Occurrence Of Ischemic Stroke Research Articles

Clinical benefits of concomitant surgical ablation for atrial fibrillation in patients undergoing mitral valve surgery

The maze procedure is the dominant concomitant surgery performed with mitral valve (MV) surgery in patients with atrial fibrillation (AF). Most clinical recommendations regarding the maze procedure depend on the individual maze expert centers. The purpose of this study was to evaluate the clinical benefits of the maze procedure during MV surgery in a national cohort. Using the national health claims database established by the National Health Insurance Service of South Korea, data on subjects with AF who had undergone MV surgery from 2009 to 2017 were reviewed. The outcomes of interest were mortality; occurrence of ischemic or hemorrhagic stroke; hospitalization for bleeding events; and the composite of death, cerebrovascular accident, and major bleeding. Propensity score (PS) matching was performed for baseline adjustment. Among 9501 subjects, the maze procedure was performed in 5508 (58.0%). In the PS-matched cohort (3376 pairs), the risk of the composite event was significantly lower in the maze group (hazard ratio [HR] 0.799; 95% confidence interval [CI] 0.731-0.873) than in the nonmaze group. The superiority of the maze procedure was similar for individual clinical events, including death (HR 0.795; 95% CI 0.711-0.889); ischemic stroke (HR 0.788; 95% CI 0.67-0.926); and major bleeding (HR 0.749; 95% CI 0.627-0.895), but not for hemorrhagic stroke (HR 0.984; 95% CI 0.768-1.262). In subgroup analyses of the composite events, these benefits were consistent among subjects aged ≥70 years or <70 years, surgery type (replacement vs repair), MV pathologies, and subjects with CHA2DS2-VASc score ≥4 or <4. The addition of the maze procedure during MV surgery provided protective effects in the composite outcome of interest.

Related factors based on non-targeted metabolomics methods in minor ischaemic stroke.

ObjectiveThis study aimed to identify potential biomarkers associated with the occurrence of minor ischaemic stroke.MethodsFour hundred patients hospitalized with minor ischaemic stroke were enrolled in the department of neurological internal medicine in Taiyuan Central Hospital, and 210 healthy subjects examined at the Taiyuan Central Hospital Medical Center during the same period were selected. We collected information on the general demographic characteristics and fasting blood samples of the subjects. We then used untargeted metabolomic assay to measure blood glucose, blood lipids, homocysteine, and high-sensitivity C-reactive protein.ResultsThere were statistically significant differences between the mild ischemic stroke group and the healthy control group in smoking, hypertension, and physical activity (P< 0.05). Compared with the healthy group, the minor ischaemic stroke group showed increased lactate, pyruvate, trimetlylamine oxide levels, and lactic acid, pyruvic acid, and trimethylamine N-oxidation (TMAO) levels were statistically significant (P< 0.001). In the minor ischaemic stroke risk model, hypertension, physical activity, smoking, and elevated TMAO levels influenced the occurrence of minor stroke.ConclusionIncreased levels of lactic acid, pyruvate, and TMAO may be related to the pathophysiological changes in the minor ischaemic stroke population. High blood pressure, a lack of physical activity, smoking, and increased TMAO level were the influencing factors for the occurrence of minor ischaemic stroke. The serum metabolite TMAO may be associated with MS occurrence

The construction of neurogenesis-related ceRNA network of ischemic stroke treated by oxymatrine.

