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Kalaitzidis G, Filippatou A, Fioravante N, Rothman A, Sotirchos ES, Vasileiou E, Ehrhardt H, Quiroga A, Pellegrini N, Murphy OC, Moussa H, Ladakis D, Lambe J, Fitzgerald KC, Solnes L, Venkatesan A, Calabresi PA, Saidha S, Probasco JC. Visual Pathway Involvement in NMDA Receptor Encephalitis: A Clinical, Optical Coherence Tomography, and 18-Fluorodeoxyglucose PET/CT Approach. J Neuroophthalmol 2023; 43:220-226. [PMID: 36000788 PMCID: PMC9950287 DOI: 10.1097/wno.0000000000001696] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Anti-NMDA receptor (NMDAR) encephalitis patients have been reported to exhibit visual dysfunction without retinal thinning. The objective of our study was to examine the involvement of the visual pathway structure and function in anti-NMDAR encephalitis by assessing postrecovery visual function and retinal structure, and acute-phase occipital cortex function. METHODS In this cross-sectional study, patients diagnosed with anti-NMDAR encephalitis per consensus criteria underwent postrecovery visual acuity (VA) testing and optical coherence tomography (OCT) with automated retinal layer segmentation. Clinical data and acute-phase brain 18F-fluorodeoxyglucose (FDG) PET/CT (performed within 90 days of symptom onset, assessed qualitatively and semi-quantitatively) were retrospectively analyzed. VA and OCT measures were compared between anti-NMDAR and age, sex, and race-matched healthy controls (HC). When available, FDG-PET/CT metabolism patterns were analyzed for correlations with VA, and OCT measures. RESULTS A total of 16 anti-NMDAR (32 eyes) and 32 HC (64 eyes) were included in the study. Anti-NMDAR exhibited lower low-contrast VA (2.5% contrast: -4.4 letters [95% CI; -8.5 to -0.3]; P = 0.04, 1.25% contrast: -6.8 letters [95%CI; -12 to -1.7]; P = 0.01) compared with HC, but no differences were found on OCT-derived retinal layer thicknesses. Acute-phase FDG-PET/CT medial occipital cortex metabolism did not correlate with follow-up low-contrast VA or ganglion cell/inner plexiform layer thickness (GCIPL) (n = 7, 2.5% contrast: r = -0.31; P = 0.50, 1.25% contrast: r = -0.34; P = 0.45, GCIPL: r = -0.04; P = 0.94). CONCLUSIONS Although the visual system seems to be involved in anti-NMDAR encephalitis, no retinal structural or occipital cortex functional abnormalities seem to be responsible for the visual dysfunction. When detected acutely, occipital lobe hypometabolism in anti-NMDAR encephalitis does not seem to associate with subsequent retrograde trans-synaptic degenerative phenomena, potentially reflecting reversible neuronal/synaptic dysfunction in the acute phase of the illness rather than neuronal degeneration.
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Affiliation(s)
- Grigorios Kalaitzidis
- Division of Neuroimmunology and Neurological Infections, Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Angeliki Filippatou
- Division of Neuroimmunology and Neurological Infections, Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Nicholas Fioravante
- Division of Neuroimmunology and Neurological Infections, Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Alissa Rothman
- Division of Neuroimmunology and Neurological Infections, Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Elias S. Sotirchos
- Division of Neuroimmunology and Neurological Infections, Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Eleni Vasileiou
- Division of Neuroimmunology and Neurological Infections, Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Henrik Ehrhardt
- Division of Neuroimmunology and Neurological Infections, Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Agustina Quiroga
- Division of Neuroimmunology and Neurological Infections, Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Nicole Pellegrini
- Division of Neuroimmunology and Neurological Infections, Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Olwen C. Murphy
- Division of Neuroimmunology and Neurological Infections, Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Hussein Moussa
- Division of Neuroimmunology and Neurological Infections, Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Dimitrios Ladakis
- Division of Neuroimmunology and Neurological Infections, Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Jeffrey Lambe
- Division of Neuroimmunology and Neurological Infections, Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Kathryn C. Fitzgerald
- Division of Neuroimmunology and Neurological Infections, Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Lilja Solnes
- Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Arun Venkatesan
- Division of Neuroimmunology and Neurological Infections, Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Peter A. Calabresi
- Division of Neuroimmunology and Neurological Infections, Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Shiv Saidha
- Division of Neuroimmunology and Neurological Infections, Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - John C. Probasco
- Division of Neuroimmunology and Neurological Infections, Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, United States
- Division of Advanced Clinical Neurology, Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, United States
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2
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Kalaitzidis G, Pellegrini N, Nagy N, Vasileiou E, Ehrhardt H, Reppen A, Murphy OC, Moussa H, Filippatou A, Lambe J, DuVal A, Fioravante N, Kwakyi O, Nguyen J, Davis S, Douglas M, Ramirez A, Ecoff K, Valenzuela A, Reyes-Mantilla M, Hu C, Fitzgerald KC, Sotirchos ES, Saidha S, Calabresi PA. Effects of Myopia on Rates of Change in Optical Coherence Tomography Measured Retinal Layer Thicknesses in People with Multiple Sclerosis and Healthy Controls. Curr Eye Res 2023; 48:312-319. [PMID: 36440535 DOI: 10.1080/02713683.2022.2149806] [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] [Indexed: 11/29/2022]
Abstract
PURPOSE To quantify the associations of myopia with longitudinal changes in retinal layer thicknesses in people with multiple sclerosis (PwMS) and healthy controls (HC). METHODS A cohort of PwMS and HC with recorded refractive error (RE) prospectively scanned on Cirrus HD-OCT at the Johns Hopkins MS Center was assessed for inclusion. Exclusion criteria included OCT follow-up < 6 months, ocular comorbidities, incidental OCT pathologies, and inadequate scan quality. Eyes were classified as having high myopia (HM) (RE≤ -6 diopters), low myopia (LM) (RE> -6 and ≤ -3 diopters), or no myopia (NM) (RE> -3 and ≤ +2.75). Linear mixed-effects regression models were used in analyses. RESULTS A total of 213 PwMS (eyes: 67 HM, 98 LM, 207 NM) and 80 HC (eyes: 26 HM, 37 LM, 93 NM) were included. Baseline average ganglion cell/inner plexiform (GCIPL) and peri-papillary retinal nerve fiber layer (pRNFL) thicknesses were lower in MS HM compared with MS NM (diff: -3.2 µm, 95% CI: -5.5 to -0.8, p = 0.008 and -5.3 µm, 95% CI: -9.0 to -1.7, p = 0.004, respectively), and similarly in HC HM, as compared with HC NM. Baseline superior, inferior, and nasal pRNFL thicknesses were lower in HM compared with NM, while temporal pRNFL thickness was higher, both in MS and HC (MS: 7.1 µm, 95% CI: 2.7-11.6, p = 0.002; HC: 4.7 µm, 95% CI: -0.3 to 9.7, p = 0.07). No longitudinal differences in rates of GCIPL change were noted between HM and LM vs. NM, either in MS or HC. CONCLUSION Cross-sectional differences in average GCIPL and pRNFL thicknesses are commonly seen in people with HM as compared to reference normative values from people with NM and can lead to false attribution of pathology if RE is not taken into account. However, our study suggests that longitudinal changes in average GCIPL thickness in PwMS with myopia are similar in magnitude to PwMS with NM, and therefore are appropriate for monitoring disease-related pathology.
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Affiliation(s)
- Grigorios Kalaitzidis
- Department of Neurology, Division of Neuroimmunology and Neurological Infections, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Nicole Pellegrini
- Department of Neurology, Division of Neuroimmunology and Neurological Infections, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Natalia Nagy
- Department of Neurology, Division of Neuroimmunology and Neurological Infections, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Eleni Vasileiou
- Department of Neurology, Division of Neuroimmunology and Neurological Infections, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Henrik Ehrhardt
- Department of Neurology, Division of Neuroimmunology and Neurological Infections, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Abbey Reppen
- Department of Neurology, Division of Neuroimmunology and Neurological Infections, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Olwen C Murphy
- Department of Neurology, Division of Neuroimmunology and Neurological Infections, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Hussein Moussa
- Department of Neurology, Division of Neuroimmunology and Neurological Infections, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Angeliki Filippatou
- Department of Neurology, Division of Neuroimmunology and Neurological Infections, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Jeffrey Lambe
- Department of Neurology, Division of Neuroimmunology and Neurological Infections, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Anna DuVal
- Department of Neurology, Division of Neuroimmunology and Neurological Infections, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Nicholas Fioravante
- Department of Neurology, Division of Neuroimmunology and Neurological Infections, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Ohemaa Kwakyi
- Department of Neurology, Division of Neuroimmunology and Neurological Infections, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - James Nguyen
- Department of Neurology, Division of Neuroimmunology and Neurological Infections, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Simidele Davis
- Department of Neurology, Division of Neuroimmunology and Neurological Infections, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Morgan Douglas
- Department of Neurology, Division of Neuroimmunology and Neurological Infections, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Alexandra Ramirez
- Department of Neurology, Division of Neuroimmunology and Neurological Infections, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Katie Ecoff
- Department of Neurology, Division of Neuroimmunology and Neurological Infections, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Alyssandra Valenzuela
- Department of Neurology, Division of Neuroimmunology and Neurological Infections, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Maria Reyes-Mantilla
- Department of Neurology, Division of Neuroimmunology and Neurological Infections, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Chen Hu
- Department of Neurology, Division of Neuroimmunology and Neurological Infections, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Kathryn C Fitzgerald
- Department of Neurology, Division of Neuroimmunology and Neurological Infections, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Elias S Sotirchos
- Department of Neurology, Division of Neuroimmunology and Neurological Infections, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Shiv Saidha
- Department of Neurology, Division of Neuroimmunology and Neurological Infections, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Peter A Calabresi
- Department of Neurology, Division of Neuroimmunology and Neurological Infections, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Solomon H. Snyder Department of Neuroscience, Johns Hopkins University, Baltimore, MD, USA
- Department of Ophthalmology, Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD,USA
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3
