Cerebrovascular Disease Patients Research Articles

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<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<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 <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.

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.

Health Care–Associated Infection in Elderly Patients With Cerebrovascular Disease in Intensive Care Units: A Retrospective Cohort Study in Taizhou, China

Cerebrovascular diseases are associated with high incidence of healthcare-associated infections (HAIs) and poor prognosis in elderly patients. This study aimed to investigate the incidence and clinical characteristics of HAIs in elderly patients with cerebrovascular disease in Intensive Care Unit (ICU) METHODS: Patients admitted with cerebrovascular disease patients aged≥65 years were included. The clinical data of the patients were retrospectively analyzed to determine the risk factors, infection type, distribution, and pathogenic characteristics of HAIs in the context of cerebrovascular diseases. Out of 381 ICU inpatients monitored, 79 (20.73%) developed HAIs. Risk analysis revealed number of ventilator days as significant risk factors for HAIs in elderly patients with cerebrovascular diseases in the comprehensive ICU. In the HAIs group, 56 patients (70.89%) had respiratory tract infection (RTI). Sixty-five patients (82.28%) were infected with gram-negative bacteria (GNB), and 42 (53.16%) with multi-drug resistant organism (MDRO). The length of hospitalization days, ventilator days, and overall hospitalization costs were higher in the HAIs group than in the non-HAIs group (p<0.05), but there was no significant difference between groups in the treatment outcome of patients. Patients with MDRO infection had longer duration and higher cost of hospitalization than those infected with non-MDRO (p<0.05), but there was no significant difference between the groups in the treatment outcome of patients. HAIs occurred mostly due to RTI and GNB infection. The hospitalization cost and duration, as well as the length of ventilator days, were higher for cerebrovascular patients with HAIs than for non-HAIs patients.

Serum alkaline phosphatase was independently associated with depression in patients with cerebrovascular disease.

Blood markers have important value in the diagnosis of depressive disorders. Serum alkaline phosphatase (ALP) not only predicts stroke recurrence and poor functional prognosis in cerebrovascular disease (CVD) patients but also increases significantly in middle-aged women with depression. Thus, it has not been reported whether serum ALP is associated with the development of depression and/or vascular depression (VDe) in CVD patients. This was a cross-sectional study of 353 CVD patients (stroke patients, n = 291; cerebral small vessel disease (CSVD) patients, n = 62). Baseline demographic information, fasting blood markers (such as blood counts, liver function, kidney function and lipids), and brain CT/MRI scans were collected. CVD patients were divided into non-depression, suspected vascular depression (SVD), and positive vascular depression (PVD) groups according to their Hamilton Rating Scale for Depression (HAMD) scores. Univariate analysis of baseline data, blood markers, and the prevalence of lesions (> 1.5 cm) was performed. Subsequently, the diagnostic performance of the univariate and combined variables for SVD and PVD was analyzed using binary logistic regression. The diagnostic value of the multivariate model for VDe was analyzed by ordinal logistic regression. (1) Serum ALP (p = 0.003) and hypersensitive C-reactive protein (hs-CRP, p = 0.001) concentrations increased as HAMD scores increased, and the prevalence of brain atrophy (p = 0.016) and lesions in the basal ganglia (p = 0.001) and parietal (p = 0.001), temporal (p = 0.002), and frontal lobes (p = 0.003) also increased, whereas the concentrations of hemoglobin (Hb, p = 0.003), cholinesterase (ChE, p = 0.001), and high-density lipoprotein cholesterol (HDL-C, p = 0.005) declined. Among these variables, hs-CRP (r = 0.218, p < 0.001) had a weak positively association with HAMD scores, and ChE (r = -0.226, p < 0.001) had a weak negative association. (2) The combination of Hb, hs-CRP, ChE, ALP, and HDL-C improved diagnostic performance for VDe [AUC = 0.775, 95% CI (0.706, 0.844), p < 0.001]. (3) Hb (OR = 0.986, p = 0.049), ChE (OR = 0.999, p = 0.020), ALP (OR = 1.017, p = 0.003), and basal ganglia lesions (OR = 2.197, p < 0.001) were important factors impacting VDe development. After adjusting for Hb, hs-CRP, ChE, HDL-C, lesions in the above mentioned four locations, sex, age and the prevalence of CSVD and brain atrophy, ALP [OR = 1.016, 95% CI (1.005, 1.027), p = 0.004] was independently associated with VDe. Hb, hs-CRP, ChE, ALP, and HDL-C concentrations are potential blood markers of depression in CVD patients and, when combined, may improve diagnostic performance for VDe. Serum ALP was independently associated with VDe in patients with CVD.

