Risultati per: Stroke

Circulation, Volume 146, Issue Suppl_1, Page A13658-A13658, November 8, 2022. Background:It is well-known that African American (AA) patients with Atrial Fibrillation (AF) have a higher incidence of stroke in comparison to the general population. To our knowledge, limited data exist on gender disparities in risk factors contributing to a higher incidence of stroke among AA patients. The objective of this study is to identify gender disparities in risk factors for AF by comparing AA females and males with AF.Methods:AA patients aged 18 years old or above with a diagnosis of AF were included in this study. Patients were selected from the 2019 national inpatient sample. The primary outcome of interest was incidence of stroke. T-test was used to compare differences in continuous variables. For categorical variables, pearson chi-square was used to compare differences. Multivariate logistic regression was used to adjust for potential confounders. A 2-sided P

Circulation, Volume 146, Issue Suppl_1, Page A9885-A9885, November 8, 2022. Introduction:Atrial septal defect (ASD) is one of the most common congenital cardiac defects. It can also allow paradoxical emboli to move into the cerebral vasculature leading to Acute Ischemic Stroke (AIS). As there is a lack of adequate information on the additional risk factors for mortality in ASD patients following AIS, we queried the largest inpatient database in the United States for answers.Methods:Patients with ASD were identified among patients of ages 25 and more admitted with a principal diagnosis of AIS ICD-10 code (I63.x) in 2019 from the National Inpatient Sample(NIS). Various patient characteristics and procedures were also studied. A Multivariate regression model adjusting for several factors allowed our study to further evaluate potential risk factors for mortality among ASD patients.Results:Our study found 551,385 cases of AIS, amongst which 19,670 (3.6%) also had a diagnosis of ASD. ASD patients had a higher risk of requiring mechanical thrombectomy (aOR 1.239, 95% CI 1.167- 1.316, p

Circulation, Volume 146, Issue Suppl_1, Page A14113-A14113, November 8, 2022. Introduction:Study of the composition of acute ischemic stroke emboli is still in infancy, though recent literature has begun to demonstrate remarkable heterogeneity in the composition of ischemic stroke emboli from different etiologies. Atrial fibrillation (AF) is a significant risk factor for stroke, and so in this study we investigate differences in proteomic composition between retrieved stroke emboli from patients with and without AF.Methods:The full proteomic composition of retrieved thromboembolic material from 24 patients with AIS was evaluated by mass spectrometry. The abundance of individual proteins in patients with AF was compared to that of patients without AF using Mann-Whitney U-tests, with significant differences described by the fold change (FC) in abundance. Cut-offs for significance were set at p = 0.05 and an FC difference of 2x. Descriptive heatmaps with sorted dendrograms were generated using the proteins with significant FC differences between patients with and without AF.Results:Proteins with the greatest FC enrichment in emboli from patients with AF included ferritin light chain (p = 0.006), ferritin heavy chain (p = 0.003), eosinophil peroxidase (p = 0.01), eosinophil lysophospholipase (p = 0.02), eosinophil-derived neurotoxin (p = 0.02), the neprilysin modulator nicastrin (p = 0.0007), HLA class I B α chain (p = 0.02), among others. Notably, neutrophil and histone proteins were also significantly enriched in emboli from patients with AF (p < 0.05 for all). Proteins with the greatest FC enrichment in emboli from patients without AF included interferon-induced GTP-binding protein Mx1 (p78) (p = 0.04) and mitsugumin-53 (p = 0.03).Conclusions:This data demonstrates that clot composition may directly reflect underlying stroke etiology. More specifically, the enrichment of eosinophil, neutrophil, and histone proteins in emboli from patients with AF points to significant immunothrombosis in emboli from this patient population. These findings may underlie distinct mechanisms in clot formation or maintenance in AF, and inform not only future studies on stroke pathophysiology, but also future work on novel pharmacotherapies for acute ischemic stroke in this patient population.