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Oertel FC, Sotirchos ES, Zimmermann HG, Motamedi S, Specovius S, Asseyer ES, Chien C, Cook L, Vasileiou E, Filippatou A, Calabresi PA, Saidha S, Pandit L, D'Cunha A, Outteryck O, Zéphir H, Pittock S, Flanagan EP, Bhatti MT, Rommer PS, Bsteh G, Zrzavy T, Kuempfel T, Aktas O, Ringelstein M, Albrecht P, Ayzenberg I, Pakeerathan T, Knier B, Aly L, Asgari N, Soelberg K, Marignier R, Tilikete CF, Calvo AC, Villoslada P, Sanchez-Dalmau B, Martinez-Lapiscina EH, Llufriu S, Green AJ, Yeaman MR, Smith TJ, Brandt AU, Chen J, Paul F, Havla J. Longitudinal retinal changes in MOGAD. Ann Neurol 2022; 92:476-485. [PMID: 35703428 DOI: 10.1002/ana.26440] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Revised: 06/09/2022] [Accepted: 06/10/2022] [Indexed: 11/09/2022]
Abstract
OBJECTIVE Patients with myelin oligodendrocyte glycoprotein antibody (MOG-IgG) associated disease (MOGAD) suffer from severe optic neuritis (ON) leading to retinal neuro-axonal loss, which can be quantified by optical coherence tomography (OCT). We assessed whether ON-independent retinal atrophy can be detected in MOGAD. METHODS Eighty MOGAD patients and 139 healthy controls (HC) were included. OCT data was acquired with 1) Spectralis spectral domain OCT (MOGAD (N=66) and HC (N=103)) and 2) Cirrus HD-OCT (MOGAD (N=14) and HC (N=36)). Macular combined ganglion cell and inner plexiform layer (GCIPL) and peripapillary retinal nerve fibre layer (pRNFL) were quantified. RESULTS At baseline, GCIPL and pRNFL were lower in MOGAD eyes with a history of ON (MOGAD-ON) compared with MOGAD eyes without a history of ON (MOGAD-NON) and HC (p<0.001). MOGAD-NON eyes had lower GCIPL volume compared to HC (p<0.001) in the Spectralis, but not in the Cirrus cohort. Longitudinally (follow-up up to 3 years), MOGAD-ON with ON within the last 6-12 months before baseline exhibited greater pRNFL thinning than MOGAD-ON with an ON >12 months ago (p<0.001). The overall MOGAD cohort did not exhibit faster GCIPL thinning compared with HC. INTERPRETATION Our study suggests the absence of attack-independent retinal damage in MOGAD. Yet, ongoing neuroaxonal damage or oedema resolution seems to occur for up to 12 months after ON, which is longer than what has been reported with other ON forms. These findings support that the pathomechanisms underlying optic nerve involvement and the evolution of OCT retinal changes after ON is distinct in MOGAD. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Frederike Cosima Oertel
- Experimental and Clinical Research Center, Max Delbrück Center for Molecular Medicine and Charité - Universitätsmedizin Berlin, Berlin, Germany.,NeuroCure Clinical Research Center, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.,Department of Neurology, University of California San Francisco, San Francisco, CA, USA
| | - Elias S Sotirchos
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Hanna G Zimmermann
- Experimental and Clinical Research Center, Max Delbrück Center for Molecular Medicine and Charité - Universitätsmedizin Berlin, Berlin, Germany.,NeuroCure Clinical Research Center, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Seyedamirhosein Motamedi
- Experimental and Clinical Research Center, Max Delbrück Center for Molecular Medicine and Charité - Universitätsmedizin Berlin, Berlin, Germany.,NeuroCure Clinical Research Center, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Svenja Specovius
- Experimental and Clinical Research Center, Max Delbrück Center for Molecular Medicine and Charité - Universitätsmedizin Berlin, Berlin, Germany.,NeuroCure Clinical Research Center, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Eva Susanna Asseyer
- Experimental and Clinical Research Center, Max Delbrück Center for Molecular Medicine and Charité - Universitätsmedizin Berlin, Berlin, Germany.,NeuroCure Clinical Research Center, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Claudia Chien
- Experimental and Clinical Research Center, Max Delbrück Center for Molecular Medicine and Charité - Universitätsmedizin Berlin, Berlin, Germany.,NeuroCure Clinical Research Center, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Lawrence Cook
- Department of Pediatrics, University of Utah, UT, USA
| | - Eleni Vasileiou
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Angeliki Filippatou
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Peter A Calabresi
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Shiv Saidha
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Lekha Pandit
- Department of Neurology, KS Hegde Medical Academy, Nitte University, Mangalore, India
| | - Anitha D'Cunha
- Department of Neurology, KS Hegde Medical Academy, Nitte University, Mangalore, India
| | - Olivier Outteryck
- Department of Neuroradiology, CHU Lille, Université de Lille, France
| | - Hélène Zéphir
- Department of Neuroradiology, CHU Lille, Université de Lille, France
| | - Sean Pittock
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
| | - Eoin P Flanagan
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
| | - M Tariq Bhatti
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
| | - Paulus S Rommer
- Department of Neurology, Medical University of Vienna, Austria
| | - Gabriel Bsteh
- Department of Neurology, Medical University of Vienna, Austria
| | - Tobias Zrzavy
- Department of Neurology, Medical University of Vienna, Austria
| | - Tania Kuempfel
- Institute of Clinical Neuroimmunology, Biomedical Center and University Hospital, Ludwig-Maximilians Universitaet Muenchen, Munich, Germany.,Data Integration for Future Medicine (DIFUTURE) Consortium, LMU Hospital, Ludwig-Maximilians Universität München, Munich, Germany
| | - Orhan Aktas
- Department of Neurology, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Marius Ringelstein
- Department of Neurology, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Germany.,Department of Neurology, Center for Neurology and Neuropsychiatry, LVR-Klinikum, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Philipp Albrecht
- Department of Neurology, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Ilya Ayzenberg
- Department of Neurology, St Josef Hospital, Ruhr University Bochum, Bochum, Germany.,Department of Neurology, I.M. Sechenov First Department of Neurology, I.M. Sechenov First Moscow State Medical University, Moscow, Russia
| | - Thivya Pakeerathan
- Department of Neurology, St Josef Hospital, Ruhr University Bochum, Bochum, Germany.,Department of Neurology, I.M. Sechenov First Department of Neurology, I.M. Sechenov First Moscow State Medical University, Moscow, Russia
| | - Benjamin Knier
- Department of Neurology, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany
| | - Lilian Aly
- Department of Neurology, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany
| | - Nasrin Asgari
- Departments of Neurology, Lillebaelt & Slagelse Hospitals, Denmark.,Institute of Regional Health Research & of Molecular Medicine, University of Southern Denmark, Odense, Denmark
| | - Kerstin Soelberg
- Institute of Regional Health Research & of Molecular Medicine, University of Southern Denmark, Odense, Denmark
| | - Romain Marignier
- Neurology, Multiple Sclerosis, Myelin Disorders and Neuroinflammation, Pierre Wertheimer Neurological Hospital, Hospices Civils de Lyon, France
| | - Caroline Froment Tilikete
- Neurology, Multiple Sclerosis, Myelin Disorders and Neuroinflammation, Pierre Wertheimer Neurological Hospital, Hospices Civils de Lyon, France
| | - Alvaro Cobo Calvo
- Neurology, Multiple Sclerosis, Myelin Disorders and Neuroinflammation, Pierre Wertheimer Neurological Hospital, Hospices Civils de Lyon, France.,Centre d'Esclerosi Múltiple de Catalunya (Cemcat). Department of Neurology/Neuroimmunology, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Pablo Villoslada
- Hospital Clinic of Barcelona-Institut d'Investigacions, Biomèdiques August Pi Sunyer, (IDIBAPS), Barcelona, Spain
| | - Bernardo Sanchez-Dalmau
- Hospital Clinic of Barcelona-Institut d'Investigacions, Biomèdiques August Pi Sunyer, (IDIBAPS), Barcelona, Spain
| | - Elena H Martinez-Lapiscina
- Hospital Clinic of Barcelona-Institut d'Investigacions, Biomèdiques August Pi Sunyer, (IDIBAPS), Barcelona, Spain
| | - Sara Llufriu
- Hospital Clinic of Barcelona-Institut d'Investigacions, Biomèdiques August Pi Sunyer, (IDIBAPS), Barcelona, Spain
| | - Ari J Green
- Department of Neurology, University of California San Francisco, San Francisco, CA, USA
| | - Michael R Yeaman
- Division of Molecular Medicine, Harbor-University of California at Los Angeles (UCLA) Medical Center, Torrance, California, United States of America.,Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California, United States of America
| | - Terry J Smith
- Departments of Ophthalmology and Visual Sciences, Kellogg Eye Center, University of Michigan, Ann Arbor, MI.,Division of Metabolism, Endocrine and Diabetes, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI
| | - Alexander U Brandt
- Experimental and Clinical Research Center, Max Delbrück Center for Molecular Medicine and Charité - Universitätsmedizin Berlin, Berlin, Germany.,NeuroCure Clinical Research Center, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.,Department of Neurology, University of California, Irvine, CA, USA
| | - John Chen
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA.,Department of Ophthalmology, Mayo Clinic, Rochester, Minnesota, USA
| | - Friedemann Paul
- Experimental and Clinical Research Center, Max Delbrück Center for Molecular Medicine and Charité - Universitätsmedizin Berlin, Berlin, Germany.,NeuroCure Clinical Research Center, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.,Department of Neurology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Joachim Havla
- Institute of Clinical Neuroimmunology, Biomedical Center and University Hospital, Ludwig-Maximilians Universitaet Muenchen, Munich, Germany.,Data Integration for Future Medicine (DIFUTURE) Consortium, LMU Hospital, Ludwig-Maximilians Universität München, Munich, Germany
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4
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Murphy OC, Kwakyi O, Iftikhar M, Zafar S, Lambe J, Pellegrini N, Sotirchos ES, Gonzalez-Caldito N, Ogbuokiri E, Filippatou A, Risher H, Cowley N, Feldman S, Fioravante N, Frohman EM, Frohman TC, Balcer LJ, Prince JL, Channa R, Calabresi PA, Saidha S. Alterations in the retinal vasculature occur in multiple sclerosis and exhibit novel correlations with disability and visual function measures. Mult Scler 2020; 26:815-828. [PMID: 31094280 PMCID: PMC6858526 DOI: 10.1177/1352458519845116] [Citation(s) in RCA: 53] [Impact Index Per Article: 13.3] [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] [Indexed: 01/23/2023]
Abstract
BACKGROUND The retinal vasculature may be altered in multiple sclerosis (MS), potentially acting as a biomarker of disease processes. OBJECTIVE To compare retinal vascular plexus densities in people with MS (PwMS) and healthy controls (HCs), and examine correlations with visual function and global disability. METHODS In this cross-sectional study, 111 PwMS (201 eyes) and 50 HCs (97 eyes) underwent optical coherence tomography angiography (OCTA). Macular superficial vascular plexus (SVP) and deep vascular plexus (DVP) densities were quantified, and poor quality images were excluded according to an artifact-rating protocol. RESULTS Mean SVP density was 24.1% (SD = 5.5) in MS eyes (26.0% (SD = 4.7) in non-optic neuritis (ON) eyes vs. 21.7% (SD = 5.5) in ON eyes, p < 0.001), as compared to 29.2% (SD = 3.3) in HC eyes (p < 0.001 for all MS eyes and multiple sclerosis optic neuritis (MSON) eyes vs. HC eyes, p = 0.03 for MS non-ON eyes vs. HC eyes). DVP density did not differ between groups. In PwMS, lower SVP density was associated with higher levels of disability (expanded disability status scale (EDSS): R2 = 0.26, p = 0.004; multiple sclerosis functional composite (MSFC): R2 = 0.27, p = 0.03) and lower letter acuity scores (100% contrast: R2 = 0.29; 2.5% contrast: R2 = 0.40; 1.25% contrast: R2 = 0.31; p < 0.001 for all). CONCLUSIONS Retinal SVP density measured by OCTA is reduced across MS eyes, and correlates with visual function, EDSS, and MSFC scores.
