Severity Of Acute Ischemic Stroke Research Articles

Biomarkers of Coagulation and Inflammation in COVID-19-Associated Ischemic Stroke.

[Figure: see text].

Hepatic fibrosis is associated with more severe acute ischemic stroke

Background and Aims: Hepatic fibrosis appears to be associated with increased cardiovascular risk but it is unclear whether it is also related to the severity of ischemic stroke. We aimed to evaluate the association between hepatic fibrosis and the severity of acute ischemic stroke.

Neutrophil-to-Lymphocyte Ratio as a Predictive Biomarker for Stroke Severity and Short-Term Prognosis in Acute Ischemic Stroke With Intracranial Atherosclerotic Stenosis.

Background: Neutrophil-to-lymphocyte ratio (NLR) is an indicator of poor prognosis in acute ischemic stroke (AIS), but associations between NLR with stroke severity and prognosis of intracranial atherosclerotic stenosis (ICAS)-related ischemic events have not been well-elucidated; therefore, we aimed to evaluate whether admission NLR levels correlate with the early stroke severity and short-term functional prognosis in patients with symptomatic intracranial atherosclerotic stenosis (sICAS).Methods: This retrospective study enrolled 899 consecutive patients with AIS attributed to ICAS at Xiangya Hospital stroke center between May 2016 and September 2020. The initial stroke severity was rated by the admission National Institutes of Health Stroke Scale (NIHSS) scores, and the short-term prognosis was evaluated using the 14-day modified Rankin Scale (mRS) scores after stroke onset. A severe stroke was defined as NIHSS >8; an unfavorable functional outcome was defined as mRS scores of 3–6. Admission NLR was determined based on circulating neutrophil and lymphocyte counts.Results: The median admission NLR of all patients was 2.80 [interquartile range (IQR), 2.00–4.00]. In univariate analysis, admission NLR was significantly elevated in patients with severe stroke and poor short-term prognosis. After multivariate adjustment, admission NLR levels were significantly correlated with severe stroke [odds ratio (OR), 1.132; 95% confidence interval (95% CI), 1.038–1.234; P = 0.005] and unfavorable short-term prognosis (OR, 1.102; 95% CI, 1.017–1.195; P = 0.018) in Model 1. In Model 2, the highest NLR tertile (≥3.533) remained an independent predictor of severe stroke (OR, 2.736; 95% CI, 1.590–4.708; P < 0.001) and unfavorable functional outcome (OR, 2.165; 95% CI, 1.416–3.311; P < 0.001) compared with the lowest NLR tertile (<2.231). The receiver operating characteristic (ROC) curves showed the predictability of NLR regarding the stroke severity [area under the curve (AUC), 0.659; 95% CI, 0.615–0.703; P < 0.001] and short-term prognosis (AUC, 0.613; 95% CI, 0.575–0.650; P < 0.001). The nomograms were constructed to create the predictive models of the severity and short-term outcome of sICAS.Conclusions: Elevated admission NLR levels were independently associated with the initial stroke severity and could be an early predictor of severity and poor short-term prognosis in AIS patients with ICAS, which might help us identify a target group timely for preventive therapies.

MALT1 positively correlates with Th1 cells, Th17 cells, and their secreted cytokines and also relates to disease risk, severity, and prognosis of acute ischemic stroke.

