Powerful Predictor Of Stroke Research Articles

Metabolism score for visceral fat (METS-VF): an innovative and powerful predictor of stroke

Metabolism score for visceral fat (METS-VF): an innovative and powerful predictor of stroke

The Usefulness of the CHA2DS2-VASc Score to Predict Outcomes in Patients with Infective Endocarditis.

Introduction: Despite diagnostic and therapeutic advances, infective endocarditis (IE) is still associated with high mortality rates. Currently, there are no good prognostic tools for the risk assessment of patients with IE. The CHA2DS2-VASc score, used to estimate the risk of ischemic stroke in patients with non-valvular atrial fibrillation (AF), has been shown to be a powerful predictor of stroke and death in patients without known AF associated with other cardiovascular conditions. Objective: We aimed to evaluate the usefulness of the CHA2DS2-VASc score as a prognostic tool in a population of patients with IE. Methods: The Rabin Medical Center Endocarditis Team (RMCET) registry is a retrospective cohort of all patients evaluated at our center due to acute or sub-acute bacterial endocarditis. The CHA2DS2-VASc score was extracted for all patients. All-cause mortality was depicted for all patients. Results: The cohort included 330 patients with a mean age of 65.2 ± 14.7 years (70% men). During a median follow-up of 24 months [IQR 4.7-48.6], 121 (36.7%) patients died. The median CHA2DS2-VASc score was 3, and any score above 2 was associated with increased overall mortality (50.8% vs. 19.9%, p < 0.001). A multivariate model incorporating important confounders not included in the CHA2DS2-VASc model showed consistent results with a risk increase of 121% for the higher CHA2DS2-VASc score groups (HR 2.21 [CI 1.12-4.39], p = 0.023). Conclusions: IE currently has no good risk stratification models for clinical practice. The CHA2DS2-VASc score might serve as a simple and available tool to stratify risk among patients with IE.

Left Atrial Strain as Evaluated by Two-Dimensional Speckle Tracking Predicts Left Atrial Appendage Dysfunction in Chinese Patients with Atrial Fibrillation.

Left atrial appendage (LAA) dysfunction identified by transesophageal echocardiography (TEE) is a powerful predictor of stroke in patients with atrial fibrillation (AF). The aim of our study is to assess if there is a correlation between the left atrial (LA) functional parameter and LAA dysfunction in the AF patients. This cross-sectional study included a total of 249 Chinese AF patients who did not have cardiac valvular diseases and were undergoing cardiac ablation. TEE was performed in all the patients who were categorized into two groups according to their left atrial appendage (LAA) function. A total of 120 of the 249 AF patients had LAA dysfunction. Univariate and multivariate logistic regression was conducted to assess the independent factors that correlated with the LAA dysfunction. Different predictive models for the LAA dysfunction were compared with the receiver operating characteristic (ROC) curve. The final ROC curve on the development and validation datasets was drawn based on the calculation of each area under the curves (AUC). Univariate and multivariate analysis showed that the peak left atrial strain (PLAS) was the most significant factor that correlated with the LAA dysfunction. PLAS did not show inferiority amongst all the models and revealed strong discrimination ability on both the development and validation datasets with AUC 0.818 and 0.817. Our study showed that a decrease in PLAS is independently associated with LAA dysfunction in the AF patients.

Peak Systolic Velocity Measurements with Transcranial Doppler Ultrasound Is a Predictor of Incident Stroke among the General Population in China.