Circulation, Volume 146, Issue Suppl_1, Page A10764-A10764, November 8, 2022. Introduction:In 20-30% cases, the cause of stroke remained unexplained which has led to coining of the term, Cryptogenic Stroke (CS). Similarly, about 48% cases of transient ischemic attacks (TIAs) had no identifiable cause after standard diagnostic workup. Undiagnosed Atrial Fibrillation (AF) is a prime suspect in CS but guidelines do not recommend initiation of anticoagulation unless AF has formally been detected.Methods:In a IRB approved retrospective study we included patients with at least one episode of ischemic stroke or TIA without identifiable cause and was monitored with either 48-hour Holter Monitor (HM), 30-day Event Monitor (EM) or Implantable loop recorder (ILR) to diagnose any undiscovered AF. All patients had at least 1 year, and up to 3 years, of follow-up after device placement. SAS Version 9.4 was used for statistical analyses.Results:Out of a total of 531 patients, 150 patients were monitored by ILR, 286 by EM and 95 by HM.Primary Outcome-detection of AF. The diagnosis of AF within 1 month of the stroke was 5.59% (16/286), 6.32% (6/95) and 9.33% (14/150) in the EM, HM and ILR cohorts, respectively (p=0.33). At 6, 12 and 24 months, ILRs detected AF in 15.33% (23/150), 16% (24/150) and 20% (30/150) of patients respectively (p=.0017, .0008 and .0001, respectively). Hence the Chi-Squared analysis showed no statistically significant difference among 3 devices for the detection of AF within 1 month of the index stroke but a significant difference in AF detection was observed at 6, 12 and 24 months. Similarly, the multivariable logistic regression model demonstrated no significant difference in capturing AF between HM, EM and ILR within 1 month (p=0.29) but showed a significant difference in AF detection when ILR was compared to HM and EM at 6,12 and 24 months (p=0.0027, 0.0012 and

Circulation, Volume 146, Issue Suppl_1, Page A9226-A9226, November 8, 2022. Background:The bicuspid aortic valve (BAV) exhibits abnormal geometry and transvalvular flow and is susceptible to calcification with subsequent cardioembolic stroke from calcific embolic material. However, the description of embolic ischemic strokes in patients with BAV is limited to case reports.Methods:Consecutive patients from 1975-2015 with BAV (n=5401) at our institution were retrospectively identified. Patients with ischemic stroke before aortic valve replacement (AVR) were analyzed, and the stroke was characterized. Patients were grouped according to stroke etiology: calcific embolism from a BAV (BAV stroke); large artery atherosclerotic or lacunar stroke (LA stroke); and non-BAV, non-large artery embolic stroke (nLA stroke).Results:There were 83/5401 (1.5%) patients with ischemic stroke. Mean age was 54 ± 12 years and 28% were female. Stroke etiology was BAV stroke in 26/83 (31%), LA stroke in 23/83 (28%), nLA stroke in 30/83 (36%), and other in 4/83 (5%). Stroke was embolic in 72/83 (87%), as shown in Figure 1. CHA2DS2-VASc score was not different in patients with BAV stroke (1.4 ± 1.2) versus nLA stroke (1.8 ± 1.2, p=0.188) but was higher in LA stroke (2.3 ± 1.2, p=0.005 vs. BAV stroke). Recurrent stroke occurred in 41% overall (50% BAV stroke vs. 30% LA stroke vs. 47% nLA stroke, both p=NS vs. BAV stroke). BAV stroke was more commonly located in the retinal circulation (39% BAV stroke vs. 13% LA stroke [p=0.044] vs. 0% nLA stroke [p=0.002]). Patients with BAV and LA stroke were more likely to have moderate-to-severe aortic stenosis and undergo AVR sooner after stroke compared to patients with nLA stroke.Conclusions:Stroke is an important complication in patients with BAV. The most common type of stroke in BAV is embolic. Greater than one-third of embolic stroke resulted from embolism from a calcific aortic valve. Patients with BAV stroke commonly have a history of recurrent cerebral ischemic events, severe valvular disease, and proceed to AVR soon after stroke.

