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Zhou Y, She R, Mei Z, Liu D, Ge J. Crosstalk between ferroptosis and necroptosis in cerebral ischemia/reperfusion injury and Naotaifang formula exerts neuroprotective effect via HSP90-GCN2-ATF4 pathway. PHYTOMEDICINE : INTERNATIONAL JOURNAL OF PHYTOTHERAPY AND PHYTOPHARMACOLOGY 2024; 130:155399. [PMID: 38850632 DOI: 10.1016/j.phymed.2024.155399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/28/2023] [Revised: 01/04/2024] [Accepted: 01/28/2024] [Indexed: 06/10/2024]
Abstract
BACKGROUND Cerebral ischemia/reperfusion injury (CIRI) is a sequence of pathophysiological processes after blood recanalization in the patients with ischemic stroke, and has become the hinder for the rehabilitation. Naotaifang formula (NTF) has exhibited the clinical effectiveness for this disease. However, its action effects and molecular mechanisms against CIRI are not fully elucidated. PURPOSE The research was to clarify the crosstalk between ferroptosis and necroptosis in CIRI, and uncover the mechanism underlying the neuroprotection of NTF. METHODS This study established MCAO/R rat models with various reperfusion times. Western blot, transmission electron microscope, laser speckle imaging, immunofluorescence, immunohistochemistry and pathological staining were conducted to detect and analyze the obtained results. Subsequently, various NTF doses were used to intervene in MCAO/R rats, and biology experiments, such as western blot, Evans blue, immunofluorescence and immunohistochemistry, were used to analyze the efficacy of NTF doses. The effect of NTF was further clarified through in vitro experiments. Eventually, HT22 cells that suffered OGD/R were subjected to pre-treatment with plasmids overexpressing HSP90, MLKL, and GPX4 to indicate the interaction among ferroptosis and necroptosis. RESULTS There was a gradual increase in the Zea Longa score and cerebral infarction volume following CIRI with prolonged reperfusion. Furthermore, the expression of factors associated with pro-ferroptosis and pro-necroptosis was upregulated in the cortex and hippocampus. NTF alleviated ferroptosis and necroptosis in a dose-dependent manner, downregulated HSP90 levels, reduced blood-brain barrier permeability, and thus protected nerve cells from CIRI. The results in vitro research aligned with those of the in vivo research. HSP90 and MLKL overexpression promoted necroptosis and ferroptosis while activating the GCN2-ATF4 pathway. GPX4 overexpression had no effect on necroptosis or the associated signaling pathway. The administration of NTF alone, as well as its combination with the overexpression of HSP90, MLKL, or GPX4 plasmids, decreased the expression levels of factors associated with pro-ferroptosis and pro-necroptosis and reduced the protein levels of the HSP90-GCN2-ATF4 pathway. Moreover, the regulatory effects of the NTF alone group on GSH, ferrous iron, and GCN2 were more significant compared with those of the HSP90 overexpression combination group. CONCLUSION Ferroptosis and necroptosis were gradually aggravated following CIRI with prolonged reperfusion. MLKL overexpression may promote ferroptosis and necroptosis, while GPX4 overexpression may have little effect on necroptosis. HSP90 overexpression accelerated both forms of cell death via the HSP90-GCN2-ATF4 pathway. NTF alleviated ferroptosis and necroptosis to attenuate CIRI by regulating the HSP90-GCN2-ATF4 pathway. Our research provided evidence for the potential of drug development by targeting HSP90, MLKL, and GPX4 to protect against ischemic stroke.
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Affiliation(s)
- Yue Zhou
- Key Laboratory of Hunan Province for Integrated Traditional Chinese and Western Medicine on Prevention and Treatment of Cardio-Cerebral Diseases, College of Integrated Traditional Chinese and Western Medicine, Hunan University of Chinese Medicine, Changsha, Hunan 410208, China; Department of Scientific Research, Hunan Provincial Hospital of Integrated Traditional Chinese and Western Medicine, Changsha 410006, China
| | - Ruining She
- Key Laboratory of Hunan Province for Integrated Traditional Chinese and Western Medicine on Prevention and Treatment of Cardio-Cerebral Diseases, College of Integrated Traditional Chinese and Western Medicine, Hunan University of Chinese Medicine, Changsha, Hunan 410208, China
| | - Zhigang Mei
- Key Laboratory of Hunan Province for Integrated Traditional Chinese and Western Medicine on Prevention and Treatment of Cardio-Cerebral Diseases, College of Integrated Traditional Chinese and Western Medicine, Hunan University of Chinese Medicine, Changsha, Hunan 410208, China.
| | - Danhong Liu
- Medical School, Hunan University of Chinese Medicine, Changsha, Hunan 410208, China
| | - Jinwen Ge
- Key Laboratory of Hunan Province for Integrated Traditional Chinese and Western Medicine on Prevention and Treatment of Cardio-Cerebral Diseases, College of Integrated Traditional Chinese and Western Medicine, Hunan University of Chinese Medicine, Changsha, Hunan 410208, China; Hunan Academy of Chinese Medicine, Changsha, Hunan 410013, China.
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2
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Özkan M, Güner A, Gündüz S, Yıldız G, Yıldırım Aİ, Kalçık M, Yesin M, Bayam E, Kalkan S, Gürsoy MO, Kılıçgedik A, Bayram Z, Sarı M, Aytürk M, Karakoyun S, Astarcıoğlu MA, Gündoğdu EC, Biçer A, Gürcü E, Koçak T, Demirbağ R. Combination anticoagulation strategy in pregnancy with mechanical valves: The KYBELE study. Am Heart J 2024; 273:21-34. [PMID: 38570020 DOI: 10.1016/j.ahj.2024.03.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Revised: 03/27/2024] [Accepted: 03/28/2024] [Indexed: 04/05/2024]
Abstract
BACKGROUND Optimal first-trimester anticoagulation is still challenging in pregnant women with mechanical heart valves (MHVs) requiring high-dose warfarin. This multicenter prospective study aims to determine the optimal anticoagulation regimens for pregnant patients with MHVs. METHODS All women were allocated to one of three treatment options during first trimester including lone low-molecular-weight heparin (LMWH), combination of LMWH + 2.5 mg warfarin, and LMWH+4 mg warfarin. Primary maternal outcome included a combination of death, thromboembolism, severe bleeding, and need for treatment of mechanical valve thrombosis (MVT). Any fetal loss was determined as primary fetal outcome. RESULTS The study included 78 pregnancies in 65 women with MHVs. Primary maternal outcome rate was 44%, 12.5%, 3.5%, respectively. The rates of primary maternal outcome (44 vs 3.5%, P < .001), obstructive MVT (16 vs 0%, P = .04), MVT requiring treatment (28 vs 0%, P = .003), and cerebral embolism (24 vs 3.4%, P = .041) were found to be significantly higher in lone LMWH group compared to LMWH + 4 mg warfarin group. Moreover, the rates of primary maternal outcome (12.5 vs 44%, P = .015) and treatment for MHV thrombus (4.2 vs 28%, P = .049) were significantly lower in LMWH + 2.5 mg warfarin group compared to lone LMWH group. The incidences of fetal loss were 8 (32%) in the lone LMWH group, 8 (33.3%) in LMWH + 2.5 mg warfarin group, and 11 (37.9%) in LMWH + 4 mg warfarin group (P = .890 for 3-group).Warfarin related-embryopathy was not observed in any case. CONCLUSIONS The combined anticoagulation strategy of LMWH plus low-dose warfarin during the first trimester of pregnancy may result in less maternal complications with comparable fetal outcomes in patients with MHVs. CONDENSED ABSTRACT Low-molecular-weight heparin (LMWH) is thought to be safer for the fetus, however it is suspected to be less protective for the mother. To solve this dilemma, the authors suggested a novel anticoagulation strategy in pregnant women with prosthetic valves. Seventy-eight pregnancies of 65 women (median age 32 [27-35] years) were included in the study. A combination of LMWH and a reduced dose warfarin were associated with low rates of thrombus-related complications in pregnant patients with mechanical heart valves.
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Affiliation(s)
- Mehmet Özkan
- Koşuyolu Kartal Heart Training and Research Hospital, Department of Cardiology, Istanbul, Turkey; Ardahan University, Faculty of Health Sciences, Ardahan, Turkey
| | - Ahmet Güner
- Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Department of Cardiology, Istanbul, Turkey.
| | - Sabahattin Gündüz
- Koşuyolu Kartal Heart Training and Research Hospital, Department of Cardiology, Istanbul, Turkey
| | - Gazi Yıldız
- Kartal Dr. Lutfi Kirdar Research and Training Hospital, Department of Obstetrics and Gynecology, Istanbul, Turkey
| | - Ayşe İnci Yıldırım
- Koşuyolu Kartal Heart Training and Research Hospital, Department of Pediatric Cardiology, Istanbul, Turkey
| | - Macit Kalçık
- Hitit University, Faculty of Medicine, Department of Cardiology, Corum, Turkey
| | - Mahmut Yesin
- Koşuyolu Kartal Heart Training and Research Hospital, Department of Cardiology, Istanbul, Turkey
| | - Emrah Bayam
- Koşuyolu Kartal Heart Training and Research Hospital, Department of Cardiology, Istanbul, Turkey
| | - Semih Kalkan
- Koşuyolu Kartal Heart Training and Research Hospital, Department of Cardiology, Istanbul, Turkey
| | - Mustafa Ozan Gürsoy
- İzmir Katip Çelebi University, Atatürk Training and Reseach Hospital, Department of Cardiology, Izmir, Turkey
| | - Alev Kılıçgedik
- Koşuyolu Kartal Heart Training and Research Hospital, Department of Cardiology, Istanbul, Turkey
| | - Zübeyde Bayram
- Koşuyolu Kartal Heart Training and Research Hospital, Department of Cardiology, Istanbul, Turkey
| | - Münevver Sarı
- Koşuyolu Kartal Heart Training and Research Hospital, Department of Cardiology, Istanbul, Turkey
| | - Mehmet Aytürk
- Koşuyolu Kartal Heart Training and Research Hospital, Department of Cardiology, Istanbul, Turkey
| | - Süleyman Karakoyun
- Koşuyolu Kartal Heart Training and Research Hospital, Department of Cardiology, Istanbul, Turkey
| | - Mehmet Ali Astarcıoğlu
- Koşuyolu Kartal Heart Training and Research Hospital, Department of Cardiology, Istanbul, Turkey
| | - Elif Cansu Gündoğdu
- Kartal Dr. Lutfi Kirdar Research and Training Hospital, Department of Obstetrics and Gynecology, Istanbul, Turkey
| | - Asuman Biçer
- Harran University, Faculty of Medicine, Department of Cardiology, Şanlıurfa, Turkey
| | - Emre Gürcü
- Koşuyolu Kartal Heart Training and Research Hospital, Department of Anesthesia and Reanimation, Istanbul, Turkey
| | - Tuncer Koçak
- Koşuyolu Kartal Heart Training and Research Hospital, Department of Anesthesia and Reanimation, Istanbul, Turkey
| | - Recep Demirbağ
- Harran University, Faculty of Medicine, Department of Cardiology, Şanlıurfa, Turkey
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Kaur M, Fusco S, Van den Broek B, Aseervatham J, Rostami A, Iacovitti L, Grassi C, Lukomska B, Srivastava AK. Most recent advances and applications of extracellular vesicles in tackling neurological challenges. Med Res Rev 2024; 44:1923-1966. [PMID: 38500405 DOI: 10.1002/med.22035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Revised: 02/22/2024] [Accepted: 03/04/2024] [Indexed: 03/20/2024]
Abstract
Over the past few decades, there has been a notable increase in the global burden of central nervous system (CNS) diseases. Despite advances in technology and therapeutic options, neurological and neurodegenerative disorders persist as significant challenges in treatment and cure. Recently, there has been a remarkable surge of interest in extracellular vesicles (EVs) as pivotal mediators of intercellular communication. As carriers of molecular cargo, EVs demonstrate the ability to traverse the blood-brain barrier, enabling bidirectional communication. As a result, they have garnered attention as potential biomarkers and therapeutic agents, whether in their natural form or after being engineered for use in the CNS. This review article aims to provide a comprehensive introduction to EVs, encompassing various aspects such as their diverse isolation methods, characterization, handling, storage, and different routes for EV administration. Additionally, it underscores the recent advances in their potential applications in neurodegenerative disorder therapeutics. By exploring their unique capabilities, this study sheds light on the promising future of EVs in clinical research. It considers the inherent challenges and limitations of these emerging applications while incorporating the most recent updates in the field.
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Affiliation(s)
- Mandeep Kaur
- Department of Medicine, Cardeza Foundation for Hematologic Research, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Salvatore Fusco
- Department of Neuroscience, Università Cattolica del Sacro Cuore, Rome, Italy
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Bram Van den Broek
- Department of Neurology, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Jaya Aseervatham
- Department of Neurology, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Abdolmohamad Rostami
- Department of Neurology, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Lorraine Iacovitti
- Department of Neuroscience, Vickie and Jack Farber Institute for Neuroscience, Jefferson Stem Cell and Regenerative Neuroscience Center, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Claudio Grassi
- Department of Neuroscience, Università Cattolica del Sacro Cuore, Rome, Italy
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Barbara Lukomska
- NeuroRepair Department, Mossakowski Medical Research Institute, Polish Academy of Sciences, Warsaw, Poland
| | - Amit K Srivastava
- Department of Medicine, Cardeza Foundation for Hematologic Research, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
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Khatami SS, Revheim ME, Høilund-Carlsen PF, Alavi A, Ghorbani Shirkouhi S, Andalib S. Central nervous system manifestations following vaccination against COVID-19. Brain Behav Immun Health 2024; 38:100788. [PMID: 38818372 PMCID: PMC11137405 DOI: 10.1016/j.bbih.2024.100788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2023] [Revised: 03/03/2024] [Accepted: 05/02/2024] [Indexed: 06/01/2024] Open
Abstract
Coronavirus disease 2019 (COVID-19) vaccination has become the most effective countermeasure in the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic. However, vaccination is associated with side effects. This narrative review focuses on central nervous system (CNS) manifestations following COVID-19 vaccination and provides a summary of the potential underlying mechanisms and methods of diagnosis and management of the vaccination-related CNS manifestations. Headache, myalgia, optic neuritis, seizure, multiple sclerosis, acute disseminated encephalomyelitis and encephalitis, delirium, acute transverse myelitis, and stroke have been reported after COVID-19 vaccination. Constant headache and myalgia are common manifestations that may necessitate further clinical investigation for stroke. To limit consequences, it is imperative to follow standard treatment protocols for each neurological disorder following COVID-19 vaccination. Immunosuppressive medication can be helpful in the treatment of seizures following vaccination since the immune response is involved in their etiology. Clinicians should be aware of the manifestations after COVID-19 vaccination to respond promptly and effectively. Clinical guidelines for the management of CNS manifestations following COVID-19 vaccination are in high demand and would be useful in each new SARS-CoV-2 variant pandemic.
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Affiliation(s)
| | - Mona-Elisabeth Revheim
- The Intervention Center, Division of Technology and Innovation, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Poul Flemming Høilund-Carlsen
- Department of Nuclear Medicine, Odense University Hospital, University of Southern Denmark, Odense, Denmark
- Research Unit of Clinical Physiology and Nuclear Medicine, Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | - Abass Alavi
- Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Pennsylvania, USA
| | | | - Sasan Andalib
- Research Unit of Neurology, Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
- Department of Neurology, Odense University Hospital, Odense, Denmark
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Deng X, Chang W, Zhu J, Lv X, Lai R, Cai Y, Liu S, Liang J. Hypothyroidism's effect on stroke limited to specific subtypes: A Mendelian randomization study. J Stroke Cerebrovasc Dis 2024; 33:107737. [PMID: 38688395 DOI: 10.1016/j.jstrokecerebrovasdis.2024.107737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 04/24/2024] [Accepted: 04/27/2024] [Indexed: 05/02/2024] Open
Abstract
BACKGROUND The association between hypothyroidism and stroke remains controversial and the association between hypothyroidism and stroke subtypes has not been satisfactorily researched. This study aimed to explore the causal effect of hypothyroidism on the risk of stroke and its subtypes by Mendelian randomization (MR) analysis. METHODS Single nucleotide polymorphisms (SNPs) were selected from published genome-wide association studies (GWAS) meta-analysis as instrumental variables (IVs) for hypothyroidism. As outcomes, summary GWAS data for stroke and its subtypes were obtained from two other large GWAS meta-analyses, including any stroke (AS), any ischemic stroke (AIS), large vessel stroke (LAS), cardiogenic embolic stroke (CES), small vessel stroke (SVS), and intracranial hemorrhage (ICH). Univariate Mendelian randomization (UVMR) and multivariate Mendelian randomization (MVMR) were used to assess the causal effect of hypothyroidism on stroke and its subtypes. RESULTS In UVMR, genetically predicted hypothyroidism was significantly associated with LAS (OR = 1.14, 95CI = 1.02-1.27) and SVS (OR = 1.14, 95CI = 1.04-1.25), but not with AS, AIS, CES, and ICH. The results of the MVMR showed that after adjusting for smoking, alcohol consumption, hypertension, diabetes, low-density lipoprotein cholesterol (LDL-c), and body mass index (BMI), the causal association between hypothyroidism and SVS remained significant, while the association between hypothyroidism and LAS became nonsignificant. CONCLUSION Hypothyroidism is causally associated with risk for LAS and SVS, but not for other stroke subtypes. Hypothyroidism may be an independent risk factor for SVS, and vascular risk factors play an important role in hypothyroidism causing LAS.
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Affiliation(s)
- Xinmin Deng
- Chengdu University of Traditional Chinese Medicine, China
| | - Wen Chang
- Chengdu University of Traditional Chinese Medicine, China
| | - Jingyi Zhu
- Chengdu University of Traditional Chinese Medicine, China
| | - Xiaofeng Lv
- Chengdu University of Traditional Chinese Medicine, China
| | - Rui Lai
- Chengdu University of Traditional Chinese Medicine, China
| | - Yu Cai
- Chengdu University of Traditional Chinese Medicine, China
| | - Shanshan Liu
- Chengdu University of Traditional Chinese Medicine, China
| | - Jingtao Liang
- Hospital of Chengdu University of Traditional Chinese Medicine, China.
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Bernardi MS, Rodriguez A, Caruso P, Furlanis G, Ridolfi M, Prandin G, Naccarato M, Laio A, Amati D, Manganotti P. Improving acute stroke assessment in non-enhanced computed tomography: automated tool for early ischemic lesion volume detection. Neurol Sci 2024; 45:3245-3253. [PMID: 38285327 DOI: 10.1007/s10072-024-07339-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Accepted: 01/20/2024] [Indexed: 01/30/2024]
Abstract
BACKGROUND AND OBJECTIVES ASPECTs is a widely used marker to identify early stroke signs on non-enhanced computed tomography (NECT), yet it presents interindividual variability and it may be hard to use for non-experts. We introduce an algorithm capable of automatically estimating the NECT volumetric extension of early acute ischemic changes in the 3D space. We compared the power of this marker with ASPECTs evaluated by experienced practitioner in predicting the clinical outcome. METHODS We analyzed and processed neuroimaging data of 153 patients admitted with acute ischemic stroke. All patients underwent a NECT at admission and on follow-up. The developed algorithm identifies the early ischemic hypodense region based on an automatic comparison of the gray level in the images of the two hemispheres, assumed to be an approximate mirror image of each other in healthy patients. RESULTS In the two standard axial slices used to estimate the ASPECTs, the regions identified by the algorithm overlap significantly with those identified by experienced practitioners. However, in many patients, the regions identified automatically extend significantly to other slices. In these cases, the volume marker provides supplementary and independent information. Indeed, the clinical outcome of patients with volume marker = 0 can be distinguished with higher statistical confidence than the outcome of patients with ASPECTs = 10. CONCLUSION The volumetric extension and the location of acute ischemic region in the 3D-space, automatically identified by our algorithm, provide data that are mostly in agreement with the ASPECTs value estimated by expert practitioners, and in some cases complementary and independent.
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Affiliation(s)
- Mara Sabina Bernardi
- Molecular and Statistical Biophysics Group, International School for Advanced Studies (SISSA), Via Bonomea 265, 34136, Trieste, Italy
| | - Alex Rodriguez
- Molecular and Statistical Biophysics Group, International School for Advanced Studies (SISSA), Via Bonomea 265, 34136, Trieste, Italy
- Dipartimento di Matematica, Informatica e Geoscienze, Università degli studi di Trieste, via Valerio 12/1, 34127, Trieste, Italy
| | - Paola Caruso
- Clinical Unit of Neurology, Department of Medicine, Surgery and Health Sciences, University Hospital and Health Services of Trieste-ASUGI, University of Trieste, Strada di Fiume 447, 34149, Trieste, Italy
| | - Giovanni Furlanis
- Clinical Unit of Neurology, Department of Medicine, Surgery and Health Sciences, University Hospital and Health Services of Trieste-ASUGI, University of Trieste, Strada di Fiume 447, 34149, Trieste, Italy
| | - Mariana Ridolfi
- Clinical Unit of Neurology, Department of Medicine, Surgery and Health Sciences, University Hospital and Health Services of Trieste-ASUGI, University of Trieste, Strada di Fiume 447, 34149, Trieste, Italy
| | - Gabriele Prandin
- Clinical Unit of Neurology, Department of Medicine, Surgery and Health Sciences, University Hospital and Health Services of Trieste-ASUGI, University of Trieste, Strada di Fiume 447, 34149, Trieste, Italy.
| | - Marcello Naccarato
- Clinical Unit of Neurology, Department of Medicine, Surgery and Health Sciences, University Hospital and Health Services of Trieste-ASUGI, University of Trieste, Strada di Fiume 447, 34149, Trieste, Italy
| | - Alessandro Laio
- Molecular and Statistical Biophysics Group, International School for Advanced Studies (SISSA), Via Bonomea 265, 34136, Trieste, Italy
| | - Daniele Amati
- Molecular and Statistical Biophysics Group, International School for Advanced Studies (SISSA), Via Bonomea 265, 34136, Trieste, Italy
| | - Paolo Manganotti
- Clinical Unit of Neurology, Department of Medicine, Surgery and Health Sciences, University Hospital and Health Services of Trieste-ASUGI, University of Trieste, Strada di Fiume 447, 34149, Trieste, Italy
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Jin Y, Shen L, Ye R, Zhou M, Guo X. Development and validation of a novel score for predicting perioperative major adverse cardiovascular events in patients with stable coronary artery disease undergoing noncardiac surgery. Int J Cardiol 2024; 405:131982. [PMID: 38521511 DOI: 10.1016/j.ijcard.2024.131982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Revised: 02/01/2024] [Accepted: 03/17/2024] [Indexed: 03/25/2024]
Abstract
BACKGROUND A model developed specifically for stable coronary artery disease (SCAD) patients to predict perioperative major adverse cardiovascular events (MACE) has not been previously reported. METHODS The derivation cohort consisted of 5780 patients with SCAD undergoing noncardiac surgery at the First Affiliated Hospital of Zhejiang University School of Medicine, from January 1, 2013 until May 31, 2021. The validation cohort consisted of 2677 similar patients from June 1, 2021 to May 31, 2023. The primary outcome was a composite of MACEs (death, resuscitated cardiac arrest, myocardial infarction, heart failure, and stroke) intraoperatively or during hospitalization postoperatively. RESULTS Six predictors, including Creatinine >90 μmol/L, Hemoglobin <110 g/L, Albumin <40 g/L, Leukocyte >10 ×109/L, high-risk Surgery (general abdominal or vascular), and American Society of Anesthesiologists (ASA) class (III or IV), were selected in the final model (CHALSA score). Each patient was assigned a CHALSA score of 0, 1, 2, 3, or > 3 according to the number of predictors present. The incidence of perioperative MACEs increased steadily across the CHALSA score groups in both the derivation (0.5%, 1.4%, 2.9%, 6.8%, and 23.4%, respectively; p < 0.001) and validation (0.3%, 1.5%, 4.1%, 9.2%, and 29.2%, respectively; p < 0.001) cohorts. The CHALSA score had a higher discriminatory ability than the revised cardiac risk index (C statistic: 0.827 vs. 0.695 in the validation dataset; p < 0.001). CONCLUSIONS The CHALSA score showed good validity in an external dataset and will be a valuable bedside tool to guide the perioperative management of patients with SCAD undergoing noncardiac surgery.
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Affiliation(s)
- Yunpeng Jin
- Department of Cardiology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China; Department of Cardiology, The Fourth Affiliated Hospital of School of Medicine, International School of Medicine, International Institutes of Medicine, Zhejiang University, Yiwu 322000, China
| | - Liang Shen
- Department of Information Technology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China
| | - Runze Ye
- Department of Cardiology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China
| | - Min Zhou
- Department of Information Technology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China
| | - Xiaogang Guo
- Department of Cardiology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China.