BackgroundKnown as a disease associated with high mortality, disability and a significant financial burden, ischemic stroke ranks as one of the three diseases threatening human health. Recent advances in omics technology created opportunities to uncover the mechanism in ischemic stroke occurrence and treatment. In this study, we aimed to construct the competitive endogenous RNA (ceRNA) networks of ischemic stroke treated by oxymatrine intervention.MethodThe middle cerebral artery occlusion (MCAO) mouse model of ischemic stroke was constructed, and oxymatrine was administered. Then RNA-Sequencing was performed and integrated analysis of mRNAs, lncRNAs and circRNAs was conducted to reveal the pharmacology of oxymatrine. Functional enrichment analysis was performed to explore the underlying mechanism of differentially expressed (DE) mRNAs. The protein-protein interaction (PPI) network of neurogenesis-related genes and long noncoding RNAs (lncRNAs)/circular RNAs (circRNAs) based ceRNA networks were constructed.ResultsFirst, this study revealed the DE-mRNAs, DE-lncRNAs and DE-circRNAs between Oxymatrine treated group and the MCAO group. Then, the common 1231 DE-mRNAs, 32 DE-lncRNAs and 31 DE-circRNAs with opposite trends were identified. The Kyoto Encyclopedia of Genes and Genomes to identify the functional enrichment of 1231 DE-mRNAs were enriched in neurogenesis-related biological processes. Based on neurogenesis-related DE-mRNAs, the PPI network was constructed, and hub genes were identified based on centrality. Finally, both the lncRNA-based and circRNAs-based ceRNA networks were constructed.ConclusionIn summary, this study identified novel coding and noncoding ischemic stroke targets of oxymatrine-treated MCAO. Most importantly, we identified lncRNAs and circRNAs candidates as potential oxymatrine targets and constructed the neurogenesis-related ceRNA networks.

Alexia without agraphia in a young adult with ischemic stroke: A case report

Introduction: Ischemic stroke in young adults is less common than in older adults, but its occurrence warrants further investigation to determine the cause and appropriate treatment to improve outcome. One of the stroke manifestations is a disconnection syndrome, such as alexia without agraphia, a condition in which a patient cannot read but the ability to write remain relatively intact. Pure alexia is associated with the lesion in the medial occipitotemporal lobe in the dominant hemisphere, also known as the visual word form area (VWFA). Case Report: Here we report a case of a 30-year-old male, who presented with an acute complaint of inability to read without any difficulty in writing, accompanied by right homonymous hemianopia which occurred two days before admission. Initial brain scan was normal. However, the repeated brain scan two weeks after admission showed infarction in the left occipitotemporal lobe. He had no known previous vascular risk factors other than obesity. The evaluation during admission showed high blood pressure, dyslipidemia, and suggestive of autoimmune disease, all of which might contribute to the ischemic stroke occurrence. During follow-up he was referred for the neuropsychological assessment and rehabilitation as well as to the outpatient clinic for use of antithrombotic as secondary prevention. He showed gradual improvement in his symptoms after sixth months follow-up. Conclusion: Stroke in young adults is an increasing problem nowadays due to its rising incidence and more diverse pathogenetic mechanisms and related high morbidity. One of the neurological deficits found in stroke is a disconnection syndrome such as alexia without agraphia in which there is an acquired inability to read with relatively preserved writing ability. Pure alexia found in this case was due to an infarction of the occipitotemporal lobe that disconnects primary language areas from incoming visual information.

Identification of a 6-RBP gene signature for a comprehensive analysis of glioma and ischemic stroke: Cognitive impairment and aging-related hypoxic stress.

There is mounting evidence that ischemic cerebral infarction contributes to vascular cognitive impairment and dementia in elderly. Ischemic stroke and glioma are two majorly fatal diseases worldwide, which promote each other's development based on some common underlying mechanisms. As a post-transcriptional regulatory protein, RNA-binding protein is important in the development of a tumor and ischemic stroke (IS). The purpose of this study was to search for a group of RNA-binding protein (RBP) gene markers related to the prognosis of glioma and the occurrence of IS, and elucidate their underlying mechanisms in glioma and IS. First, a 6-RBP (POLR2F, DYNC1H1, SMAD9, TRIM21, BRCA1, and ERI1) gene signature (RBPS) showing an independent overall survival prognostic prediction was identified using the transcriptome data from TCGA-glioma cohort (n = 677); following which, it was independently verified in the CGGA-glioma cohort (n = 970). A nomogram, including RBPS, 1p19q codeletion, radiotherapy, chemotherapy, grade, and age, was established to predict the overall survival of patients with glioma, convenient for further clinical transformation. In addition, an automatic machine learning classification model based on radiomics features from MRI was developed to stratify according to the RBPS risk. The RBPS was associated with immunosuppression, energy metabolism, and tumor growth of gliomas. Subsequently, the six RBP genes from blood samples showed good classification performance for IS diagnosis (AUC = 0.95, 95% CI: 0.902–0.997). The RBPS was associated with hypoxic responses, angiogenesis, and increased coagulation in IS. Upregulation of SMAD9 was associated with dementia, while downregulation of POLR2F was associated with aging-related hypoxic stress. Irf5/Trim21 in microglia and Taf7/Trim21 in pericytes from the mouse cerebral cortex were identified as RBPS-related molecules in each cell type under hypoxic conditions. The RBPS is expected to serve as a novel biomarker for studying the common mechanisms underlying glioma and IS.

