1
|
Jung JW, Kim KH, Yun J, Kim YD, Heo J, Lee H, Choi JK, Lee IH, Lim IH, Hong SH, Kim BM, Kim DJ, Shin NY, Cho BH, Ahn SH, Park H, Sohn SI, Hong JH, Song TJ, Chang Y, Kim GS, Seo KD, Lee K, Chang JY, Seo JH, Lee S, Baek JH, Cho HJ, Shin DH, Kim J, Yoo J, Baik M, Lee KY, Jung YH, Hwang YH, Kim CK, Kim JG, Lee CJ, Park S, Jeon S, Lee HS, Kwon SU, Bang OY, Heo JH, Nam HS. Functional Outcomes Associated With Blood Pressure Decrease After Endovascular Thrombectomy. JAMA Netw Open 2024; 7:e246878. [PMID: 38630474 PMCID: PMC11024769 DOI: 10.1001/jamanetworkopen.2024.6878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Accepted: 02/19/2024] [Indexed: 04/19/2024] Open
Abstract
Importance The associations between blood pressure (BP) decreases induced by medication and functional outcomes in patients with successful endovascular thrombectomy remain uncertain. Objective To evaluate whether BP reductions induced by intravenous BP medications are associated with poor functional outcomes at 3 months. Design, Setting, and Participants This cohort study was a post hoc analysis of the Outcome in Patients Treated With Intra-Arterial Thrombectomy-Optimal Blood Pressure Control trial, a comparison of intensive and conventional BP management during the 24 hours after successful recanalization from June 18, 2020, to November 28, 2022. This study included 302 patients who underwent endovascular thrombectomy, achieved successful recanalization, and exhibited elevated BP within 2 hours of successful recanalization at 19 stroke centers in South Korea. Exposure A BP decrease was defined as at least 1 event of systolic BP less than 100 mm Hg. Patients were divided into medication-induced BP decrease (MIBD), spontaneous BP decrease (SpBD), and no BP decrease (NoBD) groups. Main Outcomes and Measures The primary outcome was a modified Rankin scale score of 0 to 2 at 3 months, indicating functional independence. Primary safety outcomes were symptomatic intracerebral hemorrhage within 36 hours and mortality due to index stroke within 3 months. Results Of the 302 patients (median [IQR] age, 75 [66-82] years; 180 [59.6%] men), 47 (15.6%)were in the MIBD group, 39 (12.9%) were in the SpBD group, and 216 (71.5%) were in the NoBD group. After adjustment for confounders, the MIBD group exhibited a significantly smaller proportion of patients with functional independence at 3 months compared with the NoBD group (adjusted odds ratio [AOR], 0.45; 95% CI, 0.20-0.98). There was no significant difference in functional independence between the SpBD and NoBD groups (AOR, 1.41; 95% CI, 0.58-3.49). Compared with the NoBD group, the MIBD group demonstrated higher odds of mortality within 3 months (AOR, 5.15; 95% CI, 1.42-19.4). The incidence of symptomatic intracerebral hemorrhage was not significantly different among the groups (MIBD vs NoBD: AOR, 1.89; 95% CI, 0.54-5.88; SpBD vs NoBD: AOR, 2.75; 95% CI, 0.76-9.46). Conclusions and Relevance In this cohort study of patients with successful endovascular thrombectomy after stroke, MIBD within 24 hours after successful recanalization was associated with poor outcomes at 3 months. These findings suggested lowering systolic BP to below 100 mm Hg using BP medication might be harmful.
Collapse
Affiliation(s)
- Jae Wook Jung
- Department of Neurology, Yonsei University College of Medicine, Seoul, Korea
| | - Kwang Hyun Kim
- Department of Neurology, Yonsei University College of Medicine, Seoul, Korea
| | - Jaeseob Yun
- Department of Neurology, Yonsei University College of Medicine, Seoul, Korea
| | - Young Dae Kim
- Department of Neurology, Yonsei University College of Medicine, Seoul, Korea
| | - JoonNyung Heo
- Department of Neurology, Yonsei University College of Medicine, Seoul, Korea
| | - Hyungwoo Lee
- Department of Neurology, Yonsei University College of Medicine, Seoul, Korea
| | - Jin Kyo Choi
- Department of Neurology, Yonsei University College of Medicine, Seoul, Korea
| | - Il Hyung Lee
- Department of Neurology, Yonsei University College of Medicine, Seoul, Korea
| | - In Hwan Lim
- Department of Neurology, Yonsei University College of Medicine, Seoul, Korea
| | - Soon-Ho Hong
- Department of Neurology, Yonsei University College of Medicine, Seoul, Korea
| | - Byung Moon Kim
- Department of Radiology, Yonsei University College of Medicine, Seoul, Korea
| | - Dong Joon Kim
- Department of Radiology, Yonsei University College of Medicine, Seoul, Korea
| | - Na Young Shin
- Department of Radiology, Yonsei University College of Medicine, Seoul, Korea
| | - Bang-Hoon Cho
- Department of Neurology, Korea University Anam Hospital and College of Medicine, Seoul, Korea
| | - Seong Hwan Ahn
- Department of Neurology, Chosun University School of Medicine, Gwangju, Korea
| | - Hyungjong Park
- Department of Neurology, Brain Research Institute, Keimyung University School of Medicine, Daegu, Korea
| | - Sung-Il Sohn
- Department of Neurology, Brain Research Institute, Keimyung University School of Medicine, Daegu, Korea
| | - Jeong-Ho Hong
- Department of Neurology, Brain Research Institute, Keimyung University School of Medicine, Daegu, Korea
| | - Tae-Jin Song
- Department of Neurology, Seoul Hospital, Ewha Woman's University, College of Medicine, Seoul, Korea
| | - Yoonkyung Chang
- Department of Neurology, Mokdong Hospital, Ewha Woman's University College of Medicine, Seoul, Korea
| | - Gyu Sik Kim
- National Health Insurance Service, Ilsan Hospital, Goyang, Korea
| | - Kwon-Duk Seo
- National Health Insurance Service, Ilsan Hospital, Goyang, Korea
| | - Kijeong Lee
- National Health Insurance Service, Ilsan Hospital, Goyang, Korea
| | - Jun Young Chang
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jung Hwa Seo
- Department of Neurology, Busan Paik Hospital, Inje University College of Medicine, Busan, South Korea
| | - Sukyoon Lee
- Department of Neurology, Busan Paik Hospital, Inje University College of Medicine, Busan, South Korea
| | - Jang-Hyun Baek
- Department of Neurology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Han-Jin Cho
- Department of Neurology, Pusan National University School of Medicine, Busan, Korea
| | - Dong Hoon Shin
- Department of Neurology, Gachon University Gil Medical Center, Incheon, Korea
| | - Jinkwon Kim
- Department of Neurology, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin, Korea
| | - Joonsang Yoo
- Department of Neurology, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin, Korea
| | - Minyoul Baik
- Department of Neurology, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin, Korea
| | - Kyung-Yul Lee
- Department of Neurology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Yo Han Jung
- Department of Neurology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Yang-Ha Hwang
- Department of Neurology, Kyungpook National University Hospital, School of Medicine, Kyungpook National University, Daegu, South Korea
| | - Chi Kyung Kim
- Department of Neurology, Korea University Guro Hospital and College of Medicine, Seoul, Korea
| | - Jae Guk Kim
- Department of Neurology, Daejeon Eulji Medical Center, Eulji University School of Medicine, Daejon, Korea
| | - Chan Joo Lee
- Department of Health Promotion, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Sungha Park
- Department of Health Promotion, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
- Cardiovascular Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Soyoung Jeon
- Department of Research Affairs, Biostatistics Collaboration Unit, Yonsei University College of Medicine, Seoul, Korea
| | - Hye Sun Lee
- Department of Research Affairs, Biostatistics Collaboration Unit, Yonsei University College of Medicine, Seoul, Korea
| | - Sun U Kwon
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Oh Young Bang
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Ji Hoe Heo
- Department of Neurology, Yonsei University College of Medicine, Seoul, Korea
| | - Hyo Suk Nam
- Department of Neurology, Yonsei University College of Medicine, Seoul, Korea
| |
Collapse
|
2
|
Park JW, Kim JT, Lee JS, Kim BJ, Yoo J, Han JH, Kim BJ, Kim CK, Kim JG, Baik SH, Park JM, Kang K, Lee SJ, Park H, Cha JK, Park TH, Lee K, Lee J, Hong KS, Lee BC, Kim DE, Choi JC, Kwon JH, Shin DI, Sohn SI, Lee SH, Ryu WS, Lee J, Bae HJ. Brain Frailty and Outcomes of Acute Minor Ischemic Stroke With Large-Vessel Occlusion. J Clin Neurol 2024; 20:175-185. [PMID: 38171505 PMCID: PMC10921043 DOI: 10.3988/jcn.2023.0181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Revised: 06/30/2023] [Accepted: 07/04/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND AND PURPOSE The influence of imaging features of brain frailty on outcomes were investigated in acute ischemic stroke patients with minor symptoms and large-vessel occlusion (LVO). METHODS This was a retrospective analysis of a prospective, multicenter, nationwide registry of consecutive patients with acute (within 24 h) minor (National Institutes of Health Stroke Scale score=0-5) ischemic stroke with anterior circulation LVO (acute minor LVO). Brain frailty was stratified according to the presence of an advanced white-matter hyperintensity (WMH) (Fazekas grade 2 or 3), silent/old brain infarct, or cerebral microbleeds. The primary outcome was a composite of stroke, myocardial infarction, and all-cause mortality within 1 year. RESULTS In total, 1,067 patients (age=67.2±13.1 years [mean±SD], 61.3% males) were analyzed. The proportions of patients according to the numbers of brain frailty burdens were as follows: no burden in 49.2%, one burden in 30.0%, two burdens in 17.3%, and three burdens in 3.5%. In the Cox proportional-hazards analysis, the presence of more brain frailty burdens was associated with a higher risk of 1-year primary outcomes, but after adjusting for clinically relevant variables there were no significant associations between burdens of brain frailty and 1-year vascular outcomes. For individual components of brain frailty, an advanced WMH was independently associated with an increased risk of 1-year primary outcomes (adjusted hazard ratio [aHR]=1.33, 95% confidence interval [CI]=1.03-1.71) and stroke (aHR=1.32, 95% CI=1.00-1.75). CONCLUSIONS The baseline imaging markers of brain frailty were common in acute minor ischemic stroke patients with LVO. An advanced WMH was the only frailty marker associated with an increased risk of vascular events. Further research is needed into the association between brain frailty and prognosis in patients with acute minor LVO.
Collapse
Affiliation(s)
- Je-Woo Park
- Department of Neurology, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Korea
| | - Joon-Tae Kim
- Department of Neurology, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Korea.
| | - Ji Sung Lee
- Clinical Research Center, Asan Institute for Life Sciences, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Beom Joon Kim
- Department of Neurology, Cerebrovascular Center, Seoul National University Bundang Hospital, Seongnam, Korea.
| | - Joonsang Yoo
- Department of Neurology, Yongin Severance Hospital, Yongin, Korea
| | - Jung Hoon Han
- Department of Neurology, Korea University Guro Hospital, Seoul, Korea
| | - Bum Joon Kim
- Department of Neurology, Asan Medical Center, Seoul, Korea
| | - Chi Kyung Kim
- Department of Neurology, Korea University Guro Hospital, Seoul, Korea
| | - Jae Guk Kim
- Department of Neurology, Daejeon Eulji Medical Center, Eulji University School of Medicine, Daejeon, Korea
| | - Sung Hyun Baik
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Jong-Moo Park
- Department of Neurology, Uijeongbu Eulji Medical Center, Eulji University School of Medicine, Uijeongbu, Korea
| | - Kyusik Kang
- Department of Neurology, Nowon Eulji Medical Center, Eulji University School of Medicine, Seoul, Korea
| | - Soo Joo Lee
- Department of Neurology, Daejeon Eulji Medical Center, Eulji University School of Medicine, Daejeon, Korea
| | - Hyungjong Park
- Department of Neurology, Keimyung University Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Korea
| | - Jae-Kwan Cha
- Department of Neurology, Dong-A University Hospital, Busan, Korea
| | - Tai Hwan Park
- Department of Neurology, Seoul Medical Center, Seoul, Korea
| | - Kyungbok Lee
- Department of Neurology, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine, Seoul, Korea
| | - Jun Lee
- Department of Neurology, Yeungnam University Medical Center, Daegu, Korea
| | - Keun-Sik Hong
- Department of Neurology, Inje University Ilsan Paik Hospital, Goyang, Korea
| | - Byung-Chul Lee
- Department of Neurology, Hallym University Sacred Heart Hospital, Anyang, Korea
| | - Dong-Eog Kim
- Department of Neurology, Dongguk University Ilsan Hospital, Goyang, Korea
| | - Jay Chol Choi
- Department of Neurology, Jeju National University Hospital, Jeju National University School of Medicine, Jeju, Korea
| | - Jee-Hyun Kwon
- Department of Neurology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Dong-Ick Shin
- Department of Neurology, Chungbuk National University Hospital, Cheongju, Korea
| | - Sung Il Sohn
- Department of Neurology, Keimyung University Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Korea
| | - Sang-Hwa Lee
- Department of Neurology, Hallym University Chuncheon Sacred Heart Hospital, Chuncheon, Korea
| | - Wi-Sun Ryu
- Artificial Intelligence Research Center, JLK Inc., Seoul, Korea
| | - Juneyoung Lee
- Department of Biostatistics, Korea University, Seoul, Korea
| | - Hee-Joon Bae
- Department of Neurology, Cerebrovascular Center, Seoul National University Bundang Hospital, Seongnam, Korea
| |
Collapse
|
3
|
Lee HL, Lyou HJ, Song JJ, Kim CK. Abnormal quantitative sudomotor axon reflex test results in patients with tinnitus as a possible indicator of small fiber neuropathy. Front Neurol 2024; 15:1297371. [PMID: 38375462 PMCID: PMC10875021 DOI: 10.3389/fneur.2024.1297371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Accepted: 01/22/2024] [Indexed: 02/21/2024] Open
Abstract
A few cases of small fiber neuropathy (SFN) and tinnitus (TN) associated with coronavirus disease 2019 have been reported. However, the relationship between SFN and TN has not been studied. This study investigated a possible relationship between SFN and patients with TN (PwTNs) using autonomic function tests (AFTs) including quantitative sudomotor axon reflex tests (QSART). We performed QSARTs and other AFTs such as the Sympathetic skin response (SSR), Valsalva ratio (VR), and heart rate variability (HRV). The QSART results, obtained at seven hospitals using same protocols, were compared between PwTNs and healthy controls. We confirmed the abnormalities in SSR, VR, and HRV in PwTNs, although those parasympathetic AFTs were not performed in healthy controls. Additionally, we checked Tinnitus handicap inventory (THI) scores for PwTNs and ~50% of PwTNs had low-grade disability, whereas 9.3% had high-grade disability. Data from 57 PwTNs and 122 healthy controls were analyzed. The sweat volumes of QSART in the older age group tended to be higher in the PwTNs than in age-matched healthy controls, and significant differences between the PwTN and control groups were observed in the feet in both sexes (p < 0.001) and in the arms in women (p = 0.013). In the younger age group, the sweat volumes in the feet of men were higher in PwTNs than in healthy controls (p = 0.017). No association was observed between THI and QSART scores. In this study, the sweat volumes in QSARTs were higher in PwTNs than in healthy controls. However, abnormal SSR, HRV, and VR results were not commonly observed in PwTNs. Although the results should be interpreted with caution because of limitations in study, PwTNs might also have SFN apart from dysautonomia. This is the first study to perform QSART with other parasympathetic AFTs in PwTNs. However, larger and more rigorously controlled studies will be needed to reveal the relationship between SFN and TN in the future.
Collapse
Affiliation(s)
- Hye Lim Lee
- Department of Neurology, Korea University College of Medicine, Seoul, Republic of Korea
| | - Hyun Ji Lyou
- Department of Neurology, Korea University College of Medicine, Seoul, Republic of Korea
| | - Jae-Jun Song
- Department of Otorhinolaryngology, Korea University College of Medicine, Seoul, Republic of Korea
| | - Chi Kyung Kim
- Department of Neurology, Korea University College of Medicine, Seoul, Republic of Korea
| |
Collapse
|
4
|
Kang SH, Choi Y, Chung SJ, Moon SJ, Kim CK, Kim JH, Oh K, Yoon JS, Seo SW, Cho GJ, Koh SB. Fasting glucose variability and risk of dementia in Parkinson's disease: a 9-year longitudinal follow-up study of a nationwide cohort. Front Aging Neurosci 2024; 15:1292524. [PMID: 38235038 PMCID: PMC10791804 DOI: 10.3389/fnagi.2023.1292524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 11/21/2023] [Indexed: 01/19/2024] Open
Abstract
Background Diabetes is associated with an increased risk of Parkinson's disease dementia (PDD); however, it is unknown whether this association is dependent on continuous hyperglycemia, hypoglycemic events, or glycemic variability. We aimed to investigate the relationship between visit-to-visit fasting glucose variability and PDD development in patients with Parkinson's disease (PD). Methods Using data from the Korean National Health Insurance Service, we examined 9,264 patients aged ≥40 years with de novo Parkinson's disease (PD) who underwent ≥3 health examinations and were followed up until December 2019. Glucose variability was measured using the coefficient of variation, variability independent of the mean, and average real variability. Fine and Gray competing regression analysis was performed to determine the effect of glucose variability on incident PDD. Results During the 9.5-year follow-up period, 1,757 of 9,264 (19.0%) patients developed PDD. Patients with a higher visit-to-visit glucose variability had a higher risk of future PDD. In the multivariable adjusted model, patients with PD in the highest quartile (subdistribution hazard ratio [SHR] = 1.50, 95% CI 1.19 to 1.88), quartile 3 (SHR = 1.29, 95% CI 1.02 to 1.62), and quartile 2 (SHR = 1.30, 95% CI 1.04 to 1.63) were independently associated with a higher risk of PDD than those in the lowest quartile. Conclusion We highlighted the effect of long-term glucose variability on the development of PDD in patients with PD. Furthermore, our findings suggest that preventive measures for constant glucose control may be necessary to prevent PDD.
Collapse
Affiliation(s)
- Sung Hoon Kang
- Department of Neurology, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Yunjin Choi
- Biomedical Research Institute, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Su Jin Chung
- Department of Neurology, Myongji Hospital, Hanyang University College of Medicine, Goyang, Republic of Korea
| | - Seok-Joo Moon
- Smart Healthcare Center, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Chi Kyung Kim
- Department of Neurology, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Ji Hyun Kim
- Department of Neurology, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Kyungmi Oh
- Department of Neurology, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Joon Shik Yoon
- Department of Physical Medicine and Rehabilitation, Korea University Guro Hospital, Seoul, Republic of Korea
| | - Sang Won Seo
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
- Alzheimer’s Disease Convergence Research Center, Samsung Medical Center, Seoul, Republic of Korea
| | - Geum Joon Cho
- Department of Obstetrics and Gynecology, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Seong-Beom Koh
- Department of Neurology, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| |
Collapse
|
5
|
Nam KW, Kim CK, Yu S, Oh K, Chung JW, Oh YB, Kim GM, Jung JM, Song TJ, Kim YJ, Kim BJ, Heo SH, Park KY, Kim JM, Park JH, Choi JC, Park MS, Kim JT, Choi KH, Hwang YH, Seo WK. Corrigendum to "D-dimer to fibrinogen ratio predicts early neurological deterioration in ischemic stroke with atrial fibrillation" [Thromb. Res. 229 (2023) 219-224]. Thromb Res 2024; 233:173. [PMID: 38070220 DOI: 10.1016/j.thromres.2023.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2024]
Affiliation(s)
- Ki-Woong Nam
- Department of Neurology, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, South Korea
| | - Chi Kyung Kim
- Department of Neurology, Korea University Guro Hospital, Korea University College of Medicine, Seoul, South Korea.
| | - Sungwook Yu
- Department of Neurology, Korea University Anam Hospital, Korea University College of Medicine, Seoul, South Korea
| | - Kyungmi Oh
- Department of Neurology, Korea University Guro Hospital, Korea University College of Medicine, Seoul, South Korea
| | - Jong-Won Chung
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Young Bang Oh
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Gyeong-Moon Kim
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Jin-Man Jung
- Department of Neurology, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, South Korea
| | - Tae-Jin Song
- Department of Neurology, Ewha Womans University, School of Medicine, Seoul, South Korea
| | - Yong-Jae Kim
- Department of Neurology, the Catholic University of Korea, Seoul, South Korea
| | - Bum Joon Kim
- Department of Neurology, Asan Medical Center, Seoul, South Korea
| | - Sung Hyuk Heo
- Department of Neurology, Kyung Hee University College of Medicine, Seoul, South Korea
| | - Kwang-Yeol Park
- Department of Neurology, Chung-Ang University College of Medicine, Chung-Ang University Hospital, Seoul, South Korea
| | - Jeong-Min Kim
- Department of Neurology, Seoul National University Hospital, Seoul, South Korea
| | - Jong-Ho Park
- Department of Neurology, Myongji Hospital, Hanyang University College of medicine, Seoul, South Korea
| | - Jay Chol Choi
- Department of Neurology, Jeju National University, Jeju, South Korea
| | - Man-Seok Park
- Department of Neurology, Chonnam National University Hospital, Chonnam, South Korea
| | - Joon-Tae Kim
- Department of Neurology, Chonnam National University Hospital, Chonnam, South Korea
| | - Kang-Ho Choi
- Department of Neurology, Chonnam National University Hospital, Chonnam, South Korea
| | - Yang Ha Hwang
- Department of Neurology, Kyungpook National University Hospital, Dae-gu, South Korea
| | - Woo-Keun Seo
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea; Department of Digital Health, SHAIST, Sungkyunkwan University, Seoul, South Korea
| |
Collapse
|
6
|
Nam KW, Ha S, Oh MJ, Oh K, Kim CK, Cho GJ, Kim YS, Bushnell CD. Headaches during pregnancy and the risk of subsequent stroke. J Headache Pain 2023; 24:159. [PMID: 38041004 PMCID: PMC10691126 DOI: 10.1186/s10194-023-01689-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Accepted: 11/03/2023] [Indexed: 12/03/2023] Open
Abstract
BACKGROUND Primary headache disorder is a known risk factor for stroke in women and usually improves during the first trimester of pregnancy. However, despite this, some women develop headaches during pregnancy (G-HA), and the effect of this headache on subsequent stroke is unknown. In this study, we evaluated the association between G-HA and stroke after delivery in women. METHODS Based on the Korean National Health Insurance Service database, we included women hospitalized for delivery between 2012 and 2013. G-HA was defined as a headache diagnosed during pregnancy. Primary outcome was any stroke that occurred during the observational periods from delivery to December 31, 2020. All diseases were identified based on data registered in the database using the International Classification of Disease-10th Revision-Clinical Modification codes. RESULTS Of 906,187 pregnant women, G-HA was found in 56,813 (6.3%). During the observational periods, the G-HA ( +) group had a significantly higher risk of any stroke [adjusted hazard ratio (aHR) = 1.59, 95% confidence interval (CI): 1.30-1.95], ischemic stroke (aHR = 1.50, 95% CI: 1.12-2.01), hemorrhagic stroke (aHR = 1.63, 95% CI: 1.23-2.15), and intracerebral hemorrhage (aHR = 1.63, 95% CI: 1.19-2.23) than the G-HA (-) group. When analyzed considering the interaction with history of headache disorder, G-HA showed a significant association with hemorrhagic stroke, but lost its effect on ischemic stroke. CONCLUSIONS We demonstrated that G-HA was associated with subsequent stroke occurrence after delivery. However, the relationship between G-HA and ischemic stroke is mitigated by a history of pre-pregnancy headache disorder.
Collapse
Affiliation(s)
- Ki-Woong Nam
- Department of Neurology, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, Korea
- Department of Neurology, Seoul National University College of Medicine, Seoul, Korea
| | - Sungyeon Ha
- Graduate School of Statistics, Sungkyunkwan University, Seoul, Korea
| | - Min-Jeong Oh
- Department of Obstetrics and Gynecology, Korea University Guro Hospital, Korea University College of Medicine, 148 Gurodong-Ro, Guro-Gu, Seoul, 08308, Korea
| | - Kyungmi Oh
- Department of Neurology, Korea University Guro Hospital, Korea University College of Medicine, 148 Gurodong-Ro, Guro-Gu, Seoul, 08308, Korea
- Department of Neurology, Korea University College of Medicine, Seoul, Korea
| | - Chi Kyung Kim
- Department of Neurology, Korea University Guro Hospital, Korea University College of Medicine, 148 Gurodong-Ro, Guro-Gu, Seoul, 08308, Korea.
