Ischemic Stroke Patients Research Articles

Clinical efficacy of DSA-based features in predicting outcomes of acupuncture intervention on upper limb dysfunction following ischemic stroke

Background and objectivesThis study aimed to employ machine learning techniques to predict the clinical efficacy of acupuncture as an intervention for patients with upper limb motor dysfunction following ischemic stroke, as well as to assess its potential utility in clinical practice.MethodsMedical records and digital subtraction angiography (DSA) imaging data were collected from 735 ischemic stroke patients with upper limb motor dysfunction who were treated with standardized acupuncture at two hospitals. Following the initial screening, 314 patient datasets that met the inclusion criteria were selected. We applied three deep-learning algorithms (YOLOX, FasterRCNN, and TOOD) to develop the object detection model. Object detection results pertaining to the cerebral vessels were integrated into a clinical efficacy prediction model (random forest). This model aimed to classify patient responses to acupuncture treatment. Finally, the accuracies and discriminative capabilities of the prediction models were assessed.ResultsThe object detection model achieved an optimal recognition rate, The mean average precisions of YOLOX, TOOD, and FasterRCNN were 0.61, 0.7, and 0.68, respectively. The prediction accuracy of the clinical efficacy model reached 93.6%, with all three-treatment response classification area under the curves (AUCs) exceeding 0.95. Feature extraction using the prediction model highlighted the significant influence of various cerebral vascular stenosis sites within the internal carotid artery (ICA) on prediction outcomes. Specifically, the initial and C1 segments of the ICA had the highest predictive weights among all stenosis sites. Additionally, stenosis of the middle cerebral, anterior cerebral, and posterior cerebral arteries exerted a notable influence on the predictions. In contrast, the stenosis sites within the vertebral artery exhibited minimal impact on the model's predictive abilities.ConclusionsResults underscore the substantial predictive influence of each cerebral vascular stenosis site within the ICA, with the initial and C1 segments being pivotal predictors.

Age-related features of the main risk factors and clinical and laboratory parameters in men aged 30–50 years with atherothrombotic stroke

Introduction. Ischemic stroke in patients under 50 years of age is not uncommon. The prevalence of stroke in young people increases due to the increase in risk factors. Early detection of risk factors and optimization of primary and secondary preventive therapy are mandatory to reduce the burden of stroke in young people and preserve potential years of life.Objective. To identify and evaluate the main risk factors and clinical and laboratory parameters in men aged 31–40 and 41–50 years with atherothrombotic stroke.Material and methods. Before the development of the COVID-19 pandemic, 60 patients were examined (mean age 43.3±3.8 years). All patients underwent neuroimaging of the brain, ultrasound examination of the main vessels of the head, echocardiography, ECG, and laboratory analysis of blood serum.Results. Among all patients, there were 10 patients aged 31–40 years (mean age 37.4±2.6 years) and 50 patients aged 41–50 years (mean age 44.5±2.8 years). All patients had atherosclerotic lesions of the main arteries of the head, with stenosis of more than 70 % only in patients aged 41–50 years. Among patients aged 31–40 years and 41–50 years, the most common risk factors were arterial hypertension (90 and 72 %), smoking (70 and 72 %), dyslipidemia (66.7 and 60 %), and regular alcohol consumption (30 and 36 %). The study showed statistically significant correlations of the main vascular risk factors with serum lipid metabolism indices, hemostasis and endothelial dysfunction markers.Conclusions. The study showed the frequency of occurrence of the main risk factors in patients with atherothrombotic stroke aged 31–40 and 41–50 years, as well as the role of lipid metabolism disorders, hemostasis disorders and endothelial dysfunction in their development.