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Knepp B, Navi BB, Rodriguez F, DeAngelis LM, Elkind MSV, Iadecola C, Sherman CP, Tagawa ST, Saxena A, Ocean AJ, Hull H, Jickling G, Sharp FR, Ander BP, Stamova B. Ischemic Stroke with Comorbid Cancer Has Specific miRNA-mRNA Networks in Blood That Vary by Ischemic Stroke Mechanism. Ann Neurol 2024. [PMID: 38874304 DOI: 10.1002/ana.26997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Revised: 05/22/2024] [Accepted: 05/24/2024] [Indexed: 06/15/2024]
Abstract
OBJECTIVE Approximately half of ischemic strokes (IS) in cancer patients are cryptogenic, with many presumed cardioembolic. We evaluated whether there were specific miRNA and mRNA transcriptome architectures in peripheral blood of IS patients with and without comorbid cancer, and between cardioembolic versus noncardioembolic IS etiologies in comorbid cancer. METHODS We studied patients with cancer and IS (CS; n = 42), stroke only (SO; n = 41), and cancer only (n = 28), and vascular risk factor-matched controls (n = 30). mRNA-Seq and miRNA-Seq data, analyzed with linear regression models, identified differentially expressed genes in CS versus SO and in cardioembolic versus noncardioembolic CS, and miRNA-mRNA regulatory pairs. Network-level analyses identified stroke etiology-specific responses in CS. RESULTS A total of 2,085 mRNAs and 31 miRNAs were differentially expressed between CS and SO. In CS, 122 and 35 miRNA-mRNA regulatory pairs, and 5 and 3 coexpressed gene modules, were associated with cardioembolic and noncardioembolic CS, respectively. Complement, growth factor, and immune/inflammatory pathways showed differences between IS etiologies in CS. A 15-gene biomarker panel assembled from a derivation cohort (n = 50) correctly classified 81% of CS and 71% of SO participants in a validation cohort (n = 33). Another 15-gene panel correctly identified etiologies for 13 of 13 CS-cardioembolic and 11 of 11 CS-noncardioembolic participants upon cross-validation; 11 of 16 CS-cryptogenic participants were predicted cardioembolic. INTERPRETATION We discovered unique mRNA and miRNA transcriptome architecture in CS and SO, and in CS with different IS etiologies. Cardioembolic and noncardioembolic etiologies in CS showed unique coexpression networks and potential master regulators. These may help distinguish CS from SO and identify IS etiology in cryptogenic CS patients. ANN NEUROL 2024.
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Affiliation(s)
- Bodie Knepp
- Department of Neurology, School of Medicine, University of California, Davis, Sacramento, CA, USA
| | - Babak B Navi
- Clinical and Translational Neuroscience Unit, Department of Neurology, Weill Cornell Medicine, Feil Family Brain and Mind Research Institute, New York, NY, USA
- Department of Neurology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Fernando Rodriguez
- Department of Neurology, School of Medicine, University of California, Davis, Sacramento, CA, USA
| | - Lisa M DeAngelis
- Department of Neurology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Mitchell S V Elkind
- Department of Neurology, Vagelos College of Physicians and Surgeons and Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Costantino Iadecola
- Clinical and Translational Neuroscience Unit, Department of Neurology, Weill Cornell Medicine, Feil Family Brain and Mind Research Institute, New York, NY, USA
| | - Carla P Sherman
- Clinical and Translational Neuroscience Unit, Department of Neurology, Weill Cornell Medicine, Feil Family Brain and Mind Research Institute, New York, NY, USA
| | - Scott T Tagawa
- Division of Hematology and Oncology, Department of Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Ashish Saxena
- Division of Hematology and Oncology, Department of Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Allyson J Ocean
- Division of Hematology and Oncology, Department of Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Heather Hull
- Department of Neurology, School of Medicine, University of California, Davis, Sacramento, CA, USA
| | - Glen Jickling
- Department of Neurology, School of Medicine, University of California, Davis, Sacramento, CA, USA
- Division of Neurology, Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Frank R Sharp
- Department of Neurology, School of Medicine, University of California, Davis, Sacramento, CA, USA
| | - Bradley P Ander
- Department of Neurology, School of Medicine, University of California, Davis, Sacramento, CA, USA
| | - Boryana Stamova
- Department of Neurology, School of Medicine, University of California, Davis, Sacramento, CA, USA
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Chao AC, Lee TH, Pettigrew LC, Hannawi Y, Huang HY, Chi NF, Chan L, Chen PL, Devlin T. Intravenous Odatroltide for Acute Ischemic Stroke Within 24 Hours of Onset: A Phase 2, Multicenter, Randomized, Double-Blind, Placebo-Controlled Study. Drug Des Devel Ther 2024; 18:2033-2042. [PMID: 38859883 PMCID: PMC11164084 DOI: 10.2147/dddt.s460831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2024] [Accepted: 05/23/2024] [Indexed: 06/12/2024] Open
Abstract
Purpose Odatroltide (LT3001), a novel small synthetic peptide molecule designed to recanalize occluded blood vessels and reduce reperfusion injury, is safe and efficacious in multiple embolic stroke animal models. This study aimed to investigate the safety and tolerability of intravenous administration of odatroltide in patients with acute ischemic stroke within 24 hours of onset. Patients and Methods Patients with National Institutes of Health Stroke Scale (NIHSS 4-30) who were untreated with intravenous thrombolysis or endovascular thrombectomy were randomized (2:1) to receive a single dose of odatroltide (0.025 mg/kg) or placebo within 24 hours of stroke symptom onset. The primary safety outcome was symptomatic intracranial hemorrhage (sICH) occurrence within 36 hours. Results Twenty-four patients were enrolled and randomized; of these 16 and 8 received intravenous odatroltide infusion and placebo, respectively. sICH did not occur in both groups, and other safety measures were comparable between the groups. The rate of excellent functional outcome (modified Rankin Scale score, 0-1, at 90 days) was 21% and 14% in the odatroltide and placebo groups, respectively. Furthermore, 47% and 14% of patients in the odatroltide and placebo groups, respectively, showed major neurological improvement (NIHSS improvement ≥4 points from baseline to 30 days). Among the 9 odatroltide-treated patients with baseline NIHSS ≥6, 78% showed major neurological improvement. Conclusion Compared with placebo, treatment with intravenous odatroltide within 24 hours following onset of ischemic stroke appears to be safe and may be associated with better neurological and functional outcomes. However, the efficacy and safety of odatroltide requires further confirmation in the next phase of clinical trials. Clinical Trial Registration Clinicaltrials.gov identifier: NCT04091945.
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Affiliation(s)
- A-Ching Chao
- Department of Neurology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
- College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Tsong-Hai Lee
- Stroke Center and Department of Neurology, Linkou Chang Gung Memorial Hospital and College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Luther C Pettigrew
- Department of Neurology, University of Kentucky Chandler Medical Center, Lexington, KY, USA
| | - Yousef Hannawi
- Division of Cerebrovascular Diseases and Neurocritical Care, Department of Neurology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Hung-Yu Huang
- Department of Neurology, China Medical University Hospital, Taichung, Taiwan
| | - Nai-Fang Chi
- School of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Division of Cerebrovascular Diseases, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Lung Chan
- Department of Neurology, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
- Department of Neurology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Po-Lin Chen
- Division of Neurology, Neurological Institute, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Thomas Devlin
- CHI Memorial Neuroscience Institute, Chattanooga, TN, USA
- Department of Neurology, Morehouse School of Medicine, Atlanta, GA, USA
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10
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Alashram AR. Combined robot-assisted therapy virtual reality for upper limb rehabilitation in stroke survivors: a systematic review of randomized controlled trials. Neurol Sci 2024:10.1007/s10072-024-07628-z. [PMID: 38837113 DOI: 10.1007/s10072-024-07628-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2024] [Accepted: 05/28/2024] [Indexed: 06/06/2024]
Abstract
BACKGROUND Upper limb impairments are among the most common consequences following a stroke. Recently, robot-assisted therapy (RT) and virtual reality (VR) have been used to improve upper limb function in stroke survivors. OBJECTIVES This review aims to investigate the effects of combined RT and VR on upper limb function in stroke survivors and to provide recommendations for researchers and clinicians in the medical field. METHODS We searched PubMed, SCOPUS, REHABDATA, PEDro, EMBASE, and Web of Science from inception to March 28, 2024. Randomized controlled trials (RCTs) involving stroke survivors that compared combined RT and VR interventions with either passive (i.e., sham, rest) or active (i.e., traditional therapy, VR, RT) interventions and assessed outcomes related to upper limb function (e.g., strength, muscle tone, or overall function) were included. The Cochrane Collaboration tool was used to evaluate the methodological quality of the included studies. RESULTS Six studies were included in this review. In total, 201 patients with stroke (mean age 57.84 years) were involved in this review. Four studies were considered 'high quality', while two were considered as 'moderate quality' on the Cochrane Collaboration tool. The findings showed inconsistent results for the effects of combined RT and VR interventions on upper limb function poststroke. CONCLUSION In conclusion, there are potential effects of combined RT and VR interventions on improving upper limb function, but further research is needed to confirm these findings, understand the underlying mechanisms, and assess the consistency and generalizability of the results.
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Affiliation(s)
- Anas R Alashram
- Department of Physiotherapy, Middle East University, Ammam, Jordan.
- Applied Science Research Center, Applied Science Private University, Amman, Jordan.
- Department of Human Sciences and Promotion of the Quality of Life, San Raffaele Roma Open University, Rome, Italy.
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11
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Schmidt J, Düvel JA, Elkenkamp S, Greiner W. Comparing the EQ-5D-5L and stroke impact scale 2.0 in stroke patients: an analysis of measurement properties. Health Qual Life Outcomes 2024; 22:45. [PMID: 38835023 DOI: 10.1186/s12955-024-02252-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Accepted: 04/20/2024] [Indexed: 06/06/2024] Open
Abstract
BACKGROUND Stroke has evolved to become a chronic disease and a major public health challenge. To adequately capture the full disease burden of stroke patients, the assessment of health-related quality of life (HRQoL) and thus the performance of respective measures is increasingly relevant. The aim of this analysis was to compare the measurement properties of two self-report instruments, the EQ-5D-5L and the Stroke Impact Scale 2.0. METHODS The data used for the analysis was derived from a quasi-experimental case management study for mildly to moderately affected incident stroke and transient ischemic attack (TIA) patients aged ≥ 18 in Germany. Data was collected patient-individually at 3, 6 and 12 months after initial stroke. The EQ-5D-5L and SIS 2.0 were compared in terms of feasibility, ceiling and floor effects, responsiveness and known-groups validity (Kruskal-Wallis H and Wilcoxon rank-sum test). RESULTS A response for all three follow-ups is available for n = 855 patients. The feasibility of the EQ-5D-5L is determined as good (completion rate: 96.4-96.6%, ≥ one item missing: 3.2 - 3.3%), whereas the SIS 2.0 is moderately feasible (overall completion rate: 44.9-46.1%, ≥ one item missing in domains: 4.7 - 28.7%). The SIS 2.0 shows substantial ceiling effects in comparable domains (physical function: 10.4 - 13%, others: 3.5-31.3%) which are mainly larger than ceiling effects in the EQ-5D-5L index (17.1-21.5%). In terms of responsiveness, the EQ-5D-5L shows small to moderate change while the SIS 2.0 presents with moderate to large responsiveness. The EQ-5D-5L index, mobility, usual activities and Visual Analogue Scale show known-groups validity (p < 0.05). Content-related domains of the SIS 2.0 show known-groups validity as well (p < 0.05). However, it is compromised in the emotion domain in both measures (p > 0.05). CONCLUSIONS The EQ-5D-5L seems to be slightly more suitable for this cohort. Nonetheless, the results of both measures indicate limited suitability for TIA patients. Large-scale studies concerning responsiveness and known-groups validity are encouraged. TRIAL REGISTRATION The study was registered in the German Clinical Trials Register, retrospective registration on 21.09.2022. REGISTRATION ID DRKS00030297.
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Affiliation(s)
- Juliana Schmidt
- Department of Health Economics and Health Care Management, School of Public Health, Bielefeld University, Bielefeld, Germany.
| | - Juliane Andrea Düvel
- Department of Health Economics and Health Care Management, School of Public Health, Bielefeld University, Bielefeld, Germany
| | - Svenja Elkenkamp
- Department of Health Economics and Health Care Management, School of Public Health, Bielefeld University, Bielefeld, Germany
| | - Wolfgang Greiner
- Department of Health Economics and Health Care Management, School of Public Health, Bielefeld University, Bielefeld, Germany
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12
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Li G, Tao X, Lei B, Hou X, Yang X, Wang L, Zhang S, Lv Y, Wang T, Yu L. Effects of exercise on post-stroke cognitive function: a systematic review and meta-analysis of randomized controlled trials. Top Stroke Rehabil 2024:1-22. [PMID: 38825881 DOI: 10.1080/10749357.2024.2356393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Accepted: 04/23/2024] [Indexed: 06/04/2024]
Abstract
BACKGROUND A growing body of research examining the effect of exercise on cognitive function in stroke patients, while findings of available studies were conflicting. OBJECTIVES We aimed to estimate the effect of exercise on cognitive function in stroke patients. METHODS For this systematic review and meta-analysis, we searched PubMed, Web of Science, Embase, Cochrane, and Scopus electronic databases, through 13 March 2023. The three-level restricted maximum likelihood random effects model was used to synthesize the data. RESULTS Twenty-five studies met the inclusion criteria. There was a significant effect of exercise on improving cognitive function in stroke patients (Cohen's d = 0.37, 95% CI, 0.16 to 0.58, p < 0.01, I2 = 22.12%). Subgroup analysis showed that exercise significantly improved memory. In addition, aerobic exercise, exercise conducted 12 weeks or more, 3 times or more per week, less than 60 minutes per session, less than 180 minutes per week, and up to 12 months post-stroke increased cognitive function significantly. CONCLUSIONS Exercise improved cognitive function in stroke patients. To improve cognitive function, this meta-analysis provides clinicians with evidence to recommend that stroke patients participate in aerobic exercise at least 3 times per week for 30-60 minutes, with a goal of 180 minutes per week being achieved by increasing the frequency of exercise. Exercise initiated within 12 months post-stroke and continued for 12 weeks or more is most beneficial for improving cognitive function.
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Affiliation(s)
- Gen Li
- School of Physical Education & Sports Science, South China Normal University, Guangzhou, China
| | - Xifeng Tao
- Department of Strength and Conditioning Assessment and Monitoring, Beijing Sport University, Beijing, China
| | - Bingkai Lei
- School of Physical Education, Xihua University, Chengdu, China
| | - Xiao Hou
- Department of Strength and Conditioning Assessment and Monitoring, Beijing Sport University, Beijing, China
| | - Xiaoguang Yang
- Department of Strength and Conditioning Assessment and Monitoring, Beijing Sport University, Beijing, China
| | - Leiyuyang Wang
- Department of Strength and Conditioning Assessment and Monitoring, Beijing Sport University, Beijing, China
| | - Shiyan Zhang
- Department of Strength and Conditioning Assessment and Monitoring, Beijing Sport University, Beijing, China
| | - Yuanyuan Lv
- Department of Strength and Conditioning Assessment and Monitoring, Beijing Sport University, Beijing, China
| | - Tongling Wang
- Institute of Physical Education, Huzhou University, Huzhou, China
| | - Laikang Yu
- Department of Strength and Conditioning Assessment and Monitoring, Beijing Sport University, Beijing, China
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13
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Kolbaşı EN, Huseyinsinoglu BE, Ozdemir Z, Bayraktaroglu Z, Soysal A. Priming constraint-induced movement therapy with intermittent theta burst stimulation to enhance upper extremity recovery in patients with stroke: protocol for a randomized controlled study. Acta Neurol Belg 2024; 124:887-893. [PMID: 38329642 DOI: 10.1007/s13760-024-02472-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Accepted: 01/03/2024] [Indexed: 02/09/2024]
Abstract
BACKGROUND The treatments based on motor control and motor learning principles have gained popularity in the last 20 years, as well as non-invasive brain stimulations that enhance neuroplastic changes after stroke. However, the effect of intermittent theta burst stimulation (iTBS) in addition to evidence-based, intensive neurorehabilitation approaches such as modified constraint-induced movement therapy (mCIMT) is yet to be investigated. AIM We aim to establish a protocol for a randomized controlled study investigating the efficiency of mCIMT primed with iTBS after stroke. METHODS In this randomized controlled, single-blind study, patients with stroke (N = 17) will be divided into 3 groups: (a) mCIMT + real iTBS, (b) mCIMT + sham iTBS, and (c) mCIMT alone. 600-pulse iTBS will be delivered to the primary motor cortex on the ipsilesional hemisphere, and then, patients will receive mCIMT for 1 h/session, 3 sessions/week for 5 weeks. Upper extremity recovery will be assessed with Fugl-Meyer Test-Upper Extremity and Wolf Motor Function Test. Electrophysiological assessments, such as Motor-Evoked Potentials, Resting Motor Threshold, Short-Intracortical Inhibition, and Intracortical Facilitation, will also be included. CONCLUSIONS In this study, a protocol of an ongoing intervention study investigating the effectiveness of iTBS on ipsilesional M1 prior to the mCIMT in patients with stroke is proposed. This will be the first study to research priming mCIMT with iTBS and it may have the potential to reveal the true effect of the iTBS when it is added to the high-quality neurorehabilitation approaches. TRIAL REGISTRATION Trial registration number: NCT05308667.
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Affiliation(s)
- Esma Nur Kolbaşı
- Department of Physiotherapy and Rehabilitation, Istanbul Medeniyet University, Istanbul, Turkey
- Institute of Graduate Studies, Physiotherapy and Rehabilitation Department, Istanbul University-Cerrahpaşa, Istanbul, Turkey
| | - Burcu Ersoz Huseyinsinoglu
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Marmara University, Istanbul, Turkey.
| | - Zeynep Ozdemir
- Department of Neurology, Bakırkoy Prof. Dr. Mazhar Osman Training and Research Hospital for Psychiatric, Neurologic and Neurosurgical Diseases, University of Health Sciences, Istanbul, Turkey
| | - Zubeyir Bayraktaroglu
- Department of Physiology, International School of Medicine, Istanbul Medipol University, Istanbul, Turkey
| | - Aysun Soysal
- Department of Neurology, Bakırkoy Prof. Dr. Mazhar Osman Training and Research Hospital for Psychiatric, Neurologic and Neurosurgical Diseases, University of Health Sciences, Istanbul, Turkey
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14
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Mancone M, Mézquita AJV, Birtolo LI, Maurovich-Horvat P, Kofoed KF, Benedek T, Donnelly P, Rodriguez-Palomares J, Erglis A, Štěchovský C, Šakalytė G, Ađić NČ, Gutberlet M, Diez I, Davis G, Zimmermann E, Kępka C, Vidakovic R, Francone M, Ilnicka-Suckiel M, Plank F, Knuuti J, Faria R, Schröder S, Berry C, Saba L, Ruzsics B, Rieckmann N, Kubiak C, Hansen KS, Müller-Nordhorn J, Merkely B, Sigvardsen PE, Benedek I, Orr C, Valente FX, Zvaigzne L, Suchánek V, Jankauskas A, Ađić F, Woinke M, Keane S, Lecumberri I, Thwaite E, Kruk M, Jovanovic V, Kuśmierz D, Feuchtner G, Pietilä M, Ribeiro VG, Drosch T, Delles C, Palmisano V, Fisher M, Drobni ZD, Kragelund C, Aurelian R, Kelly S, Del Blanco BG, Rubio A, Boussoussou M, Hove JD, Rodean I, Regan S, Calabria HC, Becker D, Larsen L, Hodas R, Napp AE, Haase R, Feger S, Mohamed M, Neumann K, Dreger H, Rief M, Wieske V, Douglas PS, Estrella M, Bosserdt M, Martus P, Serna-Higuita LM, Dodd JD, Dewey M. Impact of smoking in patients with suspected coronary artery disease in the randomised DISCHARGE trial. Eur Radiol 2024; 34:4127-4141. [PMID: 37991508 DOI: 10.1007/s00330-023-10355-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 08/24/2023] [Accepted: 08/28/2023] [Indexed: 11/23/2023]
Abstract
OBJECTIVES To investigate if the effect of cardiac computed tomography (CT) vs. invasive coronary angiography (ICA) on cardiovascular events differs based on smoking status. MATERIALS AND METHODS This pre-specified subgroup analysis of the pragmatic, prospective, multicentre, randomised DISCHARGE trial (NCT02400229) involved 3561 patients with suspected coronary artery disease (CAD). The primary endpoint was major adverse cardiovascular events (MACE: cardiovascular death, non-fatal myocardial infarction, or stroke). Secondary endpoints included an expanded MACE composite (MACE, transient ischaemic attack, or major procedure-related complications). RESULTS Of 3445 randomised patients with smoking data (mean age 59.1 years + / - 9.7, 1151 men), at 3.5-year follow-up, the effect of CT vs. ICA on MACE was consistent across smoking groups (p for interaction = 0.98). The percutaneous coronary intervention rate was significantly lower with a CT-first strategy in smokers and former smokers (p = 0.01 for both). A CT-first strategy reduced the hazard of major procedure-related complications (HR: 0.21, 95% CI: 0.03, 0.81; p = 0.045) across smoking groups. In current smokers, the expanded MACE composite was lower in the CT- compared to the ICA-first strategy (2.3% (8) vs 6.0% (18), HR: 0.38; 95% CI: 0.17, 0.88). The rate of non-obstructive CAD was significantly higher in all three smoking groups in the CT-first strategy. CONCLUSION For patients with stable chest pain referred for ICA, the clinical outcomes of CT were consistent across smoking status. The CT-first approach led to a higher detection rate of non-obstructive CAD and fewer major procedure-related complications in smokers. CLINICAL RELEVANCE STATEMENT This pre-specified sub-analysis of the DISCHARGE trial confirms that a CT-first strategy in patients with stable chest pain referred for invasive coronary angiography with an intermediate pre-test probability of coronary artery disease is as effective as and safer than invasive coronary angiography, irrespective of smoking status. TRIAL REGISTRATION ClinicalTrials.gov NCT02400229. KEY POINTS • No randomised studies have assessed smoking status on CT effectiveness in symptomatic patients referred for invasive coronary angiography. • A CT-first strategy results in comparable adverse events, fewer complications, and increased coronary artery disease detection, irrespective of smoking status. • A CT-first strategy is safe and effective for stable chest pain patients with intermediate pre-test probability for CAD, including never smokers.
