History Of Cerebrovascular Disease Research Articles

Cardiovascular risk factors in poly-vascular vs isolated lower extremity peripheral arterial disease. analysis from the SOLACI peripheral registry

Abstract Introduction Atherosclerotic disease in more than one vascular bed (Polyvascular disease), is a strong independent risk factor for ischemic events and has worse clinical outcomes than those with disease in a single territory. Aims The objective of the present interim analysis is to describe the differences in cardiovascular risk factors and clinical presentation between patients with isolated infra-aortic peripheral artery disease (lower limb: "LL-PAD") and patients with Polyvascular Disease ("PD": simultaneuous coexistence of LL-PAD and affection of at least one more vascular bed) from a cohort of patients undergoing LL endovascular procedures in Latinamerica. Methods Our cohort included patients from The SOLACI Peripheral Registry from March 2021 to February 2024 (a prospective, multi-center, observational, and hospital-based registry of patients with LL- PAD, treated with endovascular interventions across 10 Latin American countries, 42 centers). Patients were considered to have PD if besides LL-PAD, they had a documented history of previous myocardial infarction (MI), coronary revascularization, cerebrovascular, aortic, and/or carotid artery disease. Results A total of 1438 patients were included in the analysis. PD was present in 506 patients(35.1%), of which 225(44.5%) had previous MI; 296(58.5%) previous coronary revascularization;265(52.4%) had aortic and / or carotid disease; and 121(23.9%) had cerebrovascular disease. Patients with PD were older than those with LL-PAD(70.5±9.76 vs 68.6±10.7). PD was more prevalent in men(69.6% vs 62.4%), former smokers(48.2% vs 32.8%), hypertension(92.1% vs 80.5%) and patients with dyslipidemia(75.3% vs 64%). The distribution of treated lesions in the PD group was: 15.4% ilio-femoral; 34 % femoropopliteal; 23.3% infrapopliteal; and 24% had multiple peripheral territories affected and treated at the same time-point. In the LL-PAD group, the distribution of treated lesions was: 12.5% ilio-femoral; 28.6% femoropopliteal; 31.5% infrapopliteal; and 24.8% had multiple peripheral territories affected simultaneously and treated during the same procedure. In general, the lesions were shorter in the PD group: ilio-femoral(53.5±29.2 vs 66.7±48.2mm); femoropopliteal(119±73.6 vs 122±81.7mm); and infrapopliteal(129±83.1 vs 147±93.1mm). In the PD group, a higher percentage of patients were treated with statins and antithrombotic agents: statins (87.5% vs 70.8%), aspirin (91.5% vs 81.1%), clopidogrel (60.9% vs 40.1%), and oral anticoagulants (13.8% vs 6.5%). The use of rivaroxaban was similar in both groups (3.4% vs 3.9%). The PD group had higher intrahospital complication rates: intrahospital death (2.2% vs 0.8%), cardiovascular intrahospital death (1.2% vs 0.4%), MI (0.8% vs 0.1%), stroke (0.4% vs 0%) and bleeding (0.8% vs 0.9%). Conclusions Patients with PD represent a very high-risk population. Systematic screening of multiple vascular beds in patients with LL-PAD may be warranted to prevent worse outcomes.

Investigating the influence of possible liver fibrosis on mortality in patients with coronary artery disease - a post-hoc ISCHEMIA trial analysis

Abstract Background There is a plethora of studies demonstrating that comorbidities (e.g., diabetes and renal dysfunction) directly influence outcomes in patients undergoing PCI or CABG for coronary artery disease (CAD). Yet, liver dysfunction is not really included in current risk assessment beyond the presence of liver cirrhosis. Retrospective single center evidence now suggests that the presence of liver fibrosis may be an indicator of elevated risk. Using the FIB-4 score, where increasing values correlate with increaseing degrees of histological liver fibrosis, liver fibrosis could already be detected with all required laboratory values (AST, ALT, platelets) within normal range. In addition, the study suggests a beneficial effect of off-pump CABG when FIB-4 is elevated. This finding contradicts current randomized evidence, negating any difference between off and on-pump CABG. Since randomized trials always suffer from strong selection of low risk patients, it is conceivable that trial patients may primarily have low FIB-4 scores. Purpose To address the distribution of FIB-4 scores in a selected trial population with CAD (from the ISCHEMIA trial) and relate the degree of liver fibrosis reflected by the score to mortality. Methods The FIB-4 score was calculated for all patients. According to the standard classification, a value of greater than 1.2 reflects a 90% chance of the presence of histological liver fibrosis. The imapct of FIB-4 on late all-cause mortality was assessed as a continuous and categorical variable using maximally selected rank statistics determined FIB-4 cutoff. Cox regression model was peformed including the adjustment for the main CAD risk factors. Results Among 3735 included patients, 58.8% had a FIB-4 value above 1.2. Patients with higher FIB-4 score (cutoff= 1.64) were slighly older, presented higher prevalence of male sex, prior PCI and CABG, and prior history of atrial fibrillation and cerebrovascular disease. FIB-4 score was directly associated with higher risk of mortality when addressed as a continouos variable and as a categorical variable (Fig. 1). This relationship was evident in the overall population and in all subsets (PCI, CABG and no revascularization; Fig. 2). Conclusions The use of Fib-4 to determine the degree of liver fibrosis may be powerful to predict mortality in CAD populations which may not show any evident clinical signs of liver dysfunction. The Fib-4 distribution in this trial population, considered as selected and low risk, warrants investigating randomized trial populations having compared on- and off-pump CABG.Figure 1.Mortality: overall population.Figure 2.Mortality: by therapy subsets.