COMPARATIVE ANALYSIS OF LIPID PROFILE IN PATIENTS WITH HEMORRHAGIC VERSUS ISCHEMIC STROKE: A CROSS-SECTIONAL STUDY

Objective: Stroke is a major cause of morbidity and mortality worldwide resulting from either an ischemic insult or rupture of a blood vessel in the brain. It not only leads to significant physical disability but also imposes emotional and economic burdens on patients and their families. Assessing the lipid profile in stroke patients is crucial, especially in ischemic stroke, where dyslipidemia plays a key role in atherosclerosis development. Elevated low-density lipoprotein (LDL) and triglycerides (TG) are important modifiable risk factors, and managing these can reduce the incidence and recurrence of strokes. Comprehensive lipid management should be a core component of stroke prevention and treatment strategies. Methods: This was a cross-sectional study in which 80 adult stroke patients (40 ischemic and 40 hemorrhagic strokes) were included on the basis of a predefined inclusion and exclusion criteria. The diagnosis of stroke was made on the basis of imaging and neurological examination. A comprehensive medical history, physical measurements (including body mass index), and lipid profiles (total cholesterol [TC], LDL, High-density lipoprotein [HDL], and TG) were recorded for all participants. Blood samples were taken after overnight fasting to ensure accuracy. Statistical analysis using SPSS version 21.0 compared lipid levels between the groups. An unpaired t-test and Chi-square test were used, with significance defined as a p<0.05. Results: There was a significant difference in lipid profiles between ischemic and hemorrhagic stroke patients. Ischemic stroke patients had markedly higher levels of LDL with a mean of 129.84±36.54 mg/dL compared to 106.32±26.68 mg/dL in hemorrhagic stroke patients (p=0.0015). TC levels were also significantly elevated in ischemic stroke patients, averaging 236.22±56.26 mg/dL versus 196.48±46.24 mg/dL in hemorrhagic stroke patients (p=0.0009). Total TG were higher in ischemic stroke patients (158.54±44.68 mg/dL) compared to hemorrhagic stroke patients (128.62±39.16 mg/dL, p=0.0021). HDL levels were slightly lower in ischemic stroke patients (34.54±8.26 mg/dL) compared to hemorrhagic stroke patients (38.12±9.12 mg/dL), although this difference was not statistically significant (p=0.0696). Conclusion: There were significant differences in lipid profiles between ischemic and hemorrhagic stroke patients. Ischemic stroke patients had higher levels of LDL, TC, and TG, indicating a stronger association with dyslipidemia and atherosclerosis. These findings highlight the importance of aggressive lipid management in ischemic stroke patients to reduce recurrence risk and improve outcomes.

Care Quality and Outcomes of Ischemic Stroke in Patients With Premorbid Dementia: Get With The Guidelines-Stroke Registry.

Patients with premorbid dementia have been generally excluded from trials of stroke therapies, and their dementia diagnosis may affect the care received. There are few data on the quality of stroke care and outcomes in these patients. We compared the quality of care and outcomes for acute ischemic stroke patients with versus without premorbid dementia using national data from the Get With The Guidelines-Stroke registry between July 1, 2020, and December 31, 2021. Process outcomes included receiving intravenous thrombolysis, endovascular thrombectomy, and additional national quality measures. Clinical outcomes included ambulatory status at discharge, discharge destination, and mortality. The analyses were adjusted for patient and hospital characteristics. Among 609 350 patients with acute ischemic stroke, 29 751 of 546 407 (5.4%) had documented prestroke dementia (median age, 84 [interquartile range, 78-89]; 62.8% female). Patients with versus without premorbid dementia were more likely to arrive via emergency medical services (70.5% versus 46.8%) and had more severe strokes (median National Institutes of Health Stroke Scale score, 7 [interquartile range, 3-15] versus 3 [interquartile range, 1-8]). They were less likely to be admitted to a comprehensive stroke center (17.9% versus 22.7%; P<0.0001), to receive intravenous thrombolysis (9.6% versus 11.1%; adjusted odds ratio [aOR], 0.91 [95% CI, 0.87-0.95]) or endovascular thrombectomy (4.5% versus 7.4%; aOR, 0.62 [95% CI, 0.56-0.68]), attain each of the Get With The Guidelines-Stroke Achievement Measures and Quality Measures, or attain defect-free stroke care (92.0% versus 95.0%; aOR, 0.75 [95% CI, 0.71-0.78]). Patients with premorbid dementia had longer door-to-needle times (adjusted difference, 3.17 minutes [95% CI, 1.34-5.01]), lower odds of being discharged home (43.8% versus 60.1%; aOR, 0.96 [95% CI, 0.93-1.00]), and higher odds of being nonambulatory at discharge (25.8% versus 9.3%; aOR, 1.62 [95% CI, 1.54-1.69]), and of in-hospital mortality or hospice admission (23.3% versus 8.6%; aOR, 1.38 [95% CI, 1.32-1.43]). Symptomatic intracranial hemorrhage after intravenous thrombolysis/endovascular thrombectomy did not differ (5.3% versus 3.7%; aOR, 1.13 [95% CI, 0.97-1.31]). Patients with premorbid dementia experienced slightly poorer quality of stroke care across multiple measures, were less likely to receive acute stroke interventions, and had worse poststroke outcomes than patients without dementia in a large nationwide registry. Our findings underscore the need for concerted efforts to further improve care quality and outcomes in this population.

