Predictor Of Ischemic Stroke Research Articles

Predictors of Ischemic Stroke in a cohort of patients with Chagas Cardiomyopathy: the CLOT-Chagas study

Abstract Introduction a high risk of embolic events characterizes Chronic Chagas Cardiomyopathy (CCC) due to the presence of structural alterations of the left ventricle, the high incidence of arrhythmias, and intrinsic coagulation disorders. Despite its relevance, there is limited information on factors associated with this type of embolic event in patients with CCC, with most studies designed as case-control studies. This study aimed to prospectively analyze independently associated factors with this population's Ischemic Stroke (IS). Materials and Methods A prospective study was conducted between 2019 and 2023 at a cardiovascular center's Heart Failure and Heart Transplant Clinic. Adult patients diagnosed with CCC were included, recording sociodemographic, clinical, and echocardiographic variables as potential predictors of IS. Patients were followed up for 18 months via telephone for outcome assessment. Multivariate logistic regression models were used to identify factors potentially associated with IS during follow-up. Results A total of 232 patients diagnosed with CCC were included (males: 54.9%; median age: 67 years), the majority of whom were receiving anticoagulant therapy (n=144; 62.1%), with DOACs being the most frequently prescribed type of anticoagulants (51%). During follow-up, 16 patients (6.9%) developed an IS. There was a trend towards a lower incidence of IS in patients treated with direct oral anticoagulants (6.8%) compared to those receiving Warfarin (11.5%); however, this difference was not statistically significant (p=0.584). In the multivariate regression analysis including all potential predictors of IS, only the presence of a ventricular aneurysm (RR 5.64; 95% CI 1.61-19.70, p=0.007) and the score obtained when applying the Pfeiffer cognitive impairment questionnaire (RR 0.56; 95% CI 0.42-0.75, p<0.001) were significantly associated with the outcome of IS, even after adjusting for age, sex, NYHA functional class, ejection fraction, and anticoagulant therapy. The model composed of ventricular aneurysms and the Pfeiffer questionnaire score showed adequate performance in predicting IS during follow-up (AUC 0.79). Conclusions and Discussion: The incidence of IS in this population was higher than reported in the literature for both CCC patients and those with heart failure from other etiologies. The finding of an association between the presence of ventricular aneurysms and IS has been previously reported; however, the association between the Pfeiffer cognitive test and the development of IS represents a novel observation that deserves validation in future studies for its applicability in the clinical setting.

Predictors of ischemic stroke in Chagas disease: Insights into mechanisms beyond cardiomyopathy severity

BackgroundChagas disease is a risk factor for ischemic stroke, which causes high mortality rates and significant disability. This study aims to determine the incidence and risk factors for ischemic strokes in a large cohort of Chagas cardiomyopathy patients, with a particular focus on the mechanisms involved in the pathophysiology of stroke in this condition. MethodsThe study enrolled 517 patients with Chagas cardiomyopathy who were referred to our institution from March 2000 to December 2021. All patients underwent systematic cardiological and neurological assessments. The primary outcome was the occurrence of ischemic stroke during the follow-up period, classified based on the SSS-TOAST and CCS criteria. Natural cubic splines functions were applied to examine the potential nonlinear association between continuous variables and stroke risk. ResultsThe mean age of the cohort was 52 ± 13 years, and 299 (58 %) were men. During a mean follow-up period of 4.8 years (interquartile range-IQR 1.1 to 7.1 years), a total of 72 patients (14.8 %) had an ischemic stroke, being fatal in 10. The overall incidence rate of ischemic stroke was 3.0/100 patient-years (95 % confidence interval 2.4 to 3.8). The stroke subtypes were cardioembolic (n = 41), undetermined (n = 11), and other subtypes (n = 20). The predictors of stroke were age, left atrial volume, left ventricular ejection fraction (LVEF), LV thrombus and prior stroke with thrombus. There was a nonlinear relationship between stroke risk, LVEF, and left atrial volume. A bimodal distribution of stroke occurrences was observed according to the severity of LV dysfunction, with a threshold for LVEF of 45 %. The final model for stroke risk prediction showed good discrimination, with a C statistic of 0.775. ConclusionsIn a contemporary cohort of Chagas disease patients with a broad spectrum of disease severity, stroke incidence remains high despite anticoagulation. Stroke risk shows a nonlinear association with ventricular dysfunction and left atrial size, highlighting a distinct bimodal pattern of stroke occurrence in Chagas disease.