High systemic immune-inflammation index is associated with carotid plaque vulnerability: New findings based on carotid ultrasound imaging in patients with acute ischemic stroke.

Vulnerable carotid plaque is closely related to the occurrence of Ischemic stroke. Therefore, accurate and rapid identification of the nature of carotid plaques is essential. AS is a chronic immune inflammatory process. Systemic immune-inflammation index (SII) is a novel index of immune inflammation obtained from routine whole blood cell count analysis, which comprehensively reflects the state of inflammation and immune balance in the body. This study sought to explore the relationship between SII level and carotid plaque vulnerability, plaque composition characteristics, and acute ischemic stroke (AIS) severity. A total of 131 patients diagnosed with AIS presenting with a carotid atherosclerotic plaque were enrolled in this study. Using carotid ultrasound (CDU) to assess the carotid-responsible plaque properties, we divided the patients into stable plaques group and vulnerable plaques group, and analyzed the correlation between SII levels and plaque vulnerability. And we further analyzed to evaluate the correlation between high SII levels and plaque characteristics and AIS severity. In addition, Cohen's Kappa statistics was used to detect the consistency of Carotid ultrasound (US) and cervical High-resolution magnetic resonance imaging (HRMRI) in evaluating plaque vulnerability. The findings showed that the vulnerable group had higher levels of SII compared with the stable group. The high SII group had more vulnerable plaques and a high frequency of plaque fibrous cap rupture compared with the low SII group. Logistic analysis showed that a high SII level was an independent risk factor for vulnerable plaques (odds ratio [OR] = 2.242) and plaque fibrous cap rupture (OR=3.462). The results also showed a high consistency between Carotid US and HRMRI methods in the assessment of plaque vulnerability [Cohen's kappa value was 0.89 (95% CI = 0.78–0.97)] and the level of SII was positively associated with NIHSS score (r = 0.473, P < 0.001). Our study suggests that elevated levels of SII may have adverse effects on the vulnerability of carotid plaques, especially in stroke patients with vulnerable plaques with ruptured fibrous caps, which may aggravate the severity of AIS.

Rationale and design of the AXIOMATIC-SSP phase II trial: Antithrombotic treatment with factor XIa inhibition to Optimize Management of Acute Thromboembolic events for Secondary Stroke Prevention

BackgroundIndividuals with ischemic stroke or transient ischemic attack (TIA) have a high early risk of ischemic stroke despite dual antiplatelet therapy. The risk of ischemic stroke, and associated disability, represents a significant unmet clinical need. Genetic variants resulting in reduced factor XI levels are associated with reduced risk for ischemic stroke but are not associated with increased intracranial bleeding. Milvexian is an oral small-molecule inhibitor of FXIa that binds activated factor XI with high affinity and selectivity and may reduce the risk of stroke when added to antiplatelet drugs without significant bleeding. We aimed to evaluate the dose-response relationship of milvexian in participants treated with dual antiplatelets. MethodsWe began a phase II, double-blinded, randomized, placebo-controlled trial at 367 sites in 2019. Participants (N = 2366) with ischemic stroke (National Institutes of Health Stroke Scale score ≤7) or high-risk TIA (ABCD2 score ≥6) were randomized to 1 of 5 doses of milvexian or placebo for 90 days. Participants also received clopidogrel 75 mg daily for the first 21 days and aspirin 100 mg for 90 days. The efficacy endpoint was the composite of ischemic stroke or incident infarct on magnetic resonance imaging. Major bleeding, defined as type 3 or 5 bleeding according to the Bleeding Academic Research Consortium, was the safety endpoint. Participant follow-up will end in 2022. ConclusionThe AXIOMATIC-SSP trial will evaluate the dose-response of milvexian for ischemic stroke occurrence in participants with ischemic stroke or TIA.