Detection of atrial fibrillation after stroke due to large or small vessel disease: Systematic review and meta-analysis.

Emerging evidence indicates a frequent occurrence of atrial fibrillation (AF) detection among patients with established causes of ischemic stroke unrelated to AF. This systematic review and meta-analysis aimed to evaluate AF detection rates in stroke patients with large or small vessel disease, considering the AF detection modality and duration of cardiac rhythm monitoring. We conducted a comprehensive search of PubMed and Scopus databases up to 2 March 2024, to identify randomized controlled trials, non-randomized prospective studies, and retrospective studies assessing the frequency of AF detection in stroke patients with large or small vessel disease. The primary outcome of interest was the rate of AF detection. We utilized inverse-variance weights to produce the pooled prevalence (effect size (ES)) and 95% confidence interval (CI) of patients diagnosed with post-stroke AF. In the analysis of 14 eligible studies encompassing 4334 patients, AF was identified in 154 out of 2082 patients with strokes attributed to small or large vessel disease, yielding a pooled prevalence of 6.27% (ES; 95% confidence interval (CI): 3.18-10.17, I2 = 87.83%). Among patients with large vessel disease strokes, AF was diagnosed in 79 out of 1042 patients, accounting for a pooled prevalence of 5.07% (ES; 95% CI: 1.30-10.33, I2 = 77.05%). Similarly, among those with small vessel disease strokes, AF was detected in 75 out of 1040 patients, with a pooled prevalence of 5.03% (ES; 95% CI: 1.96-9.06, I2 = 78.05%). AF is often found in ischemic stroke patients with large or small vessel disease. Detection rates increase with longer cardiac rhythm monitoring. The safety and benefits of oral anticoagulation for these AF episodes are uncertain.

Mối tương quan giữa một số chỉ số trên cộng hưởng từ bó tháp trong tiên lượng khả năng phục hồi chức năng vận động ở bệnh nhân nhồi máu não vùng trên lều

Object: Correlation between some indices on pyramidal tract magnetic resonance in predicting motor function recovery in patients with supratentorial cerebral infarction. Method: Cross-sectional description with longitudinal follow-up includes 31 patients with supratentorial cerebral infarction within seven days and had an MRI at Bach Mai Hospital from January 2023 to December 2023. Result: The proportion of male patients with ischemic stroke predominated (61,3%). Hemiplegia was the most common symptom of ischemic stroke which damaged the path of the corticospinal tract. At three months after the stroke, no patient had severe NIHSS score ; the percentage of patients with mild and moderate NIHSS score was 61,3% and 38,7%, respectively. According to mRS, 25 patients (80,6%) recovered well after three months. The patient group, who had the axons did not go through the infarct lesion, had higher at rate of better motor function recovery after three months than the other groups who had the axons go through partly or completely inside the infarction lesion (respective rates were 64,5% and 16,1%); p&lt;0,05. FA index of the axons in the infarct side of the poor recovery group was smaller than the good recovery group, p&lt;0.05. Conclusion: The axonal signal, location versus the infarct lesion, and FA index of the axons in the infarct side are the factors that significantly predictive of motor recovery after three months in ischemic stroke patients.

Interfacility Transfer for Thrombectomy: A Promising Therapeutic Window.

Currently, most acute ischemic stroke patients presenting with a large vessel occlusion are first evaluated at a nonthrombectomy-capable center before transfer to a comprehensive stroke center that performs thrombectomy. Interfacility transfer is a complex process that requires extensive coordination between the referring, transporting, and receiving facilities. As a result, long delays are common, contributing to poor clinical outcomes. In this review, we summarize the accumulating literature about the clinical as well as radiological-infarct growth, collateral change, arterial recanalization, and hemorrhagic transformation-changes during interfacility transfer for thrombectomy. Recent evidence shows that clinical/radiological changes during transfer are heterogeneous across patients and impact long-term functional outcomes, highlighting the urgent need to optimize care during this time window. We review some of the most promising therapeutic strategies-for example, penumbral protection to reduce infarct growth-that may improve clinical outcome in patients being transferred to thrombectomy-capable centers. Finally, we discuss key methodological considerations for designing clinical trials aimed at reducing infarct growth during transfer.