Background and ObjectiveIt is necessary to develop an effective and low-cost screening tool for identifying Chinese people at high risk of stroke. Transcranial Doppler ultrasound (TCD) is a powerful predictor of stroke in the pediatric sickle cell disease population, as demonstrated in the STOP trial. Our study was conducted to determine the prediction value of peak systolic velocities as measured by TCD on subsequent stroke risk in a prospective cohort of the general population from Beijing, China.MethodsIn 2002, a prospective cohort study was conducted among 1392 residents from 11 villages of the Shijingshan district of Beijing, China. The cohort was scheduled for follow up with regard to incident stroke in 2005, 2007, and 2012 by a study team comprised of epidemiologists, nurses, and physicians. Univariate and multivariate Cox proportional hazard regression models were used to determine the factors associated with incident stroke.ResultsParticipants identified by TCD criteria as having intracranial stenosis had a 3.6-fold greater risk of incident stroke (hazard ratio (HR) 3.57, 95% confidence interval (CI) 1.86–6.83, P<0.01) than those without TCD evidence of intracranial stenosis. The association remained significant in multivariate analysis (HR 2.53, 95% CI 1.31–4.87) after adjusting for other risk factors or confounders. Older age, cigarette smoking, hypertension, and diabetes mellitus remained statistically significant as risk factors after controlling for other factors.ConclusionsThe study confirmed the screening value of TCD among the general population in urban China. Increasing the availability of TCD screening may help identify subjects as higher risk for stroke.

Predictors of Stroke in Patients With Impaired Glucose Tolerance

Risk factors for stroke are well-established in general populations but sparsely studied in individuals with impaired glucose tolerance. We identified predictors of stroke among participants with impaired glucose tolerance in the Nateglinide and Valsartan in Impaired Glucose Tolerance Outcomes Research (NAVIGATOR) trial. Cox proportional-hazard regression models were constructed using baseline variables, including the 2 medications studied, valsartan and nateglinide. Among 9306 participants, 237 experienced a stroke over 6.4 years. Predictors of stroke included classical risk factors such as existing cerebrovascular and coronary heart disease, higher pulse pressure, higher low-density lipoprotein cholesterol, older age, and atrial fibrillation. Other factors, including previous venous thromboembolism, higher waist circumference, lower estimated glomerular filtration rate, lower heart rate, and lower body mass index, provided additional important predictive information, yielding a C-index of 0.72. Glycemic measures were not predictive of stroke. Variables associated with stroke were similar in participants with no prior history of cerebrovascular disease at baseline. The most powerful predictors of stroke in patients with impaired glucose tolerance included a combination of established risk factors and novel variables, such as previous venous thromboembolism and elevated waist circumference, allowing moderately effective identification of high-risk individuals.

Relation between Red Blood Cell Distribution Width and Ischemic Stroke: A Case-Control Study

Dear Editor Recent studies have showed an association between higher red blood cell distribution width (RDW) and increased risk of death (1,2) and cardiovascular disease events (3) in middle-aged and older adults. The aim of this study is to determine the strength of association between RDW levels and ischemic stroke. A case-control study in a single center was conducted. Two hundred twenty-four consecutive patients suffering a first-ever ischemic stroke confirmed by magnetic resonance imaging (MRI) were included. Two hundred twenty-four randomly selected patients, free of the cerebrovascular disease and from the same population as the cases, were chosen as controls. Baseline RDW was considered as a continuous variable and in quartiles. We use Mantel– Haenszel Test for trend to examine the association between RDW levels and stroke risk. In order to identify determinants of RDW, univariate and multivariate analyses were performed. RDW in cases ranged from 12·27% to 26·17% [mean, 14·48%; standard deviation (SD), 1·76] and in controls ranged from 11·30% to 21·70% (mean, 13·91%; SD, 1·43), P = 0·001. Patients in the fourth quartile (RDW > 14·61%) were significantly more like to have a stroke compared with patients in the lower quartile [RDW < 13·27%, odds ratio (OR) 4·50; 95% confidence interval (CI): 2·50–8·01, P < 0·0001]. After adjusting, there remained a stepwise association between RDW levels and risk of stroke; compared with the lowest quartile of RDW: second quartile, OR 2·5 (95% CI, 1·4–4·6); third quartile, OR 3·2 (95% CI, 1·7–5·9); and four quartile, OR 5·9 (95% CI, 3·1–11·4). The analysis for trend was statistically significant by Mantel–Haenszel Test, reflecting a clear dose–response gradient; higher levels of RDW were associated with increased risk of stroke (Xt = 4·69; P < 0·0001) (Fig. 1). In multivariate linear regression analysis, RDW was significantly associated with age (b = 0·121, P = 0·034), atrial fibrillation (b = 0·148, P = 0·009), cancer (b = 0·103, P = 0·063), and hemoglobin (b = -0·141, P = 0·011). Case-control studies can be a very efficient way of identifying an association between an exposure and an outcome. If care is taken with definitions, selection of the controls, and reducing the potential for bias, case-control studies can generate valuable information (4). Based on this study, RDW is a powerful predictor of stroke. The biological mechanisms underlying this association are not clear (5). Considering that RDW is an inexpensive test, further research is certainly needed to investigate the potential mechanistic role of RDW in stroke occurrence.