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Affiliation(s)
- Massimo Mancone
- Department of Clinical Internal, Anesthesiologic and Cardiovascular Sciences, Sapienza University of Rome, Rome, Italy
| | - Aldo J Vázquez Mézquita
- Department of Radiology, Charité - Universitätsmedizin Berlin, Freie Universität Berlin and Humboldt-Universität Zu Berlin, Berlin, Germany
| | - Lucia Ilaria Birtolo
- Department of Clinical Internal, Anesthesiologic and Cardiovascular Sciences, Sapienza University of Rome, Rome, Italy
| | - Pal Maurovich-Horvat
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
- Department of Radiology, Medical Imaging Center, Semmelweis University, Budapest, Hungary
| | - Klaus F Kofoed
- Department of Cardiology, Copenhagen University Hospital - Rigshospitalet & Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Department of Radiology, Copenhagen University Hospital - Rigshospitalet & Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Theodora Benedek
- Department of Internal Medicine, Clinic of Cardiology, George Emil Palade University of Medicine, Pharmacy, Science and Technology, Targu Mures, Romania
- County Clinical Emergency Hospital Targu Mures, Targu Mures, Romania
| | - Patrick Donnelly
- Department of Cardiology, Southeastern Health and Social Care Trust, Belfast, UK
| | - Jose Rodriguez-Palomares
- Department of Cardiology, Hospital Universitario Vall d'Hebron, Institut de Recerca (VHIR), Universitat Autònoma de Barcelona, Barcelona, Spain
- Centro de Investigacion Biomedica en Red, Madrid, Spain
| | - Andrejs Erglis
- Department of Cardiology, Paul Stradins Clinical University Hospital, Riga, Latvia
- Faculty of Medicine, University of Latvia, Riga, Latvia
| | - Cyril Štěchovský
- Department of Cardiology, Motol University Hospital, Prague, Czech Republic
| | - Gintare Šakalytė
- Department of Cardiology, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania
- Department of Cardiology, Hospital of Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Nada Čemerlić Ađić
- Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia
- Department of Cardiology, Institute for Cardiovascular Diseases of Vojvodina, Novi Sad, Serbia
| | - Matthias Gutberlet
- Department of Radiology, University of Leipzig Heart Centre, Leipzig, Germany
| | - Ignacio Diez
- Department of Cardiology, Basurto Hospital, Bilbao, Spain
| | - Gershan Davis
- Department of Cardiology, Aintree University Hospital, Liverpool, UK
- Edge Hill University, Ormskirk, UK
| | - Elke Zimmermann
- Department of Radiology, Charité - Universitätsmedizin Berlin, Freie Universität Berlin and Humboldt-Universität Zu Berlin, Berlin, Germany
| | - Cezary Kępka
- National Institute of Cardiology, Warsaw, Poland
| | - Radosav Vidakovic
- Department of Cardiology, Internal Medicine Clinic, Clinical Hospital Center Zemun, Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Marco Francone
- Department of Radiological Sciences, Sapienza University of Rome, Rome, Italy
- Department of Biomedical Sciences, Humanitas University and IRCCS Humanitas Research Hospital, Milan, Italy
| | | | - Fabian Plank
- Department of Internal Medicine III, Department of Cardiology, Innsbruck Medical University, Innsbruck, Austria
- Department of Radiology, Innsbruck Medical University, Innsbruck, Austria
| | - Juhanni Knuuti
- Turku PET Centre, Turku University Hospital and University of Turku, Turku, Finland
| | - Rita Faria
- Department of Cardiology, Centro Hospitalar de Vila Nova de Gaia-Espinho, Vila Nova de Gaia, Portugal
| | | | - Colin Berry
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, UK
- Golden Jubilee National Hospital, Clydebank, UK
| | - Luca Saba
- Department of Radiology, University of Cagliari, Cagliari, CA, Italy
| | - Balazs Ruzsics
- Department of Cardiology, Liverpool University Hospital NHS FT, Liverpool, UK
- Liverpool Centre for Cardiovascular Studies, University of Liverpool, Liverpool, UK
| | - Nina Rieckmann
- Institute of Public Health, Charité, Universitätsmedizin Berlin, Freie Universität Berlin and Humboldt-Universität Zu Berlin, Berlin, Germany
| | - Christine Kubiak
- ECRIN-ERIC (European Clinical Research Infrastructure Network-European Research Infrastructure Consortium), Paris, France
| | - Kristian Schultz Hansen
- Department of Public Health, Section for Health Services Research, University of Copenhagen, Copenhagen, Denmark
| | | | - Bela Merkely
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
- Department of Radiology, Medical Imaging Center, Semmelweis University, Budapest, Hungary
| | - Per E Sigvardsen
- Department of Cardiology, Copenhagen University Hospital - Rigshospitalet & Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Department of Radiology, Copenhagen University Hospital - Rigshospitalet & Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Imre Benedek
- Center of Advanced Research in Multimodality Cardiac Imaging, CardioMed Medical Center, Targu Mures, Romania
| | - Clare Orr
- Department of Cardiology, Southeastern Health and Social Care Trust, Belfast, UK
| | - Filipa Xavier Valente
- Department of Cardiology, Hospital Universitario Vall d'Hebron, Institut de Recerca (VHIR), Universitat Autònoma de Barcelona, Barcelona, Spain
- Centro de Investigacion Biomedica en Red, Madrid, Spain
| | - Ligita Zvaigzne
- Department of Cardiology, Paul Stradins Clinical University Hospital, Riga, Latvia
| | - Vojtěch Suchánek
- Department of Radiology, Motol University Hospital, Prague, Czech Republic
| | - Antanas Jankauskas
- Department of Radiology, Kaunas Clinics, Institute of Cardiology, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Filip Ađić
- Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia
- Department of Cardiology, Institute for Cardiovascular Diseases of Vojvodina, Novi Sad, Serbia
| | - Michael Woinke
- Department of Cardiology, University of Leipzig Heart Centre, Leipzig, Germany
| | - Stephen Keane
- Department of Cardiology, St. Vincent's University Hospital, Dublin, Ireland
| | | | - Erica Thwaite
- Department of Radiology, Aintree University Hospital, Liverpool, UK
| | - Mariusz Kruk
- National Institute of Cardiology, Warsaw, Poland
| | - Vladimir Jovanovic
- Department of Cardiology, Internal Medicine Clinic, Clinical Hospital Center Zemun, Belgrade, Serbia
| | - Donata Kuśmierz
- Department of Radiology, Provincial Specialist Hospital in Wroclaw, Wroclaw, Poland
| | - Gudren Feuchtner
- Department of Radiology, Innsbruck Medical University, Innsbruck, Austria
| | - Mikko Pietilä
- Heart Center, Turku University Hospital and University of Turku, Turku, Finland
- Administrative Centre, Health Care District of Southwestern Finland, Turku, Finland
| | - Vasco Gama Ribeiro
- Department of Cardiology, Centro Hospitalar de Vila Nova de Gaia-Espinho, Vila Nova de Gaia, Portugal
| | - Tanja Drosch
- Department of Cardiology, Alb Fils Kliniken, Göppingen, Germany
| | - Christian Delles
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, UK
| | - Vitanio Palmisano
- Department of Radiology, University of Cagliari, Cagliari, CA, Italy
- Department of Radiology and Neuroradiology, SS. Annunziata Hospital, Taranto, Italy
| | - Michael Fisher
- Department of Cardiology, Liverpool University Hospital NHS FT, Liverpool, UK
- Liverpool Centre for Cardiovascular Studies, University of Liverpool, Liverpool, UK
| | - Zsófia D Drobni
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Charlotte Kragelund
- Department of Cardiology, Nordsjællands Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Rosca Aurelian
- Department of Internal Medicine, Clinic of Cardiology, George Emil Palade University of Medicine, Pharmacy, Science and Technology, Targu Mures, Romania
| | - Stephanie Kelly
- Department of Cardiology, Southeastern Health and Social Care Trust, Belfast, UK
| | - Bruno Garcia Del Blanco
- Department of Cardiology, Hospital Universitario Vall d'Hebron, Institut de Recerca (VHIR), Universitat Autònoma de Barcelona, Barcelona, Spain
- Centro de Investigacion Biomedica en Red, Madrid, Spain
| | - Ainhoa Rubio
- Department of Cardiology, Basurto Hospital, Bilbao, Spain
| | | | - Jens D Hove
- Department of Cardiology, Copenhagen University Hospital - Amager and Hvidovre, Hvidovre, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Ioana Rodean
- Center of Advanced Research in Multimodality Cardiac Imaging, CardioMed Medical Center, Targu Mures, Romania
| | - Susan Regan
- Department of Cardiology, Southeastern Health and Social Care Trust, Belfast, UK
| | - Hug Cuéllar Calabria
- Department of Cardiology, Hospital Universitario Vall d'Hebron, Institut de Recerca (VHIR), Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Dávid Becker
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Linnea Larsen
- Department of Cardiology, Herlev-Gentofte Hospital, Hellerup, Denmark
| | - Roxana Hodas
- Department of Internal Medicine, Clinic of Cardiology, George Emil Palade University of Medicine, Pharmacy, Science and Technology, Targu Mures, Romania
| | - Adriane E Napp
- Department of Radiology, Charité - Universitätsmedizin Berlin, Freie Universität Berlin and Humboldt-Universität Zu Berlin, Berlin, Germany
| | - Robert Haase
- Department of Radiology, Charité - Universitätsmedizin Berlin, Freie Universität Berlin and Humboldt-Universität Zu Berlin, Berlin, Germany
| | - Sarah Feger
- Department of Radiology, Charité - Universitätsmedizin Berlin, Freie Universität Berlin and Humboldt-Universität Zu Berlin, Berlin, Germany
| | - Mahmoud Mohamed
- Department of Radiology, Charité - Universitätsmedizin Berlin, Freie Universität Berlin and Humboldt-Universität Zu Berlin, Berlin, Germany
| | - Konrad Neumann
- Institute of Biometry and Clinical Epidemiology, Charité - Universitätsmedizin Berlin, Freie Universität Berlin and Humboldt-Universität Zu Berlin, Berlin, Germany
| | - Henryk Dreger
- Deutsches Herzzentrum der Charité (DHZC), Department of Cardiology and Angiology, Campus Virchow-Klinikum, Augustenburger Platz 1, 13353, Berlin, Germany
- Deutsches Herzzentrum Der Charité (DHZC), Partner Site, Berlin, Germany
| | - Matthias Rief
- Department of Radiology, Charité - Universitätsmedizin Berlin, Freie Universität Berlin and Humboldt-Universität Zu Berlin, Berlin, Germany
| | - Viktoria Wieske
- Department of Radiology, Charité - Universitätsmedizin Berlin, Freie Universität Berlin and Humboldt-Universität Zu Berlin, Berlin, Germany
| | - Pamela S Douglas
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, USA
| | - Melanie Estrella
- Department of Radiology, Charité - Universitätsmedizin Berlin, Freie Universität Berlin and Humboldt-Universität Zu Berlin, Berlin, Germany
| | - Maria Bosserdt
- Department of Radiology, Charité - Universitätsmedizin Berlin, Freie Universität Berlin and Humboldt-Universität Zu Berlin, Berlin, Germany
| | - Peter Martus
- Department of Clinical Epidemiology and Applied Biostatistics, Universitätsklinikum Tübingen, Tübingen, Germany
| | - Lina M Serna-Higuita
- Department of Clinical Epidemiology and Applied Biostatistics, Universitätsklinikum Tübingen, Tübingen, Germany
| | - Jonathan D Dodd
- Department of Radiology, St. Vincent's University Hospital, Dublin, Ireland.
- School of Medicine, University College Dublin, Dublin, Ireland.
| | - Marc Dewey
- Department of Radiology, Charité - Universitätsmedizin Berlin, Freie Universität Berlin and Humboldt-Universität Zu Berlin, Berlin, Germany
- Deutsches Herzzentrum Der Charité (DHZC), Partner Site Berlin, Berlin, Germany
- Berlin University Alliance, Berlin, Germany
- Deutsches Herzzentrum Der Charité (DHZC), Berlin, Germany
- Berlin Institute of Health at Charité - Universitätsmedizin Berlin, Berlin, Germany
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Zhang L, Van Wouwe T, Yan S, Wang R. EMG-Constrained and Ultrasound-Informed Muscle-Tendon Parameter Estimation in Post-Stroke Hemiparesis. IEEE Trans Biomed Eng 2024; 71:1798-1809. [PMID: 38206783 DOI: 10.1109/tbme.2024.3352556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2024]
Abstract
Secondary morphological and mechanical property changes in the muscle-tendon unit at the ankle joint are often observed in post-stroke individuals. These changes may alter the force generation capacity and affect daily activities such as locomotion. This work aimed to estimate subject-specific muscle-tendon parameters in individuals after stroke by solving the muscle redundancy problem using direct collocation optimal control methods based on experimental electromyography (EMG) signals and measured muscle fiber length. Subject-specific muscle-tendon parameters of the gastrocnemius, soleus, and tibialis anterior were estimated in seven post-stroke individuals and seven healthy controls. We found that the maximum isometric force, tendon stiffness and optimal fiber length in the post-stroke group were considerably lower than in the control group. We also computed the root mean square error between estimated and experimental values of muscle excitation and fiber length. The musculoskeletal model with estimated subject-specific muscle tendon parameters (from the muscle redundancy solver), yielded better muscle excitation and fiber length estimations than did scaled generic parameters. Our findings also showed that the muscle redundancy solver can estimate muscle-tendon parameters that produce force behavior in better accordance with the experimentally-measured value. These muscle-tendon parameters in the post-stroke individuals were physiologically meaningful and may shed light on treatment and/or rehabilitation planning.
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He J, Yang W, Wu W, Yin G, Zhuang B, Xu J, Zhou D, Zhang J, Wang Y, Zhu L, Sun X, Sirajuddin A, Teng Z, Kureshi F, Arai AE, Zhao S, Lu M. Heart Failure with Normal Natriuretic Peptide Levels and Preserved Ejection Fraction: A Prospective Clinical and Cardiac MRI Study. Radiol Cardiothorac Imaging 2024; 6:e230281. [PMID: 38695743 DOI: 10.1148/ryct.230281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2024]
Abstract
Purpose To describe the clinical presentation, comprehensive cardiac MRI characteristics, and prognosis of individuals with predisposed heart failure with preserved ejection fraction (HFpEF). Materials and Methods This prospective cohort study (part of MISSION-HFpEF [Multimodality Imaging in the Screening, Diagnosis, and Risk Stratification of HFpEF]; NCT04603404) was conducted from January 1, 2019, to September 30, 2021, and included individuals with suspected HFpEF who underwent cardiac MRI. Participants who had primary cardiomyopathy and primary valvular heart disease were excluded. Participants were split into a predisposed HFpEF group, defined as HFpEF with normal natriuretic peptide levels based on an HFA-PEFF (Heart Failure Association Pretest Assessment, Echocardiography and Natriuretic Peptide, Functional Testing, and Final Etiology) score of 4 from the latest European Society of Cardiology guidelines, and an HFpEF group (HFA-PEFF score of ≥ 5). An asymptomatic control group without heart failure was also included. Clinical and cardiac MRI-based characteristics and outcomes were compared between groups. The primary end points were death, heart failure hospitalization, or stroke. Results A total of 213 participants with HFpEF, 151 participants with predisposed HFpEF, and 100 participants in the control group were analyzed. Compared with the control group, participants with predisposed HFpEF had worse left ventricular remodeling and function and higher systemic inflammation. Compared with participants with HFpEF, those with predisposed HFpEF, whether obese or not, were younger and had higher plasma volume, lower prevalence of atrial fibrillation, lower left atrial volume index, and less impaired left ventricular global longitudinal strain (-12.2% ± 2.8 vs -13.9% ± 3.1; P < .001) and early-diastolic global longitudinal strain rate (eGLSR, 0.52/sec ± 0.20 vs 0.57/sec ± 0.15; P = .03) but similar prognosis. Atrial fibrillation occurrence (hazard ratio [HR] = 3.90; P = .009), hemoglobin level (HR = 0.94; P = .001), and eGLSR (per 0.2-per-second increase, HR = 0.28; P = .002) were independently associated with occurrence of primary end points in participants with predisposed HFpEF. Conclusion Participants with predisposed HFpEF showed relatively unique clinical and cardiac MRI features, warranting greater clinical attention. eGLSR should be considered as a prognostic factor in participants with predisposed HFpEF. Keywords: Heart Failure with Preserved Ejection Fraction, Normal Natriuretic Peptide Levels, Cardiovascular Magnetic Resonance, Myocardial Strain, Prognosis Clinical trial registration no. NCT04603404 Supplemental material is available for this article. © RSNA, 2024.
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Affiliation(s)
- Jian He
- From the Department of Magnetic Resonance Imaging (J.H., W.Y., G.Y., B.Z., J.X., D.Z., Y.W., L.Z., S.Z., M.L.), Department of Echocardiography (W.W.), Heart Failure Center (J.Z.), and Department of Nuclear Medicine (X.S.), Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China; Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China (J.H.); National Heart, Lung, and Blood Institute, National Institutes of Health, Department of Health and Human Services, Bethesda, Md (A.S., A.E.A.); Andrew Arai Consulting, Kensington, Md (A.E.A.); Department of Radiology, University of Cambridge, Cambridge, UK (Z.T.); Axis Cardiovascular and Axis Cardiovascular Advanced Imaging, St David's Healthcare, Austin, Tex (F.K.); and Key Laboratory of Cardiovascular Imaging (Cultivation), Chinese Academy of Medical Sciences, Peking Union Medical College, Beilishi Road No. 167, Xicheng District, Beijing 100037, China (W.W., G.Y., X.S., M.L.)
| | - Wenjing Yang
- From the Department of Magnetic Resonance Imaging (J.H., W.Y., G.Y., B.Z., J.X., D.Z., Y.W., L.Z., S.Z., M.L.), Department of Echocardiography (W.W.), Heart Failure Center (J.Z.), and Department of Nuclear Medicine (X.S.), Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China; Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China (J.H.); National Heart, Lung, and Blood Institute, National Institutes of Health, Department of Health and Human Services, Bethesda, Md (A.S., A.E.A.); Andrew Arai Consulting, Kensington, Md (A.E.A.); Department of Radiology, University of Cambridge, Cambridge, UK (Z.T.); Axis Cardiovascular and Axis Cardiovascular Advanced Imaging, St David's Healthcare, Austin, Tex (F.K.); and Key Laboratory of Cardiovascular Imaging (Cultivation), Chinese Academy of Medical Sciences, Peking Union Medical College, Beilishi Road No. 167, Xicheng District, Beijing 100037, China (W.W., G.Y., X.S., M.L.)
| | - Weichun Wu
- From the Department of Magnetic Resonance Imaging (J.H., W.Y., G.Y., B.Z., J.X., D.Z., Y.W., L.Z., S.Z., M.L.), Department of Echocardiography (W.W.), Heart Failure Center (J.Z.), and Department of Nuclear Medicine (X.S.), Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China; Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China (J.H.); National Heart, Lung, and Blood Institute, National Institutes of Health, Department of Health and Human Services, Bethesda, Md (A.S., A.E.A.); Andrew Arai Consulting, Kensington, Md (A.E.A.); Department of Radiology, University of Cambridge, Cambridge, UK (Z.T.); Axis Cardiovascular and Axis Cardiovascular Advanced Imaging, St David's Healthcare, Austin, Tex (F.K.); and Key Laboratory of Cardiovascular Imaging (Cultivation), Chinese Academy of Medical Sciences, Peking Union Medical College, Beilishi Road No. 167, Xicheng District, Beijing 100037, China (W.W., G.Y., X.S., M.L.)
| | - Gang Yin
- From the Department of Magnetic Resonance Imaging (J.H., W.Y., G.Y., B.Z., J.X., D.Z., Y.W., L.Z., S.Z., M.L.), Department of Echocardiography (W.W.), Heart Failure Center (J.Z.), and Department of Nuclear Medicine (X.S.), Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China; Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China (J.H.); National Heart, Lung, and Blood Institute, National Institutes of Health, Department of Health and Human Services, Bethesda, Md (A.S., A.E.A.); Andrew Arai Consulting, Kensington, Md (A.E.A.); Department of Radiology, University of Cambridge, Cambridge, UK (Z.T.); Axis Cardiovascular and Axis Cardiovascular Advanced Imaging, St David's Healthcare, Austin, Tex (F.K.); and Key Laboratory of Cardiovascular Imaging (Cultivation), Chinese Academy of Medical Sciences, Peking Union Medical College, Beilishi Road No. 167, Xicheng District, Beijing 100037, China (W.W., G.Y., X.S., M.L.)
| | - Baiyan Zhuang
- From the Department of Magnetic Resonance Imaging (J.H., W.Y., G.Y., B.Z., J.X., D.Z., Y.W., L.Z., S.Z., M.L.), Department of Echocardiography (W.W.), Heart Failure Center (J.Z.), and Department of Nuclear Medicine (X.S.), Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China; Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China (J.H.); National Heart, Lung, and Blood Institute, National Institutes of Health, Department of Health and Human Services, Bethesda, Md (A.S., A.E.A.); Andrew Arai Consulting, Kensington, Md (A.E.A.); Department of Radiology, University of Cambridge, Cambridge, UK (Z.T.); Axis Cardiovascular and Axis Cardiovascular Advanced Imaging, St David's Healthcare, Austin, Tex (F.K.); and Key Laboratory of Cardiovascular Imaging (Cultivation), Chinese Academy of Medical Sciences, Peking Union Medical College, Beilishi Road No. 167, Xicheng District, Beijing 100037, China (W.W., G.Y., X.S., M.L.)
| | - Jing Xu
- From the Department of Magnetic Resonance Imaging (J.H., W.Y., G.Y., B.Z., J.X., D.Z., Y.W., L.Z., S.Z., M.L.), Department of Echocardiography (W.W.), Heart Failure Center (J.Z.), and Department of Nuclear Medicine (X.S.), Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China; Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China (J.H.); National Heart, Lung, and Blood Institute, National Institutes of Health, Department of Health and Human Services, Bethesda, Md (A.S., A.E.A.); Andrew Arai Consulting, Kensington, Md (A.E.A.); Department of Radiology, University of Cambridge, Cambridge, UK (Z.T.); Axis Cardiovascular and Axis Cardiovascular Advanced Imaging, St David's Healthcare, Austin, Tex (F.K.); and Key Laboratory of Cardiovascular Imaging (Cultivation), Chinese Academy of Medical Sciences, Peking Union Medical College, Beilishi Road No. 167, Xicheng District, Beijing 100037, China (W.W., G.Y., X.S., M.L.)
| | - Di Zhou
- From the Department of Magnetic Resonance Imaging (J.H., W.Y., G.Y., B.Z., J.X., D.Z., Y.W., L.Z., S.Z., M.L.), Department of Echocardiography (W.W.), Heart Failure Center (J.Z.), and Department of Nuclear Medicine (X.S.), Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China; Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China (J.H.); National Heart, Lung, and Blood Institute, National Institutes of Health, Department of Health and Human Services, Bethesda, Md (A.S., A.E.A.); Andrew Arai Consulting, Kensington, Md (A.E.A.); Department of Radiology, University of Cambridge, Cambridge, UK (Z.T.); Axis Cardiovascular and Axis Cardiovascular Advanced Imaging, St David's Healthcare, Austin, Tex (F.K.); and Key Laboratory of Cardiovascular Imaging (Cultivation), Chinese Academy of Medical Sciences, Peking Union Medical College, Beilishi Road No. 167, Xicheng District, Beijing 100037, China (W.W., G.Y., X.S., M.L.)
| | - Jian Zhang
- From the Department of Magnetic Resonance Imaging (J.H., W.Y., G.Y., B.Z., J.X., D.Z., Y.W., L.Z., S.Z., M.L.), Department of Echocardiography (W.W.), Heart Failure Center (J.Z.), and Department of Nuclear Medicine (X.S.), Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China; Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China (J.H.); National Heart, Lung, and Blood Institute, National Institutes of Health, Department of Health and Human Services, Bethesda, Md (A.S., A.E.A.); Andrew Arai Consulting, Kensington, Md (A.E.A.); Department of Radiology, University of Cambridge, Cambridge, UK (Z.T.); Axis Cardiovascular and Axis Cardiovascular Advanced Imaging, St David's Healthcare, Austin, Tex (F.K.); and Key Laboratory of Cardiovascular Imaging (Cultivation), Chinese Academy of Medical Sciences, Peking Union Medical College, Beilishi Road No. 167, Xicheng District, Beijing 100037, China (W.W., G.Y., X.S., M.L.)
| | - Yining Wang
- From the Department of Magnetic Resonance Imaging (J.H., W.Y., G.Y., B.Z., J.X., D.Z., Y.W., L.Z., S.Z., M.L.), Department of Echocardiography (W.W.), Heart Failure Center (J.Z.), and Department of Nuclear Medicine (X.S.), Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China; Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China (J.H.); National Heart, Lung, and Blood Institute, National Institutes of Health, Department of Health and Human Services, Bethesda, Md (A.S., A.E.A.); Andrew Arai Consulting, Kensington, Md (A.E.A.); Department of Radiology, University of Cambridge, Cambridge, UK (Z.T.); Axis Cardiovascular and Axis Cardiovascular Advanced Imaging, St David's Healthcare, Austin, Tex (F.K.); and Key Laboratory of Cardiovascular Imaging (Cultivation), Chinese Academy of Medical Sciences, Peking Union Medical College, Beilishi Road No. 167, Xicheng District, Beijing 100037, China (W.W., G.Y., X.S., M.L.)
| | - Leyi Zhu
- From the Department of Magnetic Resonance Imaging (J.H., W.Y., G.Y., B.Z., J.X., D.Z., Y.W., L.Z., S.Z., M.L.), Department of Echocardiography (W.W.), Heart Failure Center (J.Z.), and Department of Nuclear Medicine (X.S.), Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China; Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China (J.H.); National Heart, Lung, and Blood Institute, National Institutes of Health, Department of Health and Human Services, Bethesda, Md (A.S., A.E.A.); Andrew Arai Consulting, Kensington, Md (A.E.A.); Department of Radiology, University of Cambridge, Cambridge, UK (Z.T.); Axis Cardiovascular and Axis Cardiovascular Advanced Imaging, St David's Healthcare, Austin, Tex (F.K.); and Key Laboratory of Cardiovascular Imaging (Cultivation), Chinese Academy of Medical Sciences, Peking Union Medical College, Beilishi Road No. 167, Xicheng District, Beijing 100037, China (W.W., G.Y., X.S., M.L.)
