Non-stroke Group Research Articles

Factors influencing the occurrence of ischemic stroke in elderly patients with hypertension and type 2 diabetes mellitus: a case-control study

ObjectiveTo investigate the risk factors for ischemic stroke in elderly patients with hypertension and type 2 diabetes mellitus.MethodsA total of 112 elderly patients with hypertension and type 2 diabetes, treated at Jiangmen Central Hospital from January 2023 to December 2023, were selected and categorized into a stroke group and a non-stroke group, each comprising 56 patients. The two groups were examined for demographic data, risk variables were evaluated by multifactorial logistic regression analysis, and the predictive value was determined using ROC curves.ResultsThe comparison of hyperhomocysteinemia (HHcy), fibrinogen (FIB), and high-density lipoprotein cholesterol (HDL-C) between the non-stroke and stroke groups revealed statistically significant differences (P < 0.05). Logistic regression analysis indicated that HHcy (OR 16.936; 95% CI 1.946–146.071; P = 0.010), FIB (OR 1.773; 95% CI 1.238–2.540; P = 0.002), and HDL-C (OR 0.182; 95% CI 0.043–0.775; P = 0.021) were significant factors in the onset of ischemic stroke among elderly patients with hypertension and type 2 diabetes. ROC curve analysis revealed that the area under the curve (AUC) for FIB, HDL-C, and HHcy in diagnosing stroke associated with hypertension and type 2 diabetes mellitus in the elderly were 0.704, 0.640, and 0.598, respectively, while the AUC for the combined diagnosis of all three was 0.784.ConclusionsHHcy, FIB, and HDL-C independently influence the occurrence of ischemic stroke in elderly patients with hypertension combined with type 2 diabetes mellitus, and their combined enhanced predictive capability for ischemic stroke occurrence.

Identification of Sulcal Hyperintense Vessel (Vessel Wall MR Ivy Sign) in Adult Moyamoya Disease with High-resolution Vessel Wall Imaging : A Pilot Study.

The leptomeningeal ivy sign is a distinctive finding of moyamoya disease (MMD), characterized by a linear high signal intensity along the cortical sulci on contrast-enhanced T1 magnetic resonance imaging (MRI) and fluid-attenuated inversion-recovery MRI. We recently identified a similar linear enhancement along the cortical sulci using gadolinium-enhanced vessel wall MRI (VWMR) in patients with MMD. The aim of this study was to introduce the concept of the "VWMR ivy sign (VIS)". Eighteen MMD patients underwent gadolinium-enhanced VWMR. We identified the VIS in gadolinium-enhanced VWMR, represented by a linear high intensity along the cortical sulci. The VIS was assessed by comparing pre and postcontrast T1 black blood sequences on VWMR and was investigated in the precentral, central, and postcentral sulci. "VIS scores" were calculated by the sum of VIS in the three sulci, ranged from 0 to 3. We compared the VIS scores according to different stroke presentations (non-stroke, ischemic stroke, and hemorrhagic stroke). The inter-modality agreement for identifying VIS and fluid-attenuated inversion-recovery (FLAIR)/cortical sulci on contrast-enhanced T1 MRI (CEMR) ivy sign was determined using Cohen's kappa statistics. The VIS scores were significantly different among the three groups (P = 0.004). The VIS scores in both the ischemic and hemorrhagic groups were significantly higher than those in the non-stroke group (ischemic vs. non-stroke, P = 0.009; hemorrhagic vs. non-stroke, P = 0.004). After adjusting for age and sex using the non-stroke group as a reference group, the VIS scores were significantly higher in the ischemic and hemorrhagic groups (P=0.046, OR 8.27, 95% CI 1.03-66.19 and P=0.039, OR 7.78, 95% CI 1.11-54.48, respectively). Inter-modality agreement between VIS and FLAIR ivy sign was substantial, perfect, and substantial in the precentral, central, and postcentral sulci, respectively (precentral sulcus, κ=0.609, 95% CI=0.213-1; central sulcus, κ=1; and postcentral sulcus, κ=0.769, 95% CI=0.475-1). Inter-modality agreement between the VIS and CEMR ivy sign was substantial in the precentral, central, and postcentral sulci, respectively (precentral sulcus, κ=0.727, 95% CI=0.384-1; central sulcus, κ=0.609, 95% CI=0.384-1; and postcentral sulcus, κ=0.649, 95% CI=0.310-0.998). This preliminary series introduces the concept of VIS, possibly indicating slow and retrograde flow of sulcal vessels via leptomeningeal collaterals. Future studies are needed to develop an optimal scoring system for VIS and establish its clinical correlation with stroke presentations in MMD patients.