Atrial Fibrillation Significantly Increases Total Mortality and Stroke Risk Beyond that Conveyed by the CHADS2 Risk Factors

Atrial fibrillation (AF) is associated with an increased risk of mortality and stroke. However, it is unclear if AF is independently associated with these poor outcomes or it is merely a risk marker of other processes that convey the risk. Consecutive patients who underwent angiography for suspicion of coronary artery disease, but without a history of AF, were studied. Traditional CHADS2 (congestive heart failure, hypertension, age >75 years, diabetes, stroke/transient ischemic attack) risk factors for each patient were recorded. A total of 343 AF patients (age = 69 +/- 10 years, 215 [63%] male) and 2,945 non-AF patients (age = 63 +/- 12 years, 2,012 [67%] male) were studied. Among AF patients, 51 (15%) had a myocardial infarction (MI), 35 (10%) had a stroke, and 180 (52%) died. CHADS2 score incrementally increased risk of stroke (adjusted hazard ratio [HR] for 1:1.92, 2:2.30, 3:1.14, 4:3.83, 5:10.96; P-trend = 0.14), death (HR for 1:1.83, 2:2.34, 3:3.69, 4:2.27, 5:4.53; P-trend < 0.001), and major adverse cardiac event (MACE)(HR for 1:1.29, 2:1.54, 3:2.07, 4:2.41, 5:2.68; P-trend = 0.002). Among non-AF patients, CHADS2 score incrementally increased risk of stroke (HR for 1:1.18, 2:3.17, 3:5.08, 4:10.78, 5:7.50; P-trend < 0.001), MI (HR for 1:1.05, 2:1.46, 3:1.57, 4:0.53, 5:4.76; P-trend = 0.002), death (HR for 1:1.79, 2:3.22, 3:6.23, 4:9.09, 5:14.00; P-trend < 0.001), and MACE (HR for 1:1.47, 2:2.36, 3:4.16, 4:5.91, 5:7.56; P-trend < 0.001). Among all patients, both CHADS2 score (all P < or = 0.001) and AF were independent risk factors for stroke (AF: P = 0.002), MI (AF: P = 0.035), death (AF: P < 0.001), and MACE (AF: P < 0.001). The CHADS2 score is a powerful predictor of stroke and death. AF increases the risk of these outcomes in an independent manner. These data support the concept that AF is a risk factor of future cardiovascular disease.

Plasma Fibrinogen, Ambulatory Blood Pressure, and Silent Cerebrovascular Lesions

Twenty-four-hour ambulatory blood pressure (24-hour ABP) values are considered a powerful predictor of stroke. Silent cerebrovascular lesions are associated with an increased risk of stroke. Because fibrinogen is a major determinant of plasma viscosity, an elevated fibrinogen level might also be associated with stroke risk. We evaluated the association of 24-hour ABP and plasma fibrinogen levels with the risk of silent cerebrovascular lesions (white matter hyperintensity and lacunar infarct) detected by MRI. The study cohort comprised 958 individuals from the general population of Ohasama, a rural Japanese community. Multiple logistic regression analysis adjusted for age, sex, smoking and drinking status, use of antihypertensive medication, body mass index, 24-hour ABP, and a history of hypercholesterolemia, diabetes mellitus, and atrial fibrillation demonstrated that each 1-SD increase in fibrinogen level was associated with a significantly increased risk of silent cerebrovascular lesions (odds ratio, 1.26; P=0.001). The 24-hour ABP was also significantly and independently associated with the risk of silent cerebrovascular lesions. Even when 24-hour ABP values were within normal range (<135/80 mm Hg), elevated fibrinogen levels were associated with an increased risk of silent cerebrovascular lesions. Fibrinogen and 24-hour BP had additive effects on silent cerebrovascular lesions. The 24-hour ABP and plasma fibrinogen levels were closely and independently associated with the risk of silent cerebrovascular lesions including white matter hyperintensity and lacunar infarct.