Predictors of Ischemic Stroke After Acute Coronary Syndrome: A Retrospective Analysis.

Background Ischemic stroke (IS) is a fatal complication of acute coronary syndrome (ACS). Factors that speed up IS development after ACS are understudied, especially in developing countries like Pakistan. Thus, this study was designed to identify the potential risk factors of IS in patients with a preceding episode of ACS. Methodology This retrospective study was performed on 208 patients whose ACS and its consequent complications such as IS were managed in the cardiac and neurology units of Benazir Bhutto Hospital, Rawalpindi, from January 2022 to March 2023. Patients were enrolled via consecutive sampling and pre-defined inclusion and exclusion criteria. Before data collection, informed consent and ethical approval were obtained. Data were retrieved from the medical records of the patients. A self-structured proforma was applied to collect data. SPSS version 25 (IBM Corp., Armonk, NY, USA) was used for data analysis. The study variables between patients with and without IS were compared using descriptive and inferential statistics. The association between IS and its possible risk factors in patients who had previously experienced ACS was determined using multivariate logistic regression. Results Of the 208 enrolled patients, 24 (11.54%) had IS following ACS. Sedentary lifestyle (odds ratio (OR) = 3.099, 95% confidence interval (CI) = 1.025~4.219, p = 0.009), hypertension (OR = 3.060, 95% CI = 1.798~4.876, p = 0.002), diabetes mellitus (OR = 2.899, 95% CI = 1.126~4.112, p = 0.009), dyslipidemia (OR = 2.907, 95% CI = 1.332~4.254, p = 0.007), history of smoking (OR = 2.760, 95% CI = 1.234~4.122, p = 0.018), and non-adherence to ACS medication (OR = 2.966, 95% CI = 1.300~4.266, p = 0.030), were the risk factors of IS among patients with preceding ACS. Conclusions In the study population, the incidence of IS following ACS was significant. Sedentary lifestyle, hypertension, diabetes mellitus, dyslipidemia, smoking history, and non-compliance with ACS therapy all played a significant role in the development of IS in patients with prior ACS. Proper management of ACS and associated risk factors could lead to the prevention of serious complications such as IS.

Incidence and Predictors of Stroke in Australian Adults With Congenital Heart Disease (2000-2017).

Adults with congenital heart disease (CHD) are at increased risk of stroke but high-quality population level data on stroke incidence in these patients are scant. A retrospective whole-population Western Australian cohort of adultpatients with CHD aged 18 to 64 years was created and followed from January 2000 to December 2017 using linked hospital data. Stroke incidence rates within the adult cohort with CHD were calculated and compared with the general population via direct standardization. A nested case-control design assessed predictors of ischemic and hemorrhagic stroke within the cohort. Among 7916 adults with CHD, 249 (3.1%) incident strokes occurred at a median age of 47 years; 186 (2.3%) ischemic, 33 (0.4%) hemorrhagic and 30 (0.4%) unspecified strokes. Ischemic and hemorrhagic stroke incidence was, respectively, 9 and 3 times higher in adults with CHD than the general population. Absolute risk was low with annual rates of 0.26% (ischemic) and 0.05% (hemorrhagic). Highest rates were observed in adults with shunt and left-sided lesions. Predictors of ischemic stroke in adults with CHD included recent cardiac surgery, left-sided valve repair/replacements, shunt lesions, and traditional risk factors (hypertension, infective endocarditis, peripheral vascular disease, and tobacco use). Mental health disorders and increasing Charlson's comorbidity scores were strongly associated with higher risk of ischemic and hemorrhagic stroke. The CHA2DS2VASc score was associated with ischemic stroke incidence. This study provides the first population-based stroke incidence estimates for adults with CHD in Australia, showing elevated stroke risk across different CHD lesions. It highlights the potential clinical importance of managing comorbidities, especially mental health.