An Untargeted Lipidomics Study of Acute Ischemic Stroke with Hyperglycemia Based on Ultrahigh-Performance Liquid Chromatography-Mass Spectrometry.

Patients with type 2 diabetes have twice as much of the risk of acute ischemic stroke (AIS) occurrence as healthy individuals, and the AIS patients with type 2 diabetes have a higher risk of death and a poorer prognosis. This study was to investigate the interrelationship between hyperglycemia and AIS and provided a reference for blood glucose management of AIS patients. The blood glucose level of AIS patients of the present study was controlled by insulin below 180 mg/dL (standard group) and between 80 and 130 mg/dL (management group). And the fasting venous blood samples were collected for determination of blood glucose level, homeostasis model assessment of insulin resistance (HOMA-IR), peptide C, and basal insulin level. Furthermore, lipids of the blood samples were detected using metabolomics, so as to clarify the similarities and differences in metabolic patterns in AIS patients with diabetes after the intervention of different glycemic strategies. The results revealed that compared to the standard group, the blood glucose level and HOMA-IR in the management group were significantly decreased, and levels of peptide C and basal insulin level were greatly increased. Through lipidomics detection, 83, 50, and 44 types of significantly upregulated differential lipids were detected in the standard vs. normal groups, the standard vs. management groups, and the management vs. normal groups, respectively, with triacylglycerol dominated. This study preliminarily revealed metabolic differences among AIS patients with hyperglycemia after different blood glucose intervention methods, hoping to provide a theoretical basis for clinical prevention and treatment of this disease.

Identification of immune-related key genes in the peripheral blood of ischaemic stroke patients using a weighted gene coexpression network analysis and machine learning

BackgroundThe immune system plays a vital role in the pathological process of ischaemic stroke. However, the exact immune-related mechanism remains unclear. The current research aimed to identify immune-related key genes associated with ischaemic stroke.MethodsCIBERSORT was utilized to reveal the immune cell infiltration pattern in ischaemic stroke patients. Meanwhile, a weighted gene coexpression network analysis (WGCNA) was utilized to identify meaningful modules significantly correlated with ischaemic stroke. The characteristic genes correlated with ischaemic stroke were identified by the following two machine learning methods: the support vector machine-recursive feature elimination (SVM-RFE) algorithm and least absolute shrinkage and selection operator (LASSO) logistic regression.ResultsThe CIBERSORT results suggested that there was a decreased infiltration of naive CD4 T cells, CD8 T cells, resting mast cells and eosinophils and an increased infiltration of neutrophils, M0 macrophages and activated memory CD4 T cells in ischaemic stroke patients. Then, three significant modules (pink, brown and cyan) were identified to be significantly associated with ischaemic stroke. The gene enrichment analysis indicated that 519 genes in the above three modules were mainly involved in several inflammatory or immune-related signalling pathways and biological processes. Eight hub genes (ADM, ANXA3, CARD6, CPQ, SLC22A4, UBE2S, VIM and ZFP36) were revealed to be significantly correlated with ischaemic stroke by the LASSO logistic regression and SVM-RFE algorithm. The external validation combined with a RT‒qPCR analysis revealed that the expression levels of ADM, ANXA3, SLC22A4 and VIM were significantly increased in ischaemic stroke patients and that these key genes were positively associated with neutrophils and M0 macrophages and negatively correlated with CD8 T cells. The mean AUC value of ADM, ANXA3, SLC22A4 and VIM was 0.80, 0.87, 0.91 and 0.88 in the training set, 0.85, 0.77, 0.86 and 0.72 in the testing set and 0.87, 0.83, 0.88 and 0.91 in the validation samples, respectively.ConclusionsThese results suggest that the ADM, ANXA3, SLC22A4 and VIM genes are reliable serum markers for the diagnosis of ischaemic stroke and that immune cell infiltration plays a crucial role in the occurrence and development of ischaemic stroke.