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Affiliation(s)
- Olwen C. Murphy
- Division of Neuroimmunology and Neurological Infections,
Department of Neurology, Johns Hopkins Hospital, Baltimore, MD, United States
| | - Ohemaa Kwakyi
- Division of Neuroimmunology and Neurological Infections,
Department of Neurology, Johns Hopkins Hospital, Baltimore, MD, United States
| | - Mustafa Iftikhar
- Wilmer Eye Institute, Johns Hopkins University School of
Medicine, Baltimore, MD, United States
| | - Sidra Zafar
- Wilmer Eye Institute, Johns Hopkins University School of
Medicine, Baltimore, MD, United States
| | - Jeffrey Lambe
- Division of Neuroimmunology and Neurological Infections,
Department of Neurology, Johns Hopkins Hospital, Baltimore, MD, United States
| | - Nicole Pellegrini
- Division of Neuroimmunology and Neurological Infections,
Department of Neurology, Johns Hopkins Hospital, Baltimore, MD, United States
| | - Elias S. Sotirchos
- Division of Neuroimmunology and Neurological Infections,
Department of Neurology, Johns Hopkins Hospital, Baltimore, MD, United States
| | - Natalia Gonzalez-Caldito
- Division of Neuroimmunology and Neurological Infections,
Department of Neurology, Johns Hopkins Hospital, Baltimore, MD, United States
| | - Esther Ogbuokiri
- Division of Neuroimmunology and Neurological Infections,
Department of Neurology, Johns Hopkins Hospital, Baltimore, MD, United States
| | - Angeliki Filippatou
- Division of Neuroimmunology and Neurological Infections,
Department of Neurology, Johns Hopkins Hospital, Baltimore, MD, United States
| | - Hunter Risher
- Division of Neuroimmunology and Neurological Infections,
Department of Neurology, Johns Hopkins Hospital, Baltimore, MD, United States
| | - Norah Cowley
- Division of Neuroimmunology and Neurological Infections,
Department of Neurology, Johns Hopkins Hospital, Baltimore, MD, United States
| | - Sydney Feldman
- Division of Neuroimmunology and Neurological Infections,
Department of Neurology, Johns Hopkins Hospital, Baltimore, MD, United States
| | - Nicholas Fioravante
- Division of Neuroimmunology and Neurological Infections,
Department of Neurology, Johns Hopkins Hospital, Baltimore, MD, United States
| | - Elliot M. Frohman
- Department of Neurology and Ophthalmology, University of
Texas Austin Dell Medical School, Austin, TX, United States
| | - Teresa C. Frohman
- Department of Neurology and Ophthalmology, University of
Texas Austin Dell Medical School, Austin, TX, United States
| | - Laura J. Balcer
- Department of Neurology, New York University Langone
Medical Center, New York, NY, United States
| | - Jerry L. Prince
- Department of Electrical and Computer Engineering, Johns
Hopkins University, Baltimore, MD, United States
| | - Roomasa Channa
- Wilmer Eye Institute, Johns Hopkins University School of
Medicine, Baltimore, MD, United States
- Department of Ophthalmology, Baylor College of Medicine,
Houston, TX, United States
| | - Peter A. Calabresi
- Division of Neuroimmunology and Neurological Infections,
Department of Neurology, Johns Hopkins Hospital, Baltimore, MD, United States
| | - Shiv Saidha
- Division of Neuroimmunology and Neurological Infections,
Department of Neurology, Johns Hopkins Hospital, Baltimore, MD, United States
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5
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Sotirchos ES, Gonzalez Caldito N, Filippatou A, Fitzgerald KC, Murphy OC, Lambe J, Nguyen J, Button J, Ogbuokiri E, Crainiceanu CM, Prince JL, Calabresi PA, Saidha S. Progressive Multiple Sclerosis Is Associated with Faster and Specific Retinal Layer Atrophy. Ann Neurol 2020; 87:885-896. [PMID: 32285484 DOI: 10.1002/ana.25738] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Revised: 03/30/2020] [Accepted: 04/01/2020] [Indexed: 12/29/2022]
Abstract
OBJECTIVE Therapeutic development in progressive multiple sclerosis (PMS) has been hampered by a lack of reliable biomarkers to monitor neurodegeneration. Optical coherence tomography (OCT)-derived retinal measures have been proposed as promising biomarkers to fulfill this role. However, it is unclear whether retinal atrophy persists in PMS, exceeds normal aging, or can be distinguished from relapsing-remitting multiple sclerosis (RRMS). METHODS 178 RRMS, 186 PMS, and 66 control participants were followed with serial OCT for a median follow-up of 3.7 years. RESULTS The estimated proportion of peripapillary retinal nerve fiber layer (pRNFL) and macular ganglion cell + inner plexiform layer (GCIPL) thinning in multiple sclerosis (MS) attributable to normal aging increased from 42.7% and 16.7% respectively at age 25 years, to 83.7% and 81.1% at age 65 years. However, independent of age, PMS was associated with faster pRNFL (-0.34 ± 0.09%/yr, p < 0.001) and GCIPL (-0.27 ± 0.07%/yr, p < 0.001) thinning, as compared to RRMS. In both MS and controls, higher baseline age was associated with faster inner nuclear layer (INL) and outer nuclear layer (ONL) thinning. INL and ONL thinning were independently faster in PMS, as compared to controls (INL:-0.09 ± 0.04%/yr, p = 0.03; ONL:-0.12 ± 0.06%/yr, p = 0.04), and RRMS (INL:-0.10 ± 0.04%/yr, p = 0.01; ONL:-0.13 ± 0.05%/yr, p = 0.01), whereas they were similar in RRMS and controls. Unlike RRMS, disease-modifying therapies (DMTs) did not impact rates of retinal layer atrophy in PMS. INTERPRETATION PMS is associated with faster retinal atrophy independent of age. INL and ONL measures may be novel biomarkers of neurodegeneration in PMS that appear to be unaffected by conventional DMTs. The effects of aging on rates of retinal layer atrophy should be considered in clinical trials incorporating OCT outcomes. ANN NEUROL 2020;87:885-896.
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Affiliation(s)
- Elias S Sotirchos
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | | | - Angeliki Filippatou
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Kathryn C Fitzgerald
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Olwen C Murphy
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Jeffrey Lambe
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - James Nguyen
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Julia Button
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Esther Ogbuokiri
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | | | - Jerry L Prince
- Department of Electrical and Computer Engineering, Johns Hopkins University, Baltimore, MD, USA
| | - Peter A Calabresi
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Shiv Saidha
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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6
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Malhotra K, Goyal N, Katsanos AH, Filippatou A, Mistry EA, Khatri P, Anadani M, Spiotta AM, Sandset EC, Sarraj A, Magoufis G, Krogias C, Tönges L, Safouris A, Elijovich L, Goyal M, Arthur A, Alexandrov AV, Tsivgoulis G. Association of Blood Pressure With Outcomes in Acute Stroke Thrombectomy. Hypertension 2020; 75:730-739. [PMID: 31928111 DOI: 10.1161/hypertensionaha.119.14230] [Citation(s) in RCA: 48] [Impact Index Per Article: 12.0] [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: 12/12/2022]
Abstract
Limited data exist evaluating the effect of blood pressure (BP) on clinical outcomes among patients with acute ischemic stroke with large vessel occlusion treated with mechanical thrombectomy (MT). We sought to evaluate the association of BP levels on clinical outcomes among patients with acute ischemic stroke with large vessel occlusion treated with MT. Studies were identified that reported the association of systolic BP (SBP) or diastolic BP levels before, during, or after MT on the outcomes of patients with acute ischemic stroke treated with MT. Unadjusted and adjusted analyses of studies reporting odds ratios (ORadj) per 10 mm Hg BP increment were performed. Our analysis included 25 studies comprising 6474 patients. Higher pre-MT mean SBP (P=0.008) and post-MT maximum SBP (P=0.009) levels were observed in patients who died within 3 months. Patients with 3-month functional independence were noted to have lower pre-MT (P<0.001) and post-MT maximum SBP levels (P<0.001). In adjusted analyses, increasing post-MT maximum SBP and diastolic BP levels were associated with 3-month mortality (ORadj, 1.19 [95% CI,1.00-1.43]; I2=78%, P value for Cochran Q test: 0.001) and symptomatic intracranial hemorrhage (ORadj, 1.65 [95% CI, 1.11-2.44]; I2=0%, P value for Cochran Q test: 0.80), respectively. Increasing pre- and post-MT mean SBP levels were associated with lower odds of 3-month functional independence (ORadj, 0.86 [95% CI, 0.77-0.96]; I2=18%, P value for Cochran Q test: 0.30) and (ORadj, 0.80 [95% CI, 0.72-0.89]; I2=0%, P value for Cochran Q test: 0.51), respectively. In conclusion, elevated BP levels before and after MT are associated with adverse outcomes among patients with acute ischemic stroke with large vessel occlusion.
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Affiliation(s)
- Konark Malhotra
- From the Department of Neurology, Allegheny Health Network, Pittsburgh, PA (K.M.)
| | - Nitin Goyal
- Department of Neurology, University of Tennessee, Memphis (N.G., A.V.A., G.T.)
| | - Aristeidis H Katsanos
- Department of Neurology, McMaster University/Population Health Research Institute, Hamilton, Canada (A.H.K.)
| | - Angeliki Filippatou
- Second Department of Neurology, "Attikon" University Hospital, National and Kapodistrian University of Athens, Greece (A.F., G.T.)
| | - Eva A Mistry
- Department of Neurology, Vanderbilt University, Nashville, TN (E.A.M.)
| | - Pooja Khatri
- Department of Neurology, University of Cincinnati, OH (P.K.)
| | - Mohammad Anadani
- Department of Neurology, Washington University School of Medicine, St Louis, MO (M.A.).,Department of Neurosurgery, Medical University of South Carolina, Charleston (M.A., A.M.S.)
| | - Alejandro M Spiotta
- Department of Neurosurgery, Medical University of South Carolina, Charleston (M.A., A.M.S.)
| | - Else Charlotte Sandset
- Department of Neurology, Stroke Unit, Oslo University Hospital, Norway (E.C.S.).,The Norwegian Air Ambulance Foundation, Oslo, Norway (E.C.S.)
| | - Amrou Sarraj
- Department of Neurology, UT Houston, TX (A. Sarraj)
| | - Georgios Magoufis
- Stroke Unit, Metropolitan Hospital, Piraeus, Greece (G.M., A. Safouris)
| | - Christos Krogias
- Department of Neurology, St. Josef-Hospital, Ruhr-University Bochum, Germany (C.K., L.T.)
| | - Lars Tönges
- Department of Neurology, St. Josef-Hospital, Ruhr-University Bochum, Germany (C.K., L.T.)
| | | | - Lucas Elijovich
- Department of Neurosurgery, University of Tennessee/Semmes-Murphey Clinic, Memphis (L.E., A.A.)
| | - Mayank Goyal
- Departments of Radiology and Clinical Neurosciences, University of Calgary, AB, Canada (M.G.)
| | - Adam Arthur
- Department of Neurosurgery, University of Tennessee/Semmes-Murphey Clinic, Memphis (L.E., A.A.)
| | - Andrei V Alexandrov
- Department of Neurology, University of Tennessee, Memphis (N.G., A.V.A., G.T.)
| | - Georgios Tsivgoulis
- Department of Neurology, University of Tennessee, Memphis (N.G., A.V.A., G.T.).,Second Department of Neurology, "Attikon" University Hospital, National and Kapodistrian University of Athens, Greece (A.F., G.T.)
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7
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Sotirchos ES, Filippatou A, Fitzgerald KC, Salama S, Pardo S, Wang J, Ogbuokiri E, Cowley NJ, Pellegrini N, Murphy OC, Mealy MA, Prince JL, Levy M, Calabresi PA, Saidha S. Aquaporin-4 IgG seropositivity is associated with worse visual outcomes after optic neuritis than MOG-IgG seropositivity and multiple sclerosis, independent of macular ganglion cell layer thinning. Mult Scler 2019; 26:1360-1371. [PMID: 31364464 DOI: 10.1177/1352458519864928] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [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] [Indexed: 12/22/2022]
Abstract
BACKGROUND Comparative studies of characteristics of optic neuritis (ON) associated with myelin oligodendrocyte glycoprotein-IgG (MOG-ON) and aquaporin-4-IgG (AQP4-ON) seropositivity are limited. OBJECTIVE To compare visual and optical coherence tomography (OCT) measures following AQP4-ON, MOG-ON, and multiple sclerosis associated ON (MS-ON). METHODS In this cross-sectional study, 48 AQP4-ON, 16 MOG-ON, 40 MS-ON, and 31 healthy control participants underwent monocular letter-acuity assessment and spectral-domain OCT. Eyes with a history of ON >3 months prior to evaluation were analyzed. RESULTS AQP4-ON eyes exhibited worse high-contrast letter acuity (HCLA) compared to MOG-ON (-22.3 ± 3.9 letters; p < 0.001) and MS-ON eyes (-21.7 ± 4.0 letters; p < 0.001). Macular ganglion cell + inner plexiform layer (GCIPL) thickness was lower, as compared to MS-ON, in AQP4-ON (-9.1 ± 2.0 µm; p < 0.001) and MOG-ON (-7.6 ± 2.2 µm; p = 0.001) eyes. Lower GCIPL thickness was associated with worse HCLA in AQP4-ON (-16.5 ± 1.5 letters per 10 µm decrease; p < 0.001) and MS-ON eyes (-8.5 ± 2.3 letters per 10 µm decrease; p < 0.001), but not in MOG-ON eyes (-5.2 ± 3.8 letters per 10 µm decrease; p = 0.17), and these relationships differed between the AQP4-ON and other ON groups (p < 0.01 for interaction). CONCLUSION AQP4-IgG seropositivity is associated with worse visual outcomes after ON compared with MOG-ON and MS-ON, even with similar severity of macular GCIPL thinning.