Role of Serum Ferritin and Prediction of Neurological Outcome in Acute Ischemic Stroke Patients

Background: Stroke, also known as cerebrovascular accident (CVA), is an abrupt onset of neurological deficiency caused by a specific vascular aetiology. Aim: This study aimed to assess the role of serum ferritin in acute ischaemic stroke patients to correlate serum ferritin and neurological scales on the day of admission and during follow-up and to predict neurological outcomes. Methods: This prospective observational study included 100 patients who presented with acute ischaemic stroke clinically and with radiological imaging in the General Medicine and Neurology departments of Saveetha Medical College and Hospital for 18 months. Functional disability was assessed for all patients after 3 months based on the correlation of serum ferritin levels with the neurological scales, and the outcome was estimated. Results: The mean age of the patients was 59.45 ± 14.39. The serum ferritin level and Canadian Stroke Scale score during admission on day 7th and day 30th, were significantly different (p &lt; 0.01). Serum ferritin levels were positively associated with the Glasgow Coma Scale score at admission and on the 7th and 30th days after admission. Ferritin levels were significantly higher in the moderate category under all circumstances (p &lt; 0.01). Patients with mRS scores of 2, 3, and 4 were compared with serum ferritin levels and found to be significantly associated with serum ferritin levels. Conclusion: This study found that patients with higher serum ferritin levels experienced increased stroke severity and lower GCS and mRS scores, which correlated with increased morbidity.

High mechanical thrombectomy procedural volume is not a reliable predictor of improved thrombectomy outcomes in patients with acute ischemic stroke in the United States.

The volume of mechanical thrombectomy (MT) performed at hospitals is used as one of the criteria for advanced-level designation for stroke care. Our study sought to determine the relationship between annual MT procedural volume and in-hospital outcomes in acute ischemic stroke patients undergoing MT in the United States. We analyzed the National Inpatient Sample from 2016 to 2020. The hospitals were grouped into quartiles based on the volume of MT procedures performed within the calendar year. We compared the rates of routine discharge/home health care; in-hospital mortality, and post-treatment intracranial hemorrhage (ICH) between the quartiles after adjusting for potential confounders. Patients undergoing MT ranged from 15,395 in quartile 1 to 78,510 MT in quartile 4. There were lower rates of discharge home/self-care of 22.5%, 20.8%, and 20.8% for quartiles 2, 3, and 4, respectively, compared with 34.9% in quartile 1. The odds of ICH increased to 1.81 (p < 0.001), 1.84 (p < 0.001), and 1.98 (p < 0.001) among the quartiles from lowest to highest procedural volumes. The odds of home discharge/self-care decreased to 0.66 (p < 0.001), 0.60 (p < 0.001), and 0.63 (p < 0.001) among the quartiles from lowest to highest procedural volumes. The odds of in-hospital mortality increased to 1.92 (p < 0.001), 1.99 (p < 0.001), and 1.84 (p < 0.001) among the quartiles from lowest to highest procedural volumes. We observed a paradoxical relationship between adverse outcomes and the annual procedural volume of MT at the hospital presumably due to the higher severity of acute ischemic stroke treated at high-volume hospitals.

Ảnh hưởng của bệnh đi kèm trên kết cục đột quỵ thiếu máu não cấp

Background: Comorbidities that help predict poor outcomes in patients with acute ischemic stroke play a part in treatment planning and provide necessary information for patients and their families. Objective: Identify comorbidities that can predict poor outcomes 90 days after the onset of acute ischemic stroke. Subjects and methods: Prospective study including 150 acute ischemic stroke patients at Trieu An Hospital, Ho Chi Minh City. Subjects recruited upon admission were collected NIHSS score and comorbidities. Subjects had modified Rankin scores collected 90 days after disease onset. Univariate analysis and multivariate regression analysis were used to determine the role of variables on stroke outcomes. Results: The mean age was 65, male accounts for 62.0%. There were 8 factors univariately associated with poor outcome after 90 days of acute ischemic stroke onset: NIHSS, age, atrial fibrillation, valvular heart disease, coronary artery disease, heart failure, extracranial atherosclerosis and dementia. Among them, dementia is an independent prognostic factor for poor outcomes through multivariate analysis. The number of comorbidities is closely related to poor outcomes, the number of comorbidities ≥ 3 predicts patients with poor outcomes after 90 days of disease onset with a sensitivity of 96.6%; Specificity was 88.0%; The area under the curve was 96.3%. Conclusion: In acute ischemic stroke patients with comorbidities ≥ 3, the patient's prognosis is poor. In addition, dementia is an independent prognostic factor of poor outcome after 90 days from disease onset.