Hypertensive Brainstem Encephalopathy Combined with Acute Ischemic Stroke

Posterior reversible encephalopathy syndrome is a clinicoradiological syndrome characterized by a unique reversible pattern on imaging and total regression of clinical symptoms and signs. Hypertensive brainstem encephalopathy (HBE), a brainstem variant of posterior reversible encephalopathy syndrome, is rare. In addition, a concomitant occurrence of acute ischemic stroke and HBE is even more rare. We here report three patients with HBE accompanied by acute cerebral infarction detected by brain magnetic resonance imaging and the importance of initial blood pressure control.

A Novel Perspective on Ischemic Stroke: A Review of Exosome and Noncoding RNA Studies.

Ischemic stroke is a life-threatening condition that also frequently results in long-term disability. Currently, intravenous thrombolysis with tissue plasminogen activator and mechanical thrombectomy is the most popular treatment. However, the narrow time window and related complications limit the treatment benefits. Exosomes have recently emerged as ideal therapeutic candidates for ischemic stroke with the ability to pass through the blood_brain barrier and mediate intercellular communication, in addition, exosomes and their contents can be bioengineered to implement targeted delivery. In the last two decades, exosomes and exosomal noncoding RNAs have been found to be involved in the pathophysiological progression of ischemic stroke, including atherosclerosis, apoptosis, inflammation, oxidative stress, and neurovascular remodeling. In this review, we describe the latest progress regarding the role of exosomal long noncoding RNAs and circular RNAs in the occurrence, progression, and recovery of ischemic stroke. Exploration of exosomal noncoding RNAs and their correlated effects in ischemic stroke may facilitate accurate diagnosis, and they may serve as new therapeutic targets for the disease.

Association of dissection features and primary collateral circulation with ischemic stroke in patients with spontaneous internal carotid artery dissection: evaluated using vessel wall-MRI and MRA.

To study the ischemic stroke risk factors in spontaneous internal carotid artery dissection (ICAD) patients via analyzing the dissection features and primary collateral circulation using vessel wall-MRI and magnetic resonance angiography. ICAD patients who had undergone VW-MRI were included in this study. A total of 36 patients were included and divided into ICAD stroke (N = 23) and non-stroke (N = 13) group. Dissection imaging features [intramural hematoma (IMH), length of IMH, intimal flap, double lumen, intraluminal thrombus, degree of stenosis] and primary collateral status were analyzed. The primary collateral score (0-4) was evaluated based on presence of anterior communicating and ipsilateral anterior cerebral artery A1 segment (0-2) and ipsilateral posterior communicating artery (0-2). There were no significant differences in dissection imaging features such as presence of double lumen, intimal flap, IMH, length of IMH and intraluminal thrombus between the two groups. Degree of stenosis and primary collateral score showed significant differences between the two groups. Both the poor primary collateral circulation and severe stenosis may play an important role in occurrence of ischemic stroke for spontaneous ICAD patients and good primary collateral circulation can help to reduce the incidence of infarction. ICAD is one of the major causes of ischemic stroke. Early evaluation of the status of the Circle of Willis in ICAD patients by MRI may help to make treatment strategies and improve clinical outcome.

The mechanism of action of the combination of Astragalus membranaceus and Ligusticum chuanxiong in the treatment of ischemic stroke based on network pharmacology and molecular docking.

