Predictive Factor For Stroke Research Articles

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.

The association between atherogenic index of plasma and stroke in Chinese middle-aged and elderly population: a national cross-sectional study

Objective: To investigate the association between atherogenic index of plasma (AIP) and stroke. Methods: The 2015 China Health and Retirement Longitudinal Study (CHARLS) survey was used in this study. Logistic regression was adopted to examine the relationship between AIP, calculated as log (TG/HDL), and stroke. Subgroup analysis was used to further explore the associated factors. Restricted cubic spline (RCS) regression was adopted to estimate the non-linear association. Receiver operator characteristic (ROC) analysis was utilized to calculate the cutoff value of AIP. Results: In this study, 13,027 participants aged 45 years above were enrolled. The odds ratios in the fully adjusted logistic model across the quartiles of AIP were 1.00 (reference), 1.09 (95% CI 0.69–1.72), 1.62 (95% CI 1.06–2.49), 1.07 (1.08–2.58), respectively. Non-linear association between AIP and stroke was not found using RCS regression (p for non-linearity > 0.05). The subgroup analyses showed that the association between AIP and stroke varied in different gender, alcohol and cigarette consumption, but the interaction effects were insignificant (all p > 0.05). The cutoff value of AIP was 0.82, and the area under the curve (AUC) was 0.57. Conclusion: Elevated AIP is significantly associated with the increased risk of stroke in the middle- aged and elderly Chinese, indicating that AIP may be a predictive factor for stroke among the Chinese middle-aged and elderly.

Stroke and its correlates among patients on maintenance hemodialysis in Cameroon.

End-stage kidney disease is an independent risk factor for stroke; however, the relationship between hemodialysis and stroke in Sub-Saharan Africa has not been established. To evaluate the incidence, associated factors, and clinical outcome of stroke among patients undergoing maintenance hemodialysis in Cameroon. A hospital-based retrospective study using data from the medical files of 1060 patients on maintenance hemodialysis (given twice a week) was conducted. Patients with stroke prior to starting hemodialysis were excluded. Socio-demographic data, comorbidities, dialysis parameters, and data concerning the diagnosis of stroke were retrieved and analyzed. The dialysis vintage (duration of time on dialysis) averaged 11.4 ± 9.2 months. The incidence of stroke was 6.1 events per 1000 patient-years, with hemorrhagic stroke being most common (66%). Eighty percent of strokes occurred before the 30th month of dialysis. Sixty percent of strokes occurred within 24 h of a dialysis session. Predictive factors for stroke were diabetes mellitus (p = 0.026), heart failure (p = 0.045), poor dialysis compliance (p = 0.001), and short vintage (p = 0.001). The overall mortality rate was 52% and was higher for hemorrhagic stroke (60%). The leading causes of death were multiple organ failure and sepsis. The incidence of stroke is high among hemodialysis patients in Cameroon and hemorrhagic stroke is the commonest type. Diabetes and heart failure triple the risk of stroke. Mortality in patients who suffered a stroke was high.

Predictive Factors for Stroke and TIA Following Carotid Artery Stenting

Purpose: Carotid artery stenting (CAS) is an effective and minimally invasive method for the treatment of extracranial carotid artery stenosis. The aim of the present study was to explore independent risk factors to predict cerebrovascular events following CAS to identify high-risk patients and improve the safety of CAS in this population. Materials and Methods: HISPANIAS is a national prospective multicenter study that included 14 hospitals that collected data from patients who underwent CAS. We analyzed morbidity and mortality within 30 days after CAS, looking for factors that might be associated with cerebrovascular events (stroke and transient ischemic attack [TIA]). Results: The HISPANIAS cohort included 757 patients: 80.32% were men, the mean age was 70.73 years, and 82.96% underwent symptomatic CAS. Cerebrovascular complications occurred in 42 patients (5.6%), including TIA in 24 patients (70.8% ipsilateral; mean 2.79 days after CAS) and stroke in 18 patients (72.2% ipsilateral; mean 6.72 days after CAS). The main independent clinical predictors of stroke/TIA identified by logistic regression were female sex (odds ratio [OR] 2.29, 95% CI 1.15–4.54) and diabetes (OR 3.29, 95% CI 1.71–6.40). Survival analysis showed that diabetic women, compared with the rest of the patients, had a higher number of events concentrated mainly in the first days after the intervention (p=0.003). Conclusion: Cerebrovascular ischemic complications after CAS continue to be a challenge for the management of these patients. Although there are other factors, female sex and the presence of diabetes are emerging as strong risk factors for the development of complications after symptomatic CAS. Clinical Impact Carotid artery stenting (CAS) is an effective and minimally invasive method for the treatment of extracranial carotid artery stenosis. Although CAS has been regarded as a reliable and safety approach, some studies reported that CAS was associated with a higher risk of procedure-related stroke. Cerebrovascular complications after CAS continue to be a main problem and a challenge for the management of these patients. Therefore, it is essential to identify the factors involved in the development of these complications. Our study shows that the combination of female sex and diabetes is associated with a clearly worse outcome, with a greater number of events concentrated mainly in the first days. This is different from other studies that have explored each factor separately. It would be interesting to perform separate interventions for this group given the increased risk of complications.