A study of the comparative effectiveness of dual antiplatelet therapy and a combination of acetylsalicylic acid with colchicine in patients in the acute period of “minor” ischemic atherothrombotic stroke during hospitalization. Interim analysis of data from the «COLCHIDA» study

Influence on inflammation is currently becoming a priority target for the prevention of recurrent atherothrombotic events, including stroke. In 2022, we planned the KOLCHIDA study, a two-center, prospective, randomized, open-label, controlled clinical trial with endpoint assessment (ClinicalTrials.gov identifier: NCT06102720). The purpose of this study is to conduct a comparative assessment of the clinical effectiveness of dual antiplatelet therapy with acetylsalicylic acid (ASA) and clopidogrel and the combination of ASA with colchicine in patients in the acute period of “minor” ischemic atherothrombotic stroke. The purpose of this publication is to present the basic concept of the protocol, its design and the first intermediate results. Material and methods. The intervention consisted of colchicine 0.5 mg/day in addition to ASA versus dual antiplatelet therapy (DAPT) in patients with non-severe ischemic stroke. 31 patients were included in the colchicine and ASA group, and 34 patients were included in the DAPT group. Results. In the comparison group, 7 (20.6%) recurrent non-fatal strokes were recorded, in contrast to the colchicine group, where acute vascular events were recorded in only two patients (6.5%) [RRR 2.2, NNT = 7, χ2 = 2, 9, p = 0.09]. There were no clinically significant bleeding or other adverse events in both groups. Conclusion. Interim results of the study indicate possible confirmation of the hypothesis that anti-inflammatory therapy with low doses of colchicine in combination with standard therapy is not inferior to the combination of ASA and clopidogrel, and perhaps more effectively reduces the number of early neurological deteriorations and recurrent ischemic strokes in patients in the acute period of mild atherothrombotic stroke with equal security profile.

Impact of time from symptom onset to puncture, and puncture to reperfusion, in endovascular therapy in the late time window (>6 h).

Increased time from symptom onset to puncture (TSOP) and time from puncture to reperfusion (TPTR) are associated with worse outcome in ischemic stroke patients treated with endovascular therapy (EVT) in the early time window (<6 h). However, these associations are less described in the late window (>6 h), where patients may benefit from EVT because of a more favorable imaging profile (late window paradox). We sought to compare the effect of these timeframes between these two periods on efficacy and safety outcomes. The ETIS (Endovascular Treatment in Ischemic Stroke) registry is an ongoing, prospective, observational study in 21 centers that perform EVT in France. We included adult patients with an anterior occlusion, successfully treated by EVT (modified treatment in cerebral ischemia (mTICI) 2b-3) between January 2015 and June 2023, with a known time of stroke onset. The cohort was divided into two groups according to the TSOP (⩽6 h vs >6 h). Primary outcome was favorable outcome (modified Rankin Scale 0-2 at 90 days). In total, 7516 patients were included, with 5936 patients being treated ⩽6 h and 1580 >6 h. In the early window, TSOP and TPTR were associated with worse outcomes at 90 days (adjusted odds ratio (aOR) = 0.68 per hour; 95% confidence interval (CI) = 0.64-0.73; p < 0.001 and aOR = 0.92 per 10-min increment; 95% CI = 0.90-0.94, p < 0.001, respectively). TSOP was not associated with worse outcomes at 90 days in the late window (p = 0.955), but TPTR was associated with worse outcomes (aOR = 0.91 per 10-min increment; 95% CI = 0.86-0.96, p = 0.001), every 10 additional minutes in TPTR being associated with a 1.7% (95% CI = 0.6-2.7) decreased probability of favorable outcome. Only EVT procedural time is associated with unfavorable outcomes at 90 days in late window patients. These results highlight how the late window paradox may end at the start of EVT and underscore the need for timely management, particularly for the EVT, even for late window patients with a presumed more favorable imaging profile.