Development and validation of a nomogram-based model to predict combined esophageal injury post-esophagoscopy for esophageal foreign bodies.

The aim of this study is to create and validate a nomogram model for predicting complications of esophageal injury post-esophagoscopy in patients with esophageal foreign bodies (EFB). We examined 303 patients who underwent esophagoscopy from January 2019 to December 2022 at a leading hospital in Anhui, known for its expertise in otorhinolaryngology-head and neck surgery. The patients were split into a modeling group and a validation group in a 7:3 ratio. Logistic regression analysis was employed to determine the risk factors for esophageal injury after undergoing esophagoscopy in patients with EFB. Based on these factors, a nomogram risk prediction model was developed and assessed using a goodness of fit test. Logistic regression analysis revealed that the type of foreign body, failure of gastroscopic retrieval, duration of lodgment, lodgment site, and presence of combined cardiovascular and cerebrovascular diseases were significant (p < 0.05) independent risk factors for esophageal injury following esophagoscopy for EFB. The area under the ROC curve for the training set was 0.850, and the Hosmer-Lemeshow goodness of fit test resulted in a p value of 0.908. For the validation set, the area under the ROC curve was 0.848, and the Hosmer-Lemeshow test gave a p value of 0.665. The calibration curve showed a close alignment between the predicted and observed values. The type of foreign body, duration of lodgment, lodgment site, previous failure of gastroscopic retrieval, and history of combined cardiovascular and cerebrovascular diseases are significant risk factors for esophageal injury following EFB esophagoscopy. This model accurately quantifies the risk of esophageal injury after EFB esophagoscopy.

Long-Term (12-Month) Safety and Tolerability of STS101 (Dihydroergotamine Nasal Powder) in the Acute Treatment of Migraine: Data from the Phase 3 Open-Label ASCEND Study.

STS101 is an investigational drug-device combination comprising 5.2 mg dihydroergotamine (DHE) powder (6.0 mg DHE mesylate) in a single-use nasal delivery device for the acute treatment of migraine. The primary objective of the ASCEND trial was to assess long-term safety and tolerability of STS101 in the acute treatment of migraine attacks across 12-18 months, with secondary objectives describing efficacy. ASCEND was an open-label study of STS101 in adults aged 18-65 years with a ≥ 1 year history of migraine with or without aura, with onset before the age of 50 years and 4-12 migraine attacks/month and < 15 headache days/month in each of the 3 months prior to screening. Exclusion criteria included diagnosis of non-migraine headache, history of cerebrovascular disease, and ≥ 2 cardiovascular risk factors. After establishing eligibility, participants could self-administer STS101 5.2 mg as needed for up to 2 doses within 24 h to treat a single migraine attack and up to 12 doses/month. Safety and tolerability evaluations included physical and nasal examinations, vital signs, laboratory tests, and treatment-emergent adverse event (TEAE) assessments. Participants used an electronic diary to record exploratory efficacy parameters, including intensity of headache pain and associated migraine symptoms (photophobia, phonophobia, and nausea). Participant impression questions were asked at months 3, 6, and 12. Of the 6610 migraine attacks treated with a total of 8234 STS101 doses in 344 participants, 945/6610 (14.3%) were associated with a TEAE. Events were predominantly mild or moderate in nature and rarely led to premature study discontinuation (15/344 [4.4%] participants). Treatment was associated with rapid onset of freedom from pain (36.6%, 67.1%, and 85.5% of treated attacks 2, 4, and 24 h post-dose, respectively), freedom from most bothersome symptoms (54.3%, 79.6%, and 91.3%), and headache relief (66.5%, 89.1%, and 94.3%). Most participants rated treatment results as good or very good and ease of use as easy or very easy at all time points (months 3, 6, and 12) and indicated they were likely or very likely to use STS101 again. The repeated long-term, as-needed use of STS101 was well tolerated, demonstrating a favorable safety profile in the acute treatment of migraine attacks in appropriately indicated adults. Exploratory efficacy evaluations indicated beneficial effects, which warrant further evaluation. ClinicalTrials.gov identification NCT04406649.