P-wave duration and interatrial block as predictors of ischemic stroke: a systematic review and meta-analysis

Abstract Introduction Ischemic stroke-risk has been associated with clinical characteristics, atrial remodeling and P- wave changes, like P-wave duration (PWD) or interatrial block (IAB). Despite the increasing evidence though, their use in risk-stratification remains limited. Purpose The aim of this review and meta-analysis was to examine the predictive value of PWD/IAB for stroke and offer practical implications. Methods Publication databases were systematically searched and studies reporting PWD and/or morphology at baseline and thromboembolic events (TEs) during follow-up (FUP) were included. IAB was defined as partial (pIAB) if PWD≥120 ms or advanced (aIAB) if the P-wave was biphasic in the inferior leads. After quality assessment and data extraction, random-effects analysis calculated odds ratio (OR) and confidence intervals (CI). Subgroup-analysis was performed to address heterogeneity. Results Among 180.997 patients (17 studies, mean 66 years old), including primary care patients (n=152.759), 15.578 (9%) had a new TE during 4 years of FUP. The pIAB was significant TE-risk predictor for non-primary care patients (OR:1.7; 95% CI:1.4-2.1) and those with prior TE (OR:1.8; 95% CI:1.4-2.2), but not for primary-care (OR:1.0) or those without prior TE (OR:1.3). The aIAB was significant TE-risk predictor both for primary (OR:1.6; 95% CI:1.4-1.9) and nonprimary care (OR:2.5; 95% CI:1.8-3.4) as well as those without (OR:2.2; 95% CI:1.1-4.4) or with prior TE (OR:2.6; 95% CI:1.4-4.7). There was heterogeneity but no publication bias in the subgroup-analysis. Conclusion Interatrial block is an independent predictor of TE-risk. The association is stronger for non-primary care patients or those with prior TE. Thus, PWD and IAB could be used as selection criteria for intensive screening, follow-up or interventions.

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.

Predictive capacity of combined P-wave-indices-CHA2DS2-VASc Score in sinus node dysfunction patients without atrial fibrillation

Abstract Background and Aims Isolated sinus node dysfunction (ISND) is sinus node dysfunction without atrial fibrillation. A high risk of ischemic stroke (IS) has been reported in western ISND populations, but its epidemiology in Chinese populations remains unknown. Moreover, anticoagulation therapy is not recommended in ISND management under current guidelines, partially due to the lack of a precise predictive score to evaluate IS risk. In Chinese ISND patients, IS incidence and IS-risk prediction capacity of a new score incorporating P-wave indices (PWIs) should be investigated. Methods In this longitudinal cohort study with prospective design, 1185 ISND patients were analyzed. Hazard ratios (HRs) and 95% CIs of PWIs for IS were estimated by Cox proportional hazards models. Based on HRs of significantly abnormal PWIs and CHA2DS2-VASc score, new score was constructed. IS prediction improvement was assessed by discrimination, calibration, and clinical effectiveness. The cutoff value of the new score was explored by restricted cubic spline analysis. Results 124 (10.46%) ISND patients developed IS (yearly rate: 1.63%; 95% CI: 1.49%-1.78%) after a median follow-up time of 3.02 years. In them, P-wave terminal force in ECG-lead V1 (PTFV1) was the only significantly abnormal PWI (adjusted HR: 2.56; 95% CI: 1.72–3.80). We incorporated PTFV1 results with the CHA2DS2-VASc score to generate a P-combined score. For 5-year IS risk, P-combined score improved the area under the receiver operating characteristic curve (95% CI) from 0.647 (0.590-0.703) to 0.706 (0.652-0.760) and improved Harrell's C-statistic (95% CI) from 0.678 (0.618-0.738) to 0.716 (0.657-0.774). The categorical net reclassification improvement and the relative integrated discrimination improvement were 0.248 (0.120-0.363) and 0.021 (0.008-0.035), respectively. The calibration and decision curve analysis shown improvement at the same time. The cutoff value (P-combined score=3) by restricted cubic spline analysis was confirmed. Conclusions Chinese ISND patients have a higher IS risk than the general population. Incorporating PWIs into a P-combined score increased IS prediction capacity for ISND patients. Accurate stratification of IS risk should facilitate anticoagulation therapeutic strategies in ISND patients after further randomized trials with P-combined score-predicted high-risk ISND patients.Structured Graphical Abstract

Self-Efficacy and Self-Care as Risk Factors for Ischemic Stroke: Development and Validation of a Nomogram.