Predictors of stroke in high-risk patients after acute myocardial infarction: insights from the VALIANT trial

We sought to determine risk models for predicting early and late stroke in a large cohort of high-risk post-myocardial infarction (MI) patients. We prospectively analysed data from 14 703 patients in the VALIANT trial with acute MI complicated by heart failure, left ventricular (LV) systolic dysfunction, or both. Patients were randomized 0.5-10 days after acute MI to valsartan, captopril, or their combination. We evaluated risk factors for early (<45 days) and late (>45 days) stroke by using multivariable Cox proportional hazards regression analyses with stepwise variable selection techniques applied to 92 pre-specified potential predictor variables. After randomization, 463 (3.2%) patients had fatal (n = 124) or non-fatal (n = 339) strokes, with 134 strokes occurring in the first 45 days. The strokes were classified as ischaemic (348), haemorrhagic (40), or of indeterminate cause (75). Estimated glomerular filtration rate and heart rate when in sinus rhythm were the most powerful predictors of early stroke (<45 days after MI), whereas diastolic blood pressure (DBP) >90 mmHg, prior stroke, and atrial fibrillation (AF) were the most powerful predictors of stroke overall. Ejection fraction and sex were not predictive of stroke in this cohort. Among high-risk patients presenting with MI but without initial neurological symptoms, the risk of stroke 6 weeks thereafter is 0.94% (95% CI 0.78-1.09). Of the most powerful baseline predictors of stroke, DBP and AF are amenable to therapeutic interventions and thus merit special attention in these patients.

Blood Pressure Lowering for Primary and Secondary Prevention of Stroke

Hypertension affects from 20% to 30% of the world population.1,2 Blood pressure is the most consistent and powerful predictor of stroke. Population mortality trends for stroke parallel those in hypertension.3,4 A systolic blood pressure >115 mm Hg explains 60% of the population-attributable risk of stroke.5 In the Framingham cohort,6 the lifetime risk of stroke at ages 55, 65, and 75 years was similar, approximating 1 in 5 for women and 1 in 6 for men. In many countries, such as China,7 stroke is the third cause of death only preceded by heart disease and total cancer. Two thirds of stroke deaths occur in developing nations.8 According to recent estimates published by the World Health Organization, worldwide, &15 million people per year fall victim to a stroke, of whom &5 million die and another &5 million are left permanently disabled.1 From this vantage point, we reviewed the recent literature to underscore the deadly but reversible link between stroke and blood pressure. ### Nonmodifiable Risk Factors Nonwhite ethnicity, male sex, older age, and a positive family history are among the nonmodifiable risk factors of stroke.9,10 Monogenic stroke disorders,11 such as, for instance, cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy,12 are extremely rare. In the vast majority of cases, stroke has a polygenic background associated with proven or suspected variation in the genes contributing to hypertension, carotid intima-media thickness, vascular remodeling, small vessel disease,13 inflammation, oxidative stress, dyslipidemia, or the generation of angiotensin II.14,15 Small vessel disease of the brain underlies 20% to 30% of ischemic strokes and a larger proportion of intracerebral hemorrhages.13 ### Modifiable Risk Factors Smoking,1,9,10 excessive alcohol intake (>60 g per day),9,10,16 obesity,9,10 dyslipidemia,9,10 diabetes mellitus,9,17 carotid artery disease,9,10 atrial fibrillation, heart failure, and other forms …

Headache and the risk of stroke.