| | - Xiaoxin Sun
- From the Department of Magnetic Resonance Imaging (J.H., W.Y., G.Y., B.Z., J.X., D.Z., Y.W., L.Z., S.Z., M.L.), Department of Echocardiography (W.W.), Heart Failure Center (J.Z.), and Department of Nuclear Medicine (X.S.), Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China; Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China (J.H.); National Heart, Lung, and Blood Institute, National Institutes of Health, Department of Health and Human Services, Bethesda, Md (A.S., A.E.A.); Andrew Arai Consulting, Kensington, Md (A.E.A.); Department of Radiology, University of Cambridge, Cambridge, UK (Z.T.); Axis Cardiovascular and Axis Cardiovascular Advanced Imaging, St David's Healthcare, Austin, Tex (F.K.); and Key Laboratory of Cardiovascular Imaging (Cultivation), Chinese Academy of Medical Sciences, Peking Union Medical College, Beilishi Road No. 167, Xicheng District, Beijing 100037, China (W.W., G.Y., X.S., M.L.)
| | - Arlene Sirajuddin
- From the Department of Magnetic Resonance Imaging (J.H., W.Y., G.Y., B.Z., J.X., D.Z., Y.W., L.Z., S.Z., M.L.), Department of Echocardiography (W.W.), Heart Failure Center (J.Z.), and Department of Nuclear Medicine (X.S.), Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China; Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China (J.H.); National Heart, Lung, and Blood Institute, National Institutes of Health, Department of Health and Human Services, Bethesda, Md (A.S., A.E.A.); Andrew Arai Consulting, Kensington, Md (A.E.A.); Department of Radiology, University of Cambridge, Cambridge, UK (Z.T.); Axis Cardiovascular and Axis Cardiovascular Advanced Imaging, St David's Healthcare, Austin, Tex (F.K.); and Key Laboratory of Cardiovascular Imaging (Cultivation), Chinese Academy of Medical Sciences, Peking Union Medical College, Beilishi Road No. 167, Xicheng District, Beijing 100037, China (W.W., G.Y., X.S., M.L.)
| | - Zhongzhao Teng
- From the Department of Magnetic Resonance Imaging (J.H., W.Y., G.Y., B.Z., J.X., D.Z., Y.W., L.Z., S.Z., M.L.), Department of Echocardiography (W.W.), Heart Failure Center (J.Z.), and Department of Nuclear Medicine (X.S.), Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China; Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China (J.H.); National Heart, Lung, and Blood Institute, National Institutes of Health, Department of Health and Human Services, Bethesda, Md (A.S., A.E.A.); Andrew Arai Consulting, Kensington, Md (A.E.A.); Department of Radiology, University of Cambridge, Cambridge, UK (Z.T.); Axis Cardiovascular and Axis Cardiovascular Advanced Imaging, St David's Healthcare, Austin, Tex (F.K.); and Key Laboratory of Cardiovascular Imaging (Cultivation), Chinese Academy of Medical Sciences, Peking Union Medical College, Beilishi Road No. 167, Xicheng District, Beijing 100037, China (W.W., G.Y., X.S., M.L.)
| | - Faraz Kureshi
- From the Department of Magnetic Resonance Imaging (J.H., W.Y., G.Y., B.Z., J.X., D.Z., Y.W., L.Z., S.Z., M.L.), Department of Echocardiography (W.W.), Heart Failure Center (J.Z.), and Department of Nuclear Medicine (X.S.), Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China; Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China (J.H.); National Heart, Lung, and Blood Institute, National Institutes of Health, Department of Health and Human Services, Bethesda, Md (A.S., A.E.A.); Andrew Arai Consulting, Kensington, Md (A.E.A.); Department of Radiology, University of Cambridge, Cambridge, UK (Z.T.); Axis Cardiovascular and Axis Cardiovascular Advanced Imaging, St David's Healthcare, Austin, Tex (F.K.); and Key Laboratory of Cardiovascular Imaging (Cultivation), Chinese Academy of Medical Sciences, Peking Union Medical College, Beilishi Road No. 167, Xicheng District, Beijing 100037, China (W.W., G.Y., X.S., M.L.)
| | - Andrew E Arai
- From the Department of Magnetic Resonance Imaging (J.H., W.Y., G.Y., B.Z., J.X., D.Z., Y.W., L.Z., S.Z., M.L.), Department of Echocardiography (W.W.), Heart Failure Center (J.Z.), and Department of Nuclear Medicine (X.S.), Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China; Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China (J.H.); National Heart, Lung, and Blood Institute, National Institutes of Health, Department of Health and Human Services, Bethesda, Md (A.S., A.E.A.); Andrew Arai Consulting, Kensington, Md (A.E.A.); Department of Radiology, University of Cambridge, Cambridge, UK (Z.T.); Axis Cardiovascular and Axis Cardiovascular Advanced Imaging, St David's Healthcare, Austin, Tex (F.K.); and Key Laboratory of Cardiovascular Imaging (Cultivation), Chinese Academy of Medical Sciences, Peking Union Medical College, Beilishi Road No. 167, Xicheng District, Beijing 100037, China (W.W., G.Y., X.S., M.L.)
| | - Shihua Zhao
- From the Department of Magnetic Resonance Imaging (J.H., W.Y., G.Y., B.Z., J.X., D.Z., Y.W., L.Z., S.Z., M.L.), Department of Echocardiography (W.W.), Heart Failure Center (J.Z.), and Department of Nuclear Medicine (X.S.), Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China; Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China (J.H.); National Heart, Lung, and Blood Institute, National Institutes of Health, Department of Health and Human Services, Bethesda, Md (A.S., A.E.A.); Andrew Arai Consulting, Kensington, Md (A.E.A.); Department of Radiology, University of Cambridge, Cambridge, UK (Z.T.); Axis Cardiovascular and Axis Cardiovascular Advanced Imaging, St David's Healthcare, Austin, Tex (F.K.); and Key Laboratory of Cardiovascular Imaging (Cultivation), Chinese Academy of Medical Sciences, Peking Union Medical College, Beilishi Road No. 167, Xicheng District, Beijing 100037, China (W.W., G.Y., X.S., M.L.)
| | - Minjie Lu
- From the Department of Magnetic Resonance Imaging (J.H., W.Y., G.Y., B.Z., J.X., D.Z., Y.W., L.Z., S.Z., M.L.), Department of Echocardiography (W.W.), Heart Failure Center (J.Z.), and Department of Nuclear Medicine (X.S.), Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China; Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China (J.H.); National Heart, Lung, and Blood Institute, National Institutes of Health, Department of Health and Human Services, Bethesda, Md (A.S., A.E.A.); Andrew Arai Consulting, Kensington, Md (A.E.A.); Department of Radiology, University of Cambridge, Cambridge, UK (Z.T.); Axis Cardiovascular and Axis Cardiovascular Advanced Imaging, St David's Healthcare, Austin, Tex (F.K.); and Key Laboratory of Cardiovascular Imaging (Cultivation), Chinese Academy of Medical Sciences, Peking Union Medical College, Beilishi Road No. 167, Xicheng District, Beijing 100037, China (W.W., G.Y., X.S., M.L.)
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17
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Geraldes R, Santos M, Ponte C, Craven A, Barra L, Robson JC, Hammam N, Springer J, Henes J, Hocevar A, Putaala J, Santos E, Rajasekhar L, Daikeler T, Karadag O, Costa A, Khalidi N, Pagnoux C, Canhão P, Melo TPE, Fonseca AC, Ferro JM, Fonseca JE, Suppiah R, Watts RA, Grayson P, Merkel PA, Luqmani RA. Stroke frequency, associated factors, and clinical features in primary systemic vasculitis: a multicentric observational study. J Neurol 2024; 271:3309-3320. [PMID: 38472397 PMCID: PMC11136713 DOI: 10.1007/s00415-024-12251-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Revised: 01/31/2024] [Accepted: 02/10/2024] [Indexed: 03/14/2024]
Abstract
OBJECTIVES The cerebral vessels may be affected in primary systemic vasculitis (PSV), but little is known about cerebrovascular events (CVEs) in this population. This study aimed to determine the frequency of CVEs at the time of diagnosis of PSV, to identify factors associated with CVEs in PSV, and to explore features and outcomes of stroke in patients with PSV. METHODS Data from adults newly diagnosed with PSV within the Diagnostic and Classification Criteria in VASculitis (DCVAS) study were analysed. Demographics, risk factors for vascular disease, and clinical features were compared between patients with PSV with and without CVE. Stroke subtypes and cumulative incidence of recurrent CVE during a prospective 6-month follow-up were also assessed. RESULTS The analysis included 4828 PSV patients, and a CVE was reported in 169 (3.50%, 95% CI 3.00-4.06): 102 (2.13% 95% CI 1.73-2.56) with stroke and 81 (1.68% 95% CI 1.33-2.08) with transient ischemic attack (TIA). The frequency of CVE was highest in Behçet's disease (9.5%, 95% CI 5.79-14.37), polyarteritis nodosa (6.2%, 95% CI 3.25-10.61), and Takayasu's arteritis (6.0%, 95% CI 4.30-8.19), and lowest in microscopic polyangiitis (2.2%, 95% CI 1.09-3.86), granulomatosis with polyangiitis (2.0%, 95% CI 1.20-3.01), cryoglobulinaemic vasculitis (1.9%, 95% CI 0.05-9.89), and IgA-vasculitis (Henoch-Schönlein) (0.4%, 95% CI 0.01-2.05). PSV patients had a 11.9% cumulative incidence of recurrent CVE during a 6-month follow-up period. CONCLUSION CVEs affect a significant proportion of patients at time of PSV diagnosis, and the frequency varies widely among different vasculitis, being higher in Behçet's. Overall, CVE in PSV is not explained by traditional vascular risk factors and has a high risk of CVE recurrence.
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Affiliation(s)
- Ruth Geraldes
- Neurology Department, Wexham Park Hospital, Frimley Health Foundation Trust, Slough, UK.
- Department of Clinical Neurosciences, Oxford University Hospitals, Oxford, UK.
| | - Monica Santos
- Serviço de Neurologia, Departamento de Neurociências e Saúde Mental, Centro Hospitalar Universitário Lisboa Norte, Lisbon, Portugal
- Centro de Estudos Egas Moniz, Faculdade de Medicina da Universidade de Lisboa, Lisbon, Portugal
| | - Cristina Ponte
- Rheumatology and Metabolic Bone Diseases Department, Centro Hospitalar Universitário Lisboa Norte, Lisbon Academic Medical Centre, Lisbon, Portugal
- Rheumatology Research Unit, Instituto de Medicina Molecular, Faculdade de Medicina da Universidade de Lisboa, Lisbon Academic Medical Centre, Lisbon, Portugal
| | - Anthea Craven
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Nuffield Orthopaedic Centre, Botnar Research Centre, University of Oxford, Oxford, UK
| | - Lillian Barra
- Lawson Health Research Institute, London, ON, Canada
| | - Joanna C Robson
- Centre for Health and Clinical Research, University of the West of England, Bristol, UK
| | - Nevin Hammam
- Rheumatology Department, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Jason Springer
- University of Kansas Medical Centre Institute, Lawrence, Kansas, KS, USA
| | - Jöerg Henes
- Centre for Interdisciplinary Clinical Immunology, Rheumatology and Auto-Inflammatory Diseases, Department of Internal Medicine II (Oncology, Haematology, Immunology and Rheumatology), University Hospital Tuebingen, Tuebingen, Germany
| | | | - Jukka Putaala
- Helsinki University Central Hospital, Helsinki, Finland
| | - Ernestina Santos
- Hospital de Santo António, Centro Hospitalar Universitário do Porto, Porto, Portugal
- Unit for Multidisciplinary Research in Biomedicine, Instituto de Ciências Biomédicas de Abel Salazar, Universidade do Porto, Porto, Portugal
| | | | - Thomas Daikeler
- Department of Rheumatology and Clinical Research, University Hospital, Basel, Switzerland
| | - Omer Karadag
- Division of Rheumatology, Department of Internal Medicine, Vasculitis Research Center, Hacettepe University School of Medicine, Ankara, Turkey
| | - Andreia Costa
- Centro Hospitalar Universitário de São João, Porto, Portugal
- Neuroscience and Mental Health Department, Faculdade de Medicina da Universidade do Porto, Porto, Portugal
| | - Nader Khalidi
- Joseph's Healthcare Hamilton and McMaster University, Hamilton, ON, Canada
| | | | - Patrícia Canhão
- Serviço de Neurologia, Departamento de Neurociências e Saúde Mental, Centro Hospitalar Universitário Lisboa Norte, Lisbon, Portugal
- Centro de Estudos Egas Moniz, Faculdade de Medicina da Universidade de Lisboa, Lisbon, Portugal
| | - Teresa Pinho E Melo
- Serviço de Neurologia, Departamento de Neurociências e Saúde Mental, Centro Hospitalar Universitário Lisboa Norte, Lisbon, Portugal
- Centro de Estudos Egas Moniz, Faculdade de Medicina da Universidade de Lisboa, Lisbon, Portugal
| | - Ana Catarina Fonseca
- Serviço de Neurologia, Departamento de Neurociências e Saúde Mental, Centro Hospitalar Universitário Lisboa Norte, Lisbon, Portugal
- Centro de Estudos Egas Moniz, Faculdade de Medicina da Universidade de Lisboa, Lisbon, Portugal
| | - José M Ferro
- Instituto de Medicina Molecular, Faculdade de Medicina da Universidade de Lisboa, Lisbon, Portugal
| | - João Eurico Fonseca
- Rheumatology and Metabolic Bone Diseases Department, Centro Hospitalar Universitário Lisboa Norte, Lisbon Academic Medical Centre, Lisbon, Portugal
- Rheumatology Research Unit, Instituto de Medicina Molecular, Faculdade de Medicina da Universidade de Lisboa, Lisbon Academic Medical Centre, Lisbon, Portugal
| | | | | | - Peter Grayson
- National Institutes of Health, NIAMS Vasculitis Translational Research Program, Bethesda, USA
| | - Peter A Merkel
- Division of Rheumatology, Department of Medicine, University of Pennsylvania, Philadelphia, USA
- Division of Epidemiology, Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania, Philadelphia, USA
| | - Raashid A Luqmani
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Nuffield Orthopaedic Centre, Botnar Research Centre, University of Oxford, Oxford, UK
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18
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Douglas VP, Rachapudi SS, Davila-Siliezar P, Laylani NAR, Lee AG. Transient Monocular Visual Loss (Amaurosis Fugax): How Does Age Impact Diagnosis? Ophthalmol Ther 2024; 13:1417-1425. [PMID: 38587773 PMCID: PMC11109035 DOI: 10.1007/s40123-024-00932-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Accepted: 03/07/2024] [Indexed: 04/09/2024] Open
Abstract
Transient monocular visual loss (TMVL), also known as transient monocular blindness or amaurosis fugax ("fleeting blindness"), is a temporary loss of vision often due to ischemia to the retina. While acute TMVL should be considered an emergency that further requires exhaustive investigation, there are some cases in which TMVL arises secondary to benign causes. Age has a major impact in the diagnosis of ischemia and although the differential diagnosis of TMVL can be broad, timely and appropriate history, examination, diagnostic testing, and treatment can be vision- or life-saving. We review the causes of TMVL and the impact of age on the differential diagnoses and management.
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Affiliation(s)
| | - Sruti S Rachapudi
- Department of Ophthalmology, University of Texas Medical Branch, Galveston, TX, USA
| | - Pamela Davila-Siliezar
- Department of Ophthalmology, Blanton Eye Institute, Houston Methodist Hospital, 6560 Fannin St. Ste 450, Houston, TX, 77030, USA
| | - Noor A R Laylani
- Department of Ophthalmology, Blanton Eye Institute, Houston Methodist Hospital, 6560 Fannin St. Ste 450, Houston, TX, 77030, USA
| | - Andrew G Lee
- Department of Ophthalmology, University of Texas Medical Branch, Galveston, TX, USA.
- Department of Ophthalmology, Blanton Eye Institute, Houston Methodist Hospital, 6560 Fannin St. Ste 450, Houston, TX, 77030, USA.
- Departments of Ophthalmology, Neurology, and Neurosurgery, Weill Cornell Medicine, New York, NY, USA.
- University of Texas MD Anderson Cancer Center, Houston, TX, USA.
- Texas A and M College of Medicine, Bryan, TX, USA.
- Department of Ophthalmology, The University of Iowa Hospitals and Clinics, Iowa City, IA, USA.
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19
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Banyas P, Jadhav A. Stroke and Transient Ischemic Attack. Prim Care 2024; 51:283-297. [PMID: 38692775 DOI: 10.1016/j.pop.2024.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/03/2024]
Abstract
Cerebrovascular disease is a common and potentially life-threatening illness if not triaged and/or treated appropriately. The diagnosis is made based on a combination of clinical history and neuroimaging studies. The majority of strokes can be prevented, and this process often begins in the primary care office through the careful assessment of vascular risk factors. Appropriate workup aims to pinpoint a pathogenic mechanism and guide therapy. Stroke treatment has rapidly advanced over the past several years, resulting in improved outcomes.
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Affiliation(s)
- Paige Banyas
- Department of Neurology, HonorHealth Neurology Bob Bove Neuroscience Institute, 7242 E Osborn Road, Suite 400, Scottsdale, AZ 85251, USA.
| | - Ashutosh Jadhav
- Department of Neurology and Neurosurgery, Barrow Brain and Spine, 2910 North Third Avenue, Suite 200, Phoenix, AZ 85013, USA
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20
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Matos J, Moura A, Teixeira F, Henriques A, Alves E. Professional reintegration among professionally active Portuguese stroke survivors: a multicentric study. Disabil Rehabil 2024; 46:2619-2628. [PMID: 37370241 DOI: 10.1080/09638288.2023.2228200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Accepted: 06/18/2023] [Indexed: 06/29/2023]
Abstract
PURPOSE To assess professional reintegration, the perceived impact of stroke on work, and the main determinants of return to work (RTW) among stroke survivors. MATERIALS AND METHODS A cross-sectional study was performed, based on a cohort of stroke survivors. A structured questionnaire was administered to previously working stroke survivors, 18-24 months post-stroke. Data on sociodemographic characteristics, stroke features and their impact on work, access to rehabilitation services during hospital admission and after discharge, social support, and professional reintegration were reported by 553 stroke survivors. RESULTS On average, 56.6% (95% CI 52.4-60.8) of stroke survivors resumed professional activity, 20 months after stroke. Approximately 90% of survivors who RTW, returned to the same job and same function they performed before stroke. The majority did not receive reintegration support. The main determinants of RTW were lower age, higher socioeconomic status, and better functional status. CONCLUSIONS Professional reintegration and vocational support after stroke, remained below the international goals for community reintegration of stroke survivors. Future studies should explore the impact of professional and social reintegration on the psychological health and quality of life of stroke survivors and the barriers, challenges, and strategies used to overcome them, to allow for effective professional reintegration policies.
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Affiliation(s)
- Joana Matos
- EPIUnit-Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal
- Centro Hospitalar de Entre Douro e Vouga, Santa Maria da Feira, Aveiro, Portugal
- Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Universidade do Porto, Porto, Portugal
| | - Ana Moura
- EPIUnit-Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal
- Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Universidade do Porto, Porto, Portugal
- Centre for Research and Intervention in Education (CIIE), Faculty of Psychology and Education Sciences, University of Porto, Porto, Portugal
| | - Filipa Teixeira
- EPIUnit-Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal
- Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Universidade do Porto, Porto, Portugal
| | - Ana Henriques
- EPIUnit-Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal
- Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Universidade do Porto, Porto, Portugal
| | - Elisabete Alves
- São João de Deus School of Nursing, University of Évora Évora, Portugal
- Comprehensive Health Research Centre (CHRC), University of Évora, Évora, Portugal
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21
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Ebrahimian M, Hosein Mohamadi M, Mahyad M, Rezaeitalab F. Association of early seizures after ischemic stroke with diffusion-weighted imaging-alberta stroke program early CT score (DWI-ASPECTS) and neutrophil-to-lymphocyte ratio. Epilepsy Behav 2024; 155:109752. [PMID: 38640725 DOI: 10.1016/j.yebeh.2024.109752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2024] [Revised: 03/10/2024] [Accepted: 03/21/2024] [Indexed: 04/21/2024]
Abstract
BACKGROUND Post-stroke seizure (PSS) is a common considerable complication of acute ischemic stroke (AIS). Early risk assessment can clinical practitioners to plan effective prevention and management. We aimed to determine whether assessing Diffusion-Weighted Imaging-Alberta Stroke Program Early CT Score (DWI-ASPECTS), and neutrophil indices allows for identifying patients at risk of PSS. METHODS This prospective study included AIS patients with cortical involvement admitted to a single academic center between January 2020 to October 2023. For all included subjects, DWI-Brain MRI, blood neutrophils, and platelet counts were obtained and the DWI-ASPECTS score was calculated. Then, the patients were followed up for 6 months in terms of PSS occurrence. Based on the occurrence of PSS, patients were divided into two groups of PSS and non-PSS. For analysis, imaging and laboratory data were compared between two groups. Logistic regression was applied to determine the relationship between DWI-ASPECTS and neutrophil indices, with early PSS. Finally, the sensitivity and specificity of these variables for PSS were estimated. RESULTS A total of 309 were included in the final statistical analysis. DWI-ASPECT and neutrophil-to-lymphocyte ratio (NLR) were significantly associated with early PSS with OR of 0.74 and OR of 1.13, respectively (P < 0.05). Further analysis showed that, a combination of DWI-ASPECTS, NLR had an area under the curve (AUC) of 0.72 for predicting the occurrence of early PSS. CONCLUSION DWI-ASPECTS and NLR are associated with the occurrence of early PSS after cortical ischemic stroke. A combination of these predictors had higher sensitivity and specificity for PSS rather than each factor alone. These findings may be helpful for determining the risk of PSS if validated in future studies.
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Affiliation(s)
- Maryam Ebrahimian
- Department of Neurology, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | | | - Mahshid Mahyad
- Department of Neurology, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Fariborz Rezaeitalab
- Department of Neurology, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran; Neurocsience Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.
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22
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Mina AI, Espino JU, Bradley AM, Thirumala PD, Batmanghelich K, Visweswaran S. Detecting Cerebral Ischemia From Electroencephalography During Carotid Endarterectomy Using Machine Learning. AMIA JOINT SUMMITS ON TRANSLATIONAL SCIENCE PROCEEDINGS. AMIA JOINT SUMMITS ON TRANSLATIONAL SCIENCE 2024; 2024:613-622. [PMID: 38827046 PMCID: PMC11141851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 06/04/2024]
Abstract
Monitoring cerebral neuronal activity via electroencephalography (EEG) during surgery can detect ischemia, a precursor to stroke. However, current neurophysiologist-based monitoring is prone to error. In this study, we evaluated machine learning (ML) for efficient and accurate ischemia detection. We trained supervised ML models on a dataset of 802 patients with intraoperative ischemia labels and evaluated them on an independent validation dataset of 30 patients with refined labels from five neurophysiologists. Our results show moderate-to-substantial agreement between neurophysiologists, with Cohen's kappa values between 0.59 and 0.74. Neurophysiologist performance ranged from 58-93% for sensitivity and 83-96% for specificity, while ML models demonstrated comparable ranges of 63-89% and 85-96%. Random Forest (RF), LightGBM (LGBM), and XGBoost RF achieved area under the receiver operating characteristic curve (AUROC) values of 0.92-0.93 and area under the precision-recall curve (AUPRC) values of 0.79-0.83. ML has the potential to improve intraoperative monitoring, enhancing patient safety and reducing costs.
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Affiliation(s)
- Amir I Mina
- Department of Biomedical Informatics, University of Pittsburgh, Pittsburgh, PA
| | - Jessi U Espino
- Department of Biomedical Informatics, University of Pittsburgh, Pittsburgh, PA
| | - Allison M Bradley
- Department of Biomedical Informatics, University of Pittsburgh, Pittsburgh, PA
| | | | - Kayhan Batmanghelich
- Department of Electrical and Computer Engineering, Boston University, Boston, MA
| | - Shyam Visweswaran
- Department of Biomedical Informatics, University of Pittsburgh, Pittsburgh, PA
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23
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Li L, Shi C, Dong F, Xu G, Lei M, Zhang F. Targeting pyroptosis to treat ischemic stroke: From molecular pathways to treatment strategy. Int Immunopharmacol 2024; 133:112168. [PMID: 38688133 DOI: 10.1016/j.intimp.2024.112168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Revised: 04/19/2024] [Accepted: 04/25/2024] [Indexed: 05/02/2024]
Abstract
Ischemic stroke is the primary reason for human disability and death, but the available treatment options are limited. Hence, it is imperative to explore novel and efficient therapies. In recent years, pyroptosis (a pro-inflammatory cell death characterized by inflammation) has emerged as an important pathological mechanism in ischemic stroke that can cause cell death through plasma membrane rupture and release of inflammatory cytokines. Pyroptosis is closely associated with inflammation, which exacerbates the inflammatory response in ischemic stroke. The level of inflammasomes, GSDMD, Caspases, and inflammatory factors is increased after ischemic stroke, exacerbating brain injury by mediating pyroptosis. Hence, inhibition of pyroptosis can be a therapeutic strategy for ischemic stroke. In this review, we have summarized the relationship between pyroptosis and ischemic stroke, as well as a series of treatments to attenuate pyroptosis, intending to provide insights for new therapeutic targets on ischemic stroke.
