Previous Cerebrovascular Events Research Articles

Primary aldosteronism patients with previous cardiovascular and cerebrovascular events have high aldosterone responsiveness to ACTH stimulation.

Aldosterone secretion in primary aldosteronism (PA) is often regulated by adrenocorticotropic hormone (ACTH) in addition to its autonomous secretion. However, the clinical characteristics and risk of cardiovascular and cerebrovascular (CCV) events in PA patients with aldosterone responsiveness to ACTH stimulation remain unclear. This study aimed to investigate the prevalence of CCV events in PA patients with high aldosterone responsiveness to ACTH stimulation. A retrospective cross-sectional study was conducted as part of the Japan Primary Aldosteronism Study/Japan Rare Intractable Adrenal Disease project. PA patients with adrenal venous sampling (AVS) between January 2006 and March 2019 were enrolled. The ACTH-stimulated plasma aldosterone concentration (PAC) of the inferior vena cava during AVS was used to evaluate aldosterone responsiveness to ACTH. We analyzed the relationship between responsiveness and previous CCV events. Logistic regression analysis demonstrated that the ΔPAC (the difference between the PAC measurements before and after ACTH stimulation) significantly increased the odds of previous CCV events in PA patients after adjusting for classical CCV event risk factors, baseline PAC and duration of hypertension (relative PAC: odds ratio [OR], 2.896; 95% confidence interval [CI], 0.989-8.482; ΔPAC: OR, 2.344; 95% CI, 1.149-4.780; ACTH-stimulated PAC: OR, 2.098; 95% CI, 0.694-6.339). This study clearly demonstrated that aldosterone responsiveness to ACTH is closely related to previous CCV events. The responsiveness of the PAC to ACTH could be useful in predicting CCV event risk.Registration Number in UMIN-CTR is UMIN000032525.

Predictors of outcome in patients with moderate mixed aortic valve disease

ObjectivesGrading the severity of moderate mixed aortic stenosis and regurgitation (MAVD) is challenging and the disease poorly understood. Identifying markers of haemodynamic severity will improve risk stratification and potentially guide...

Clinical outcomes of renal transplant recipients undergoing percutaneous coronary intervention

Abstract Background Cardiovascular disease is the leading cause of mortality among renal transplant (RT) recipients. Despite this, the clinical outcomes of patients with RT undergoing percutaneous coronary intervention (PCI) remain poorly elucidated. Purpose This study compared characteristics and outcomes among three groups of patients undergoing PCI: (1) RT recipients, (2) patients receiving dialysis and (3) patients with stage 3 chronic kidney disease (CKD) (estimated glomerular filtration rate 30–59 ml/min/1.73m²) without previous RT. Methods Data were analyzed for consecutive patients undergoing PCI enrolled in a large, multicenter Australian registry between 2014 and 2021 stratified into RT (n=226), dialysis (n=992) and CKD (n=15,534) groups. The primary outcome was 30-day major adverse cardiac and cerebrovascular events (MACCE) (composite of mortality, myocardial infarction, stent thrombosis, target vessel revascularization and stroke). Long-term mortality was derived from linkage with the Australian National Death Index. Multivariable logistic and Cox regression were performed to assess the risk of 30-day MACCE and long-term mortality, respectively. Results RT recipients were younger compared to dialysis and CKD patients (61±10 vs 68±12 vs 78±8.2 years, p<0.001). The majority of patients were male: 72%, 76% and 61% in RT, dialysis, and CKD groups, respectively (p<0.001). RT patients had fewer comorbidities (diabetes mellitus, peripheral vascular disease and previous cerebrovascular events) than dialysis patients, however more than the CKD group (all p<0.001). Compared to dialysis and CKD groups, RT patients less frequently had severe left ventricular dysfunction (14% and 8.5% vs 6.7%), however more often presented with acute coronary syndrome (52% and 48% vs 58%), especially ST-elevation myocardial infarction (12% and 17% vs 20%) (all p<0.001). RT and CKD patients had lower rates of in-hospital mortality (2.7% and 3.8% vs 6.4%), target vessel revascularization (0.4% and 0.7% vs 1.7%) and 30-day MACCE (4.4% and 6.8% vs 11.6%) compared to the dialysis group (all p<0.001). Three-year survival was similar between RT and CKD groups, however lower in the dialysis group (80% and 83% vs 60%) (p<0.001) (Figure 1). After adjustment, dialysis at baseline was an independent predictor of 30-day MACCE (OR 1.90, 95% CI 1.44–2.50, p<0.001), however RT status was not (0.91, 0.42–1.96, p=0.802). In contrast, both RT status (HR 2.07, 95% CI 1.46–2.95, p<0.001) and dialysis at baseline (1.35, 1.02–1.80, p=0.036) conferred a heightened long-term hazard for mortality (Figure 2). Conclusions RT recipients have more favorable clinical outcomes following PCI compared to patients receiving dialysis. Nevertheless, despite having similar short-term outcomes to those with CKD, the hazard of long-term mortality is significantly greater for RT recipients. Close follow-up is warranted in this high-risk population.Figure 1Figure 2