- Department of Neurology, Korea University College of Medicine, Seoul, Korea.
| | - Geum Joon Cho
- Department of Obstetrics and Gynecology, Korea University Guro Hospital, Korea University College of Medicine, 148 Gurodong-Ro, Guro-Gu, Seoul, 08308, Korea.
| | - Young Seo Kim
- Department of Neurology, College of Medicine, Hanyang University, Seoul, Korea
| | - Cheryl D Bushnell
- Department of Neurology, Wake Forest School of Medicine, Winston-Salem, North Carolina, United States
| |
Collapse
|
7
|
Parente J, Gianlorenco AC, Rebello-Sanchez I, Kim M, Prati JM, Kim CK, Choi H, Song JJ, Fregni F. Neural, Anti-inflammatory, and Clinical Effects of Transauricular Vagus Nerve Stimulation in Major Depressive Disorder: A Systematic Review. Int J Neuropsychopharmacol 2023:pyad058. [PMID: 37870480 DOI: 10.1093/ijnp/pyad058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Indexed: 10/24/2023] Open
Abstract
OBJECTIVES The discovery of effective treatments for major depressive disorder (MDD) may help target different brain pathways. Invasive vagus nerve stimulation (VNS) is an effective neuromodulation technique for the treatment of MDD; however, the effectiveness of the noninvasive technique, transauricular VNS (taVNS), remains unknown. Moreover, a mechanistic understanding of the neural effects behind its biological and therapeutic effects is lacking. This review aimed to evaluate the clinical evidence and the neural and anti-inflammatory effects of taVNS in MDD. REVIEW METHODS Two searches conducted using a systematic search strategy reviewed the clinical efficacy and neural connectivity of taVNS in MDD in humans and evaluated the changes in inflammatory markers after taVNS in humans or animal models of depression. A risk of bias assessment was performed in all human studies. RESULTS Only five studies evaluated the effects of taVNS in patients with depression. Although the studies demonstrated the efficacy of taVNS in treating depression, they used heterogeneous methodologies and limited data, thus preventing the conduct of pooled quantitative analyses. Pooled analysis could not be performed for studies that investigated the modulation of connectivity between brain areas; of the six publications, five were based on the same experiment. The animal studies that analyzed the presence of inflammatory markers showed a reduction in the level of pro-inflammatory cytokines or receptor expression. CONCLUSION Data on the clinical efficacy of taVNS in the treatment of MDD are limited. Although these studies showed positive results, no conclusions can be drawn regarding this topic considering the heterogeneity of these studies; as in the case of functional connectivity studies. Based on animal studies, the application of taVNS causes a decrease in the level of inflammatory factors in different parts of the brain, which also regulate the immune system. Therefore, further studies are needed to understand the effects of taVNS in patients with MDD.
Collapse
Affiliation(s)
- Joao Parente
- Medical student, Escola Bahiana de Medicina e Saúde Pública, Salvador, Bahia, Brazil
| | | | | | - Minkyung Kim
- MD, Department of Neurology, Korea University Guro Hospital, Seoul, Republic of Korea
| | - Jose Mario Prati
- PhD, Department of Physical Therapy, Federal University of Sao Carlos, Sao Paulo, Brazil
| | - Chi Kyung Kim
- MD, Department of Neurology, Korea University Guro Hospital, Seoul, Republic of Korea
| | - Hyuk Choi
- PhD, Department of Medical Sciences, Graduate School of Medicine, Korea University, Seoul, Republic of Korea
- Neurive Co., Ltd., Gimhae, Republic of Korea
| | - Jae-Jun Song
- Neurive Co., Ltd., Gimhae, Republic of Korea
- PhD, Department of Otorhinolaryngology-Head and Neck Surgery, Korea University Medical Center, Seoul, Republic of Korea
| | - Felipe Fregni
- PhD, Neuromodulation Center and Center for Clinical Research Learning, Spaulding Rehabilitation Hospital and Massachusetts General Hospital, Harvard Medical School, Boston, USA
| |
Collapse
|
8
|
Kang SH, Kang M, Han JH, Lee ES, Lee KJ, Chung SJ, Suh SI, Koh SB, Eo JS, Kim CK, Oh K. Independent effect of Aβ burden on cognitive impairment in patients with small subcortical infarction. Alzheimers Res Ther 2023; 15:178. [PMID: 37838715 PMCID: PMC10576878 DOI: 10.1186/s13195-023-01307-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 09/17/2023] [Indexed: 10/16/2023]
Abstract
BACKGROUND The effect of amyloid-β (Aβ) on cognitive impairment in patients with small subcortical infarction remains controversial, although a growing body of evidence shows a substantial overlap between Alzheimer's disease (AD) and subcortical ischemic vascular dementia, another form of cerebral small vessel disease (cSVD). Therefore, we investigated the relationships between Aβ positivity and the development of post-stroke cognitive impairment (PSCI) in patients with small subcortical infarction. METHODS We prospectively recruited 37 patients aged ≥ 50 years, with first-ever small subcortical infarction, who underwent amyloid positron emission tomography, 3 months after stroke at Korea University Guro Hospital. We also enrolled CU participants matched for age and sex with stroke patients for comparison of Aβ positivity. Patients were followed up at 3 and 12 months after the stroke to assess cognitive decline. Logistic and linear mixed-effect regression analyses were performed to identify the effect of Aβ positivity on PSCI development and long-term cognitive trajectories. RESULTS At 3 months after stroke, 12/37 (32.4%) patients developed PSCI, and 11/37 (29.7%) patients had Aβ deposition. Aβ positivity (odds ratio [OR] = 72.2, p = 0.024) was predictive of PSCI development regardless of cSVD burden. Aβ positivity (β = 0.846, p = 0.014) was also associated with poor cognitive trajectory, assessed by the Clinical Dementia Rating-Sum of Box, for 1 year after stroke. CONCLUSIONS Our findings highlight that Aβ positivity is an important predictor for PSCI development and cognitive decline over 1 year. Furthermore, our results provide evidence that anti-AD medications may be a strategy for preventing cognitive decline in patients with small subcortical infarctions.
Collapse
Affiliation(s)
- Sung Hoon Kang
- Department of Neurology, Korea University Guro Hospital, Korea University College of Medicine, 148 Gurodong-ro, Guro-gu, Seoul, 08308, South Korea
| | - Minwoong Kang
- Department of Biomedical Research Center, Korea University Guro Hospital, Korea University College of Medicine, Seoul, South Korea
| | - Jung Hoon Han
- Department of Neurology, Korea University Guro Hospital, Korea University College of Medicine, 148 Gurodong-ro, Guro-gu, Seoul, 08308, South Korea
| | - Eun Seong Lee
- Department of Nuclear Medicine, Korea University Guro Hospital, Korea University College of Medicine, 148 Gurodong-ro, Guro-gu, Seoul, 08308, South Korea
| | - Keon-Joo Lee
- Department of Neurology, Korea University Guro Hospital, Korea University College of Medicine, 148 Gurodong-ro, Guro-gu, Seoul, 08308, South Korea
| | - Su Jin Chung
- Department of Neurology, Myongji Hospital, Hanyang University College of Medicine, Goyang, South Korea
| | - Sang-Il Suh
- Department of Radiology, Korea University Guro Hospital, Korea University College of Medicine, Seoul, South Korea
| | - Seong-Beom Koh
- Department of Neurology, Korea University Guro Hospital, Korea University College of Medicine, 148 Gurodong-ro, Guro-gu, Seoul, 08308, South Korea
| | - Jae Seon Eo
- Department of Nuclear Medicine, Korea University Guro Hospital, Korea University College of Medicine, 148 Gurodong-ro, Guro-gu, Seoul, 08308, South Korea.
| | - Chi Kyung Kim
- Department of Neurology, Korea University Guro Hospital, Korea University College of Medicine, 148 Gurodong-ro, Guro-gu, Seoul, 08308, South Korea.
| | - Kyungmi Oh
- Department of Neurology, Korea University Guro Hospital, Korea University College of Medicine, 148 Gurodong-ro, Guro-gu, Seoul, 08308, South Korea
| |
Collapse
|
9
|
Choi H, Oh J, Kim CK, Ryu H, Ryu Y. Residents need competence not confidence: A retrospective evaluation of the new competency education program for Korean neurology residents. PLoS One 2023; 18:e0290503. [PMID: 37796843 PMCID: PMC10553350 DOI: 10.1371/journal.pone.0290503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 08/10/2023] [Indexed: 10/07/2023] Open
Abstract
The objective of our study was to scrutinize the learning experiences of Korean neurology residents, with an emphasis on the implications of the novel competency-based curriculum implemented in 2021. We hypothesized that this revised curriculum could modulate residents' cognitive conduct, primarily the manifestation of overconfidence, in distinctive ways across different stages of training. Our investigative framework was three-fold. Initially, we began with a qualitative inquiry involving in-depth interviews with a purposively selected cohort of eight residents from four training sites. This approach facilitated comprehensive insight into their perceptions of their competence and confidence across the continuum of a four-year residency program. Subsequently, we incorporated the K-NEPA13 assessment instrument, administered to the residents and their overseeing supervisors. This stage aimed to dissect potential cognitive biases, particularly overconfidence and consistency, within the resident population. The final study involved a comprehensive survey administered to a group of 97 Korean neurology residents, allowing us to consolidate and validate our preceding findings. Our findings revealed that junior residents portrayed heightened confidence in their clinical capabilities compared to their senior peers. Intriguingly, junior residents also displayed a stronger inclination towards reevaluating their clinical judgments, a behavior we hypothesize is stimulated by the recently introduced competency-based curriculum. We identified cognitive divergence between junior and senior residents, with the latter group favoring more consistent and linear cause-and-effect reasoning, while the former demonstrated receptiveness to introspection and reconsideration. We speculate this adaptability might be engendered by the supervisor assignment protocol intrinsic to the new curriculum. Our study highlights the essentiality of incorporating cognitive behaviors when devising medical education strategies. Acknowledging and addressing these diverse cognitive biases, and instilling a spirit of adaptability, can nurture a culture that persists in continuous learning and self-reflection among trainee doctors.
Collapse
Affiliation(s)
- Hojin Choi
- Department of Neurology, Hanyang University, Seoul, Republic of Korea
| | - Jeeyoung Oh
- Department of Neurology, Konkuk University School of Medicine, Seoul, Republic of Korea
| | - Chi Kyung Kim
- Department of Neurology, Korea University Guro Hospital, Seoul, Republic of Korea
| | - Hokyoung Ryu
- Graduate School of Innovation & Technology Management, Hanyang University, Seoul, Republic of Korea
| | - Youngji Ryu
- School of Psychology, Korea University, Seoul, Republic of Korea
| |
Collapse
|
10
|
Park JY, Choi SA, Kim JJ, Park YJ, Kim CK, Cho GJ, Koh SB, Kang SH. Effect of Tablet-based Cognitive Intervention on Cognition in Patients With Mild Cognitive Impairment: A Pilot Study. Dement Neurocogn Disord 2023; 22:130-138. [PMID: 38025410 PMCID: PMC10654482 DOI: 10.12779/dnd.2023.22.4.130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2023] [Revised: 08/17/2023] [Accepted: 09/05/2023] [Indexed: 12/01/2023] Open
Abstract
Background and Purpose Growing evidence has shown that cognitive interventions can mitigate cognitive decline in patients with mild cognitive impairment (MCI). However, most previous cognitive interventions have been group-based programs. Due to their intrinsic limitations, group-based programs are not widely used in clinical practice. Therefore, we have developed a tablet-based cognitive intervention program. This preliminary study investigated the feasibility and effects of a 12-week structured tablet-based program on cognitive function in patients with MCI. Methods We performed a single-arm study on 24 patients with MCI. The participants underwent a tablet-based cognitive intervention program 5 times a week over a 12-week period. The primary outcome was changes in cognitive function, measured using the Korean version of the Consortium to Establish a Registry for Alzheimer's Disease Assessment Packet (CERAD-K). Outcomes were evaluated at baseline, within two weeks of the last program (post-intervention), and at the six-month follow-up session. Results The completion rate of the tablet-based program was 83.3% in patients with MCI. The program improved cognitive function based on the CERAD-K total score (p=0.026), which was maintained for at least three months (p=0.004). There was also an improvement in the depression scale score (p=0.002), which persisted for three months (p=0.027). Conclusions Our 12-week structured tablet-based program is feasible for patients with MCI. Furthermore, although further studies with a double-arm design are required, the program appears to be an effective strategy to prevent cognitive decline in patients with MCI.
Collapse
Affiliation(s)
| | | | | | - Yu Jeong Park
- Department of Neurology, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Chi Kyung Kim
- Department of Neurology, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Geum Joon Cho
- Department of Obstetrics and Gynecology, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Seong-Beom Koh
- Department of Neurology, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Sung Hoon Kang
- Geumcheon Center for Dementia, Seoul, Korea
- Department of Neurology, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| |
Collapse
|
11
|
Nam HS, Kim YD, Heo J, Lee H, Jung JW, Choi JK, Lee IH, Lim IH, Hong SH, Baik M, Kim BM, Kim DJ, Shin NY, Cho BH, Ahn SH, Park H, Sohn SI, Hong JH, Song TJ, Chang Y, Kim GS, Seo KD, Lee K, Chang JY, Seo JH, Lee S, Baek JH, Cho HJ, Shin DH, Kim J, Yoo J, Lee KY, Jung YH, Hwang YH, Kim CK, Kim JG, Lee CJ, Park S, Lee HS, Kwon SU, Bang OY, Anderson CS, Heo JH. Intensive vs Conventional Blood Pressure Lowering After Endovascular Thrombectomy in Acute Ischemic Stroke: The OPTIMAL-BP Randomized Clinical Trial. JAMA 2023; 330:832-842. [PMID: 37668619 PMCID: PMC10481233 DOI: 10.1001/jama.2023.14590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 07/22/2023] [Indexed: 09/06/2023]
Abstract
Importance Optimal blood pressure (BP) control after successful reperfusion with endovascular thrombectomy (EVT) for patients with acute ischemic stroke is unclear. Objective To determine whether intensive BP management during the first 24 hours after successful reperfusion leads to better clinical outcomes than conventional BP management in patients who underwent EVT. Design, Setting, and Participants Multicenter, randomized, open-label trial with a blinded end-point evaluation, conducted across 19 stroke centers in South Korea from June 2020 to November 2022 (final follow-up, March 8, 2023). It included 306 patients with large vessel occlusion acute ischemic stroke treated with EVT and with a modified Thrombolysis in Cerebral Infarction score of 2b or greater (partial or complete reperfusion). Interventions Participants were randomly assigned to receive intensive BP management (systolic BP target <140 mm Hg; n = 155) or conventional management (systolic BP target 140-180 mm Hg; n = 150) for 24 hours after enrollment. Main Outcomes and Measures The primary outcome was functional independence at 3 months (modified Rankin Scale score of 0-2). The primary safety outcomes were symptomatic intracerebral hemorrhage within 36 hours and death related to the index stroke within 3 months. Results The trial was terminated early based on the recommendation of the data and safety monitoring board, which noted safety concerns. Among 306 randomized patients, 305 were confirmed eligible and 302 (99.0%) completed the trial (mean age, 73.0 years; 122 women [40.4%]). The intensive management group had a lower proportion achieving functional independence (39.4%) than the conventional management group (54.4%), with a significant risk difference (-15.1% [95% CI, -26.2% to -3.9%]) and adjusted odds ratio (0.56 [95% CI, 0.33-0.96]; P = .03). Rates of symptomatic intracerebral hemorrhage were 9.0% in the intensive group and 8.1% in the conventional group (risk difference, 1.0% [95% CI, -5.3% to 7.3%]; adjusted odds ratio, 1.10 [95% CI, 0.48-2.53]; P = .82). Death related to the index stroke within 3 months occurred in 7.7% of the intensive group and 5.4% of the conventional group (risk difference, 2.3% [95% CI, -3.3% to 7.9%]; adjusted odds ratio, 1.73 [95% CI, 0.61-4.92]; P = .31). Conclusions and Relevance Among patients who achieved successful reperfusion with EVT for acute ischemic stroke with large vessel occlusion, intensive BP management for 24 hours led to a lower likelihood of functional independence at 3 months compared with conventional BP management. These results suggest that intensive BP management should be avoided after successful EVT in acute ischemic stroke. Trial Registration ClinicalTrials.gov Identifier: NCT04205305.
Collapse
Affiliation(s)
- Hyo Suk Nam
- Department of Neurology, Yonsei University College of Medicine, Seoul, Korea
| | - Young Dae Kim
- Department of Neurology, Yonsei University College of Medicine, Seoul, Korea
| | - JoonNyung Heo
- Department of Neurology, Yonsei University College of Medicine, Seoul, Korea
| | - Hyungwoo Lee
- Department of Neurology, Yonsei University College of Medicine, Seoul, Korea
| | - Jae Wook Jung
- Department of Neurology, Yonsei University College of Medicine, Seoul, Korea
| | - Jin Kyo Choi
- Department of Neurology, Yonsei University College of Medicine, Seoul, Korea
| | - Il Hyung Lee
- Department of Neurology, Yonsei University College of Medicine, Seoul, Korea
| | - In Hwan Lim
- Department of Neurology, Yonsei University College of Medicine, Seoul, Korea
| | - Soon-Ho Hong
- Department of Neurology, Yonsei University College of Medicine, Seoul, Korea
| | - Minyoul Baik
- Department of Neurology, Yonsei University College of Medicine, Seoul, Korea
| | - Byung Moon Kim
- Department of Radiology, Yonsei University College of Medicine, Seoul, Korea
| | - Dong Joon Kim
- Department of Radiology, Yonsei University College of Medicine, Seoul, Korea
| | - Na-Young Shin
- Department of Radiology, Yonsei University College of Medicine, Seoul, Korea
| | - Bang-Hoon Cho
- Department of Neurology, Korea University Anam Hospital and College of Medicine, Seoul, Korea
| | - Seong Hwan Ahn
- Department of Neurology, Chosun University School of Medicine, Gwangju, Korea
| | - Hyungjong Park
- Department of Neurology, Brain Research Institute, Keimyung University School of Medicine, Daegu, Korea
| | - Sung-Il Sohn
- Department of Neurology, Brain Research Institute, Keimyung University School of Medicine, Daegu, Korea
| | - Jeong-Ho Hong
- Department of Neurology, Brain Research Institute, Keimyung University School of Medicine, Daegu, Korea
| | - Tae-Jin Song
- Department of Neurology, Seoul Hospital, Ewha Womans University College of Medicine, Seoul, Korea
| | - Yoonkyung Chang
- Department of Neurology, Mokdong Hospital, Ewha Womans University College of Medicine, Seoul, Korea
| | - Gyu Sik Kim
- Department of Neurology, National Health Insurance Service, Ilsan Hospital, Goyang, Korea
| | - Kwon-Duk Seo
- Department of Neurology, National Health Insurance Service, Ilsan Hospital, Goyang, Korea
| | - Kijeong Lee
- Department of Neurology, National Health Insurance Service, Ilsan Hospital, Goyang, Korea
| | - Jun Young Chang
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jung Hwa Seo
- Department of Neurology, Busan Paik Hospital, Inje University College of Medicine, Busan, South Korea
| | - Sukyoon Lee
- Department of Neurology, Busan Paik Hospital, Inje University College of Medicine, Busan, South Korea
| | - Jang-Hyun Baek
- Department of Neurology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Han-Jin Cho
- Department of Neurology, Pusan National University School of Medicine, Busan, Korea
| | - Dong Hoon Shin
- Department of Neurology, Gachon University Gil Medical Center, Incheon, Korea
| | - Jinkwon Kim
- Department of Neurology, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin, Korea
| | - Joonsang Yoo
- Department of Neurology, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin, Korea
| | - Kyung-Yul Lee
- Department of Neurology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Yo Han Jung
- Department of Neurology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Yang-Ha Hwang
- Department of Neurology, Kyungpook National University Hospital, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Chi Kyung Kim
- Department of Neurology, Korea University Guro Hospital and College of Medicine, Seoul, Korea
| | - Jae Guk Kim
- Department of Neurology, Daejeon Eulji Medical Center, Eulji University School of Medicine, Daejeon, Korea
| | - Chan Joo Lee
- Division of Cardiology, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Sungha Park
- Integrative Research Center for Cerebrovascular and Cardiovascular Diseases, Yonsei University College of Medicine, Division of Cardiology, Yonsei University College of Medicine, Severance Hospital, Seoul, Korea
| | - Hye Sun Lee
- Department of Research Affairs, Biostatistics Collaboration Unit, Yonsei University College of Medicine, Seoul, Korea
| | - Sun U. Kwon
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Oh Young Bang
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Craig S. Anderson
- The George Institute for Global Health, University of New South Wales, Sydney, Australia
| | - Ji Hoe Heo
- Department of Neurology, Yonsei University College of Medicine, Seoul, Korea
| |
Collapse
|
12
|
Chung D, Song TJ, Kim BJ, Heo SH, Jung JM, Oh K, Kim CK, Yu S, Park KY, Kim JM, Park JH, Park MS, Kim JT, Hwang YH, Kim YJ, Chung JW, Bang OY, Kim GM, Seo WK, Choi JC. Stroke-Specific Predictors of Major Bleeding in Anticoagulated Patients With Stroke and Atrial Fibrillation: A Nationwide Multicenter Registry-Based Study. J Clin Neurol 2023; 19:429-437. [PMID: 37455504 PMCID: PMC10471546 DOI: 10.3988/jcn.2022.0289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2022] [Revised: 12/26/2022] [Accepted: 12/30/2022] [Indexed: 07/18/2023] Open
Abstract
BACKGROUND AND PURPOSE The congestive heart failure, hypertension, age, diabetes, previous stroke/transient ischemic attack (CHA2DS2-VASc) and hypertension, abnormal renal/liver function, stroke, bleeding history or predisposition, labile international normalized ratio, elderly, drugs/alcohol (HAS-BLED) scores have been validated in estimating the risks of ischemic stroke and major bleeding, respectively, in patients with atrial fibrillation (AF). This study investigated stroke-specific predictors of major bleeding in patients with stroke and AF who were taking oral anticoagulants (OACs). METHODS Subjects were selected from patients enrolled in the Korean ATrial fibrillaTion EvaluatioN regisTry in Ischemic strOke patieNts (K-ATTENTION) nationwide multicenter registry between 2013 and 2015. Patients were excluded if they were not taking OACs, had no brain imaging data, or had intracranial bleeding directly related to the index stroke. Major bleeding was defined according to International Society of Thrombosis and Haemostasis criteria. Cox regression analyses were performed to assess the associations between clinical variables and major bleeding and Kaplan-Meier estimates were performed to analyze event-free survival. RESULTS Of a total of 3,213 patients, 1,414 subjects (mean age of 72.6 years, 52.5% males) were enrolled in this study. Major bleeding was reported in 34 patients during the median follow-up period of 1.73 years. Multivariable analysis demonstrated that initial National Institutes of Health Stroke Scale scores (hazard ratio [HR] 1.07, p=0.006), hypertension (HR 3.18, p=0.030), persistent AF type (HR 2.51, p=0.016), and initial hemoglobin level (HR 0.74, p=0.001) were independently associated with major bleeding risk. Except for hypertension, these associations remained significant after adjusting for the HAS-BLED score. Intracranial atherosclerosis presented a trend of association without statistical significance (HR 2.21, p=0.050). CONCLUSIONS This study found that major bleeding risk was independently associated with stroke-specific factors in anticoagulated patients with stroke and AF. This has the clinical implication that baseline characteristics of patients with stroke and AF should be considered in secondary prevention, which would bring the net clinical benefit of balancing recurrent stroke prevention with minimal bleeding complications.
Collapse
Affiliation(s)
- Darda Chung
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Tae-Jin Song
- Department of Neurology, Ewha Womans University Seoul Hospital, Ewha Womans University College of Medicine, Seoul, Korea
| | - Bum Joon Kim
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Sung Hyuk Heo
- Department of Neurology, Kyung Hee University College of Medicine, Seoul, Korea
| | - Jin-Man Jung
- Department of Neurology, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, Korea
| | - Kyungmi Oh
- Department of Neurology, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Chi Kyung Kim
- Department of Neurology, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Sungwook Yu
- Department of Neurology, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea
| | - Kwang Yeol Park
- Department of Neurology, Chung-Ang University College of Medicine, Seoul, Korea
| | - Jeong-Min Kim
- Department of Neurology, Seoul National University Hospital, Seoul, Korea
| | - Jong-Ho Park
- Department of Neurology, Myongji Hospital, Hanyang University College of Medicine, Goyang, Korea
| | - Man-Seok Park
- Department of Neurology, Chonnam National University Hospital, Gwangju, Korea
| | - Joon-Tae Kim
- Department of Neurology, Chonnam National University Hospital, Gwangju, Korea
| | - Yang-Ha Hwang
- Department of Neurology, Kyungpook National University Hospital, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Yong-Jae Kim
- Department of Neurology, Eunpyeong St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea
| | - Jong-Won Chung
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Oh Young Bang
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Gyeong-Moon Kim
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Woo-Keun Seo
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
| | - Jay Chol Choi
- Department of Neurology, Jeju National University Hospital, Jeju, Korea.
| |
Collapse
|
13
|
Schilling J, Lin JP, Mankad SV, Krishnam MS, Ning M, Patel PM, Kim CK, Kapoor R, Di Tullio MR, Jung J, Kim JK, Fisher MJ. The 2022 FASEB Virtual Catalyst Conference on the Cardiac Interatrial Septum and Stroke Risk, December 7, 2022. FASEB J 2023; 37:e23122. [PMID: 37606555 DOI: 10.1096/fj.202300897] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 05/09/2023] [Accepted: 07/20/2023] [Indexed: 08/23/2023]
Abstract
There is emerging evidence that the cardiac interatrial septum has an important role as a thromboembolic source for ischemic strokes. There is little consensus on treatment of patients with different cardiac interatrial morphologies or pathologies who have had stroke. In this paper, we summarize the important background, diagnostic, and treatment considerations for this patient population as presented during the Federation of American Societies for Experimental Biology (FASEB) Virtual Catalytic Conference on the Cardiac Interatrial Septum and Stroke Risk, held on December 7, 2022. During this conference, many aspects of the cardiac interatrial septum were discussed. Among these were the embryogenesis of the interatrial septum and development of anatomic variants such as patent foramen ovale and left atrial septal pouch. Also addressed were various mechanisms of injury such as shunting physiologies and the consequences that can result from anatomic variants, as well as imaging considerations in echocardiography, computed tomography, and magnetic resonance imaging. Treatment options including anticoagulation and closure were addressed, as well as an in-depth discussion on whether the left atrial septal pouch is a stroke risk factor. These issues were discussed and debated by multiple experts from neurology, cardiology, and radiology.