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Affiliation(s)
- Elias S Sotirchos
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Angeliki Filippatou
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Kathryn C Fitzgerald
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Sara Salama
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA/Department of Neurology, University of Alexandria, Alexandria, Egypt
| | - Santiago Pardo
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Jiangxia Wang
- Department of Biostatistics, Johns Hopkins University, Baltimore, MD, USA
| | - Esther Ogbuokiri
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Norah J Cowley
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Nicole Pellegrini
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Olwen C Murphy
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Maureen A Mealy
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Jerry L Prince
- Department of Electrical and Computer Engineering, Johns Hopkins University, Baltimore, MD, USA
| | - Michael Levy
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Peter A Calabresi
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Shiv Saidha
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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8
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Liu Y, Carass A, He Y, Antony BJ, Filippatou A, Saidha S, Solomon SD, Calabresi PA, Prince JL. Layer boundary evolution method for macular OCT layer segmentation. Biomed Opt Express 2019; 10:1064-1080. [PMID: 30891330 PMCID: PMC6420297 DOI: 10.1364/boe.10.001064] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Revised: 12/27/2018] [Accepted: 12/28/2018] [Indexed: 05/30/2023]
Abstract
Optical coherence tomography (OCT) is used to produce high resolution depth images of the retina and is now the standard of care for in-vivo ophthalmological assessment. It is also increasingly being used for evaluation of neurological disorders such as multiple sclerosis (MS). Automatic segmentation methods identify the retinal layers of the macular cube providing consistent results without intra- and inter-rater variation and is faster than manual segmentation. In this paper, we propose a fast multi-layer macular OCT segmentation method based on a fast level set method. Our framework uses contours in an optimized approach specifically for OCT layer segmentation over the whole macular cube. Our algorithm takes boundary probability maps from a trained random forest and iteratively refines the prediction to subvoxel precision. Evaluation on both healthy and multiple sclerosis subjects shows that our method is statistically better than a state-of-the-art graph-based method.
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Affiliation(s)
- Yihao Liu
- Dept. of Electrical and Computer Engineering, The Johns Hopkins University, Baltimore, MD 21218, USA
| | - Aaron Carass
- Dept. of Electrical and Computer Engineering, The Johns Hopkins University, Baltimore, MD 21218, USA
- Dept. of Computer Science, The Johns Hopkins University, Baltimore, MD 21218, USA
| | - Yufan He
- Dept. of Electrical and Computer Engineering, The Johns Hopkins University, Baltimore, MD 21218, USA
| | | | - Angeliki Filippatou
- Dept. of Neurology, The Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
| | - Shiv Saidha
- Dept. of Neurology, The Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
| | - Sharon D. Solomon
- Wilmer Eye Institute, The Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
| | - Peter A. Calabresi
- Dept. of Neurology, The Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
| | - Jerry L. Prince
- Dept. of Electrical and Computer Engineering, The Johns Hopkins University, Baltimore, MD 21218, USA
- Dept. of Computer Science, The Johns Hopkins University, Baltimore, MD 21218, USA
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9
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Sotirchos ES, Gonzalez-Caldito N, Dewey BE, Fitzgerald KC, Glaister J, Filippatou A, Ogbuokiri E, Feldman S, Kwakyi O, Risher H, Crainiceanu C, Pham DL, Van Zijl PC, Mowry EM, Reich DS, Prince JL, Calabresi PA, Saidha S. Effect of disease-modifying therapies on subcortical gray matter atrophy in multiple sclerosis. Mult Scler 2019; 26:312-321. [PMID: 30741108 DOI: 10.1177/1352458519826364] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [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: 11/17/2022]
Abstract
BACKGROUND The effects of disease-modifying therapies (DMTs) on region-specific brain atrophy in multiple sclerosis (MS) are unclear. OBJECTIVE To determine the effects of higher versus lower efficacy DMTs on rates of brain substructure atrophy in MS. METHODS A non-randomized, observational cohort of people with MS followed with annual brain magnetic resonance imaging (MRI) was evaluated retrospectively. Whole brain, subcortical gray matter (GM), cortical GM, and cerebral white matter (WM) volume fractions were obtained. DMTs were categorized as higher (DMT-H: natalizumab and rituximab) or lower (DMT-L: interferon-beta and glatiramer acetate) efficacy. Follow-up epochs were analyzed if participants had been on a DMT for ⩾6 months prior to baseline and had at least one follow-up MRI while on DMTs in the same category. RESULTS A total of 86 DMT epochs (DMT-H: n = 32; DMT-L: n = 54) from 78 participants fulfilled the study inclusion criteria. Mean follow-up was 2.4 years. Annualized rates of thalamic (-0.15% vs -0.81%; p = 0.001) and putaminal (-0.27% vs -0.73%; p = 0.001) atrophy were slower during DMT-H compared to DMT-L epochs. These results remained significant in multivariate analyses including demographics, clinical characteristics, and T2 lesion volume. CONCLUSION DMT-H treatment may be associated with slower rates of subcortical GM atrophy, especially of the thalamus and putamen. Thalamic and putaminal volumes are promising imaging biomarkers in MS.
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Affiliation(s)
- Elias S Sotirchos
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | | | - Blake E Dewey
- Department of Electrical and Computer Engineering, Johns Hopkins University, Baltimore, MD, USA.,F. M. Kirby Research Center for Functional Brain Imaging, Kennedy Krieger Institute, Baltimore, MD, USA
| | - Kathryn C Fitzgerald
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Jeffrey Glaister
- Department of Electrical and Computer Engineering, Johns Hopkins University, Baltimore, MD, USA
| | - Angeliki Filippatou
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Esther Ogbuokiri
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Sydney Feldman
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Ohemaa Kwakyi
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Hunter Risher
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | | | - Dzung L Pham
- Department of Electrical and Computer Engineering, Johns Hopkins University, Baltimore, MD, USA.,Department of Radiology and Radiological Science, Johns Hopkins University, Baltimore, MD, USA.,Center for Neuroscience and Regenerative Medicine, The Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, USA
| | - Peter C Van Zijl
- F. M. Kirby Research Center for Functional Brain Imaging, Kennedy Krieger Institute, Baltimore, MD, USA.,Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Ellen M Mowry
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Daniel S Reich
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.,Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, USA.,Department of Biostatistics, Johns Hopkins University, Baltimore, MD, USA.,Translational Neuroradiology Section, National Institute of Neurological Disorders and Stroke, Bethesda, MD, USA
| | - Jerry L Prince
- Department of Electrical and Computer Engineering, Johns Hopkins University, Baltimore, MD, USA.,Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Peter A Calabresi
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Shiv Saidha
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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10
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Malhotra K, Ahmed N, Filippatou A, Katsanos AH, Goyal N, Tsioufis K, Manios E, Pikilidou M, Schellinger PD, Alexandrov AW, Alexandrov AV, Tsivgoulis G. Abstract WP102: Association of Elevated Blood Pressure Levels With Outcomes in Acute Ischemic Stroke Patients Treated With Intravenous Thrombolysis: A Systematic Review and Meta-Analysis. Stroke 2019. [DOI: 10.1161/str.50.suppl_1.wp102] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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:
Although arbitrary blood pressure (BP) thresholds exist for acute ischemic stroke (AIS) patients eligible for intravenous thrombolysis (IVT), current international recommendations lack clarity on the impact of mean pre- and post-IVT BP levels on clinical outcomes.
Methods:
We identified eligible studies involving IVT-treated AIS patients that reported the association of mean systolic (SBP) or diastolic BP (DBP) levels before and after IVT with the following outcomes: three-month favorable functional outcome (FFO; mRS-scores of 0-1), three-month functional independence (FI; mRS-scores of 0-2)], three-month mortality and symptomatic intracranial hemorrhage (sICH). Unadjusted analyses of standardized mean differences (SMD) for individual outcomes and adjusted analyses of studies reporting odds ratios (ORadj) per 10mmHg BP increment were performed using the random-effects models.
Results:
We identified 26 studies comprising 56,513 patients. Higher pre- (SMD: 0.24; 95%CI: 0.04 to 0.43; p=0.02) and post-treatment (SMD: 0.50; 95%CI: 0.14 to 0.86; p=0.006) SBP levels were observed in patients with sICH. Patients with 3-month FI had lower pre- (SMD: -0.18; 95%CI: -0.34 to -0.01; p=0.04) and post-treatment (SMD: -0.19; 95%CI: -0.23 to -0.15; p<0.001) SBP. In adjusted analyses, elevated pre- (ORadj: 1.08; 95%CI: 1.01 to 1.16) and post-treatment (ORadj: 1.13; 95%CI: 1.01 to 1.25) SBP levels were associated with increased likelihood of sICH. Increasing pre- (ORadj: 0.91; 95%CI: 0.84 to 0.98) and post-treatment (ORadj: 0.70; 95%CI: 0.57 to 0.87) SBP values were also related to lower odds of 3-month FI. No association was noted between either mean pre-treatment or post-treatment SBP levels with three-month mortality. Likewise, no associations were observed with either mean pre-treatment or post-treatment DBP levels and three-month FFO, three-month FI, sICH, or three-month mortality.
Conclusions:
We found that elevated BP levels adversely impact AIS outcomes in patients receiving IVT. Future randomized-controlled clinical trials will provide definitive data regarding the potential association of BP control with improved outcomes of AIS patients treated with IVT.
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Affiliation(s)
| | - Niaz Ahmed
- Karolinska Univ Hosp Solna, Stockholm, Sweden
| | | | | | - Nitin Goyal
- Univ of Tennessee Health Science Cntr, Memphis, TN
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11
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Malhotra K, Ahmed N, Filippatou A, Katsanos AH, Goyal N, Tsioufis K, Manios E, Pikilidou M, Schellinger PD, Alexandrov AW, Alexandrov AV, Tsivgoulis G. Association of Elevated Blood Pressure Levels with Outcomes in Acute Ischemic Stroke Patients Treated with Intravenous Thrombolysis: A Systematic Review and Meta-Analysis. J Stroke 2019; 21:78-90. [PMID: 30732443 PMCID: PMC6372893 DOI: 10.5853/jos.2018.02369] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [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: 08/25/2018] [Accepted: 11/23/2018] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND AND PURPOSE Although arbitrary blood pressure (BP) thresholds exist for acute ischemic stroke (AIS) patients eligible for intravenous thrombolysis (IVT), current international recommendations lack clarity on the impact of mean pre- and post-IVT BP levels on clinical outcomes. METHODS Eligible studies involving IVT-treated AIS patients were identified that reported the association of mean systolic BP (SBP) or diastolic BP levels before and after IVT with the following outcomes: 3-month favorable functional outcome (modified Rankin Scale [mRS] scores of 0-1) and 3-month functional independence (mRS scores of 0-2), 3-month mortality and symptomatic intracranial hemorrhage (sICH). Unadjusted analyses of standardized mean differences and adjusted analyses of studies reporting odds ratios (ORadj) per 10 mm Hg BP increment were performed using random-effects models. RESULTS We identified 26 studies comprising 56,513 patients. Higher pre- (P=0.02) and posttreatment (P=0.006) SBP levels were observed in patients with sICH. Patients with 3-month functional independence had lower post-treatment (P<0.001) SBP whereas trended towards lower pre-treatment (P=0.06) SBP. In adjusted analyses, elevated pre- (ORadj, 1.08; 95% confidence interval [CI], 1.01 to 1.16) and post-treatment (ORadj, 1.13; 95% CI, 1.01 to 1.25) SBP levels were associated with increased likelihood of sICH. Increasing pre- (ORadj, 0.91; 95% CI, 0.84 to 0.98) and post-treatment (ORadj, 0.70; 95% CI, 0.57 to 0.87) SBP values were also related to lower odds of 3-month functional independence. CONCLUSION s We found that elevated BP levels adversely impact AIS outcomes in patients receiving IVT. Future randomized-controlled clinical trials will provide definitive data on the aforementioned association.