The factor structure of the Patient Health Questionnaire-9 in stroke: A comparison with a non-stroke population

BackgroundIt is unclear if certain post-stroke somatic symptoms load onto items of the Patient Health Questionnaire-9 (PHQ-9), a self-report depression questionnaire. We investigated these concerns in a stroke sample using factor analysis, benchmarked against a non-stroke comparison group. MethodsThe secondary dataset constituted 787 stroke and 12,016 non-stroke participants. A subsample of 1574 comparison participants was selected via propensity score matching. Dimensionality was assessed by comparing fit statistics of one-factor, two-factor, and bi-factor models. Between-group differences in factor structure were explored using measurement invariance. ResultsA two-factor model, consisting of somatic and cognitive-affective factors, showed better fit than the unidimensional model (CFI = 0.984 versus CFI = 0.974, p < .001), but the high correlation between the factors indicated unidimensionality (r = 0.866). Configural invariance between stroke and non-stroke was supported (CFI = 0.983, RMSEA = 0.080), as were invariant thresholds (p = .092) and loadings (p = .103). Strong invariance was violated (p < .001, ΔCFI = −0.003), stemming from differences in the tiredness and appetite intercepts. These differences resulted in a moderate overestimation of depression in stroke when using a summed score approach, relative to the comparison sample (Cohen's d = 0.434). ConclusionsThe findings suggest that the PHQ-9 measures a single factor in stroke. Because stroke patients may report higher tiredness on item 4, caution is advisable when classifying patients as depressed if they are near the cut-off and have significant post-stroke fatigue. Caution is also advised when comparing total scores between stroke and other populations.

Characteristic of 24-Hour Blood Pressure Dipping Patterns in Hypertensive Stroke Patients.

We conducted a study titled for Investigation on the characteristics of 24-hour blood pressure (BP) dipping patterns in hypertensive stroke patients. Descriptive research, analysis, and comparison, the research was conducted from July 2019 to September 2020 at the Vietnam Heart Institute - Bach Mai Hospital. There are 100 patients diagnosed with idiopathic hypertension who were divided into two groups (without stroke complications and another group with chronic stroke complications > 6weeks), both groups were similar in age (45-64 years old). The daytime systolic BP (SBP) indices, 24-hour BP including SBP, diastolic BP (DBP), and mean arterial pressure (MAP), and particularly night-time BP indices were elevated in the stroke group compared with those without stroke complications (p < 0.05); there were no significant differences observed in daytime DBP and MAP between the two groups. SBP indices were higher in those with hemorrhage stroke compared with those with ischemic stroke, albeit without statistical significance. The prevalence of non-dipper was significantly higher in the stroke group compared with the non-stroke group (p < 0.001). The daytime SBP indices, 24-hour BP (SBP, DBP, MAP), and particularly night-time BP indices were elevated in the stroke group compared with those without stroke complications. The prevalence of non-dipper was significantly higher in the stroke group compared with the non-stroke group.

Prognosis of the post COVID-19 stroke based on D-dimer and inflammatory markers: A mixed model meta-regression analysis

Background &amp; Objective: With regard to the importance of inflammatory biomarker and stroke in COVID-19 prognosis, this study aims to compare the mortality of stroke in COVID-19 patients based on the level of inflammatory biomarkers, considering the temporality of stroke occurrence after COVID-19 infection. Methods: As a secondary study, aggregate data were collected by a systematic review. Mixed model meta-regression analyses were conducted to study the effects of stroke, inflammatory biomarkers and D-dimer on mortality of patient with COVID-19 as main effects and interactions. The effect measure was death rate. The protocol was registered in PROSPERO with registration number CRD42023383065. Results: A total of 2,725 COVID-19 patients, consisting of 96 patients with stroke with a temporal precedence of COVID-19 were investigated from three studies. Among the inflammatory biomarkers, only CRP found eligible for pooled analysis. In the interaction model of CRP, significant positive interactions with CRP were found for both groups of stroke and non-stroke (P &lt;0.001), in which the interaction with stroke group was more severe. In the interaction model of D-dimer, a significant positive interaction with D-dimer was found for the stroke group (P &lt;0.001), while the interaction with the non-stroke group was not statistically significant (P =0.158). Conclusion: The present study found the role CRP and D-dimer in prognosis of stroke in patients with COVID-19 as both main effect and interaction modeling. The evidence obtained from these mixed model meta-regression analyses was of moderate quality.