Since 1990, the incidence of stroke has been rising to become the second leading cause of death in the world, posing a huge burden and challenge to society and families. Astragalus membranaceus and Ligusticum chuanxiong (A&L) have been used as traditional Chinese medicine (TCM) prescriptions to treat and prevent the occurrence of ischemic stroke (IS), but their mechanism of action on the disease has not been fully elucidated. The main objective of this study was to reveal the pharmacological mechanism of A&L in the treatment of IS and to perform preliminary validation. The active ingredients of A&L were obtained from the systematic pharmacology platform of traditional Chinese medicine (TCMSP) database, whereas the genes of IS were obtained from 2 major databases, DrugBank and GeneCards. Cytoscape_v3.8.2 was used to construct the TCM-active ingredient and TCM-active ingredient-cross-target-disease relationship maps, and the MCODE plug-in was used to obtain the core genes, whereas the protein-protein interaction maps were obtained from the STRING database. The results of gene ontology and Kyoto encyclopedia of genes and genomes enrichment were obtained using the Hiplot online tool, and the small molecules in the relevant signalling pathways were verified by molecular docking using AutoDock. A&L contained a total of 26 eligible active ingredients, sharing 161 common targets with IS. A total of 58 core genes with 1326 edges were obtained using the MCODE plug-in. Gene ontology and Kyoto encyclopedia of genes and genomes enrichment results showed association with interleukin-17 signaling pathway, lipid and atherosclerosis, tumor necrosis factor signaling pathway, and Toll-like receptor signaling pathway, which mainly mediates the development of inflammatory responses. Furthermore, molecular docking was conducted and most of the components were found to have good binding to the receptors. This study demonstrates that A&L can be used to treat IS by controlling the inflammatory response through multiple targets and multiple pathways, and provides a reference for subsequent trials.

Imaging diagnosis and research progress of carotid plaque vulnerability.

Ischemic stroke (IS) exhibits a high disability rate, mortality, and recurrence rate, imposing a serious threat to human survival and health. Its occurrence is affected by various factors. Although the previous research has demonstrated that the occurrence of IS is mainly associated with lumen stenosis caused by carotid atherosclerotic plaque (AP), recent studies have revealed that many patients will still suffer from IS even with mild carotid artery lumen stenosis. Blood supply disturbance causes 10% of IS to the corresponding cerebral blood supply area caused by carotid vulnerable plaque. Thrombus blockage of distal branch vessels caused by rupture of vulnerable carotid plaque is the main cause of ischemic stroke. Therefore, how to accurately evaluate vulnerable plaque and intervene as soon as possible is a problem that needs to be solved in clinic. The vulnerability of plaque is determined by its internal components, including thin and incomplete fibrous cap, necrotic lipid core, intra-plaque hemorrhage, intra-plaque neovascularization, and ulcerative plaque formation. The development of imaging technology enables the routine detection of AP vulnerability. By analyzing the pathological changes, characteristics, and formation mechanism of carotid plaque vulnerability, this article aims to explore the modern imaging methods which can be used to identify plaque composition and plaque vulnerability to provide a reference basis for disease diagnosis and differential diagnosis.

Child Neurology: Aicardi-Goutières Syndrome Presenting as Recurrent Ischemic Stroke

Aicardi-Goutières syndrome (AGS) is a rare, single-gene disorder, characterized by neurologic and skin involvement with an increased level of interferon-α (IFN-α) in the CSF. We describe the case of a young patient presenting with recurrent ischemic stroke. Evaluation revealed the presence of chilblains, white matter abnormalities, cerebral atrophy, and raised IFN-α in the CSF. Compound heterozygous variants of TREX1 were detected, confirming a diagnosis of AGS. After excluding other causes, we attributed the stroke to AGS. Tofacitinib, a Janus kinase inhibitor, was administered to our patient in addition to antiplatelet drugs. There was no recurrence of stroke during 3-month follow-up. This is a rare case of recurrent stroke in TREX1-mutated AGS. Small vessel involvement has been previously demonstrated to play a significant role in the pathogenesis of AGS. This microvascular mechanism might explain the occurrence of ischemic stroke in our patient. For young patients with stroke and multiple system involvement, genetic disorders including AGS should be considered.