Collapse
Affiliation(s)
- Jonathan Schilling
- Department of Medicine, University of California, Irvine, California, USA
| | - Jeannette P Lin
- Department of Cardiology, University of California, Los Angeles, California, USA
| | - Sunil V Mankad
- Department of Cardiology, Mayo Clinic, Rochester, Minnesota, USA
| | - Mayil S Krishnam
- Department of Radiology, Stanford University, Stanford, California, USA
| | - MingMing Ning
- Cardio-Neurology Clinic, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Pranav M Patel
- Division of Cardiology, Department of Medicine, University of California, Irvine, California, USA
| | - Chi Kyung Kim
- Department of Neurology, Korea University College of Medicine, Seoul, South Korea
| | - Ruchi Kapoor
- Division of Cardiology, Department of Medicine, University of Washington, Seattle, Washington, USA
| | - Marco R Di Tullio
- Division of Cardiology, Department of Medicine, Columbia University, New York, New York, USA
| | - Jinman Jung
- Department of Neurology, Korea University Ansan Hospital, Ansan, South Korea
| | - Jin Kyung Kim
- Division of Cardiology, Department of Medicine, University of California, Irvine, California, USA
| | - Mark J Fisher
- Departments of Neurology, Anatomy & Neurobiology, and Pathology & Laboratory Medicine, University of California, Irvine, California, USA
| |
Collapse
|
14
|
Nam KW, Kim CK, Yu S, Oh K, Chung JW, Bang OY, Kim GM, Jung JM, Song TJ, Kim YJ, Kim BJ, Heo SH, Park KY, Kim JM, Park JH, Choi JC, Park MS, Kim JT, Choi KH, Hwang YH, Seo WK. D-dimer to fibrinogen ratio predicts early neurological deterioration in ischemic stroke with atrial fibrillation. Thromb Res 2023; 229:219-224. [PMID: 37562164 DOI: 10.1016/j.thromres.2023.07.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 07/19/2023] [Accepted: 07/28/2023] [Indexed: 08/12/2023]
Abstract
INTRODUCTION The D-dimer to fibrinogen ratio (DFR) is a good indicator of clot-producing activity in thrombotic disease, but its clinical usefulness in stroke patients with nonvalvular atrial fibrillation (NVAF) has not been studied. We evaluated the association between the DFR and early neurological deterioration (END) in acute ischemic stroke (AIS) patients with NVAF. METHODS We included consecutive AIS patients with NVAF between 2013 and 2015 from the registry of a real-world prospective cohort from 11 large centers in South Korea. END was defined as an increase ≥2 in the total NIHSS score or ≥ 1 in the motor NIHSS score within the first 72 h of admission. The DFR was calculated as follows: DFR = D-dimer (mg/L)/fibrinogen (mg/dL) x 100. RESULTS A total of 1018 AIS patients with NVAF were evaluated. In multivariable logistic regression analysis, the highest DFR tertile was closely associated with END (adjusted odds ratio [aOR] = 2.14, 95 % confidence interval [CI]: 1.24-3.69). Hypertension (aOR = 1.71, 95 % CI: 1.09-2.70), initial NIHSS score (aOR = 1.05, 95 % CI: 1.02-1.07) and use of anticoagulants (aOR = 0.41, 95 % CI: 0.28-0.60) were also correlated with END. In addition to END, the DFR was correlated with discharge NIHSS and modified Rankin Scale (mRS) scores and the 3-month mRS score. CONCLUSIONS High DFR values were associated with END in AIS patients with NVAF. As the DFR is an indicator directly related to the main pathological mechanism of NVAF patients (fibrinolysis and coagulation), it may be useful in predicting their prognosis.
Collapse
Affiliation(s)
- Ki-Woong Nam
- Department of Neurology, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, South Korea
| | - Chi Kyung Kim
- Department of Neurology, Korea University Guro Hospital, Korea University College of Medicine, Seoul, South Korea.
| | - Sungwook Yu
- Department of Neurology, Korea University Anam Hospital, Korea University College of Medicine, Seoul, South Korea
| | - Kyungmi Oh
- Department of Neurology, Korea University Guro Hospital, Korea University College of Medicine, Seoul, South Korea
| | - Jong-Won Chung
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Oh Young Bang
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Gyeong-Moon Kim
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Jin-Man Jung
- Department of Neurology, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, South Korea
| | - Tae-Jin Song
- Department of Neurology, Ewha Womans University, School of Medicine, Seoul, South Korea
| | - Yong-Jae Kim
- Department of Neurology, the Catholic University of Korea, Seoul, South Korea
| | - Bum Joon Kim
- Department of Neurology, Asan Medical Center, Seoul, South Korea
| | - Sung Hyuk Heo
- Department of Neurology, Kyung Hee University College of Medicine, Seoul, South Korea
| | - Kwang-Yeol Park
- Department of Neurology, Chung-Ang University College of Medicine, Chung-Ang University Hospital, Seoul, South Korea
| | - Jeong-Min Kim
- Department of Neurology, Seoul National University Hospital, Seoul, South Korea
| | - Jong-Ho Park
- Department of Neurology, Myongji Hospital, Hanyang University College of medicine, Seoul, South Korea
| | - Jay Chol Choi
- Department of Neurology, Jeju National University, Jeju, South Korea
| | - Man-Seok Park
- Department of Neurology, Chonnam National University Hospital, Chonnam, South Korea
| | - Joon-Tae Kim
- Department of Neurology, Chonnam National University Hospital, Chonnam, South Korea
| | - Kang-Ho Choi
- Department of Neurology, Chonnam National University Hospital, Chonnam, South Korea
| | - Yang Ha Hwang
- Department of Neurology, Kyungpook National University Hospital, Dae-gu, South Korea
| | - Woo-Keun Seo
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea; Departement of Digital Health, SHAIST, Sungkyunkwan University, Seoul, South Korea
| |
Collapse
|
15
|
de Melo PS, Parente J, Rebello-Sanchez I, Marduy A, Gianlorenco AC, Kyung Kim C, Choi H, Song JJ, Fregni F. Understanding the Neuroplastic Effects of Auricular Vagus Nerve Stimulation in Animal Models of Stroke: A Systematic Review and Meta-Analysis. Neurorehabil Neural Repair 2023; 37:564-576. [PMID: 37272448 DOI: 10.1177/15459683231177595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
BACKGROUND Transauricular vagus nerve stimulation (taVNS) is being studied as a feasible intervention for stroke, but the mechanisms by which this non-invasive technique acts in the cortex are still broadly unknown. OBJECTIVES This study aimed to systematically review the current pre-clinical evidence in the auricular vagus nerve stimulation (aVNS) neuroplastic effects in stroke. METHODS We searched, in December of 2022, in Medline, Cochrane, Embase, and Lilacs databases. The authors executed the extraction of the data on Excel. The risk of bias was evaluated by adapted Cochrane Collaboration's tool for animal studies (SYRCLES's RoB tool). RESULTS A total of 8 studies published between 2015 and 2022 were included in this review, including 391 animal models. In general, aVNS demonstrated a reduction in neurological deficits (SMD = -1.97, 95% CI -2.57 to -1.36, I2 = 44%), in time to perform the adhesive removal test (SMD = -2.26, 95% CI -4.45 to -0.08, I2 = 81%), and infarct size (SMD = -1.51, 95% CI -2.42 to -0.60, I2 = 58%). Regarding the neuroplasticity markers, aVNS showed to increase microcapillary density, CD31 proliferation, and BDNF protein levels and RNA expression. CONCLUSIONS The studies analyzed show a trend of results that demonstrate a significant effect of the auricular vagal nerve stimulation in stroke animal models. Although the aggregated results show high heterogeneity and high risk of bias. More studies are needed to create solid conclusions.
Collapse
Affiliation(s)
- Paulo S de Melo
- Department of Medicine, Escola Bahiana de Medicina e Saúde Pública, Salvador, Bahia, Brazil
- Neuromodulation Center and Center for Clinical Research Learning, Spaulding Rehabilitation Hospital and Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - João Parente
- Department of Medicine, Escola Bahiana de Medicina e Saúde Pública, Salvador, Bahia, Brazil
- Neuromodulation Center and Center for Clinical Research Learning, Spaulding Rehabilitation Hospital and Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Ingrid Rebello-Sanchez
- Neuromodulation Center and Center for Clinical Research Learning, Spaulding Rehabilitation Hospital and Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Universidade Federal da Bahia, Salvador, Bahia, Brazil
| | - Anna Marduy
- Neuromodulation Center and Center for Clinical Research Learning, Spaulding Rehabilitation Hospital and Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- União Metropolitana de Ensino e Cultura (UNIME) Salvador, Bahia, Brazil
| | - Anna Carolyna Gianlorenco
- Neuromodulation Center and Center for Clinical Research Learning, Spaulding Rehabilitation Hospital and Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Department of Physical Therapy, Federal University of Sao Carlos, Sao Carlos, Brazil
| | - Chi Kyung Kim
- Department of Neurology, Korea University Guro Hospital, Seoul, Republic of Korea
| | - Hyuk Choi
- Department of Medical Sciences, Graduate School of Medicine, Korea University, Seoul, Republic of Korea
- Neurive Co., Ltd., Gimhae, Republic of Korea
| | - Jae-Jun Song
- Neurive Co., Ltd., Gimhae, Republic of Korea
- Department of Otorhinolaryngology-Head and Neck Surgery, Korea University Medical Center, Seoul, Republic of Korea
| | - Felipe Fregni
- Neuromodulation Center and Center for Clinical Research Learning, Spaulding Rehabilitation Hospital and Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| |
Collapse
|
16
|
Hong KS, Bang OY, Park JH, Jung JM, Lee SH, Song TJ, Nam HS, Park HK, Jung KH, Heo SH, Koo J, Yu KH, Park KY, Kim CK, Park HK, Lee J, Lee J, Seo WK. Moderate-Intensity Rosuvastatin Plus Ezetimibe Versus High-Intensity Rosuvastatin for Target Low-Density Lipoprotein Cholesterol Goal Achievement in Patients With Recent Ischemic Stroke: A Randomized Controlled Trial. J Stroke 2023:jos.2022.02957. [PMID: 37032475 DOI: 10.5853/jos.2022.02957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Accepted: 02/14/2023] [Indexed: 04/11/2023] Open
Abstract
Background and Purpose Moderate-intensity statin plus ezetimibe versus high-intensity statin alone may provide a greater low-density lipoprotein cholesterol (LDL-C) reduction in patients with recent ischemic stroke. Methods This randomized, open-label, controlled trial assigned patients with recent ischemic stroke <90 days to rosuvastatin/ezetimibe 10/10 mg once daily (ROS10/EZT10) or to rosuvastatin 20 mg once daily (ROS20). The primary endpoint was LDL-C reduction ≥50% from baseline at 90 days. Key secondary endpoints were LDL-C <70 mg/dL and multiple lipid goal achievement, and composite of major vascular events. Results Of 584 randomized, 530 were included in the modified intention-to-treat analysis. The baseline LDL-C level was 130.2±34.7 mg/dL in the ROS10/EZT10 group and 131.0±33.9 mg/dL in the ROS20 group. The primary endpoint was achieved in 198 patients (72.5%) in the ROS10/EZT10 group and 148 (57.6%) in the ROS20 group (odds ratio [95% confidence interval], 1.944 [1.352-2.795]; P= 0.0003). LDL-C level <70 mg/dL was achieved in 80.2% and 65.4% in the ROS10/EZT10 and ROS20 groups (P=0.0001). Multiple lipid goal achievement rate was 71.1% and 53.7% in the ROS10/EZT10 and ROS20 groups (P<0.0001). Major vascular events occurred in 1 patient in the ROS10/EZT10 group and 9 in the ROS20 group (P=0.0091). The adverse event rates did not differ between the two groups. Conclusion Moderate-intensity rosuvastatin plus ezetimibe was superior to high-intensity rosuvastatin alone for intensive LDL-C reduction in patients with recent ischemic stroke. With the combination therapy, more than 70% of patients achieved LDL-C reduction ≥50% and 80% had an LDL-C <70 mg/dL at 90 days.
Collapse
Affiliation(s)
- Keun-Sik Hong
- Department of Neurology, Ilsan Paik Hospital, Inje University, Goyang, Korea
| | - Oh Young Bang
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jong-Ho Park
- Department of Neurology, Myongji Hospital, Hanyang University College of Medicine, Goyang, Korea
| | - Jin-Man Jung
- Department of Neurology, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, Korea
| | - Sang-Hun Lee
- Department of Neurology, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, Korea
| | - Tae-Jin Song
- Department of Neurology, Seoul Hospital, Ewha Women's University College of Medicine, Seoul, Korea
| | - Hyo Suk Nam
- Department of Neurology, Yonsei University College of Medicine, Seoul, Korea
| | - Hee-Kwon Park
- Department of Neurology, Inha University Hospital, Incheon, Korea
| | - Keun-Hwa Jung
- Department of Neurology, Seoul National University College of Medicine, Seoul, Korea
| | - Sung Hyuk Heo
- Department of Neurology, Kyung Hee University Medical Center, Seoul, Korea
| | - Jaseong Koo
- Department of Neurology, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea
| | - Kyung-Ho Yu
- Department of Neurology, Hallym University Sacred Heart Hospital, Anyang, Korea
| | - Kwang-Yeol Park
- Department of Neurology, Chung-Ang University Hospital, Seoul, Korea
| | - Chi Kyung Kim
- Department of Neurology, Korea University Guro Hospital, Seoul, Korea
| | - Hong-Kyun Park
- Department of Neurology, Ilsan Paik Hospital, Inje University, Goyang, Korea
| | - Jiyoon Lee
- Department of Biostatistics, Korea University College of Medicine, Seoul, Korea
| | - Juneyoung Lee
- Department of Biostatistics, Korea University College of Medicine, Seoul, Korea
| | - Woo-Keun Seo
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| |
Collapse
|
17
|
Kang SH, Choi Y, Chung SJ, Kim CK, Kim JH, Oh K, Yoon JS, Cho GJ, Koh SB. Independent effect of cardiometabolic syndromes and depression on dementia in Parkinson's disease: A 12-year longitudinal follow-up study of a nationwide cohort. Eur J Neurol 2023; 30:911-919. [PMID: 36692249 DOI: 10.1111/ene.15689] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 12/23/2022] [Accepted: 01/16/2023] [Indexed: 01/25/2023]
Abstract
BACKGROUND We aimed to investigate the incidence rate of Parkinson's disease dementia (PDD) according to age and disease duration by sex. Furthermore, we explored the effect of each cardiometabolic syndrome and depression on the incidence of PDD. METHODS Using data from the Korean National Health Insurance Service, 79,622 patients with de novo Parkinson's disease (PD) aged ≥40 years between January 2002 and December 2010 were followed to December 2019. We analyzed the incidence of PDD according to age at PD diagnosis and disease duration. To determine cardiometabolic syndromes and depression that affected PDD, we used Fine and Gray competing regression after controlling for age and sex. RESULTS During the 12.5-year follow-up period, the incidence of PDD increased with age at PD diagnosis (0.81-45.31 per 1000 person-years among those aged 40-44 and over 80 years, respectively) and longer disease duration (22.68 per 1000 person-years in 1-2 years to 34.16 per 1000 person-years in 15-16 years). Hypertension (subdistribution hazard ratio [SHR] = 1.11; 95% confidence interval [CI] 1.07-1.16), diabetes (SHR = 1.09; 95% CI 1.05-1.14), dyslipidemia (SHR = 1.15; 95% CI 1.11-1.20), and depression (SHR = 1.36; 95% CI 1.30-1.41) independently increased the risk for PDD. CONCLUSIONS Our findings provide insights into cardiometabolic syndromes as modifiable risk factors for incident PDD. Furthermore, our results will help in designing public health policies with respect to controlling cardiometabolic syndromes and depression to prevent incident PDD in patients with PD.
Collapse
Affiliation(s)
- Sung Hoon Kang
- Department of Neurology, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Yunjin Choi
- Biomedical Research Institute, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Su Jin Chung
- Department of Neurology, Myongji Hospital, Hanyang University College of Medicine, Goyang, Korea
| | - Chi Kyung Kim
- Department of Neurology, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Ji Hyun Kim
- Department of Neurology, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Kyungmi Oh
- Department of Neurology, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Joon Shik Yoon
- Department of Physical Medicine and Rehabilitation, Korea University Guro Hospital, Seoul, Korea
| | - Geum Joon Cho
- Department of Obstetrics and Gynecology, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Seong-Beom Koh
- Department of Neurology, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| |
Collapse
|
18
|
Kim TJ, Lee JS, Yoon JS, Oh MS, Kim JW, Park SH, Jung KH, Kim HY, Kwon JH, Choi HY, Kim HY, Eah KY, Han SW, Oh HG, Kim YJ, Shin BS, Kim CH, Kim CK, Park JM, Lee KB, Park TH, Lee J, Park MS, Choi JC, Kim C, Shin DI, Lee SJ, Kim DE, Cha JK, Kim EG, Yu KH, Hong KS, Lee YS, Lee JH, Sohn SI, Bae HJ, Lee YB, Lee JH, Rha JH, Lee BC, Chang DI, Ko SB, Yoon BW. Optimal use of antithrombotic agents in ischemic stroke with atrial fibrillation and large artery atherosclerosis. Int J Stroke 2023:17474930231158211. [PMID: 36748980 DOI: 10.1177/17474930231158211] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND Optimal antithrombotic regimens to prevent recurrent stroke in patients with ischemic stroke due to atrial fibrillation (AF) and atherosclerotic large-vessel stenosis remain unknown. AIMS This study aimed to evaluate the effect of multiple antithrombotic therapies on outcomes at 1 year after ischemic stroke due to two or more causes. METHODS We identified 862 patients with ischemic stroke due to AF and large artery atherosclerosis from the linked data. These patients were categorized into three groups according to antithrombotic therapies at discharge: (1) antiplatelets, (2) oral anticoagulants (OAC), and (3) antiplatelets plus OAC. The study outcomes were recurrent ischemic stroke, composite outcomes for cardiovascular events, and major bleeding after 1 year. Inverse probability of treatment weighting (IPTW) was used to balance the three groups using propensity scores. RESULTS Among 862 patients, 169 (19.6%) were treated with antiplatelets, 405 (47.0%) were treated with OAC, and 288 (33.4%) were treated with antiplatelets and OAC. After applying IPTW, only OAC had a significant beneficial effect on the 1-year composite outcome (hazard ratio (HR): 0.37, 95% confidence interval (CI): 0.23-0.60, p < 0.001) and death (HR: 0.35, 95% CI: (0.19-0.63), p < 0.001). The combination of antiplatelet agents and OAC group had an increased risk of major bleeding complications (HR: 5.27, 95% CI: (1.31-21.16), p = 0.019). However, there was no significant difference in 1-year recurrent stroke events among the three groups. CONCLUSION This study demonstrated that OAC monotherapy was associated with lower risks of composite outcome and death in patients at 1 year after ischemic stroke due to AF and atherosclerotic stenosis. In addition, the combination of an antiplatelet and OAC had a high risk of major bleeding.
Collapse
Affiliation(s)
- Tae Jung Kim
- Department of Neurology, Seoul National University College of Medicine, Seoul, Korea.,Department of Critical Care Medicine, Seoul National University Hospital, Seoul, Korea
| | - Ji Sung Lee
- Department of Clinical Epidemiology and Biostatistics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jae Sun Yoon
- Department of Neurology, Seoul National University College of Medicine, Seoul, Korea
| | - Mi Sun Oh
- Department of Neurology, Hallym University Sacred Heart Hospital, Anyang, Korea
| | - Ji-Woo Kim
- Health Insurance Review and Assessment Service, Wonju, Korea
| | - Soo-Hyun Park
- Department of Neurology, Inha University Hospital, Incheon, Korea
| | - Keun-Hwa Jung
- Department of Neurology, Seoul National University College of Medicine, Seoul, Korea
| | - Hyun Young Kim
- Department of Neurology, Hanyang University Hospital, Seoul, Korea
| | - Jee-Hyun Kwon
- Department of Neurology, Ulsan University Hospital, Ulsan, Korea
| | - Hye-Yeon Choi
- Department of Neurology, Kyung Hee University Hospital at Gangdong, Seoul, Korea
| | - Hahn Young Kim
- Department of Neurology, Konkuk University School of Medicine, Seoul, Korea
| | - Kyung Yoon Eah
- Department of Neurology, Dongguk University College of Medicine, Gyeongju, Korea
| | - Sang Won Han
- Department of Neurology, Inje University College of Medicine, Seoul, Korea
| | - Hyung-Geun Oh
- Department of Neurology, Soonchunhyang University Cheonan Hospital, Cheonan, Korea
| | - Young-Jae Kim
- Department of Neurology, Eunpyeong St. Mary's Hospital, Seoul, Korea
| | - Byoung-Soo Shin
- Department of Neurology, Chungbuk National University Hospital, Jeonju, Korea
| | - Chang Hun Kim
- Department of Neurology, Gyeongsang National University Hospital, Jinju, Korea
| | - Chi Kyung Kim
- Department of Neurology, Korea University Guro Hospital, Seoul, Korea
| | - Jong-Moo Park
- Department of Neurology, Uijeongbu Eulji Medical Center, Uijeongbu, Korea
| | - Kyung Bok Lee
- Department of Neurology, Soonchunhyang University Hospital, Seoul, Korea
| | - Tai Hwan Park
- Department of Neurology, Seoul Medical Center, Seoul, Korea
| | - Jun Lee
- Department of Neurology, Yeungnam University Hospital, Daegu, Korea
| | - Man-Seok Park
- Department of Neurology, Chonnam National University Hospital, Gwangju, Korea
| | - Jay Chol Choi
- Department of Neurology, Jeju National University Hospital, Jeju, Korea
| | - Chulho Kim
- Department of Neurology, Hallym University College of Medicine, Chuncheon, Korea
| | - Dong-Ick Shin
- Department of Neurology, Chungbuk National University Hospital, Cheongju, Korea
| | - Soo Joo Lee
- Department of Neurology, Daejeon Eulji University Hospital, Deajeon, Korea
| | - Dong-Eog Kim
- Department of Neurology, Dongguk University Ilsan Hospital, Goyang, Korea
| | - Jae-Kwan Cha
- Department of Neurology, Dong-A University Hospital, Busan, Korea
| | - Eung-Gyu Kim
- Department of Neurology, Inje University Busan Paik Hospital, Busan, Korea
| | - Kyung-Ho Yu
- Department of Neurology, Hallym University Sacred Heart Hospital, Anyang, Korea
| | - Keun-Sik Hong
- Department of Neurology, Ilsan Paik Hospital, Goyang, Korea
| | - Young-Seok Lee
- Department of Neurology, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, Korea
| | - Ju-Hun Lee
- Department of Neurology, Kangdong Sacred Heart Hospital, Seoul, Korea
| | - Sung Il Sohn
- Department of Neurology, Keimyung University Dongsan Hospital, Daegu, Korea
| | - Hee-Joon Bae
- Department of Neurology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Young-Bae Lee
- Department of Neurology, Gachon University Gil Medical Center, Incheon, Korea
| | - Jun Hong Lee
- Department of Neurology, Ilsan Hospital, National Health Insurance Service, Goyang, Korea
| | - Joung-Ho Rha
- Department of Neurology, Inha University Hospital, Incheon, Korea
| | - Byung-Chul Lee
- Department of Neurology, Hallym University Sacred Heart Hospital, Anyang, Korea
| | - Dae-Il Chang
- Department of Neurology, Kyung Hee University Hospital, Seoul, Korea
| | - Sang-Bae Ko
- Department of Neurology, Seoul National University College of Medicine, Seoul, Korea.,Department of Critical Care Medicine, Seoul National University Hospital, Seoul, Korea
| | - Byung-Woo Yoon
- Department of Neurology, Uijeongbu Eulji Medical Center, Uijeongbu, Korea
| |
Collapse
|
19
|
Kim CK, Nam KW, Kim HJ, Han JH, Oh K. Abstract TMP100: Gestational Headaches Are Associated With The Risk Of Postpartum Stroke. Stroke 2023. [DOI: 10.1161/str.54.suppl_1.tmp100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Background:
Chronic primary headaches (CPHs) are known to increase the risk of stroke in women. However, the effect of a novel headache during pregnancy (G-HA) on the occurrence of subsequent stroke is unknown. In this study, we evaluated the association between G-HA and postpartum stroke in women.