APOE gene polymorphism in ischemic stroke patients from Huizhou and its correlation with blood lipids and homocysteine

ObjectivesTo investigate the correlation between apolipoprotein E (APOE) gene polymorphisms and ischemic stroke and its relationship with blood lipids and homocysteine (HCY) level in Huizhou City. Materials and methodsIn this analytical cross-sectional study, we selected 2612 patients who underwent APOE genotyping from November 2019 to November 2021 at the Third People's Hospital of Huizhou. Among them, 2014 were ischemic stroke patients and 598 were non-stroke patients. The independent variables were ischemic stroke, different genotypes, and different alleles, while the dependent variables were blood lipid levels and HCY levels. ResultsThe distribution frequency of ε4 allele in stroke group was higher than that in non-stroke group (P < 0.05). Compared with ε4 allele carriers in the stroke group, the levels of lipid total cholesterol (TC) and low-density lipoprotein cholesterol (LDL-C) in ε2 and ε3 allele carriers were significantly lower, while the levels of high-density lipoprotein cholesterol (HDL-C) were significantly higher (P < 0.01). The levels of lipid Lipoprotein a (LPa) and small dense low-density lipoprotein (sdLDL) in ε2 allele carriers in stroke group were significantly lower than those of ε4 allele carriers (P < 0.05). Logistics regression analysis showed that age, TC, HCY level and allele ε4 were positively correlated with the risk of ischemic stroke (P < 0.01), TG level was positively correlated with the risk of ischemic stroke in females (P < 0.01). ConclusionsAPOE gene polymorphism is associated with ischemic stroke, and ε4 allele carriers have a higher risk than ε3 allele carriers.

The Burden of Stroke in Neonates Undergoing Congenital Heart Surgery: A Large Multicenter Analysis

BackgroundStroke affects surgical decision making and outcomes of neonatal cardiac surgery (CHS). We sought to assess the burden of stroke in this population from a large multicenter database. MethodsWe analyzed neonates undergoing CHS with cardiopulmonary bypass from the Pediatric Health Information System database (2004-2022). The cohort was divided into the stroke group, which included preoperative/postoperative ischemic, hemorrhagic subtypes, and grade III to IV intraventricular hemorrhages, and compared in-hospital and follow-up outcomes to a nonstroke group. ResultsA perioperative stroke occurred in 800 of 14,228 neonates (5.6%). The stroke group was more likely to have hypoplastic left heart syndrome (HLHS; 30.5% vs 20.7%), born preterm (19.4% vs 11.7%), low birth weight (17.8% vs 11.9%), and require extracorporeal membrane oxygenation (ECMO; 48.8% vs 13.8%; all P < .001). Outcomes comparing stroke vs no stroke were mortality, 33.1% vs 8.9%; nonhome discharge, 12.5% vs 6.9%; length of stay, 41 vs 24 days; and hospitalization costs, $354,521 vs $180,489 (all, P < .05). Stroke increased the odds of mortality by 2-fold (odds ratio, 2.20; 95% CI, 1.75-2.77; P < .001) after adjusting for ECMO, prematurity among other significant factors. On follow-up, the stroke group had a higher incidence of hydrocephalus (9.5% vs 1.3%), cerebral palsy (6.2% vs 1.3%), and autism spectrum disorder (7.1% vs 3.5%), and survivors of the index admission had higher 1- and 5-year mortality (5.3% and 11.3% vs 3.3% and 5.9%, respectively; all P < .05). ConclusionsNeonatal CHS patients born prematurely, diagnosed with HLHS, or those requiring ECMO are disproportionately affected by stroke. The occurrence of stroke is marked by significantly higher mortality. Future research should seek to identify factors leading to stroke to increase rescue after stroke and for improvement of long-term outcomes.

Analysis and prevention strategies of risk factors for postoperative stroke complications in cardiac surgery

Objective To analyze the risk factors associated with postoperative stroke complications in cardiac surgery. Methods A retrospective analysis was conducted on the clinical data of 549 patients who underwent cardiac surgery. Among these patients, 501 did not experience a stroke postoperatively (non-stroke group), while 48 developed a postoperative stroke (stroke group). Patients who experienced a stroke postoperatively were divided into two groups based on the type of surgery: those who underwent surgery with cardiopulmonary bypass (18 patients) and those without cardiopulmonary bypass (30 patients). The clinical characteristics of the two groups of patients with postoperative strokes were compared, and the risk factors influencing the occurrence of postoperative stroke complications in cardiac surgery were analyzed. Results ① Clinical findings: Cardiopulmonary bypass group had lower cortical infarction rates but higher large-area and bilateral infarction rates compared to the non-cardiopulmonary bypass group (p < 0.05). No significant gender, age, or infarction type differences were observed (p > 0.05). ② Univariate analysis: No significant differences were found in gender, smoking, alcohol, lipids, or glucose levels (p > 0.05). However, age, education, hypertension, diabetes, hypotension, and atrial fibrillation showed significant differences (p < 0.05). ③ Multivariate Logistic regression: Age, education, hypertension, diabetes, hypotension, and atrial fibrillation were independent risk factors for postoperative stroke complications (p < 0.05). Conclusion Cardiopulmonary bypass increases risk of large-area and bilateral strokes; non-bypass surgery associates with cortical strokes. Age, educational level, hypertension, diabetes, postoperative hypotension, and atrial fibrillation are all factors independently associated with the occurrence of postoperative cerebral infarctions in cardiac surgery. Early interventions may reduce postoperative strokes.