This study addresses the knowledge gap on how self-efficacy and self-care affect stroke risk as factors and develops a valuable tool for clinicians to assess stroke risk. From January 2022 to January 2023, this nested-case control study was conducted. Medical data including gender, age, ethnicity, locality, education, marital status, employment, caregiver, social environment, blood viscosity, Barthel Index, modified Rankin Scale (mRS), stroke risk score, self-care score, and self-efficacy score were collected. Logistic regression was used to predict stroke risk, and a nomogram was developed and validated. 240 patients were included in the analysis. Stroke risk score (OR: 3.513; p = 0.005), self-efficacy score (OR: 0.753; p = 0.048), and self-care score (OR: 0.817; p = 0.018) were predictors of ischemic stroke. Internal validation was carried out, with a C-index of 0.774, and the Hosmer-Lemeshow test indicated a good fit (p = 0.92). The calibration plot also shows that this nomogram model has good calibration abilities. The decision curve analysis (DCA) results show a threshold probability range of 10-95%. A nomogram has been developed with good validity, calibration, and clinical utility, including self-care and self-efficacy as risk factors for predicting ischemic stroke.

Value of C-reactive Protein Level to Distinguish between Ischemic and Hemorrhagic Stroke

Abstract Background Stroke is considered as a life threatening case in neurological patients. It is one of the leading causes of morbidity and mortality worldwide, as cerebrovascular accidents rank first in the frequency and importance among all neurological disease. Spontaneous ICH accounts for approximately 20% of all strokes, and it is characterized by high rates of mortality and residual disability among survivors. Aim of the Work To detect the value of serum CRP level in differentiation between ischemic and hemorrhagic stroke. Patients and Methods We conducted a prospective cross section study which included patients who were diagnosed with acute stroke through the period Jan 2021 and July 2021, we recruited 72 patients who were admitted to stroke unit of Ain shams university, they were subsequently divided based on etiology of the stroke into 2 groups: Ischemic stroke group: 36 patients and hemorrhagic stroke group: 36 patients. Results We conducted a cross section analytical study to compare the CRP level among egyptian cohort of patients (n = 72) who were diagnosed with acute ischemic (n = 36) versus hemorrhagic strokes (n = 36) who were admitted to emergency of Ain shams university, aiming to detect the value of serum CRP level in differentiation between ischemic and hemorrhagic stroke. In the present study we found that there was a statistically significant difference between the studied groups and CRP on day 0, mean CRP during Hospital Stay and CRP at discharge. Conclusion Elevated CRP levels are associated with excessive risk of ischemic stroke but not hemorrhagic stroke. The serum CRP level can be used as a predictor for ischemic stroke in the general population.

Left ventricular hypertrophy and left atrial size are associated with ischemic strokes among non-vitamin K antagonist oral anticoagulant users.

Ischemic strokes (IS) occurring in patients taking non-vitamin K antagonist oral anticoagulants (NOACs) are becoming increasingly more frequent. We aimed to determine the clinical, echocardiographic, and neuroimaging markers associated with developing IS in patients taking NOACs for atrial fibrillation. From a quaternary care center, clinical/radiologic data were collected from consecutive NOAC users with IS and age-matched controls without IS. Brain MRIs were reviewed for markers of cerebral small vessel disease. Variables with significant differences between groups were entered into a multivariable regression model to determine predictors of IS. Among IS patients, a Cox regression analysis was constructed to determine predictors of IS recurrence during follow-up. 112 patients with IS and 94 controls were included in the study. Variables significantly different between groups included apixaban use, dabigatran use, prior cerebrovascular events, hemoglobin A1c (HbA1c), left ventricular hypertrophy, left atrial volume index, and severe white matter hyperintensities. After multivariable adjustment, prior cerebrovascular events (aOR 23.86, 95% CI [6.02-94.48]), HbA1c levels (aOR 2.36, 95% CI [1.39-3.99]), left ventricular hypertrophy (aOR 2.73, 95% CI [1.11-6.71]) and left atrial volume index (aOR 1.05, 95% CI [1.01-1.08]) increased the risk of stroke, whereas apixaban use appeared to decrease the risk (aOR 0.38, 95% CI [0.16-0.92]). Malignancy was associated with IS recurrence (aHR 4.90, 95% CI [1.35-18.42]) after adjustment for age and chronic renal failure. Prior cerebrovascular events, diabetes, left ventricular hypertrophy, and increased left atrial size are risk factors for developing an IS among NOAC users.