BackgroundThis study aimed to explore the association of mucosa‐associated lymphoid tissue lymphoma translocation protein 1 (MALT1) with acute ischemic stroke (AIS) risk and also to explore its association with T helper type 1 (Th1) cells, Th17 cells, disease severity, and prognosis in AIS patients.MethodsOne hundred twenty first‐episode AIS patients and 120 non‐AIS patients with high‐stroke‐risk factors (as controls) were recruited. Besides, in the cluster of differentiation 4‐positive (CD4+) T cells, the MALT1 gene expression was detected by reverse transcription quantitative polymerase chain reaction; meanwhile, Th1 and Th17 were detected by flow cytometry. Moreover, serum interferon (IFN)‐γ and interleukin (IL)‐17 were determined by enzyme‐linked immunosorbent assay.ResultsMALT1 expression was increased in AIS patients compared with controls and also it could differentiate AIS patients from controls, with an area under curve of 0.905 (95% confidence interval: 0.869–0.941). In AIS patients, MALT1 positively correlated with Th1 cells, Th17 cells, IFN‐γ, and IL‐17. Besides, MALT1 positively correlated with the National Institutes of Health Stroke Scale score. Furthermore, the Kaplan‐Meier curve and univariate Cox's regression analyses showed no correlation of MALT1 high expression with recurrence‐free survival (RFS) in AIS patients, although after adjustment using multivariant Cox's regression, high MALT1 expression independently correlated with worse RFS in AIS patients.ConclusionMALT1 expression is increased and positively correlates with disease severity, Th1 cells, and Th17 cells, whose high expression severs as an independent risk factor for worse RFS in AIS patients.

Dynamic Decrease in Eosinophil After Intravenous Thrombolysis Predicts Poor Prognosis of Acute Ischemic Stroke: A Longitudinal Study.

Background and PurposeBlood eosinophil counts are thought to be associated with atherosclerosis in acute ischemic stroke (AIS) and AIS severity. We aimed to investigate 1): the temporal profile of eosinophil in AIS patients treated with recombinant tissue plasminogen activator (r-tPA); 2): The association between dynamic eosinophil and 3-month outcomes in different AIS etiologies; 3): incremental predictive ability of dynamic eosinophil adding to conventional model; and 4): the longitudinal change of neutrophil-to-lymphocyte ratio (NLR) and compared its prognostic value with eosinophils.MethodsA total of 623 AIS patients with intravenous thrombolysis in two hospitals were included. Blood samples were obtained on admission, within 24 h after an intravenous thrombolysis and on the seventh day. A multivariate logistic regression model with restricted cubic spline was performed to explore the association between dynamic eosinophil and a 3-month poor outcome. C-statistic, net reclassification improvement (NRI) and integrated discrimination improvement (IDI) were adopted to explore the incremental predictive ability.ResultsPercent change in eosinophil counts after intravenous thrombolysis was median −25.00% (IQR −68.25%–+14.29%). Decrease in eosinophil >75% after intravenous thrombolysis was associated with 2.585 times risk for poor outcome and 13.836 times risk for death. However, the association were weak for patients outside of cardioembolic stroke. Adding eosinophil changes to a conventional model improved the discriminatory ability of poor outcome (NRI = 53.3%; IDI = 2.2%) and death (NRI = 101.0%; IDI = 6.9%).ConclusionsDynamic decrease in eosinophil after intravenous thrombolysis predicts a 3-month poor outcome and death in AIS patients with r-tPA treatment and improved the predictive ability of conventional model. However, this result needs to be interpreted carefully in non-cardioembolic AIS patients.

A Study of Human Carcinoembryonic Antigen as a Biomarker for Assessing the Severity of Stroke

Background and Objectives: Human carcinoembryonic antigen (CEA) is widely used as a tumor marker. Striking similarities have been reported between process of tumor genesis and atherosclerotic diseases. CEA levels have also been associated with development of atherosclerosis; there are not many studies on the use of CEA as a biomarker in prognostication of stroke. This study was aimed at evaluating the role of CEA as a marker of severity and as a prognostic marker in patients with acute ischemic stroke. Materials and Methods: A hospital-based case–control study was conducted at a tertiary care hospital in Bangalore. Sixty-eight individuals above 18 years of age were divided into two groups with 34 individuals each: Group A (ischemic stroke) and Group B (age- and sex-matched healthy controls). Exclusion criteria for Group A included diabetes mellitus, heavy smoking, and recent cerebrovascular or myocardial events. The blood sample was taken not later than 24 h of onset of stroke in Group A. CEA levels were estimated using double-sandwich ELISA method. CEA was compared in both the groups. Data were analyzed using statistical software SPSS version 21. Results: The mean standard error serum CEA levels in ischemic stroke patients (cases) and healthy controls were 5.67 ± 1.64 and 0.973 ± 0.21 ng/mL, respectively (P &lt; 0.001). This was significant even after adjusting for confounders. The cases were further divided into three quartiles based on CEA levels. The mean duration of hospital stay, mortality and higher National Institutes of Health Stroke Scale scores, and poor improvement in grade of power were seen in cases under higher CEA quartile (&gt;7 ng/ml) group. The difference was statistically significant. Conclusion: Patients with ischemic stroke have raised level of CEA. CEA is a promising novel biomarker for assessing the severity of acute ischemic stroke.