Efficacy of anodal transcranial direct current stimulation for upper extremity function after ischemic stroke: A systematic review of parallel randomized clinical trials

BackgroundAlthough existing studies had shown therapeutic effects of transcranial direct current stimulation (tDCS) on upper limb dysfunction after stroke, previous systematic reviews had mostly provided general analyses on the polarity of tDCS and the type of stroke, with inconsistent results. We aimed to determine the efficacy of anodal transcranial direct current stimulation in enhancing upper extremity function following ischemic stroke. MethodsA comprehensive search was conducted across a variety of databases, spanning from their inception to March 15th, 2024.The focus was on parallel randomized clinical trials published that explored the impact of anodal transcranial direct current stimulation on upper extremity function in ischemic stroke patients. Data extraction and quality assessment were conducted independently by two reviewers. The Cochrane Risk of Bias Tool was utilized to assess the risk of bias in the included studies. ResultsA total of 19 studies involving 1032 participants were included in the analysis. The pooled results of these studies indicated that anodal transcranial direct current stimulation had a positive impact on the Fugl-Meyer Assessment Upper Extremity, Wolf Motor Function Test, Resting Motion Threshold, and Barthel Index Score in ischemic stroke patients with upper extremity dysfunction. Follow-up data suggested the potential long-term efficacy of anodal transcranial direct current stimulation in ischemic stroke. Reported adverse reactions indicated that anodal transcranial direct current stimulation was relatively safe for stroke patients. ConclusionsAnodal transcranial direct current stimulation is an effective intervention and relatively safe and effective intervention for improving upper extremity function in ischemic stroke patients.

Efficacy and safety of tirofiban plus recombinant tissue plasminogen activator versus recombinant tissue plasminogen activator alone in acute ischemic stroke patients: a meta-analysis

ObjectiveTirofiban plus recombinant tissue plasminogen activator (rtPA) shows good efficacy and safety in treating acute ischemic stroke (AIS) patients, but there is a lack of comprehensive assessment. This meta-analysis aimed to compare the efficacy and safety of rtPA plus tirofiban with rtPA alone in AIS patients. MethodsThis meta-analysis retrieved studies comparing rtPA intravenous thrombolysis followed by tirofiban (rtPA+T group) versus rtPA intravenous thrombolysis alone (rtPA group) for AIS patients in Excerpt Medica Database, Web of Science, Cochrane, PubMed, China National Knowledge Infrastructure, Wanfang, and SinoMed until March 2024. ResultsTwenty studies with 2048 AIS patients were enrolled in this meta-analysis. National Institute of Health stroke scale (NIHSS) score after treatment was lower in the rtPA+T group than the rtPA group [standardized mean differences (SMD)=-1.41; 95 % confidence interval (CI)=-1.83, -0.98; P<0.001]. The proportion of AIS patients achieving a favorable functional outcome (modified Rankin Scale score ≤2) was increased in the rtPA+T group versus the rtPA group [relative risk (RR)=1.13; 95 % CI=1.05, 1.21; P=0.001]. The incidence of re-occlusion was lower in the rtPA+T group than in the rtPA group (RR=0.24; 95 % CI=0.10, 0.59; P=0.002), but the incidence of intracranial hemorrhage (ICH) (RR=0.85; 95 % CI=0.51, 1.43), symptomatic ICH (RR=1.10; 95 % CI=0.43, 2.84), and mortality (RR=1.39; 95 % CI=0.53, 3.65) was not different between the two groups (all P>0.05). The stability assessed by sensitivity analysis was good, and no publication bias was found. ConclusionrtPA plus tirofiban achieves superior efficacy with comparable safety profiles compared to rtPA alone in AIS patients.

Incident dementia in ischaemic stroke patients with early cardiac complications: A propensity-score matched cohort study.

The risk of dementia in patients with stroke-heart syndrome (SHS) remains unexplored. Retrospective analysis using the TriNetX network, including patients with ischaemic stroke from 2010 to 2020. These patients were categorised into two groups: those with SHS (heart failure, myocardial infarction, ventricular fibrillation, or Takotsubo cardiomyopathy within 30 days post-stroke) and those without SHS. The primary outcome was the 1-year risk of dementia (vascular dementia, dementia in other disease, unspecified dementia, or Alzheimer's disease). The secondary outcome was the 1-year risk of all-cause death. Cox regression analysis after 1:1 propensity score matching (PSM) was performed to calculate the hazard ratios (HRs) and 95% confidence intervals (CIs) for the outcomes. We included 52,971 patients with SHS (66.6 ± 14.6 years, 42.2% females) and 854,232 patients without SHS (64.7 ± 15.4 years, 48.2% females). Following PSM, 52,970 well-balanced patients were considered in each group. Patients with SHS had a higher risk of incident dementia compared to those without SHS (HR 1.28, 95%CI 1.20-1.36). The risk was the highest during the first 31 days of follow-up (HR 1.51, 95%CI 1.31-1.74) and was mainly driven by vascular and mixed forms. The increased risk of dementia in patients with SHS, was independent of oral anticoagulant use, sex and age but it was the highest in those aged <75 years compared to ⩾75 years. SHS is associated with increased risk of dementia. Future studies are needed to develop innovative strategies for preventing complications associated with stroke-heart syndrome and improving the long-term prognosis of these patients.