Methods:
Based on the Korean National Health Insurance Service database, we included consecutive women hospitalized for delivery between 2007 and 2008. G-HA was defined as the novel CPH diagnosed during pregnancy, and was divided into migraine and other CPH groups. Primary outcome was determined any stroke, ischemic stroke, and hemorrhagic stroke that occurred during the identification period from delivery to December 31 2016. All diseases were identified based on data registered in the database using the International Classification of Disease-10
th
Revision-Clinical Modification codes.
Results:
A total of 919,810 women were evaluated. In multivariable cox regression analysis, G-HA was significantly associated with postpartum stroke [adjusted hazard ratio (aHR) = 1.65, 95% confidence interval (CI): 1.32-2.06]. The close association between G-HA and postpartum stroke was the strongest with migraine (aHR = 2.32, 95% CI: 1.59-3.40), but it was also statistically significant with other CPHs (aHR = 1.40, 95% CI: 1.07-1.83). According to the stroke subtype, G-HA showed a close correlation with ischemic stroke (aHR = 1.87, 95% CI: 1.45-2.41), but not with hemorrhagic stroke.
Conclusions:
We demonstrated that G-HA, especially migraines, was associated with postpartum stroke occurrence in women. This close association was evident in ischemic stroke and not hemorrhagic stroke.
Collapse
Affiliation(s)
- Chi Kyung Kim
- Neurology, Korea Univ Guro Hosp, Seoul, Korea, Republic of
| | | | - Han Jun Kim
- Neurology, Korea Univ Guro Hosp, Seoul, Korea, Republic of
| | - Jung Hoon Han
- Neurology, Korea Univ Guro Hosp, Seoul, Korea, Republic of
| | - Kyungmi Oh
- Neurology, Korea Univ Guro Hosp, Seoul, Korea, Republic of
| |
Collapse
|
20
|
Kim YS, Kim BJ, Yoo J, Han JH, Kim BJ, Kim CK, Kim JG, Kim JT, Park H, Baik SH, Han MK, Bae HJ. Abstract WP50: Stress Hyperglycemia And Early Neurological Deterioration In Patients With Acute LVO And Low NIHSS. Stroke 2023. [DOI: 10.1161/str.54.suppl_1.wp50] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Introduction:
Stress hyperglycemia is an essential survival response. However, it is associated with poor prognosis after ischemic stroke, and its contribution to collateral failure is not well defined. We investigated whether stress hyperglycemia would be associated with early neurological deterioration (END) in acute large vessel occlusion (LVO) patients who present with mild neurological deficit.
Methods:
From a multicenter stroke registry, ischemic stroke patients with acute anterior circulation LVO and mild symptoms (NIHSS<6) were included and were grouped by a history of diabetes before the index stroke. Stress hyperglycemia ratio (SHR) was calculated as a ratio of serum glucose at arrival over glycosylated hemoglobin. END was defined as an increase in total NIHSS≥2 or any increase in the NIHSS consciousness or motor sub-scores.
Results:
Among a total of 731 mild LVO patients (mean age 68.0±12.9 years; 62.7% male), 172 (23.5%) had a history of diabetes, and 73 (10.0%) were newly diagnosed with diabetes during admission. The SHR was higher in known diabetic patients compared to no-DM / newly diagnosed diabetic patients (24.3±8.5 vs. 21.8±5.6, p-value<0.01). END occurred in 94 (12.9%) patients. The second (T2) and third (T3) tertile groups of SHR were more likely to experience END than the lowest tertile group (adjusted odds ratio (aOR) 2.29 [95% confidence interval (CI), 1.26-4.17] for T2; aOR 1.85 [95% CI 1.01-3.39] for T3). The association was maintained in the no-DM / newly diagnosed diabetic subgroup but not in cases with a history of diabetes (p for interaction=0.047). [Figure]
Conclusions:
Stress hyperglycemia was associated with END in acute LVO patients with low NIHSS, especially in the subgroup of patients without or newly diagnosed diabetes. In patients without a history of diabetes, where the physiologic response to hyperglycemia may currently be preserved, intensive glycemic control may benefit in maintaining leptomeningeal collaterals.
Collapse
Affiliation(s)
- Yong Soo Kim
- Nowon Eulji medical center, Seoul, Korea, Republic of
| | - Beom J Kim
- SNU BUNDANG HOSPITAL, Seongnam-si Gyeonggi-do
| | - Joonsang Yoo
- Yongin Severance Hosp, Yongin-si, Korea, Republic of
| | | | | | | | - Jae Guk Kim
- Eulji Univ Hosp, Daejeon, Korea, Republic of
| | - Joon-Tae Kim
- Chonnam National Univ Hosp, Gwangju, Korea, Republic of
| | - Hyungjong Park
- Keimyung Univ Dongsan Med Cntr, Daegu, Korea, Republic of
| | - Sung Hyun Baik
- Seoul National Univ Bundang Hosp, Seongnam, Korea, Republic of
| | | | - Hee-Joon Bae
- SEOUL NATL UNIV BUNDANG HOSPITAL, Seongnam-si Gyeonggi-do, Korea, Republic of
| |
Collapse
|
21
|
Kim CK, Kim HJ, Han JH, Oh K. Abstract TP241: Therapeutic Effects Of Magnet-induced Stem Cells Using Ferrimagnetic Iron Oxide Nanoparticles In Ischemic Stroke Model. Stroke 2023. [DOI: 10.1161/str.54.suppl_1.tp241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Background:
The efficiency of targeted delivery of stem cells via transplantation by intravenous injection is limited because of rapid clearance. Thus, more effective, newer methods are required. We hypothesized that combining the use of ferrimagnetic iron oxide nanoparticles (FION) labeling and magnetic fields could enhance the targeted delivery of stem cells after ischemic stroke.
Methods:
In a typical synthesis of FION nanocubes, iron(III) acetylacetonate was added to a mixture of oleic acid, 4-biphenylcarboxylic acid, and benzyl ether. Therapeutic effects of neural stem cells (NSC) using the magnetic nanoparticles in the cerebral ischemic stroke. Transient middle cerebral artery occlusion (MCAO) was induced in SD-rats. Iron oxide nanoparticle-labeled NSCs were injected into the tail vein. Magnetic resonance tracking and confirming labeled stem cells with Prussian blue staining. Polypeptides derived from receptors for advanced glycation end products and pharmaceutical composition for preventing and treating cerebrovascular disease comprise the same.
Results:
In the F3-VEGF NSC cell, FION uptake was shown as immunofluorescence. After overexpression of VEGF in F3 cells, it was confirmed by Western blotting. The measurements of cytotoxicity in FION's NSC showed toxicity over 80g but 40g was treated for 7 days and was not toxic. Six hours after MCAO induction, 4x10
6
NSCs were injected, and a magnet hat so that the stem cells implanted in the pathogen could move well. After one day, a behavioral test was conducted every week for up to 35 days. After MCAO induction, the group transplanted with FION-NSCs significantly improved in the behavioral test on Day 35 compared to the control group. In order to measure the distribution of FION in tissue, MRI was performed showing penetrating into the lesions of the white circles. As a result of ICP-MS, the magnet-applioed group was concentrated with FION 7 times more compared with the FION-only group. The distribution in brain tissue was observed through FION's Fluorescence images.
Conclusions:
Our study suggests that this use of a magnetic field may be useful for improving the efficacy of targeted migration of stem cells in stem-based cell therapy in ischemic brain injury.
Collapse
Affiliation(s)
| | - Han Jun Kim
- Neurology, Korea Univ Guro Hosp, Seoul, Korea, Republic of
| | - Jung Hoon Han
- Neurology, Korea Univ Guro Hosp, Seoul, Korea, Republic of
| | - Kyungmi Oh
- Neurology, Korea Univ Guro Hosp, Seoul, Korea, Republic of
| |
Collapse
|
22
|
Jung S, Lee HA, Kang IS, Shin SH, Chang Y, Shin DW, Park M, Kim YD, Nam HS, Heo JH, Kim TH, Yu HT, Lee JM, Heo SH, Woo HG, Park JK, Ro SY, Kim CK, Lee YS, Do JK, Kim DH, Song TJ, Park J. Corrigendum: Clinical implications of atrial fibrillatioN detection using wearabLE devices in patients with cryptogenic stroke (CANDLE-AF) trial: Design and rationale. Front Cardiovasc Med 2023; 10:1199185. [PMID: 37153467 PMCID: PMC10155058 DOI: 10.3389/fcvm.2023.1199185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 04/04/2023] [Indexed: 05/09/2023] Open
Abstract
[This corrects the article DOI: 10.3389/fcvm.2022.837958.].
Collapse
Affiliation(s)
- Sodam Jung
- Mokdong Hospital, Ewha Womans University School of Medicine, Seoul, South Korea
| | - Hye Ah Lee
- Mokdong Hospital, Ewha Womans University School of Medicine, Seoul, South Korea
| | - In Sook Kang
- Mokdong Hospital, Ewha Womans University School of Medicine, Seoul, South Korea
| | - Sang Hoon Shin
- Ewha Womans University Seoul Hospital, Seoul, South Korea
| | - Yoonkyung Chang
- Mokdong Hospital, Ewha Womans University School of Medicine, Seoul, South Korea
| | - Dong Woo Shin
- Mokdong Hospital, Ewha Womans University School of Medicine, Seoul, South Korea
| | - Mooseok Park
- Ewha Womans University Seoul Hospital, Seoul, South Korea
| | - Young Dae Kim
- College of Medicine, Yonsei University, Seoul, South Korea
| | - Hyo Suk Nam
- College of Medicine, Yonsei University, Seoul, South Korea
| | - Ji Hoe Heo
- College of Medicine, Yonsei University, Seoul, South Korea
| | - Tae-Hoon Kim
- Severance Cardiovascular Hospital, Seoul, South Korea
| | - Hee Tae Yu
- Severance Cardiovascular Hospital, Seoul, South Korea
| | | | - Sung Hyuk Heo
- Kyung Hee University Medical Center, Seoul, South Korea
| | - Ho Geol Woo
- Kyung Hee University Medical Center, Seoul, South Korea
| | - Jin-Kyu Park
- Hanyang University Seoul Hospital, Seoul, South Korea
| | - Seung-Y. Ro
- Korea University Guro Hospital, Seoul, South Korea
| | | | - Young-Soo Lee
- Daegu Catholic University Medical Center, Daegu, North Gyeongsang, South Korea
| | - Jin Kuk Do
- Daegu Catholic University Medical Center, Daegu, North Gyeongsang, South Korea
| | - Dong-Hyeok Kim
- Ewha Womans University Seoul Hospital, Seoul, South Korea
| | - Tae-Jin Song
- Ewha Womans University Seoul Hospital, Seoul, South Korea
| | - Junbeom Park
- Mokdong Hospital, Ewha Womans University School of Medicine, Seoul, South Korea
- Correspondence: Junbeom Park
| |
Collapse
|
23
|
Gianlorenco ACL, de Melo PS, Marduy A, Kim AY, Kim CK, Choi H, Song JJ, Fregni F. Electroencephalographic Patterns in taVNS: A Systematic Review. Biomedicines 2022; 10:biomedicines10092208. [PMID: 36140309 PMCID: PMC9496216 DOI: 10.3390/biomedicines10092208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Revised: 08/24/2022] [Accepted: 08/27/2022] [Indexed: 11/16/2022] Open
Abstract
Transcutaneous auricular vagus nerve stimulation (taVNS) is a newer delivery system using a non-invasive stimulation device placed at the ear. taVNS research is focused on clinical trials showing potential therapeutic benefits, however the neurophysiological effects of this stimulation on brain activity are still unclear. We propose a systematic review that aims to describe the effects of taVNS on EEG measures and identify taVNS parameters that can potentially lead to consistent EEG-mediated biomarkers for this therapy. A systematic literature review was carried out following the Preferred Reporting Items for Systematic Reviews and Meta-Analyzes (PRISMA) and the Cochrane handbook for systematic reviews. Clinical trials examining EEG parameters were considered, including absolute and relative power, coherence, degree of symmetry, evoked potentials, and peak frequency of all bands. According to our criteria, 18 studies (from 122 articles) were included. Our findings show a general trend towards increased EEG power spectrum activity in lower frequencies, and changes on early components of the ERP related to inhibitory tasks. This review suggests that quantitative electroencephalography can be used to assess the effects of taVNS on brain activity, however more studies are needed to systematically establish the specific effects and metrics that would reflect the non-invasive stimulation through the auricular branch of the vagus nerve.
Collapse
Affiliation(s)
- Anna Carolyna L. Gianlorenco
- Department of Physical Therapy, Federal University of Sao Carlos, Sao Carlos 13565-090, Brazil
- Neuromodulation Center and Center for Clinical Research Learning, Spaulding Rehabilitation Hospital and Massachusetts General Hospital, Harvard Medical School, Boston, MA 02129, USA
| | - Paulo S. de Melo
- Neuromodulation Center and Center for Clinical Research Learning, Spaulding Rehabilitation Hospital and Massachusetts General Hospital, Harvard Medical School, Boston, MA 02129, USA
- Medicine, Escola Bahiana de Medicina e Saúde Pública, Salvador 40290-000, Brazil
| | - Anna Marduy
- Neuromodulation Center and Center for Clinical Research Learning, Spaulding Rehabilitation Hospital and Massachusetts General Hospital, Harvard Medical School, Boston, MA 02129, USA
- União Metropolitana de Ensino e Cultura (UNIME) Salvador, Salvador 42700-000, Brazil
| | - Angela Yun Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, Korea University Medical Center, Seoul 08308, Korea
| | - Chi Kyung Kim
- Department of Neurology, Korea University Guro Hospital, Seoul 08308, Korea
| | - Hyuk Choi
- Department of Medical Sciences, Graduate School of Medicine, Korea University, Seoul 08308, Korea
- Neurive Co., Ltd., Gimhae 08308, Korea
| | - Jae-Jun Song
- Department of Otorhinolaryngology-Head and Neck Surgery, Korea University Medical Center, Seoul 08308, Korea
- Neurive Co., Ltd., Gimhae 08308, Korea
| | - Felipe Fregni
- Neuromodulation Center and Center for Clinical Research Learning, Spaulding Rehabilitation Hospital and Massachusetts General Hospital, Harvard Medical School, Boston, MA 02129, USA
- Correspondence:
| |
Collapse
|
24
|
Kim BJ, Menon BK, Yoo J, Han JH, Kim BJ, Kim CK, Kim JG, Kim JT, Park H, Baik SH, Han MK, Kang J, Kim JY, Lee KJ, Park JM, Kang K, Lee SJ, Cha JK, Kim DH, Jeong JH, Park TH, Park SS, Lee KB, Lee J, Hong KS, Cho YJ, Park HK, Lee BC, Yu KH, Oh MS, Kim DE, Ryu WS, Choi KH, Choi JC, Kim JG, Kwon JH, Kim WJ, Shin DI, Yum KS, Sohn SI, Hong JH, Kim C, Lee SH, Lee J, Almekhlafi MA, Demchuk A, Bae HJ. Effectiveness and safety of EVT in patients with acute LVO and low NIHSS. Front Neurol 2022; 13:955725. [PMID: 35989920 PMCID: PMC9389111 DOI: 10.3389/fneur.2022.955725] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2022] [Accepted: 07/12/2022] [Indexed: 11/13/2022] Open
Abstract
Background and purposeThere is much uncertainty in endovascular treatment (EVT) decisions in patients with acute large vessel occlusion (LVO) and mild neurological deficits.MethodsFrom a prospective, nationwide stroke registry, all patients with LVO and baseline NIHSS <6 presenting within 24 h from the time last known well (LKW) were included. Early neurological deterioration (END) developed before EVT was prospectively collected as an increasing total NIHSS score ≥2 or any worsening of the NIHSS consciousness or motor subscores during hospitalization not related to EVT. Significant hemorrhage was defined as PH2 hemorrhagic transformation or hemorrhage at a remote site. The modified Rankin Scale (mRS) was prospectively collected at 3 months.ResultsAmong 1,083 patients, 149 (14%) patients received EVT after a median of 5.9 [3.6–12.3] h after LKW. In propensity score-matched analyses, EVT was not associated with mRS 0-1 (matched OR 0.99 [0.63–1.54]) but increased the risk of a significant hemorrhage (matched OR, 4.51 [1.59–12.80]). Extraneous END occurred in 207 (19%) patients after a median of 24.5 h [IQR, 13.5–41.9 h] after LKW (incidence rate, 1.41 [95% CI, 1.23–1.62] per 100 person-hours). END unrelated to EVT showed a tendency to modify the effectiveness of EVT (P-for-interaction, 0.08), which decreased the odds of having mRS 0–1 in mild LVO patients without END (adjusted OR, 0.63 [0.40–0.99]).ConclusionsThe use of EVT in patients with acute LVO and low NIHSS scores may require the assessment of individual risks of early deterioration, hemorrhagic complications and expected benefit.
Collapse
Affiliation(s)
- Beom Joon Kim
- Department of Neurology and Cerebrovascular Center, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam-si, South Korea
- *Correspondence: Beom Joon Kim
| | - Bijoy K. Menon
- Calgary Stroke Program, Department of Clinical Neuroscience, Radiology and Community Health Sciences, University of Calgary, Calgary, AB, Canada
| | - Joonsang Yoo
- Department of Neurology, Yongin Severance Hospital, Yongin-si, South Korea
| | - Jung Hoon Han
- Department of Neurology, Korea University Guro Hospital, Seoul, South Korea
| | - Bum Joon Kim
- Department of Neurology, Asan Medical Center, Seoul, South Korea
| | - Chi Kyung Kim
- Department of Neurology, Korea University Guro Hospital, Seoul, South Korea
| | - Jae Guk Kim
- Department of Neurology, Eulji University Hospital, Daejeon, South Korea
| | - Joon-Tae Kim
- Department of Neurology, Chonnam National University Hospital, Gwangju, South Korea
| | - Hyungjong Park
- Department of Neurology, Keimyung University Dongsan Medical Center, Daegu, South Korea
| | - Sung Hyun Baik
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam-si, South Korea
| | - Moon-Ku Han
- Department of Neurology and Cerebrovascular Center, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam-si, South Korea
| | - Jihoon Kang
- Department of Neurology and Cerebrovascular Center, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam-si, South Korea
| | - Jun Yup Kim
- Department of Neurology and Cerebrovascular Center, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam-si, South Korea
| | - Keon-Joo Lee
- Department of Neurology and Cerebrovascular Center, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam-si, South Korea
| | - Jong-Moo Park
- Department of Neurology, Uijeongbu Eulji Medical Center, Eulji University School of Medicine, Uijeongbu-si, South Korea
| | - Kyusik Kang
- Department of Neurology, Nowon Eulji Medical Center, Eulji University School of Medicine, Seoul, South Korea
| | - Soo Joo Lee
- Department of Neurology, Eulji University Hospital, Daejeon, South Korea
| | - Jae-Kwan Cha
- Department of Neurology, Dong-A University Hospital, Busan, South Korea
| | - Dae-Hyun Kim
- Department of Neurology, Dong-A University Hospital, Busan, South Korea
| | - Jin-Heon Jeong
- Department of Neurology, Dong-A University Hospital, Busan, South Korea
| | - Tai Hwan Park
- Department of Neurology, Seoul Medical Center, Seoul, South Korea
| | - Sang-Soon Park
- Department of Neurology, Seoul Medical Center, Seoul, South Korea
| | - Kyung Bok Lee
- Department of Neurology, Soonchunhyang University Hospital, Seoul, South Korea
| | - Jun Lee
- Department of Neurology, Yeungnam University Medical Center, Daegu, South Korea
| | - Keun-Sik Hong
- Department of Neurology, Inje University Ilsan Paik Hospital, Goyang-si, South Korea
| | - Yong-Jin Cho
- Department of Neurology, Inje University Ilsan Paik Hospital, Goyang-si, South Korea
| | - Hong-Kyun Park
- Department of Neurology, Inje University Ilsan Paik Hospital, Goyang-si, South Korea
| | - Byung-Chul Lee
- Department of Neurology, Hallym University Sacred Heart Hospital, Anyang-si, South Korea
| | - Kyung-Ho Yu
- Department of Neurology, Hallym University Sacred Heart Hospital, Anyang-si, South Korea
| | - Mi-Sun Oh
- Department of Neurology, Hallym University Sacred Heart Hospital, Anyang-si, South Korea
| | - Dong-Eog Kim
- Department of Neurology, Dongguk University Ilsan Hospital, Goyang-si, South Korea
| | - Wi-Sun Ryu
- Department of Neurology, Dongguk University Ilsan Hospital, Goyang-si, South Korea
| | - Kang-Ho Choi
- Department of Neurology, Chonnam National University Hospital, Gwangju, South Korea
| | - Jay Chol Choi
- Department of Neurology, Jeju National University Hospital, Jeju, South Korea
| | - Joong-Goo Kim
- Department of Neurology, Jeju National University Hospital, Jeju, South Korea
| | - Jee-Hyun Kwon
- Department of Neurology, Ulsan University Hospital, Ulsan, South Korea
| | - Wook-Joo Kim
- Department of Neurology, Ulsan University Hospital, Ulsan, South Korea
| | - Dong-Ick Shin
- Department of Neurology, Chungbuk National University Hospital, Cheongju-si, South Korea
| | - Kyu Sun Yum
- Department of Neurology, Chungbuk National University Hospital, Cheongju-si, South Korea
| | - Sung-Il Sohn
- Department of Neurology, Keimyung University Dongsan Medical Center, Daegu, South Korea
| | - Jeong-Ho Hong
- Department of Neurology, Keimyung University Dongsan Medical Center, Daegu, South Korea
| | - Chulho Kim
- Department of Neurology, Hallym University Chuncheon Sacred Heart Hospital, Chuncheon-si, South Korea
| | - Sang-Hwa Lee
- Department of Neurology, Hallym University Chuncheon Sacred Heart Hospital, Chuncheon-si, South Korea
| | - Juneyoung Lee
- Department of Biostatistics, Korea University, Seoul, South Korea
| | - Mohammed A. Almekhlafi
- Calgary Stroke Program, Department of Clinical Neuroscience, Radiology and Community Health Sciences, University of Calgary, Calgary, AB, Canada
| | - Andrew Demchuk
- Calgary Stroke Program, Department of Clinical Neuroscience, Radiology and Community Health Sciences, University of Calgary, Calgary, AB, Canada
| | - Hee-Joon Bae
- Department of Neurology and Cerebrovascular Center, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam-si, South Korea
| |
Collapse
|
25
|
Ryu H, Ahn SY, Kim CK, Oh K, Han JH, Lee DW, Kim SH, Kim HJ. Hypomagnesemia as a prognostic marker of ischemic stroke. J Neurocrit Care 2022. [DOI: 10.18700/jnc.210035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
|
26
|
Nam KW, Kim CK, Yu S, Oh K, Chung JW, Bang OY, Kim GM, Jung JM, Song TJ, Kim YJ, Kim BJ, Heo SH, Park KY, Kim JM, Park JH, Choi JC, Park MS, Kim JT, Choi KH, Hwang YH, Seo WK. Plasma Total Homocysteine Level Is Related to Unfavorable Outcomes in Ischemic Stroke With Atrial Fibrillation. J Am Heart Assoc 2022; 11:e022138. [PMID: 35470699 PMCID: PMC9238578 DOI: 10.1161/jaha.121.022138] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Background Unlike patients with stroke caused by other mechanisms, the effect of elevated plasma total homocysteine (tHcy) on the prognosis of patients with both ischemic stroke and atrial fibrillation (AF) is unknown. This study aimed to evaluate the association between tHcy level and the functional outcome of patients with AF‐related stroke. Methods and Results We included consecutive patients with AF‐related stroke between 2013 and 2015 from the registry of a real‐world prospective cohort from 11 large centers in South Korea. A 3‐month modified Rankin Scale score ≥3 was considered an unfavorable outcome. Since tHcy is strongly affected by renal function, we performed a subgroup analysis according to the presence of renal dysfunction. A total of 910 patients with AF‐related stroke were evaluated (mean age, 73 years; male sex, 56.0%). The mean tHcy level was 11.98±8.81 μmol/L. In multivariable analysis, the tHcy level (adjusted odds ratio, 1.04; 95% CI, 1.01–1.07, per 1 μmol/L) remained significantly associated with unfavorable outcomes. In the subgroup analysis based on renal function, tHcy values above the cutoff point (≥14.60 μmol/L) showed a close association with the unfavorable outcome only in the normal renal function group (adjusted odds ratio, 3.10; 95% CI, 1.60–6.01). In patients with renal dysfunction, tHcy was not significantly associated with the prognosis of AF‐related stroke. Conclusions A higher plasma tHcy level was associated with unfavorable outcomes in patients with AF‐related stroke. This positive association may vary according to renal function but needs to be verified in further studies.