The interplay of genetic and environmental factors on the morphology of the limbic cortex and hippocampal subfields: Insights from an MRI twin study

IntroductionThe limbic system and the hippocampus are complex brain structures with key roles in memory, emotions, sexual stimulation and learning, with subregion abnormalities associated with a range of disorders and psychopathologies. Our study aimed to explore the heritability of specific subfield structures within the limbic system and hippocampus first in a Caucasian twin sample with volBrain pipeline. Materials and Methods59 healthy adult Caucasian twin pairs from the Hungarian Twin Registry without any history of previous neurodegenerative or cerebrovascular diseases underwent brain MRI on a 3.0 T scanner (43 monozygotic, MZ and 16 dizygotic, DZ pairs, with a median age of 50±+27 years). The volBrain automated volumetry pipeline was used to calculate the subcortical and general brain volumes from three-dimensional T1-weighted images. Based on age- and sex-adjusted MZ and DZ intra-pair correlations, the univariate ACE model was applied to calculate additive genetic, shared and unshared environmental influences. ResultsAdjusting for age and sex, moderate to strong heritability (A: 59.7 to 73.1 %) was found for most limbic cortex volumes, except for the volumes of entorhinal area and posterior cingulate gyrus where common environmental contribution was detected (C: 56.6 % and 65.0 %, respectively). A substantial heritability (A: 67.0 to 79.4 %) was estimated for the overall hippocampus and most subfield volumes, except for the CA2-CA3 region which was determinated by common environmental factors (C: 45.7 %). Unique environmental variance was a minor to moderate contributor across all variables (E: 20.6 to 54.3 %). ConclusionsAlbeit most limbic cortex, overall hippocampus and most subfield volumes are under substantial genetic influence in healthy adult twins, the volumes of entorhinal area, posterior cingulate gyrus and the CA2-CA3 region of the hippocampus are influenced common environmental factors. The findings underline the importance of unique environmental factors which may play a role in the prevention of disorders related to limbic cortex and hippocampus.

Periprocedural clinical outcomes of stenting and endarterectomy in patients with carotid artery stenosis

Purpose: To identify the chief pathological cause of extracranial cerebrovascular disease, which is atherosclerosis, we analyzed and compared the early and 6-month morbidity and mortality rates of patients who underwent carotid endarterectomy (CEA) and carotid artery stenting (CAS) for carotid artery stenosis. Materials and Methods: We retrospectively included patients who had undergone surgical endarterectomy and endovascular carotid stent implantation for carotid artery stenosis between April 2019 and August 2022. We evaluated neurological examinations, routine blood tests, neurological and systemic complications, mortality rates, and follow-up colour Doppler ultrasonography 6 months post-discharge. Results: The study included a total of 300 patients, with 52.7% (n = 158) undergoing CEA and 47.3% (n = 142) undergoing endovascular stent implantation (CAS). The patients’ average ages were 66±8 years in the CEA group and 70±7.4 years in the CAS group, suggesting that those undergoing CAS were generally older. Notably, there were significantly more instances of congestive heart failure and a history of cerebrovascular disease within the CAS group compared to the CEA group. However, no significant difference was observed in the rates of postprocedural complications. Furthermore, there were no cases of mortality reported in either group. Conclusion: The preferred method for treating severe carotid artery stenosis should be determined by considering patient characteristics and preferences, as well as the complication rates in the centre.

How Are FIM Gains Improved after Intensive Rehabilitation for Cerebrovascular Diseases?

The purpose of this study was to determine functional independence measure (FIM) gains based on clinical factors after rehabilitation for cerebrovascular diseases, and to determine how FIM scores and FIM gains can predict rehabilitation outcomes. Of the 181 patients in the study 161 suffered strokes (cerebral infarction 107, cerebral hemorrhage 41, subarachnoid hemorrhage 12, subdural hematoma 1). There were also 12 traumatic brain injuries, and 8 other miscellaneous cases. Dementia, higher brain dysfunction, etiology, sex, age, history of cerebrovascular diseases, location involvement, disability severity, duration of hospitalization and period from onset to rehabilitation were analyzed using FIM. FIM gains decreased in relation to an increase in age. Patients with intermediate disability (FIM 41-80) on admission showed significantly higher FIM-total gain on discharge than others. Factors influencing FIM gain were revealed to be age, duration of hospitalization, FIM gain 4 weeks after admission, etiology, disability severity, dementia and past history of cerebrovascular diseases. Multiple regression analysis determined that significant factors to contribute FIM gain were duration of hospitalization, FIM gain at 4 weeks after admission, age, and disability severity. FIM scores and FIM gains could predict rehabilitation outcomes.