Circulation, Volume 146, Issue Suppl_1, Page A9847-A9847, November 8, 2022. Introduction:Recurrent atrial fibrillation (AF) is estimated to occur in at least 20% of patients with paroxysmal or persistent AF who undergo catheter ablation (CA). Recent studies have suggested that extent of left atrial (LA) scar is of prognostic value, but it is unknown whether there is an association with patient co-morbidities.Hypothesis:Patients with structural heart disease or prior thromboembolic events have more LA scar and greater risk of AF recurrence.Methods:We retrospectively studied 117 patients who underwent CA for AF at our institution. Only ablations using the same method for radiofrequency ablation of pulmonary vein antra were included. We evaluated the association between demographic variables, LA volume, history of stroke, AF recurrence (defined as AF relapse more than 3 months after CA) and LA scar quantified by 3D electroanatomic mapping using simple regression and Kaplan-Meier analyses.Results:Mean age was 64 years, 68% were male, 60% had paroxysmal AF, 34% had persistent AF, and 6% had long-standing persistent AF. Recurrence of AF occurred in 22% of patients overall, and was significantly associated with systolic heart failure (HF) (p=0.042), number of prior cardioversions (CV) (p=0.014), left ventricular ejection fraction (LV EF) (p=0.02), LA volume (p=0.032), and atrial flutter (p=0.014). Total LA scar was significantly associated with CHA2DS2-VASc score (p=0.0095) and history of stroke or transient ischemic attack (TIA) (p=0.031).Conclusion:AF recurrence is more likely to occur in patients with LV dysfunction, prior CV, increased LA volume, and atrial flutter during CA. Total LA scar was not associated with clinical AF recurrence. However, we demonstrate a new association between LA scar burden, CHA2DS2-VASc score and history of stroke or TIA. This may explain why patients do not need to be in AF at the time they develop thromboembolic events, as enduring LA scar may contribute to the pathogenesis of stroke.

Circulation, Volume 146, Issue Suppl_1, Page A13858-A13858, November 8, 2022. Background:With the legalization of cannabis in many states for medical or recreational purposes, cannabis utilization has been increased to treat various health concerns. However, little is known about the prevalence of cannabis abuse and outcome trend among acute ischemic stroke (AIS) patients. This study examines the epidemiological characteristics and outcome trend of cannabis abuse among adults with AIS hospitalizations in the USA.Methods:We performed a population-based retrospective analysis of the Nationwide Inpatient Sample over year from 2003 to 2017 in adult hospitalizations for AIS to compare the outcomes [death, risk mortality & discharge disposition (short-term hospital / skilled nursing home/home health care)] in cannabis abusers using ICD 9 & 10 codes. We performed weighted analyses using chi-square, t-test, and Cochran-Armitage trend test.Results:Amongst the total of 5,690,773 AIS hospitalizations, 50,895 (0.89%) cannabis users were identified from 2003 to 2017. The prevalence trend of cannabis abuse has increased among stroke hospitalizations (2003: 0.22% to 2017:1.64%; p-trend < 0.0001). The cannabis abuse was higher among the younger to middle age compared to older aged stroke hospitalization (75 year: 0.02%; p

Circulation, Volume 146, Issue Suppl_1, Page A9761-A9761, November 8, 2022. Introduction:Recent studies have shown an improvement in survival among Cardiopulmonary resuscitation (CPR) cases in several situations. However, risk factors of CPR among patients admitted for Acute Ischemic Stroke (AIS) remain uncertain.Methods:Our analysis used the most extensive US inpatient database, the 2019 National Inpatient Sample, to identify patients diagnosed with CPR among adults of ages 40 and more admitted with a principal diagnosis of AIS. We also queried the different cardiac arrhythmias seen in these patients. Multivariable analysis was used to find the adjusted odds ratio(aOR) of requiring cardiopulmonary resuscitation.Results:Our study found 1425 AIS patients requiring cardiopulmonary resuscitation, which was also more common in patients of ages 40-60 (aOR 1.168), diabetics (aOR 1.160), with heart failure (aOR 1.130), hypotension (aOR 1.932), hepatic failure (aOR 3.317), renal failure (aOR 1.856), respiratory failure (aOR 18.223), gastrointestinal hemorrhage (aOR 1.960), hyperkalemia (aOR 2.258), and hypokalemia (aOR 1.265). Smokers (aOR 0.663), Females (aOR 0.878), and those with hyperlipidemia (aOR 0.689) were less likely to need CPR. Several cardiac arrhythmias were noted among those who needed CPR, such as supraventricular tachycardia (6.0% vs. 1.4%), and ventricular tachycardia (19.6% vs. 1.6%), paroxysmal atrial fibrillation (11.9% vs. 9.7%), and ventricular fibrillation (13.3% vs. 0.1%). Finally, CPR patients were slightly younger (mean age 69.82 vs. 70.89) with a longer (mean length of stay 11.48 vs. 5.01 days) hospitalization. A higher mortality rate was also found as 1030 patients died (72.3% vs. 3.6%).Conclusions:We observed several significant potential risk factors for CPR among AIS patients. Further studies, strategies, and changes in protocols among AIS admissions may benefit the long-term prognosis.