Biliverdin reductase B is a plasma biomarker for intraplaque hemorrhage and a predictor of ischemic stroke in symptomatic carotid stenosis

Biliverdin reductase B is a plasma biomarker for intraplaque hemorrhage and a predictor of ischemic stroke in symptomatic carotid stenosis

The identification of sex-specific biomarkers in peripheral blood mononuclear cells from elderly individuals with ischemic stroke.

The aim of this study was to identify sex-specific biomarkers for ischemic stroke (IS) prophylaxis in elderly individuals. The GSE22255 dataset for elderly individuals with IS was retrieved from the gene expression omnibus database. Thereafter, gene ontology and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway enrichment analyses were performed, as well as gene set enrichment analysis (GSEA). Furthermore, protein-protein interactions (PPIs) were explored using the STRING database, and to screen central genes from the Cytoscape PPI network, corresponding to peripheral blood samples from elderly individuals, we used the molecular complex detection plug-in and cytoHubba. Moreover, a Venn diagram was used to visualize the key genes common among elderly women and men with IS. Statistical analysis was also performed, and receiver operating characteristic (ROC) curves were constructed to evaluate the specificity and sensitivity of the prediction of IS in the elderly. Compared with the healthy controls, in elderly women with IS, 511 biological process (BP) terms, 16 molecular function (MF) terms, and 34 KEGG terms were significantly enriched, whereas in the elderly men with IS, 681 BP terms, 12 MF terms, and 44 KEGG terms were enriched. The GSEA revealed 99 and 140 significantly enriched gene sets in elderly women and men with IS, respectively. Furthermore, in the PPI network, 10 hub genes for each sex with high specificity and sensitivity were identified using ROC curves. Ten genes for each sex with significant differential expression were also identified in individuals with IS. The novel sex-specific gene targets may be promising diagnostic or prognostic markers and potential therapeutic targets for IS in the elderly.

Biliverdin Reductase B Is a Plasma Biomarker for Intraplaque Hemorrhage and a Predictor of Ischemic Stroke in Patients with Symptomatic Carotid Atherosclerosis

Background: Intraplaque hemorrhage (IPH) is a hallmark of atherosclerotic plaque instability. Biliverdin reductase B (BLVRB) is enriched in plasma and plaques from patients with symptomatic carotid atherosclerosis and functionally associated with IPH. Objective: We explored the biomarker potential of plasma BLVRB through (1) its correlation with IPH in carotid plaques assessed by magnetic resonance imaging (MRI), and with recurrent ischemic stroke, and (2) its use for monitoring pharmacotherapy targeting IPH in a preclinical setting. Methods: Plasma BLVRB levels were measured in patients with symptomatic carotid atherosclerosis from the PARISK study (n = 177, 5 year follow-up) with and without IPH as indicated by MRI. Plasma BLVRB levels were also measured in a mouse vein graft model of IPH at baseline and following antiangiogenic therapy targeting vascular endothelial growth factor receptor 2 (VEGFR-2). Results: Plasma BLVRB levels were significantly higher in patients with IPH (737.32 ± 693.21 vs. 520.94 ± 499.43 mean fluorescent intensity (MFI), p = 0.033), but had no association with baseline clinical and biological parameters. Plasma BLVRB levels were also significantly higher in patients who developed recurrent ischemic stroke (1099.34 ± 928.49 vs. 582.07 ± 545.34 MFI, HR = 1.600, CI [1.092–2.344]; p = 0.016). Plasma BLVRB levels were significantly reduced following prevention of IPH by anti-VEGFR-2 therapy in mouse vein grafts (1189 ± 258.73 vs. 1752 ± 366.84 MFI; p = 0.004). Conclusions: Plasma BLVRB was associated with IPH and increased risk of recurrent ischemic stroke in patients with symptomatic low- to moderate-grade carotid stenosis, indicating the capacity to monitor the efficacy of IPH-preventive pharmacotherapy in an animal model. Together, these results suggest the utility of plasma BLVRB as a biomarker for atherosclerotic plaque instability.

Risk factors assessment and a Bayesian network model for predicting ischemic stroke in patients with cardiac myxoma.