A novel predictive model based on pericarotid adipose tissue and lumen stenosis for stroke risk in patients with asymptomatic carotid stenosis.

The study aimed to investigate the predictive value of clinical characteristics, major computed tomography angiography (CTA) indexes of carotid AS (carotid lumen stenosis and plaque burden), and inflammatory pericarotid adipose tissue for acute stroke risk in patients with a moderate or higher degree of carotid stenosis. In all, 119 patients with unilateral carotid stenosis who underwent head and neck computed tomography angiography were included and assigned to the stroke group or non-stroke group according to magnetic resonance imaging. Pericarotid adipose tissue attenuation value, net enhancement value in the base phase and the enhancement phase, and atherosclerotic features (plaque burden and lumen stenosis) were recorded. Multivariate logistic regression analysis and the operating characteristic curve (ROC) were performed to establish a predictive model for the presence of acute ischemic stroke. ROC analysis showed that pericarotid adipose tissue attenuation value and lumen stenosis were predictive factors for stroke. The AUC of pericarotid adipose tissue attenuation (PCAT) attenuation, lumen stenosis, the novel prediction model independently constructed based on PCAT attenuation, and lumen stenosis resulted in 0.838 (95% CI 0.759-0.899), 0.700 (95% CI 0.826-0.944), and 0.942 (95% CI 0.884-0.977), respectively. The model had a sensitivity and specificity of 0.909 and 0.893, respectively, when the cutoff value was 0.388. We found that the risk model combining pericarotid adipose tissue attenuation value and lumen stenosis has significant predictive values for the presence of symptomatic stroke among patients with a moderate or higher degree of carotid stenosis.

Left Atrial Expansion Index for Ischemic Stroke Prediction in Patients with Atrial Fibrillation.

The efficacy of the left atrial (LA) expansion index (LAEI) to predict cerebral ischemic events in patients with atrial fibrillation (AF) is unknown. We enrolled 177 patients with AF (88 with paroxysmal AF and 89 with persistent AF) and a baseline CHA2DS2-VASc score (at enrollment) of 3.6 ± 2.3. Comprehensive echocardiography was performed at enrollment. The LAEI was calculated as (Volmax - Volmin) × 100%/Volmin, where Volmax and Volmin denoted maximal and minimal LA volumes, respectively. The study endpoint was ischemic stroke. Stroke subtypes were classified into cardioembolic stroke (CE), non-CE with determined mechanism (NCE), embolic stroke of undetermined source (ESUS), or transient ischemic attack (TIA). Over a mean 9.9-year follow-up period, 44 (24.9%) of the patients reached the endpoint (24 with CE, 4 with NCE, 6 with ESUS, and 10 with TIA). The LAEI was lower in the stroke group than in the non-stroke group. Stroke incidence in the lowest LAEI quartile was much higher than that in the other LAEI quartiles; the 10-year cumulative stroke risk was 15.9% (14/88) and 33.7% (30/89) in the patients with paroxysmal and persistent AF, respectively. An LAEI of < 35% predicted the presence of stroke with 77% sensitivity and 78% specificity. In multivariable analysis, the LAEI was independently associated with ischemic stroke (hazard ratio 0.952 per 1% increase, 95% confidence interval 0.932-0.971, p < 0.0001). The LAEI is a useful predictor of ischemic stroke in patients with AF.

Medical Management of Traumatic Vertebral Artery Injury Is Safe Regardless of the Severity of Injury