Abstract 15088: Presence and Severity of Subclinical Atherosclerotic Disease in the Primary Prevention of the Oncologic Population

Introduction: There is scarce evidence about endothelial dysfunction and damage in patients with a history of cancer in cardiovascular primary prevention and the impact in the development of Subclinical Atherosclerotic Disease (SCAD). Methods: A cross-sectional study was carried out on a registry of patients enrolled in primary prevention who had a Doppler ultrasound (DUS) screening for SCAD in the carotid and ileofemoral territory from 09/2020 to 04/2023. Inclusion criteria: 18 years old or older. Exclusion criteria: Previous cardiovascular and/or cerebrovascular event. History of cancer was defined as active or remitted cancer, excluding basal cell and squamous cell carcinoma. Population was divided in two, G1: non-oncologic group; G2 oncologic group. SCAD was defined as the presence of more than 1 atherosclerotic plaque in the carotid and/or ileofemoral territory. Univariate and bivariate analysis were done to establish population characteristics. Results: A total of 7920 patients were included: 7694 in G1 and 226 in G2 (97.15% vs 2.85%). G2 patients were older, mostly women and had higher prevalence of hypertension and dyslipidemia. Clinical characteristics and findings of the DUS are shown in Table1. A linear regression was done to assess the total plaque area compared to oncologic history, adjusted for age, sex, smoking history, dyslipidemia, obesity, sedentarism, diabetes, and hypertension. Results show that history of cancer is a predictor for SCAD (OR=1.43 [IC 95%: 1.1-1.9], p=0.021). Cancer also seems to be associated with a higher number of territories affected by SCAD (OR=1.63 [IC 95%: 1.2-2.1], 0.001) adjusted for age, sex, tobacco use, obesity, dyslipidemia, diabetes, sedentarism, and hypertension. Conclusions: Patients with history of cancer had more SCAD. Cancer behaved as a predisposing factor for increased plaque presence and area, adjusted for classic risk factors. This raises the need for more intensive control of SCAD in cancer patients.

TCT-483 Patients With Previous Cerebrovascular Events Undergoing Transcatheter Aortic Valve Implantation Have More Periprocedural Strokes

TCT-483 Patients With Previous Cerebrovascular Events Undergoing Transcatheter Aortic Valve Implantation Have More Periprocedural Strokes

Association between extracellular water/body cell mass ratio and cognitive impairment in patients on maintenance hemodialysis

Objective: To explore the correlation between extracellular water/body cell mass (ECW/BCM) ratio and cognitive impairment (CI) in patients on maintenance hemodialysis (MHD). Methods: A multicenter, cross-sectional study was conducted in Guizhou Province. All adult MHD patients in hemodialysis centers of 18 hospitals in Guizhou Province between June and October 2020 were included. Cognitive function was assessed with the Mini-Mental State Examination (MMSE) score. The ECW and BCM was derived from bioelectrical impedance, and the ECW/BCM ratio was calculated. The patients were divided into four groups based on the quartile of ECW/BCM ratio. Multivariate logistic regression analysis and subgroup analysis were conducted. Results: A total of 3 160 patients were included in the final analysis, of which 761 (24.1%) developed CI. There were 1 868 males (59.1%) and 1 292 females (40.9%), and the mean age was (55±15) years. Multivariate logistic regression analysis showed that the risk of CI in ECW/BCM Q3 group was 1.55 times (95%CI: 1.03-2.34, P=0.035) of that in group Q1, while the risk of CI in Q4 group was 1.62 times of that in group Q1 (95%CI: 1.05-2.51, P=0.029). Subgroup analysis showed that there was an interaction between previous cerebrovascular event and ECW/BCM on CI (P for interaction=0.04). Patients with a previous history of cerebrovascular events had a higher risk of CI than those without. Among those with no previous cerebrovascular events, the risk of CI in group Q4 was 1.62 times of that in group Q1 (95%CI: 1.19-2.20), while the risk of CI in group Q4 was 7.17 times of that in group Q1 (95%CI: 1.59-32.35) in those with previous cerebrovascular events. Conclusion: Increased ECW/BCM ratio is associated with increased CI risk in patients with MHD, and the risk was more obvious in those with previous history of cerebrovascular events.