Dynamic Neutrophil-Lymphocyte Ratios Predict Short-term Prognostic Outcome of Thrombolysis in Patients with Acute Ischemic Stroke.

The main purpose of this study was to investigate the dynamic changes of neutrophils-lymphocytes ratios (NLRs) in patients with acute ischemic stroke (AIS) and their relationships with 3-month prognostic outcomes. Two hundred ninety-one patients with AIS were included in this study, followed up for 3months. At admission, 1 and 7days after recombinant tissue plasminogen activator (r-tPA) injection, blood samples were obtained. Outcome events included excellent outcome, good outcome, and death defined as modified Rankin Scale (mRS) scores of 0-1, 0-2, and 6 respectively. NLRs measured in admission and 7days after r-tPA treatment were associated with prognosis outcome after 3months. Twenty-four-hour NLR is an excellent indicator in forecasting (excellent outcome's the areas under the curve (AUC) = 0.725; good outcome AUC = 0.742; death AUC = 0.759). In addition, we were surprised to find that dynamic increase in NLR within 24h is significantly related to excellent and good outcomes. Twenty-four-hour NLR is related to the severity of AIS and poor prognosis, which can help early risk stratification. We can predict the prognosis of AIS more accurately. Compared with previous studies, our study has shown the dynamic changes of NLR and its relationship with NIHSS and multiple prognostic.

Correlation between HS-CRP in Serum with Neurological Deficit Measured by Nihss in Acute Ischemic Stroke

Background: CRP can increase the regulation of adhesion receptors on endothelial cells which can lead toinfiltration of neutrophil and monocyte cells to endothelial cells. This causes endothelial cell damage andblood brain barrier dysfunction eventually leading to brain cell death. This brain cell death will result inimpaired brain function and affect the severity of the stroke. The problem that arises is whether there is acorrelation between CRP levels in serum and the severity of acute ischemic stroke as measured by NIHSS.Method: Sixty patients with acute thrombotic stroke who were treated at the neurology ward of Dr.SoetomoGeneral Hospital (a Teaching Hospital of Faculty of Medicine, Universitas Airlangga) during June-September2019 had serum levels of CRP measured with sandwich ELISA method using high sensitivity CRP (hs-CRP)and neurological deficit was assessed using the NIHSS.Result: Mean age of subjects was 57,45±8,89 years. The study subjects consisted of 37 male and 23 female.The median serum levels of hs-CRP is 0,4 mg/dL with a range of 0,1-15,1 mg/dL. Median NIHSS is 5 witha range of 2-15. There is a positive correlation with moderate correlation strength between serum levels ofhs-CRP and the NIHSS value in patients with acute thrombotic stroke and statistically significant (p=0.000,r=0.454).Conclusion: There is a moderate positive correlation between serum levels of hs-CRP and neurologicaldeficit measured by NIHSS.