Management of traumatic vertebral artery injury (VAI) remains under debate. Current consensus reserves surgical or endovascular management for high-grade injury in order to prevent stroke. We sought to evaluate the factors that influence posterior fossa stroke outcomes following traumatic VAI. A search of the prospectively maintained PROOVIT trauma registry of patients older than 18years of age with a diagnosis of VAI was performed at a level 1 trauma center from 2013 to 2019. Patient demographics, type of injury, the timing of presentation, Biffl Classification of Cerebrovascular Injury Grade score, medical management, procedural interventions, and stroke outcomes were analyzed. VAIs were identified in 66 trauma patients were identified out of 14,323 patients entered into the PROOVIT registry. The dominant mechanism was blunt injury (91.5% vs. 8.5%, blunt versus penetrating). Nine patients presented with symptomatic ipsilateral posterior circulation strokes visible on imaging. The average Biffl classification grade was similar between the stroke and nonstroke groups (2.0 vs. 1.5; P=0.39). The average injury severity score (ISS) between stroke and nonstroke groups was also similar (9.0 vs. 14.0; P=0.35). All 9 patients in the stroke group had magnetic resonance imaging verification of their infarct within an average of 21.2hr from presentation. In the stroke group, 1 patient underwent diagnostic angiography but had no intervention. In the nonstroke group, all were treated with medical management alone and none underwent vertebral artery intervention. During a mean follow-up of 14.5months, no patients experienced a new neurological deficit. The severity of VAI by Biffl grading and ISS are not associated with ischemic stroke at presentation following VAI. Medical management of VAI appears safe regardless of Biffl and ISS staging in this trauma population. Neurological changes related to embolic stroke were generally appreciated on presentation. Conservative medical management was sufficient to protect from secondary neurological deficit regardless of index vertebral injury.

Association between left atrial strain and peri-operative stroke in catheter ablation for atrial fibrillation

Abstract Background It has been reported that left atrial (LA) phasic function, evaluated by LA strain, is associated with cardiogenic stroke in patients with atrial fibrillation (AF). There are no well-established echocardiographic findings to predict peri-operative stroke in AF ablation. Purpose The aim is to evaluate between LA strain and peri-operative stroke in AF ablation. Methods This study included 103 consecutive AF patients (90 paroxysmal and 13 non-paroxysmal AF cases) who underwent initial cryo-ablation without interruption of peri-operative anticoagulation from January 2019 to August 2022. Pre-operative echocardiography was used to measure the LA strain items: LA reservoir strain, contractile strain, and conduit strain in sinus rhythm. Twenty-three patients were excluded due to AF rhythm and atrial septal defect. Peri-operative stroke was detected by using magnetic resonance imaging on the day after ablation. Results Peri-operative stroke occurred in 9 patients (11.3%), and there was no symptomatic stroke. In univariate analysis, age (69.6 ± 4.8 years vs. 64.2 ± 10.9 years, p&amp;lt;0.05) and log brain natriuretic peptide (1.61 ± 0.26 vs. 1.32 ± 0.42 p&amp;lt;0.05) were significantly higher in the stroke group. On the other hand, LA reservoir strain (20.9 ± 5.6% vs. 29.8 ± 8.3%, p&amp;lt;0.01) and LA conduit strain (10.9 ± 2.3% vs. 15.9 ± 7.0%, p&amp;lt;0.01) in the stroke group was significantly lower compared with the non-stroke group. There were no significant differences in the rate of intra-operative electrical cardioversion and other clinical parameters between both groups. Receiver operating characteristic curve analysis revealed that LA reservoir strain cut-off value of 22.7% provided a c-statistic of 0.82 for predicting peri-operative stroke in AF ablation. Conclusions LA reservoir strain is closely associated with peri-operative stroke in AF ablation.ROC curve analysis

Risk Factors for Stroke Development After Thoracic Aortic Surgery

Stroke after thoracic aortic surgery is a complication that is associated with poor outcomes. The aim is to characterize the intraoperative risk factors for stroke development. A retrospective analysis. Tertiary, high-volume cardiac surgery center. Patients who had surgical repair of thoracic aortic diseases from January 1, 2017, through December 31, 2021. None. A total of 704 patients were included, of whom 533 had ascending aortic aneurysms, and 171 had type A aortic dissection. The incidence of postoperative stroke was 4.5% (95% CI 2.9%-6.6%) for ascending aortic aneurysms compared with 12.3% (95% CI 7.8%-18.16%) in type-A aortic dissections. Patients who developed postoperative strokes had significantly lower intraoperative hemoglobin median (7.5 gm/dL [IQR 6.8-8.6] v 8.55 gm/dL [IQR 7.3-10.0]; p < 0.001). The median cardiopulmonary bypass time was 185 minutes (IQR 136-328) in the stroke group versus 156 minutes (IQR 113-206) in the nonstroke group (p=0.014). Circulatory arrest was used in 57.8% versus 38.5% of the nonstroke patients (p=0.017). The initial temperature after leaving the operating room was lower, with a median of 35.0°C (IQR 34-35.92) in the stroke group versus 35.5°C (IQR 35-36) in the nonstroke cohort (p=0.021). This single-center study highlighted the potential importance of intra-operative factors in preventing stroke. Lower hemoglobin, longer duration of cardiopulmonary bypass, deep hypothermic circulatory arrest, and postoperative hypothermia are potential risk factors for postoperative stroke. Further studies are needed to prevent this significant complication in patients with thoracic aortic diseases.