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Affiliation(s)
- Lina Li
- Department of Rehabilitation Medicine, The Third Hospital of Hebei Medical University, Shijiazhuang 050051, PR China
| | - Chonglin Shi
- Department of Rehabilitation Medicine, The Third Hospital of Hebei Medical University, Shijiazhuang 050051, PR China
| | - Fang Dong
- Department of Clinical Laboratory Medicine, The Third Hospital of Hebei Medical University, Shijiazhuang 050051, PR China
| | - Guangyu Xu
- Department of Rehabilitation Medicine, The Third Hospital of Hebei Medical University, Shijiazhuang 050051, PR China
| | - Mingcheng Lei
- Department of Rehabilitation Medicine, The Third Hospital of Hebei Medical University, Shijiazhuang 050051, PR China
| | - Feng Zhang
- Department of Rehabilitation Medicine, The Third Hospital of Hebei Medical University, Shijiazhuang 050051, PR China.
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24
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Privitera D, Geraneo A, Li Veli G, Parravicini G, Mazzone A, Rossini M, Sanfilippo M, Gubertini A, Airoldi C, Capsoni N, Busca E, Bassi E, Langer T, Dal Molin A. Complications related to short peripheral intravenous catheters in patients with acute stroke: a prospective, observational, single-cohort study. Intern Emerg Med 2024:10.1007/s11739-024-03651-2. [PMID: 38805082 DOI: 10.1007/s11739-024-03651-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Accepted: 05/16/2024] [Indexed: 05/29/2024]
Abstract
Patients with acute stroke often require venous access to facilitate diagnostic investigations or intravenous therapy. The primary aim of this study was to describe the rate and type of complications associated with the placement of a short peripheral catheter (SPC) in patients with acute ischemic or hemorrhagic stroke. A prospective, observational, single-cohort study was conducted at Niguarda Hospital, Italy, with enrolment in the Emergency Department. Adult patients with an ischemic or hemorrhagic stroke requiring an SPC were enrolled. Complications, such as infiltration, occlusion, phlebitis and dislodgment, were recorded daily. Descriptive statistics were used, and the incidence rate ratio (IRR) was estimated to assess the difference in complications, considering catheter calibre, dominant side, exit site, limb, and limb mobility, ictus type (ischemic/haemorrhagic), impairment deficit (language, motor, visual) and EA-DIVA score. A total of 269 participants and 755 SPC were analysed. Removal of SPC due to at least one local complication occurred in 451 (60%). Dislodgment was the major cause of SPC removal (31%), followed by infiltration (18%), occlusion (6%), and phlebitis (5%). The SPC calibre (22G), exit-site other than antecubital and forearm, visual deficit and EA-DIVA ≥ 8 were associated with a higher rate of SPC complications: IRR, 1.71 [1.31; 2.31]; 1.27 [1.01; 1.60], 1.38 [1.06; 1.80], 1.30 [1.04; 1.64], respectively. No other differences in complication rates were observed according to the insertion site, i.e. dominant side, left side, plegic/hyposthenic limb, or exit site. This study provides novel insights into the frequency and types of complications associated with SPC in patients with acute stroke. Compared to the literature, a higher dislodgment rate was observed, being the first cause of SPC removal, whereas no differences in the number of infiltrations, occlusions, and phlebitis were recorded.
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Affiliation(s)
- Daniele Privitera
- Department of Biomedicine and Prevention, University of Rome Tor Vergata Rome, Rome, Italy.
| | - Annalisa Geraneo
- Department of Emergency Medicine, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Greta Li Veli
- Department of Emergency Medicine, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Giorgio Parravicini
- Department of Emergency Medicine, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Annamaria Mazzone
- Department of Emergency Medicine, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Michela Rossini
- Department of Emergency Medicine, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Marianna Sanfilippo
- Department of Emergency Medicine, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Alessandro Gubertini
- Department of Emergency Medicine, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Chiara Airoldi
- Department of Translational Medicine, Università del Piemonte Orientale, Novara, Italy
| | - Nicolò Capsoni
- Department of Emergency Medicine, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Erica Busca
- Department of Translational Medicine, Università del Piemonte Orientale, Novara, Italy
- Health Professions' Direction, Maggiore Della Carità Hospital, Novara, Italy
| | - Erika Bassi
- Department of Translational Medicine, Università del Piemonte Orientale, Novara, Italy
- Health Professions' Direction, Maggiore Della Carità Hospital, Novara, Italy
| | - Thomas Langer
- Department of Medicine and Surgery, University of Milan-Bicocca, Monza, Italy
- Department of Anesthesia and Intensive Care Medicine, Niguarda Ca' Granda, Milan, Italy
| | - Alberto Dal Molin
- Department of Translational Medicine, Università del Piemonte Orientale, Novara, Italy
- Health Professions' Direction, Maggiore Della Carità Hospital, Novara, Italy
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25
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Valdez M, Bartolini C, Candoni G, Scaminaci-Russo F, Tomadín R, Mendelevich A. [Psychometric properties of performance outcome tools to assess sensitivity in subjects with stroke sequela: A systematic review]. Rehabilitacion (Madr) 2024; 58:100855. [PMID: 38795503 DOI: 10.1016/j.rh.2024.100855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 01/25/2024] [Accepted: 04/27/2024] [Indexed: 05/28/2024]
Abstract
The objective was to perform a systematic review of those performance outcomes (HRD) tools that assess sensitivity in post-stroke subjects, as well as to know which of all is the most reliable and viable. The design was a systematic review. The following were included: HRD, developed in post-stroke subjects, of any etiology and period of evolution; 18 years of age or older and testing for sensitivity; results on psychometric properties. Excluded: self-reported results, the report of cross-cultural adaptation, designed through computerized means. 19 HRD were acquired. The psychometric properties analyzed were reliability, internal consistency, measurement error, construct validity, content validity, and sensitivity to change, the first being the most studied. Psychometric properties were identified, assessed, compared, and summarized. Of all of them, we recommend the use of the modified Erasmus Nottingham Sensory Assessment, as it presents the best degree of confidence in the evidence.
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Affiliation(s)
- M Valdez
- División de Kinesiología, Hospital de Rehabilitación Manuel Rocca, Ciudad Autónoma de Buenos Aires, Argentina.
| | - C Bartolini
- División de Kinesiología, Hospital de Rehabilitación Manuel Rocca, Ciudad Autónoma de Buenos Aires, Argentina
| | - G Candoni
- División de Kinesiología, Hospital de Rehabilitación Manuel Rocca, Ciudad Autónoma de Buenos Aires, Argentina
| | - F Scaminaci-Russo
- Santa Catalina Neurorrehabilitación Clínica, Ciudad Autónoma de Buenos Aires, Argentina
| | - R Tomadín
- División de Kinesiología, Hospital de Rehabilitación Manuel Rocca, Ciudad Autónoma de Buenos Aires, Argentina
| | - A Mendelevich
- Coordinación en Investigación y Docencia de la Universidad de Mendoza, Ciudad Autónoma de Buenos Aires, Argentina
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26
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Yildiz A, Demir R, Mustafaoglu R, Erkut U, Kesiktas FN. Structured different exercise protocols improve lung function, respiratory muscle strength, and thickness in stroke patients. A randomized controlled trial. Top Stroke Rehabil 2024:1-13. [PMID: 38780025 DOI: 10.1080/10749357.2024.2356413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Accepted: 04/23/2024] [Indexed: 05/25/2024]
Abstract
BACKGROUND The effect of core stabilization exercises (CSE) alone, or in combination with neuromuscular electrical stimulation (NMES) and Kinesio taping (KT) on lung function, respiratory muscle strength, and thickness in patients with stroke is not fully known. ObjectivesTo compare the efficacy of NMES and KT applied with CSE on lung functions, respiratory muscle strength, and thickness in stroke. OBJECTIVE The effect of core stabilization exercises (CSE) alone, or in combination with neuromuscular electrical stimulation (NMES) and Kinesio taping (KT) on lung function, respiratory muscle strength, and thickness in patients with stroke is not fully known. The aim of this study was to compare the efficacy of NMES and KT applied with CSE on lung functions, respiratory muscle strength, and thickness in stroke. METHODS A total of 45 stroke patients were randomly assigned to the core stabilization exercises (CSE) group, CSE+KT group or CSE+NMES group, respectively. All groups received the training protocol for 30-45 minutes, 3 days a week, for 6 weeks. Lung functions were measured using portable spirometry. Respiratory muscle strength was assessed using an analog manometer to measure maximal inspiratory pressure (MIP) and maximal expiratory pressure (MEP). Peak cough flow (PCF) was measured with a peak flow meter. Respiratory muscles thickness were determined using ultrasonography. RESULTS Except for FVC (%pred%) (F = 4.432, p = 0.018, ηp = 0.174), FEV1(%pred%) (F = 3.725, p = 0.032, ηp = 0.151), and MEP (F = 3.861, p = 0.029, ηp = 0.155), the overall group by time interaction for rmANOVA showed that there was no statistically significant difference between groups (p > 0.05). After post hoc analysis, it was determined that there was no statistically significant difference between the groups in terms of FVC (%pred%), FEV1(%pred%) and MEP (p > 0.025). CONCLUSIONS The addition of NMES or KT to core stabilization exercises did not appear to provide additional benefit in improving lung function, respiratory muscle strength, and thickness in stroke patients.
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Affiliation(s)
- Abdurrahim Yildiz
- Department of Physiotherapy and Rehabilitation, Sakarya University of Applied Sciences, Sakarya, Türkiye
| | - Rengin Demir
- Department of Cardiology, Cardiology Institute, Istanbul University-Cerrahpasa, Istanbul, Türkiye
| | - Rustem Mustafaoglu
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Istanbul University-Cerrahpasa, Istanbul, Türkiye
| | - Umit Erkut
- Department of Physiotherapy and Rehabilitation, Rumeli University, Istanbul, Türkiye
| | - Fatma Nur Kesiktas
- Istanbul Physical Medicine and Rehabilitation Training and Research Hospital, University of Health Sciences, Istanbul, Türkiye
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27
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Ojagbemi A, Bello T, Elugbadebo O, Alabi M, Owolabi M, Baiyewu O. Resilience in the first year of surviving a stroke in Nigeria. Aging Ment Health 2024:1-8. [PMID: 38779920 DOI: 10.1080/13607863.2024.2356873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Accepted: 05/13/2024] [Indexed: 05/25/2024]
Abstract
OBJECTIVES There is a knowledge gap on resilience and its impact on mental health of Africans who survive a stroke. We describe the trajectory of psychological resilience and its association with depression and quality of life (QoL) across the first poststroke year in Nigeria. METHOD Prospective observational study of 150 survivors of a first ever stroke. Resilience was ascertained at 3 time-points prospectively over 12 months using the 25-items Resilience Scale (RS). Depression and QoL were also assessed at baseline and follow-up, respectively using the centre for epidemiologic studies depression scale (CES-D 10) and health related quality of life in stroke patients (HRQOLISP-26). Associations were investigated using regression models and presented as adjusted odds ratios (OR) and Wald test coefficients within 95% confidence intervals (CI). RESULTS Resilience improved across time points of measurement (p < 0.001). In multivariate logistic regression analyses adjusted for the effect of age, education, alcohol use, and hypertension, higher resilience was associated with male sex (OR = 5.3, 95% CI= 1.7, 17.2), younger age (OR = 4.8, 95% CI = 1.5,15.7), and baseline hypertension (OR= 0.2, 95% CI ≤ 0.1,0.8). In similarly adjusted mixed effect linear regression analyses, higher resilience was associated with improvement in depression (months 12= -4.2, 95% CI= -5.6, -2.8) and quality of life (months twelve = 5.2, 95% CI = 2.2, 8.2) overtime. CONCLUSION Resilience, which was associated with better mental health and wellbeing of stroke survivors, was less likely with hypertension. Results suggest an important role for control of vascular risk factors as part of resilience interventions to promote poststroke recovery.
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Affiliation(s)
- Akin Ojagbemi
- Department of Psychiatry, College of Medicine, University of Ibadan, Ibadan, Nigeria
- Centre for Dementia Studies, Brighton and Sussex Medical School, Brighton, UK
| | - Toyin Bello
- Department of Psychiatry, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Olufisayo Elugbadebo
- Department of Psychiatry, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Morufat Alabi
- Department of Nursing, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Mayowa Owolabi
- Division of Neurology, Department of Medicine, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Olusegun Baiyewu
- Department of Psychiatry, College of Medicine, University of Ibadan, Ibadan, Nigeria
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Jiang F, Li J, Yu S, Miao J, Wang W, Xi X. Body fluids biomarkers associated with prognosis of acute ischemic stroke: progress and prospects. Future Sci OA 2024; 10:FSO931. [PMID: 38817358 PMCID: PMC11137785 DOI: 10.2144/fsoa-2023-0142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 10/27/2023] [Indexed: 06/01/2024] Open
Abstract
Acute ischemic stroke (AIS) is one of the most common strokes posing a grave threat to human life and health. Predicting the prognosis of AIS allows for an understanding of disease progress, and a better quality of life by making individualized treatment scheme. In this paper, we conducted a systematic search on PubMed, focusing on the relevant literature in the last 5 years. Summarizing the candidate prognostic biomarkers of AIS in body fluids such as blood, urine, saliva and cerebrospinal fluid is often of great significance for the management of acute ischemic stroke, which has the potential to facilitate early diagnosis, treatment, prevention and long-term outcome improvement.
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Affiliation(s)
- Fengmang Jiang
- Emergency Intensive Care Unit, The Quzhou Affiliated Hospital of Wenzhou Medical University, Quzhou People's Hospital, Quzhou, 324000, PR China
| | - Junhua Li
- Emergency Intensive Care Unit, The Quzhou Affiliated Hospital of Wenzhou Medical University, Quzhou People's Hospital, Quzhou, 324000, PR China
| | - Simin Yu
- Emergency Intensive Care Unit, The Quzhou Affiliated Hospital of Wenzhou Medical University, Quzhou People's Hospital, Quzhou, 324000, PR China
| | - Jinli Miao
- Biological Medicine Research & Development Center, Yangtze Delta of Zhejiang, Hangzhou, 314006, PR China
| | - Wenmin Wang
- Biological Medicine Research & Development Center, Yangtze Delta of Zhejiang, Hangzhou, 314006, PR China
| | - Xiaohong Xi
- Emergency Intensive Care Unit, The Quzhou Affiliated Hospital of Wenzhou Medical University, Quzhou People's Hospital, Quzhou, 324000, PR China
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29
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Colantoni A, Bucci T, Cocomello N, Angelico F, Ettorre E, Pastori D, Lip GYH, Del Ben M, Baratta F. Lipid-based insulin-resistance markers predict cardiovascular events in metabolic dysfunction associated steatotic liver disease. Cardiovasc Diabetol 2024; 23:175. [PMID: 38769519 PMCID: PMC11106932 DOI: 10.1186/s12933-024-02263-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Accepted: 05/03/2024] [Indexed: 05/22/2024] Open
Abstract
BACKGROUND Insulin resistance (IR) is the cornerstone of Metabolic Dysfunction Associated Steatotic Liver Disease (MASLD), pathophysiologically being the key link between MASLD, metabolic disorders, and cardiovascular (CV) diseases. There are no prospective studies comparing the predictive values of different markers of insulin resistance (IR) in identifying the presence of MASLD and the associated risk of cardiovascular events (CVEs). METHODS Post hoc analysis of the prospective Plinio Study, involving dysmetabolic patients evaluated for the presence of MASLD. The IR markers considered were Homeostatic Model Assessment for IR (HOMA-IR), Triglycerides-Glycemia (TyG) index, Triglycerides to High-Density Lipoprotein Cholesterol ratio (TG/HDL-C), Lipid Accumulation Product (LAP) and Visceral Adiposity Index (VAI). Receiver operative characteristic (ROC) analyses were performed to find the optimal cut-offs of each IR marker for detecting MASLD and predicting CVEs in MASLD patients. Logistic and Cox multivariable regression analyses were performed, after dichotomizing the IR markers based on the optimal cut-offs, to assess the factors independently associated with MASLD and the risk of CVEs. RESULTS The study included 772 patients (age 55.6 ± 12.1 years, 39.4% women), of whom 82.8% had MASLD. VAI (Area Under the Curve [AUC] 0.731), TyG Index (AUC 0.723), and TG/HDL-C ratio (AUC: 0.721) predicted MASLD but was greater with HOMA-IR (AUC: 0.792) and LAP (AUC: 0.787). After a median follow-up of 48.7 (25.4-75.8) months, 53 MASLD patients experienced CVEs (1.8%/year). TyG index (AUC: 0.630), LAP (AUC: 0.626), TG/HDL-C (AUC: 0.614), and VAI (AUC: 0.590) demonstrated comparable, modest predictive values in assessing the CVEs risk in MASLD patients. CONCLUSION In dysmetabolic patients HOMA-IR and LAP showed the best accuracy in detecting MASLD. The possible use of lipid-based IR markers in stratifying the CV risk in patients with MASLD needs further validation in larger cohorts.
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Affiliation(s)
- Alessandra Colantoni
- Department of Clinical Internal, Anesthesiologic and Cardiovascular Sciences, Sapienza University of Rome, Rome, Italy
- Department of Human Anatomy, Histology, Forensic Medicine and Orthopedics, Sapienza University of Rome, Rome, Italy
| | - Tommaso Bucci
- Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool and Heart and Chest Hospital, Liverpool, UK
- Department of General and Specialized Surgery, Sapienza University of Rome, Rome, Italy
| | - Nicholas Cocomello
- Department of Clinical Internal, Anesthesiologic and Cardiovascular Sciences, Sapienza University of Rome, Rome, Italy
- Department of Human Anatomy, Histology, Forensic Medicine and Orthopedics, Sapienza University of Rome, Rome, Italy
| | - Francesco Angelico
- Department of Clinical Internal, Anesthesiologic and Cardiovascular Sciences, Sapienza University of Rome, Rome, Italy
| | - Evaristo Ettorre
- Department of Clinical Internal, Anesthesiologic and Cardiovascular Sciences, Sapienza University of Rome, Rome, Italy
| | - Daniele Pastori
- Department of Clinical Internal, Anesthesiologic and Cardiovascular Sciences, Sapienza University of Rome, Rome, Italy
| | - Gregory Y H Lip
- Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool and Heart and Chest Hospital, Liverpool, UK
- Department of Clinical Medicine, Danish Center for Health Services Research, Aalborg University, Aalborg, Denmark
| | - Maria Del Ben
- Department of Clinical Internal, Anesthesiologic and Cardiovascular Sciences, Sapienza University of Rome, Rome, Italy
| | - Francesco Baratta
- Department of Clinical Internal, Anesthesiologic and Cardiovascular Sciences, Sapienza University of Rome, Rome, Italy.
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Lim XY, Gao NL, Lee WY, Neo JH, Tan AH, Sia CH, Sharma VK, Yeo LL, Lim Y, Lin CY, Ho JSY, Tan BY. Patent foramen ovale closure in ischemic stroke patients with and without thrombophilia: a systematic review and meta-analyses. J Thromb Thrombolysis 2024:10.1007/s11239-024-02990-3. [PMID: 38762709 DOI: 10.1007/s11239-024-02990-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/24/2024] [Indexed: 05/20/2024]
Abstract
Ischemic stroke patients with thrombophilia and patient foramen ovale (PFO) may have an increased risk of recurrent stroke and transient ischemic attack (TIA), and may benefit from PFO closure. However, screening for thrombophilia is not routinely performed and the impact of thrombophilia on prognosis after PFO closure is uncertain. We aim to compare the risk of recurrent stroke and TIA after PFO closure in patients with thrombophilia versus those without. We performed a systematic review and meta-analyses of the literature, with a comprehensive literature search performed on 12 January 2023. Studies comparing the outcomes of patients with and without thrombophilia after PFO closure were included. The primary outcome evaluated was a recurrence of acute cerebrovascular event (ACE), a composite of recurrent ischemic stroke and recurrent TIA. The secondary outcomes included recurrent ischemic stroke only or TIA only. A total of 8 cohort studies were included, with a total of 3514 patients. There was an increased risk of stroke/TIA in patients with thrombophilia compared to those without thrombophilia after PFO (OR: 1.42, 95% CI: 1.01-1.99, I2 = 50%). The association between risk of TIA only (OR: 1.36, 95% CI: 0.77-2.41, I2 = 0%) and stroke only (OR: 1.09, 95% CI: 0.54-2.21, I2 = 0%) with thrombophilia did not reach statistical significance. There is an increased risk of recurrent cerebral ischemia event in patients with thrombophilia compared to those without thrombophilia after PFO closure. Future large prospective studies are necessary to characterise the risk and benefits of PFO closure, as well as the appropriate medical treatment to reduce the risk of recurrent stroke and TIA in this high-risk population.
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Affiliation(s)
- Xue Yang Lim
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Nicholas Lx Gao
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Wynne Yu Lee
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Jia Hui Neo
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Alethea He Tan
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Ching-Hui Sia
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Department of Cardiology, National University Heart Centre, Singapore, Singapore
| | - Vijay K Sharma
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Division of Neurology, Department of Medicine, National University Hospital, National University Health System, 1E Kent Ridge Road, Singapore, 119228, Singapore
| | - Leonard Ll Yeo
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Division of Neurology, Department of Medicine, National University Hospital, National University Health System, 1E Kent Ridge Road, Singapore, 119228, Singapore
| | - Yinghao Lim
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Department of Cardiology, National University Heart Centre, Singapore, Singapore
| | - Chee Yen Lin
- Division of Hematology, Department of Haematology-Oncology, National University Cancer Institute, Singapore, Singapore
| | - Jamie Sin Ying Ho
- Division of Neurology, Department of Medicine, National University Hospital, National University Health System, 1E Kent Ridge Road, Singapore, 119228, Singapore.
| | - Benjamin Yq Tan
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Division of Neurology, Department of Medicine, National University Hospital, National University Health System, 1E Kent Ridge Road, Singapore, 119228, Singapore
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31
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Chen C, Reeves MJ, He K, Morgenstern LB, Lisabeth LD. Sex Differences in Trends in Stroke Recurrence and Postrecurrence Mortality 2000-2020: Population-Based Brain Attack Surveillance in Corpus Christi Project. Ann Neurol 2024. [PMID: 38757636 DOI: 10.1002/ana.26955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Revised: 02/29/2024] [Accepted: 04/05/2024] [Indexed: 05/18/2024]
Abstract
OBJECTIVE This study was undertaken to delineate 21-year sex-specific trends in recurrence and postrecurrence mortality. METHODS Between 2000 and 2020, first-ever ischemic stroke (IS) patients, ascertained from the population-based BASIC (Brain Attack Surveillance in Corpus Christi) project in South Texas, were followed for recurrent stroke and all-cause mortality until December 31, 2020. Multivariable regression models with an interaction between calendar year and sex were used to estimate sex-specific trends and sex differences in recurrence and postrecurrence mortality. RESULTS Of the 6,057 IS patients (median age = 69 years, 49.8% women), 654 (10.8%) had a recurrence and 399 (47.7%) had postrecurrence mortality during 5 years of follow-up. In 2000, women had 2.5% higher albeit non-statistically significant 5-year risk of recurrence than men in absolute scale. With the trend declining in women by 7.6% (95% confidence interval [CI] = -10.8 to -4.5%) and in men by 3.6% (95% CI = -6.5% to -0.7%), the risk at the end of the study period was 1.5% (95% CI = -0.3% to 3.6%) lower among women than men. For postrecurrence mortality, the risk was 10.2% lower among women in 2000, but the sex difference was 3.3% by the end of the period, which was due to a larger overall increase in the risk among women than men over the entire time period. INTERPRETATION The declines in recurrent stroke suggest successful secondary stroke prevention, especially in women. However, the continued high postrecurrence mortality among both sexes at the end of study period emphasizes the need for ongoing interventions to improve prognosis in those who have had recurrent cerebrovascular events. ANN NEUROL 2024.