Circulation, Volume 146, Issue Suppl_1, Page A11096-A11096, November 8, 2022. Introduction:Many randomized controlled trials (RCTs) compared rate control vs rhythm control therapy in patients with atrial fibrillation (AF). In this study, we systematically reviewed these RCTs and performed a meta-analysis of the outcomes comparing the two therapies.Methods:We searched PubMed, Medline, EMBASE, and SCOPUS databases until April 30, 2022 for all RCTs investigating AF rate vs rhythm control. We used the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) for constructing and reporting this review. We assigned I2 >50% as an indicator of statistical heterogeneity among the RCTs. We analyzed all-cause mortality, stroke rate, heart failure (HF) hospitalization, and total hospitalization between the two groups. We estimated the risk ratios (RR) with a random-effects model using the Mantel-Haenszel technique and calculated the 95% confidence intervals (CI). A P-value

Circulation, Volume 146, Issue Suppl_1, Page A15361-A15361, November 8, 2022. Introduction:Individuals living with heart failure (HF) in rural settings have higher age-adjusted mortality than urban dwelling individuals. Thus, we sought to examine sociodemographic and clinical differences between rural and urban populations with HF to better understand this disparity.Methods:We examined participants from the REasons for Geographic and Racial Differences in Stroke (REGARDS) population-based cohort who completed a computer-assisted telephone interview (CATI) 10-years following initial recruitment, and who either self-reported a history of HF or had an adjudicated HF hospitalization prior to the CATI. Rural and urban designations utilized a dichotomized adaption of the Rural Urban Commuting Area. We compared sociodemographic and clinical characteristics between rural/urban participants. Logistic regression was used to examine the association between depression and health literacy with urban dwelling.Results:A total of 1002 participants had self reported HF or an adjudicated HF hospitalization during approximately 10 years of follow-up, of which 195 (19%) were classified as rural. Rural dwelling participants with HF were younger (73.5 vs 75.4 years; p=0.004) and more likely to live in the stroke belt (45% vs 33%; p

Circulation, Volume 146, Issue Suppl_1, Page A12601-A12601, November 8, 2022. Introduction:Ischemic stroke is one of the main causes of long-term morbidity/mortality and early treatment is key. Xenon (Xe) has demonstrated powerful neuroprotective effects on both ischemic and hemorrhagic stroke, but its clinical and long-term outpatient administration is limited by currently available delivery methods. Development of an oral Xe formulation is an attractive strategy for stroke treatment in the field. We developed a Xenon (Xe)-cyclodextrin (CD) oral formulation.Hypothesis:Xe-CD formulation can be delivered orally for acute stroke treatment.Methods:A stable, oral Xe-CD clathrate (Xe solid gas) was formed by pressurizing Xe (3 atm) into 14% alpha-cyclodextrin at room temperature. Xe concentration was measured by GC-MS. Rat middle cerebral artery occlusion (MCAO) was induced by intraluminar suture. The animals were divided into groups: stroke (n=4); stroke with CD (n=3); stroke with 0.5 ml Xe-CD (n=3); stroke with 1.0 ml Xe-CD (n=3); and stroke with 1.5 ml Xe-CD (n=3). Treatments were administered by gavage once a day for 3 days. At day 3, neurological behavior testing was conducted. The infarct size and neuronal death were assessed and normalized by total brain volume.Results:There are 1.56 mM Xe clathrate per 0.6 mM alpha-cyclodextrin. MCAO for 2 hours induced 21% ± 3.6% infarct volume. Xe-CD treatment dose-dependently reduced the infarct size to 18.9% ± 2.3% by 0.5 ml Xe-CD, 6.7% ± 1.8% by 1.0 ml Xe-CD, and 4.8% ± 1.2% by 1.5 ml Xe-CD (Fig. 1A). Behavioral test assessment using forelimb placement rate and Rotarod score matched infarct size. TUNEL staining demonstrated significant decreases in apoptosis in stroke rats treated with 1.5 ml Xe-CD (Fig. 1B).Conclusions:We have demonstrated oral Xe-CD formulation ameliorates neuronal apoptosis and reduces infarct size. Xe-CD represents a promising therapeutic for ischemic stroke treatment.