Acute stroke in patients undergoing coronary artery bypass grafting surgery in acute coronary syndrome: Predictors and outcomes.

Coronary artery bypass grafting (CABG) surgery in patients with acute coronary syndrome (ACS) remains a high-risk procedure and is associated with adverse outcomes. The risk factors of acute stroke in the above-mentioned patients stay unclear and some appropriate data is lacking in the literature. Thus, we aimed to investigate the predictors of acute stroke in patients undergoing CABG surgery in ACS. The retrospective single-centre cohort analysis was conducted. All patients (n = 1344) who suffered from acute coronary syndrome and underwent CABG procedure at the University hospital Cologne from June 2011 until October 2019 were included in our study. In order to find the risk factors of acute stroke after bypass surgery, patients were divided into two groups (non-stroke group (n = 1297) and stroke group (n = 47)). In order to even above-mentioned groups propensity score matching (PSM) analysis was performed (non-stroke group (n = 46) and stroke group (n = 46). Duration of cardiopulmonary bypass (p = .015) and cross clamp time (p = .006) were significantly longer in patients who suffered stroke. Perioperative myocardial infarction was significantly higher (p = .030) in the stroke group. Likewise, the duration of intensive care unit stay (p < .001) and in-hospital stay (p < .001) were significantly longer in patients with stroke. However, the mortality rate did not differ significantly (p = .131) between above-mentioned groups. Univariate and multivariate analysis showed cardiogenic shock (p = .003), peripheral vascular disease (PVD, p = .025) and previous stroke (p = .045) as relevant independent predictors for acute stroke after CABG procedure in patients with ACS. Based on our findings, acute stroke after bypass surgery in patients with ACS is associated with increased mortality and adverse outcomes. Cardiogenic shock, peripheral vascular disease and previous stroke were independent predictors of stroke after CABG procedure. Therefore, preoperative evaluation of potential risk factors may be crucial to improve postoperative results.

Comparison of circulating lipid profiles, D-dimer and fibrinogen levels between hypertensive patients with and without stroke

BackgroundStroke is one of the leading causes of global mortality and disability, particularly in hypertensive patients. This study aimed to compare lipid profile, fibrinogen, and D-dimer levels between hypertensive patient with and without stroke. MethodsThis was a facility-based cross-sectional study conducted from November 2022 to January 2023 among 115 hypertensive patients (70 patients without stroke and 45 with stroke) who had follow-up at Yikatit 12 Hospital Medical College, Ethiopia. All data analyses were done using SPSS version 25.0 and comparisons of variables between groups were made using the Chi-square test, independent sample t-test, and Mann-Whitney U test. Multiple logistic regression analysis was done to identify predictors of stroke among hypertensive patients. A p-value <0.05 was assumed to be statistically significant for all statistical tests. ResultsSignificantly elevated levels of TC, LDL-C, D-DI, and fibrinogen were observed in the stroke group than in the non-stroke group (p-value<0.05). The mean values of TC, D-DI, and fibrinogen were significantly higher in patients with ischemic stroke compared to those with hemorrhagic stroke. Duration of hypertension (AOR: 1.21; CI: 1.10, 2.09), TC (AOR:1.07; CI: 1.01, 1.22), D-DI (AOR: 1.15; CI: 1.05, 1.69) and fibrinogen (AOR:1.19; CI: 1.10, 2.89) were identified to be independent predictors of stroke in hypertensive patients. ConclusionThe circulating levels of TC, LDL-C, D-DI and fibrinogen in hypertensive patients with stroke were significantly higher than in those without stroke. But only TC, D-DI, and fibrinogen were found to be predictors of stroke in hypertensives. Considerably higher TC, D-DI, and fibrinogen levels were also seen in patients with ischemic stroke than in those with hemorrhagic stroke. This confirms the key roles of dyslipidemia (hypercholesterolemia) and aberrant hemostatic activation to stroke development, notably ischemic stroke.

Cerebrovascular Complications of COVID-19 on Venovenous Extracorporeal Membrane Oxygenation.