Calcium Channel Subunit α2δ-1 as a Potential Biomarker Reflecting Illness Severity and Neuroinflammation in Patients with Acute Ischemic Stroke

BackgroundVoltage-gated calcium channels (VGCCs) dysfunction is involved in the development of acute ischemic stroke (AIS). As a subunit of VGCC complexes, we detected the levels of α2δ-1 subunit in serum and cerebrospinal fluid (CSF) specimens from AIS patients. MethodsThe study included 105 patients with first-ever AIS, who were admitted within 48 hours after stroke onset. The serum and CSF levels of α2δ-1 were measured with ELISA and the severity of AIS patients was evaluated according to the National Institutes of Health Stroke Scale (NIHSS) score. The cerebral infarct volume was calculated through the Pullicino formula based on the cranial CT or MRI scan. C-reactive protein (CRP) and serum amyloid A (SAA) were measured using the latex-enhanced immunoturbidimetric assay. ResultsCompared to the control subjects, the serum α2δ-1 level was significantly increased in AIS patients with large infarct volume and in severe AIS cases with high NIHSS score, which correlated positively with the inflammatory markers CRP and SAA. Furthermore, the concentration of α2δ-1 in CSF was elevated with the infarct volume, which was higher in severe AIS patients. ConclusionOur study suggests that the increased α2δ-1 levels in serum and CSF specimens may be used as a potential marker for reflecting VGCCs dysfunction, illness severity and neuroinflammation in AIS patients.

Association of Circulating ICAM3 Concentrations with Severity and Short-term Outcomes of Acute Ischemic Stroke.

Increased circulating intercellular adhesion molecule 3 (ICAM3) is associated with a risk of acute ischemic stroke. This study aims to investigate the association of serum levels of ICAM3 with the severity and short-term outcomes of ischemic stroke. This study recruited 152 stroke patients with supratentorial cerebral infarcts and 133 healthy controls. Patients were followed up for 2 weeks since admission for observation of functional outcomes. Serum ICAM3 concentrations at baseline were determined by Elisa. Serum ICAM3 concentrations were higher in stroke patients than in healthy controls. Serum concentrations of ICAM3 were not associated with stroke severity at baseline, as reflected by NIH Stroke Scale (NIHSS) and infarction volume. However, serum ICAM3 levels were positively associated with mRS scores at 2 weeks since admission. Furthermore, regression analyses found that increased serum ICAM3 levels were associated with worse short-term functional outcomes of stroke. These findings imply that circulating ICAM3 might be a potential short-term prognostic biomarker for acute ischemic stroke.

Conscious sedation compared to general anesthesia for intracranial mechanical thrombectomy: A meta-analysis.

IntroductionEndovascular therapy is the standard of care for severe acute ischemic stroke caused by large‐vessel occlusion in the anterior circulation, but there is a debate on the optimal anesthetic approach during this therapy. Meta‐analyses of observational studies suggest that general anesthesia increases disability and death compared with conscious sedation However, their results are conflicting. This meta‐analysis study was performed to assess the relationship between the effects of general anesthesia compared to conscious sedation during endovascular therapy for acute ischemic stroke.MethodsThrough a systematic literature search up to August 2020, 18 studies included 4,802 subjects at baseline with endovascular therapy for acute ischemic stroke and reported a total of 1,711 subjects using general anesthesia and 1,961 subjects using conscious sedation were found. They recorded relationships between the effects of general anesthesia compared to conscious sedation during endovascular therapy for acute ischemic stroke. Odds ratio (OR) or Mean differences (MD) with 95% confidence intervals (CIs) were calculated between the effect of general anesthesia compared to conscious sedation during endovascular therapy for acute ischemic stroke using the dichotomous or contentious methods with a random or fixed‐effect model.ResultsNo significant difference were found between general anesthesia and conscious sedation during the endovascular therapy for acute ischemic stroke in functional independence at 90 days (OR, 0.78; 95% CI, 0.44–1.40, p = 40); successful recanalization at 24 hr (OR, 1.23; 95% CI, 0.62–2.41, p = 55); mortality at 90 days (OR, 1.36; 95% CI, 0.83–2.24, p = .22); interventional complication (OR, 1.24; 95% CI, 0.76–2.02, p = .40); symptomatic intracranial hemorrhage (OR, 0.64; 95% CI, 0.41–0.99, p = .05); aspiration pneumonia (OR, 0.96; 95% CI, 0.58–1.58, p = .87); and National Institute of Health Stroke Scale score after 24 hr (MD, 0.38; 95% CI, −1.15–1.91, p = .62); with relative relationship favoring general anesthesia only in decreasing the symptomatic intracranial hemorrhage.ConclusionsGeneral anesthesia has no independent relationship compared to conscious sedation during the endovascular therapy for acute ischemic stroke with a relative relationship favoring general anesthesia only in decreasing the symptomatic intracranial hemorrhage.This relationship encouraged us to recommend either anesthetic strategy during the endovascular therapy for acute ischemic stroke with no possible fear of higher complication.