Collapse
Affiliation(s)
- Ki-Woong Nam
- Department of Neurology Seoul Metropolitan Government-Seoul National University Boramae Medical Center Seoul South Korea
| | - Chi Kyung Kim
- Department of Neurology Korea University Guro HospitalKorea University College of Medicine Seoul South Korea
| | - Sungwook Yu
- Department of Neurology Korea University Anam HospitalKorea University College of Medicine Seoul South Korea
| | - Kyungmi Oh
- Department of Neurology Korea University Guro HospitalKorea University College of Medicine Seoul South Korea
| | - Jong-Won Chung
- Department of Neurology Samsung Medical CenterSungkyunkwan University School of Medicine Seoul South Korea
| | - Oh Young Bang
- Department of Neurology Samsung Medical CenterSungkyunkwan University School of Medicine Seoul South Korea
| | - Gyeong-Moon Kim
- Department of Neurology Samsung Medical CenterSungkyunkwan University School of Medicine Seoul South Korea
| | - Jin-Man Jung
- Department of Neurology Korea University Ansan HospitalKorea University College of Medicine Ansan South Korea
| | - Tae-Jin Song
- Department of Neurology Ewha Womans UniversitySchool of Medicine Seoul South Korea
| | - Yong-Jae Kim
- Department of Neurology The Catholic University of Korea Seoul South Korea
| | - Bum Joon Kim
- Department of Neurology Asan Medical Center Seoul South Korea
| | - Sung Hyuk Heo
- Department of Neurology Kyung Hee University College of Medicine Seoul South Korea
| | - Kwang-Yeol Park
- Department of Neurology Chung-Ang University College of MedicineChung-Ang University Hospital Seoul South Korea
| | - Jeong-Min Kim
- Department of Neurology Seoul National University Hospital Seoul South Korea
| | - Jong-Ho Park
- Department of Neurology Myongji HospitalHanyang University College of medicine Seoul South Korea
| | - Jay Chol Choi
- Department of Neurology Jeju National University Jeju South Korea
| | - Man-Seok Park
- Department of Neurology Chonnam National University Hospital Chonnam South Korea
| | - Joon-Tae Kim
- Department of Neurology Chonnam National University Hospital Chonnam South Korea
| | - Kang-Ho Choi
- Department of Neurology Chonnam National University Hospital Chonnam South Korea
| | - Yang Ha Hwang
- Department of Neurology Kyungpook National University Hospital Dae-gu South Korea
| | - Woo-Keun Seo
- Department of Neurology Samsung Medical CenterSungkyunkwan University School of Medicine Seoul South Korea.,Departement of Digital Health SHAISTSungkyunkwan University Seoul South Korea
| |
Collapse
|
27
|
Jung S, Lee HA, Kang IS, Shin SH, Chang Y, Woo Shin D, Park MS, Kim YD, Nam HS, Heo JH, Kim TH, Yu HT, Lee JM, Heo SH, Woo HG, Park JK, Roh SY, Kim CK, Lee YS, Do JK, Kim DH, Song TJ, Park J. Clinical Implications of Atrial Fibrillation Detection Using Wearable Devices in Patients With Cryptogenic Stroke (CANDLE-AF) Trial: Design and Rationale. Front Cardiovasc Med 2022; 9:837958. [PMID: 35445088 PMCID: PMC9013795 DOI: 10.3389/fcvm.2022.837958] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Accepted: 02/28/2022] [Indexed: 11/14/2022] Open
Abstract
Background Although many electrocardiography wearable devices have been released recently for the detection of atrial fibrillation (AF), there are few studies reporting prospective data for wearable devices compared to the strategy of the existing guidelines in the detection of atrial fibrillation (AF) after cryptogenic stroke. A tiny single-patch monitor is more convenient than a conventional Holter monitor recording device and, therefore, longer duration of monitoring may be acceptable. Methods and Design The CANDLE-AF study is a multicenter, prospective, randomized controlled trial. Patients with transient ischemic attack or ischemic stroke without any history of AF will be enrolled. The superiority of the 72-h single-patch monitor to standard strategy and non-inferiority of the 72-h single-patch monitor to an event-recorder-type device will be investigated. Single-patch monitor arm will repeat monitoring at 1, 3, 6, and 12 months, event-recorder-type arm will repeat monitoring twice daily for 12 months. The enrollment goal is a total of 600 patients, and the primary outcome is the detection of AF which continues at least 30 s during study period. The secondary outcome is the rate of changes from antiplatelet to anticoagulant and major adverse cardiac and cerebrovascular events within 1 year. Conclusions The results of CANDLE-AF will clarify the role of a single-lead patch ECG for the early detection of AF in patients with acute ischemic stroke. In addition, the secondary outcome will be analyzed to determine whether more sensitive AF detection can affect the prognosis and if further device development is meaningful. (cris.nih.go.kr KCT0005592).
Collapse
Affiliation(s)
- Sodam Jung
- Division of Cardiology, Ewha Womans University Mokdong Hospital, Seoul, South Korea
| | - Hye Ah Lee
- Clinical Trial Center, Ewha Womans University Mokdong Hospital, Seoul, South Korea
| | - In Sook Kang
- Division of Cardiology, Ewha Womans University Mokdong Hospital, Seoul, South Korea
| | - Sang Hoon Shin
- Division of Cardiology, Ewha Womans University Seoul Hospital, Seoul, South Korea
| | - Yoonkyung Chang
- Division of Cardiology, Ewha Womans University Mokdong Hospital, Seoul, South Korea
| | - Dong Woo Shin
- Department of Neurology, Ewha Womans University Mokdong Hospital, Seoul, South Korea
| | - Moo-Seok Park
- Department of Neurology, Ewha Womans University Seoul Hospital, Seoul, South Korea
| | - Young Dae Kim
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea
| | - Hyo Suk Nam
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea
| | - Ji Hoe Heo
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea
| | - Tae-Hoon Kim
- Division of Cardiology, Severance Cardiovascular Hospital, Seoul, South Korea
| | - Hee Tae Yu
- Division of Cardiology, Severance Cardiovascular Hospital, Seoul, South Korea
| | - Jung Myung Lee
- Division of Cardiology, Kyung Hee University Hospital, Seoul, South Korea
| | - Sung Hyuk Heo
- Department of Neurology, Kyung Hee University Hospital, Seoul, South Korea
| | - Ho Geol Woo
- Department of Neurology, Kyung Hee University Hospital, Seoul, South Korea
| | - Jin-Kyu Park
- Division of Cardiology, Hanyang University Seoul Hospital, Seoul, South Korea
| | - Seung-Young Roh
- Devision of Cardiology, Korea University Guro Hospital, Seoul, South Korea
| | - Chi Kyung Kim
- Department of Neurology, Korea University Guro Hospital, Seoul, South Korea
| | - Young-Soo Lee
- Division of Cardiology, Daegu Catholic University Medical Center, Daegu, South Korea
| | - Jin Kuk Do
- Department of Neurology, Daegu Catholic University Medical Center, Daegu, South Korea
| | - Dong-Hyeok Kim
- Division of Cardiology, Ewha Womans University Seoul Hospital, Seoul, South Korea
- *Correspondence: Dong-Hyeok Kim
| | - Tae-Jin Song
- Department of Neurology, Ewha Womans University Seoul Hospital, Seoul, South Korea
- Tae-Jin Song
| | - Junbeom Park
- Division of Cardiology, Ewha Womans University Mokdong Hospital, Seoul, South Korea
- Junbeom Park
| | | |
Collapse
|
28
|
Jung SJ, Kim BJ, Kim CK, Shim SR, Jung JM. Antiplatelet regimens after ischemic stroke or transient ischemic attack: a systematic review and updated network meta-analysis. Ann Transl Med 2022; 10:245. [PMID: 35402589 PMCID: PMC8987873 DOI: 10.21037/atm-21-3748] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Accepted: 12/24/2021] [Indexed: 11/06/2022]
Abstract
Background Methods Results Conclusions
Collapse
Affiliation(s)
- Seung Jin Jung
- Department of Neurology, Korea University College of Medicine, Seoul, Republic of Korea
- Department of Family Medicine, Gimpo Woori Hospital, Gimpo, Republic of Korea
| | - Bum Joon Kim
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Chi Kyung Kim
- Department of Neurology, Korea University College of Medicine, Seoul, Republic of Korea
- Department of Neurology, Korea University Guro Hospital, Seoul, Republic of Korea
| | - Sung Ryul Shim
- Department of Biomedical Informatics, CHA University of Medicine, Seongnam, Republic of Korea
- Institute for Biomedical Informatics, CHA University School of Medicine, CHA University, Seongnam, Republic of Korea
| | - Jin-Man Jung
- Department of Neurology, Korea University College of Medicine, Seoul, Republic of Korea
- Department of Neurology, Korea University Ansan Hospital, Ansan, Republic of Korea
- Korea University Zebrafish Translational Medical Research Center, Ansan, Republic of Korea
| |
Collapse
|
29
|
Kim YC, Seo WK, Baek IY, Lee JE, Song HN, Chung JW, Kim CK, Oh K, Suh SI, Bang OY, Kim GM, Saver JL, Liebeskind DS. Diffusion-Weighted Imaging-Alone Endovascular Thrombectomy Triage in Acute Stroke: Simulating Diffusion-Perfusion Mismatch Using Machine Learning. J Stroke 2022; 24:148-151. [PMID: 35135068 PMCID: PMC8829488 DOI: 10.5853/jos.2021.02817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Accepted: 11/01/2021] [Indexed: 11/26/2022] Open
Affiliation(s)
- Yoon-Chul Kim
- Research Institute for Future Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Woo-Keun Seo
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
- Department of Digital Health, Samsung Advanced Institute for Health Sciences & Technology, Sungkyunkwan University, Seoul, Korea
- Correspondence: Woo-Keun Seo Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul 06351, Korea Tel: +82-2-3410-0799 Fax: +82-2-3410-0630 E-mail:
| | - In-Young Baek
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Ji-Eun Lee
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Ha-Na Song
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jong-Won Chung
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Chi Kyung Kim
- Department of Neurology, Korea University College of Medicine, Seoul, Korea
| | - Kyungmi Oh
- Department of Neurology, Korea University College of Medicine, Seoul, Korea
| | - Sang-il Suh
- Department of Radiology, Korea University College of Medicine, Seoul, Korea
| | - Oh Young Bang
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Gyeong-Moon Kim
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jeffrey L. Saver
- Department of Neurology, University of California in Los Angeles, Los Angeles, CA, USA
| | - David S. Liebeskind
- Department of Neurology, University of California in Los Angeles, Los Angeles, CA, USA
| |
Collapse
|
30
|
Kim BJ, Hwang YH, Park MS, Kim JT, Choi KH, Jung JM, Yu S, Kim CK, Oh K, Song TJ, Kim YJ, Park KY, Kim JM, Park JH, Choi JC, Chung JW, Bang OY, Kim GM, Heo SH, Seo WK. Atrial Fibrillation Related and Unrelated Stroke Recurrence Among Ischemic Stroke Patients With Atrial Fibrillation. Front Neurol 2021; 12:744607. [PMID: 34744981 PMCID: PMC8566747 DOI: 10.3389/fneur.2021.744607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Accepted: 09/21/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Ischemic stroke with atrial fibrillation (AF) may recur despite appropriate treatment. It may be AF-related or AF-unrelated. We compared the factors associated with AF-related and AF-unrelated recurrences among ischemic stroke patients with AF. Methods: Patients with ischemic stroke and AF were enrolled from 11 centers in Korea. Ischemic stroke recurrence was classified as AF-related if the lesion pattern was compatible with cardioembolism without significant stenosis or as AF-unrelated if the lesion was more likely due to small vessel disease or arterial stenosis. Factors associated with stroke recurrence (AF-related and AF-unrelated) were investigated. Results: Among the 2,239 patients, 115 (5.1%) experienced recurrence (75 AF-related and 40 AF-unrelated). Factors independently associated with any stroke recurrence included AF diagnosed before stroke, small subcortical infarctions, and small scattered lesions in a single vascular territory. Type of AF was associated with the type of stroke recurrence, with persistent AF being associated with AF-related stroke [hazard ratio (HR) = 2.94, 95% confidence interval (CI) 1.69-5.26; p < 0.001]. By contrast, paroxysmal AF (HR = 3.76, 95% CI 1.56-9.04; p = 0.003), AF diagnosed before stroke (HR = 2.38, 95% CI 1.19-4.55; p = 0.014), small scattered lesions in a single vascular territory (reference: corticosubcortical lesion, HR = 3.19, 95% CI 1.18-8.63; p = 0.022), and the use of antiplatelet agents (HR = 2.11, 95% CI 1.11-4.03; p = 0.024) were independently associated with AF-unrelated stroke. Conclusion: Persistent AF was more associated with AF-related stroke recurrence, whereas paroxysmal AF was more associated with AF-unrelated stroke recurrence. A scattered lesion in a single vascular territory may predict AF-unrelated stroke recurrence.
Collapse
Affiliation(s)
- Bum Joon Kim
- Department of Neurology, Asan Medical Center, Seoul, South Korea
| | - Yang-Ha Hwang
- Department of Neurology, Kyungpook National University Hospital, Daegu, South Korea
| | - Man-Seok Park
- Department of Neurology, Chonnam National University Hospital, Gwangju, South Korea
| | - Joon-Tae Kim
- Department of Neurology, Chonnam National University Hospital, Gwangju, South Korea
| | - Kang-Ho Choi
- Department of Neurology, Chonnam National University Hospital, Gwangju, South Korea
| | - Jin-Man Jung
- Department of Neurology, Korea University Ansan Hospital, Ansan, South Korea
| | - Sungwook Yu
- Department of Neurology, Korea University Anam Hospital, Seoul, South Korea
| | - Chi Kyung Kim
- Department of Neurology, Korea University Guro Hospital, Seoul, South Korea
| | - Kyungmi Oh
- Department of Neurology, Korea University Guro Hospital, Seoul, South Korea
| | - Tae-Jin Song
- Department of Neurology, Ewha Womans University Seoul Hospital, Seoul, South Korea
| | - Yong-Jae Kim
- Department of Neurology, Eunpyeong St. Mary's Hospital, The Catholic University of Korea, Seoul, South Korea
| | - Kwang-Yeol Park
- Department of Neurology, Chung-Ang University Hospital, Seoul, South Korea
| | - Jeong-Min Kim
- Department of Neurology, Seoul National University Hospital, Seoul, South Korea
| | - Jong-Ho Park
- Department of Neurology, Myongji Hospital, Hanyang University College of Medicine, Goyang, South Korea
| | - Jay Chol Choi
- Department of Neurology, Jeju National University Hospital, Jeju, South Korea
| | - Jong-Won Chung
- Department of Neurology, Samsung Medical Center, Seoul, South Korea
| | - Oh Young Bang
- Department of Neurology, Samsung Medical Center, Seoul, South Korea
| | - Gyeong-Moon Kim
- Department of Neurology, Samsung Medical Center, Seoul, South Korea
| | - Sung Hyuk Heo
- Department of Neurology, Kyung Hee University Hospital, Seoul, South Korea
| | - Woo-Keun Seo
- Department of Neurology, Samsung Medical Center, Seoul, South Korea
| |
Collapse
|
31
|
Kim SH, Jeon ET, Yu S, Kyungmi O, Kim CK, Song TJ, Kim YJ, Heo SH, Park KY, Kim JM, Park JH, Choi JC, Park MS, Kim JT, Choi KH, Hwang YH, Kim BJ, Chung JW, Bang OY, Kim G, Seo WK, Jung JM. Interpretable machine learning for early neurological deterioration prediction in atrial fibrillation-related stroke. J Neurol Sci 2021. [DOI: 10.1016/j.jns.2021.118754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
32
|
Nam HS, Kim YD, Choi JK, Baik M, Kim BM, Kim DJ, Heo J, Shin DH, Lee KY, Jung YH, Baek JH, Hwang YH, Sohn SI, Hong JH, Park H, Kim CK, Kim GS, Seo KD, Lee K, Seo JH, Bang OY, Seo WK, Chung JW, Chang JY, Kwon SU, Lee J, Kim J, Yoo J, Song TJ, Ahn SH, Cho BH, Cho HJ, Kim JG, Chang Y, Lee CJ, Park S, Park G, Lee HS. Outcome in Patients Treated with Intra-arterial thrombectomy: The optiMAL Blood Pressure control (OPTIMAL-BP) Trial. Int J Stroke 2021; 17:17474930211041213. [PMID: 34427481 DOI: 10.1177/17474930211041213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
RATIONALE Very early stage blood pressure (BP) levels may affect outcome in stroke patients who have successfully undergone recanalization following intra-arterial treatment, but the optimal target of BP management remains uncertain. AIM We hypothesized that the clinical outcome after intensive BP-lowering is superior to conventional BP control after successful recanalization by intra-arterial treatment. SAMPLE-SIZE ESTIMATES We aim to randomize 668 patients (334 per arm), 1:1. METHODS AND DESIGN We initiated a multicenter, prospective, randomized, open-label trial with a blinded end-point assessment (PROBE) design. After successful recanalization (thrombolysis in cerebral infarction score ≥ 2 b), patients with elevated systolic BP level, defined as the mean of two readings ≥ 140 mmHg, will be randomly assigned to the intensive BP-lowering (systolic BP < 140 mm Hg) group or the conventional BP-lowering (systolic BP, 140-180 mm Hg) group. STUDY OUTCOMES The primary efficacy outcomes are from dichotomized analysis of modified Rankin Scale (mRS) scores at three months (mRS scores: 0-2 vs. 3-6). The primary safety outcomes are symptomatic intracerebral hemorrhage and death within three months. DISCUSSION The OPTIMAL-BP trial will provide evidence for the effectiveness of active BP control to achieve systolic BP < 140 mmHg during 24 h in patients with successful recanalization after intra-arterial treatment. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT04205305.
Collapse
Affiliation(s)
- Hyo Suk Nam
- Department of Neurology, Yonsei University College of Medicine, Seoul, Korea
| | - Young Dae Kim
- Department of Neurology, Yonsei University College of Medicine, Seoul, Korea
| | - Jin Kyo Choi
- Department of Neurology, Yonsei University College of Medicine, Seoul, Korea
| | - Minyoul Baik
- Department of Neurology, Yonsei University College of Medicine, Seoul, Korea
| | - Byung Moon Kim
- Department of Radiology, Yonsei University College of Medicine, Seoul, Korea
| | - Dong Joon Kim
- Department of Radiology, Yonsei University College of Medicine, Seoul, Korea
| | - JoonNyung Heo
- Department of Neurology, Yonsei University College of Medicine, Seoul, Korea
| | - Dong Hoon Shin
- Department of Neurology, Gachon University Gil Medical Center, Incheon, Korea
| | - Kyung-Yul Lee
- Department of Neurology, Yonsei University College of Medicine, Gangnam Severance Hospital, Seoul, Korea
| | - Yo Han Jung
- Department of Neurology, Yonsei University College of Medicine, Gangnam Severance Hospital, Seoul, Korea
| | - Jang-Hyun Baek
- Department of Neurology, Sungkyunkwan University School of Medicine, Kangbuk Samsung Hospital, Seoul, Korea
| | - Yang-Ha Hwang
- Department of Neurology, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu, South Korea
| | - Sung-Il Sohn
- Department of Neurology, Brain Research Institute, Keimyung University School of Medicine, Daegu, Korea
| | - Jeong-Ho Hong
- Department of Neurology, Brain Research Institute, Keimyung University School of Medicine, Daegu, Korea
| | - Hyungjong Park
- Department of Neurology, Brain Research Institute, Keimyung University School of Medicine, Daegu, Korea
| | - Chi Kyung Kim
- Department of Neurology, Korea University Guro Hospital and College of Medicine, Seoul, Korea
| | - Gyu Sik Kim
- National Health Insurance Service Ilsan Hospital, Goyang, Korea
| | - Kwon-Duk Seo
- National Health Insurance Service Ilsan Hospital, Goyang, Korea
| | - Kijeong Lee
- National Health Insurance Service Ilsan Hospital, Goyang, Korea
| | - Jung Hwa Seo
- Department of Neurology, Inje University College of Medicine, Busan Paik Hospital, Busan, South Korea
| | - Oh Young Bang
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Woo-Keun Seo
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jong-Won Chung
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jun Young Chang
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Sun U Kwon
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jun Lee
- Department of Neurology, Yeungnam University School of Medicine, Daegu, Korea
| | - Jinkwon Kim
- Department of Neurology, Yonsei University College of Medicine, Yongin Severance Hospital, Yongin, Korea
| | - Joonsang Yoo
- National Health Insurance Service Ilsan Hospital, Goyang, Korea
- Department of Neurology, Yonsei University College of Medicine, Yongin Severance Hospital, Yongin, Korea
| | - Tae-Jin Song
- Department of Neurology, College of Medicine, Ewha Woman's University, Seoul Hospital, Seoul, Korea
| | - Seong Hwan Ahn
- Department of Neurology, Chosun University School of Medicine, Gwangju, Korea
| | - Bang-Hoon Cho
- Department of Neurology, Korea University Anam Hospital and College of Medicine, Seoul, Korea
| | - Han-Jin Cho
- Department of Neurology, Pusan National University School of Medicine, Busan, Korea
| | - Jae Guk Kim
- Department of Neurology, Daejeon Eulji Medical Center, Eulji University School of Medicine, Daejon, Korea
| | - Yoonkyung Chang
- Department of Neurology, Ewha Womans University College of Medicine, Mokdong Hospital, Seoul, Korea
| | - Chan Joo Lee
- Department of Health Promotion, Yonsei University College of Medicine, Severance Hospital, Seoul, Republic of Korea
| | - Sungha Park
- Department of Health Promotion, Yonsei University College of Medicine, Severance Hospital, Seoul, Republic of Korea
- Cardiovascular Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Goeun Park
- Department of Research Affairs, Biostatistics Collaboration Unit, Yonsei University College of Medicine, Seoul, Korea
| | - Hye S Lee
- Department of Research Affairs, Biostatistics Collaboration Unit, Yonsei University College of Medicine, Seoul, Korea
| |
Collapse
|
33
|
Kang DO, Eo JS, Park EJ, Nam HS, Song JW, Park YH, Park SY, Na JO, Choi CU, Kim EJ, Rha SW, Park CG, Seo HS, Kim CK, Yoo H, Kim JW. Stress-associated neurobiological activity is linked with acute plaque instability via enhanced macrophage activity: a prospective serial 18F-FDG-PET/CT imaging assessment. Eur Heart J 2021; 42:1883-1895. [PMID: 33462618 DOI: 10.1093/eurheartj/ehaa1095] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Revised: 07/07/2020] [Accepted: 12/23/2020] [Indexed: 01/28/2023] Open
Abstract
AIMS Emotional stress is associated with future cardiovascular events. However, the mechanistic linkage of brain emotional neural activity with acute plaque instability is not fully elucidated. We aimed to prospectively estimate the relationship between brain amygdalar activity (AmygA), arterial inflammation (AI), and macrophage haematopoiesis (HEMA) in acute myocardial infarction (AMI) as compared with controls. METHODS AND RESULTS 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG-PET/CT) imaging was performed within 45 days of the index episode in 62 patients (45 with AMI, mean 60.0 years, 84.4% male; 17 controls, mean 59.6 years, 76.4% male). In 10 patients of the AMI group, serial 18F-FDG-PET/CT imaging was performed after 6 months to estimate the temporal changes. The signals were compared using a customized 3D-rendered PET reconstruction. AmygA [target-to-background ratio (TBR), mean ± standard deviation: 0.65 ± 0.05 vs. 0.60 ± 0.05; P = 0.004], carotid AI (TBR: 2.04 ± 0.39 vs. 1.81 ± 0.25; P = 0.026), and HEMA (TBR: 2.60 ± 0.38 vs. 2.22 ± 0.28; P < 0.001) were significantly higher in AMI patients compared with controls. AmygA correlated significantly with those of the carotid artery (r = 0.350; P = 0.005), aorta (r = 0.471; P < 0.001), and bone marrow (r = 0.356; P = 0.005). Psychological stress scales (PHQ-9 and PSS-10) and AmygA assessed by PET/CT imaging correlated well (P < 0.001). Six-month after AMI, AmygA, carotid AI, and HEMA decreased to a level comparable with the controls. CONCLUSION AmygA, AI, and HEMA were concordantly enhanced in patients with AMI, showing concurrent dynamic changes over time. These results raise the possibility that stress-associated neurobiological activity is linked with acute plaque instability via augmented macrophage activity and could be a potential therapeutic target for plaque inflammation in AMI.