Evidence of cerebrovascular complications in COVID-19 requiring venovenous extracorporeal membrane oxygenation (ECMO) is limited. Our study aims to characterize the prevalence and risk factors of stroke secondary to COVID-19 in patients on venovenous ECMO. We analyzed prospectively collected observational data, using univariable and multivariable survival modeling to identify risk factors for stroke. Cox proportional hazards and Fine-Gray models were used, with death and discharge treated as competing risks. Three hundred eighty institutions in 53 countries in the COVID-19 Critical Care Consortium (COVID Critical) registry. Adult COVID-19 patients who were supported by venovenous ECMO. None. Five hundred ninety-five patients (median age [interquartile range], 51 yr [42-59 yr]; male: 70.8%) had venovenous ECMO support. Forty-three patients (7.2%) suffered strokes, 83.7% of which were hemorrhagic. In multivariable survival analysis, obesity (adjusted hazard ratio [aHR], 2.19; 95% CI, 1.05-4.59) and use of vasopressors before ECMO (aHR, 2.37; 95% CI, 1.08-5.22) were associated with an increased risk of stroke. Forty-eight-hour post-ECMO Pa co2 -pre-ECMO Pa co2 /pre-ECMO Pa co2 (relative ΔPa co2 ) of negative 26% and 48-hour post-ECMO Pa o2 -pre-ECMO Pa o2 /pre-ECMO Pa o2 (relative ΔPa o2 ) of positive 24% at 48 hours of ECMO initiation were observed in stroke patients in comparison to relative ΔPa co2 of negative 17% and relative ΔPa o2 of positive 7% in the nonstroke group. Patients with acute stroke had a 79% in-hospital mortality compared with 45% mortality for stroke-free patients. Our study highlights the association of obesity and pre-ECMO vasopressor use with the development of stroke in COVID-19 patients on venovenous ECMO. Also, the importance of relative decrease in Pa co2 and moderate hyperoxia within 48 hours after ECMO initiation were additional risk factors.

Could the echocardiographic parameters be a predictor to estimate cerebrovascular events in patients with micro-atrial fibrillation?

Objectives: This study examined possible predictors of stroke [left atrial sphericity index (LASI), left atrial kinetic energy (LAKE), left atrial volume index (LAVI) atrial electromechanical delay (AEMD)] intervals in patients with micro-atrial fibrillation (micro-AF). Patients and methods: A total of 102 consecutive patients (40 males, 62 females; mean age: 61.5±9.2 years; range, 18 to 75 years) diagnosed with micro-AF on rhythm Holter were included in this retrospective study between June 2021 and October 2021. Cranial magnetic resonance and computed tomography images of these patients were scanned from the hospital database. The patients were divided into two groups according to their stroke status (Group 1, the stroke group [n=25]; Group 2, the nonstroke group [n=77]). The LASI was calculated as a fraction of the left atrial maximum volume to the left atrial volume of the sphere in a four-chamber view. The biplane method of disks was used to calculate left atrium volume. The LAVI was calculated by dividing left atrium (LA) volume by the body surface area of patients. Atrial electromechanical delay intervals were calculated from the atrial walls by tissue Doppler imaging. These two groups were compared to assess whether echocardiographic parameters could be a predictor of cerebrovascular events. Results: There was a statistically significant difference between Groups 1 and 2 in terms of left (75.7±4.5 vs. 68.4±3.5, p&lt;0.001) and right (69.5±7.1 vs. 57±3.2, p&lt;0.001) atrial lateral wall and LA medial wall (72±4 vs. 66.2±3.5, p&lt;0.001) electromechanical delay times, LAVI (38.9±3.3 vs. 30.9±3.8, p&lt;0.001), LASI (0.78±0.05 vs. 0.67±0.4, p&lt;0.001), and LAKE (3.7±0.9 vs. 7.9±1.9, p&lt;0.001), left atrial diameter (40±5 vs. 38±2, p&lt;0.001). Conclusion: Changes in LASI, LAVI, LAKE, left atrial diameter, and atrial AEMD times may be a predictor of stroke in patients with micro-AF.

Left atrial appendage filling defects restricted to the early phase of cardiac computed tomography is significantly associated with ischemic stroke

PurposeTo investigate the relationship between filling defects in the left atrial appendage restricted to the early phase of cardiac computed tomography (CCT), and ischemic stroke in patients with atrial fibrillation (AF). Materials and methodsA total of 152 patients with non-valvular AF were retrospectively enrolled and divided into two groups according to the stroke history, as confirmed by brain computed tomography (CT) or magnetic resonance imaging (MRI), as the non-stroke group (n = 89) and stroke group (n = 63), respectively. The numbers of patients with filling defects in the early phase of CCT images without thrombi were recorded. Morphological parameters of the LAA were measured for all participants. All patients with early-phase filling defects (n = 44) were assigned to two groups according to ischemic stroke history: the filling defects with stroke group (n = 28) and the filling defects without stroke group (n = 16). The clinical characteristics and LAA morphological parameters were compared. ResultsUnivariate analysis showed that compared with the non-stroke group，LAA volume index and age were higher in the stroke group, and the ratio of early phase filling defect in LAA, hypertension and diabetes were also higher, in the meanwhile the LVEF and BMI were lower (P < 0.05).After adjusting confounding factors by the multivariate logistic regression analysis, filling defect was significantly related with stroke [odds ratio (OR): 4.339, 95% confidence interval (CI): 1.951–9.653, P = 0.000]. LAA morphological parameters were not significantly different between the filling defects with stroke group and the group without stroke. ConclusionAF patients with LAA non-thrombotic filling defects in the early-phase of CCT had an increased risk of ischemic stroke compared to those without filling defects. This finding may help to optimize stroke risk stratification in patients with AF.