This study aims to identify relevant risk factors, assess the interactions between variables, and establish a predictive model for ischemic stroke (IS) in patients with cardiac myxoma (CM) using the Bayesian network (BN) approach. Data of patients with CM were collected from three tertiary comprehensive hospitals in Beijing from January 2002 to January 2022. Age, sex, medical history, and information related to CM were extracted from the electronic medical record system. The BN model was constructed using the tabu search algorithm, and the conditional probability of each node was calculated using the maximum likelihood estimation method. The probability of each node of the network and the interrelationship between IS and its related factors were qualitatively and quantitatively analyzed. A receiver operating characteristic (ROC) curve was also plotted. Sensitivity, specificity, and area under the curve (AUC) values were calculated and compared between the BN and logistic regression models to evaluate the efficiency of the predictive model. A total of 416 patients with CM were enrolled in this study, including 61 with and 355 without IS. The BN model found that cardiac symptoms, systemic embolic symptoms, platelet counts, and tumor with high mobility were directly associated with the occurrence of IS in patients with CM. The BN model for predicting CM-IS achieved higher scores on AUC {0.706 [95% confidence interval (CI), 0.639-0.773]} vs. [0.697 (95% CI, 0.629-0.766)] and sensitivity (99.44% vs. 98.87%), but lower scores on accuracies (85.82% vs. 86.06%) and specificity (6.56% vs. 11.48%) than the logistic regression model. Cardiac symptoms, systemic embolic symptoms, platelet counts, and tumor with high mobility are candidate predictors of IS in patients with CM. The BN model was superior or at least non-inferior to the traditional logistic regression model, and hence is potentially useful for early IS detection, diagnosis, and prevention in clinical practice.

Abstract WP194: The Prevalence Of Intracranial Artery Stenosis And Ischemic Stroke In Familial Hypercholesterolemia: A Retrospective Cohort Study

Introduction: Familial hypercholesterolemia (FH) is an autosomal dominant genetic disorder, characterized by the early-onset elevation of LDL cholesterol (LDL-C) levels and premature coronary artery disease (CAD). Although the association between FH and CAD is well known, that between FH and cerebrovascular diseases including stroke and intracranial artery stenosis (ICAS) is still unclear. We hypothesized that long-standing excessive LDL-C levels in FH patients confer an increased risk of developing ICAS, and consequently FH patients are subject to ischemic stroke (IS). The aim of our study is to unveil the relationship between FH and cerebrovascular diseases including ICAS and IS. Methods: The associations of FH and high LDL-C with IS and ICAS were tested in neurologically normal subjects (NNS) who voluntarily underwent brain MRI from December 2000 to September 2011 at Health Science Center in Shimane, Japan, and FH patients who underwent brain MRI at National Cerebral and Cardiovascular Center in Japan from May 2005 to March 2020. The severity of ICAS was evaluated with MRA. Results: We enrolled 3181 NNS and 167 FH patients with the mean age of 62.3±0.2 and 61.5±1.3, respectively ( p = 0.10). There were 1159 females (46.2%) in NNS and 89 (53.3%) in FH patients ( p = 0.075). The prevalence of ICAS in the FH patients was significantly higher than in the NNS (5.7% vs. 37.1%, p &lt; 0.001), and the incidence of IS was also higher in the FH patients (0.8% vs. 10.8%, p&lt;0.001). Multiple regression analysis revealed that FH was an independent predictor for IS (OR 13.96, 95%CI 6.60-29.55, p &lt; 0.001). Kaplan-Meier analysis showed a significant difference in the incidence of IS between the NNS and FH patients ( p &lt; 0.001). Moreover, the presence of ICAS significantly associated with the incidence of IS in the FH patients (Cox regression analysis: HR 6.55, 95%CI 1.66-25.78, p = 0.007). Discussion: Our study demonstrated a significantly higher prevalence of ICAS in FH patients than control subjects with similar age. Moreover, ICAS conferred an increased risk of IS among the FH patients. These results may necessitate routine examinations of the brain as well as systemic arteries in FH patients. We conclude a positive relationship of FH with cerebrovascular diseases, including ICAS and IS.