Collapse
Affiliation(s)
- Dong Oh Kang
- Multimodal Imaging and Theranostic Lab, Cardiovascular Center, Korea University Guro Hospital, 148 Gurodong-ro, Guro-gu, Seoul 08308, Republic of Korea.,Cardiovascular Center, Korea University Guro Hospital, 148 Gurodong-ro, Guro-gu, Seoul 08308, Republic of Korea
| | - Jae Seon Eo
- Department of Nuclear Medicine, Korea University Guro Hospital, 148 Gurodong-ro, Guro-gu, Seoul 08308, Republic of Korea
| | - Eun Jin Park
- Multimodal Imaging and Theranostic Lab, Cardiovascular Center, Korea University Guro Hospital, 148 Gurodong-ro, Guro-gu, Seoul 08308, Republic of Korea.,Cardiovascular Center, Korea University Guro Hospital, 148 Gurodong-ro, Guro-gu, Seoul 08308, Republic of Korea
| | - Hyeong Soo Nam
- Department of Mechanical Engineering, Korea Advanced Institute of Science and Technology, 291 Daehak-ro, Yuseong-gu, Daejeon 34141, Republic of Korea
| | - Joon Woo Song
- Multimodal Imaging and Theranostic Lab, Cardiovascular Center, Korea University Guro Hospital, 148 Gurodong-ro, Guro-gu, Seoul 08308, Republic of Korea
| | - Ye Hee Park
- Multimodal Imaging and Theranostic Lab, Cardiovascular Center, Korea University Guro Hospital, 148 Gurodong-ro, Guro-gu, Seoul 08308, Republic of Korea
| | - So Yeon Park
- Multimodal Imaging and Theranostic Lab, Cardiovascular Center, Korea University Guro Hospital, 148 Gurodong-ro, Guro-gu, Seoul 08308, Republic of Korea
| | - Jin Oh Na
- Cardiovascular Center, Korea University Guro Hospital, 148 Gurodong-ro, Guro-gu, Seoul 08308, Republic of Korea
| | - Cheol Ung Choi
- Cardiovascular Center, Korea University Guro Hospital, 148 Gurodong-ro, Guro-gu, Seoul 08308, Republic of Korea
| | - Eung Ju Kim
- Cardiovascular Center, Korea University Guro Hospital, 148 Gurodong-ro, Guro-gu, Seoul 08308, Republic of Korea
| | - Seung-Woon Rha
- Cardiovascular Center, Korea University Guro Hospital, 148 Gurodong-ro, Guro-gu, Seoul 08308, Republic of Korea
| | - Chang Gyu Park
- Cardiovascular Center, Korea University Guro Hospital, 148 Gurodong-ro, Guro-gu, Seoul 08308, Republic of Korea
| | - Hong Seog Seo
- Cardiovascular Center, Korea University Guro Hospital, 148 Gurodong-ro, Guro-gu, Seoul 08308, Republic of Korea
| | - Chi Kyung Kim
- Department of Neurology, Korea University Guro Hospital, 148 Gurodong-ro, Guro-gu, Seoul 08308, Republic of Korea
| | - Hongki Yoo
- Department of Mechanical Engineering, Korea Advanced Institute of Science and Technology, 291 Daehak-ro, Yuseong-gu, Daejeon 34141, Republic of Korea
| | - Jin Won Kim
- Multimodal Imaging and Theranostic Lab, Cardiovascular Center, Korea University Guro Hospital, 148 Gurodong-ro, Guro-gu, Seoul 08308, Republic of Korea.,Cardiovascular Center, Korea University Guro Hospital, 148 Gurodong-ro, Guro-gu, Seoul 08308, Republic of Korea
| |
Collapse
|
34
|
Park JH, Chung JW, Bang OY, Kim GM, Choi KH, Park MS, Kim JT, Hwang YH, Song TJ, Kim YJ, Kim BJ, Heo SH, Jung JM, Oh K, Kim CK, Yu S, Park KY, Kim JM, Choi JC, Seo WK. Atherosclerotic Burden and Vascular Risk in Stroke Patients With Atrial Fibrillation. Stroke 2021; 52:1662-1672. [PMID: 33794654 DOI: 10.1161/strokeaha.120.032232] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
[Figure: see text].
Collapse
Affiliation(s)
- Jong-Ho Park
- Department of Neurology, Myongji Hospital, Hanyang University College of Medicine, Goyang, Korea (J.-H.P.)
| | - Jong-Won Chung
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea (J.-W.C., O.Y.B., G.-M.K., W.-K.S.)
| | - Oh Young Bang
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea (J.-W.C., O.Y.B., G.-M.K., W.-K.S.)
| | - Gyeong-Moon Kim
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea (J.-W.C., O.Y.B., G.-M.K., W.-K.S.)
| | - Kang-Ho Choi
- Department of Neurology, Chonnam National University Hospital, Gwangju, Korea (K.-H.C., M.-S.P., J.-T.K.)
| | - Man-Seok Park
- Department of Neurology, Chonnam National University Hospital, Gwangju, Korea (K.-H.C., M.-S.P., J.-T.K.)
| | - Joon-Tae Kim
- Department of Neurology, Chonnam National University Hospital, Gwangju, Korea (K.-H.C., M.-S.P., J.-T.K.)
| | - Yang-Ha Hwang
- Department of Neurology, Kyungpook National University Hospital, School of Medicine, Kyungpook National University, Daegu, Korea (Y.-H.H.)
| | - Tae-Jin Song
- Department of Neurology, Ewha Womans University Seoul Hospital, Ewha Womans University College of Medicine, Seoul, Korea (T.-J.S.)
| | - Yong-Jae Kim
- Department of Neurology, Eunpyeong St. Mary's Hospital, The Catholic University of Korea, Seoul (Y.-J.K.)
| | - Bum Joon Kim
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea (B.J.K.)
| | - Sung Hyuk Heo
- Department of Neurology, Kyung Hee University College of Medicine, Seoul, Korea (S.H.H.)
| | - Jin-Man Jung
- Department of Neurology, Korea University Ansan Hospital (J.-M.J.), Korea University College of Medicine
| | - Kyungmi Oh
- Department of Neurology, Korea University Guro Hospital (K.O., C.K.K.), Korea University College of Medicine
| | - Chi Kyung Kim
- Department of Neurology, Korea University Guro Hospital (K.O., C.K.K.), Korea University College of Medicine
| | - Sungwook Yu
- Department of Neurology, Korea University Anam Hospital (S.Y.), Korea University College of Medicine
| | - Kwang Yeol Park
- Department of Neurology, Chung-Ang University College of Medicine, Seoul, Korea (K.Y.P.)
| | - Jeong-Min Kim
- Department of Neurology, Seoul National University Hospital, Korea (J.-M.K.)
| | - Jay Chol Choi
- Department of Neurology, Jeju National University, Korea (J.C.C.)
| | - Woo-Keun Seo
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea (J.-W.C., O.Y.B., G.-M.K., W.-K.S.)
| |
Collapse
|
35
|
Nam KW, Kim CK, Yu S, Chung JW, Bang OY, Kim GM, Jung JM, Song TJ, Kim YJ, Kim BJ, Heo SH, Park KY, Kim JM, Park JH, Choi JC, Park MS, Kim JT, Choi KH, Hwang YH, Oh K, Seo WK. Pre-Admission CHADS2 and CHA2DS2-VASc Scores on Early Neurological Worsening. Cerebrovasc Dis 2021; 50:288-295. [PMID: 33588410 DOI: 10.1159/000513396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Accepted: 11/19/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Stroke risk scores (CHADS2 and CHA2DS2-VASc) not only predict the risk of stroke in atrial fibrillation (AF) patients, but have also been associated with prognosis after stroke. OBJECTIVE The aim of this study was to evaluate the relationship between stroke risk scores and early neurological deterioration (END) in ischemic stroke patients with AF. METHODS We included consecutive ischemic stroke patients with AF admitted between January 2013 and December 2015. CHADS2 and CHA2DS2-VASc scores were calculated using the established scoring system. END was defined as an increase ≥2 on the total National Institutes of Health Stroke Scale (NIHSS) score or ≥1 on the motor NIHSS score within the first 72 h of admission. RESULTS A total of 2,099 ischemic stroke patients with AF were included. In multivariable analysis, CHA2DS2-VASc score (adjusted odds ratio [aOR] = 1.17, 95% confidence interval [CI] = 1.04-1.31) was significantly associated with END after adjusting for confounders. Initial NIHSS score, use of anticoagulants, and intracranial atherosclerosis (ICAS) were also found to be closely associated with END, independent of the CHA2DS2-VASc score. Multivariable analysis stratified by the presence of ICAS demonstrated that both CHA2DS2-VASc (aOR = 1.20, 95% CI = 1.04-1.38) and CHADS2 scores (aOR = 1.24, 95% CI = 1.01-1.52) were closely related to END in only patients with ICAS. In patients without ICAS, neither of the risk scores were associated with END. CONCLUSIONS High CHA2DS2-VASc score was associated with END in ischemic stroke patients with AF. This close relationship is more pronounced in patients with ICAS.
Collapse
Affiliation(s)
- Ki-Woong Nam
- Department of Neurology, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Chi Kyung Kim
- Department of Neurology, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Sungwook Yu
- Department of Neurology, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Jong-Won Chung
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Oh Young Bang
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Gyeong-Moon Kim
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Jin-Man Jung
- Department of Neurology, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, Republic of Korea
| | - Tae-Jin Song
- Department of Neurology, Ewha Womans University, School of Medicine, Seoul, Republic of Korea
| | - Yong-Jae Kim
- Department of Neurology, The Catholic University of Korea, Seoul, Republic of Korea
| | - Bum Joon Kim
- Department of Neurology, Kyung Hee University College of Medicine, Seoul, Republic of Korea
| | - Sung Hyuk Heo
- Department of Neurology, Kyung Hee University College of Medicine, Seoul, Republic of Korea
| | - Kwang-Yeol Park
- Department of Neurology, Chung-Ang University College of Medicine, Chung-Ang University Hospital, Seoul, Republic of Korea
| | - Jeong-Min Kim
- Department of Neurology, Chung-Ang University College of Medicine, Chung-Ang University Hospital, Seoul, Republic of Korea
| | - Jong-Ho Park
- Department of Neurology, Myongji Hospital, Hanyang University College of Medicine, Seoul, Republic of Korea
| | - Jay Chol Choi
- Department of Neurology, Jeju National University, Jeju, Republic of Korea
| | - Man-Seok Park
- Department of Neurology, Chonnam National University Hospital, Chonnam, Chonnam, Republic of Korea
| | - Joon-Tae Kim
- Department of Neurology, Chonnam National University Hospital, Chonnam, Chonnam, Republic of Korea
| | - Kang-Ho Choi
- Department of Neurology, Chonnam National University Hwasun Hospital, Hwasun, Republic of Korea
| | - Yang Ha Hwang
- Department of Neurology, Kyungpook National University Hospital, Dae-gu, Dae-gu, Republic of Korea
| | - Kyungmi Oh
- Department of Neurology, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Woo-Keun Seo
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea, .,Department of Digital Health, SHAIST, Sungkyunkwan University, Seoul, Republic of Korea,
| |
Collapse
|
36
|
Eun MY, Kim JY, Hwang YH, Park MS, Kim JT, Choi KH, Jung JM, Yu S, Kim CK, Oh K, Song TJ, Kim YJ, Kim BJ, Heo SH, Park KY, Kim JM, Park JH, Choi JC, Chung JW, Bang OY, Kim GM, Seo WK. Initiation of Guideline-Matched Oral Anticoagulant in Atrial Fibrillation-Related Stroke. J Stroke 2021; 23:113-123. [PMID: 33600708 PMCID: PMC7900398 DOI: 10.5853/jos.2020.03440] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Accepted: 11/19/2020] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND AND PURPOSE To evaluate the outcome events and bleeding complications of the European Society of Cardiology (ESC) guideline-matched oral anticoagulant therapy for patients with acute ischemic stroke and atrial fibrillation (AF). METHODS Patients with acute ischemic stroke and AF from a nationwide multicenter registry (Korean ATrial fibrillaTion EvaluatioN regisTry in Ischemic strOke patieNts [K-ATTENTION]) between January 2013 and December 2015 were included in the study. Patients were divided into the ESC guideline-matched and the non-matched groups. The primary outcome was recurrence of any stroke during the 90-day follow-up period. Secondary outcomes were major adverse cerebrovascular and cardiovascular events, ischemic stroke, intracranial hemorrhage, acute coronary syndrome, allcause mortality, and major hemorrhage. Propensity score matching and logistic regression analyses were performed to assess the effect of the treatments administered. RESULTS Among 2,321 eligible patients, 1,126 patients were 1:1 matched to the ESC guidelinematched and the non-matched groups. As compared with the non-matched group, the ESC guideline-matched group had a lower risk of any recurrent stroke (1.4% vs. 3.4%; odds ratio [OR], 0.41; 95% confidence interval [CI], 0.18 to 0.95). The risk of recurrent ischemic stroke was lower in the ESC guideline-matched group than in the non-matched group (0.9% vs. 2.7%; OR, 0.32; 95% CI, 0.11 to 0.88). There was no significant difference in the other secondary outcomes between the two groups. CONCLUSIONS ESC guideline-matched oral anticoagulant therapy was associated with reduced risks of any stroke and ischemic stroke as compared with the non-matched therapy.
Collapse
Affiliation(s)
- Mi-Yeon Eun
- Department of Neurology, Kyungpook National University Chilgok Hospital, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Jae-Young Kim
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.,Department of Digital Health, Samsung Advanced Institute for Health Sciences & Technology, Sungkyunkwan University, Seoul, Korea
| | - Yang-Ha Hwang
- Department of Neurology, Kyungpook National University Hospital, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Man-Seok Park
- Department of Neurology, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Korea
| | - Joon-Tae Kim
- Department of Neurology, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Korea
| | - Kang-Ho Choi
- Department of Neurology, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Korea
| | - Jin-Man Jung
- Department of Neurology, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, Korea
| | - Sungwook Yu
- Department of Neurology, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea
| | - Chi Kyung Kim
- Department of Neurology, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Kyungmi Oh
- Department of Neurology, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Tae-Jin Song
- Department of Neurology, Ewha Womans University Seoul Hospital, Ewha Womans University School of Medicine, Seoul, Korea
| | - Yong-Jae Kim
- Department of Neurology, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Kore, Seoul, Korea
| | - Bum Joon Kim
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Sung Hyuk Heo
- Department of Neurology, Kyung Hee University Hospital, Kyung Hee University School of Medicine, Seoul, Korea
| | - Kwang-Yeol Park
- Department of Neurology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea
| | - Jeong-Min Kim
- Department of Neurology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea
| | - Jong-Ho Park
- Department of Neurology, Myongji Hospital, Hanyang University College of Medicine, Goyang, Korea
| | - Jay Chol Choi
- Department of Neurology, Jeju National University Hospital, Jeju National University College of Medicine, Jeju, Korea
| | - Jong-Won Chung
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Oh Young Bang
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Gyeong-Moon Kim
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Woo-Keun Seo
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.,Department of Digital Health, Samsung Advanced Institute for Health Sciences & Technology, Sungkyunkwan University, Seoul, Korea
| |
Collapse
|
37
|
Yu I, Song TJ, Kim BJ, Heo SH, Jung JM, Oh KM, Kim CK, Yu S, Park KY, Kim JM, Park JH, Choi JC, Park MS, Kim JT, Hwang YH, Chung JW, Bang OY, Kim GM, Kim YJ, Kim S, Woo SY, Cho H, Seo WK. CHADS2, CHA2DS2-VASc, ATRIA, and Essen stroke risk scores in stroke with atrial fibrillation: A nationwide multicenter registry study. Medicine (Baltimore) 2021; 100:e24000. [PMID: 33545993 PMCID: PMC7837865 DOI: 10.1097/md.0000000000024000] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Accepted: 11/25/2020] [Indexed: 11/27/2022] Open
Abstract
The performance of scoring systems for risk stratification in patients with atrial fibrillation (AF) was not validated well in patients with stroke. The purpose of this study was to evaluate whether the risk scoring systems predict vascular outcomes in stroke patients with AF.Data were obtained from a nationwide multicenter registry for acute stroke with AF from January 1, 2013, to December 31, 2015. We investigated the predictive power of the CHADS2, CHA2DS2-VASc, ATRIA, and Essen stroke scores in stroke patients with AF. The subjects were further stratified into groups according to treatment with or without oral anticoagulants (OACs).A total of 3112 stroke with AF subjects were included. The rate of recurrent ischemic stroke and any stroke were not associated with the CHADS2, CHA2DS2-VASc, ATRIA, and Essen stroke risk scores. The risks of death and major adverse cerebrovascular and cardiovascular events (MACEs) increased sequentially with the increase of each risk score in OAC group. (the range of C-index 0.544-0.558 for recurrent ischemic stroke; 0.523-0.537 for any stroke; 0.580-0.597 for death; 0.564-0.583 for MACEs). However, in the group treated with OACs, all risk scores were significantly associated with the risk of MACEs. The C-statistics of the 4 scoring systems were 0.544 to 0.558, 0.523 to 0.537, 0.580 to 0.597, 0.564 to 0.583, respectively, for recurrent ischemic stroke, any stroke, death, and MACEs.The performance of the CHADS2, CHA2DS2-VASc, ATRIA, and Essen stroke risk scores for the prediction of recurrent stroke was unsatisfactory in stroke patients with AF whereas the performance for the prediction of recurrent stroke was not MACEs or death was good. A new risk stratification scheme that is specific for secondary stroke prevention in the AF population is needed.
Collapse
Affiliation(s)
- Inwu Yu
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine
| | - Tae-Jin Song
- Department of Neurology, Seoul Hospital Ewha Womans University College of Medicine
| | - Bum Joon Kim
- Department of Neurology, Stroke Center, Asan Medical Center
| | - Sung Hyuk Heo
- Department of Neurology, Kyung Hee University College of Medicine, Seoul
| | - Jin-Man Jung
- Department of Neurology, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, Kyungki-Do
| | - Kyung-Mi Oh
- Department of Neurology, Korea University Guro Hospital
| | - Chi Kyung Kim
- Department of Neurology, Korea University Guro Hospital
| | - Sungwook Yu
- Department of Neurology, Korea University Anam Hospital, Korea University College of Medicine
| | - Kwang Yeol Park
- Department of Neurology, Chung-Ang University College of Medicine
| | - Jeong-Min Kim
- Department of Neurology, Seoul National University Hospital, Seoul
| | - Jong-Ho Park
- Department of Neurology, Myongji Hospital, Hanyang University College of Medicine, Goyang
| | - Jay Chol Choi
- Department of Neurology, Jeju National University, Jeju
| | - Man-Seok Park
- Department of Neurology, Chonnam National University Hospital, Gwangju
| | - Joon-Tae Kim
- Department of Neurology, Chonnam National University Hospital, Gwangju
| | - Yang-Ha Hwang
- Department of Neurology, Cerebrovascular Center, Kyungpook National University School of Medicine and Hospital, Daegu
| | - Jong-Won Chung
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine
| | - Oh Young Bang
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine
| | - Geong-Moon Kim
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine
| | - Yong-Jae Kim
- Department of Neurology, Eunpyeong St. Mary's Hospital, the Catholic University of Korea
| | - Seonwoo Kim
- Statistics and Data Center, Samsung Medical Center, Seoul, Republic of Korea
| | - Sook young Woo
- Statistics and Data Center, Samsung Medical Center, Seoul, Republic of Korea
| | - Hyun Cho
- Statistics and Data Center, Samsung Medical Center, Seoul, Republic of Korea
| | - Woo-Keun Seo
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine
| |
Collapse
|
38
|
Chang Y, Kim CK, Kim MK, Seo WK, Oh K. Insulin resistance is associated with poor functional outcome after acute ischemic stroke in non-diabetic patients. Sci Rep 2021; 11:1229. [PMID: 33441784 PMCID: PMC7806587 DOI: 10.1038/s41598-020-80315-z] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Accepted: 11/17/2020] [Indexed: 11/24/2022] Open
Abstract
Insulin resistance is associated with the occurrence of stroke and atherosclerotic disease. However, the relationship between insulin resistance and the prognosis of acute ischemic stroke in non-diabetic patients is unclear. We hypothesized that insulin resistance might affect short-term functional recovery after acute ischemic stroke in non-diabetic patients. Between May 2014 and December 2016, 1377 consecutive patients with acute ischemic stroke were enrolled from a prospectively maintained stroke registry. After excluding patients with transient ischemic attacks (TIA), pre-stroke disabilities, diabetes mellitus, and patients with incomplete evaluations, 517 patients were included in the study. The homeostasis model assessment of insulin resistance (HOMA-IR) score was used to evaluate the degree of insulin resistance. The patients with the highest quartile of log HOMA-IR index scores were younger and had higher fasting blood glucose, total cholesterol, triglycerides, low-density lipoprotein, and HbA1c levels. Multivariable logistic regression analysis revealed that log HOMA-IR scores were independently associated with poor prognosis after adjusting for age and sex and p < 0.1 in univariable analysis. Insulin resistance was associated with the poor functional outcome of non-diabetic stroke patients. This evidence supports treating insulin resistance in acute ischemic stroke patients with blood glucose levels within the normal range.
Collapse
Affiliation(s)
- Yoonkyung Chang
- Department of Neurology, Ewha Womans University Mokdong Hospital and Ewha University College of Medicine, 1071 Anyangcheon-ro, Yangcheon-gu, Seoul, South Korea
| | - Chi Kyung Kim
- Department of Neurology, Korea University Guro Hospital and Korea University College of Medicine, 148 Gurodong-Ro, Guro-gu, Seoul, 08308, South Korea
| | - Min-Kyung Kim
- Department of Neurology, Korea University Guro Hospital and Korea University College of Medicine, 148 Gurodong-Ro, Guro-gu, Seoul, 08308, South Korea
| | - Woo-Keun Seo
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81, Irwon-ro, Gangnam-gu, Seoul, South Korea
| | - Kyungmi Oh
- Department of Neurology, Korea University Guro Hospital and Korea University College of Medicine, 148 Gurodong-Ro, Guro-gu, Seoul, 08308, South Korea.
| |
Collapse
|
39
|
Kim JH, Yoon W, Kim CK, Roh H, Bae HJ, Kwon TH, Suh SI, Oh K, Chong K. Efficacy and Safety of Timely Urgent Superficial Temporal Artery-to-Middle Cerebral Artery Bypass Surgery in Patients with Acute Ischemic Stroke: A Single-Institutional Prospective Study and a Pooled Analysis. Cerebrovasc Dis 2021; 50:34-45. [PMID: 33423028 DOI: 10.1159/000512106] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Accepted: 10/03/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Clinical outcome in patients with acute ischemic stroke (AIS) caused by large vessel occlusion (LVO) is not satisfactory if reperfusion treatment fails or is not tried. AIMS We aimed to assess the efficacy and safety of urgent superficial temporal-to-middle cerebral artery (STA-MCA) bypass surgery in selected patients. METHODS Patients who were diagnosed with LVO-induced AIS in the anterior circulation but had a failed intra-arterial thrombectomy (IAT) or were not tried due to IAT contraindications were prospectively enrolled. Timely urgent STA-MCA bypass surgery was performed if they showed perfusion-diffusion mismatch or symptom-diffusion mismatch in the acute phase of disease. Clinical and radiological data of these patients were assessed to demonstrate the safety and efficacy of urgent bypass procedures. A pooled analysis of published data on urgent bypass surgery in acute stroke patients was conducted and analyzed. RESULTS In 18 patients who underwent timely bypass, the National Institutes of Health Stroke Scale (NIHSS) score improved from 12.11 ± 4.84 to 9.89 ± 6.52, 1 week after surgery. Three-month and long-term (9.72 ± 5.00 months) favorable outcomes (modified Rankin Scale [mRS] scores 0-2) were achieved in 50 and 75% of the patients, respectively. The pooled analysis (117 patients from 10 articles, including ours) identified favorable mRS scores in 71.79% patients at 3 months. A significant NIHSS score improvement from 11.51 ± 4.89 to 7.59 ± 5.50 was observed after surgery with significance. Major complications occurred in 3 patients (2.6%, 3/117) without mortality. CONCLUSIONS Urgent STA-MCA bypass surgery can be regarded as a safe optional treatment to prevent cerebral infarct expansion and to improve clinical and radiological outcomes in highly selected patients.
Collapse
Affiliation(s)
- Jang Hun Kim
- Trauma Center, Armed Forces Capital Hospital, Gyeonggi-do, Republic of Korea
| | - Wonki Yoon
- Department of Neurosurgery, Guro Hospital, Korea University College of Medicine, Seoul, Republic of Korea,
| | - Chi Kyung Kim
- Department of Neurology, Guro Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Haewon Roh
- Department of Neurosurgery, Guro Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Hee Jin Bae
- Department of Neurosurgery, Guro Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Taek-Hyun Kwon
- Department of Neurosurgery, Guro Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Sang-Il Suh
- Department of Radiology, Guro Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Kyungmi Oh
- Department of Neurology, Guro Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Kyuha Chong
- Department of Neurosurgery, Guro Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| |
Collapse
|
40
|
Kang DO, Kim CK, Park Y, Jang WY, Kim W, Choi JY, Roh SY, Choi CU, Kim EJ, Rha SW, Park CG, Seo HS, Oh K, Na JO. Impact of Sleep-Disordered Breathing on Functional Outcomes in Ischemic Stroke: A Cardiopulmonary Coupling Analysis. Stroke 2020; 51:2188-2196. [PMID: 32513093 DOI: 10.1161/strokeaha.119.028730] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND AND PURPOSE Cardiopulmonary coupling (CPC) analysis is an easily assessable method to evaluate sleep-disordered breathing (SDB); however, its prognostic impact in patients with acute ischemic stroke needs to be investigated. We performed a CPC analysis using Holter monitoring at the early stage of noncardioembolic ischemic stroke to investigate the prognostic effect of SDB on functional impairment at the 3-month follow-up. METHODS A total 615 patients with acute noncardioembolic ischemic stroke who underwent Holter monitoring within 30 days of stroke onset were enrolled from a multicenter, prospective, all-comer cohort. CPC analysis was conducted, and SDB was defined by the presence of narrow-band coupling during sleep time. We investigated the association between SDB and functional impairment at 3 months as measured by the modified Rankin Scale. RESULT Narrow-band coupling was present in 191 (31.1%) of 615 patients (mean age 64.5±12.6 years). The narrow-band group showed a significantly higher rate of severe functional impairment (modified Rankin Scale score >2; 45.5% versus 12.9%, P<0.001) and persistent disability (Δmodified Rankin Scale score ≤0; 53.9% versus 39.8%, P<0.001) at the 3-month follow-up. In multivariate analysis, narrow-band coupling was an independent predictor of higher risk of severe and persistent functional impairment at 3 months (odds ratio, 3.98 [95% CI, 2.34-6.78]; P<0.001; and odds ratio, 1.81 [95% CI, 1.23-2.66]; P<0.001, respectively). The results remained consistent after propensity-score matched analysis with 157 patient pairs (C-statistic=0.770). CONCLUSIONS SDB assessed by CPC analysis at the early stage of ischemic stroke could predict severe and prolonged functional impairment at 3 months. CPC analysis using Holter monitoring can help predicting functional impairment in acute ischemic stroke.