Phenylacetyl glutamine: a novel biomarker for stroke recurrence warning

BackgroundStroke is the second leading cause of disease-related death and the third leading cause of disability worldwide. However, how to accurately warn of stroke onset remains extremely challenging. Recently, phenylacetyl glutamine (PAGln) has been implicated in the onset of stroke, but evidences from cohort studies of onset are lacking, especially in patients with first-onset or recurrent. It is necessary to deeply demonstrate the effectiveness of PAGln level on warning stroke onset.MethodsOne hundred fifteen first onset stroke patients, 33 recurrent stroke patients, and 135 non-stroke controls were included in the analysis. Risk factors associated with stroke attacking were evaluated, and plasma PAGln levels were detected via HPLC-MS based method. LASSO regression, Pearson correlation analysis, and univariate analysis were carried out to demonstrate the associations between PAGln levels and risk factors of stroke. Random forest machine learning algorithm was used to build classification models to achieve the distinction of first-onset stroke patients, recurrent stroke patients, and non-stroke controls, and further demonstrate the contribution of PAGln levels in the distinction of stroke onset.ResultsThe median level of PAGln in the first-onset stroke group, recurrent stroke group, and non-stroke group was 933 ng/mL, 1014 ng/mL, and 556 ng/mL, respectively. No statistical correlation was found between PAGln level and subject’s living habits, eating preferences, and concomitant diseases (hypertension, hyperlipidemia, and diabetes). Stroke severity indicators, mainly age and NIHSS score, were found associate with the PAGln levels. Machine learning classification models confirmed that PAGln levels, as the main contributing variable, could be used to distinguish recurrent stroke patients (but not first-onset stroke patients) from non-stroke controls.ConclusionPAGln may be an effective indicator to monitor the recurrence in stroke patients.

Abstract TP114: Stroke Mimics: Uncovering The Truth In The History

Background: Inpatient acute stroke identification may be challenging given the complexity related to both concomitant and comorbid illness. Rapid and accurate diagnosis requires a skilled clinician to discern acute stroke patients from other mimics such as hypoglycemia, hemiplegic migraine, post-ictal paresis, relapse of a demyelinating disease, or recrudescence of prior stroke. Hypothesis: Negative predictors of acute stroke can be identified in inpatients with inpatient stroke alerts. Methods: IRB approved, retrospective analysis of prospectively obtained data was performed for all inpatient stroke alerts between March 2017 and May 2020. Patients with MRI confirmed diagnosis of acute stroke were compared to all others. Univariant analysis was performed with Wilcoxon Ranked Sum test used for non-parametric data to identify risk factors to include in the logistic regression (p&lt;0.05). Results: 674 inpatient stroke alerts resulted in 223 (33%) acute strokes and 451 (67%) non-stroke diagnoses. For stroke vs. non-stroke patients, median age 70.5 vs. 68.6 years, last seen well 77.5 vs. 65.0 minutes (p= 0.030), NIHSS score 10 vs. 4 (p&lt;0.001). In the non-stroke group, 156 (23%) had a witnessed seizure documented during the alert compared to 0% in the stroke group. Negative predictors of stroke included previous diagnosis of epilepsy (0.302 odds, P&lt;0.007), anti-seizure drug (ASDs) prescribed prior to (1.662 odds, p&lt;0.001) or at time of the alert (2.479 odds), and previous EEG(P&lt;0.001). Conclusions: It is imperative to consider post-ictal paresis as a differential diagnosis when assessing patients who present as stroke alerts. The administration of thrombolytics in stroke mimics is not without harm and incorrect diagnosis will delay appropriate treatment. Witnessed seizure at time of alert, history of epilepsy diagnosis, use of ASD prior to or at the time of the alert, and prior EEG findings may serve as a tool to help differentiate between acute stroke and seizure diagnosis. Further study will be aimed at identifying alternative pathways for rapid assessment of patients with acute changes in neurologic exam.