Vascular and Macrophage Heme Oxygenase-1 in Hypertension: A Mini-Review.

Hypertension is one predictive factor for stroke and heart ischemic disease. Nowadays, it is considered an inflammatory disease with elevated cytokine levels, oxidative stress, and infiltration of immune cells in several organs including heart, kidney, and vessels, which contribute to the hypertension-associated cardiovascular damage. Macrophages, the most abundant immune cells in tissues, have a high degree of plasticity that is manifested by polarization in different phenotypes, with the most well-known being M1 (proinflammatory) and M2 (anti-inflammatory). In hypertension, M1 phenotype predominates, producing inflammatory cytokines and oxidative stress, and mediating many mechanisms involved in the pathogenesis of this disease. The increase in the renin–angiotensin system and sympathetic activity contributes to the macrophage mobilization and to its polarization to the pro-inflammatory phenotype. Heme oxygenase-1 (HO-1), a phase II detoxification enzyme responsible for heme catabolism, is induced by oxidative stress, among others. HO-1 has been shown to protect against oxidative and inflammatory insults in hypertension, reducing end organ damage and blood pressure, not only by its expression at the vascular level, but also by shifting macrophages toward the anti-inflammatory phenotype. The regulatory role of heme availability for the synthesis of enzymes involved in hypertension development, such as cyclooxygenase or nitric oxide synthase, seems to be responsible for many of the beneficial HO-1 effects; additionally, the antioxidant, anti-inflammatory, antiapoptotic, and antiproliferative effects of the end products of its reaction, carbon monoxide, biliverdin/bilirubin, and Fe2+, would also contribute. In this review, we analyze the role of HO-1 in hypertensive pathology, focusing on its expression in macrophages.

Effects of parathyroid hormone and vitamin D supplementation on stroke among patients receiving peritoneal dialysis

BackgroundContinuous ambulatory peritoneal dialysis (CAPD) patients have a high incidence of stroke and commonly have increased parathyroid hormone levels and vitamin D insufficiency. We seek to investigate the incidence of stroke and the role of parathyroid hormone and vitamin D supplementation in stroke risk among CAPD patients.MethodsThis study employed a retrospective design. We enrolled a Chinese cohort of 980 CAPD patients who were routinely followed in our department. The demographic and clinical data were recorded at the time of initial CAPD and during follow-up. The included patients were separated into non-stroke and stroke groups. The effects of parathyroid hormone and vitamin D supplementation on stroke in CAPD patients was evaluated. The primary endpoint is defined as the first occurrence of stroke, and composite endpoint events are defined as death or switch to hemodialysis during follow-up.ResultsA total of 757 eligible CAPD patients with a mean follow-up time of 54.7 (standard deviation, 33) months were included in the study. The median incidence of stroke among our CAPD patients was 18.9 (interquartile range, 15.7–22.1) per 1000 person-years. A significant nonlinear correlation between baseline iPTH and hazard of stroke (p-value of linear association = 0.2 and nonlinear association = 0.002) was observed in our univariate Cox regression analysis, and low baseline iPTH levels (≤150 pg/ml) were associated with an increased cumulative hazard of stroke. Multivariate Cox regression analysis indicated a significant interaction effect between age and iPTH after adjusting for other confounders. Vitamin D supplementation during follow-up was a predictive factor for stroke in our cohort.ConclusionsCAPD patients suffered a high risk of stroke, and lower iPTH levels were significantly correlated with an increased risk of stroke. Nevertheless, vitamin D supplementation may reduce the risk of stroke in these patients.