Role of S100β Glial Protein as a Serological Marker for Analysis of Acute Ischemic Stroke

Background: Stroke is a major cause of neurological disability, which can be often predicted with serological markers. Glial-derived S100β protein is a potential biomarker for cerebral ischemia and may be helpful in predicting the severity, outcome, and recovery of stroke. Aim: This study aimed to study the role of S100β glial protein as a serological marker in predicting the severity of acute ischemic stroke (AIS), outcome, and functional recovery after 1 month. Methods: A hospital-based prospective case control study included 43 consecutive patients, &gt;18 years old, who were admitted with acute middle cerebral artery (MCA) territory infarcts within 72 h of onset of neurological deficits. Control group comprised of 43 age-matched asymptomatic volunteers. Independent t-test and chi square test were used to compare the means and evaluate the association between protein level and various parameters. P ≤ .05 was statistically significant. Results: S100β protein level in AIS patients was significantly higher compared to controls ( P &lt; .05). Elevated serum S100β protein level was found to be associated with larger infarct volumes, higher National Institute Health Stroke Scale scores, and higher modified Rankin Scale scores at admission ( P &lt; .05). Patients with higher S100β protein levels at admission had poor recovery at 1 month compared to patients having normal S100β protein levels. Conclusion: S100β protein levels at admission after an acute MCA territory infarct may be used as a reliable serological tool in predicting the severity, outcome, and functional recovery in stroke.

The severity of acute ischemic stroke is associated with the decrease in peak systolic velocity in the common carotid arteries

Abstract Funding Acknowledgements Type of funding sources: None. Introduction A negative effect on the prognosis of ischemic stroke of the aggressive decrease in blood pressure, leading to a decrease in cerebral blood flow, is known. On the other side, increased blood pressure can be a compensatory mechanism. Currently, however, it is difficult to assess the adequacy of cerebral blood flow, one of the indicators of which is the blood flow velocity in the common carotid artery. Purpose The aim of this study was to estimate the peak systolic velocity in the common carotid arteries (CCA PSV) depending on the severity of acute ischemic stroke (IS). Methods 180 patients with acute ischemic stroke (70 females and 110 males, mean age was 66.3 ± 12.3 years) were studied. Including 46 (25.6%) patients with cardioembolic stroke, 25 (13.9%) - with a thrombotic stroke, 27 (15.0%) – with a lacunar stroke and 82 (45.5%) – with undifferentiated stroke. Most of them 173 (96.1%) had grade 3 of arterial hypertension according to ESH/ESC Guidelines for the management of arterial hypertension, 2018. 59 (32.8%) patients had coronary artery disease, 52 (28.9%) - had atrial fibrillation. Patients were categorized according to National Institutes of Health Stroke Scale (NIHSS) severity in mild NIHSS (&amp;lt;9) - 122 (67.8%) patients, moderate NIHSS (9–15) - 35 (19.4%) patients, and severe stroke NIHSS (&amp;gt;16) - 23 (12.8%) patients. Median NIHSS score was 9.2 ± 0.9. All patients underwent a transthoracic echocardiography and a carotid ultrasound examination. A comparative assessment of echographic parameters was performed in patients of lower (NIHSS score ≤ 4.0) and upper (NIHSS score≥11.0) quartile according to the NIHSS score. Results It is shown a decrease of peak systolic velocity in the common carotid arteries with an increase in the severity of IS on the NIHSS scale: in mild stroke, it was 73.9 ± 18.7 cm/s, in moderate stroke - 66.3 ± 19.2 cm/s (p = 0.04), in severe stroke - 62.1 ± 17,4 cm/sec (p = 0.006 and p = 0.4, respectively). Peak systolic velocity in patients with the lower quartile of stroke severity was 73.8 ± 19.1 cm/sec, in the group of patients with the upper quartile – 64.3 ± 19.2 cm/sec (р=0.02). There were no differences in the resistance index of common carotid arteries: 0.75 ± 0.05, 0.76 ± 0.06 and 0.75 ± 0.07 for mild, moderate and severe severity, respectively, p &amp;gt; 0.5). A multiple linear regression analysis in which the severity of ischemic stroke on the NIHSS scale was a dependent variable and age, CCA PSV, common carotid artery intima–media thickness and systolic, diastolic and pulse blood pressure were independent variables, showed that the severity of ischemic stroke was independently correlated with the CCA PSV (β =-0.13, p = 0.009). Conclusions.1. It is shown the decrease of peak systolic velocity in the common carotid arteries with an increase in the severity of ischemic stroke on the NIHSS scale. 2. The reduction of CCA PSV exacerbates brain ischemia and reflecting disorders of autoregulation of cerebral blood flow.