Abstract TP162: Age, Weight, And Prior Stroke Predicts Ischemic Stroke Despite Direct Acting Oral Anticoagulant Use In Patients With Atrial Fibrillation

Introduction: Direct-acting oral anticoagulants (DOACs) and warfarin are standard of care for secondary prevention of ischemic stroke (IS) in persons with atrial fibrillation (AF). However, despite adequate anticoagulation (AC), patients may still experience recurrent IS. We aimed to study the characteristics of patients who developed IS despite therapeutic AC, specifically with DOACs. Methods: Between 2012 and 2021, patients admitted at our hospital with IS despite adequate AC for AF were enrolled. Clinical variables collected included National Institute of Health Stroke Scale (NIHSS), CHA 2 DS 2 -VASc and modified Rankin Score (mRS) at admission. Baseline characteristics were compared between patients taking DOACs and warfarin. Logistic regression analyses were performed to identify predictors of IS in patients using DOACs. Results: A total of 595 patients were included. Of these, 291 patients (48.9%) were on DOACs with a mean age of 75.21 and 43.9% were female. The median CHA 2 DS 2 -VASc and NIHSS score in the DOAC group was 4 and 6, respectively. Compared to those on Warfarin, patients on DOACs were younger (75.21 vs. 78.99 p &lt; 0.001), more likely to be men (55.3% vs. 45.2% p = 0.01) and had higher rates of prior TIA/IS (37.5% vs. 29.3% p = 0.04). Both groups had similar rates of hemorrhagic transformation, but more patients in the DOAC group were on antiplatelet agents concomitantly (21% vs. 6.9% p &lt; 0.001). The most prescribed DOAC was apixaban (66.3%) and cardioembolism was the most common stroke etiology (63.6%), followed by cryptogenic, which was significantly higher in the DOAC group (18.2% vs. 8.3% p = 0.02). Notably, DOAC failure in preventing IS was associated with younger age, overweight/obesity, and prior TIA/IS (Table) . Conclusions: IS despite the use of DOACs is more likely to occur in younger people with prior TIA/IS and obesity. Focusing on preventative strategies and risk factor control for competing mechanisms in this subgroup may help prevent IS recurrence.

Metabolic Profile as a Predictor of Ischaemic Stroke: The Experience of a Rural Hospital in Nigeria

BACKGROUNDThe metabolic profile which includes glycated haemoglobin, insulin resistance, pancreatic beta cell function and lipid profile is frequently deranged in acute ischaemic stroke. Stroke is a leading cause of death worldwide and an emerging cause of long-term disability and mortality in Africa. Our study aimed to determine the correlation between the metabolic profile and acute ischaemic stroke in a rural Hospital in Southern Nigeria.METHODOLOGYThis was a prospective cross-sectional study. Fifty consecutive first-ever ischaemic stroke patients presenting within 72 hours of stroke were matched for age and sex with 3 control groups (49 persons with type 2 diabetes and hypertension, 49 persons with hypertension only and 57 apparently healthy individuals). Blood samples were obtained from all participants to determine glycated haemoglobin, fasting lipid profile, fasting plasma glucose, fasting insulin and C-peptide and random plasma glucose (in stroke cases at presentation). Insulin resistance and pancreatic beta-cell function were determined using the Homeostatic Model Assessment (HOMA). Data were analysed by multivariate and univariate statistics.RESULTSOne hundred and two (49.8%) males and 103 (50.2%) females participated in the study. The overall mean age of the study participants was 61.6 ± 10.1 years. Compared with the control groups, predictors of acute ischaemic stroke were Fasting insulin (hyperinsulinaemia) [OR (95%CI) = 1.108 (1.043-1.178), p= 0.001], HOMA-β% [OR (95%CI) = 0.994 (0.990-1.001) p=0.006] and total cholesterol [OR (95%CI)= 0.009 (0.001-0.012) p=0.022].CONCLUSIONIn this study, hyperinsulinaemia, impaired beta-cell secretory function (HOMA-β) and elevated total cholesterol were found to be significant risk factors of ischaemic stroke. Hence, the need for regular screening to detect abnormal metabolic profiles and prompt treatment.