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Affiliation(s)
- Konark Malhotra
- Department of Neurology, West Virginia University-Charleston Division, Charleston, WV, USA
| | - Niaz Ahmed
- Department of Neurology, Karolinska University Hospital, Stockholm, Sweden
| | - Angeliki Filippatou
- Second Department of Neurology, Attikon University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Aristeidis H Katsanos
- Second Department of Neurology, Attikon University Hospital, National and Kapodistrian University of Athens, Athens, Greece.,Department of Neurology, University of Ioannina School of Medicine, Ioannina, Greece
| | - Nitin Goyal
- Department of Neurology, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Konstantinos Tsioufis
- First Cardiology Clinic, Hippokration Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Efstathios Manios
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Maria Pikilidou
- First Department of Internal Medicine, Hypertension Excellence Center, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Peter D Schellinger
- Department of Neurology and Neurogeriatry, Johannes Wesling Medical Center, Ruhr University Bochum, Minden, Germany
| | - Anne W Alexandrov
- Department of Neurology, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Andrei V Alexandrov
- Department of Neurology, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Georgios Tsivgoulis
- Second Department of Neurology, Attikon University Hospital, National and Kapodistrian University of Athens, Athens, Greece.,Department of Neurology, University of Tennessee Health Science Center, Memphis, TN, USA
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12
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Filippatou A, Shoemaker T, Esch M, Qutab M, Gonzalez-Caldito N, Prince JL, Mowry EM, Calabresi PA, Saidha S, Sotirchos ES. Spinal cord and infratentorial lesions in radiologically isolated syndrome are associated with decreased retinal ganglion cell/inner plexiform layer thickness. Mult Scler 2018; 25:1878-1887. [PMID: 30507269 DOI: 10.1177/1352458518815597] [Citation(s) in RCA: 6] [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] [Indexed: 12/30/2022]
Abstract
BACKGROUND The role of retinal imaging with optical coherence tomography (OCT) in assessing individuals with radiologically isolated syndrome (RIS) remains largely unexplored. OBJECTIVE To assess retinal layer thicknesses in RIS and examine their associations with clinical features suggestive of increased risk for conversion to multiple sclerosis (MS). METHODS A total of 30 RIS subjects and 60 age- and sex-matched healthy controls (HC) underwent retinal imaging with spectral-domain OCT, followed by automated segmentation of retinal layers. RESULTS Overall, retinal layer thicknesses did not differ between RIS and HC. However, RIS subjects with spinal cord (SC) lesions had lower ganglion cell + inner plexiform layer (GCIP) thickness compared to HC (-4.41 μm; p = 0.007) and RIS without SC lesions (-3.53 μm; p = 0.041). Similarly, RIS subjects with infratentorial (IT) brain lesions had lower GCIP thickness compared to HC (-4.07 μm; p < 0.001) and RIS without IT lesions (-3.49 μm; p = 0.029). Multivariate analyses revealed that the presence of SC or IT lesions were independently associated with lower GCIP thickness in RIS (p = 0.04 and p = 0.03, respectively). Other patient characteristics, including sex, abnormal cerebrospinal fluid, and presence of gadolinium-enhancing or juxtacortical lesions, were not associated with retinal layer thicknesses. CONCLUSION The presence of SC or IT lesions in RIS may be associated with retinal neuro-axonal loss, supporting the presence of more disseminated disease.
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Affiliation(s)
- Angeliki Filippatou
- Division of Neuroimmunology and Neurological Infections, Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Thomas Shoemaker
- Division of Neuroimmunology and Neurological Infections, Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Megan Esch
- Division of Neuroimmunology and Neurological Infections, Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Madiha Qutab
- Division of Neuroimmunology and Neurological Infections, Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Natalia Gonzalez-Caldito
- Division of Neuroimmunology and Neurological Infections, Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Jerry L Prince
- Department of Electrical and Computer Engineering, Johns Hopkins University, Baltimore, MD, USA
| | - Ellen M Mowry
- Division of Neuroimmunology and Neurological Infections, Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Peter A Calabresi
- Division of Neuroimmunology and Neurological Infections, Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Shiv Saidha
- Division of Neuroimmunology and Neurological Infections, Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Elias S Sotirchos
- Division of Neuroimmunology and Neurological Infections, Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Katsanos AH, Schellinger PD, Köhrmann M, Filippatou A, Gurol ME, Caso V, Paciaroni M, Perren F, Alexandrov AV, Tsivgoulis G. Fatal oral anticoagulant‐related intracranial hemorrhage: a systematic review and meta‐analysis. Eur J Neurol 2018; 25:1299-1302. [DOI: 10.1111/ene.13742] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Accepted: 06/21/2018] [Indexed: 01/17/2023]
Affiliation(s)
- A. H. Katsanos
- Second Department of Neurology Attikon University Hospital National & Kapodistrian University of Athens Athens
- Department of Neurology University of Ioannina Ioannina Greece
| | - P. D. Schellinger
- Departments of Neurology and Neurogeriatry Johannes Wesling Medical Center Ruhr University Bochum Minden
| | - M. Köhrmann
- Department of Neurology Universitätsklinikum Essen Essen Germany
| | - A. Filippatou
- Second Department of Neurology Attikon University Hospital National & Kapodistrian University of Athens Athens
| | - M. E. Gurol
- J. P. Kistler Stroke Research Center Massachusetts General Hospital Boston MA USA
| | - V. Caso
- Stroke Unit and Division of Cardiovascular Medicine University of Perugia Perugia Italy
| | - M. Paciaroni
- Stroke Unit and Division of Cardiovascular Medicine University of Perugia Perugia Italy
| | - F. Perren
- Department of Neurology University Hospital of Geneva Geneva Switzerland
| | - A. V. Alexandrov
- Department of Neurology University of Tennessee Health Science Center Memphis TN USA
| | - G. Tsivgoulis
- Second Department of Neurology Attikon University Hospital National & Kapodistrian University of Athens Athens
- Department of Neurology University of Tennessee Health Science Center Memphis TN USA
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14
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Tsivgoulis G, Katsanos AH, Mavridis D, Frogoudaki A, Vrettou AR, Ikonomidis I, Parissis J, Deftereos S, Karapanayiotides T, Palaiodimou L, Filippatou A, Perren F, Hadjigeorgiou G, Alexandrov AW, Mitsias PD, Alexandrov AV. Percutaneous patent foramen ovale closure for secondary stroke prevention: Network meta-analysis. Neurology 2018; 91:e8-e18. [PMID: 29875217 DOI: 10.1212/wnl.0000000000005739] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2017] [Accepted: 03/02/2018] [Indexed: 01/01/2023] Open
Abstract
OBJECTIVE Current guidelines report no benefit for patent foramen ovale (PFO) closure compared to medical treatment in patients with cryptogenic ischemic stroke (IS) or TIA. Two recent randomized controlled clinical trials have challenged these recommendations. METHODS We performed a systematic review and network meta-analysis of randomized controlled trials to estimate the safety and efficacy of closure compared to medical treatment, and to compare available devices. We conducted pairwise meta-analyses for closure vs medical therapy, irrespective of the device used, and for each device vs medical therapy. RESULTS Our literature search highlighted 6 studies. PFO occlusion was associated with reduced risk of recurrent IS (risk ratio [RR] 0.42, 95% confidence interval [CI] 0.20-0.91) and IS/TIA (RR 0.65, 95% CI 0.48-0.88) but with increased risk of new-onset atrial fibrillation (AF) (RR 4.59, 95% CI 2.01-10.45) compared to medical treatment. In indirect analyses, both Amplatzer (AMP) and GORE devices were found to be associated with a lower risk of new-onset AF compared to STARFlex (SFX) (RR 0.25, 95% CI 0.10-0.65 and RR 0.28, 95% CI 0.08-0.95). Moreover, AMP was found to be associated with a lower risk of recurrent IS/TIA events compared to the SFX device (RR 0.35, 95% CI 0.14-0.91). In the clustered ranking plot on the risk of IS against new-onset AF, GORE was comparable to AMP; however, on the risk of IS/TIA against new-onset AF, AMP appeared to be superior to the GORE device. In both ranking plots, SFX was highlighted as the worst option. CONCLUSION PFO closure is associated with reduced risk of recurrent IS or IS/TIA and with increased risk of new-onset AF.
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Affiliation(s)
- Georgios Tsivgoulis
- From the Second Department of Neurology (G.T., A.H.K., L.P., A. Filippatou) and Second Department of Cardiology (A. Frogoudaki, A.-R.V., I.I., J.P., S.D.), Attikon University Hospital, School of Medicine, National and Kapodistrian University of Athens, Greece; Department of Neurology (G.T., A.W.A., A.V.A.), University of Tennessee Health Science Center, Memphis; Departments of Neurology (A.H.K.) and Hygiene and Epidemiology (D.M.), School of Medicine, and Department of Primary Education (D.M.), University of Ioannina; Second Department of Neurology (T.K.), Aristotle University of Thessaloniki, AHEPA University Hospital, Thessaloniki, Greece; Department of Neurology (F.P.), University Hospital of Geneva, Switzerland; Department of Neurology (G.H.), University of Thessaly, Larissa; and Department of Neurology (P.D.M.), School of Medicine, University of Crete, Heraklion, Greece.
| | - Aristeidis H Katsanos
- From the Second Department of Neurology (G.T., A.H.K., L.P., A. Filippatou) and Second Department of Cardiology (A. Frogoudaki, A.-R.V., I.I., J.P., S.D.), Attikon University Hospital, School of Medicine, National and Kapodistrian University of Athens, Greece; Department of Neurology (G.T., A.W.A., A.V.A.), University of Tennessee Health Science Center, Memphis; Departments of Neurology (A.H.K.) and Hygiene and Epidemiology (D.M.), School of Medicine, and Department of Primary Education (D.M.), University of Ioannina; Second Department of Neurology (T.K.), Aristotle University of Thessaloniki, AHEPA University Hospital, Thessaloniki, Greece; Department of Neurology (F.P.), University Hospital of Geneva, Switzerland; Department of Neurology (G.H.), University of Thessaly, Larissa; and Department of Neurology (P.D.M.), School of Medicine, University of Crete, Heraklion, Greece
| | - Dimitris Mavridis
- From the Second Department of Neurology (G.T., A.H.K., L.P., A. Filippatou) and Second Department of Cardiology (A. Frogoudaki, A.-R.V., I.I., J.P., S.D.), Attikon University Hospital, School of Medicine, National and Kapodistrian University of Athens, Greece; Department of Neurology (G.T., A.W.A., A.V.A.), University of Tennessee Health Science Center, Memphis; Departments of Neurology (A.H.K.) and Hygiene and Epidemiology (D.M.), School of Medicine, and Department of Primary Education (D.M.), University of Ioannina; Second Department of Neurology (T.K.), Aristotle University of Thessaloniki, AHEPA University Hospital, Thessaloniki, Greece; Department of Neurology (F.P.), University Hospital of Geneva, Switzerland; Department of Neurology (G.H.), University of Thessaly, Larissa; and Department of Neurology (P.D.M.), School of Medicine, University of Crete, Heraklion, Greece
| | - Alexandra Frogoudaki
- From the Second Department of Neurology (G.T., A.H.K., L.P., A. Filippatou) and Second Department of Cardiology (A. Frogoudaki, A.-R.V., I.I., J.P., S.D.), Attikon University Hospital, School of Medicine, National and Kapodistrian University of Athens, Greece; Department of Neurology (G.T., A.W.A., A.V.A.), University of Tennessee Health Science Center, Memphis; Departments of Neurology (A.H.K.) and Hygiene and Epidemiology (D.M.), School of Medicine, and Department of Primary Education (D.M.), University of Ioannina; Second Department of Neurology (T.K.), Aristotle University of Thessaloniki, AHEPA University Hospital, Thessaloniki, Greece; Department of Neurology (F.P.), University Hospital of Geneva, Switzerland; Department of Neurology (G.H.), University of Thessaly, Larissa; and Department of Neurology (P.D.M.), School of Medicine, University of Crete, Heraklion, Greece
| | - Agathi-Rosa Vrettou