MACHINE LEARNING IN HYPERTENSION DETECTION: A STUDY ON WORLD HYPERTENSION DAY DATA

Objective: Many modifiable and non-modifiable risk factors have been associated with hypertension. However, current screening programs are still failing in identifying individuals at higher risk of hypertension. Given the major impact of high blood pressure on cardiovascular events and mortality, there is an urgent need to find new strategies to improve hypertension detection. We aimed to explore whether a machine learning (ML) algorithm can help identifying individual predictors of hypertension. Design and method: We analysed the data set generated by the questionnaires administered during the World Hypertension Day from 2015 to 2019. Demographic information (age, sex, BMI), self-reported information on cardio- vascular risk factors (hypertension, diabetes, smoking, high cholesterol, kidney disease, family history of cardiovascular diseases), sleep complaints (snoring, witnessed apneas, daytime sleepiness) and prior cardiovascular diseases (previous cardio and cerebrovascular events, previous myocardial infarction) as well as information about the awareness of hypertension and its health consequences were collected through the questionnaire. We computed the performance (sensitivity and specificity) of standard screening programmes as recommended by World Health Organisation and of five different ML algorithms, exploiting different balancing techniques (oversampling and undersampling). Results: A total of 20206 individuals (mean age 50.89 years, 51.65% females) have been included for analysis. Results show that a gain of sensitivity reflects in a loss of specificity, bringing to a scenario where there is not an algorithm and a configuration which properly outperforms against the others (Table 1). However, Random Forest provides the most interesting balance between sensitivity and specificity with a greater Area Under the Curve compared to the standard screening programs (Table 1). Conclusions: Detection of hypertension at a population level still remains challenging and a machine learning approach could help in making screening programs more precise and cost effective, when based on accurate data collection. More studies are needed to identify new features to be acquired and to further improve the performances of ML models. Table 1: Performance in the test set of the three experimented schemes, original, oversampling and undersampling the training set, and of the medical protocol evaluation.

History of cerebrovascular events is associated with a higher risk of significant left anterior descending artery stenosis

Abstract Funding Acknowledgements Type of funding sources: None. Background Acute coronary syndrome (ACS) remains a frequent cause of hospital admission, with its prognosis depending on many factors, one being the location of the culprit lesion. It is established that anterior myocardial infarction, caused mostly by left anterior descending artery occlusion is associated with a worse prognosis and higher morbimortality. Therefore, identifying patients at a higher risk of significant LAD lesions could potentially impact outcomes. Purpose We aim to identify if having personal history of cerebrovascular events could be related to more severe LAD stenosis. Methods We retrospectively analysed a population of 988 patients (L) admitted with ACS and divided them into two groups: those who had significant stenosis of the left anterior descending artery (LAD) documented in coronary angiography, defined as a stenosis above 50% (L1), and those who had no significant stenosis of the LAD (L2), which included those with no stenosis or stenosis under 50%. We then compared the prevalence of previous cerebrovascular events, defined as stroke or TIA, between both groups. Age, sex, personal history of smoking, hypertension, dyslipidaemia and diabetes mellitus were also documented. Results L1 was comprised of 553 patients (56,0% of the population). When comparing between groups, results show that L1 had a significantly higher prevalence of previously documented stroke or TIA (1,4% vs 0,2%, p=0,026; odds ratio: 7,628, 95% CI [0,922; 63,120]) than L2. Regarding age, sex and history of hypertension, dyslipidaemia and diabetes, there were no relevant differences and no impact on the severity of the LAD stenosis. Conclusions Patients with ACS and previous history of cerebrovascular events have a sevenfold-increased risk of having significant LAD stenosis on coronary angiography. This could potentially impact pre-procedure risk stratification and timing of percutaneous intervention.