Collapse
Affiliation(s)
- Dong Oh Kang
- Cardiovascular Center, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Republic of Korea (D.O.K., Y.P., W.Y.J., W.K., J.Y.C., S.-Y.R., C.U.C., E.J.K., S.-W.R., C.G.P., H.S.S., J.O.N.)
| | - Chi Kyung Kim
- Department of Neurology, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Republic of Korea (C.K.K., K.O.)
| | - Yoonjee Park
- Cardiovascular Center, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Republic of Korea (D.O.K., Y.P., W.Y.J., W.K., J.Y.C., S.-Y.R., C.U.C., E.J.K., S.-W.R., C.G.P., H.S.S., J.O.N.)
| | - Won Young Jang
- Cardiovascular Center, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Republic of Korea (D.O.K., Y.P., W.Y.J., W.K., J.Y.C., S.-Y.R., C.U.C., E.J.K., S.-W.R., C.G.P., H.S.S., J.O.N.)
| | - Woohyeun Kim
- Cardiovascular Center, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Republic of Korea (D.O.K., Y.P., W.Y.J., W.K., J.Y.C., S.-Y.R., C.U.C., E.J.K., S.-W.R., C.G.P., H.S.S., J.O.N.)
| | - Jah Yeon Choi
- Cardiovascular Center, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Republic of Korea (D.O.K., Y.P., W.Y.J., W.K., J.Y.C., S.-Y.R., C.U.C., E.J.K., S.-W.R., C.G.P., H.S.S., J.O.N.)
| | - Seung-Young Roh
- Cardiovascular Center, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Republic of Korea (D.O.K., Y.P., W.Y.J., W.K., J.Y.C., S.-Y.R., C.U.C., E.J.K., S.-W.R., C.G.P., H.S.S., J.O.N.)
| | - Cheol Ung Choi
- Cardiovascular Center, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Republic of Korea (D.O.K., Y.P., W.Y.J., W.K., J.Y.C., S.-Y.R., C.U.C., E.J.K., S.-W.R., C.G.P., H.S.S., J.O.N.)
| | - Eung Ju Kim
- Cardiovascular Center, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Republic of Korea (D.O.K., Y.P., W.Y.J., W.K., J.Y.C., S.-Y.R., C.U.C., E.J.K., S.-W.R., C.G.P., H.S.S., J.O.N.)
| | - Seung-Woon Rha
- Cardiovascular Center, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Republic of Korea (D.O.K., Y.P., W.Y.J., W.K., J.Y.C., S.-Y.R., C.U.C., E.J.K., S.-W.R., C.G.P., H.S.S., J.O.N.)
| | - Chang Gyu Park
- Cardiovascular Center, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Republic of Korea (D.O.K., Y.P., W.Y.J., W.K., J.Y.C., S.-Y.R., C.U.C., E.J.K., S.-W.R., C.G.P., H.S.S., J.O.N.)
| | - Hong Seog Seo
- Cardiovascular Center, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Republic of Korea (D.O.K., Y.P., W.Y.J., W.K., J.Y.C., S.-Y.R., C.U.C., E.J.K., S.-W.R., C.G.P., H.S.S., J.O.N.)
| | - Kyungmi Oh
- Department of Neurology, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Republic of Korea (C.K.K., K.O.)
| | - Jin Oh Na
- Cardiovascular Center, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Republic of Korea (D.O.K., Y.P., W.Y.J., W.K., J.Y.C., S.-Y.R., C.U.C., E.J.K., S.-W.R., C.G.P., H.S.S., J.O.N.)
| |
Collapse
|
41
|
Kim JM, Park KY, Yu IW, Song TJ, Kim YJ, Kim BJ, Heo SH, Jung JM, Oh KM, Kim CK, Yu S, Park JH, Choi JC, Park MS, Kim JT, Choi KH, Hwang YH, Chung JW, Bang OY, Kim GM, Seo WK. Incidence of oral anticoagulant interruption among stroke patients with atrial fibrillation and subsequent stroke. Eur J Neurol 2020; 27:900-902. [PMID: 32064742 DOI: 10.1111/ene.14175] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2019] [Accepted: 02/10/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND PURPOSE We analyzed the incidence and causes of oral anticoagulant (OAC) cessation and subsequent stroke after OAC withdrawal in a cohort of Korean stroke patients with atrial fibrillation. METHODS The Korean Atrial Fibrillation Evaluation Registry in Ischemic Stroke patients (K-ATTENTION) is a multicenter cohort study, merging stroke registries from 11 tertiary centers in Korea. The number of OAC interruption episodes and the reasons were reviewed from hospital records. Stroke after OAC withdrawal was defined when a patient experienced ischaemic stroke within 31 days after OAC withdrawal. Clinical variables were compared between patients who experienced stroke recurrence during OAC interruption and those who did not experience recurrence. RESULTS Among 3213 stroke patients with atrial fibrillation, a total of 329 episodes of OAC interruption were detected in 229 patients after index stroke (mean age 72.9 ± 8.3 years, 113 female patients). The most frequent reason for OAC withdrawal was poor compliance [103 episodes (31.3%)] followed by extracranial bleeding [96 episodes (29.2%)]. Stroke after OAC withdrawal was noted in 13 patients. Mean age, vascular risk factor profile and mean CHA2 DS2 -VASc score were not significantly different between patients with and without recurrent stroke. CONCLUSIONS A considerable number of stroke patients with atrial fibrillation experienced temporary interruption of OAC after index stroke, which was associated with stroke recurrence of 4.0 cases per 100 interruption episodes.
Collapse
Affiliation(s)
- J-M Kim
- Department of Neurology, Chung-Ang University College of Medicine, Seoul, Korea
| | - K-Y Park
- Department of Neurology, Chung-Ang University College of Medicine, Seoul, Korea
| | - I-W Yu
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - T-J Song
- Department of Neurology, Seoul Hospital, Ewha Womans University College of Medicine, Seoul, Korea
| | - Y-J Kim
- Department of Neurology, Eunpyeong St Mary's Hospital, The Catholic University of Korea, Seoul, Korea
| | - B J Kim
- Department of Neurology, Asan Medical Center, University of Ulsan, College of Medicine, Seoul, Korea
| | - S H Heo
- Department of Neurology, Kyung Hee University College of Medicine, Seoul, Korea
| | - J-M Jung
- Department of Neurology, Korea University Ansan Hospital, Korea University College of Medicine, Kyungki-Do, Korea
| | - K-M Oh
- Department of Neurology, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - C K Kim
- Department of Neurology, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - S Yu
- Department of Neurology, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea
| | - J-H Park
- Department of Neurology, Myongji Hospital, Hanyang University College of Medicine, Goyang, South Korea
| | - J C Choi
- Department of Neurology, Jeju National University, Jeju, Korea
| | - M-S Park
- Department of Neurology, Chonnam National University Hospital, Gwangju, Korea
| | - J-T Kim
- Department of Neurology, Chonnam National University Hospital, Gwangju, Korea
| | - K-H Choi
- Department of Neurology, Chonnam National University Hospital, Gwangju, Korea
| | - Y-H Hwang
- Department of Neurology, Kyungpook National University School of Medicine and Hospital, Daegu, Korea
| | - J-W Chung
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - O Y Bang
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - G-M Kim
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - W-K Seo
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| |
Collapse
|
42
|
Eun MY, Hwang YH, Park MS, Kim JT, Choi KH, Jung JM, Yu S, Oh K, Kim CK, Song TJ, Kim YJ, Kim BJ, Heo SH, Park KY, Kim JM, Park JH, Choi JC, Chung JW, Bang OY, Kim GM, Seo WK. Abstract TP435: Oral Anticoagulant Therapy Adherent to ESC Guidelines Reduces the Risk of Recurrent Stroke in Patients With Atrial Fibrillation. Stroke 2020. [DOI: 10.1161/str.51.suppl_1.tp435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction:
Oral anticoagulant therapy is the primary treatment for the prevention of recurrent ischemic stroke in patients with atrial fibrillation (AF). Early anticoagulant therapy can be beneficial for the prevention of recurrent ischemic stroke, however, also can provoke symptomatic intracranial hemorrhage. This study aims to evaluate the efficacy and safety of standard oral anticoagulant therapy adherent to the European Society of Cardiology (ESC) guidelines compared to early oral anticoagulant therapy.
Methods:
Acute ischemic stroke patients with AF were included from a nationwide multicenter registry (K-ATTENTION). The primary outcome was recurrent all-type stroke during 90 days of follow-up. Secondary outcomes were major adverse cardiovascular events (MACE), ischemic stroke, intracranial hemorrhage, acute coronary syndrome, all-cause death, and major hemorrhage. The propensity score was used to match the baseline characteristics between the two treatment groups.
Results:
Among 2,321 eligible patients, 532 patients with standard anticoagulation were matched to 532 patients with early anticoagulation. Eight participants (1.5%) with standard anticoagulation had recurrence of all-type stroke compared with 19 (3.5%) of participants with early anticoagulation (odds ratio [OR], 0.41; 95% confidence interval [CI], 0.18-0.95; P=0.038). Standard anticoagulation was also associated with reduced risk of recurrent ischemic stroke (OR, 0.30; 95% CI, 0.11-0.82; P=0.019). Other secondary outcomes, including intracranial hemorrhage and major hemorrhage, appeared not to be informative.
Conclusions:
In conclusion, standard oral anticoagulant therapy adherent to ESC guidelines reduces the risk of recurrent all-type stroke and ischemic stroke compared to early oral anticoagulant therapy.
Collapse
Affiliation(s)
- Mi-Yeon Eun
- Neurology, Kyungpook National Univ Chilgok Hosp, Sch of Medicine, Kyungpook National Univ, Daegu, Korea, Republic of
| | - Yang-Ha Hwang
- Neurology, Kyungpook National Univ Hosp, Sch of Medicine, Kyungpook National Univ, Daegu, Korea, Republic of
| | - Man-Seok Park
- Neurology, Chonnam National Univ Hosp, Gwangju, Korea, Republic of
| | - Joon-Tae Kim
- Neurology, Chonnam National Univ Hosp, Gwangju, Korea, Republic of
| | - Kang-Ho Choi
- Neurology, Chonnam National Univ Hosp, Gwangju, Korea, Republic of
| | - Jin-Man Jung
- Neurology, Korea Univ Ansan Hosp, Korea Univ College of Medicine, Ansan, Korea, Republic of
| | - Sungwook Yu
- Neurology, Korea Univ Anam Hosp, Korea Univ College of Medicine, Seoul, Korea, Republic of
| | - Kyungmi Oh
- Neurology, Korea Univ Guro Hosp, Korea Univ College of Medicine, Seoul, Korea, Republic of
| | - Chi Kyung Kim
- Neurology, Korea Univ Guro Hosp, Korea Univ College of Medicine, Seoul, Korea, Republic of
| | - Tae-Jin Song
- Neurology, Ewha Womans Mokdong’s Hosp, Ewha Womans Univ Sch of Medicine, Seoul, Korea, Republic of
| | - Yong-Jae Kim
- Neurology, Eunpyeong St. Mary’s Hosp, The Catholic Univ of Korea, Seoul, Korea, Republic of
| | - Bum Joon Kim
- Neurology, Kyung Hee Univ Hosp, Seoul, Korea, Republic of
| | - Sung Hyuk Heo
- Neurology, Kyung Hee Univ Hosp, Seoul, Korea, Republic of
| | - Kwang-Yeol Park
- Neurology, Chung-Ang Univ Hosp, Chung-Ang Univ College of Medicine, Seoul, Korea, Republic of
| | - Jeong-Min Kim
- Neurology, Chung-Ang Univ Hosp, Chung-Ang Univ College of Medicine, Seoul, Korea, Republic of
| | - Jong-Ho Park
- Neurology, Myongji Hosp, Hanyang Univ College of Medicine, Goyang, Korea, Republic of
| | - Jay Chol Choi
- Neurology, Jeju National Univ Hosp, Jeju National Univ College of Medicine, Jeju, Korea, Republic of
| | - Jong-Won Chung
- Neurology, Samsung Med Cntr, Sungkyunkwan Univ Sch of Medicine, Seoul, Korea, Republic of
| | - Oh Young Bang
- Neurology, Samsung Med Cntr, Sungkyunkwan Univ Sch of Medicine, Seoul, Korea, Republic of
| | - Gyeong-Moon Kim
- Neurology, Samsung Med Cntr, Sungkyunkwan Univ Sch of Medicine, Seoul, Korea, Republic of
| | - Woo-Keun Seo
- Neurology, Samsung Med Cntr, Sungkyunkwan Univ Sch of Medicine, Seoul, Korea, Republic of
| |
Collapse
|
43
|
Choi KH, Seo WK, Park MS, Kim JT, Chung JW, Bang OY, Kim GM, Song TJ, Kim BJ, Heo SH, Jung JM, Oh KM, Kim CK, Yu S, Park KY, Kim JM, Park JH, Choi JC, Hwang YH, Kim YJ. Effect of Statin Therapy on Outcomes of Patients With Acute Ischemic Stroke and Atrial Fibrillation. J Am Heart Assoc 2019; 8:e013941. [PMID: 31826725 PMCID: PMC6951051 DOI: 10.1161/jaha.119.013941] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Background There is insufficient evidence on the effect of statins, particularly high‐intensity statins, in patients with acute ischemic stroke and atrial fibrillation. We investigated the impact of statins on the outcomes in these patients, including those who might be vulnerable to statin therapy and those without clinical atherosclerotic cardiovascular diseases. Methods and Results A total of 2153 patients with acute ischemic stroke and atrial fibrillation were enrolled in the present nationwide, multicenter, cohort study. The primary composite end point was the occurrence of net adverse clinical and cerebral events (NACCE; death from any cause, stroke, acute coronary syndrome, or major bleeding) over a 3‐year period based on statin intensity. NACCE rates were lower in patients receiving low‐ to moderate‐intensity (adjusted hazard ratio 0.64; 95% CI: 0.52‐0.78) and high‐intensity statins (hazard ratio 0.51; 95% CI 0.40‐0.66) than in those not receiving statin therapy. High‐intensity statins were associated with a lower risk for NACCE than low‐ to moderate‐intensity statins (hazard ratio 0.76; 95% CI 0.59‐0.96). Subgroup analyses showed that the differences in hazard ratio for 3‐year NACCE favored statin use across all subgroups, including older patients, those with low cholesterol levels, patients receiving anticoagulants, and patients without clinical atherosclerotic cardiovascular diseases. Magnified benefits of high‐intensity statins compared with low‐ to moderate‐intensity statins were observed in patients who underwent revascularization therapy and those under 75 years of age. Conclusions Statins, particularly high‐intensity statins, could reduce the risk for NACCE in patients with acute ischemic stroke and atrial fibrillation; this needs to be further explored in randomized controlled trials.
Collapse
Affiliation(s)
- Kang-Ho Choi
- Department of Neurology Chonnam National University College of Medicine and Hospital Gwangju Korea
| | - Woo-Keun Seo
- Department of Neurology Samsung Medical Center and Department of Digital Health, SAHIST Sunkyunkwan University Seoul Korea
| | - Man-Seok Park
- Department of Neurology Chonnam National University College of Medicine and Hospital Gwangju Korea
| | - Joon-Tae Kim
- Department of Neurology Chonnam National University College of Medicine and Hospital Gwangju Korea
| | - Jong-Won Chung
- Department of Neurology Samsung Medical Center Sungkyunkwan University School of Medicine Seoul Korea
| | - Oh Young Bang
- Department of Neurology Samsung Medical Center Sungkyunkwan University School of Medicine Seoul Korea
| | - Gyeong-Moon Kim
- Department of Neurology Samsung Medical Center Sungkyunkwan University School of Medicine Seoul Korea
| | - Tae-Jin Song
- Department of Neurology Seoul Hospital Ewha Womans University College of Medicine Seoul Korea
| | - Bum Joon Kim
- Department of Neurology Kyung Hee University College of Medicine Seoul Korea
| | - Sung Hyuk Heo
- Department of Neurology Kyung Hee University College of Medicine Seoul Korea
| | - Jin-Man Jung
- Department of Neurology Korea University Ansan Hospital Korea University College of Medicine Seoul Korea
| | - Kyung-Mi Oh
- Department of Neurology Korea University Guro Hospital Korea University College of Medicine Seoul Korea
| | - Chi Kyung Kim
- Department of Neurology Korea University Guro Hospital Korea University College of Medicine Seoul Korea
| | - Sungwook Yu
- Department of Neurology Korea University Hospital Korea University College of Medicine Seoul Korea
| | - Kwang-Yeol Park
- Department of Neurology Chung-Ang University College of Medicine Seoul Korea
| | - Jeong-Min Kim
- Department of Neurology Chung-Ang University College of Medicine Seoul Korea
| | - Jong-Ho Park
- Department of Neurology Myongji Hospital Hanyang University College of Medicine Goyang Korea
| | - Jay Chol Choi
- Department of Neurology Jeju National University Jeju Korea
| | - Yang-Ha Hwang
- Department of Neurology Cerebrovascular Center Kyungpook National University School of Medicine and Hospital Daegu Korea
| | - Yong-Jae Kim
- Department of Neurology Eunpyeong St. Mary's Hospital The Catholic University of Korea Seoul Korea
| |
Collapse
|
44
|
Kim MS, Jeong HY, Cho KH, Oh SW, Byun SJ, Woo SJ, Yang HK, Hwang JM, Park KH, Kim CK, Park SJ. Nonarteritic anterior ischemic optic neuropathy is associated with cerebral small vessel disease. PLoS One 2019; 14:e0225322. [PMID: 31725805 PMCID: PMC6855457 DOI: 10.1371/journal.pone.0225322] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Accepted: 11/01/2019] [Indexed: 11/18/2022] Open
Abstract
We investigated the presence of cerebral small vessel disease (SVD) in patients with nonarteritic anterior ischemic optic neuropathy (NAION) compared to control subjects without NAION to identify the association between NAION and cerebral SVD. We retrospectively reviewed the cases of 63 patients with NAION and 2749 control subjects without any neurologic and ocular diseases including NAION who underwent careful medical interviews, ophthalmic examinations, and magnetic resonance imaging (MRI) studies of the brain. We assessed and compared the degree of cerebral SVD on the MRIs. The patients with NAION presented with cerebral SVD more frequently than controls (68% versus 37%, respectively, p<0.001), which was also observed after adjusting for age, sex, comorbid conditions including hypertension, diabetes, and dyslipidemia, and smoking using the standardized mortality ratio (68% vs. 37%, p<0.001). A multivariate logistic regression analysis showed that the odds of cerebral SVD were 4.86 (95% CI, 2.10 to 11.24, p<0.001) times higher in patients with NAION than in the controls. We found that there was an association between cerebral SVD and NAION even after adjusting for age, sex, and medical histories. Clinicians should consider brain MRI scans in patients with NAION to prevent neurological impairment after cerebral SVD.
Collapse
Affiliation(s)
- Min Seok Kim
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Han Yeong Jeong
- Department of Neurology, Seoul National University Hospital, Seoul, South Korea
| | - Kwan Hyuk Cho
- Retina Center, Moon's Eye Clinic, Suwon, South Korea
| | - Seung Won Oh
- Department of Family Medicine, Healthcare System Gangnam Center, Seoul National University Hospital, Seoul, South Korea
| | - Seong Jun Byun
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea
- School of Pharmacy, Sungkyunkwan University, Suwon, Republic of Korea
| | - Se Joon Woo
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Hee Kyung Yang
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Jeong Min Hwang
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Kyu Hyung Park
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Chi Kyung Kim
- Department of Neurology, Korea University Guro Hospital and College of Medicine, Korea University, Seoul, South Korea
- * E-mail: (SJP); (CKK)
| | - Sang Jun Park
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea
- * E-mail: (SJP); (CKK)
| |
Collapse
|
45
|
Nam KW, Kim CK, Ko SB, Yoon BW, Yoo RE, Sohn CH. Regional Arterial Spin Labeling Perfusion Defect Is Associated With Early Ischemic Recurrence in Patients With a Transient Ischemic Attack. Stroke 2019; 51:186-192. [PMID: 31718505 DOI: 10.1161/strokeaha.119.026556] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background and Purpose- With the lack of confirmatory examinations, the distinction of a transient ischemic attack (TIA) from various TIA-mimicking diseases is difficult, particularly in diffusion-weighted imaging (DWI)-negative TIAs. In this study, we aimed to evaluate the relationship between arterial spin labeling (ASL) perfusion defects and early ischemic recurrence (FU-DWI [+]) in patients with DWI-negative TIAs. Methods- We assessed consecutive patients with a DWI-negative TIA within 24 hours of symptom onset, who underwent both ASL images and follow-up magnetic resonance imaging during the acute period. As markers of the ASL images, we evaluated the ASL perfusion defects in each hemisphere. Arterial transit artifact (ATA) and intraarterial high-intensity signal (IAS) were also rated as markers of collateral status and blood stagnation due to large vessel occlusion, respectively. Results- Among the 136 patients with a DWI-negative TIA, 33 patients had FU-DWI (+) lesions in 36 hemispheres. In the multivariable analysis, ASL defects remained an independent predictor of FU-DWI (+) (adjusted odds ratio, 13.94 [95% CI, 5.77-33.70], P<0.001). In the evaluation of the interactive relationship between ASL defects and ATA/IAS, the (ASL [+] ATA [-]) group showed the highest frequencies of FU-DWI (+) events (55.6%) with the highest adjusted odds ratio values (adjusted odds ratio, 14.86 [95% CI, 5.63-39.24], P<0.001), indicating a negative synergistic effect between the ASL defects and ATA. Meanwhile, the (ASL [+] IAS [+]) group showed higher frequencies of FU-DWI (+) and higher adjusted odds ratio values than those of the (ASL [+] IAS [-]) and (ASL [-] IAS [-]) groups, indicating a positive synergistic effect. Conclusions- We demonstrated that ASL perfusion defects were associated with ipsilateral FU-DWI (+) in patients with a DWI-negative TIA. Furthermore, this association was enhanced with IASs and attenuated with ATAs.
Collapse
Affiliation(s)
- Ki-Woong Nam
- From the Department of Neurology (K.-W.N., S.-B.K., B.-W.Y.), Seoul National University Hospital, Korea.,Seoul National University College of Medicine, Korea (K.-W.N., S.-B.K., B.-W.Y., C.-H.S.)
| | - Chi Kyung Kim
- Department of Neurology, Korea University Guro Hospital, Seoul (C.K.K.).,Korea University College of Medicine, Seoul (C.K.K.)
| | - Sang-Bae Ko
- From the Department of Neurology (K.-W.N., S.-B.K., B.-W.Y.), Seoul National University Hospital, Korea.,Seoul National University College of Medicine, Korea (K.-W.N., S.-B.K., B.-W.Y., C.-H.S.)
| | - Byung-Woo Yoon
- From the Department of Neurology (K.-W.N., S.-B.K., B.-W.Y.), Seoul National University Hospital, Korea.,Seoul National University College of Medicine, Korea (K.-W.N., S.-B.K., B.-W.Y., C.-H.S.)
| | - Roh-Eul Yoo
- Department of Radiology (R.-E.Y., C.-H.S.), Seoul National University Hospital, Korea
| | - Chul-Ho Sohn
- Department of Radiology (R.-E.Y., C.-H.S.), Seoul National University Hospital, Korea.,Seoul National University College of Medicine, Korea (K.-W.N., S.-B.K., B.-W.Y., C.-H.S.)
| |
Collapse
|
46
|
Song TJ, Baek IY, Woo HG, Kim YJ, Chang Y, Kim BJ, Heo SH, Jung JM, Oh K, Kim CK, Yu S, Park KY, Kim JM, Park JH, Choi JC, Park MS, Kim JT, Choi KH, Hwang YH, Chung JW, Bang OY, Kim GM, Seo WK. Characteristics and Factors for Short-Term Functional Outcome in Stroke Patients With Atrial Fibrillation, Nationwide Retrospective Cohort Study. Front Neurol 2019; 10:1101. [PMID: 31681159 PMCID: PMC6813464 DOI: 10.3389/fneur.2019.01101] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Accepted: 10/01/2019] [Indexed: 01/07/2023] Open
Abstract
Background and aims: Atrial fibrillation (AF) is a major cause of ischemic stroke; however, detailed clinical data and prognostic factors for stroke patients with AF are lacking in Korea. We aimed to investigate clinical information and factors associated with functional outcomes of stroke patients with AF from the Korean nationwide ATrial fibrillaTion EvaluatioN regisTry in Ischemic strOke patieNts (K-ATTENTION) database. Methods: From January 2013 to December 2015, consecutive clinical information from acute stroke patients with AF or history of AF was collected from 11 centers in Korea. Collected data included demographics, risk factors, pre-stroke medication, stroke severity, stroke subtypes, concomitant cerebral atherosclerosis, brain image findings, recanalization therapy, discharge medication, and functional outcome at 3 months after index stroke. Results: A total of 3,213 stroke patients (mean age, 73.6 ± 9.8 years; female, 48.6%) were included. The mean CHA2DS2-VASc score was 4.9. Among the 1,849 (57.5%) patients who had brain image and functional outcome data, poor outcome (modified Rankin scale > 2) was noted in 53.1% (981/1,849) of patients. After adjusting for age, sex, and variables that had a p < 0.05 in univariate analysis or well-known factors for functional outcome, presence of asymptomatic extracranial cerebral atherosclerosis [odd ratio (OR): 1.96, 95% confidence interval (CI): 1.36–2.82, p = 0.001] and less frequent prior stroke statin intake (OR: 0.69, 95% CI: 0.49–0.98, p = 0.038) were associated with poor functional outcome. Conclusion: Our results suggest that presence of non-relevant extracranial cerebral atherosclerosis may affect poor functional outcome and prior stroke statin therapy may be feasible in Korean stroke patients with AF.