Cerebrovascular disease in patients with COVID-19 infection: a case series from Lebanon.

COVID-19 has been associated with a variety of multi-organs complications, with an increasing proportion of patients presenting with neurologic manifestations. There is still an uncertainty in the relationship between stroke and COVID-19. Therefore, in this study, the authors report 18 cases of acute stroke occurring in the setting of COVID-19 infection, including 11 ischaemic strokes and 7 haemorrhagic strokes and identified in a Lebanese tertiary hospital. In this case series, patients with ischaemic and haemorrhagic stroke had elevated markers of inflammation and coagulation. Ischaemic stroke patients were treated with different regimens of anti-platelets, anticoagulants, and thrombolytic therapies. Death was the most common outcome observed and was associated with the severity of COVID-19 infection.

BP-Net: Boundary and perfusion feature guided dual-modality ultrasound video analysis network for fibrous cap integrity assessment.

Ultrasonography is one of the main imaging methods for monitoring and diagnosing atherosclerosis due to its non-invasiveness and low-cost. Automatic differentiation of carotid plaque fibrous cap integrity by using multi-modal ultrasound videos has significant diagnostic and prognostic value for cardiovascular and cerebrovascular disease patients. However, the task faces several challenges, including high variation in plaque location and shape, the absence of analysis mechanism focusing on fibrous cap, the lack of effective mechanism to capture the relevance among multi-modal data for feature fusion and selection, etc. To overcome these challenges, we propose a new target boundary and perfusion feature guided video analysis network (BP-Net) based on conventional B-mode ultrasound and contrast-enhanced ultrasound videos for assessing the integrity of fibrous cap. Based on our previously proposed plaque auto-tracking network, in our BP-Net, we further introduce the plaque edge attention module and reverse mechanism to focus the dual video analysis on the fiber cap of plaques. Moreover, to fully explore the rich information on the fibrous cap and inside/outside of the plaque, we propose a feature fusion module for B-mode and contrast video to filter out the most valuable features for fibrous cap integrity assessment. Finally, multi-head convolution attention is proposed and embedded into transformer-based network, which captures semantic features and global context information to obtain accurate evaluation of fibrous caps integrity. The experimental results demonstrate that the proposed method has high accuracy and generalizability with an accuracy of 92.35% and an AUC of 0.935, which outperforms than the state-of-the-art deep learning based methods. A series of comprehensive ablation studies suggest the effectiveness of each proposed component and show great potential in clinical application.

Triglyceride glucose index is a significant predictor of severe disturbance of consciousness and all-cause mortality in critical cerebrovascular disease patients

ObjectiveThe association of the triglyceride-glucose (TyG) index with severe consciousness disturbance and in-hospital mortality in patients with cerebrovascular disease in the intensive care unit (ICU) is unclear. This study aimed to investigate the TyG index’s predictive ability on the severity of impaired consciousness and in-hospital mortality in patients with cerebrovascular disease in the ICU.MethodPatients diagnosed with non-traumatic cerebral hemorrhage and cerebral infarction were extracted from the MIMIC-IV database and analyzed as two cohorts. The association between the TyG index and the severity of patients’ impairment of consciousness and in-hospital mortality was analyzed using logistic regression models. Using restricted cubic spline curves, we analyzed potential nonlinear relationships between TyG indices and outcome indicators. receiver operating characteristic (ROC) curves were utilized to evaluate the predictive ability of the TyG index for outcome indicators.ResultThe study’s last two cohorts comprised 537 patients with traumatic cerebral hemorrhage and 872 patients with cerebral infarction. TyG index was a significant predictor of the severity of impaired consciousness and in-hospital mortality in patients with cerebrovascular disease, as determined by logistic regression. The risk of severe consciousness impairment and in-hospital mortality increased roughly linearly with increasing TyG index.ConclusionThe TyG index was found to be a significant predictor for severe impairment of consciousness and in-hospital death in patients with cerebrovascular disease in the ICU, and it provides some predictive value for the severity of consciousness disturbances and in-hospital mortality in cerebrovascular disease patients.

A smart devices based secondary prevention program for cerebrovascular disease patients.