Percutaneous atrial shunt closure and the risk of recurrent ischemic stroke: A register-based, nationwide cohort study

ObjectivesWe aimed to investigate the risk of recurrent stroke in patients with transcatheter closure of an atrial shunt (ASCIos), compared to patients with an atrial shunt and cerebrovascular event (CVE) but only medical treated (ASMed), and to age- and sex-matched control individuals without a previous CVE. MethodsIn total, 663 ASCIos patients were identified in the Swedish National Patient Register from 1997 to 2016 and matched by using propensity score with 663 ASMed patients. Nine age- and sex-matched controls to ASCIos patients (n = 6,302) without a diagnosis of atrial shunt or history of CVE were randomly selected from the general population. ResultsAt a mean follow-up of 6.5 years, the incidence rate of recurrent stroke in the ASCIos group vs ASMed group was 0.9 vs 0.7 per 100 patient-years. The hazard ratio of recurrent stroke in the ASCIos group compared with index stroke in the control group was 9.9 (95% confidence interval, 5.5–17.9). The incidence of atrial fibrillation was similar in the ASCIos and the ASMed group, however four times higher in the ASCIos than in the control group. ConclusionsOur large nationwide, register-based cohort study showed that, unexpectedly, the risk of recurrent stroke in the ASCos group was as high as in the ASMed group and almost ten times higher than the risk of an index stroke in matched controls without previous stroke.

Approach to acute psychosis in older adults.

Approach to acute psychosis in older adults.

Predictive Value of Supraventricular Short Runs for New-Onset Atrial Fibrillation in Patients with Ischemic Stroke.

The clinical importance of supraventricular run (SVR) is uncertain in the management of patients with previous cerebrovascular events. We aim to evaluate the role of SVRs in the development of future atrial fibrillation (AF) in patients diagnosed with ischemic stroke. We retrospectively evaluated patients who underwent 24-h Holter monitoring for the evaluation of possible AF after ischemic cerebrovascular events. The presence and duration of SVR were noted. Subsequent diagnosis of AF was searched in patients with sinus rhythm. A total of 694 patients were included in the analysis. SVR was detected in 104 (14.9%) patients in the study group. Seventy-one (10.2%) patients were diagnosed with AF in the follow-up. SVRs were more prevalent among patients with AF (P < 0.001). The median atrial run duration was 5.96 (2.02-17.84) s in the AF absent group vs. 8.76 (3.78-17.62) s in the AF present group (P < 0.001). The best predictive cut-off duration of an atrial run was 8 s (sensitivity = 61.5% and specificity = 74.4%, Area Under Curve (AUC) = 0.708). Cox regression analysis showed that age (odds ratio [OR]: 1.03, 95% confidence interval [CI]: 1.00-1.060, P = 0.020), presence of short supraventricular run (OR: 2.53, 95% CI 1.40-4.57, P = 0.002), and left atrial diameter (OR: 1.13 95% CI: 1.07-1.19, P < 0.001) were the independent predictors of AF development in the follow-up. Age, left atrial diameter, and the presence of SVRs are associated with an increased risk of future AF after ischemic stroke. SVR duration may be an important parameter in risk stratification.

Predictors and outcomes of acute, sub-acute and early stroke following transcatheter aortic valve implantation