Safety of Ticagrelor in Moderate and Severe Acute Ischemic Stroke: A Single-Center Retrospective Review

ObjectivesTicagrelor may be superior to aspirin after minor ischemic stroke or TIA, particularly in patients with symptomatic atherosclerotic disease. However, there may be an increased risk of intracerebral hemorrhage in patients with moderate to severe ischemic stroke, and ticagrelor has not been studied in this patient population. Therefore, we sought to evaluate the safety of ticagrelor after moderate or severe ischemic stroke. Materials and MethodsRetrospective chart review of all patients admitted with acute ischemic stroke and NIHSS 6 or greater who were discharged on ticagrelor between January 2016 and December 2019. Patients who underwent angioplasty, stenting or carotid revascularization during the hospitalization were excluded. ResultsOf 183 patients discharged on ticagrelor, 61 patients were included. Median age was 61 (IQR 52-68); 33 (54%) patients were men. Median NIHSS was 11 (IQR 8–15). Fourteen (23%) patients received IV alteplase and 35 (57%) patients received mechanical thrombectomy. Stroke mechanism was large artery atherosclerosis in 53 (87%) of patients, of which 40 (71%) were deemed intracranial atherosclerosis. Final infarct volume was greater than 10 mL in 32 (52%) patients. Follow-up information was available for 53 (87%) patients; median length of follow-up was 3 (IQR 2–6) months. Six (10%) patients experienced recurrent ischemic stroke. No patients experienced symptomatic intracerebral hemorrhage after initiation of ticagrelor. One (2%) patient experienced major bleeding. ConclusionsThis study provides preliminary evidence supporting the potential safety of ticagrelor following moderate or severe acute ischemic stroke. These findings support the need for future prospective studies.

Relation Between Neutrophil Lymphocyte Ratio, Brain Imaging and Carotid Duplex Findings in Acute Ischemic Stroke.

Background: Neutrophil lymphocyte ratio (NLR) reflects the balance between neutrophils and lymphocytes. It may represents a prognostic predictor for the acute ischemic stroke severity. Objective: This study aimed to assess the relationship of NLR with the brain imaging (Computed Tomography (CT) and or Magnetic Resonance Imaging (MRI)) and carotid duplex findings in acute ischemic stroke patients. Methods: This study was conducted on sixty acute ischemic stroke patients (26 males, 34 females), their ages ranged from 45 to 95 years. Patients were subjected to detailed medical, neurology history taking, laboratory assessment including white blood cells (WBCs) count, absolute neutrophil count (ANC), and absolute lymphocyte count (ALC). NLR was calculated by dividing ANL by ALC, imaging investigation including CT and or MRI and carotid duplex ultrasonography. Results: There was a statistical significant association between NLR and the size of infarction among the studied patients, however there was no statistical significant association between NLR and findings of carotid duplex in our study. Conclusion: The higher the neutrophil lymphocyte ratio, the larger the size of infarction is expected.