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Affiliation(s)
- Chen Chen
- Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, MI, USA
| | - Mathew J Reeves
- Department of Epidemiology and Biostatistics, Michigan State University, East Lansing, MI, USA
| | - Kevin He
- Department of Biostatistics, University of Michigan School of Public Health, Ann Arbor, MI, USA
| | - Lewis B Morgenstern
- Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, MI, USA
- Stroke Program, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Lynda D Lisabeth
- Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, MI, USA
- Stroke Program, University of Michigan Medical School, Ann Arbor, MI, USA
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32
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Diel NJ, Gerner ST, Doeppner TR, Juenemann M, Maxhuni T, Frühwald T, Worm A, Alhaj Omar O, Lytvynchuk L, Struffert T, Bauer P, Huttner HB. Comparison of vascular risk profile and clinical outcomes among patients with central (branch) retinal artery occlusion versus amaurosis fugax. Neurol Res Pract 2024; 6:27. [PMID: 38750601 PMCID: PMC11097454 DOI: 10.1186/s42466-024-00326-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2024] [Accepted: 04/22/2024] [Indexed: 05/18/2024] Open
Abstract
BACKGROUND Retinal artery occlusions lead to sudden, painless vision loss, affecting millions globally. Despite their significance, treatment strategies remain unestablished, contrasting with acute ischemic stroke (AIS), where IVT has proven efficacy. Similar to AIS, retinal artery occlusions demand urgent evaluation and treatment, reflecting the principle "time is retina". Even for patients with transient monocular vision loss, also known as amaurosis fugax (AF), pertinent guidelines meanwhile recommend immediate emergency assessment in a specialized facility. However, data on the clinical benefit and comparability with persistent occlusions are missing. This study aimed to compare the results of a comprehensive stroke-workup among patients with persistent retinal artery occlusions (RAO), including both central retinal (CRAO) and branch retinal artery occlusion (BRAO) and those with AF. METHODS Conducted at the University Hospital Giessen, Germany, this exploratory cross-sectional study enrolled patients with transient or permanent unilateral vision loss of non-arteritic origin. The primary outcome were differences between the two groups RAO and AF with regard to cardiovascular risk profiles and comorbidities, vascular and pharmacological interventions and clinical neurological and ophthalmological outcomes. Secondary outcome was a sub-group analysis of patients receiving IVT. RESULTS Out of 166 patients assessed, 76 with RAO and 40 with AF met the inclusion criteria. Both groups exhibited comparable age, gender distribution, and cardiovascular risk profiles. Notably, RAO patients did not show significantly more severe vascular comorbidities than AF patients. However, AF patients received vascular interventions more frequently. Pharmacological intervention rates were similar across groups. RAO patients had slightly worse neurological outcomes, and IVT did not yield favorable ophthalmological outcomes within any observed patients. CONCLUSION The study found similar vascular burden and risk factors in patients with RAO and AF, with implications for clinical workflows. IVT for RAO may only be effective in very early treatment windows. This emphasizes the need for public awareness and collaborative protocols between ophthalmologists and neurologists to improve outcomes.
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Affiliation(s)
- Norma J Diel
- Department of Neurology, University Hospital Giessen, Klinikstrasse 33, 35392, Giessen, Germany.
| | - Stefan T Gerner
- Department of Neurology, University Hospital Giessen, Klinikstrasse 33, 35392, Giessen, Germany
- Center for Mind, Brain and Behavior (CMBB), University of Marburg, Marburg, Germany
| | - Thorsten R Doeppner
- Department of Neurology, University Hospital Giessen, Klinikstrasse 33, 35392, Giessen, Germany
- Center for Mind, Brain and Behavior (CMBB), University of Marburg, Marburg, Germany
| | - Martin Juenemann
- Department of Neurology, University Hospital Giessen, Klinikstrasse 33, 35392, Giessen, Germany
- Center for Mind, Brain and Behavior (CMBB), University of Marburg, Marburg, Germany
| | - Toska Maxhuni
- Department of Neurology, University Hospital Giessen, Klinikstrasse 33, 35392, Giessen, Germany
| | - Tobias Frühwald
- Department of Neurology, University Hospital Giessen, Klinikstrasse 33, 35392, Giessen, Germany
| | - Andre Worm
- Department of Neurology, University Hospital Giessen, Klinikstrasse 33, 35392, Giessen, Germany
| | - Omar Alhaj Omar
- Department of Neurology, University Hospital Giessen, Klinikstrasse 33, 35392, Giessen, Germany
| | | | - Tobias Struffert
- Department of Neuroradiology, University Hospital Giessen, Giessen, Germany
| | - Pascal Bauer
- Department of Internal Medicine I, Division of Cardiology and Angiology, University Hospital Giessen, Giessen, Germany
| | - Hagen B Huttner
- Department of Neurology, University Hospital Giessen, Klinikstrasse 33, 35392, Giessen, Germany
- Center for Mind, Brain and Behavior (CMBB), University of Marburg, Marburg, Germany
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Asowata OJ, Okekunle AP, Olaiya MT, Akinyemi J, Owolabi M, Akpa OM. Stroke risk prediction models: A systematic review and meta-analysis. J Neurol Sci 2024; 460:122997. [PMID: 38669758 DOI: 10.1016/j.jns.2024.122997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2024] [Revised: 04/03/2024] [Accepted: 04/04/2024] [Indexed: 04/28/2024]
Abstract
BACKGROUND Prediction algorithms/models are viable methods for identifying individuals at high risk of stroke across diverse populations for timely intervention. However, evidence summarizing the performance of these models is limited. This study examined the performance and weaknesses of existing stroke risk-score-prediction models (SRSMs) and whether performance varied by population and region. METHODS PubMed, EMBASE, and Web of Science were searched for articles on SRSMs from the earliest records until February 2022. The Prediction Model Risk of Bias Assessment Tool was used to assess the quality of eligible articles. The performance of the SRSMs was assessed by meta-analyzing C-statistics (0 and 1) estimates from identified studies to determine the overall pooled C-statistics by fitting a linear restricted maximum likelihood in a random effect model. RESULTS Overall, 17 articles (cohort study = 15, nested case-control study = 2) comprising 739,134 stroke cases from 6,396,594 participants from diverse populations/regions (Asia; n = 8, United States; n = 3, and Europe and the United Kingdom; n = 6) were eligible for inclusion. The overall pooled c-statistics of SRSMs was 0.78 (95%CI: 0.75, 0.80; I2 = 99.9%), with most SRSMs developed using cohort studies; 0.78 (95%CI: 0.75, 0.80; I2 = 99.9%). The subgroup analyses by geographical region: Asia [0.81 (95%CI: 0.79, 0.83; I2 = 99.8%)], Europe and the United Kingdom [0.76 (95%CI: 0.69, 0.83; I2 = 99.9%)] and the United States only [0.75 (95%CI: 0.72, 0.78; I2 = 73.5%)] revealed relatively indifferent performances of SRSMs. CONCLUSION SRSM performance varied widely, and the pooled c-statistics of SRSMs suggested a fair predictive performance, with very few SRSMs validated in independent population group(s) from diverse world regions.
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Affiliation(s)
- Osahon Jeffery Asowata
- Department of Epidemiology and Medical Statistics, University of Ibadan, 200284, Nigeria
| | - Akinkunmi Paul Okekunle
- Department of Epidemiology and Medical Statistics, University of Ibadan, 200284, Nigeria; Department of Medicine, College of Medicine, University of Ibadan, 200284, Nigeria; Research Institute of Human Ecology, Seoul National University, 08826, Republic of Korea.
| | - Muideen Tunbosun Olaiya
- Stroke and Ageing Research, School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC 3168, Australia
| | - Joshua Akinyemi
- Department of Epidemiology and Medical Statistics, University of Ibadan, 200284, Nigeria
| | - Mayowa Owolabi
- Department of Medicine, College of Medicine, University of Ibadan, 200284, Nigeria; Lebanese American University, 1102 2801 Beirut, Lebanon; Center for Genomic and Precision Medicine, College of Medicine, University of Ibadan, 200284, Nigeria
| | - Onoja M Akpa
- Department of Epidemiology and Medical Statistics, University of Ibadan, 200284, Nigeria; Preventive Cardiology Research Unit, Institute of Cardiovascular Diseases, College of Medicine, University of Ibadan, 200284, Nigeria; Division of Epidemiology, Biostatistics and Environmental Health, School of Public Health, University of Memphis, Memphis, USA.
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Hilkens NA, Casolla B, Leung TW, de Leeuw FE. Stroke. Lancet 2024:S0140-6736(24)00642-1. [PMID: 38759664 DOI: 10.1016/s0140-6736(24)00642-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Revised: 03/19/2024] [Accepted: 03/26/2024] [Indexed: 05/19/2024]
Abstract
Stroke affects up to one in five people during their lifetime in some high-income countries, and up to almost one in two in low-income countries. Globally, it is the second leading cause of death. Clinically, the disease is characterised by sudden neurological deficits. Vascular aetiologies contribute to the most common causes of ischaemic stroke, including large artery disease, cardioembolism, and small vessel disease. Small vessel disease is also the most frequent cause of intracerebral haemorrhage, followed by macrovascular causes. For acute ischaemic stroke, multimodal CT or MRI reveal infarct core, ischaemic penumbra, and site of vascular occlusion. For intracerebral haemorrhage, neuroimaging identifies early radiological markers of haematoma expansion and probable underlying cause. For intravenous thrombolysis in ischaemic stroke, tenecteplase is now a safe and effective alternative to alteplase. In patients with strokes caused by large vessel occlusion, the indications for endovascular thrombectomy have been extended to include larger core infarcts and basilar artery occlusion, and the treatment time window has increased to up to 24 h from stroke onset. Regarding intracerebral haemorrhage, prompt delivery of bundled care consisting of immediate anticoagulation reversal, simultaneous blood pressure lowering, and prespecified stroke unit protocols can improve clinical outcomes. Guided by underlying stroke mechanisms, secondary prevention encompasses pharmacological, vascular, or endovascular interventions and lifestyle modifications.
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Affiliation(s)
- Nina A Hilkens
- Department of Neurology, Radboud University Nijmegen Medical Center, Nijmegen, Netherlands; Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, Netherlands
| | - Barbara Casolla
- Université Nice Cote d'Azur UR2CA-URRIS, Stroke Unit, CHU Pasteur 2, Nice, France
| | - Thomas W Leung
- Division of Neurology, Department of Medicine and Therapeutics, The Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong Special Administrative Region, China
| | - Frank-Erik de Leeuw
- Department of Neurology, Radboud University Nijmegen Medical Center, Nijmegen, Netherlands; Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, Netherlands.
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Berger C, Hammer H, Costa M, Lowiec P, Yagensky A, Scutelnic A, Antonenko K, Biletska O, Karaszewski B, Sarikaya H, Zdrojewski T, Klymiuk A, Bassetti CLA, Yashchuk N, Chwojnicki K, Arnold M, Saner H, Heldner MR. Baseline characteristics, reperfusion treatment secondary prevention and outcome after acute ischemic stroke in three different socioeconomic environments in Europe. Eur Stroke J 2024:23969873241245518. [PMID: 38745422 DOI: 10.1177/23969873241245518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/16/2024] Open
Abstract
INTRODUCTION The differences in vascular risk factors' and stroke burden across Europe are notable, however there is limited understanding of the influence of socioeconomic environment on the quality of secondary prevention and outcome after acute ischemic stroke. PATIENTS AND METHODS In this observational multicenter cohort study, we analyzed baseline characteristics, reperfusion treatment, outcome and secondary prevention in patients with acute ischemic stroke from three tertiary-care teaching hospitals with similar service population size in different socioeconomic environments: Bern/CH/n = 293 (high-income), Gdansk/PL/n = 140 (high-income), and Lutsk/UA/n = 188 (lower-middle-income). RESULTS We analyzed 621 patients (43.2% women, median age = 71.4 years), admitted between 07 and 12/2019. Significant differences were observed in median BMI (CH = 26/PL = 27.7/UA = 27.8), stroke severity [(median NIHSS CH = 4(0-40)/PL = 11(0-33)/UA = 7(1-30)], initial neuroimaging (CT:CH = 21.6%/PL = 50.7%/UA = 71.3%), conservative treatment (CH = 34.1%/PL = 38.6%/UA = 95.2%) (each p < 0.001), in arterial hypertension (CH = 63.8%/PL = 72.6%/UA = 87.2%), atrial fibrillation (CH = 28.3%/PL = 41.4%/UA = 39.4%), hyperlipidemia (CH = 84.9%/PL = 76.4%/UA = 17%) (each p < 0.001) and active smoking (CH = 32.2%/PL = 27.3%/UA = 10.2%) (p < 0.007). Three-months favorable outcome (mRS = 0-2) was seen in CH = 63.1%/PL = 50%/UA = 59% (unadjusted-p = 0.01/adjusted-p CH-PL/CH-UA = 0.601/0.981), excellent outcome (mRS = 0-1) in CH = 48.5%/PL = 32.1%/UA = 27% (unadjusted-p < 0.001/adjusted-p CH-PL/CH-UA = 0.201/0.08 and adjusted-OR CH-UA = 2.09). Three-months mortality was similar between groups (CH = 17.2%/PL = 15.7%/UA = 4.8%) (unadjusted-p = 0.71/adjusted-p CH-PL/CH-UA = 0.087/0.24). Three-months recurrent stroke/TIA occurred in CH = 3.1%/PL = 10.7%/UA = 3.1%, adjusted-p/OR CH-PL = 0.04/0.32). Three-months follow-up medication intake rates were the same for antihypertensives. Statin/OAC intake was lowest in UA = 67.1%/25.5% (CH = 87.3%/39.2%/unadjusted-p < 0.001/adjusted-p CH-UA = 0.02/0.012/adjusted-OR CH-UA = 2.33/2.18). Oral intake of antidiabetics was lowest in CH = 10.8% (PL = 15.7%/UA = 16.1%/unadjusted-p = 0.245/adjusted-p CH-PL/CH-UA = 0.061/0.002/adjusted-OR CH-UA = 0.25). Smoking rates decreased in all groups during follow-up. DISCUSSION AND CONCLUSION Substantial differences in presentation, treatment and secondary prevention measures, are linked to a twofold difference in adjusted 3-months excellent outcome between Switzerland and Ukraine. This underscores the importance of socioeconomic factors that influence stroke outcomes, emphasizing the necessity for targeted interventions to address disparities in treatment and secondary prevention strategies.
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Affiliation(s)
- Charlotte Berger
- Department of Neurology, Inselspital, University Hospital and University of Bern, Bern, Switzerland
| | - Helly Hammer
- Department of Neurology, Inselspital, University Hospital and University of Bern, Bern, Switzerland
| | - Marino Costa
- Department of Neurology, Inselspital, University Hospital and University of Bern, Bern, Switzerland
| | - Pawel Lowiec
- Department of Neurology, Medical University of Gdansk, Gdansk, Poland
| | - Andriy Yagensky
- Regional Center for Cardiovascular Disease, Lutsk City Hospital, Lutsk, Ukraine
| | - Adrian Scutelnic
- Department of Neurology, Inselspital, University Hospital and University of Bern, Bern, Switzerland
| | - Kateryna Antonenko
- Department of Neurology, Inselspital, University Hospital and University of Bern, Bern, Switzerland
| | - Olga Biletska
- Regional Center for Cardiovascular Disease, Lutsk City Hospital, Lutsk, Ukraine
| | | | - Hakan Sarikaya
- Department of Neurology, Inselspital, University Hospital and University of Bern, Bern, Switzerland
| | - Tomasz Zdrojewski
- Department of Cardiovascular Prevention, Medical University of Gdansk, Gdansk, Poland
| | - Anastasiia Klymiuk
- Regional Center for Cardiovascular Disease, Lutsk City Hospital, Lutsk, Ukraine
| | - Claudio LA Bassetti
- Department of Neurology, Inselspital, University Hospital and University of Bern, Bern, Switzerland
| | - Natalia Yashchuk
- Regional Center for Cardiovascular Disease, Lutsk City Hospital, Lutsk, Ukraine
| | - Kamil Chwojnicki
- Department of Neurology, Medical University of Gdansk, Gdansk, Poland
- Department of Anaesthesiology and Intensive Care, Medical University of Gdansk, Gdansk, Poland
| | - Marcel Arnold
- Department of Neurology, Inselspital, University Hospital and University of Bern, Bern, Switzerland
| | - Hugo Saner
- Institute for Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Mirjam R Heldner
- Department of Neurology, Inselspital, University Hospital and University of Bern, Bern, Switzerland
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Kitchen NM, Dexheimer B, Yuk J, Maenza C, Ruelos PR, Kim T, Sainburg RL. The complementary dominance hypothesis: a model for remediating the 'good' hand in stroke survivors. J Physiol 2024. [PMID: 38733166 DOI: 10.1113/jp285561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2024] [Accepted: 04/25/2024] [Indexed: 05/13/2024] Open
Abstract
The complementary dominance hypothesis is a novel model of motor lateralization substantiated by decades of research examining interlimb differences in the control of upper extremity movements in neurotypical adults and hemisphere-specific motor deficits in stroke survivors. In contrast to earlier ideas that attribute handedness to the specialization of one hemisphere, our model proposes complementary motor control specializations in each hemisphere. The dominant hemisphere mediates optimal control of limb dynamics as required for smooth and efficient movements, whereas the non-dominant hemisphere mediates impedance control, important for countering unexpected mechanical conditions and achieving steady-state limb positions. Importantly, this model proposes that each hemisphere contributes its specialization to both arms (though with greater influence from either arm's contralateral hemisphere) and thus predicts that lesions to one hemisphere should produce hemisphere-specific motor deficits in not only the contralesional arm, but also the ipsilesional arm of stroke survivors - a powerful prediction now supported by a growing body of evidence. Such ipsilesional arm motor deficits vary with contralesional arm impairment, and thus individuals with little to no functional use of the contralesional arm experience both the greatest impairments in the ipsilesional arm, as well as the greatest reliance on it to serve as the main or sole manipulator for activities of daily living. Accordingly, we have proposed and tested a novel intervention that reduces hemisphere-specific ipsilesional arm deficits and thereby improves functional independence in stroke survivors with severe contralesional impairment.
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Affiliation(s)
- Nick M Kitchen
- Department of Neurology, College of Medicine, Pennsylvania State University, Hershey, Pennsylvania, USA
- Department of Kinesiology, Pennsylvania State University, University Park, Pennsylvania, USA
| | - Brooke Dexheimer
- Department of Occupational Therapy, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Jisung Yuk
- Department of Kinesiology, Pennsylvania State University, University Park, Pennsylvania, USA
| | - Candice Maenza
- Department of Neurology, College of Medicine, Pennsylvania State University, Hershey, Pennsylvania, USA
| | - Paul R Ruelos
- Department of Kinesiology, Pennsylvania State University, University Park, Pennsylvania, USA
| | - Taewon Kim
- Department of Kinesiology, Pennsylvania State University, University Park, Pennsylvania, USA
- Department of Physical Medicine and Rehabilitation, College of Medicine, Pennsylvania State University, Hershey, Pennsylvania, USA
- Huck Institute of the Life Sciences, Pennsylvania State University, University Park, Pennsylvania, USA
| | - Robert L Sainburg
- Department of Neurology, College of Medicine, Pennsylvania State University, Hershey, Pennsylvania, USA
- Department of Kinesiology, Pennsylvania State University, University Park, Pennsylvania, USA
- Huck Institute of the Life Sciences, Pennsylvania State University, University Park, Pennsylvania, USA
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Schneckenburger R, Boulanger M, Nehme A, Watrin M, Le Du G, Guettier S, Guittet L, Touzé E. Epidemiology of transient ischemic attack in the normandy stroke population-based study. Eur Stroke J 2024:23969873241251722. [PMID: 38711259 DOI: 10.1177/23969873241251722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/08/2024] Open
Abstract
INTRODUCTION Transient ischemic attack (TIA) is a frequent neurological emergency which management and definition have changed radically over the last 15 years. However, recent epidemiological studies of TIA are scarce. We report here on the impact of the shift from a time-based to a tissue-based definition of TIA on its incidence and risk of recurrence in a new population-based cohort with a high rate of patients investigated by MRI. MATERIALS AND METHODS We prospectively included all TIAs that occurred between May 2017 and May 2021 from the Normandy Stroke Study, a population-based registry using multiple overlapping sources for exhaustive case identification in Caen la Mer area. TIAs were classified as either time-based (symptoms <24 h) or tissue-based (<24 h and no lesion on brain imaging). Attack and incidence rates were calculated, as was the 90-day ischemic stroke rate. RESULTS Five hundred and sixty-seven TIAs (549 single patients) were included, with 80.6% having a brain MRI. Four hundred and ten (72.3%) met the definition of tissue-based TIA. The age standardized attack (to the 2013 European population) rate was 39.5 (95% CI 35.7-43.5) and the age-standardized incidence rate (first ever cerebrovascular event) was 29.7 (95% CI 27.3-34.2). The overall recurrent stroke rate at 90 days was 2.7%, with no difference between patients with or without ischemic lesions on MRI. CONCLUSION We found that the use of the tissue-based definition of TIA resulted in a 27.5% reduction in incidence as compared to the time-based definition, but had no impact on the 90-day stroke rate. The burden of TIA remains high, and is likely to increase as the population ages.
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Affiliation(s)
- Romain Schneckenburger
- Université Caen Normandie, Caen, France
- Department of Neurology, CHU de Caen Normandie, Caen, France
- INSERM UMR-S U1237 PhIND/BB@C, Caen, France
| | - Marion Boulanger
- Université Caen Normandie, Caen, France
- Department of Neurology, CHU de Caen Normandie, Caen, France
- INSERM UMR-S U1237 PhIND/BB@C, Caen, France
| | - Ahmad Nehme
- Université Caen Normandie, Caen, France
- Department of Neurology, CHU de Caen Normandie, Caen, France
- INSERM UMR-S U1237 PhIND/BB@C, Caen, France
| | - Marguerite Watrin
- INSERM UMR-S U1237 PhIND/BB@C, Caen, France
- Department of Clinical Research, CHU de Caen Normandie, Caen, France
| | - Gwendoline Le Du
- INSERM UMR-S U1237 PhIND/BB@C, Caen, France
- Department of Clinical Research, CHU de Caen Normandie, Caen, France
| | - Sophie Guettier
- Department of Neurology, CHU de Caen Normandie, Caen, France
| | - Lydia Guittet
- Université Caen Normandie, Caen, France
- Department of Clinical Research, CHU de Caen Normandie, Caen, France
| | - Emmanuel Touzé
- Université Caen Normandie, Caen, France
- Department of Neurology, CHU de Caen Normandie, Caen, France
- INSERM UMR-S U1237 PhIND/BB@C, Caen, France
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Dong J, Ma Y, Chen Y, Guo J, Zhang T, Yang T, Zhang H, Yan F, Han L. Prevalence and influencing factors of patient delay in stroke patients: a systematic review and meta-analysis. Neurosurg Rev 2024; 47:202. [PMID: 38700541 DOI: 10.1007/s10143-024-02436-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2023] [Revised: 03/03/2024] [Accepted: 04/27/2024] [Indexed: 06/01/2024]
Abstract
PURPOSE Determine the prevalence and influencing factors of patient delay in stroke patients and explore variation in prevalence by country and delayed time. METHODS PubMed, The Cochrane Library, Embase, Web of Science, China National Knowledge Infrastructure (CNKI), Chinese Biomedical Database (CBM), Weipu database, and Wanfang database were comprehensively searched for observational studies from inception to April, 2023. The pooled prevalence, odds ratio (OR), and 95% confidence intervals (CI) were calculated with Stata 16.0 software. RESULTS In total, 2721 articles were screened and data from 70 studies involving 85,468 subjects were used in meta-analysis. The pooled prevalence of patient delay in stroke patients was 59% (95% CI, 0.54-0.64). The estimates of pooled prevalence calculated for African, Asian, and European patient delay in stroke patients were 55% (0.29-0.81), 61% (0.56-0.66), and 49% (0.34-0.64).According to the patient delay time, the prevalence of 6 h, 5 h, 4.5 h, 3.5 h, 3 h and 2 h were 54% (0.47-0.61), 73% (0.61-0.86), 60% (0.49-0.71), 81% (0.68-0.93), 52% (0.42-0.62), 63% (0.19-1.07). Distance from the place of onset to the hospital > 10 km [OR=2.49, 95%CI (1.92, 3.24)], having medical insurance [OR = 0.45, 95%CI (0.26,0.80)], lack of stroke-related knowledge [OR = 1.56, 95%CI (1.08,2.26)], education level below junior high school [OR = 1.69, 95%CI (1.22,2.36)], non-emergency medical services (Non-EMS) [OR = 2.10, 95%CI (1.49,2.97)], living in rural areas [OR = 1.54, 95%CI (1.15,2.07)], disturbance of consciousness [OR = 0.60, 95%CI (0.39,0.93)], history of atrial fibrillation [OR = 0.53, 95%CI (0.47,0.59)], age ≥ 65 years [OR = 1.18, 95%CI (1.02,1.37)], National institutes of health stroke scale (NIHSS) ≤ 4 points [OR= 2.26, 95%CI (1.06,4.79)]were factors for patient delay in stroke patients. CONCLUSIONS The prevalence of patient delay in stroke patients is high, we should pay attention to the influencing factors of patient delay in stroke patients and provide a theoretical basis for shortening the treatment time of stroke patients.