Abstract Background Stroke is one of the most devastating complications after transcatheter aortic valve implantation (TAVI). The recent third Valve Academic Research Consortium (VARC-3) proposes new stroke terminology according to time between TAVI and stroke onset. Purpose We aimed to identify predictors and assessed mortality in patients undergoing transfemoral TAVI complicated by acute, sub-acute and early stroke. Methods Patients undergoing transfemoral TAVI were included in a global patient level database. Acute stroke was defined as stroke occurring ≤24 hours after the index procedure. Sub-acute stroke was defined as stroke occurring between &amp;gt;1 day and ≤30 days and early stroke as &amp;gt;30 and ≤365 days following TAVI, according to VARC-3. We identified predictors for these complications using multivariate logistic regression analysis and assessed mortality outcomes in these patients. Results A total of 11230 patients underwent transfemoral TAVI. Mean age was 81.5±7.0 years, 58% was female and median STS-PROM score was 6.5% (4.0%-13.2%). A total of 405 (3.6%) experienced stroke during the first year after TAVI. Of these 93 (23%) had acute stroke, 195 (46%) sub-acute stroke and 117 (27%) early stroke. One year mortality was highest after acute stroke (56.9%), followed by sub-acute stroke (41.7%), and early stroke (29.0%), but one-year mortality in all stroke patients was higher than in non-stroke patients (40.5% vs 15.8%, p&amp;lt;0.001). Glomerular filtration rate was an independent predictor for acute stroke (odds ratio [OR] 0.9, 95% confidence interval [CI] 0.9–1.0, p=0.03). Previous cerebrovascular events independently predicted sub-acute stroke (OR 2.1, 95% CI 1.4–3.1, p=0.001). Independent predictors for early stroke were age (OR 1.0 per year, 95% CI 1.0–1.0, p=0.04) and peripheral vascular disease (OR 2.0, 95% CI 1.4–3.0, p&amp;lt;0.001). Conclusions Patients undergoing transfemoral TAVI complicated by stroke showed higher one-year mortality than non-stroke patients. Earlier timing of post-TAVI stroke was associated with increased mortality. Acute stroke was predicted by renal impairment; sub-acute stroke by previous cerebrovascular events and early stroke by age and peripheral vascular disease, suggesting different pathways leading to stroke in these patients. Funding Acknowledgement Type of funding sources: Foundation. Main funding source(s): Hartstichting

QTc prolongation is associated with severe desaturations in stroke patients with sleep apnea

BackgroundObstructive sleep apnea (OSA) is associated with vascular diseases from which stroke and sudden cardiac death are the most significant ones. It is known that disturbances of the autonomic nervous system and electrocardiographic changes are seen in patients with a previous cerebrovascular event. However, the pathophysiological cascade between breathing cessations, autonomic regulation, and cardiovascular events is not fully understood.MethodsWe aimed to investigate the acute effect of desaturation on repolarisation in OSA patients with a previous stroke. We retrospectively analysed heart-rate corrected QT (QTc) intervals before, within, and after 975 desaturations in OSA patients with a stroke history and at least moderate sleep apnea (apnea–hypopnea index ≥ 15 events/h, n = 18). For the control population (n = 18), QTc intervals related to 1070 desaturation were analysed. Desaturations were assigned to groups according to their length and duration. Groupwise comparisons and regression analyses were further executed to investigate the influence of desaturation features on repolarization.ResultsIn the stroke population the QTc prolonged at least 11 ms during 27.1% of desaturations, and over 20 ms during 12.2% of desaturations. QTc was significantly prolonged during longer (> 30 s, p < 0.04) and deeper (> 7%, p < 0.03) desaturations. Less severe desaturations didn't influence QTc. In median, QTc prolonged 7.5 ms during > 45 s desaturations and 7.4 ms during > 9% deep desaturations. In the control population, QTc prolongation was observed but to a significantly lesser extent than in stroke patients. In addition, desaturation duration was found to be an independent predictor of QTc prolongation (β = 0.08, p < 0.001) among all study patients.ConclusionsWe demonstrated that longer (> 30 s) and deeper (> 7%) desaturations prolong QTc in patients with stroke history. A significant proportion of desaturations produced clinically relevant QTc prolongation. As it is known that a long QTc interval is associated with lethal arrhythmias, this finding might in part explain the pathophysiological sequelae of cardiovascular mortality in OSA patients with a history of stroke.

Clinical Phenotypes of Atrial Fibrillation and Mortality Risk-A Cluster Analysis from the Nationwide Italian START Registry.