Correlation of serum calcium with severity of acute ischaemic stroke.

Stroke results in the death of around 6.5 million people annually with a majority of these occurring in developing countries. Serum calcium has been hypothesised to play a significant role in causing ischaemic stroke. This retrospective observational study was conducted to determine the correlation, if any, between serum calcium and the severity of acute ischaemic stroke in our population. Two hundred and seventy-nine patients admitted with acute ischaemic stroke were enrolled in the study. Of the 279 patients 162 (58%) were male and mean age was 62.4 ± 3.8 years. Characteristics of stroke patients were compared with stroke severity. Mean albumin corrected serum calcium and Scandinavian stroke severity score was 9.1 (± 5.6) and 33.67 (± 15.2), respectively. Hypertension and mean GCS on admission were significantly associated with increased stroke severity score. However, no correlation was observed between serum calcium and severity of acute ischaemic stroke.

Are prominent medullary veins better than prominent cortical veins as predictors of early clinical outcome in patients with acute ischemic stroke?

The prominent vessel sign (PVS) on susceptibility-weighted imaging (SWI) can be dichotomized into prominent cortical veins (PCV) and prominent medullary veins (PMV). This study was designed to compare the predictive value of PCV and PMV in the evaluation of the severity of acute ischemic stroke (AIS) in patients within the reperfusion window. Forty-seven consecutive patients with AIS within the middle cerebral artery territory were recruited. Magnetic resonance imaging was performed within 8 hours of symptom onset and at 7 days after stroke onset. Infarct volume was measured, and the early clinical outcome at 7 days was assessed using the modified Rankin Scale. PVS was dichotomized into cases with both PCV and PMV and cases with only PCV according to location. Patients with both PCV and PMV (n=32) had higher admission National Institutes of Health Stroke Scale scores (p = 0.020), larger infarct volumes at baseline (p = 0.026) and 7 days (p = 0.007), and larger infarct growth at 7 days (p = 0.050) than those with PCV only. Multivariate regression analysis showed that both the time of onset at baseline (p = 0.013) and infarct growth at 7 days (p = 0.014) could independently predict poor early clinical outcome. PMV may predict poor early clinical outcome in AIS patients, and reperfusion therapy may, therefore, be required more urgently in patients with PMV.

Abnormal dynamic functional connectivity is linked to recovery after acute ischemic stroke.

The aim of the current study was to explore the whole‐brain dynamic functional connectivity patterns in acute ischemic stroke (AIS) patients and their relation to short and long‐term stroke severity. We investigated resting‐state functional MRI‐based dynamic functional connectivity of 41 AIS patients two to five days after symptom onset. Re‐occurring dynamic connectivity configurations were obtained using a sliding window approach and k‐means clustering. We evaluated differences in dynamic patterns between three NIHSS‐stroke severity defined groups (mildly, moderately, and severely affected patients). Furthermore, we built Bayesian hierarchical models to evaluate the predictive capacity of dynamic connectivity and examine the interrelation with clinical measures, such as white matter hyperintensity lesions. Finally, we established correlation analyses between dynamic connectivity and AIS severity as well as 90‐day neurological recovery (ΔNIHSS). We identified three distinct dynamic connectivity configurations acutely post‐stroke. More severely affected patients spent significantly more time in a configuration that was characterized by particularly strong connectivity and isolated processing of functional brain domains (three‐level ANOVA: p < .05, post hoc t tests: p < .05, FDR‐corrected). Configuration‐specific time estimates possessed predictive capacity of stroke severity in addition to the one of clinical measures. Recovery, as indexed by the realized change of the NIHSS over time, was significantly linked to the dynamic connectivity between bilateral intraparietal lobule and left angular gyrus (Pearson's r = −.68, p = .003, FDR‐corrected). Our findings demonstrate transiently increased isolated information processing in multiple functional domains in case of severe AIS. Dynamic connectivity involving default mode network components significantly correlated with recovery in the first 3 months poststroke.