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Affiliation(s)
- Jianhui Dong
- Evidence-based Nursing Center, School of Nursing, Lanzhou University, Lanzhou, Gansu, 730010, China
| | - Yuxia Ma
- Evidence-based Nursing Center, School of Nursing, Lanzhou University, Lanzhou, Gansu, 730010, China.
- School of First Clinical Medical, Lanzhou University, Lanzhou, Gansu, 730000, China.
| | - Yanru Chen
- Evidence-based Nursing Center, School of Nursing, Lanzhou University, Lanzhou, Gansu, 730010, China
| | - Jiali Guo
- Evidence-based Nursing Center, School of Nursing, Lanzhou University, Lanzhou, Gansu, 730010, China
| | - Tong Zhang
- Evidence-based Nursing Center, School of Nursing, Lanzhou University, Lanzhou, Gansu, 730010, China
| | - Tingting Yang
- Evidence-based Nursing Center, School of Nursing, Lanzhou University, Lanzhou, Gansu, 730010, China
| | - Hongyan Zhang
- Department of Nursing, Gansu Provincial Hospital, Lanzhou, Gansu, 730030, China
| | - Fanghong Yan
- Evidence-based Nursing Center, School of Nursing, Lanzhou University, Lanzhou, Gansu, 730010, China
| | - Lin Han
- Evidence-based Nursing Center, School of Nursing, Lanzhou University, Lanzhou, Gansu, 730010, China.
- Department of Nursing, Gansu Provincial Hospital, Lanzhou, Gansu, 730030, China.
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Gibello L, Antonello M, Civilini E, Pellenc Q, Bellosta R, Carbonari L, Bonardelli S, Freyrie A, Riambau V, Varetto G, Verzini F. Multicentre experience of antegrade thoracic endovascular aortic repair for the treatment of thoracic aortic diseases. Eur J Cardiothorac Surg 2024; 65:ezae185. [PMID: 38733578 DOI: 10.1093/ejcts/ezae185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Revised: 04/09/2024] [Accepted: 04/21/2024] [Indexed: 05/13/2024] Open
Abstract
OBJECTIVES The goal of this multicentre retrospective cohort study was to evaluate technical success and early and late outcomes of thoracic endovascular repair (TEVAR) with grafts deployed upside down through antegrade access, to treat thoracic aortic diseases. METHODS Antegrade TEVAR operations performed between January 2010 and December 2021 were collected and analysed. Both elective and urgent procedures were included. Exclusion criteria were endografts deployed in previous or concomitant surgical or endovascular repairs. RESULTS Fourteen patients were enrolled; 13 were males (94%) with a mean age of 71 years (interquartile range 62; 78). Five patients underwent urgent procedures (2 ruptured aortas and 3 symptomatic patients). Indications for treatment were 8 (57%) aneurysms/pseudoaneurysms, 3 (21%) dissections and 3 (21%) penetrating aortic ulcers. Technical success was achieved in all procedures. Early mortality occurred in 4 (28%) cases, all urgent procedures. Median follow-up was 13 months (interquartile range 1; 44). Late deaths occurred in 2 (20%) patients, both operated on in elective settings. The first died at 19 months of aortic-related reintervention; the second died at 34 months of a non-aortic-related cause. Two patients (14%) underwent aortic-related reinterventions for late type I endoleak. The survival rate of those having the elective procedures was 100%, 84% and 67% at 12, 24 and 36 months, respectively. Freedom from reintervention was 92%, 56% and 56% at 12, 24 and 36 months, respectively. CONCLUSIONS Antegrade TEVAR can seldom be considered an alternative when traditional retrograde approach is not feasible. Despite good technical success and few access-site complications, this study demonstrates high rates of late type I endoleak and aortic-related reinterventions.
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Affiliation(s)
- Lorenzo Gibello
- Unit of Vascular Surgery, Department of Surgical Sciences, University of Turin, AOU Città della Salute e della Scienza di Torino, Turin, Italy
| | - Michele Antonello
- Section of Vascular and Endovascular Surgery, Department of Cardiac Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Efrem Civilini
- Humanitas University Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Quentin Pellenc
- Department of Thoracic and Vascular Surgery, Marfan Syndrome National Referral Center, Bichat University Hospital, APHP, Paris, France
- Vascular and Endovascular Surgery Division, La Cote HealthCare Group, Morges, VD, Switzerland
| | - Raffaello Bellosta
- Vascular and Endovascular Surgery, Poliambulanza Foundation Hospital, Brescia, Italy
| | | | - Stefano Bonardelli
- Vascular Surgery, Department of Surgery, Spedali Civili University Teaching Hospital, University of Brescia School of Medicine, Brescia, Italy
| | - Antonio Freyrie
- Vascular Surgery, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Vincent Riambau
- Department of Vascular Surgery, Cardiovascular Institute, Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - Gianfranco Varetto
- Unit of Vascular Surgery, Department of Surgical Sciences, University of Turin, AOU Città della Salute e della Scienza di Torino, Turin, Italy
| | - Fabio Verzini
- Unit of Vascular Surgery, Department of Surgical Sciences, University of Turin, AOU Città della Salute e della Scienza di Torino, Turin, Italy
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Jeong H, Lim H, Yoon C, Won J, Lee GY, de la Rosa E, Kirschke JS, Kim B, Kim N, Kim C. Robust Ensemble of Two Different Multimodal Approaches to Segment 3D Ischemic Stroke Segmentation Using Brain Tumor Representation Among Multiple Center Datasets. JOURNAL OF IMAGING INFORMATICS IN MEDICINE 2024:10.1007/s10278-024-01099-6. [PMID: 38693333 DOI: 10.1007/s10278-024-01099-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/23/2023] [Revised: 03/18/2024] [Accepted: 03/22/2024] [Indexed: 05/03/2024]
Abstract
Ischemic stroke segmentation at an acute stage is vital in assessing the severity of patients' impairment and guiding therapeutic decision-making for reperfusion. Although many deep learning studies have shown attractive performance in medical segmentation, it is difficult to use these models trained on public data with private hospitals' datasets. Here, we demonstrate an ensemble model that employs two different multimodal approaches for generalization, a more effective way to perform on external datasets. First, after we jointly train a segmentation model on diffusion-weighted imaging (DWI) and apparent diffusion coefficient (ADC) MR modalities, the model is inferred on the DWI images. Second, a channel-wise segmentation model is trained by concatenating the DWI and ADC images as input, and then is inferred using both MR modalities. Before training with ischemic stroke data, we utilized BraTS 2021, a public brain tumor dataset, for transfer learning. An extensive ablation study evaluates which strategy learns better representations for ischemic stroke segmentation. In our study, nnU-Net well-known for robustness is selected as our baseline model. Our proposed method is evaluated on three different datasets: the Asan Medical Center (AMC) I and II, and the 2022 Ischemic Stroke Lesion Segmentation (ISLES). Our experiments are widely validated over a large, multi-center, and multi-scanner dataset with a huge amount of 846 scans. Not only stroke lesion models can benefit from transfer learning using brain tumor data, but combining the MR modalities using different training schemes also highly improves segmentation performance. The method achieved a top-1 ranking in the ongoing ISLES'22 challenge and performed particularly well on lesion-wise metrics of interest to neuroradiologists, achieving a Dice coefficient of 78.69% and a lesion-wise F1 score of 82.46%. Also, the method was relatively robust on the AMC I (Dice, 60.35%; lesion-wise F1, 68.30%) and II (Dice; 74.12%; lesion-wise F1, 67.53%) datasets in different settings. The high segmentation accuracy of our proposed method could improve radiologists' ability to detect ischemic stroke lesions in MRI images. Our model weights and inference code are available on https://github.com/MDOpx/ISLES22-model-inference .
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Affiliation(s)
- Hyunsu Jeong
- Graduate School of Artificial Intelligence (GSAI), Department of Electrical Engineering, Medical Science and Engineering, and Medical Device Innovation Center, Convergence IT Engineering, Mechanical Engineering, Pohang University of Science and Technology (POSTECH), Pohang, South Korea
| | - Hyunseok Lim
- Graduate School of Artificial Intelligence (GSAI), Department of Electrical Engineering, Medical Science and Engineering, and Medical Device Innovation Center, Convergence IT Engineering, Mechanical Engineering, Pohang University of Science and Technology (POSTECH), Pohang, South Korea
| | - Chiho Yoon
- Graduate School of Artificial Intelligence (GSAI), Department of Electrical Engineering, Medical Science and Engineering, and Medical Device Innovation Center, Convergence IT Engineering, Mechanical Engineering, Pohang University of Science and Technology (POSTECH), Pohang, South Korea
| | - Jongjun Won
- Department of Medical Science, Asan Medical Center, Asan Medical Institute of Convergence Science and Technology, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Grace Yoojin Lee
- Department of Medical Science, Asan Medical Center, Asan Medical Institute of Convergence Science and Technology, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Ezequiel de la Rosa
- icometrix, Leuven, Belgium
- Department of Informatics, Technical University of Munich, Neuroradiology Munich, Germany
| | - Jan S Kirschke
- Department of Informatics, Technical University of Munich, Neuroradiology Munich, Germany
- Department of Diagnostic and Interventional Neuroradiology, School of Medicine, Klinikum Rechtsder Isar, Technical University of Munich, Munich, Germany
| | - Bumjoon Kim
- Department of Biomedical Engineering, Convergence Medicine, Radiology, Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.
| | - Namkug Kim
- Department of Biomedical Engineering, Convergence Medicine, Radiology, Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.
| | - Chulhong Kim
- Graduate School of Artificial Intelligence (GSAI), Department of Electrical Engineering, Medical Science and Engineering, and Medical Device Innovation Center, Convergence IT Engineering, Mechanical Engineering, Pohang University of Science and Technology (POSTECH), Pohang, South Korea.
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Ironside N, Melmed K, Chen CJ, Dabhi N, Omran S, Park S, Agarwal S, Connolly ES, Claassen J, Hod EA, Roh D. ABO blood type and thromboembolic complications after intracerebral hemorrhage: An exploratory analysis. J Stroke Cerebrovasc Dis 2024; 33:107678. [PMID: 38479493 PMCID: PMC11097653 DOI: 10.1016/j.jstrokecerebrovasdis.2024.107678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 03/03/2024] [Accepted: 03/10/2024] [Indexed: 03/26/2024] Open
Abstract
BACKGROUND AND PURPOSE Non-O blood types are known to be associated with thromboembolic complications (TECs) in population-based studies. TECs are known drivers of morbidity and mortality in intracerebral hemorrhage (ICH) patients, yet the relationships of blood type on TECs in this patient population are unknown. We sought to explore the relationships between ABO blood type and TECs in ICH patients. METHODS Consecutive adult ICH patients enrolled into a prospective observational cohort study with available ABO blood type data were analyzed. Patients with cancer history, prior thromboembolism, and baseline laboratory evidence of coagulopathy were excluded. The primary exposure variable was blood type (non-O versus O). The primary outcome was composite TEC, defined as pulmonary embolism, deep venous thrombosis, ischemic stroke or myocardial infarction, during the hospital stay. Relationships between blood type, TECs and clinical outcomes were separately assessed using logistic regression models after adjusting for sex, ethnicity and ICH score. RESULTS Of 301 ICH patients included for analysis, 44% were non-O blood type. Non-O blood type was associated with higher admission GCS and lower ICH score on baseline comparisons. We identified TECs in 11.6% of our overall patient cohort. . Although TECs were identified in 9.9% of non-O blood type patients compared to 13.0% in O blood type patients, we did not identify a significant relationship of non-O blood type with TECs (adjusted OR=0.776, 95%CI: 0.348-1.733, p=0.537). The prevalence of specific TECs were also comparable in unadjusted and adjusted analyses between the two cohorts. In additional analyses, we identified that TECs were associated with poor 90-day mRS (adjusted OR=3.452, 95% CI: 1.001-11.903, p=0.050). We did not identify relationships between ABO blood type and poor 90-day mRS (adjusted OR=0.994, 95% CI:0.465-2.128, p=0.988). CONCLUSIONS We identified that TECs were associated with worse ICH outcomes. However, we did not identify relationships in ABO blood type and TECs. Further work is required to assess best diagnostic and prophylactic and treatment strategies for TECs to improve ICH outcomes.
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Affiliation(s)
- Natasha Ironside
- Department of Neurological Surgery, University of Virginia Health System, Charlottesville, VA, United States
| | - Kara Melmed
- Department of Neurology and Neurosurgery, New York University Grossman School of Medicine, New York, NY, United States
| | - Ching-Jen Chen
- Department of Neurological Surgery, University of Virginia Health System, Charlottesville, VA, United States
| | - Nisha Dabhi
- Department of Neurological Surgery, University of Virginia Health System, Charlottesville, VA, United States
| | - Setareh Omran
- Department of Neurology, University of Colorado School of Medicine, Aurora, CO, United States
| | - Soojin Park
- Department of Neurology, Vagelos College of Physicians and Surgeons, Columbia University, 177 Fort Washington Ave, New York, NY 10032, United States
| | - Sachin Agarwal
- Department of Neurology, Vagelos College of Physicians and Surgeons, Columbia University, 177 Fort Washington Ave, New York, NY 10032, United States
| | - E Sander Connolly
- Department of Neurological Surgery, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, United States
| | - Jan Claassen
- Department of Neurology, Vagelos College of Physicians and Surgeons, Columbia University, 177 Fort Washington Ave, New York, NY 10032, United States
| | - Eldad A Hod
- Department of Pathology and Cell Biology, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, United States
| | - David Roh
- Department of Neurology, Vagelos College of Physicians and Surgeons, Columbia University, 177 Fort Washington Ave, New York, NY 10032, United States.
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Eltayib EM, Jirjees F, Suliman D, AlObaidi H, Ahmed M, Kharaba ZJ, Alfoteih Y, Barakat M, Khidhair Z, ALSalamat H, Mustafa N, Cherri S, El Khatib S, Hallit S, Malaeb D, Hosseini H. Stroke awareness and knowledge in Sudan: a cross-sectional analysis of public perceptions and understanding. Front Public Health 2024; 12:1362979. [PMID: 38774053 PMCID: PMC11107802 DOI: 10.3389/fpubh.2024.1362979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Accepted: 04/18/2024] [Indexed: 05/24/2024] Open
Abstract
Introduction Stroke, a leading cause of morbidity and mortality globally, demands heightened awareness and knowledge for effective preventive strategies and tailored response. Sudan is classified as a low income country with a low rate of literacy, lack of knowledge, and awareness about diseases. Thus, this study aimed to assess stroke awareness and knowledge among Sudanese population, and identify the associated factors influencing awareness. Methods A cross-sectional study conducted between October and November 2022 through a self-administered online survey distributed via various social media platforms. The study involved adults aged 18 years and above through snow-ball sampling technique. The survey covered general awareness and knowledge concerning stroke risk factors, consequences, and the appropriate responses taken during acute stroke attacks. Results A total of 410 participants were enrolled in the study, majority (93.4%) were from urban area and had university degree (92.4%). Furthermore, 92.2% were aware about stroke and 74.9% were able to recognize the symptoms of stroke. Only 40.2% identified all correct answers, 96.3, 92.3, and 95.1% recognized at least one risk factor, early symptom, and consequences, respectively. Females were significantly more than males able to identify at least one risk factor. Almost all participants (99.5%) perceived stroke as a serious disease (99.5%). Notably, 86.3% would promptly transport a suspected stroke patient to the hospital. The multivariable analysis showed that females versus males and patients with depression versus without depression had significantly higher odds to identify at least one risk factor (OR of 14.716 [95% CI 1.901; 113.908] and 0.241 [95% CI 0.059; 0.984], respectively). Conclusion The study concluded that stroke knowledge and awareness among Sudanese population is suboptimal. Furthermore, early stroke recognition and intake of the appropriate management strategies are lacking which highlights the need for targeted education and awareness campaigns.
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Affiliation(s)
| | - Feras Jirjees
- College of Pharmacy, University of Sharjah, Sharjah, United Arab Emirates
| | - Duaa Suliman
- Health Policy, Mohammed Bin Rashid School of Government, Dubai, United Arab Emirates
| | - Hala AlObaidi
- School of Pharmacy, Queen's University Belfast, Belfast, United Kingdom
| | - Munazza Ahmed
- College of Pharmacy, University of Sharjah, Sharjah, United Arab Emirates
| | - Zelal J. Kharaba
- College of Pharmacy, University of Sharjah, Sharjah, United Arab Emirates
- College of Pharmacy, Al Ain University, Abu Dhabi, United Arab Emirates
| | - Yassen Alfoteih
- College of Dentistry and College of Humanities, City University College of Ajman, Ajman, United Arab Emirates
| | - Muna Barakat
- Faculty of Pharmacy, Applied Science Private University, Amman, Jordan
| | | | - Husam ALSalamat
- Faculty of Medicine, Al-Balqa Applied University, Al-Salt, Jordan
| | - Nazik Mustafa
- Department of Pharmacology, Faculty of Pharmacy, Al Neelain University, Khartoum, Sudan
| | - Sarah Cherri
- Lebanese International University, School of Pharmacy, Beirut, Lebanon
| | - Sami El Khatib
- Department of Biomedical Sciences, Lebanese International University, Bekaa, Lebanon
- Center for Applied Mathematics and Bioinformatics (CAMB), Gulf University for Science and Technology, West Mishref, Kuwait
| | - Souheil Hallit
- School of Medicine and Medical Sciences, Holy Spirit University of Kaslik, Jounieh, Lebanon
- Applied Science Research Center, Applied Science Private University, Amman, Jordan
| | - Diana Malaeb
- College of Pharmacy, Gulf Medical University, Ajman, United Arab Emirates
| | - Hassan Hosseini
- UPEC-University Paris-Est, Creteil, France
- RAMSAY SANTÉ, HPPE, Champigny-sur-Marne, France
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43
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Chen HS, Cui Y, Wang XH, Ma YT, Han J, Duan YJ, Lu J, Shen LY, Liang Y, Wang WZ, Wang H, Zhao Y, Zhang JT, Song YL, He XM, Li RH, Tao DB, Li J, Huang SM, Wang N, Hong M, Meng C, Zhang W, Wang DL, Nguyen TN. Clopidogrel Plus Aspirin vs Aspirin Alone in Patients With Acute Mild to Moderate Stroke: The ATAMIS Randomized Clinical Trial. JAMA Neurol 2024; 81:450-460. [PMID: 38466274 PMCID: PMC10928538 DOI: 10.1001/jamaneurol.2024.0146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Accepted: 01/11/2024] [Indexed: 03/12/2024]
Abstract
Importance Dual antiplatelet therapy has been demonstrated to be superior to single antiplatelet in reducing recurrent stroke among patients with transient ischemic attack or minor stroke, but robust evidence for its effect in patients with mild to moderate ischemic stroke is lacking. Objective To evaluate whether dual antiplatelet therapy is superior to single antiplatelet among patients with mild to moderate ischemic stroke. Design, Setting, and Participants This was a multicenter, open-label, blinded end point, randomized clinical trial conducted at 66 hospitals in China from December 20, 2016, through August 9, 2022. The date of final follow-up was October 30, 2022. The analysis was reported on March 12, 2023. Of 3065 patients with ischemic stroke, 3000 patients with acute mild to moderate stroke within 48 hours of symptom onset were enrolled, after excluding 65 patients who did not meet eligibility criteria or had no randomization outcome. Interventions Within 48 hours after symptom onset, patients were randomly assigned to receive clopidogrel plus aspirin (n = 1541) or aspirin alone (n = 1459) in a 1:1 ratio. Main Outcomes and Measures The primary end point was early neurologic deterioration at 7 days, defined as an increase of 2 or more points in National Institutes of Health Stroke Scale (NIHSS) score, but not as a result of cerebral hemorrhage, compared with baseline. The superiority of clopidogrel plus aspirin to aspirin alone was assessed based on a modified intention-to-treat population, which included all randomized participants with at least 1 efficacy evaluation regardless of treatment allocation. Bleeding events were safety end points. Results Of the 3000 randomized patients, 1942 (64.6%) were men, the mean (SD) age was 65.9 (10.6) years, median (IQR) NIHSS score at admission was 5 (4-6), and 1830 (61.0%) had a stroke of undetermined cause. A total of 2915 patients were included in the modified intention-to-treat analysis. Early neurologic deterioration occurred in 72 of 1502 (4.8%) in the dual antiplatelet therapy group vs 95 of 1413 (6.7%) in the aspirin alone group (risk difference -1.9%; 95% CI, -3.6 to -0.2; P = .03). Similar bleeding events were found between 2 groups. Conclusions and Relevance Among Chinese patients with acute mild to moderate ischemic stroke, clopidogrel plus aspirin was superior to aspirin alone with regard to reducing early neurologic deterioration at 7 days with similar safety profile. These findings indicate that dual antiplatelet therapy may be a superior choice to aspirin alone in treating patients with acute mild to moderate stroke. Trial Registration ClinicalTrials.gov Identifier: NCT02869009.
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Affiliation(s)
- Hui-Sheng Chen
- Department of Neurology, General Hospital of Northern Theatre Command, Shenyang, China
| | - Yu Cui
- Department of Neurology, General Hospital of Northern Theatre Command, Shenyang, China
| | - Xin-Hong Wang
- Department of Neurology, General Hospital of Northern Theatre Command, Shenyang, China
| | - Yu-Tong Ma
- Department of Neurology, Beipiao Central Hospital, Beipiao, China
| | - Jing Han
- Department of Neurology, Panjin Central Hospital, Panjin, China
| | - Ying-Jie Duan
- Department of Neurology, General Hospital of Fuxin Mining Industry Group of Liaoning Health Industry Group, Fuxin, China
| | - Jiang Lu
- Department of Neurology, Linghai Dalinghe Hospital, Jinzhou, China
| | - Li-Ying Shen
- Department of Neurology, Tieling County Central Hospital, Tieling, China
| | - Yong Liang
- Department of Neurology, Tieling Central Hospital, Tieling, China
| | - Wei-Zhong Wang
- Department of Neurology, Dandong Central Hospital, Dandong, China
| | - Hui Wang
- Department of Neurology, Chinese People’s Liberation Army 966 Hospital, Dandong, China
| | - Yong Zhao
- Department of Neurology, Haicheng Traditional Chinese Medicine Hospital, Haicheng, China
| | - Jin-Tao Zhang
- Department of Neurology, Chinese People’s Liberation Army 960 Hospital, Taian, China
| | - Yu-Lin Song
- Department of Neurology, Anshan Changda Hospital, Anshan, China
| | - Xiao-Mei He
- Department of Neurology, Chaoyang Central Hospital, Chaoyang, China
| | - Run-Hui Li
- Department of Neurology, The Affiliated Central Hospital of Shenyang Medical College, Shenyang, China
| | - Ding-Bo Tao
- Department of Neurology, The First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Jing Li
- Department of Neurology, Donggang Central Hospital, Donggang, China
| | - Shu-Man Huang
- Department of Neurology, Dawa District People’s Hospital, Panjin, China
| | - Ni Wang
- Department of Neurology, Wafangdian Central Hospital, Wafangdian, China
| | - Mei Hong
- Department of Neurology, China Railway 19th Bureau Group Central Hospital, Liaoyang, China
| | - Chong Meng
- Department of Neurology, Liaoyang County Central Hospital, Liaoyang, China
| | - Wei Zhang
- Department of Neurology, Liaoning Electrical Power Central Hospital, Shenyang, China
| | - Duo-Lao Wang
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Thanh N. Nguyen
- Department of Neurology, Radiology, Boston Medical Center, Boston, Massachusetts
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Wang L, Guo T, Wang L, Yang W, Wang J, Nie J, Cui J, Jiang P, Li J, Zhang H. Improving radiomic modeling for the identification of symptomatic carotid atherosclerotic plaques using deep learning-based 3D super-resolution CT angiography. Heliyon 2024; 10:e29331. [PMID: 38644848 PMCID: PMC11033096 DOI: 10.1016/j.heliyon.2024.e29331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2024] [Revised: 04/04/2024] [Accepted: 04/05/2024] [Indexed: 04/23/2024] Open
Abstract
Rationale and objectives Radiomic models based on normal-resolution (NR) computed tomography angiography (CTA) images can fail to distinguish between symptomatic and asymptomatic carotid atherosclerotic plaques. This study aimed to explore the effectiveness of a deep learning-based three-dimensional super-resolution (SR) CTA radiomic model for improved identification of symptomatic carotid atherosclerotic plaques. Materials and methods A total of 193 patients with carotid atherosclerotic plaques were retrospectively enrolled and allocated into either a symptomatic (n = 123) or an asymptomatic (n = 70) groups. SR CTA images were derived from NR CTA images using deep learning-based three-dimensional SR technology. Handcrafted radiomic features were extracted from both the SR and NR CTA images and three risk models were developed based on manually measured quantitative CTA characteristics and NR and SR radiomic features. Model performances were assessed via receiver operating characteristic, calibration, and decision curve analyses. Results The SR model exhibited the optimal performance (area under the curve [AUC] 0.820, accuracy 0.802, sensitivity 0.854, F1 score 0.847) in the testing cohort, outperforming the other two models. The calibration curve analyses and Hosmer-Lemeshow test demonstrated that the SR model exhibited the best goodness of fit, and decision curve analysis revealed that SR model had the highest clinical value and potential patient benefits. Conclusions Deep learning-based three-dimensional SR technology could improve the CTA-based radiomic models in identifying symptomatic carotid plaques, potentially providing more accurate and valuable information to guide clinical decision-making to reduce the risk of ischemic stroke.