Patients with atrial fibrillation (AF) still experience a high mortality rate despite optimal antithrombotic treatment. We aimed to identify clinical phenotypes of patients to stratify mortality risk in AF. Cluster analysis was performed on 5171 AF patients from the nationwide START registry. The risk of all-cause mortality in each cluster was analyzed. We identified four clusters. Cluster 1 was composed of the youngest patients, with low comorbidities; Cluster 2 of patients with low cardiovascular risk factors and high prevalence of cancer; Cluster 3 of men with diabetes and coronary disease and peripheral artery disease; Cluster 4 included the oldest patients, mainly women, with previous cerebrovascular events. During 9857 person-years of observation, 386 deaths (3.92%/year) occurred. Mortality rates increased across clusters: 0.42%/year (cluster 1, reference group), 2.12%/year (cluster 2, adjusted hazard ratio (aHR) 3.306, 95% confidence interval (CI) 1.204–9.077, p = 0.020), 4.41%/year (cluster 3, aHR 6.702, 95%CI 2.433–18.461, p < 0.001), and 8.71%/year (cluster 4, aHR 8.927, 95%CI 3.238–24.605, p < 0.001). We identified four clusters of AF patients with progressive mortality risk. The use of clinical phenotypes may help identify patients at a higher risk of mortality.

Association between T-tau protein and Aβ42 in plasma neuronal-derived exosomes and cognitive impairment in patients with permanent atrial fibrillation and the role of anticoagulant therapy and inflammatory mechanisms.

This study explores whether the differences in cognitive performance among individuals with permanent atrial fibrillation (AF) are attributable to the duration of AF and anticoagulant therapy and explores the possible inflammatory mechanism of cognitive dysfunction related to AF. A total of 260 patients aged 50-75 years without previous cerebrovascular events were enrolled in this study. These 260 patients had been divided into the AF group (140 patients) and sinus rhythm group (120 patients). In the AF group, we divided participants into cognitive impairment (CI) group (90 patients) and cognitive normal (CN) group (50 patients). In the sinus rhythm group, we also divided participants into CIgroup (61 patients) and CNgroup (59 patients). The Mini-Mental State Examination (MMSE) was used to assess the cognitive function of all participants. Neuronal-derived exosomes were enriched in peripheral blood by immunoprecipitation and were confirmed by a transmission electron microscope, nanoparticle tracking analysis, and western blot. Alzheimer's disease-pathogenic exosomal proteins and inflammatory cytokines were quantified. The association between AF and cognitive function was estimated by logistic regression analysis. ANOVA or Welch's t-test compared the difference in protein concentrations between groups. Non-anticoagulant therapy in patients with AF was significantly associated with CI(OR = 13.99, 95% CI: 2.67-73.36, p < .01). The incidence of dementia in patients with AF > 3 years was significantly higher than in patients with AF ≤ 3 years, but there was no significant difference in total cognitive dysfunction (mild cognitive impairment [MCI] + dementia) (p = .126). The adjusted exosome concentrations of T-tau and amyloid-β protein 42 (Aβ42) in the CI group were significantly higher than in the CNgroup (p < .001). The serum concentrations of IL-6 and matrix metalloproteinase-9 (MMP-9) in patients with AF were higher than those in patients with sinus rhythm (p < .001). Aβ42 and T-tau in peripheral blood neuronal-derived exosomes maybe be associated with the early diagnosis of CI in patients with permanent AF. However, the value of Aβ42 and T-tau for CI in patients with permanent AF still needs to be confirmed in future randomized control trials.

Choice of Frontline Tyrosine-Kinase Inhibitor in Very Elderly Patients with Chronic Myeloid Leukemia: A “Campus CML” Study