Abstract P323: Stroke Lesion Pattern-Specific Influence of White Matter Hyperintensities on Stroke Severity in Acute Ischemic Stroke

Introduction: MRI-detected white matter hyperintensity (WMH) burden is linked to the overall brain health and incident stroke outcomes. However, data are limited as to whether specific acute stroke lesion patterns purport greater stroke severity in patients with extensive pre-existing WMH. In this analysis, we sought to investigate lesion pattern-specific WMH effects on AIS severity. Methods: We analyzed clinical and lesion data from 621 AIS patients enrolled in the multi-site MRI-GENIE study. The acute NIHSS was modelled via Bayesian hierarchical regression. Using ten stroke lesion patterns, that served as input variables of main interest, we introduced a hierarchical level differentiating between patients with higher and lower than median WMH volume (WMHv). Lesion pattern posterior distributions for higher and lower WMHv patients were subtracted to infer substantial differences. Results: In this AIS cohort [age: 65.3±14.6, 60% male], a higher WMHv was associated with greater stroke severity only when specific left-hemispheric brain regions were infarcted. This “lesion pattern 3” was mainly characterized by left middle and inferior frontal gyrus, insular and opercular cortex, pre- and post-central gyrus, and subcortical basal ganglia regions ( Fig ). Conclusions: Higher WMH burden appears to enhance the detrimental effect of acute stroke lesions involving left-hemispheric brain regions underlying language and motor functions. This effect might be due to an exacerbated disruption of functional network integrity by the combination of WMH and stroke lesions and could be explored further in functional imaging studies that simultaneously considered information from both lesion types.

Abstract P607: Interplay Between Post-Myocardial Infarction Left Ventricular Systolic Dysfunction and Atrial Fibrillation: Prognostic Implications for Post-Myocardial Infarction Acute Ischaemic Stroke

Introduction: Acute myocardial infarction (MI) and acute ischaemic stroke (AIS) are leading causes of morbidity and mortality. There is scarce data examining the interplay between post-MI left ventricular systolic dysfunction (LVSD), with or without atrial fibrillation (AF), and subsequent AIS, especially in patients with milder degrees of LVSD (ejection fraction 40-49%). Evidence of an association would be helpful in developing new strategies of reducing AIS after MI. As such, we sought to study this relationship in a real-world population-based registry. Methods: This study involved linking national-level data from the Singapore Myocardial Infarction Registry with the Singapore Stroke Registry from 1st January 2007 to 31st December 2018. Both data sets have similar definitions for patient demographics. The ejection fraction (EF) and AF status were recorded during the MI episode. The outcome studied was the first instance of AIS that developed after the MI episode. We also studied the relationship between EF, AF and the severity of AIS as measured by the NIH Stroke Scale (NIHSS). Results: There were 64,512 patients available for analysis. The median age was 65.7 (IQR 56.1-76.5) and 69.5% were male. The median duration post-MI to develop AIS was 16.9 (IQR 1.6-46.1) months. There was an independent association between LVSD and the outcome of AIS (adjusted HR 1.18, 95% CI 1.10-1.27); this was evident even in mild forms of LVSD (adjusted HR 1.16, 95% CI 1.06-1.27). AF was not a statistically significant predictor of AIS in post-MI patients with LVSD. Amongst patients without AF, post-MI LVSD was associated with a more severe stroke and higher NIHSS. Conclusion: Post-MI LVSD is associated with the occurrence of subsequent AIS. Although this relationship was independent of AF status, patients with LVSD but no AF had suffered a more severe AIS. These findings support the need to develop effectives therapies to prevent AIS post-MI, especially among those with LVSD.