Collapse
Affiliation(s)
- Tae-Jin Song
- Department of Neurology, College of Medicine, Ewha Womans University Mokdong Hospital, Seoul, South Korea
| | - In-Young Baek
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.,Department of Digital Health, SAIHST, Sungkyunkwan University, Seoul, South Korea
| | - Ho Geol Woo
- Department of Neurology, College of Medicine, Ewha Womans University Mokdong Hospital, Seoul, South Korea
| | - Yong-Jae Kim
- Department of Neurology, Eunpyeong St.Mary's Hospital, The Catholic University of Korea, Seoul, South Korea
| | - Younkyung Chang
- Department of Neurology, College of Medicine, Ewha Womans University Mokdong Hospital, Seoul, South Korea
| | - Bum Joon Kim
- Department of Neurology, Kyung Hee University College of Medicine, Seoul, South Korea
| | - Sung Hyuk Heo
- Department of Neurology, Kyung Hee University College of Medicine, Seoul, South Korea
| | - Jin-Man Jung
- Department of Neurology, Korea University Ansan Hospital, Korea University College of Medicine, Seoul, South Korea
| | - Kyungmi Oh
- Department of Neurology, Korea University Guro Hospital, Korea University College of Medicine, Seoul, South Korea
| | - Chi Kyung Kim
- Department of Neurology, Korea University Guro Hospital, Korea University College of Medicine, Seoul, South Korea
| | - Sungwook Yu
- Department of Neurology, Korea University Anam Hospital, Korea University College of Medicine, Seoul, South Korea
| | - Kwang Yeol Park
- Department of Neurology, Chung-Ang University College of Medicine, Seoul, South Korea
| | - Jeong-Min Kim
- Department of Neurology, Chung-Ang University College of Medicine, Seoul, South Korea
| | - Jong-Ho Park
- Department of Neurology, MyongjiHospital, Hanyang University, College of Medicine, Goyang-si, South Korea
| | - Jay Chol Choi
- Department of Neurology, Jeju National University, Jeju-si, South Korea
| | - Man-Seok Park
- Department of Neurology, Chonnam National University Medical School and Hospital, Gwangju, South Korea
| | - Joon-Tae Kim
- Department of Neurology, Chonnam National University Medical School and Hospital, Gwangju, South Korea
| | - Kang-Ho Choi
- Department of Neurology, Chonnam National University Medical School and Hospital, Gwangju, South Korea
| | - Yang-Ha Hwang
- Department of Neurology, School of Medicine, Kyungpook National University, Daegu, South Korea
| | - Jong-Won Chung
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Oh Young Bang
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Gyeong-Moon Kim
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Woo-Keun Seo
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.,Department of Digital Health, SAIHST, Sungkyunkwan University, Seoul, South Korea
| |
Collapse
|
47
|
Jung JM, Kim YH, Yu S, O K, Kim CK, Song TJ, Kim YJ, Kim BJ, Heo SH, Park KY, Kim JM, Park JH, Choi JC, Park MS, Kim JT, Choi KH, Hwang YH, Chung JW, Bang OY, Kim GM, Seo WK. Long-Term Outcomes of Real-World Korean Patients with Atrial-Fibrillation-Related Stroke and Severely Decreased Ejection Fraction. J Clin Neurol 2019; 15:545-554. [PMID: 31591844 PMCID: PMC6785482 DOI: 10.3988/jcn.2019.15.4.545] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Revised: 07/29/2019] [Accepted: 07/29/2019] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND AND PURPOSE The clinical implications of echocardiography findings for long-term outcomes in atrial fibrillation (AF)-related stroke patients are unknown. METHODS This was a substudy of the Korean ATrial fibrillaTion EvaluatioN regisTry in Ischemic strOke patieNts (K-ATTENTION), which is a multicenter-based cohort comprising prospective stroke registries from 11 tertiary centers. Stroke survivors who underwent two-dimensional transthoracic echocardiography during hospitalization were enrolled. Echocardiography markers included the left-ventricle (LV) ejection fraction (LVEF), the left atrium diameter, and the ratio of the peak transmitral filling velocity to the mean mitral annular velocity during early diastole (E/e' ratio). LVEF was categorized into normal (≥55%), mildly decreased (>40% and <55%), and severely decreased (≤40%). The E/e' ratio associated with the LV filling pressure was categorized into normal (<8), borderline (≥8 and <15), and elevated (≥15). Kaplan-Meier and Cox regression analyses were performed for recurrent stroke, major adverse cardiac events, and all-cause death. RESULTS This study finally included 1,947 patients. Over a median follow-up of 1.65 years (interquartile range, 0.42-2.87 years), the rates of recurrent stroke, major adverse cardiac events, and all-cause death were 35.1, 10.8, and 69.6 cases per 1,000 person-years, respectively. Multivariable analyses demonstrated that severely decreased LVEF was associated with a higher risks of major adverse cardiac events [hazard ratio (HR), 3.91; 95% confidence interval (CI), 1.58-9.69] and all-cause death (HR, 1.95; 95% CI, 1.23-3.10). The multivariable fractional polynomial plot indicated that recurrent stroke might be associated with a lower LVEF. CONCLUSIONS Severe LV systolic dysfunction could be a determinant of long-term outcomes in AF-related stroke.
Collapse
Affiliation(s)
- Jin Man Jung
- Department of Neurology, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, Korea
| | - Yong Hyun Kim
- Department of Cardiology, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, Korea
| | - Sungwook Yu
- Department of Neurology, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea
| | - Kyungmi O
- Department of Neurology, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea
| | - Chi Kyung Kim
- Department of Neurology, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Tae Jin Song
- Department of Neurology, Mokdong Hospital, Ewha Womans University, College of Medicine, Seoul, Korea
| | - Yong Jae Kim
- Department of Neurology, Eunpyeong St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea
| | - Bum Joon Kim
- Department of Neurology, Kyung Hee University College of Medicine, Seoul, Korea
| | - Sung Hyuk Heo
- Department of Neurology, Kyung Hee University College of Medicine, Seoul, Korea
| | - Kwang Yeol Park
- Department of Neurology, Chung-Ang University College of Medicine, Chung-Ang University Hospital, Seoul, Korea
| | - Jeong Min Kim
- Department of Neurology, Chung-Ang University College of Medicine, Chung-Ang University Hospital, Seoul, Korea
| | - Jong Ho Park
- Department of Neurology, Myongji Hospital, Hanyang University College of Medicine, Goyang, Korea
| | - Jay Chol Choi
- Department of Neurology, Jeju National University, Jeju, Korea
| | - Man Seok Park
- Department of Neurology, Chonnam National University Hospital, Gwangju, Korea
| | - Joon Tae Kim
- Department of Neurology, Chonnam National University Hospital, Gwangju, Korea
| | - Kang Ho Choi
- Department of Neurology, Chonnam National University Hospital, Gwangju, Korea.,Department of Neurology, Chonnam National University Hwasun Hospital, Hwasun, Korea
| | - Yang Ha Hwang
- Department of Neurology, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Jong Won Chung
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Oh Young Bang
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Gyeong Moon Kim
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Woo Keun Seo
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
| |
Collapse
|
48
|
Jeong HG, Cha BG, Kang DW, Kim DY, Ki SK, Kim SI, Han JH, Yang W, Kim CK, Kim J, Lee SH. Ceria Nanoparticles Synthesized With Aminocaproic Acid for the Treatment of Subarachnoid Hemorrhage. Stroke 2019; 49:3030-3038. [PMID: 30571409 DOI: 10.1161/strokeaha.118.022631] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Background and Purpose- Despite early aneurysm repair and aggressive management for complications, subarachnoid hemorrhage (SAH) results in at least 25% mortality rate and 50% persistent neurological deficit. We investigated whether ceria nanoparticles which have potent antioxidative activities can protect against subarachnoid hemorrhage via attenuating fatal brain injuries. Methods- Uniform, 3 nm, water-dispersed ceria nanoparticles were prepared from short sol-gel reaction of cerium (III) ions with aminocaproic acid in aqueous phase. SAH was induced by endovascular perforation of middle cerebral artery of rats. A single dose of ceria nanoparticles (0.5 mg Ce/kg) or saline control was randomly administered intravenously at an hour post-SAH. Neuronal death, macrophage infiltration, SAH grade, and brain edema were evaluated at 72 hours. Mortality and neurological function were assessed for 14 days. Results- The obtained ceria nanoparticles with high Ce3+ to Ce4+ ratio demonstrated potent antioxidative, cytoprotective, and anti-inflammatory activities in vitro. In rodent SAH models, the severity of hemorrhage was comparable between the ceria nanoparticles- and saline-treated groups. However, ceria nanoparticles significantly reduced neuronal death, macrophage infiltration, and brain edema after SAH. Ceria nanoparticles successfully improved survival rates (88.2% in the ceria nanoparticles group versus 21.1% in the control group; P<0.001) and neurological outcomes (modified Garcia score: 12.1±0.5 in the ceria nanoparticles group versus 4.4±0.5 in the control group; P<0.001) of the animals with SAH. Conclusions- Ceria nanoparticles, totally synthesized in aqueous phase using aminocaproic acid, demonstrated promising results against SAH via potent antioxidative, neuroprotective and anti-inflammatory activities. Given the obvious limitations of current therapies for SAH, ceria nanoparticles can be a potential therapeutic agent which might result in a paradigm shift in SAH treatment.
Collapse
Affiliation(s)
- Han-Gil Jeong
- From the Laboratory of Innovative Nanotechnology, Biomedical Research Institute and Department of Neurology, Seoul National University Hospital, Republic of Korea (H.-G.J., D.-W.K., D.Y.K., S.K.K., S.I.K., J.h.H., W.Y., C.K.K., S.-H.L.).,Korean Cerebrovascular Research Institute, Seoul (H.-G.J., D.-W.K., D.Y.K., S.K.K., S.I.K., J.h.H., W.Y., C.K.K., S.-H.L.), Sungkyunkwan University (SKKU), Suwon, Republic of Korea
| | - Bong Geun Cha
- School of Chemical Engineering (B.G.C., J.K.), Sungkyunkwan University (SKKU), Suwon, Republic of Korea
| | - Dong-Wan Kang
- From the Laboratory of Innovative Nanotechnology, Biomedical Research Institute and Department of Neurology, Seoul National University Hospital, Republic of Korea (H.-G.J., D.-W.K., D.Y.K., S.K.K., S.I.K., J.h.H., W.Y., C.K.K., S.-H.L.).,Korean Cerebrovascular Research Institute, Seoul (H.-G.J., D.-W.K., D.Y.K., S.K.K., S.I.K., J.h.H., W.Y., C.K.K., S.-H.L.), Sungkyunkwan University (SKKU), Suwon, Republic of Korea
| | - Do Yeon Kim
- From the Laboratory of Innovative Nanotechnology, Biomedical Research Institute and Department of Neurology, Seoul National University Hospital, Republic of Korea (H.-G.J., D.-W.K., D.Y.K., S.K.K., S.I.K., J.h.H., W.Y., C.K.K., S.-H.L.).,Korean Cerebrovascular Research Institute, Seoul (H.-G.J., D.-W.K., D.Y.K., S.K.K., S.I.K., J.h.H., W.Y., C.K.K., S.-H.L.), Sungkyunkwan University (SKKU), Suwon, Republic of Korea
| | - Seul Ki Ki
- From the Laboratory of Innovative Nanotechnology, Biomedical Research Institute and Department of Neurology, Seoul National University Hospital, Republic of Korea (H.-G.J., D.-W.K., D.Y.K., S.K.K., S.I.K., J.h.H., W.Y., C.K.K., S.-H.L.).,Korean Cerebrovascular Research Institute, Seoul (H.-G.J., D.-W.K., D.Y.K., S.K.K., S.I.K., J.h.H., W.Y., C.K.K., S.-H.L.), Sungkyunkwan University (SKKU), Suwon, Republic of Korea
| | - Song I Kim
- From the Laboratory of Innovative Nanotechnology, Biomedical Research Institute and Department of Neurology, Seoul National University Hospital, Republic of Korea (H.-G.J., D.-W.K., D.Y.K., S.K.K., S.I.K., J.h.H., W.Y., C.K.K., S.-H.L.).,Korean Cerebrovascular Research Institute, Seoul (H.-G.J., D.-W.K., D.Y.K., S.K.K., S.I.K., J.h.H., W.Y., C.K.K., S.-H.L.), Sungkyunkwan University (SKKU), Suwon, Republic of Korea
| | - Ju Hee Han
- From the Laboratory of Innovative Nanotechnology, Biomedical Research Institute and Department of Neurology, Seoul National University Hospital, Republic of Korea (H.-G.J., D.-W.K., D.Y.K., S.K.K., S.I.K., J.h.H., W.Y., C.K.K., S.-H.L.).,Korean Cerebrovascular Research Institute, Seoul (H.-G.J., D.-W.K., D.Y.K., S.K.K., S.I.K., J.h.H., W.Y., C.K.K., S.-H.L.), Sungkyunkwan University (SKKU), Suwon, Republic of Korea
| | - Wookjin Yang
- From the Laboratory of Innovative Nanotechnology, Biomedical Research Institute and Department of Neurology, Seoul National University Hospital, Republic of Korea (H.-G.J., D.-W.K., D.Y.K., S.K.K., S.I.K., J.h.H., W.Y., C.K.K., S.-H.L.).,Korean Cerebrovascular Research Institute, Seoul (H.-G.J., D.-W.K., D.Y.K., S.K.K., S.I.K., J.h.H., W.Y., C.K.K., S.-H.L.), Sungkyunkwan University (SKKU), Suwon, Republic of Korea
| | - Chi Kyung Kim
- From the Laboratory of Innovative Nanotechnology, Biomedical Research Institute and Department of Neurology, Seoul National University Hospital, Republic of Korea (H.-G.J., D.-W.K., D.Y.K., S.K.K., S.I.K., J.h.H., W.Y., C.K.K., S.-H.L.).,Korean Cerebrovascular Research Institute, Seoul (H.-G.J., D.-W.K., D.Y.K., S.K.K., S.I.K., J.h.H., W.Y., C.K.K., S.-H.L.), Sungkyunkwan University (SKKU), Suwon, Republic of Korea.,Department of Neurology, Korea University Guro Hospital and Korea University College of Medicine, Seoul (C.K.K.)
| | - Jaeyun Kim
- School of Chemical Engineering (B.G.C., J.K.), Sungkyunkwan University (SKKU), Suwon, Republic of Korea.,Department of Health Sciences and Technology, Samsung Advanced Institute for Health Science & Technology (SAIHST) (J.K.), Sungkyunkwan University (SKKU), Suwon, Republic of Korea.,Biomedical Institute for Convergence (BICS) (J.K.), Sungkyunkwan University (SKKU), Suwon, Republic of Korea
| | - Seung-Hoon Lee
- From the Laboratory of Innovative Nanotechnology, Biomedical Research Institute and Department of Neurology, Seoul National University Hospital, Republic of Korea (H.-G.J., D.-W.K., D.Y.K., S.K.K., S.I.K., J.h.H., W.Y., C.K.K., S.-H.L.).,Korean Cerebrovascular Research Institute, Seoul (H.-G.J., D.-W.K., D.Y.K., S.K.K., S.I.K., J.h.H., W.Y., C.K.K., S.-H.L.), Sungkyunkwan University (SKKU), Suwon, Republic of Korea.,Center for Nanoparticle Research, Institute for Basic Science (IBS), Seoul, Republic of Korea (S.-H.L.)
| |
Collapse
|
49
|
Kang DO, Kim CK, Park Y, Jang WY, Kim W, Choi JY, Choi CU, Na JO. P3715Impact of sleep-disordered breathing on short-term functional outcomes in ischemic stroke patients: a cardiopulmonary coupling analysis using holter-monitoring. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz745.0569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Sleep-disordered breathing (SDB) assessed by conventional polysomnography is reported to have close association with worsened clinical outcomes in patients with ischemic stroke. The cardiopulmonary coupling (CPC) analysis using Holter-monitoring is an easily assessable method to evaluate SDB. However, its prognostic impact needs to be investigated.
Purpose
The present study investigated the prognostic impact of SDB defined by CPC analysis using Holter-monitoring at early stage of ischemic stroke on the functional disability at 3-month follow-up.
Methods
Total 692 patients with acute ischemic stroke who underwent Holter-monitoring were enrolled. The CPC analysis was conducted and SDB was defined as the presence of narrow-band (NB) coupling during sleep time. We investigated the association between SDB and functional disability at 3-month measured by modified Rankin scale (mRS).
Result
The NB coupling was present in 216 (31.2%) of 692 patients with mean age of 64.2±12.8 years. The NB group showed significantly higher proportion of severe functional disability (mRS ≥3; 45.3% vs. 12.3%, p<0.001) and persistent disability (ΔmRS≤0; 42.6% vs. 56.4%, p<0.001) after 3-month. In multivariate analysis, the presence of NB coupling was an independent predictor of higher risk of both severe and persistent functional disability (HR: 3.97; 95% CI: 2.37–6.64; p<0.001; and HR 1.92; 95% CI: 1.34–2.77; p<0.001, respectively). The results were consistent after propensity-score matched analysis with 175 patient pairs (C-statistics=0.759).
Parameters of functional disability Overall population (n=692) PSM population (n=350) no NB (n=476) NB (n=216) OR (95% CI) p-value no NB (n=175) NB (n=175) OR (95% CI) p-value Initial NIHSS ≥5 89 (18.6) 81 (37.5) <0.001 52 (29.7) 52 (29.7) >0.999 Discharge mRS ≥3 146 (30.6) 126 (58.3) <0.001 90 (51.4) 89 (50.8) 0.915 3-month mRS ≥3 59 (12.3) 98 (45.3) 5.86 (4.00–8.60) <0.001 38 (21.7) 72 (41.1) 2.52 (1.57–4.02) <0.001 3-month ΔmRS ≤0 (persisent disability) 203 (42.6) 122 (56.4) 1.74 (1.26–2.41) 0.001 77 (44.0) 100 (57.1) 1.69 (1.11–2.58) 0.014 Data are expressed as n (%). mRS = modified Rankin's scale; NB = narrow-band; NIHSS = National Institutes of Health Stroke Scale; OR = odds ratio; PSM = propensity-score matched.
Functional disabilities after 3-month
Conclusion
SDB assessed by CPC analysis at early phase of ischemic stroke was able to predict both greater and persistent functional disability at 3-month. The CPC analysis using Holter-monitoring is a useful modality for predicting functional disabilities in acute ischemic stroke.
Collapse
Affiliation(s)
- D O Kang
- Korea University Guro Hospital, Cardiovascular Center, Division of Cardiology, Department of Internal Medicine, Seoul, Korea (Republic of)
| | - C K Kim
- Korea University Guro Hospital, Department of Neurology, Seoul, Korea (Republic of)
| | - Y Park
- Korea University Guro Hospital, Cardiovascular Center, Division of Cardiology, Department of Internal Medicine, Seoul, Korea (Republic of)
| | - W Y Jang
- Korea University Guro Hospital, Cardiovascular Center, Division of Cardiology, Department of Internal Medicine, Seoul, Korea (Republic of)
| | - W Kim
- Korea University Guro Hospital, Cardiovascular Center, Division of Cardiology, Department of Internal Medicine, Seoul, Korea (Republic of)
| | - J Y Choi
- Korea University Guro Hospital, Cardiovascular Center, Division of Cardiology, Department of Internal Medicine, Seoul, Korea (Republic of)
| | - C U Choi
- Korea University Guro Hospital, Cardiovascular Center, Division of Cardiology, Department of Internal Medicine, Seoul, Korea (Republic of)
| | - J O Na
- Korea University Guro Hospital, Cardiovascular Center, Division of Cardiology, Department of Internal Medicine, Seoul, Korea (Republic of)
| |
Collapse
|
50
|
Kang DO, Kim CK, Park Y, Jang WY, Kim W, Choi JY, Choi CU, Na JO. P5744Sleep-disordered breathing assessed by holter-monitoring is associated to worsened one-year clinical outcomes in ischemic stroke patients: a cardiopulmonary coupling analysis. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz746.0684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Sleep-disorder breathing (SDB) using polysomnography is closely associated to poor functional and clinical outcomes in ischemic stroke patients. The cardiopulmonary coupling analysis using Holter-monitoring (CPC-Holter analysis) is an emerging feasible modality to investigate SDB.
Purpose
We investigated the association between SDB defined by CPC-Holter analysis and one-year clinical outcome in patients with acute ischemic stroke.
Methods
Total 666 patients with acute ischemic stroke who underwent Holter-monitoring were enrolled. The CPC-Holter analysis was conducted and SDB was defined as the presence of narrow-band (NB) coupling during sleep time. Primary outcome was recurrent ischemic stroke, and secondary outcome was major adverse cerebrovascular event (MACE), a composite of recurrent ischemic stroke, transient ischemic attack, and all-cause mortality within one year since discharge.
Result
The NB coupling was present in 205 (30.8%) of 666 patients with mean age of 64.1±12.8 years. The NB group showed significantly higher incidence of both recurrent ischemic stroke (8.3% vs. 1.4%, p<0.001) and MACE (14.9% vs. 3.0%, p<0.001) within one-year. In multivariate analysis, presence of NB coupling remained as an independent predictor of both recurrent ischemic stroke and MACE (HR: 4.81; 95% CI: 1.73–13.4; p=0.003; and HR 4.17; 95% CI: 1.74–10.0; p<0.001, respectively). The results were consistent after propensity-score matched analysis with 164 patient pairs (C-statistics=0.757).
One-year clinical outcomes Overall population (n=666) PSM population (n=328) no NB (=461) NB (n=205) Log-rank p-value OR (95% CI) no NB (n=164) NB (n=164) Log-rank p-value OR (95% CI) Recurrent ischemic stroke 6 (1.4) 14 (8.3) <0.001 5.73 (2.20–14.9) 3 (2.0) 11 (8.1) 0.026 3.85 (1.07–13.8) Transient ischemic attack 3 (0.7) 3 (1.7) 0.275 2 (1.3) 3 (2.1) 0.633 Hemorrhagic stroke 0 (0.0) 2 (1.2) 0.027 0 (0.0) 2 (1.5) 0.148 Total death 3 (0.7) 9 (4.8) 0.001 2 (1.3) 3 (1.9) 0.641 MACEs 12 (3.0) 25 (14.9) <0.001 4.63 (2.06–10.4) 7 (5.2) 17 (13.1) 0.030 2.95 (1.06–8.21) Data are expressed as n (%). CI = confidence interval; MACE = major adverse cardiovascular event; NB = narrow-band; OR = odds ratio.
One-year clinical outcomes
Conclusion
SDB assessed by CPC-Holter analysis at early phase of ischemic stroke is a powerful prognostic marker for predicting one-year adverse clinical outcomes. The CPC analysis using Holter-monitoring is a useful modality and could be easily applied to predict clinical outcomes in acute ischemic stroke patients.
Collapse
Affiliation(s)
- D O Kang
- Korea University Guro Hospital, Cardiovascular Center, Division of Cardiology, Department of Internal Medicine, Seoul, Korea (Republic of)
| | - C K Kim
- Korea University Guro Hospital, Department of Neurology, Seoul, Korea (Republic of)
| | - Y Park
- Korea University Guro Hospital, Cardiovascular Center, Division of Cardiology, Department of Internal Medicine, Seoul, Korea (Republic of)
| | - W Y Jang
- Korea University Guro Hospital, Cardiovascular Center, Division of Cardiology, Department of Internal Medicine, Seoul, Korea (Republic of)
| | - W Kim
- Korea University Guro Hospital, Cardiovascular Center, Division of Cardiology, Department of Internal Medicine, Seoul, Korea (Republic of)
| | - J Y Choi
- Korea University Guro Hospital, Cardiovascular Center, Division of Cardiology, Department of Internal Medicine, Seoul, Korea (Republic of)
| | - C U Choi
- Korea University Guro Hospital, Cardiovascular Center, Division of Cardiology, Department of Internal Medicine, Seoul, Korea (Republic of)
| | - J O Na
- Korea University Guro Hospital, Cardiovascular Center, Division of Cardiology, Department of Internal Medicine, Seoul, Korea (Republic of)
| |
Collapse
|