Introduction Treatment of chronic phase (CP) chronic myeloid leukemia (CML) with tyrosine kinase inhibitors (TKIs) proved to be almost equally effective in young and elderly patients. Three TKIs, imatinib (IM), dasatinib (DAS) and nilotinib (NIL), are approved for frontline therapy in Italy. Choice of frontline TKI is based on a combined evaluation of patient's characteristics and expectations, with age usually playing a prominent role. However, to date, few data are available on patterns of TKI selection in very elderly patients.Aim To analyse the use of frontline TKI therapy in a large and unselected cohort of very elderly CP-CML patientsMethods We retrospectively evaluated 332 patients aged ≥75 year diagnosed from 1/2012 to 12/2019 at 36 Hematology Centres participating at the “Campus CML” project.Results Clinical features at diagnosis for the whole cohort and according to frontline TKI are reported in Table 1. As to frontline TKI, 285 patients (85.8%) received IM and 47 (14.2%) a 2G-TKI (DAS n=28, 59.5%; NIL n=19, 40.5%). Of the 285 IM-treated patients, 192 (67.3%) started with standard dose (400 mg/day) and 93 (32.7%) with a reduced dose (300 mg/day n=64, 22.5%; <300 mg/day n=29, 10.2%). Among the 47 patients starting a 2G-TKIs, 35 (74.4%) received standard dose and 12 (25.6%) a reduced dose (NIL <600 mg/day n=3; DAS 80 mg/day n=4 and 50 mg/day n=5). There were no differences between patients treated with imatinib or 2G-TKI (Table 1); only a previous cerebrovascular event was reported in a significantly higher rate of IM-treated patients. It is however evident that the distinct toxicity profiles of NIL and DAS had an impact on TKI choice as, for example, no patient with diabetes or ischemic heart disease received NIL.Following widespread introduction of generic IM in Italy in early 2018, patients were divided in 2 groups: among 238 patients diagnosed from 2012 to 2017, 198 (83.1%) received IM and 40 (16.9%) a 2G-TKI, while patients diagnosed in 2018-2019 were treated with IM in 87/94 (92.5%) cases and with a 2G-TKI in 7 (7.5%) cases only (p=0.028).Conclusions IM remains the frontline drug of choice in very elderly CML patients, and this trend seems to increase after the introduction of the generic formulation. However, 2G-TKI are used in a small but sizeable group of patients, without a clear correlation with baseline CML features, thus probably reflecting a physician's evaluation of patient's fitness and/or expectation. Efficacy and safety of initial reduced TKIs doses in the setting of very elderly patients warrant further analyses. [Display omitted] DisclosuresLatagliata: Novartis: Honoraria; BMS Cellgene: Honoraria; Pfizer: Honoraria. Bonifacio: Novartis: Honoraria; Pfizer: Honoraria; Amgen: Honoraria; Bristol Myers Squibb: Honoraria. Elena: CELGENE: Other: funding for meeting participation; PFIZER: Membership on an entity's Board of Directors or advisory committees; NOVARTIS: Membership on an entity's Board of Directors or advisory committees; GILEAD: Membership on an entity's Board of Directors or advisory committees. Iurlo: Novartis: Speakers Bureau; Incyte: Speakers Bureau; Pfizer: Speakers Bureau; Bristol Myers Squibb: Speakers Bureau. Sportoletti: AstraZeneca: Consultancy, Honoraria; Janssen: Consultancy, Honoraria; AbbVie: Consultancy, Honoraria. Stagno: Pfizer: Consultancy, Honoraria, Other: Support for attending meetings and/or travel; InCyte: Consultancy, Honoraria; Novartis: Consultancy, Honoraria, Other: Support for attending meetings and/or travel, Research Funding. Abruzzese: Pfizer: Consultancy, Honoraria; Novartis: Consultancy, Honoraria; Incyte: Consultancy, Honoraria; Bristol Myers Squibb: Consultancy, Honoraria. Breccia: Bristol Myers Squibb/Celgene: Honoraria; Incyte: Honoraria; Abbvie: Honoraria; Pfizer: Honoraria; Novartis: Honoraria.

Advances in Neurocardiology: Focus on Atrial Fibrillation.

Advances in Neurocardiology: Focus on Atrial Fibrillation.

Risk Factors of In-Hospital Mortality in Non-Specialized Tertiary Center Repurposed for Medical Care to COVID-19 Patients in Russia

The purpose of our study is to investigate the risk factors of in-hospital mortality among patients who were admitted in an emergency setting to a non-specialized tertiary center during the first peak of coronavirus disease in Moscow in 2020. The Federal Center of Brain and Neurotechnologies of the Federal Medical and Biological Agency of Russia was repurposed for medical care for COVID-19 patients from 6th of April to 16th of June 2020 and admitted the patients who were transported by an ambulance with severe disease. In our study, we analyzed the data of 635 hospitalized patients aged 59.1 ± 15.1 years. The data included epidemiologic and demographic characteristics, laboratory, echocardiographic and radiographic findings, comorbidities, and complications of the COVID-19, developed during the hospital stay. Results of our study support previous reports that risk factors of mortality among hospitalized patients are older age, male gender (OR 1.91, 95% CI 1.03–3.52), previous myocardial infarction (OR 3.15, 95% CI 1.47–6.73), previous acute cerebrovascular event (stroke, OR = 3.78, 95% CI 1.44–9.92), known oncological disease (OR = 3.39, 95% CI 1.39–8.26), and alcohol abuse (OR 6.98, 95% CI 1.62–30.13). According to the data collected, high body mass index and smoking did not influence the clinical outcome. Arterial hypertension was found to be protective against in-hospital mortality in patients with coronavirus pneumonia in the older age group. The neutrophil-to-lymphocyte ratio showed a significant increase in those patients who died during the hospitalization, and the borderline was found to be 2.5. CT pattern of “crazy paving” was more prevalent in those patients who died since their first CT scan, and it was a 4-fold increase in the risk of death in case of aortic and coronal calcinosis (4.22, 95% CI 2.13–8.40). Results largely support data from other studies and emphasize that some factors play a major role in patients’ stratification and medical care provided to them.