- From the Second Department of Neurology (G.T., A.H.K., L.P., A. Filippatou) and Second Department of Cardiology (A. Frogoudaki, A.-R.V., I.I., J.P., S.D.), Attikon University Hospital, School of Medicine, National and Kapodistrian University of Athens, Greece; Department of Neurology (G.T., A.W.A., A.V.A.), University of Tennessee Health Science Center, Memphis; Departments of Neurology (A.H.K.) and Hygiene and Epidemiology (D.M.), School of Medicine, and Department of Primary Education (D.M.), University of Ioannina; Second Department of Neurology (T.K.), Aristotle University of Thessaloniki, AHEPA University Hospital, Thessaloniki, Greece; Department of Neurology (F.P.), University Hospital of Geneva, Switzerland; Department of Neurology (G.H.), University of Thessaly, Larissa; and Department of Neurology (P.D.M.), School of Medicine, University of Crete, Heraklion, Greece
| | - Ignatios Ikonomidis
- From the Second Department of Neurology (G.T., A.H.K., L.P., A. Filippatou) and Second Department of Cardiology (A. Frogoudaki, A.-R.V., I.I., J.P., S.D.), Attikon University Hospital, School of Medicine, National and Kapodistrian University of Athens, Greece; Department of Neurology (G.T., A.W.A., A.V.A.), University of Tennessee Health Science Center, Memphis; Departments of Neurology (A.H.K.) and Hygiene and Epidemiology (D.M.), School of Medicine, and Department of Primary Education (D.M.), University of Ioannina; Second Department of Neurology (T.K.), Aristotle University of Thessaloniki, AHEPA University Hospital, Thessaloniki, Greece; Department of Neurology (F.P.), University Hospital of Geneva, Switzerland; Department of Neurology (G.H.), University of Thessaly, Larissa; and Department of Neurology (P.D.M.), School of Medicine, University of Crete, Heraklion, Greece
| | - John Parissis
- From the Second Department of Neurology (G.T., A.H.K., L.P., A. Filippatou) and Second Department of Cardiology (A. Frogoudaki, A.-R.V., I.I., J.P., S.D.), Attikon University Hospital, School of Medicine, National and Kapodistrian University of Athens, Greece; Department of Neurology (G.T., A.W.A., A.V.A.), University of Tennessee Health Science Center, Memphis; Departments of Neurology (A.H.K.) and Hygiene and Epidemiology (D.M.), School of Medicine, and Department of Primary Education (D.M.), University of Ioannina; Second Department of Neurology (T.K.), Aristotle University of Thessaloniki, AHEPA University Hospital, Thessaloniki, Greece; Department of Neurology (F.P.), University Hospital of Geneva, Switzerland; Department of Neurology (G.H.), University of Thessaly, Larissa; and Department of Neurology (P.D.M.), School of Medicine, University of Crete, Heraklion, Greece
| | - Spyridon Deftereos
- From the Second Department of Neurology (G.T., A.H.K., L.P., A. Filippatou) and Second Department of Cardiology (A. Frogoudaki, A.-R.V., I.I., J.P., S.D.), Attikon University Hospital, School of Medicine, National and Kapodistrian University of Athens, Greece; Department of Neurology (G.T., A.W.A., A.V.A.), University of Tennessee Health Science Center, Memphis; Departments of Neurology (A.H.K.) and Hygiene and Epidemiology (D.M.), School of Medicine, and Department of Primary Education (D.M.), University of Ioannina; Second Department of Neurology (T.K.), Aristotle University of Thessaloniki, AHEPA University Hospital, Thessaloniki, Greece; Department of Neurology (F.P.), University Hospital of Geneva, Switzerland; Department of Neurology (G.H.), University of Thessaly, Larissa; and Department of Neurology (P.D.M.), School of Medicine, University of Crete, Heraklion, Greece
| | - Theodore Karapanayiotides
- From the Second Department of Neurology (G.T., A.H.K., L.P., A. Filippatou) and Second Department of Cardiology (A. Frogoudaki, A.-R.V., I.I., J.P., S.D.), Attikon University Hospital, School of Medicine, National and Kapodistrian University of Athens, Greece; Department of Neurology (G.T., A.W.A., A.V.A.), University of Tennessee Health Science Center, Memphis; Departments of Neurology (A.H.K.) and Hygiene and Epidemiology (D.M.), School of Medicine, and Department of Primary Education (D.M.), University of Ioannina; Second Department of Neurology (T.K.), Aristotle University of Thessaloniki, AHEPA University Hospital, Thessaloniki, Greece; Department of Neurology (F.P.), University Hospital of Geneva, Switzerland; Department of Neurology (G.H.), University of Thessaly, Larissa; and Department of Neurology (P.D.M.), School of Medicine, University of Crete, Heraklion, Greece
| | - Lina Palaiodimou
- From the Second Department of Neurology (G.T., A.H.K., L.P., A. Filippatou) and Second Department of Cardiology (A. Frogoudaki, A.-R.V., I.I., J.P., S.D.), Attikon University Hospital, School of Medicine, National and Kapodistrian University of Athens, Greece; Department of Neurology (G.T., A.W.A., A.V.A.), University of Tennessee Health Science Center, Memphis; Departments of Neurology (A.H.K.) and Hygiene and Epidemiology (D.M.), School of Medicine, and Department of Primary Education (D.M.), University of Ioannina; Second Department of Neurology (T.K.), Aristotle University of Thessaloniki, AHEPA University Hospital, Thessaloniki, Greece; Department of Neurology (F.P.), University Hospital of Geneva, Switzerland; Department of Neurology (G.H.), University of Thessaly, Larissa; and Department of Neurology (P.D.M.), School of Medicine, University of Crete, Heraklion, Greece
| | - Angeliki Filippatou
- From the Second Department of Neurology (G.T., A.H.K., L.P., A. Filippatou) and Second Department of Cardiology (A. Frogoudaki, A.-R.V., I.I., J.P., S.D.), Attikon University Hospital, School of Medicine, National and Kapodistrian University of Athens, Greece; Department of Neurology (G.T., A.W.A., A.V.A.), University of Tennessee Health Science Center, Memphis; Departments of Neurology (A.H.K.) and Hygiene and Epidemiology (D.M.), School of Medicine, and Department of Primary Education (D.M.), University of Ioannina; Second Department of Neurology (T.K.), Aristotle University of Thessaloniki, AHEPA University Hospital, Thessaloniki, Greece; Department of Neurology (F.P.), University Hospital of Geneva, Switzerland; Department of Neurology (G.H.), University of Thessaly, Larissa; and Department of Neurology (P.D.M.), School of Medicine, University of Crete, Heraklion, Greece
| | - Fabienne Perren
- From the Second Department of Neurology (G.T., A.H.K., L.P., A. Filippatou) and Second Department of Cardiology (A. Frogoudaki, A.-R.V., I.I., J.P., S.D.), Attikon University Hospital, School of Medicine, National and Kapodistrian University of Athens, Greece; Department of Neurology (G.T., A.W.A., A.V.A.), University of Tennessee Health Science Center, Memphis; Departments of Neurology (A.H.K.) and Hygiene and Epidemiology (D.M.), School of Medicine, and Department of Primary Education (D.M.), University of Ioannina; Second Department of Neurology (T.K.), Aristotle University of Thessaloniki, AHEPA University Hospital, Thessaloniki, Greece; Department of Neurology (F.P.), University Hospital of Geneva, Switzerland; Department of Neurology (G.H.), University of Thessaly, Larissa; and Department of Neurology (P.D.M.), School of Medicine, University of Crete, Heraklion, Greece
| | - Georgios Hadjigeorgiou
- From the Second Department of Neurology (G.T., A.H.K., L.P., A. Filippatou) and Second Department of Cardiology (A. Frogoudaki, A.-R.V., I.I., J.P., S.D.), Attikon University Hospital, School of Medicine, National and Kapodistrian University of Athens, Greece; Department of Neurology (G.T., A.W.A., A.V.A.), University of Tennessee Health Science Center, Memphis; Departments of Neurology (A.H.K.) and Hygiene and Epidemiology (D.M.), School of Medicine, and Department of Primary Education (D.M.), University of Ioannina; Second Department of Neurology (T.K.), Aristotle University of Thessaloniki, AHEPA University Hospital, Thessaloniki, Greece; Department of Neurology (F.P.), University Hospital of Geneva, Switzerland; Department of Neurology (G.H.), University of Thessaly, Larissa; and Department of Neurology (P.D.M.), School of Medicine, University of Crete, Heraklion, Greece
| | - Anne W Alexandrov
- From the Second Department of Neurology (G.T., A.H.K., L.P., A. Filippatou) and Second Department of Cardiology (A. Frogoudaki, A.-R.V., I.I., J.P., S.D.), Attikon University Hospital, School of Medicine, National and Kapodistrian University of Athens, Greece; Department of Neurology (G.T., A.W.A., A.V.A.), University of Tennessee Health Science Center, Memphis; Departments of Neurology (A.H.K.) and Hygiene and Epidemiology (D.M.), School of Medicine, and Department of Primary Education (D.M.), University of Ioannina; Second Department of Neurology (T.K.), Aristotle University of Thessaloniki, AHEPA University Hospital, Thessaloniki, Greece; Department of Neurology (F.P.), University Hospital of Geneva, Switzerland; Department of Neurology (G.H.), University of Thessaly, Larissa; and Department of Neurology (P.D.M.), School of Medicine, University of Crete, Heraklion, Greece
| | - Panayiotis D Mitsias
- From the Second Department of Neurology (G.T., A.H.K., L.P., A. Filippatou) and Second Department of Cardiology (A. Frogoudaki, A.-R.V., I.I., J.P., S.D.), Attikon University Hospital, School of Medicine, National and Kapodistrian University of Athens, Greece; Department of Neurology (G.T., A.W.A., A.V.A.), University of Tennessee Health Science Center, Memphis; Departments of Neurology (A.H.K.) and Hygiene and Epidemiology (D.M.), School of Medicine, and Department of Primary Education (D.M.), University of Ioannina; Second Department of Neurology (T.K.), Aristotle University of Thessaloniki, AHEPA University Hospital, Thessaloniki, Greece; Department of Neurology (F.P.), University Hospital of Geneva, Switzerland; Department of Neurology (G.H.), University of Thessaly, Larissa; and Department of Neurology (P.D.M.), School of Medicine, University of Crete, Heraklion, Greece
| | - Andrei V Alexandrov
- From the Second Department of Neurology (G.T., A.H.K., L.P., A. Filippatou) and Second Department of Cardiology (A. Frogoudaki, A.-R.V., I.I., J.P., S.D.), Attikon University Hospital, School of Medicine, National and Kapodistrian University of Athens, Greece; Department of Neurology (G.T., A.W.A., A.V.A.), University of Tennessee Health Science Center, Memphis; Departments of Neurology (A.H.K.) and Hygiene and Epidemiology (D.M.), School of Medicine, and Department of Primary Education (D.M.), University of Ioannina; Second Department of Neurology (T.K.), Aristotle University of Thessaloniki, AHEPA University Hospital, Thessaloniki, Greece; Department of Neurology (F.P.), University Hospital of Geneva, Switzerland; Department of Neurology (G.H.), University of Thessaly, Larissa; and Department of Neurology (P.D.M.), School of Medicine, University of Crete, Heraklion, Greece
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Tsivgoulis G, Katsanos AH, Mavridis D, Frogoudaki A, Vrettou AR, Ikonomidis I, Parissis J, Deftereos S, Karapanayiotides T, Palaiodimou L, Filippatou A, Perren F, Hadjigeorgiou G, Alexandrov AW, Mitsias PD, Alexandrov AV. Abstract 105: Percutaneous Patent Foramen Ovale Closure for the Secondary Prevention of Cryptogenic Cerebral Ischemia: A Network Meta-Analysis. Stroke 2018. [DOI: 10.1161/str.49.suppl_1.105] [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:
Current guidelines report no benefit for patent foramen ovale (PFO) closure compared to medical treatment in patients with cryptogenic ischemic stroke (IS) or transient ischemic attack (TIA). Two recent randomized-controlled clinical trials (RCTs) have challenged these recommendations. We performed a systematic review and network meta-analysis (NMA) of RCTs to estimate the safety and efficacy of closure compared to medical treatment, and to compare available devices.
Methods:
We conducted pairwise meta-analyses for closure vs medical therapy, and for each device vs medical therapy. We performed subgroup analyses for the outcome of IS recurrence according to shunt size and atrial septal aneurysm (ASA) presence. For all devices we calculated the pooled rates of effective closure and serious peri-procedural complications. We used NMA to combine direct and indirect evidence for any given pair of treatments.
Results:
Literature search identified 6 eligible studies. PFO occlusion was associated with reduced risk of recurrent IS (RR=0.39, 95%CI:0.18-0.88) and IS/TIA (RR=0.66, 95%CI:0.46-0.94), but with increased risk of new-onset atrial fibrillation (AF; RR=4.73, 95%CI:2.09-10.71) compared to medical treatment. We detected no differences on the risk of recurrent IS according to PFO size (p=0.83) or ASA presence (p=0.39). Amplatzer and GORE HELEX/CARDIOFORM occluders were associated with more effective IS/TIA prevention (Panels A-B) and lower AF risk compared to STARFlex Septal Occluder (Panel C).