Computer-aided diagnosis of ischemic stroke using multi-dimensional image features in carotid color Doppler

PurposeStroke is one of the leading causes of disability and mortality. Carotid atherosclerosis is a crucial factor in the occurrence of ischemic stroke. To achieve timely recognition, a computer-aided diagnosis (CAD) system was proposed to evaluate the ischemic stroke patterns in carotid color Doppler (CCD). MethodsA total of 513 stroke and 458 normal CCD images were collected from 102 stroke and 75 normal patients, respectively. For each image, quantitative histogram, shape, and texture features were extracted to interpret the diagnostic information. In the experiment, a logistic regression classifier with backward elimination and leave-one-out cross validation was used to combine features as a prediction model. ResultsThe performance of the CAD system using histogram, shape, and texture features achieved accuracies of 87%, 60%, and 87%, respectively. With respect to the combined features, the CAD achieved an accuracy of 89%, a sensitivity of 89%, a specificity of 88%, a positive predictive value of 89%, a negative predictive value of 88%, and Kappa = 0.77, with an area under the receiver operating characteristic curve of 0.94. ConclusionsBased on the extracted quantitative features in the CCD images, the proposed CAD system provides valuable suggestions for assisting physicians in improving ischemic stroke diagnoses during carotid ultrasound examination.

Concept of 5P-medicine for prevention of acute cerebral ischemia in women

The objective. To evaluate the effectiveness of the 5P-model for the prevention of acute cerebral ischemia in Dagestan women.Materials and methods. The prospective study included 35 women permanently residing in Dagestan. The mean age was 66.46 ± 10.9 years. Each participant of the study was individually interviewed and examined clinically, neurologically, an additional examination included: complete blood test, biochemical blood test, coagulation test, molecular genetic study for 11 candidate gene mutations significant for the occurrence of ischemic stroke, electrocardiography, neuroimaging.Results. By analyzing the results of the study, individual background conditions that predispose to the occurrence of ischemic stroke were established. The results of the examination were explained to each participant, there were given the recommendations on lifestyle modification, a diet was prescribed and the necessary therapy was selected. In the process of dynamic observation for 4 years the observed group had no episodes of acute cerebrovascular accident.Conclusions. The study confirms the effectiveness of the use of the 5P-model for the prevention of acute cerebral ischemia in women Dagestan and declare a positive experience of its application.

Texture Analysis Based on Vascular Ultrasound to Identify the Vulnerable Carotid Plaques.

Vulnerable carotid plaques are closely related to the occurrence of ischemic stroke. Therefore, accurate and rapid identification of the nature of carotid plaques is essential. This study aimed to determine whether texture analysis based on a vascular ultrasound can be applied to identify vulnerable plaques. Data from a total of 150 patients diagnosed with atherosclerotic plaque (AP) by carotid ultrasound (CDU) and high-resolution magnetic resonance imaging (HRMRI) were collected. HRMRI is the in vivo reference to assess the nature of AP. MaZda software was used to delineate the region of interest and extract 303 texture features from ultrasonic images of plaques. Following regression analysis using the least absolute shrinkage and selection operator (LASSO) algorithm, the overall cohort was randomized 7:3 into the training (n = 105) and testing (n = 45) sets. In the training set, the conventional ultrasound model, the texture feature model, and the conventional ultrasound-texture feature combined model were constructed. The testing set was used to validate the model’s effectiveness by calculating the area under the curve (AUC), accuracy, sensitivity, and specificity. Based on the combined model, a nomogram risk prediction model was established, and the consistency index (C-index) and the calibration curve were obtained. In the training and testing sets, the AUC of the prediction performance of the conventional ultrasonic-texture feature combined model was higher than that of the conventional ultrasonic model and the texture feature model. In the training set, the AUC of the combined model was 0.88, while in the testing set, AUC was 0.87. In addition, the C-index results were also favorable (0.89 in the training set and 0.84 in the testing set). Furthermore, the calibration curve was close to the ideal curve, indicating the accuracy of the nomogram. This study proves the performance of vascular ultrasound-based texture analysis in identifying the vulnerable carotid plaques. Texture feature extraction combined with CDU sonogram features can accurately predict the vulnerability of AP.