Influencing Factors Associated with Psychological Capital Among Ischemic Stroke Patients: A Latent Profile Analysis.

China has the highest incidence of stroke worldwide because of a high rate of recurrence of ischemic stroke, which has significant negative impacts on the physical and mental health of patients. However, little research has been devoted to the psychological capital of ischemic stroke patients. To investigate the psychological capital of ischemic stroke patients, and uses latent profile analysis to identify the potential profiles of the psychological capital among patients as well as to explore heterogeneity within subgroups and the factors influencing it. A survey was distributed among and completed by 427 ischemic stroke patients from November 2023 to March 2024. Four types of questionnaires were administered: the Psychological Capital Questionnaire (PCQ-26), Perceived Stress Scale (CPSS), Athens Insomnia Scale (AIS), and a general information questionnaire. Three latent profiles of the psychological capital of ischemic stroke patients were identified: the deficient psychological capital group(19.7%), medium psychological capital group(52.5%), and affluent psychological capital group(27.9%). Compared with the deficient psychological capital group, the results of a disordered multi-classification logistic regression analysis showed that the factors influencing the participants of the medium psychological capital group were their marital status (married OR = 1.081, 95% CI: 1.163-7.468, p = 0.023), perceived stress (OR = -0.2, 95% CI: 0.769-0.872, p < 0.001), and insomnia (OR = -0.273, 95% CI: 0.696-0.833, p < 0.001). The factors influencing the affluent psychological capital group were perceived stress (OR = -0.334, 95% CI: 0.664-0.773, p < 0.001) and insomnia (OR = -0.46, 95% CI: 0.56-0.712, p < 0.001). Three potential categories of psychological capital in ischemic stroke patients were identified. Sex, marital status, education, perceived stress, and insomnia were found to be associated with psychological capital in stroke patients. Future research should explore other determinants of psychological capital in ischemic stroke patients to formulate interventions that can improve their psychological capital.

Heart rate variability in chronic ischemic stroke: analysis during the sleep-wake cycle.

Alterations of the autonomic nervous system (ANS) in the chronic stage of ischemic stroke (IS) are not well understood. Heart rate variability (HRV) provides a noninvasive approach to assess autonomic function. To compare the HRV parameters during the sleep-wake cycle between patients with IS in the chronic stage and healthy subjects. We conducted a retrospective transversal study based on clinical records and 24-hour electrocardiogram (EKG) monitoring registries of 179 patients with a confirmed IS diagnosis and 184 age- and sex-matched healthy subjects. Circadian variation was calculated according to the variation of the total autonomic activity (VTAI) and the parasympathetic activity (VPAI) indexes. Comparisons were performed using nonparametric tests. Multivariable analyses were performed with canonical discriminant analysis (CDA) and a three-way analysis of variance (ANOVA). Statistical significance was established with a confidence level of 95%. During waking hours, the healthy group exhibited higher variability in the time domain and frequency domain parameters: standard deviation of NN intervals (SDNN, p < 0.001) and of the average NN intervals (SDANN, p < 0.001), as well as low-frequency (LF) band (p < 0.001). During sleep, the difference was higher in the high-frequency (HF) band (p < 0.001), and lower in the low-/high-frequency ratio (LF/HF, p < 0.001). Both VPAI and VTAI showed less significant difference in IS patients (p < 0.001). There was diminished heart vagal activity among IS patients, as measured through HRV. During sleep, this is likely caused by an imbalance in the sympathetic and parasympathetic systems shifting through the sleep phases. These imbalances could persist over time in patients with IS, lasting months after the initial injury.

