,791 CVD, 62,266 CHD, 3129 PAD) and 108,569 controls were included. Overall, 37,249 patients had G1691A, 32,254 G20210A, 42,546 MTHFR C677T, 8889 MTHFR A1298C, and 19,861 PAI-1 4G/5G gene polymorphisms. In CVD patients, PPs were 6.5 % for G1691A, 3.9 % for G20210A, 56.4 % for MTHFR C677T, 51.9 % for MTHFR A1298C, and 77.6 % for PAI-1. In CHD, corresponding PPs were 7.2 %, 3.8 %, 52.3 %, 53.9 %, and 76.4 %. In PAD, PPs were 6.9 %, 4.7 %, 55.1 %, 52.1 %, and 75.0 %, respectively. Strongest ORs in CVD were for homozygous G1691A (2.76; 95 %CI, 1.83–4.18) and for homozygous G20210A (3.96; 95 %CI, 2.05–7.64). Strongest ORs in CHD were for homozygous G1691A (OR 1.68; 95%CI, 1.02–2.77) and G20210A (heterozygous 1.49 95%CI, 1.22–1.82; homozygous 1.54 95%CI, 0.79–2.99). The OR for PAI-1 4G/4G in PAD was 5.44 (95%CI, 1.80–16.43). Specific subgroups with higher PPs and ORs were identified according to age and region. ConclusionsPatients with arterial disease have an increased prevalence and odds of having some inherited thrombophilia. Some thrombophilia testing may be considered in specific subgroups of patients.

Mortality and Outcomes in Cerebrovascular Disease Patients With Emphasis on COVID-19: A Cross-Sectional Analysis of the National Inpatient Sample 2020.

Background COVID-19-related pulmonary complications have been explored extensively in the recent past. There is also a significant amount of literature on the neurological manifestations of COVID-19. However, there exists an unmet need to assess the impact of COVID-19 on patients with cerebrovascular diseases and its role in affecting mortality in such patients. Methods In this cross-sectional study, we analyzed 401,318 hospitalized patients with cerebrovascular diseases using the discharge data from the National Inpatient Sample 2020 to assess the association of COVID-19 with multiple clinical conditions, along with additional factors, such as length of stay in the hospital, total charges incurred, region and type of hospital, and primary insurance/payer in the United States of America. We used a multivariable logistic regression model to predict factors relating to mortality in such patients. Results The mortality during hospitalization in patients with cerebrovascular disease who were also diagnosed with COVID-19 was significantly higher than the patients without COVID-19 (22.50% vs 5.44%, p-value <0.0001). COVID-19 independently increased the odds of death significantly in patients with cerebrovascular diseases (adjusted OR = 4.81, p-value <0.0001). Other statistically and clinically significant factors that contributed to increased odds of mortality in such patients were comorbidities such as moderate/severe liver disease, myocardial infarction, congestive heart failure, and complications such as the development of a saddle pulmonary embolus. Conclusion COVID-19 was associated with higher mortality in patients with cerebrovascular diseases. It also significantly increased the duration of hospital stay and odds of mortality in such patients.