Additional predictors of stroke and transient ischaemic attack in BEFAST positive patients in out-of-hours emergency primary care

Introduction In patients suspected of stroke or transient ischemic attack (TIA), rapid triaging is imperative to improve clinical outcomes. For this purpose, balance-eye-face-arm-speech-time (BEFAST) items are used in out-of-hours primary care (OHS-PC). We explored the risk of stroke and TIA among BEFAST positive patients calling to the OHS-PC, and assessed whether additional predictors could improve risk stratification. Methods This is a cross-sectional study of retrospectively gathered routine care data from telephone triage tape-recordings of patients calling the OHS-PC with neurological deficit symptoms, classified as BEFAST positive. Four models–with the predictors age, sex, a history of cardiovascular or cerebrovascular disease, and cardiovascular risk factors–were fitted using logistic regression to predict the outcome stroke or TIA. Likelihood ratio testing was used to select the best model, which was subsequently internally validated. Results The risk of stroke or TIA diagnosis was 52% among 1,289 BEFAST positive patients, median age 72 years, 56% female sex. Of patients with the outcome stroke/TIA, 24% received a low urgency allocation, while 92% had signs or symptoms when calling. Only the addition of age and sex improved predicting stroke or TIA (internally validated c-statistic 0.72, 95%CI 0.69–0.75). The predicted risk of stroke or TIA remained below 20% in those aged below 40. Females aged 70 or over and males aged 55 or over, had a predicted risk above 50%. Discussion Urgency allocation appears to be suboptimal in BEFAST positive patients calling the OHS-PC. Risk stratification could be improved in this setting by adding age and sex.

What Factors Influence In-Hospital Mortality Following Aseptic Revision Total Hip Arthroplasty? A Single-Center Analysis of 13,203 Patients

BackgroundRevision total hip arthroplasty (rTHA) is associated with an extended surgical period, an increased hospitalization period, expanded blood loss, and high mortality rates. The purpose of the present study was to assess the risk factors that contribute to in-hospital mortality following aseptic rTHA. MethodsWe performed a retrospective examination of the medical records of all patients who underwent elective rTHA surgery at our tertiary referral arthroplasty center between March 1996 and March 2019. The study involved a group of 13,203 patients, including 70 who expired during hospitalization and 13,133 in the control group. Baseline characteristics, medical history, comorbidities, and surgery-related parameters of the patients were recorded. Logistic regression analyses were performed to examine the association between independent variables and in-hospital mortalities, which were presented as odds ratios (ORs) and confidence intervals (CIs). ResultsPatient factors associated with in-hospital mortality included hepatitis C (OR 75.5, 95% CI 3.5 to 1,625.2), chronic obstructive pulmonary disease (OR 30.7, 95% CI 6.5 to 145.7), rheumatoid arthritis (OR 28.9, 95% CI 3.8 to 218.5), history of myocardial infarction (OR 24.9, 95% CI 4.4 to 140.8), history of cerebrovascular disease (OR 23.1, 95% CI 3.8 to 142), congestive heart failure (OR 18.9, 95% CI 3.8 to 94.2), and diabetes mellitus (OR 10.2, 95% CI 2.4 to 42.6). Surgical factors included the history of multiple prior revisions (OR 1.75, 95% CI 1.1 to 2.7), postoperative blood transfusion (OR 2.8, 95% CI 1.1 to 7.3), and decreased preoperative hemoglobin (OR 2.3, 95% CI 1.7 to 3.1). ConclusionsSeveral patient-related and intraoperative factors significantly increased the risk of in-hospital mortality following aseptic rTHA. Vigilance and close perioperative monitoring are essential for patients undergoing this complex surgery. Level of EvidenceIII.

The effects of micro- and macrovascular diabetic complications on ischemic stroke in patients with type 2 diabetes mellitus

Objectives: The present study aimed to examine the effects of diabetes complications on the ischemic stroke risk among patients with type 2 diabetes mellitus (T2DM). Patients and methods: The medical records of all patients (n=5,468) who were admitted to a tertiary care hospital between January 1, 2021, and June 1, 2022, were retrospectively reviewed. Of 911 patients diagnosed with T2DM for at least two years, 37 patients with a history of hemorrhagic cerebrovascular disease were excluded. Consequently, the study was conducted with 874 patients (460 males, 414 females; mean age: 65.5±12.1 years; range, 39 to 92 years) with T2DM. Demographic data, presence of chronic disease other than diabetes, duration of diabetes, retinopathy, nephropathy, peripheral arterial disease, and diabetes medications were recorded. The patients were divided into two groups: those with and without a history of ischemic stroke. The two groups were compared in terms of demographic characteristics and diabetes complications. Results: The prevalence of ischemic stroke was 18.6% (n=163). Patients with ischemic stroke were older than those without ischemic stroke, had longer diabetes durations, and had higher rates of hypertension, hyperlipidemia, and insulin use (p=0.001, p&lt;0.001, p&lt;0.001, p&lt;0.001, and p&lt;0.001, respectively). Diabetic retinopathy (41.7%), diabetic nephropathy (27.6%), and peripheral arterial disease (16.6%) were more commonly observed among patients with ischemic stroke compared to the others. Examining the parameters differing between the groups, diabetes duration, hypertension, insulin use, and peripheral arterial disease were found to be independent risk factors for ischemic stroke (p&lt;0.001, p&lt;0.001, p=0.001, and p=0.001, respectively). Conclusion: Examining the relationship between diabetes complications and ischemic stroke risk from a broader perspective, the present study provided important implications for clinical management. Large-scale studies are needed in the future.