Biliverdin Reductase B Is a Plasma Biomarker for Intraplaque Hemorrhage and a Predictor of Ischemic Stroke in Symptomatic Carotid Stenosis

Biliverdin Reductase B Is a Plasma Biomarker for Intraplaque Hemorrhage and a Predictor of Ischemic Stroke in Symptomatic Carotid Stenosis

Cerebral infarction in HIV-negative patients with cryptococcal meningitis: its predictors and impact on outcomes

BackgroundDescriptions of the patterns of acute/subacute cerebral infarction (ASCI) in HIV-negative patients with cryptococcal meningitis (CM) are scarce, and the predictors of ischemic stroke and outcomes following ASCI remain unclear.AimTo study the clinical characteristics and evaluate the predictors of ASCI in HIV-negative patients with CM and assess the impact of ischemic stroke on the outcomes of the patients.MethodsWe retrospectively analyzed the data of 61 HIV-negative patients with CM treated between January, 2016 and February, 2022, and among them, 53 patients with complete neuroimaging and cerebrospinal fluid (CSF) data were enrolled in this study. The cohort was stratified by the occurrence of ASCI diagnosed based on MRI evidences for comparison of the clinical characteristics (consciousness disturbance, GCS score, duration of symptoms, and treatment), CSF parameters, imaging findings (meningeal inflammation, hydrocephalus, posterior fossa exudates) and outcomes of the patients. A favorable outcome was defined as a modified Rankin scale (mRS) score ≤ 2 and a poor outcome as a mRS score > 2. Logistic regression analysis was used to identify the risk factors of ASCI in the HIV-negative patients with CM.ResultsOf the 53 HIV-negative patients with CM, 14 (26.4%) had ASCI. The incidences of fever, headache, neck stiffness, duration of symptoms, CSF parameters, meningeal enhancement in brain MRI and the treatment regimens were similar between the patients with and those without ASCI. Most of the infarcts (92.9%) were of the lacunar type, involving both the anterior and posterior territories. Basal ganglia-corona radiata and the brainstem-cerebellum were the most frequently involved sites. Univariate logistic regression analysis suggested that consciousness disturbance (P = 0.002), MRI evidence of hydrocephalus (P = 0.042) and posterior fossa exudates (P = 0.028) were predictors of ASCI in these HIV-negative patients with CM. Multivariate analysis identified consciousness disturbance as a significant predictor of ASCI (P = 0.020). Compared with the patients without ASCI, the HIV-negative patients with CM and ASCI had poorer outcomes (P = 0.001).ConclusionASCI can occur in HIV-negative patients with CM, presented commonly as multiple lacunar infarctions involving all the cerebrovascular territories. The presence of consciousness disturbance, hydrocephalus and posterior fossa exudates may increase the risk of ASCI in patients with CM. ASCI is associated with a poor outcome of the HIV-negative patients with CM.

Risk factors and a Bayesian network model to predict ischemic stroke in patients with dilated cardiomyopathy.

This study aimed to identify risk factors and create a predictive model for ischemic stroke (IS) in patients with dilated cardiomyopathy (DCM) using the Bayesian network (BN) approach. We collected clinical data of 634 patients with DCM treated at three referral management centers in Beijing between 2016 and 2021, including 127 with and 507 without IS. The patients were randomly divided into training (441 cases) and test (193 cases) sets at a ratio of 7:3. A BN model was established using the Tabu search algorithm with the training set data and verified with the test set data. The BN and logistic regression models were compared using the area under the receiver operating characteristic curve (AUC). Multivariate logistic regression analysis showed that hypertension, hyperlipidemia, atrial fibrillation/flutter, estimated glomerular filtration rate (eGFR), and intracardiac thrombosis were associated with IS. The BN model found that hyperlipidemia, atrial fibrillation (AF) or atrial flutter, eGFR, and intracardiac thrombosis were closely associated with IS. Compared to the logistic regression model, the BN model for IS performed better or equally well in the training and test sets, with respective accuracies of 83.7 and 85.5%, AUC of 0.763 [95% confidence interval (CI), 0.708-0.818] and 0.822 (95% CI, 0.748-0.896), sensitivities of 20.2 and 44.2%, and specificities of 98.3 and 97.3%. Hypertension, hyperlipidemia, AF or atrial flutter, low eGFR, and intracardiac thrombosis were good predictors of IS in patients with DCM. The BN model was superior to the traditional logistic regression model in predicting IS in patients with DCM and is, therefore, more suitable for early IS detection and diagnosis, and could help prevent the occurrence and recurrence of IS in this patient cohort.