Several studies have suggested that migraine is a risk factor for stroke. The association between migraine and the risk of stroke has been observed most often among premenopausal women but also in some studies among men. The association may be stronger among women who smoke and among women using oral contraceptives compared with nonsmokers and nonusers. Classic migraine with aura may be a more powerful predictor of stroke than common migraine without aura. Findings of a recent population-based study suggest that subclinical brain lesions are more common among migraine patients, particularly among those with aura, than among the control subjects. Two cohort studies have shown that chronic non-specific headache also is related to increased stroke risk. The effect of treatment of migraine and other types of headache on the risk of stroke is not known. Even though the relative risk of stroke may be fairly high among migraine patients, the absolute risk is usually low due to low baseline risk among young people.

Antihypertensive treatment and prevention of stroke and dementia

Hypertension is the most consistent and powerful predictor of stroke and is involved in nearly 70% of strokes. Placebo-controlled trials have proven that blood-pressure-lowering treatment reduces the incidence of stroke by 40% in middle-aged or older hypertensive patients with predominantly diastolic hypertension and by 30% in older patients with isolated systolic hypertension. Recent trials have compared new agents (calcium-channel blockers, α-blockers, angiotensin converting enzyme inhibitors or angiotensin type-1 receptor blockers) with old durg classes (diuretics or β-blockers). Calcium-channel blockers, including (−8%, P=0.07) or excluding verapamil (−10%, P=0.02), as well as angiotensin type-1 receptor blockers (−24%, P=0.0002) resulted in better stroke prevention than did the old drugs, whereas the opposite trend was observed for angiotension converting enzyme inhibitors (+10%, P=0.03). An overview of 6 trials conducted in patients with a history of cerebrovascular disease demonstrated that antihypertensive drug treatment reduced stroke recurrence by 25% ( P=0.004). A meta-regression analysis showed that within-trial differences in systolic blood pressure accounted for the prevention of stroke in most trials. In 5 trials, dementia was a secondary outcome. Overall, antihypertensive treatment did not reduce the incidence of vascular or degenerative dementia (−11%, P=0.15). However, when the analysis was limited to 3 trials involving a dihydropyridine or a diuretic as the mainstay of therapy, this benefit increased to 25% ( P=0.01). Randomized clinical trials should urgently address the question to what extent blood-pressure-lowering therapy may prevent degenerative dementia.

Stroke in coronary artery bypass graft surgery: an analysis of the CASS experience

An analysis of the Coronary Artery Surgery Registry (CASS) was performed to determine the occurrence of stroke after coronary artery bypass surgery in patients entered into the Coronary Artery Surgery Study Registry. Of the 10,098 patients having coronary artery bypass surgery at the Coronary Artery Surgery Study participating sites during the period July 1974 through May 1979, a total of 348 patients (or 3.4%) sustained a stroke during the first year after coronary bypass surgery. Fifty-nine strokes occurred on the day of surgery, and an additional 129 strokes occurred during hospitalization for coronary bypass surgery. Thus, 188 patients (1.9%) of the entire surgical group sustained a stroke during initial hospitalization for coronary artery bypass surgery. Logistic regression analysis was used to predict stroke on the day of surgery, during the hospitalization for surgery, and during the first year after surgery. The most powerful predictors of stroke on the day of coronary artery bypass surgery were: 1) older age ( n = < 0.0001); 2) use of α-adrenergic drugs after bypass ( n = 0.0001); and 3) longer duration of cardiopulmonary bypass ( n = 0.002). For those strokes occurring at least 1 day after coronary artery bypass but during the initial hospitalization, age and duration of cardiopulmonary bypass were the most powerful predictors of stroke. An analysis of predictors of stroke within 1 yr after hospital dismissal for initial coronary bypass surgery revealed that the most powerful predictor was a history of previous cerebrovascular disease ( n < 0.0001) and a history of hypertension ( n < 0.0001). These data provide a perspective of stroke after coronary bypass surgery and identify predictors of high-risk subgroups of patients for such an event.