Could the systemic immune-inflammation index be a predictor to estimate cerebrovascular events in hypertensive patients?

Hypertension is one of the most important risk factors for cardiovascular and cerebrovascular events. Inflammatory processes occupy an important place in the pathogenesis of hypertension. Many studies have studied inflammatory markers responsible for the onset of hypertension and organ damage. In this study, we investigated whether the systemic immune-inflammation index (SII) (platelet × neutrophil/lymphocyte), - one of the new inflammatory markers - can be used to predict cerebrovascular events in hypertensive patients. Ambulatory blood pressure monitoring results between January 2019 and June 2020 of approximately 379 patients followed up with hypertension were retrospectively analyzed. These patients were divided into two groups as with or without a previous cerebrovascular event in the analyzed database. In all patients, complete blood count and biochemistry test results just before the cerebrovascular event were found from the database. SII, atherogenic index, neutrophil-lymphocyte ratio were calculated from the complete blood count. Forty-nine patients with stroke (group 1: 12.9%; mean age: 64.3 ± 14.6) and 330 patients without stroke (group 2: 87.1%; mean age: 50.8 ± 14.4). Ambulatory blood pressure measurements were lower in group 1. Lipid parameters were also lower in this group. Receiver operating characteristic curve analysis showed that SII had a sensitivity of 85.7% and specificity of 84.8 % for stroke in individuals who participated in the study when the cutoff value of SII was 633.26 × 103 (P = 0.0001) area under curve (95%); 0.898 (0.856-0.941). In multivariate logistic regression analysis, age and SII were significantly associated with a higher risk of stroke. Age, (hazard ratio:1.067; 95% CI, 1.021-1.115), SII (hazard ratio:1.009; 95% CI, 1.000-1.009), respectively. In conclusion, SII is a simple, useful new inflammatory parameter for predicting stroke from hypertension. We found that the high SII levels increase the risk of stroke in hypertensive patients.

Factors associated with recurrent transient global amnesia: systematic review and pathophysiological insights.

The examination of the risk factors that affect the recurrence of transient global amnesia (TGA) may shed light on the pathophysiological substrate of the disease. A systematic review was performed to identify the factors associated with the recurrence of TGA. MEDLINE, EMBASE, CENTRAL and PsycINFO were meticulously searched. Observational controlled studies involving patients with single (s-TGA) and recurrent TGA (r-TGA) according to Hodges and Warlow's criteria were retrieved. Differences in the demographic characteristics, personal and family medical history, previous exposure to precipitating events and laboratory findings were examined. Retrieved evidence was assessed in the context of the individual article validity, based on the numerical power and methodological quality of each study. Nine cohort studies with retrospective, prospective or mixed design were retrieved. In total, 1989 patients with TGA were included, 269 of whom suffered from r-TGA (13.5%). R-TGA presented an earlier age of onset. Evidence was suggestive of a relationship between recurrence and a family or personal history of migraine, as well as a personal history of depression. There was weaker evidence that associated recurrence with a positive family history of dementia, a personal history of head injury and hippocampal lesions in diffusion-weighted MRI. On the other hand, no connection was found between recurrence and electroencephalographic abnormalities, impaired jugular venous drainage, cardiovascular risk factors, atrial fibrillation, previous cerebrovascular events, exposure to precipitating events, a positive family history of TGA and hypothyroidism. Important pathophysiological insights that arised from these findings were discussed.