O59 INFLUENCE OF CIRCADIAN BLOOD PRESSURE PATTERN ON RIGHT VENTRICULAR STRUCTURE AND FUNCTION IN PATIENTS WITH ARTERIAL HYPERTENSIION

Background and Objective: It is well proven, that arterial hypertension affects left side of the heart and causes its remodeling and functional changes. Since heart works as a unit and has ventricular interdependence, aim of the study was to assess influence of hypertension and circadian blood pressure (BP) profile on a right ventricular structure and function. Methods: 75 hypertensive patients (57.13±7.27 y/o) and 25 normotensive control subjects (57.56±7.55 y/o) were involved in a study. All of them were males without history of coronary artery disease, cerebrovascular or peripheral artery disease, obstructive lung disease, significant valvular heart disease or heart failure. All of them were either lifetime nonsmokers, or stopped smoking more than 5 years. All the patients underwent to 24-hour ambulatory BP monitoring and heart ultrasound with tissue doppler imaging. Results: Hypertensive patients with dipper circadian BP profile had higher TAPSE (19±1.586 vs 17.708±2.857; P&lt;0.05), higher right ventricular ejection fraction (55.103±4.597 vs 47.829±14.605; P&lt;0,005) and lower right ventricular outflow tract diameter (29.985±3.932 vs 32.639±3.510; P&lt;0/05). None of the echo parameters were different between normotensive subjects with different circadian BP pattern. Trans tricuspid valve early diastolic (E) and late diastolic (A) peak velocities were significantly lower in hypertensive patients (1.416±0.130 vs 0.897±1.49; P&lt;0.005). Hence, non-dipper hypertensives had significantly lower tricuspid E/A ratio in comparison with dippers (0.812±0.094 vs 1.048±0.101; P&lt;0.00001). Interventricular septum and posterior wall diameters were higher in non-dipper hypertensives (1.134±0.131 vs. 1.322±0.138; P&lt;0.00001 and 1.072±0.175 vs. 1.254±0.135; P&lt;0.001; respectively). Conclusion: Study data show increased interdependence between two ventricles. Patients with arterial hypertension have systole-diastolic dysfunction, which especially well is present in patients with non-dipper circadian BP profile.

Innovative nomogram for predicting 1-year clinically driven revascularization outcomes in endovascular femoropopliteal disease.

Femoropopliteal artery disease (FPAD) is a common vascular disease that usually requires surgical treatment. The aim of this study was to apply predictive modeling to develop predictive models for predicting clinically driven target revascularization (CD-TLR) events 1 year after intervention in patients with FPAD. In this study, clinical data were collected from a total of 484 patients who underwent FPAD endovascular intervention from 2014 to 2019. According to the inclusion and exclusion criteria, 400 patients will be finally included and assigned to the training cohort and test cohort in the ratio of 7:3. By analyzing these data through statistical methods, we will explore the effects of different factors on target revascularization events 1 year after intervention in FPAD patients, and build the corresponding prediction model of the column line graph. The final nomogram model consisted of 5 independent predictors: history of cerebrovascular disease, lesion length >15 cm, no atherectomy device used, no medicated balloon used and procedure time. The C-index of the model was 0.766 and 0.726 for the training cohort and validation cohort, respectively. The calibration curves also showed that the model had satisfactory agreement in both cohorts. The newly developed prediction model can accurately predict clinically driven target revascularization events at 1 year in patients with FPAD, providing valuable information for the development of individualized treatment plans.

GGC repeat expansions in NOTCH2NLC cause uN2CpolyG cerebral amyloid angiopathy.