Commercially available health devices are gaining momentum and represent a great opportunity for monitoring patients for prolonged periods. This study aimed at testing the feasibility of a smart device-based secondary prevention program in a cohort of patients with cryptogenic stroke. In this proof-of-principle study, patients with non-disabling ischemic stroke and transient ischemic attacks (TIA) in the subacute phase were provided with a smartwatch and smart devices to monitor several parameters - i.e., oxygen saturation, blood pressure, steps a day, heart rate and heart rate variability - for a 4-week period (watch group). This group was compared with a standard-of-care group. Our primary endpoint was the compliance with the use of smart devices that was evaluated as the number of measures performed during the observation period. In total, 161 patients were recruited, 87 in the WATCH group and 74 in the control group. In the WATCH group, more than 90% of patients recorded the ECG at least once a day. In total, 5,335 ECGs were recorded during the study. The median blood pressure value was 132/78 mmHg and the median oxygen saturation value was 97%. From a clinical standpoint, although not statistically significant, nine atrial fibrillation episodes (10.3%) in the WATCH group vs. 3 (4%) in the control group were detected. Our study suggests that prevention programs for cerebrovascular disease may benefit from the implementation of new technologies.

A Multi-channel System Architecture Design for Myocardial Infarction Prediction

Cardiac and cerebral infarctions represent the most perilous pathologies within the spectrum of cardiovascular and cerebrovascular diseases, with grave consequences following their onset. However, prompt diagnosis and treatment can substantially enhance the chances of successful rescue and avert severe outcomes. Therefore, the development of a non-invasive, low-cost, and easy-to-use cardiac and cerebral infarction prediction system for home and personal use bears considerable social and economic significance.The electrocardiogram (ECG), acupoint electrical signals, and pulse, as physiological signals, contain abundant information on human health status. Integrating the information from these three signals can offer a more comprehensive and accurate risk prediction of cardiovascular and cerebrovascular diseases in patients. This approach represents a promising avenue for advancing the field of healthcare and disease management.Firstly, we analyzed the myocardial infarction and cerebral infarction prediction system requirements. The research determines four pulse collection points, two ECG, and ten acupoint electricity collection points. Then, we completed the cardiovascular and cerebrovascular disease risk warning system’s overall architecture design and front-end scheme design of ECG, acupoint electricit and pulse wave acquisition. The system successfully collects data from the test subjects by connecting to the computer.

THE IMPACT OF HYPERTENSION AND OTHER COMORBIDITIES ON THE SEVERITY AND OUTCOME OF COVID-19 INFECTION IN SUDANESE HOSPITALIZED PATIENTS AT JABRA ISOLATION CENTRE 2021

Objective: Covid-19 has rapidly spread throughout the globe ever since it was declared as a pandemic in March 2020, it was associated with increased morbidity and mortality worldwide. In Sudan, (3rd January 2020 - 27th January 2023) there had been 63,736 confirmed cases of COVID-19 with 5,001 deaths, reported by WHO. Objective: To measure the effects of Hypertension and other comorbidities on the severity and outcome of COVID 19 hospitalized patients at Jabra Isolation Centre. Design and method: A descriptive hospital-based study conducted in 2022 based on 2021 records at Jabra COVID-19 Isolation Centre/Sudan. The severity was assigned according to the hospital based categorized zones at Jabra Centre, and shown on admission sheets either to ICU red, HDU yellow, or floor green zones. Results: 308 patients were enrolled, 197 (64%) were males; and 132 (42.9%) were hypertensive, 122 (39.6%) were diabetic, 25 (8.1%) had a cardiac disease, 23 (7.5%) had a kidney disease, 16 (5.2%) were asthmatic, 12 (3.9) had a thyroid disease, 11 (3.6%) had a cerebrovascular disease, and 7 (2.3%) had a history of a malignant disease. It was found that about 172 (55.8%) of the hospitalized patients were &gt;60 years. All deaths were 177 (57.5%); of which 74 (41.8%) were hypertensive, 62 (35%) were diabetic, 17 (9.6%) of the death had cardiovascular disease, 16 (9%) had kidney disease, 9 asthmatic patients and 9 cerebrovascular disease patients died respectively. By age distribution, 105 (59.3%) of all deaths were &gt;60 years; 80 (45.2%) of total deaths were ICU admitted patients. There was a significant association between the age and severity (P 0.017); and between the severity and the outcome (P 0.002). Conclusions: The presence of Hypertension and other comorbidities led to increased adverse outcomes in the hospitalized Covid-19 patients. The deaths were (57.5%) of which the hypertensive was (41.8%) and the diabetic were 35%. There was significant association between the severity the disease and the outcome, and the age and the severity.