Blood pressure predictors of stroke in rural Chinese dwellers with hypertension: a large-scale prospective cohort study

BackgroundLittle was known about the different predictive power of blood pressure (BP) parameters (SBP, systolic BP; mean arterial pressure, MAP; pulse pressure, PP; and diastolic BP, DBP) and stroke incidence. This study’s aim was to compare power of BP parameters predict stroke events among rural dwelling Chinese individuals with hypertension.MethodA total of 5097 hypertension patients (56.2% women; mean age, 56.3 ± 11.2 years) were included in the prospective cohort study with a median follow-up of 8.4 years.ResultsUntil the end of the last follow-up, there were 501 onset strokes (310 ischemic, 186 hemorrhagic, and 5 unclassified strokes) among the 5097 participants. The results showed that hazard ratio (HR) (95% confidence interval, 95% CI) with an increment of 5 mmHg were 1.095 (1.070–1.121) for PP, 1.173 (1.139–1.208) for MAP, 1.109(1.089–1.130) for SBP, 1.143(1.104–1.185) for DBP. The SBP indicated the largest β coefficient in the Cox proportional hazard model for all stroke except PP or MAP, and the SBP revealed slightly higher value than MAP (βSBP = 0.435, βMAP = 0.430, P = 0.756).ConclusionsBoth PP and MAP were predictive factors for stroke. The MAP showed a stronger ability to predict stroke events than PP, and slightly inferior to SBP for hypertension patients.

Abstract WP214: Differential Impact of Stroke Risk Factors Across the Age Spectrum: The Reasons for Geographic and Racial Differences in Stroke (REGARDS) Study

Introduction: With the “graying of America” an increasing proportion of stroke events occur in the very old; however, risk models to predict stroke were developed in studies with few elderly participants. We hypothesized that, among those aged 45+, predictive factors for stroke differ in older than younger people. Methods: REGARDS enrolled 30,231 black and white adults 45 and older in 2003-7. We considered 3 age strata (45-65, 66-73 and 74+) with approximately equal number of stroke events, and hence equal statistical power to detect risk factor associations. Age specific race-sex adjusted associations of risk factors were assessed using proportional hazards models. We used bootstrap techniques to test the likelihood of specific risk factors being selected for a prediction model in each of the 3 age groups. This was based on the percentage of times each risk factor was selected for inclusion by backwards elimination in 1000 bootstrap model. Results: 27,123 stroke-free participants were followed for 9.4 years, during which 1,114 ischemic strokes occurred (379, 364 and 371 across age groups). Among those age 65 and younger, risk factors with the strongest association with incident stroke were heart disease, hypertension, atrial fibrillation, diabetes, and chronic kidney disease (HRs >2; see table). Hypertension, diabetes, heart disease, smoking, atrial fibrillation, and frailty were selected in the multivariable model for those age 45-65. The impact of some factors decreased at older age 74+, where atrial fibrillation, LVH, smoking, hypertension and frailty emerged as most important. Conclusions: Many “traditional” stroke risk factors were defined in middle-aged populations (and were confirmed here); however, a different milieu of risk factors are important for stroke risk prediction in the elderly.

Perioperative low cardiac output: A predictive factor for stroke after lung transplantation

Atrial arrhythmias (AA) frequently occur after thoracic surgery, and are usually transient and benign. Strokes are a rare but serious neurological complication after lung transplantation. Although their incidence is now well known, their predictive factors remain uncertain. The objective of this study was to evaluate the occurrence of postoperative AA in a cohort of lung transplanted patients and their relationship with the onset of stroke. In total, 271 consecutive lung transplanted patients between 2005 and 2014 were retrospectively studied and followed during a mean of 3.2 ± 2.4 years. The data collected included clinical features, preoperative assessment, surgical reports and clinical follow-up. All arrhythmias recorded since the transplantation were analyzed. All strokes were collected. Thirty-three percent of patients presented AA in the immediate postoperative period. Fifteen patients (5.5%) presented stroke after transplantation, in 13 cases of ischemic origin. For 80%, stroke occurred within the first 6 months postoperatively. Mean CHA2DS2-VASc score was 1.1. Per- or postoperative low cardiac output was found as the only independent predictive factor of stroke onset [OR 4.6; CI (1.18–17.86); P = 0.027]. Postoperative AA and CHA2DS2-VASc score were not significantly associated with stroke. Postoperative AA did not affect in-house and long-term mortality. AA are frequent after lung transplantation and don’t affect mortality. Neither AA nor CHA2DS2-VASc score are related to the occurrence of stroke. In contrast, a perioperative low cardiac output is an independent predictive factor of stroke after lung transplantation.