The expansion of GGC repeats within NOTCH2NLC leads to the translation of the uN2CpolyG protein, the primary pathogenic factor in neuronal intranuclear inclusion disease (NIID). This study aims to explore the deposition of uN2CpolyG as an amyloid in the vessel wall, leading to uN2CpolyG cerebral amyloid angiopathy (CAA)-related cerebral microbleeds (CMBs). A total of 97 patients with genetically confirmed NIID were enrolled in this study. We analyzed the presence of CMBs using susceptibility-weighted imaging sequences and compared general clinical information, cerebrovascular risk factors, stroke history, antiplatelet medication use, and MRI features between NIID patients with and without CMBs. We further performed hematoxylin and eosin (H&E), Perl's, Congo red, and Thioflavin S staining, ubiquitin, p62 and uN2CpolyG immunostaining on brain tissue obtained from four NIID patients. A total of 354 CMBs were detected among 41 patients with NIID, with nearly half located in the deep brain, one-third in the lobes, and approximately 20% in the infratentorial area. No significant differences in cerebrovascular disease risk factors or history of antiplatelet drug use were observed between patients with and without CMBs. However, patients with CMBs suffered a higher incidence of previous ischemic and hemorrhagic stroke events. This group also had a higher incidence of recent subcortical infarcts and a higher proportion of white matter lesions in the external capsule and temporal pole. Conversely, patients without CMBs showed higher detection of high signals at the corticomedullary junction on diffusion-weighted imaging and more pronounced brain atrophy. H&E staining showed blood vessel leakage and hemosiderin-laden macrophage clusters, and Prussian blue staining revealed brain tissue iron deposition. CMBs occurred more frequently in small vessels lacking intranuclear inclusions, and extensive degeneration of endothelial cells and smooth muscle fibres was observed mainly in vessels lacking inclusions. Congo red-positive amyloid deposition was observed in the cerebral vessels of NIID patients, with disordered filamentous fibres appearing under an electron microscope. Additionally, the co-localization of Thioflavin S-labeled amyloid and uN2CpolyG protein in the cerebral vascular walls of NIID patients further suggested that uN2CpolyG is the main pathogenic protein in this form of amyloid angiopathy. In conclusion, we reviewed patients with GGC repeat expansion of NOTCH2NLC from a novel perspective, providing initial clinical, neuroimaging, and pathological evidence suggesting that uN2CpolyG may contribute to a distinct type of CAA.

Impact of sex on outcomes associated with polyvascular disease in patients after PCI

Atherosclerosis in more than one vs. one arterial bed is associated with increased risk for major adverse cardiovascular events (MACE). This study aimed to determine whether the risk of post percutaneous coronary intervention (PCI) MACE associated with polyvascular disease (PVD) differs by sex. We analyzed 18,721 patients undergoing PCI at a tertiary-care center between 2012-2019. Polyvascular disease was defined as history of peripheral artery and/or cerebrovascular disease. The primary endpoint was MACE, a composite of all-cause death, myocardial infarction, or stroke at 1 year. Multivariate Cox regression was used to adjust for differences in baseline risk between patients with PVD vs. coronary artery disease (CAD) alone and interaction testing was used to assess risk modification by sex. Women represented 29.2% (N=5,467) of the cohort and were more likely to have PVD than men (21.7% vs. 16.1%; p<0.001). Among both sexes, patients with PVD were older with higher prevalence of comorbidities and cardiovascular risk factors. Women with PVD had the highest MACE rate (10.0%), followed by men with PVD (7.2%), women with CAD alone (5.0%), and men with CAD alone (3.6%). Adjusted analyses revealed similar relative MACE risk associated with PVD vs. CAD alone in women and men (adjusted hazard ratio [aHR] 1.54, 95% confidence interval [CI] 1.20-1.99; p<0.001 and aHR 1.31, 95% CI 1.06-1.62; p=0.014, respectively; p-interaction=0.460). Women and men derive similar excess risk of MACE from PVD after PCI. The heightened risk associated with PVD needs to be addressed with maximized use of secondary prevention in both sexes.

Safety of Triptans in Patients Who Have or Are at High Risk for Cardiovascular Disease: A Target Trial Emulation

ObjectiveTo evaluate the safety of triptans in migraine patients with cardiovascular disease or elevated cardiovascular risk. Patients and MethodsWe retrieved data from a multistate US-based health system (January 2000 to August 2022) on adults with migraine and confirmed cardiovascular/cerebrovascular disease, or at least two cardiovascular risk factors. We compared the effect of triptans to nontriptan treatments on major adverse cardiovascular events (MACE) and its components at 60 days of starting treatments. We emulated a target trial and used propensity score matching for analysis. ResultsThe 3518 patients in the triptan group were matched to the 3518 patients in the nontriptan group (median age, 55 years; 80.60% female). At 60 days, 52 patients (1.48%) in the triptan group had MACE, compared with 13 patients (0.37%) in the nontriptan group (relative risk [RR], 4.00; 95% CI, 2.24 to 7.14). Patients treated with triptans also had significantly higher risk of nonfatal myocardial infarction (15 patients (0.43%) vs 0 patients (0.00%)); heart failure (RR, 4.50; 95% CI, 1.91 to 10.61); and nonfatal stroke (RR, 8.00; 95% CI, 1.00 to 63.96). Five patients (0.14%) in each group died. The findings were consistent when analyses were restricted to sumatriptan, oral administration of triptan, patients with chronic migraine, history of cardiovascular disease, or history of cerebrovascular disease. ConclusionTriptans likely increase the risk of MACE; however, the incidence of MACE remains low in migraine patients with cardiovascular disease or elevated cardiovascular risk. Trial RegistrationTreatments of Migraine With Triptans in Individuals With Elevated Cardiovascular Risk and in Pregnant Women. ClinicalTrials.gov Identifier: NCT05854992 (https://classic.clinicaltrials.gov/ct2/show/NCT05854992)