Conclusions:
PFO closure is related with reduced risk of recurrent IS/TIA and with increased risk of new-onset AF. These associations are independent of PFO size and ASA presence.
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Affiliation(s)
- Georgios Tsivgoulis
- Second Dept of Neurology, “Attikon Univ Hosp”, Sch of Medicine, National and Kapodistrian Univ of Athens, Athens, Greece
| | - Aristeidis H Katsanos
- Second Dept of Neurology, “Attikon Univ Hosp”, Sch of Medicine, National and Kapodistrian Univ of Athens, Athens, Greece
| | - Dimitris Mavridis
- Dept of Hygiene and Epidemiology, Sch of Medicine, Univ of Ioannina, Ioannina, Greece
| | - Alexandra Frogoudaki
- Second Dept of Cardiology, “Attikon Univ Hosp”, Sch of Medicine, National and Kapodistrian Univ of Athens, Athens, Greece
| | - Agathi-Rosa Vrettou
- Second Dept of Cardiology, “Attikon Univ Hosp”, Sch of Medicine, National and Kapodistrian Univ of Athens, Athens, Greece
| | - Ignatios Ikonomidis
- Second Dept of Cardiology, “Attikon Univ Hosp”, Sch of Medicine, National and Kapodistrian Univ of Athens, Athens, Greece
| | - John Parissis
- Second Dept of Cardiology, “Attikon Univ Hosp”, Sch of Medicine, National and Kapodistrian Univ of Athens, Athens, Greece
| | - Spyridon Deftereos
- Second Dept of Cardiology, “Attikon Univ Hosp”, Sch of Medicine, National and Kapodistrian Univ of Athens, Athens, Greece
| | | | - Lina Palaiodimou
- Second Dept of Neurology, “Attikon Univ Hosp”, Sch of Medicine, National and Kapodistrian Univ of Athens, Athens, Greece
| | - Angeliki Filippatou
- Second Dept of Neurology, “Attikon Univ Hosp”, Sch of Medicine, National and Kapodistrian Univ of Athens, Athens, Greece
| | | | | | - Anne W Alexandrov
- Dept of Neurology, Univ of Tennessee Health Science Cntr, Memphis, TN
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Tsivgoulis G, Pikilidou M, Katsanos AH, Stamatelopoulos K, Michas F, Lykka A, Zompola C, Filippatou A, Boviatsis E, Voumvourakis K, Zakopoulos N, Manios E. Association of Ambulatory Blood Pressure Monitoring parameters with the Framingham Stroke Risk Profile. J Neurol Sci 2017; 380:106-111. [PMID: 28870547 DOI: 10.1016/j.jns.2017.07.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [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: 04/03/2017] [Revised: 06/14/2017] [Accepted: 07/04/2017] [Indexed: 10/19/2022]
Abstract
The Framingham Stroke Risk Profile (FSRP) is a novel and reliable tool for estimating the 10-year probability for incident stroke in stroke-free individuals, while the predictive value of ambulatory blood pressure monitoring (ABPM) for first-ever and recurrent stroke has been well established. We sought to evaluate cross-sectionally the association of ABPM parameters with FSRP score in a large sample of 2343 consecutive stroke-free individuals (mean age: 56.0±12.9, 49.1% male) who underwent 24-hour ABPM. True hypertensives showed significantly higher FSRP (11.2±5.0) compared to the normotensives (8.2±5.0, p<0.001), while subjects with white coat hypertension also had higher FSRP (10.2±4.7) than normotensives (8.2±5.0, p<0.001). Compared to dippers that exhibited the lowest FSRP, non-dippers and reverse-dippers exhibited significantly higher FSRP (9.8±4.8 for dippers vs 10.6±5.2 and 11.5±5.0 for non-dippers and reverse-dippers respectively, p≤0.001 for comparisons). In univariate analyses, the ABPM parameters that had the strongest correlation with FSRP were 24-hour (r=0.440, p<0.001), daytime (r=0.435, p<0.001) and night-time (r=0.423; p<0.001) pulse pressure (PP). The best fitting model for predicting FSRP (R2=24.6%) on multiple linear regression analyses after adjustment for vascular risk factors not included in FSRP comprised the following parameters in descending order: 24-hour PP (β=0.349, p<0.001), daytime SBP variability (β=0.124, p<0.001), 24-hour HR variability (β=-0.091, p<0.001), mean 24-hour HR (β=-0.107, p<0.001), BMI (β=0.081, p<0.001) and dipping percentage (β=-0.063, p=0.001). 24-hour PP and daytime SBP variability are the two ABPM parameters that were more strongly associated with FSRP-score. Reverse dippers had the highest FSRP among all dipping status profiles.
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Affiliation(s)
- Georgios Tsivgoulis
- Second Department of Neurology, "Attikon" Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece.
| | - Maria Pikilidou
- Hypertension Excellence Center, 1st Department of Internal Medicine, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Aristeidis H Katsanos
- Second Department of Neurology, "Attikon" Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece; Department of Neurology, University of Ioannina School of Medicine, Ioannina, Greece
| | - Kimon Stamatelopoulos
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Fotios Michas
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Aikaterini Lykka
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Christina Zompola
- Second Department of Neurology, "Attikon" Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Angeliki Filippatou
- Second Department of Neurology, "Attikon" Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Efstathios Boviatsis
- Department of Neurosurgery, "Attikon" Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Konstantinos Voumvourakis
- Second Department of Neurology, "Attikon" Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Nikolaos Zakopoulos
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Efstathios Manios
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
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17
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Tsivgoulis G, Katsanos AH, Filippatou A, Manios E, Deftereos S, Parissis J, Frogoudaki A, Vrettou AR, Ikonomidis I, Pikilidou M, Kargiotis O, Voumvourakis K, Alexandrov AW, Alexandrov AV. Abstract 77: Intensity of Blood Pressure Reduction and Secondary Stroke Prevention: A Systematic Review and Meta-regression Analysis of Randomized Clinical Trials. Stroke 2017. [DOI: 10.1161/str.48.suppl_1.77] [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
Background & Purpose:
Current recommendations do not specifically address the optimal blood pressure (BP) cut-off for secondary stroke prevention in patients with previous cerebrovascular events. We conducted a systematic review and meta-regression analysis on the association of BP reduction with recurrent stroke and cardiovascular events using data from randomized-controlled clinical trials (RCTs) of secondary stroke prevention.
Methods:
For all reported events during each eligible study period we calculated the corresponding risk ratios (RRs) to express the comparison of event occurrence risk between patients randomized to antihypertensive treatment and those randomized to placebo. Based on the reported BP values, we performed univariate meta-regression analyses according to achieved BP values under the random-effects model (Method of Moments) for those outcome events reported in ≥10 total subgroups of included RCTs.
Results:
In pairwise meta-analyses of 14 RCTs comprising 42,736 patients antihypertensive treatment lowered the risk for recurrent stroke (RR=0.73, 95%CI: 0.62-0.87, p<0.001), disabling or fatal stroke (RR=0.71, 95%CI: 0.59-0.85, p<0.001) and cardiovascular death (RR=0.85, 95%CI: 0.75-0.96, p=0.010). In meta-regression analyses systolic BP reduction was linearly related to lower risk of recurrent stroke (p=0.049; Figure A), myocardial infarction (p=0.024), death from any cause (p=0.001) and cardiovascular death (p<0.001). Similarly, diastolic BP reduction was linearly related to a lower risk of recurrent stroke (p=0.026; Figure B) and all-cause mortality (p=0.009). Funnel plot inspection and Egger’s statistical test revealed no evidence of publication bias.
Conclusion:
The extent of BP reduction is linearly associated with the magnitude of risk reduction in recurrent cerebro- and cardio-vascular events. Strict and aggressive BP control appears to be essential for effective secondary stroke prevention.
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Affiliation(s)
- Georgios Tsivgoulis
- Second Dept of Neurology, “Attikon” Univ Hosp, Univ of Athens, Athens, Greece
| | | | - Angeliki Filippatou
- Second Dept of Neurology, “Attikon” Univ Hosp, Univ of Athens, Athens, Greece
| | - Efstathios Manios
- Dept of Clinical Therapeutics, “Alexandra Hosp”, Univ of Athens, Athens, Greece
| | - Spyridon Deftereos
- Second Dept of Cardiology, “Attikon” Univ Hosp, Univ of Athens, Athens, Greece
| | - John Parissis
- Second Dept of Cardiology, “Attikon” Univ Hosp, Univ of Athens, Athens, Greece
| | | | - Agathi-Rosa Vrettou
- Second Dept of Cardiology, “Attikon” Univ Hosp, Univ of Athens, Athens, Greece
| | - Ignatios Ikonomidis
- Second Dept of Cardiology, “Attikon” Univ Hosp, Univ of Athens, Athens, Greece
| | - Maria Pikilidou
- First Dept of Internal Medicine, Hypertension Excellence Cntr, AHEPA Univ Hosp, Thessaloniki, Greece
| | | | | | - Anne W Alexandrov
- Dept of Neurology, Univ of Tennessee Health Science Cntr, Memphis, TN
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18
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Katsanos AH, Filippatou A, Manios E, Deftereos S, Parissis J, Frogoudaki A, Vrettou AR, Ikonomidis I, Pikilidou M, Kargiotis O, Voumvourakis K, Alexandrov AW, Alexandrov AV, Tsivgoulis G. Blood Pressure Reduction and Secondary Stroke Prevention. Hypertension 2017; 69:171-179. [DOI: 10.1161/hypertensionaha.116.08485] [Citation(s) in RCA: 117] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2016] [Revised: 09/28/2016] [Accepted: 10/09/2016] [Indexed: 11/16/2022]
Abstract
Current recommendations do not specifically address the optimal blood pressure (BP) reduction for secondary stroke prevention in patients with previous cerebrovascular events. We conducted a systematic review and metaregression analysis on the association of BP reduction with recurrent stroke and cardiovascular events using data from randomized controlled clinical trials of secondary stroke prevention. For all reported events during each eligible study period, we calculated the corresponding risk ratios to express the comparison of event occurrence risk between patients randomized to antihypertensive treatment and those randomized to placebo. On the basis of the reported BP values, we performed univariate metaregression analyses according to the achieved BP values under the random-effects model (Method of Moments) for those adverse events reported in ≥10 total subgroups of included randomized controlled clinical trials. In pairwise meta-analyses, antihypertensive treatment lowered the risk for recurrent stroke (risk ratio, 0.73; 95% confidence interval, 0.62–0.87;
P
<0.001), disabling or fatal stroke (risk ratio, 0.71; 95% confidence interval, 0.59–0.85;
P
<0.001), and cardiovascular death (risk ratio, 0.85; 95% confidence interval, 0.75–0.96;
P
=0.01). In metaregression analyses, systolic BP reduction was linearly related to the lower risk of recurrent stroke (
P
=0.049), myocardial infarction (
P
=0.024), death from any cause (
P
=0.001), and cardiovascular death (
P
<0.001). Similarly, diastolic BP reduction was linearly related to a lower risk of recurrent stroke (
P
=0.026) and all-cause mortality (
P
=0.009). Funnel plot inspection and Egger statistical test revealed no evidence of publication bias. The extent of BP reduction is linearly associated with the magnitude of risk reduction in recurrent cerebrovascular and cardiovascular events. Strict and aggressive BP control seems to be essential for effective secondary stroke prevention.