Management strategies to prevent stroke in patients with atrial fibrillation and malignant left atrial appendage

BackgroundPatients with atrial fibrillation and malignant left atrial appendage (LAA) may benefit from LAA closure (LAAC); however, evidence is limited. ObjectiveThe purpose of this study was to determine management strategies and clinical outcomes in patients with atrial fibrillation and malignant LAA. MethodsMalignant LAA was defined as a history of ischemic stroke and/or evidence of LAA thrombus despite continuous oral anticoagulation (OAC) therapy (continuous for ≥3 weeks). We studied 80 patients with malignant LAA treated with LAAC. We compared these patients first against 44 patients with malignant LAA treated with OAC alone and second against 114 patients without malignant LAA who were treated with LAAC for conventional indications. ResultsAmong patients with malignant LAA (first comparison), those treated with LAAC had a higher 1-year cumulative incidence rate of ischemic stroke than did patients treated with OAC alone (6.3% vs 5.3%; log-rank, P = .09) whereas the difference in stroke risk while receiving OAC was comparable (2.7% vs 5.3%; log-rank, P = .84). Furthermore, all disabling stroke events in patients with malignant LAA treated with LAAC occurred only while not receiving OAC. Among patients treated with LAAC (second comparison), those with malignant LAA had a higher 1-year cumulative incidence rate of ischemic stroke (and ischemic stroke due to device-related thrombosis) than did those without malignant LAA (6.3% vs 2.2%; log-rank, P = .009 and 2.2% vs 0%; log-rank, P = .04, respectively). However, these differences in stroke risk were no longer significant while receiving OAC (2.7% vs 1.0%; log-rank, P = .11). ConclusionCombination performing LAAC and continuation of OAC may be options to prevent ischemic stroke in patients with high thromboembolic risk and malignant LAA.

Role of anticoagulation therapy in modifying stroke risk associated with new-onset atrial fibrillation after non-cardiac surgery.

The role of antithrombotic therapy in the prevention of ischemic stroke after non-cardiac surgery is unclear. In this study, we tested the hypothesis that the association of new-onset postoperative atrial fibrillation (POAF) on ischemic stroke can be mitigated by postoperative oral anticoagulation therapy. Of 251,837 adult patients (155,111 female (61.6%) and 96,726 male (38.4%)) who underwent non-cardiac surgical procedures at two sites, POAF was detected in 4,538 (1.8%) patients. The occurrence of POAF was associated with increased 1-year ischemic stroke risk (3.6% versus 2.3%; adjusted risk ratio (RRadj) = 1.60 (95% confidence interval (CI): 1.37-1.87), P < 0.001). In patients with POAF, the risk of developing stroke attributable to POAF was 1.81 (95% CI: 1.44-2.28; P < 0.001) without oral anticoagulation, whereas, in patients treated with anticoagulation, no significant association was observed between POAF and stroke (RRadj = 1.04 (95% CI: 0.71-1.51), P = 0.847, P for interaction = 0.013). Furthermore, we derived and validated a computational model for the prediction of POAF after non-cardiac surgery based on demographics, comorbidities and procedural risk. These findings suggest that POAF is predictable and associated with an increased risk of postoperative ischemic stroke in patients who do not receive postoperative anticoagulation.

S100A4 Exerts Neuroprotective Effects by Attenuating Blood-Brain Barrier Disruption and Oxidative Stress via the PI3K/Akt/Nrf2 Axis in Ischemic Stroke

Ischemic stroke is a major cause of disability and mortality worldwide, with oxidative stress and blood-brain barrier (BBB) injury playing crucial roles in its pathogenesis. Our RNA sequencing results revealed that S100 calcium-binding protein A4 (S100A4) is highly expressed in the middle cerebral artery occlusion (MCAO) mouse model. We analyzed S100A4 expression in ischemic stroke patients and in mice subjected to the MCAO model. Moreover, using adeno-associated virus (AAV)-mediated knockdown of S100A4 in mice, we evaluated its effects on neurological deficits, BBB integrity, and oxidative stress in MCAO mice. Bioinformatic analyses explored the potential downstream pathways of S100A4.S100A4 expression was significantly elevated in the serum of ischemic stroke patients and brain tissues of MCAO mice. AAV-mediated knockdown of S100A4 exacerbated neurological deficits, BBB disruption, and oxidative stress in MCAO mice. The upregulation of S100A4 mitigated these outcomes, which were facilitated through the stimulation of the PI3K/Akt/Nrf2 signaling cascade.Our results illustrate that S100A4 plays a protective role in preventing neuronal damage during ischemic stroke by reducing oxidative stress and preserving BBB integrity through the PI3K/Akt/Nrf2 pathway. This highlights its promise as a potential therapeutic approach for ischemic stroke.