Predicting the Risk of Postoperative Delirium in Elderly Patients Undergoing Hip Arthroplasty: Development and Assessment of a Novel Nomogram

Objective To construct and internally validate a nomogram that predicts the likelihood of postoperative delirium in a cohort of elderly individuals undergoing hip arthroplasty. Methods Data for a total of 681 elderly patients underwent hip arthroplasty were retrospectively collected and divided into a model (n = 477) and a validation cohort (n = 204) according to the principle of 7:3 distribution temporally. The assessment of postoperative cognitive function was conducted through the utilization of The Confusion Assessment Method (CAM). The nomogram model for postoperative cognitive impairments was established by a combination of Lasso regression and logistic regression. The receiver operating characteristic (ROC) curve, calibration plot, and decision curve analysis (DCA) were used to evaluate the performance. Results The nomogram utilized various predictors, including age, body mass index (BMI), education, preoperative Barthel Index, preoperative hemoglobin level, history of diabetes, and history of cerebrovascular disease, to forecast the likelihood of postoperative delirium in patients. The area under the ROC curves (AUC) for the nomogram, incorporating the aforementioned predictors, was 0.836 (95% CI: 0.797–0.875) for the training set and 0.817 (95% CI: 0.755–0.880) for the validation set. The calibration curves for both sets indicated a good agreement between the nomogram’s predictions and the actual probabilities. Conclusion The use of this novel nomogram can help clinicians predict the likelihood of delirium after hip arthroplasty in elderly patients and help prevent and manage it in advance.

Risk factors for serious postoperative complications following gastrectomy in super‐elderly patients ≥85‐years‐old with gastric cancer: A National Clinical Database study in Japan

AbstractAimThis study aimed to evaluate the technical safety and feasibility of gastrectomy for super‐elderly patients ≥85‐y‐old with gastric cancer and to clarify the risk factors for serious postoperative complications in these patients.MethodsBetween 2017 and 2020, 10,203 patients who underwent distal gastrectomy (DG) and 2580 patients who underwent total gastrectomy (TG) were reviewed from the Japanese National Clinical Database. All possible preoperative factors were used to explore the risk factors for serious postoperative complications in the super‐elderly patients with gastric cancer.ResultsFor DG, the operative mortality rate was 1.6% (162 patients), and the rate of serious postoperative complications was 7.8% (796 patients). Similarly, the mortality rate was 2.6% (67 patients), and the rate of serious complications was 11.3% (292 patients) for TG. Based on multivariate analysis, body mass index (≥25 kg/m2), activities of daily living (ADL) (partially dependent), ASA‐PS (Grade ≥3), dyspnea, ascites, history of cerebrovascular disease, serum albumin (&lt;4 g/dL), and creatinine (&gt;1.2 mg/dL) in DG, and ADL (partially dependent), ASA‐PS (Grade ≥3), previous percutaneous coronary intervention, dialysis, WBC (&gt;9000 μL), and AST (&gt;35 IU/L) in TG were strong risk factors for serious postoperative complications.ConclusionsThe study findings suggest that gastrectomy for super‐elderly gastric cancer patients is relatively safe and feasible. Surgeons need to pay special attention to physical status and past medical history than tumor factors for preventing serious postoperative complications in super‐elderly gastric cancer patients.

Inflammatory risk and clinical outcomes according to polyvascular atherosclerotic disease status in patients undergoing PCI.