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Affiliation(s)
- Aristeidis H. Katsanos
- From the Second Department of Neurology (A.H.K., A.F., K.V., G.T.) and Second Department of Cardiology (S.D., J.P., A.F., A.-R.V., I.I.), Attikon University Hospital, School of Medicine, University of Athens, Greece; Department of Neurology, University of Ioannina School of Medicine, Greece (A.H.K.); Department of Clinical Therapeutics, Alexandra Hospital, School of Medicine, University of Athens, Greece (E.M.); First Department of Internal Medicine, Hypertension Excellence Center, AHEPA University
| | - Angeliki Filippatou
- From the Second Department of Neurology (A.H.K., A.F., K.V., G.T.) and Second Department of Cardiology (S.D., J.P., A.F., A.-R.V., I.I.), Attikon University Hospital, School of Medicine, University of Athens, Greece; Department of Neurology, University of Ioannina School of Medicine, Greece (A.H.K.); Department of Clinical Therapeutics, Alexandra Hospital, School of Medicine, University of Athens, Greece (E.M.); First Department of Internal Medicine, Hypertension Excellence Center, AHEPA University
| | - Efstathios Manios
- From the Second Department of Neurology (A.H.K., A.F., K.V., G.T.) and Second Department of Cardiology (S.D., J.P., A.F., A.-R.V., I.I.), Attikon University Hospital, School of Medicine, University of Athens, Greece; Department of Neurology, University of Ioannina School of Medicine, Greece (A.H.K.); Department of Clinical Therapeutics, Alexandra Hospital, School of Medicine, University of Athens, Greece (E.M.); First Department of Internal Medicine, Hypertension Excellence Center, AHEPA University
| | - Spyridon Deftereos
- From the Second Department of Neurology (A.H.K., A.F., K.V., G.T.) and Second Department of Cardiology (S.D., J.P., A.F., A.-R.V., I.I.), Attikon University Hospital, School of Medicine, University of Athens, Greece; Department of Neurology, University of Ioannina School of Medicine, Greece (A.H.K.); Department of Clinical Therapeutics, Alexandra Hospital, School of Medicine, University of Athens, Greece (E.M.); First Department of Internal Medicine, Hypertension Excellence Center, AHEPA University
| | - John Parissis
- From the Second Department of Neurology (A.H.K., A.F., K.V., G.T.) and Second Department of Cardiology (S.D., J.P., A.F., A.-R.V., I.I.), Attikon University Hospital, School of Medicine, University of Athens, Greece; Department of Neurology, University of Ioannina School of Medicine, Greece (A.H.K.); Department of Clinical Therapeutics, Alexandra Hospital, School of Medicine, University of Athens, Greece (E.M.); First Department of Internal Medicine, Hypertension Excellence Center, AHEPA University
| | - Alexandra Frogoudaki
- From the Second Department of Neurology (A.H.K., A.F., K.V., G.T.) and Second Department of Cardiology (S.D., J.P., A.F., A.-R.V., I.I.), Attikon University Hospital, School of Medicine, University of Athens, Greece; Department of Neurology, University of Ioannina School of Medicine, Greece (A.H.K.); Department of Clinical Therapeutics, Alexandra Hospital, School of Medicine, University of Athens, Greece (E.M.); First Department of Internal Medicine, Hypertension Excellence Center, AHEPA University
| | - Agathi-Rosa Vrettou
- From the Second Department of Neurology (A.H.K., A.F., K.V., G.T.) and Second Department of Cardiology (S.D., J.P., A.F., A.-R.V., I.I.), Attikon University Hospital, School of Medicine, University of Athens, Greece; Department of Neurology, University of Ioannina School of Medicine, Greece (A.H.K.); Department of Clinical Therapeutics, Alexandra Hospital, School of Medicine, University of Athens, Greece (E.M.); First Department of Internal Medicine, Hypertension Excellence Center, AHEPA University
| | - Ignatios Ikonomidis
- From the Second Department of Neurology (A.H.K., A.F., K.V., G.T.) and Second Department of Cardiology (S.D., J.P., A.F., A.-R.V., I.I.), Attikon University Hospital, School of Medicine, University of Athens, Greece; Department of Neurology, University of Ioannina School of Medicine, Greece (A.H.K.); Department of Clinical Therapeutics, Alexandra Hospital, School of Medicine, University of Athens, Greece (E.M.); First Department of Internal Medicine, Hypertension Excellence Center, AHEPA University
| | - Maria Pikilidou
- From the Second Department of Neurology (A.H.K., A.F., K.V., G.T.) and Second Department of Cardiology (S.D., J.P., A.F., A.-R.V., I.I.), Attikon University Hospital, School of Medicine, University of Athens, Greece; Department of Neurology, University of Ioannina School of Medicine, Greece (A.H.K.); Department of Clinical Therapeutics, Alexandra Hospital, School of Medicine, University of Athens, Greece (E.M.); First Department of Internal Medicine, Hypertension Excellence Center, AHEPA University
| | - Odysseas Kargiotis
- From the Second Department of Neurology (A.H.K., A.F., K.V., G.T.) and Second Department of Cardiology (S.D., J.P., A.F., A.-R.V., I.I.), Attikon University Hospital, School of Medicine, University of Athens, Greece; Department of Neurology, University of Ioannina School of Medicine, Greece (A.H.K.); Department of Clinical Therapeutics, Alexandra Hospital, School of Medicine, University of Athens, Greece (E.M.); First Department of Internal Medicine, Hypertension Excellence Center, AHEPA University
| | - Konstantinos Voumvourakis
- From the Second Department of Neurology (A.H.K., A.F., K.V., G.T.) and Second Department of Cardiology (S.D., J.P., A.F., A.-R.V., I.I.), Attikon University Hospital, School of Medicine, University of Athens, Greece; Department of Neurology, University of Ioannina School of Medicine, Greece (A.H.K.); Department of Clinical Therapeutics, Alexandra Hospital, School of Medicine, University of Athens, Greece (E.M.); First Department of Internal Medicine, Hypertension Excellence Center, AHEPA University
| | - Anne W. Alexandrov
- From the Second Department of Neurology (A.H.K., A.F., K.V., G.T.) and Second Department of Cardiology (S.D., J.P., A.F., A.-R.V., I.I.), Attikon University Hospital, School of Medicine, University of Athens, Greece; Department of Neurology, University of Ioannina School of Medicine, Greece (A.H.K.); Department of Clinical Therapeutics, Alexandra Hospital, School of Medicine, University of Athens, Greece (E.M.); First Department of Internal Medicine, Hypertension Excellence Center, AHEPA University
| | - Andrei V. Alexandrov
- From the Second Department of Neurology (A.H.K., A.F., K.V., G.T.) and Second Department of Cardiology (S.D., J.P., A.F., A.-R.V., I.I.), Attikon University Hospital, School of Medicine, University of Athens, Greece; Department of Neurology, University of Ioannina School of Medicine, Greece (A.H.K.); Department of Clinical Therapeutics, Alexandra Hospital, School of Medicine, University of Athens, Greece (E.M.); First Department of Internal Medicine, Hypertension Excellence Center, AHEPA University
| | - Georgios Tsivgoulis
- From the Second Department of Neurology (A.H.K., A.F., K.V., G.T.) and Second Department of Cardiology (S.D., J.P., A.F., A.-R.V., I.I.), Attikon University Hospital, School of Medicine, University of Athens, Greece; Department of Neurology, University of Ioannina School of Medicine, Greece (A.H.K.); Department of Clinical Therapeutics, Alexandra Hospital, School of Medicine, University of Athens, Greece (E.M.); First Department of Internal Medicine, Hypertension Excellence Center, AHEPA University
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19
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Katsanos AH, Mavridis D, Parissis J, Deftereos S, Frogoudaki A, Vrettou AR, Ikonomidis I, Chondrogianni M, Safouris A, Filippatou A, Voumvourakis K, Triantafyllou N, Ellul J, Karapanayiotides T, Giannopoulos S, Alexandrov AW, Alexandrov AV, Tsivgoulis G. Novel oral anticoagulants for the secondary prevention of cerebral ischemia: a network meta-analysis. Ther Adv Neurol Disord 2016; 9:359-68. [PMID: 27582891 DOI: 10.1177/1756285616659411] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [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: 01/09/2023] Open
Abstract
BACKGROUND Novel oral anticoagulants (NOACs) have shown to be both safe and effective for ischemic stroke prevention in patients with nonvalvular atrial fibrillation (NVAF). We conducted a network meta-analysis (NMA) using published data from secondary prevention subgroups of different phase III randomized clinical trials (RCTs) comparing individual NOACs with warfarin. METHODS Eligible studies were identified by searching MEDLINE and SCOPUS and the Cochrane Central Register of Controlled Trials databases. First, we conducted a pairwise meta-analysis for each pairwise comparison, and then we performed NMA to combine direct and indirect evidence for any given pair of treatments. The comparative effects of all NOACs against warfarin were ranked with the surface under the cumulative ranking (SUCRA) curve for each outcome. RESULTS We identified four RCTs (including 15,240 patients) comparing individual NOACs (apixaban, dabigatran, rivaroxaban) with warfarin. Using indirect evidence, dabigatran was related to a significantly lower risk of hemorrhagic stroke compared with rivaroxaban [risk ratio (RR) 0.28; 95% confidence interval (CI) 0.11-0.75], while rivaroxaban was associated with a significantly lower risk of major gastrointestinal bleeding compared with dabigatran (RR 0.14; 95% CI 0.03-0.74). We also performed clustered ranking plot for the primary efficacy and safety endpoints to identify the treatment with the probably best benefit-to-risk ratio profile. CONCLUSIONS The three NOACs showed differences in terms of safety and efficacy for secondary stroke prevention in NVAF. Our findings can serve only as hypothesis generation and require independent confirmation in head-to-head RCTs, owing to the sparse available evidence and increased uncertainty in both indirect effect estimates and ranking of treatments.
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Affiliation(s)
- Aristeidis H Katsanos
- Department of Neurology, University of Ioannina School of Medicine, Ioannina, Greece Second Department of Neurology, 'Attikon University Hospital', School of Medicine, University of Athens, Athens, Greece
| | - Dimitris Mavridis
- Department of Primary Education, University of Ioannina, Ioannina, Greece Department of Hygiene and Epidemiology, School of Medicine, University of Ioannina, Ioannina, Greece
| | - John Parissis
- Second Department of Cardiology, 'Attikon University Hospital', School of Medicine, University of Athens, Athens, Greece
| | - Spyridon Deftereos
- Second Department of Cardiology, 'Attikon University Hospital', School of Medicine, University of Athens, Athens, Greece
| | - Alexandra Frogoudaki
- Second Department of Cardiology, 'Attikon University Hospital', School of Medicine, University of Athens, Athens, Greece
| | - Agathi-Rosa Vrettou
- Second Department of Cardiology, 'Attikon University Hospital', School of Medicine, University of Athens, Athens, Greece
| | - Ignatios Ikonomidis
- Second Department of Cardiology, 'Attikon University Hospital', School of Medicine, University of Athens, Athens, Greece
| | - Maria Chondrogianni
- Second Department of Neurology, Attikon University Hospital, School of Medicine, University of Athens, Athens, Greece
| | - Apostolos Safouris
- Second Department of Neurology, Attikon University Hospital, School of Medicine, University of Athens, Athens, Greece
| | - Angeliki Filippatou
- Second Department of Neurology, Attikon University Hospital, School of Medicine, University of Athens, Athens, Greece
| | - Konstantinos Voumvourakis
- Second Department of Neurology, Attikon University Hospital, School of Medicine, University of Athens, Athens, Greece
| | - Nikos Triantafyllou
- First Department of Neurology, 'Attikon University Hospital', School of Medicine, University of Athens, Athens, Greece
| | - John Ellul
- Department of Neurology, University of Patras, Patras, Greece
| | - Theodore Karapanayiotides
- Second Department of Neurology, Aristotelian University of Thessaloniki, AHEPA University Hospital, Thessaloniki, Greece
| | - Sotirios Giannopoulos
- Department of Neurology, University of Ioannina School of Medicine, Ioannina, Greece
| | - Anne W Alexandrov
- Department of Neurology, University of Tennessee Health Science Center, Memphis, TN, USA Australian Catholic University, Sydney, Australia
| | - Andrei V Alexandrov
- Department of Neurology, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Georgios Tsivgoulis
- Second Department of Neurology, Attikon University Hospital, University of Athens, School of Medicine, Iras 39, Gerakas Attikis, Athens, 15344, Greece
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Katsanos S, Filippatou A, Ruschitzka F, Filippatos G. Positive emotions and Takotsubo syndrome: ‘happy heart’ or ‘Diagoras’ syndrome? Eur Heart J 2016; 37:2821-2822. [DOI: 10.1093/eurheartj/ehw197] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2016] [Revised: 04/25/2016] [Accepted: 04/26/2016] [Indexed: 11/14/2022] Open
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