NR2 antibodies: Risk assessment of transient ischemic attack (TIA)/stroke in patients with history of isolated and multiple cerebrovascular events

Background and purpose Predicting stroke using biomarkers would enable clinicians to help prevent stroke or mitigate damage. Several stroke biomarkers have been investigated but none has shown near term predictive value. Methods We studied patients presenting with a history of stroke or transient ischemic attack (TIA) to determine whether serum levels of autoantibodies to the NMDA receptor NR2 peptide (NR2Ab) reflected the presence of recent stroke compared with controls. Antibody levels were also correlated with clinical risk factors for stroke, including diabetes, hypertension, hyperlipidemia, and history of recent TIA or stroke. Results Of the 245 patients that presented with acute stroke or TIA, 130 consented to participate and results are available for the 120. Volunteers from the community were recruited as controls. Males and females with multiple recent strokes and females with acute strokes had elevated NR2Ab levels compared to non-stroke patients or controls. Using a multiple regression model, the predictive value for NR2Ab was compared to clinical risk factors. In men, the presence of stroke correlated with hypertension ( p < 0.001) and NR2Ab levels ( p < 0.01) and in women the presence of stroke correlated with hypertension ( p < 0.001), diabetes ( p < 0.05), atrial fibrillation ( p < 0.05) and NR2Ab ( p < 0.01). Conclusion These results suggest that NR2Ab levels reflect a history of multiple strokes and may serve as a predictive factor for stroke.

Cerebral hemodynamics as a predictor of stroke in adult patients with moyamoya disease: a prospective observational study

Moyamoya disease is an obliterative vasculopathy of the large arteries at the base of the brain. In the US, it most commonly affects women in their 3rd and 4th decades of life, frequently causing ischemic stroke. The natural history of this disorder is not well described. It is very likely that hemodynamic factors play an important role in the risk of future stroke, as has been established in atherosclerotic carotid occlusive disease. The authors describe an ongoing, prospective observational study designed to test the hypothesis that increased oxygen extraction in the cerebral hemisphere beyond the occlusive lesion is a predictor of subsequent risk of ipsilateral stroke in medically treated patients with moyamoya phenomenon. On enrollment, all patients undergo regional measurements of cerebral oxygen extraction fraction (OEF) with PET. Information on baseline clinical, laboratory, epidemiological, and angiographic risk factors are obtained at the time of the PET study. Decisions regarding surgery are made by the treating physicians based on clinical information while being blinded to PET data. Patients undergo follow-up at 6-month intervals to determine the subsequent risk of ipsilateral stroke. All patients will return at 1 and 3 years for repeat PET studies. Secondary, exploratory, aims of this longitudinal and blinded study are to determine other predictive factors for stroke in this population; to determine preliminary estimates of the effects of different medical treatment regimens in this population; to determine the temporal changes in hemodynamic impairment in medically treated patients; to determine the effects of surgery on hemodynamic impairment in the subset of patients who undergo surgical revascularization; and to obtain estimates of surgical complication rates for patients with and without hemodynamic impairment.

Perioperative Stroke in Coronary Artery Bypass Surgery: Analysis of Risk Factors

The incidence of neurologic complications after coronary bypass surgery is steadily rising as older and sicker patients are increasingly being treated. To identify patients requiring special attention, we reviewed the records in 2263 consecutive cases of first-time coronary artery bypass grafting in 1993-1995, in order to find predictive factors for stroke. Significant factors in univariate analysis were patient age, peripheral vascular disease, cerebrovascular disease, renal failure (defined as serum creatinine > or = 150 micromol/l), aneurysmal disease of the abdominal aorta, stenosis of the left main coronary artery, urgent or emergency operation, NYHA class, cardiopulmonary bypass time, number of aortic anastomoses, intraoperatively detected loose or calcified atheromatosis of the ascending aorta, left ventricular venting, intra-aortic balloon counterpulsation, cardiac complications necessitating early reoperation, and perioperative myocardial infarction. In a multivariate analysis, age, renal failure, cerebrovascular disease, peripheral vascular disease, NYHA class, number of aortic anastomoses, perioperative myocardial infarction and intraoperatively detected loose atheromatosis of the ascending aorta remained significant.