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Affiliation(s)
- Lingjie Wang
- Department of Medical Imaging, First Hospital of Shanxi Medical University, Taiyuan, Shanxi Province, 030001, China
| | - Tiedan Guo
- Department of Medical Imaging, First Hospital of Shanxi Medical University, Taiyuan, Shanxi Province, 030001, China
| | - Li Wang
- Department of Medical Imaging, First Hospital of Shanxi Medical University, Taiyuan, Shanxi Province, 030001, China
| | - Wentao Yang
- Basic Medical College, Shanxi Medical University, Taiyuan, Shanxi Province, 030001, China
| | - Jingying Wang
- Department of Endemic Disease Prevention and Control, Shanxi Province Disease Prevention and Control Center, Shanxi Province, 030001, China
| | - Jianlong Nie
- Shanghai United Imaging Intelligence, Co., Ltd., Shanghai City, 200030, China
| | - Jingjing Cui
- Shanghai United Imaging Intelligence, Co., Ltd., Shanghai City, 200030, China
| | - Pengbo Jiang
- Shanghai United Imaging Intelligence, Co., Ltd., Shanghai City, 200030, China
| | - Junlin Li
- Department of Imaging Medicine, Inner Mongolia Autonomous Region People's Hospital, Hohhot, 010017, China
| | - Hua Zhang
- Department of Medical Imaging, First Hospital of Shanxi Medical University, Taiyuan, Shanxi Province, 030001, China
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Didier R, Garnier L, Duloquin G, Meloux A, Sagnard A, Graber M, Dogon G, Benali K, Pommier T, Laurent G, Vergely C, Bejot Y, Guenancia C. Distribution of atrial cardiomyopathy markers and association with atrial fibrillation detected after ischaemic stroke in the SAFAS study. Stroke Vasc Neurol 2024; 9:165-173. [PMID: 37429637 PMCID: PMC11103154 DOI: 10.1136/svn-2023-002447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 06/27/2023] [Indexed: 07/12/2023] Open
Abstract
BACKGROUND Atrial cardiomyopathy (AC) is an emerging concept explaining the pathophysiology of cardioembolic strokes in absence of atrial fibrillation (AF). A definition based on the presence of electrical abnormality (P-wave terminal force in lead V1 (PTFV1) >5000 µV×ms), N-Terminal pro-B-type natriuretic peptide (NT pro BNP) >250 pg/mL and/or indexed left atrial diameter (LADI) >3 cm/m² is currently tested in the ARCADIA (AtRial Cardiopathy and Antithrombotic Drugs In prevention After cryptogenic stroke) trial. We set out to estimate the prevalence of AC as defined in the ARCADIA trial, its determinants and its association with AF detected after stroke (AFDAS). METHODS Stepwise screening for silent Atrial Fibrillation After Stroke (SAFAS) study prospectively included 240 ischaemic stroke patients. AC markers were complete for 192 of them and 9 were not included in this analysis because AF had been diagnosed on admission. RESULTS A total of 183 patients were analysed, of whom 57% (104 patients) met the AC criteria (79 NT-proBNP, 47 PTFV1, 4 LADI). In the multivariate logistic regression, C reactive protein >3 mg/L (OR (95% CI) 2.60 (1.30 to 5.21), p=0.007) and age (OR (95% CI) 1.07 (1.04 to 1.10), p<0.001) were found to be independently associated with AC. After 6 months of follow-up, AFDAS was detected in 33% of AC patients and in 14% of the remaining ones (p=0.003). However, AC was not independently associated with AFDAS, contrary to left atrial volume index (>34 mL/m2, OR 2.35 (CI 1.09 to 5.06) p=0029). CONCLUSION AC as defined in ARCADIA is mostly based on NT pro BNP elevation (76% of patients) and is associated with age and inflammation. Moreover, AC was not independently associated with AFDAS at follow-up. The ARCADIA trial, which compares aspirin to apixaban in patients with embolic strokes of undetermined source with AC markers and must, therefore be analysed in the light of these limitations. TRIAL REGISTRATION NUMBER NCT03570060.
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Affiliation(s)
| | - Lucie Garnier
- Dijon Stroke Registry, Department of Neurology, University Hospital Centre Dijon, Dijon, France
| | - Gauthier Duloquin
- Dijon Stroke Registry, Department of Neurology, University Hospital Centre Dijon, Dijon, France
| | | | | | - Mathilde Graber
- Dijon Stroke Registry, Department of Neurology, University Hospital Centre Dijon, Dijon, France
| | | | - Karim Benali
- Cardiology, CHU Saint Etienne, Saint Etienne, France
| | - Thibaut Pommier
- Cardiology, CHU Dijon Bourgogne, Dijon, France
- PEC 2, Université de Bourgogne, Dijon, France
| | - Gabriel Laurent
- Cardiology, CHU Dijon Bourgogne, Dijon, France
- PEC 2, Université de Bourgogne, Dijon, France
| | | | - Yannick Bejot
- Dijon Stroke Registry, Department of Neurology, University Hospital Centre Dijon, Dijon, France
- PEC 2, Université de Bourgogne, Dijon, France
| | - Charles Guenancia
- Cardiology, CHU Dijon Bourgogne, Dijon, France
- PEC 2, Université de Bourgogne, Dijon, France
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Wandscher K, Hoffmann F, Heesen C, Thomalla G, Rahn AC, Helbach J. Effectiveness of motivational interviewing on medication adherence for the prevention of recurrent stroke or transient ischemic attack: Systematic review of randomized controlled trials. Eur J Neurol 2024:e16313. [PMID: 38676444 DOI: 10.1111/ene.16313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2024] [Revised: 03/28/2024] [Accepted: 04/08/2024] [Indexed: 04/28/2024]
Abstract
BACKGROUND AND PURPOSE This systematic review examines the effectiveness of motivational interviewing (MI) on medication adherence for preventing recurrent stroke and transient ischemic attack (TIA). METHODS MEDLINE (via PubMed), CINAHL, PsycINFO, CENTRAL, and ClinicalTrials.gov were searched from inception to 12 June 2023. Randomized controlled trials comparing MI with usual care or interventions without MI in participants with any stroke type were identified and summarized descriptively. Primary outcome was medication adherence. Secondary outcomes were quality of life (QoL) and different clinical outcomes. We assessed risk of bias with RoB 2 (revised Cochrane risk-of-bias tool) and intervention complexity with the iCAT_SR (intervention Complexity Assessment Tool for Systematic Reviews). RESULTS We screened 691 records for eligibility and included four studies published in five articles. The studies included a total of 2751 participants, and three were multicentric. Three studies had a high risk of bias, and interventions varied in complexity. Two studies found significantly improved medication adherence, one at 9 (96.9% vs. 88.2%, risk ratio = 1.098, 95% confidence interval = 1.03-1.17) and one at 12 months (97.0% vs. 95.0%, p = 0.026), but not at other time points, whereas two other studies reported no significant changes. No significant differences were found in QoL or clinical outcomes. CONCLUSIONS Evidence on MI appears inconclusive for improving medication adherence for recurrent stroke and TIA prevention, with no benefits on QoL and clinical outcomes. There is a need for robustly designed studies and process evaluations of MI as a complex intervention for people with stroke. REGISTRATION PROSPERO (CRD42023433284).
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Affiliation(s)
- Kathrin Wandscher
- Department of Health Services Research, School of Medicine and Health Sciences, Carl von Ossietzky University Oldenburg, Oldenburg, Germany
| | - Falk Hoffmann
- Department of Health Services Research, School of Medicine and Health Sciences, Carl von Ossietzky University Oldenburg, Oldenburg, Germany
| | - Christoph Heesen
- Institute of Neuroimmunology and Multiple Sclerosis, Center for Molecular Neurobiology, University Hospital Hamburg-Eppendorf, Hamburg, Germany
- Department of Neurology, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Götz Thomalla
- Department of Neurology, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Anne Christin Rahn
- Nursing Research Unit, Institute for Social Medicine and Epidemiology, University of Lübeck, Lübeck, Germany
| | - Jasmin Helbach
- Department of Health Services Research, School of Medicine and Health Sciences, Carl von Ossietzky University Oldenburg, Oldenburg, Germany
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French S, Arias J, Bolakale-Rufai I, Zahra S, Rubab Khakwani KZ, Bedrick EJ, Serrano GE, Beach TG, Reiman E, Weinkauf C. Serum detection of blood brain barrier injury in subjects with a history of stroke and transient ischemic attack. JVS Vasc Sci 2024; 5:100206. [PMID: 38873494 PMCID: PMC11170223 DOI: 10.1016/j.jvssci.2024.100206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2024] [Accepted: 04/13/2024] [Indexed: 06/15/2024] Open
Abstract
Objective Stroke and transient ischemic attack may have long-term negative effects on the blood-brain barrier (BBB) and promote endothelial inflammation, both of which could increase neurodegeneration and dementia risk beyond the cell death associated with the index event. Methods Serum from 88 postmortem subjects in the Arizona Study of Aging and Neurodegenerative Disorders were analyzed by sandwich ELISA for specific biomarkers to investigate the effects of cerebrovascular accidents (CVAs) on BBB integrity and endothelial activation. Statistical analyses were performed using the Mann-Whitney U Test, Spearman rank correlation, and linear/logistic regressions adjusted for potential confounders; a P-value < .05 was considered significant for all analyses. Results Serum PDGFRẞ, a putative biomarker of BBB injury, was significantly increased in subjects with vs without a history of CVA who had similar cardiovascular risk factors (P < .01). This difference was stable after adjusting for age, hypertension, and other potential confounders in regression analysis (odds ratio, 27.02; 95% confidence interval, 2.61-411.7; P < .01). In addition, PDGFRẞ was positively associated with VCAM-1, a biomarker of endothelial inflammation (ρ = 0.42; P < .01). Conclusions Our data suggest that patients with stroke or transient ischemic attack have lasting changes in the BBB. Still more, this demonstrates the utility of PDGFRẞ as a serum-based biomarker of BBB physiology, a potentially powerful tool in studying the role of the BBB in various neurodegenerative diseases and COVID infection sequelae. Clinical Relevance Our data demonstrate the utility of serum PDGFRẞ, a putative biomarker of BBB integrity in the setting of stroke and TIA (CVA). A serum biomarker of BBB integrity could be a useful tool to detect early BBB damage and allow prospective work to study how such damage affects long-term neurodegenerative risk. Since BBB disruption occurs early in ADRD development, it could be monitored to help better understand disease progression and involvement of vascular pathways in ADRD.
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Affiliation(s)
- Scott French
- The Division of Vascular Surgery, University of Arizona, and Sarver Heart Center, Tucson, AZ
| | - Juan Arias
- The Division of Vascular Surgery, University of Arizona, and Sarver Heart Center, Tucson, AZ
| | | | - Summan Zahra
- The Division of Vascular Surgery, University of Arizona, and Sarver Heart Center, Tucson, AZ
| | | | - Edward J. Bedrick
- Department of Epidemiology and Biostatistics, University of Arizona College of Public Health, Tucson, AZ
| | | | | | - Eric Reiman
- Banner Alzheimer's Institute, University of Arizona, Arizona State University, Translational Genomics Research Institute, and Arizona Alzheimer's Consortium, Phoenix, AZ
| | - Craig Weinkauf
- The Division of Vascular Surgery, University of Arizona, and Sarver Heart Center, Tucson, AZ
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Lengyel B, Magyar-Stang R, Pál H, Debreczeni R, Sándor ÁD, Székely A, Gyürki D, Csippa B, István L, Kovács I, Sótonyi P, Mihály Z. Non-Invasive Tools in Perioperative Stroke Risk Assessment for Asymptomatic Carotid Artery Stenosis with a Focus on the Circle of Willis. J Clin Med 2024; 13:2487. [PMID: 38731014 PMCID: PMC11084304 DOI: 10.3390/jcm13092487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2024] [Revised: 04/17/2024] [Accepted: 04/20/2024] [Indexed: 05/13/2024] Open
Abstract
This review aims to explore advancements in perioperative ischemic stroke risk estimation for asymptomatic patients with significant carotid artery stenosis, focusing on Circle of Willis (CoW) morphology based on the CTA or MR diagnostic imaging in the current preoperative diagnostic algorithm. Functional transcranial Doppler (fTCD), near-infrared spectroscopy (NIRS), and optical coherence tomography angiography (OCTA) are discussed in the context of evaluating cerebrovascular reserve capacity and collateral vascular systems, particularly the CoW. These non-invasive diagnostic tools provide additional valuable insights into the cerebral perfusion status. They support biomedical modeling as the gold standard for the prediction of the potential impact of carotid artery stenosis on the hemodynamic changes of cerebral perfusion. Intraoperative risk assessment strategies, including selective shunting, are explored with a focus on CoW variations and their implications for perioperative ischemic stroke and cognitive function decline. By synthesizing these insights, this review underscores the potential of non-invasive diagnostic methods to support clinical decision making and improve asymptomatic patient outcomes by reducing the risk of perioperative ischemic neurological events and preventing further cognitive decline.
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Affiliation(s)
- Balázs Lengyel
- Department of Vascular and Endovascular Surgery, Heart and Vascular Center, Semmelweis University, 1122 Budapest, Hungary; (B.L.); (P.S.J.)
| | - Rita Magyar-Stang
- Department of Neurology, Semmelweis University, 1085 Budapest, Hungary; (R.M.-S.); (H.P.); (R.D.)
- Szentágothai Doctoral School of Neurosciences, Semmelweis University, 1085 Budapest, Hungary
| | - Hanga Pál
- Department of Neurology, Semmelweis University, 1085 Budapest, Hungary; (R.M.-S.); (H.P.); (R.D.)
- Szentágothai Doctoral School of Neurosciences, Semmelweis University, 1085 Budapest, Hungary
| | - Róbert Debreczeni
- Department of Neurology, Semmelweis University, 1085 Budapest, Hungary; (R.M.-S.); (H.P.); (R.D.)
- Szentágothai Doctoral School of Neurosciences, Semmelweis University, 1085 Budapest, Hungary
| | - Ágnes Dóra Sándor
- Department of Anesthesiology and Intensive Therapy, Semmelweis University, 1085 Budapest, Hungary; (Á.D.S.); (A.S.)
| | - Andrea Székely
- Department of Anesthesiology and Intensive Therapy, Semmelweis University, 1085 Budapest, Hungary; (Á.D.S.); (A.S.)
| | - Dániel Gyürki
- Department of Hydrodynamic Systems, Faculty of Mechanical Engineering, Budapest University of Technology and Economics, 1085 Budapest, Hungary; (D.G.); (B.C.)
| | - Benjamin Csippa
- Department of Hydrodynamic Systems, Faculty of Mechanical Engineering, Budapest University of Technology and Economics, 1085 Budapest, Hungary; (D.G.); (B.C.)
| | - Lilla István
- Department of Ophthalmology, Semmelweis University, 1085 Budapest, Hungary; (L.I.); (I.K.)
| | - Illés Kovács
- Department of Ophthalmology, Semmelweis University, 1085 Budapest, Hungary; (L.I.); (I.K.)
- Department of Ophthalmology, Weill Cornell Medical College, New York, NY 10065, USA
- Department of Clinical Ophthalmology, Faculty of Health Sciences, Semmelweis University, 1085 Budapest, Hungary
| | - Péter Sótonyi
- Department of Vascular and Endovascular Surgery, Heart and Vascular Center, Semmelweis University, 1122 Budapest, Hungary; (B.L.); (P.S.J.)
| | - Zsuzsanna Mihály
- Department of Vascular and Endovascular Surgery, Heart and Vascular Center, Semmelweis University, 1122 Budapest, Hungary; (B.L.); (P.S.J.)
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Ceasovschih A, Șorodoc V, Covantsev S, Balta A, Uzokov J, Kaiser SE, Almaghraby A, Lionte C, Stătescu C, Sascău RA, Onofrei V, Haliga RE, Stoica A, Bologa C, Ailoaei Ș, Şener YZ, Kounis NG, Șorodoc L. Electrocardiogram Features in Non-Cardiac Diseases: From Mechanisms to Practical Aspects. J Multidiscip Healthc 2024; 17:1695-1719. [PMID: 38659633 PMCID: PMC11041971 DOI: 10.2147/jmdh.s445549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Accepted: 04/10/2024] [Indexed: 04/26/2024] Open
Abstract
Despite the noteworthy advancements and the introduction of new technologies in diagnostic tools for cardiovascular disorders, the electrocardiogram (ECG) remains a reliable, easily accessible, and affordable tool to use. In addition to its crucial role in cardiac emergencies, ECG can be considered a very useful ancillary tool for the diagnosis of many non-cardiac diseases as well. In this narrative review, we aimed to explore the potential contributions of ECG for the diagnosis of non-cardiac diseases such as stroke, migraine, pancreatitis, Kounis syndrome, hypothermia, esophageal disorders, pulmonary embolism, pulmonary diseases, electrolyte disturbances, anemia, coronavirus disease 2019, different intoxications and pregnancy.
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Affiliation(s)
- Alexandr Ceasovschih
- Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, Iasi, Romania
- 2nd Internal Medicine Department, “Sf. Spiridon” Clinical Emergency Hospital, Iasi, Romania
| | - Victorița Șorodoc
- Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, Iasi, Romania
- 2nd Internal Medicine Department, “Sf. Spiridon” Clinical Emergency Hospital, Iasi, Romania
| | - Serghei Covantsev
- Department of Research and Clinical Development, Botkin Hospital, Moscow, Russia
| | - Anastasia Balta
- Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, Iasi, Romania
- 2nd Internal Medicine Department, “Sf. Spiridon” Clinical Emergency Hospital, Iasi, Romania
| | - Jamol Uzokov
- Department of Cardiology, Republican Specialized Scientific Practical Medical Center of Therapy and Medical Rehabilitation, Tashkent, Uzbekistan
| | - Sergio E Kaiser
- Discipline of Clinical and Experimental Pathophysiology, Rio de Janeiro State University, Rio de Janeiro, Brazil
| | - Abdallah Almaghraby
- Department of Cardiology, Ibrahim Bin Hamad Obaidallah Hospital, Ras Al Khaimah, United Arab Emirates
| | - Cătălina Lionte
- Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, Iasi, Romania
- 2nd Internal Medicine Department, “Sf. Spiridon” Clinical Emergency Hospital, Iasi, Romania
| | - Cristian Stătescu
- Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, Iasi, Romania
- Department of Cardiology, “Prof. Dr. George I.M. Georgescu” Cardiovascular Diseases Institute, Iasi, Romania
| | - Radu A Sascău
- Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, Iasi, Romania
- Department of Cardiology, “Prof. Dr. George I.M. Georgescu” Cardiovascular Diseases Institute, Iasi, Romania
| | - Viviana Onofrei
- Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, Iasi, Romania
- Department of Cardiology, “Sf. Spiridon” Clinical Emergency Hospital, Iasi, Romania
| | - Raluca Ecaterina Haliga
- Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, Iasi, Romania
- 2nd Internal Medicine Department, “Sf. Spiridon” Clinical Emergency Hospital, Iasi, Romania
| | - Alexandra Stoica
- Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, Iasi, Romania
- 2nd Internal Medicine Department, “Sf. Spiridon” Clinical Emergency Hospital, Iasi, Romania
| | - Cristina Bologa
- Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, Iasi, Romania
- 2nd Internal Medicine Department, “Sf. Spiridon” Clinical Emergency Hospital, Iasi, Romania
| | - Ștefan Ailoaei
- Department of Cardiology, “Prof. Dr. George I.M. Georgescu” Cardiovascular Diseases Institute, Iasi, Romania
| | - Yusuf Ziya Şener
- Department of Internal Medicine, Hacettepe University Faculty of Medicine, Ankara, Turkiye
| | - Nicholas G Kounis
- Department of Internal Medicine, Division of Cardiology, University of Patras Medical School, Patras, Greece
| | - Laurențiu Șorodoc
- Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, Iasi, Romania
- 2nd Internal Medicine Department, “Sf. Spiridon” Clinical Emergency Hospital, Iasi, Romania
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Wróbel D, Wrona P, Homa T, Jakobschy K, Wrona G, Sawczyńska K, Giełczyński M, Popiela T, Słowik A, Turaj W. Sex Alters the Effect of Perfusion Deficits on Functional Outcome in Patients with Acute Ischemic Stroke Undergoing Mechanical Thrombectomy. Cerebrovasc Dis 2024:1-10. [PMID: 38631293 DOI: 10.1159/000538633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2024] [Accepted: 03/25/2024] [Indexed: 04/19/2024] Open
Abstract
INTRODUCTION The discourse surrounding differences in cerebral hemodynamics and clinical outcomes among male and female patients treated with mechanical thrombectomy (MT) for acute ischemic stroke (AIS) remains unresolved. We aimed to elucidate these differences by employing computed tomography perfusion (CTP) imaging before MT and examining the influence of perfusion deficits on the 90-day functional outcome. METHODS This single-center retrospective analysis involved patients with anterior circulation AIS treated with MT at the Comprehensive Stroke Center, University Hospital, Krakow, from January 2019 to July 2023. We compared male and female patients in terms of baseline characteristics, CTP deficits, hypoperfusion intensity ratio (HIR, defined as T10max/T6max), and complications. The endpoints included the 90-day excellent functional outcome, defined as modified Rankin Score <2, and the 90-day mortality rate. RESULTS We included 794 patients, of whom 408 were female (51.4%). Female patients had a smaller early infarct volume (median [interquartile range]: 7 mL [0-24.8] vs. 10 mL [0-33], p = 0.004), smaller penumbra volume (77.5 mL [46-117] vs. 99.5 mL [59.8-140], p < 0.001), lower HIR (0.34 [0.16-0.5] vs. 0.37 [0.2-9.53], p = 0.043) and were less likely to achieve an excellent functional outcome (55.6% vs. 66.1%, p = 0.003). For every 10 mL increase in early infarct volume, the odds for achieving an excellent outcome were lower in females (odds ratio [OR]: 0.82 [95% confidence interval: 0.73-0.92]) compared to males (OR: 0.96 [0.88-1.04]), whereas the risk of death was higher for females (OR: 1.25 [1.13-1.39] than for males (OR: 1.05 [0.98-1.14]). DISCUSSION Despite more favorable cerebral hemodynamic profile, female AIS patients have worse outcomes than their male counterparts. This effect seems to be independently mediated by the more pronounced impact of early infarct volume on the prognosis in female patients. These findings underscore the possible explanatory power arising from sex-specific interpretation of early infarct volume in clinical practice.
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Affiliation(s)
- Dominik Wróbel
- Jagiellonian University Medical College, Student Scientific Group in Cerebrovascular Diseases, Krakow, Poland
| | - Paweł Wrona
- Department of Neurology, Jagiellonian University Medical College, Krakow, Poland
- Department of Neurology, University Hospital, Krakow, Poland
| | - Tomasz Homa
- Department of Neurology, University Hospital, Krakow, Poland
| | - Klaudia Jakobschy
- Jagiellonian University Medical College, Student Scientific Group in Cerebrovascular Diseases, Krakow, Poland
| | | | - Katarzyna Sawczyńska
- Department of Neurology, Jagiellonian University Medical College, Krakow, Poland
- Department of Neurology, University Hospital, Krakow, Poland
| | - Mateusz Giełczyński
- Jagiellonian University Medical College, Student Scientific Group in Cerebrovascular Diseases, Krakow, Poland
| | - Tadeusz Popiela
- Department of Radiology, University Hospital, Krakow, Poland
- Department of Radiology, Jagiellonian University Medical College, Krakow, Poland
| | - Agnieszka Słowik
- Department of Neurology, Jagiellonian University Medical College, Krakow, Poland
- Department of Neurology, University Hospital, Krakow, Poland
| | - Wojciech Turaj
- Department of Neurology, Jagiellonian University Medical College, Krakow, Poland
- Department of Neurology, University Hospital, Krakow, Poland
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