Individuals suffering from polyvascular atherosclerotic disease (PolyVD) face a higher likelihood of adverse cardiovascular events. Additionally, inflammation, assessed by high-sensitivity C-reactive protein (hsCRP), affects residual risk following percutaneous coronary intervention (PCI). We aimed to explore the interplay between PolyVD and hsCRP in terms of clinical outcomes after PCI. Patients undergoing PCI for chronic coronary disease at a tertiary center between January 2012 and February 2020 were included for the current analysis. PolyVD was defined by additional history of cerebrovascular and/or peripheral artery disease. HsCRP levels were defined as elevated when the measured baseline concentration was > 3mg/L. The primary outcome of interest was major adverse cardiovascular events (MACE), a composite of all-cause mortality, spontaneous MI, or target vessel revascularization. Overall, 10,359 participants were included in the current study, with 17.4% affected by PolyVD and 82.6% included in the non-PolyVD subgroup. Patients with PolyVD had higher hsCRP levels than those without. Among the PolyVD group, a larger proportion (33.6%) exhibited elevated hsCRP compared to the non-PolyVD group (24.7%). Patients with both PolyVD and elevated hsCRP levels had significantly higher adverse event rates than all other subgroups at 1-year follow-up. Furthermore, an independent association between elevated hsCRP and MACE was observed within the PolyVD population, while this was not the case for individuals without PolyVD. A residual risk of adverse outcomes after PCI linked to inflammation appears to be present among individuals with PolyVD. This could help define further target populations for anti-inflammatory treatment options.

#2929 Plasma levels of brain injury markers NfL and GFAP are independently predicted by glomerular filtration rate in patients with chronic kidney disease

Abstract Background and Aims Patients with chronic kidney disease (CKD) have a high prevalence of cerebrovascular disease and cognitive impairment. The aim of the present study was to measure brain injury biomarkers in plasma in a cohort of patients with CKD stages 3 and 4, without a diagnosis of cerebrovascular disease, and to determine factors that independently predicted plasma levels of these biomarkers. Method This was a cross-sectional cohort study including 110 patients with CKD stages 3 and 4, and 55 healthy, matched, controls, recruited from the outpatient clinic at Sahlgrenska university hospital, Gothenburg, Sweden. None of the included study subjects had a diagnosis of cerebrovascular disease, cognitive impairment, or any other neurological disease. Plasma concentrations of neurofilament light (NfL), glial fibrillary acidic protein (GFAP) and phosphorylated Tau (p-Tau231) were analyzed with ultrasensitive single molecule array (SIMOA). Measured GFR (mGFR) was determined by plasma clearance of ⁵¹Cr-EDTA. Values are medians [interquartile range]. For linear regression analyses standardised beta coefficients (β) are presented. Results Characteristics of CKD patients and healthy controls are presented in Table 1. Plasma concentrations of NfL (37.5 [22.1-47.5] vs. 13.4 [10.5-16.7] ng/L, p &amp;lt; 0.001), p-Tau231 (25.7 [19.1-38.7] vs. 13.9 [10.5-16.3] ng/L, p &amp;lt; 0.001) and GFAP (190 [140-281] vs. 153 [116-211] ng/L, p = 0.001) were significantly elevated in patients with CKD vs. controls. In CKD patients, mGFR showed statistically significant inverse correlations to plasma concentrations of NfL, p-Tau231, and GFAP (Table 2). In multiple regression analyses, mGFR was associated with plasma levels of NfL (β = −0.457, p &amp;lt; 0.001) and GFAP (β = −0.322, p &amp;lt; 0.001) independently of diabetes, age, troponin-T, b-hemoglobin, and aortic pulse-wave velocity. However, mGFR was not significantly associated with plasma levels of p-Tau231 in a multiple regression analysis. Conclusion Plasma levels of brain injury markers NfL, p-Tau231 and GFAP were elevated in patients with CKD stages 3 and 4, without a history of cerebrovascular disease, compared to healthy controls. Furthermore, mGFR independently predicted plasma concentrations of NfL and GFAP in multiple regression models. These results raise the possibility that reduced GFR per se may be associated with subclinical brain injury.

Development of an individualized model for predicting postoperative delirium in elderly patients with hepatocellular carcinoma.

Postoperative delirium (POD) is a common complication in older patients with hepatocellular carcinoma (HCC) that adversely impacts clinical outcomes. We aimed to evaluate the risk factors for POD and to construct a predictive nomogram. Data for a total of 1481 older patients (training set: n=1109; validation set: n=372) who received liver resection for HCC were retrospectively retrieved from two prospective databases. The receiver operating characteristic (ROC) curve, calibration plot, and decision curve analysis (DCA) were used to evaluate the performance. The rate of POD was 13.3% (148/1109) in the training set and 16.4% (61/372) in the validation set. Multivariate analysis of the training set revealed that factors including age, history of cerebrovascular disease, American Society of Anesthesiologists (ASA) classification, albumin level, and surgical approach had significant effects on POD. The area under the ROC curves (AUC) for the nomogram, incorporating the aforementioned predictors, was 0.798 (95% CI 0.752-0.843) and 0.808 (95% CI 0.754-0.861) for the training and validation sets, respectively. The calibration curves of both sets showed a degree of agreement between the nomogram and the actual probability. DCA demonstrated that the newly established nomogram was highly effective for clinical decision-making. We developed and validated a nomogram with high sensitivity to assist clinicians in estimating the individual risk of POD in older patients with HCC.