Impact of a NDUFC2 Variant on the Occurrence of Acute Coronary Syndromes.

BackgroundAmong several potential mechanisms, mitochondrial dysfunction has been proposed to be involved in the pathogenesis of coronary artery disease (CAD). A mitochondrial complex I deficiency severely impairs cardiovascular health and contributes to CAD development. Previous evidence highlighted a key role of NDUFC2, a subunit of complex I, deficiency in the increased occurrence of renal and cerebrovascular damage in an animal model of hypertension, and of juvenile ischemic stroke occurrence in humans. Furthermore, a significant decrease of NDUFC2 mRNA was detected in peripheral blood mononuclear cells from patients experiencing acute coronary syndrome (ACS). The T allele at NDUFC2/rs23117379 variant is known to associate with reduced gene expression and mitochondrial dysfunction.ObjectiveIn the present study we tested the impact of the T/C NDUFC2/rs23117379 variant on occurrence of ACS in a prospective cohort of CAD patients (n = 260).ResultsHypertension, smoking habit, diabetes and hypercholesterolemia were present in a large proportion of patients. Non-ST-elevation myocardial infarction (NSTEMI) represented the most frequent type of ACS (44%, n = 115), followed by ST-elevation myocardial infarction (STEMI) (34%, n = 88) and unstable angina (22%, n = 57). The alleles/genotypes distribution for T/C at NDUFC2/rs23117379 revealed that the TT genotype was associated with a trend toward the development of ACS at an earlier age (TT 61 ± 12, CT 65 ± 12 and CC 66 ± 11 years; p = 0.051 after adjustment for gender, hypertension, smoking habit, diabetes and hypercholesterolemia) and with a significant predictive role for ACS recurrence (hazard ratio [HR]1.671; 95% confidence interval [CI], 1.138–2.472; p = 0.009).ConclusionsOur findings are consistent with a deleterious effect of NDUFC2 deficiency on acute coronary events predisposition and further support a role of the NDUFC2/rs23117379 variant as a genetic cardiovascular risk factor.

Prediction of Atrial Fibrillation Being Asymptomatic at First Onset by Cardiac Pacing.

Asymptomatic or silent atrial fibrillation (AF) has long been a clinical problem due to the incidence of ischemic stroke. A method is needed to predict the development of silent AF before the occurrence of ischemic stroke. This study was focused on the symptoms of AF, especially palpitation, in pacemaker patients. We assessed the hypothesis that absence of palpitation during rapid ventricular pacing could be a predictor of future onset AF being asymptomatic.In this study, we assessed the presence of symptoms during RV pacing and AF symptoms on 145 pacemaker patients at the outpatient clinic by VVI pacing at 120 ppm. The relationship between symptoms during RV pacing and symptom during AF was assessed. The predictive value of absence of symptom during RV pacing on AF being asymptomatic was assessed.Of 145 patients, 74 had previous AF episode. Among the AF patients, absence of symptom during VVI pacing was associated with AF being asymptomatic.Of 145 patients, 71 had no previous AF events. There were 14 patients who had new-onset AF or atrial flutter (AFL) after the device implantation. Four of the 14 patients (28.6%) were symptomatic during first AF/AFL episode, and 10 (71.4%) were asymptomatic during first-onset AF. All ten patients who were asymptomatic during cardiac pacing test were asymptomatic during their initial episodes of AF as well.This study showed that absence of symptoms during rapid ventricular pacing was associated with first-onset AF being asymptomatic.