Introduction
Non-valvular atrial fibrillation (NVAF) is a high-risk factor for ischaemic stroke. The 2016 European Society of Cardiology Atrial Fibrillation Management guidelines recommend oral anticoagulants (OACs) to prevent stroke in men with CHA2DS2-VASc scores ≥2 and women ≥3. However, in patients with a high risk of stroke and a high risk of bleeding (HAS-BLED (Hypertension, Abnormal renal/liver function, Stroke, Bleeding history or predisposition, Labile international normalized ratio, Elderly ( > 65 years), Drugs/alcohol concomitantly) score≥3), OAC had a higher risk of bleeding. Left atrial appendage closure (LAAC) is non-inferior to OAC as a means of preventing stroke in several studies. As a minimally invasive intervention to prevent stroke, transthoracic LAAC (TS-LAAC) has a high successful closure rate, but there is a lack of literature reports directly comparing it with OAC. Our research compares TS-LAAC with novel oral anticoagulants (NOACs) and provides an appropriate programme for stroke prevention in a specific population.

Methods and analysis
This is a non-randomised controlled trial study protocol, and we will conduct this study from April 2022 to April 2025. The study included 186 patients with confirmed NVAF, 93 of whom completed thoracoscopic LAAC, and the control group treated with NOACs. The primary outcome was the incidence of stroke and systemic embolism, as well as the composite endpoint events (stroke, systemic embolism, myocardial infarction, bleeding, cardiovascular death, etc). Secondary outcomes were ischaemic stroke, haemorrhagic stroke, any bleeding events, death from cardiovascular causes, death from all causes, residual root rate in the surgery group, device-related thrombosis in the surgery group, changes in blood pressure, cardiac chamber size changes, etc. Each subject completed at least 1 year of follow-up.

Ethics and dissemination
The study has been approved by the Medical Ethics Committee of Beijing Tiantan Hospital, Capital Medical University, China (approval number: KY2022-013-02). The results from this study will be disseminated through manuscript publications and national/international conferences.

Trial registration number
ChiCTR2200058109.

Stroke, Ahead of Print. Background:Adropin is a peptide encoded by the energy homeostasis-associated gene (Enho) that is highly expressed in the brain. Aging and stroke are associated with reduced adropin levels in the brain and plasma. We showed that treatment with synthetic adropin provides long-lasting neuroprotection in permanent ischemic stroke. However, it is unknown whether the protective effects of adropin are observed in aged animals following cerebral ischemia/reperfusion. We hypothesized that adropin provides neuroprotection in aged mice subjected to transient middle cerebral artery occlusion.Methods:Aged (18–24 months old) male mice were subjected to 30 minutes of middle cerebral artery occlusion followed by 48 hours or 14 days of reperfusion. Sensorimotor (weight grip test and open field) and cognitive tests (Y-maze and novel object recognition) were performed at defined time points. Infarct volume was quantified by 2,3,5-triphenyltetrazolium chloride staining at 48 hours or Cresyl violet staining at 14 days post–middle cerebral artery occlusion. Blood-brain barrier damage, tight junction proteins, and MMP-9 (matrix metalloproteinase-9) were assessed 48 hours after middle cerebral artery occlusion by ELISA and Western blots.Results:Genetic deletion ofEnhosignificantly increased infarct volume and worsened neurological function, whereas overexpression of adropin dramatically reduced stroke volume compared to wild-type controls. Postischemic treatment with synthetic adropin peptide given at the onset of reperfusion markedly reduced infarct volume, brain edema, and significantly improved locomotor function and muscular strength at 48 hours. Delayed adropin treatment (4 hours after the stroke onset) reduced body weight loss, infarct volume, and muscular strength dysfunction, and improved long-term cognitive function. Postischemic adropin treatment significantly reduced blood-brain barrier damage. This effect was associated with reduced MMP-9 and preservation of tight junction proteins by adropin treatment.Conclusions:These data unveil a promising neuroprotective role of adropin in the aged brain after transient ischemic stroke via reducing neurovascular damage. These findings suggest that poststroke adropin therapy is a potential strategy to minimize brain injury and improve functional recovery in ischemic stroke patients.

Stroke, Ahead of Print. BACKGROUND:Long-term outcome assessment patients with stroke is not fully captured by usual clinical scales such as the modified Rankin Scale (mRS). Patient-reported outcome measures (PROMs) are standardized and validated assessments that consider clinical outcomes from the patient perspective. We aim to analyze the added value of PROMs in patients with transient ischemic attack and minor stroke.METHODS:We included consecutive patients with minor stroke or transient ischemic attack (National Institutes of Health Stroke Scale score 0–5) from April 2020 to October 2021 that participated in the PROMs-through-App program (NORA, NoraHealth Barcelona Spain). Clinician and self-evaluated outcomes were assessed at 90 days: clinician-evaluated mRS, self-reported mRS, the 10-item patient-reported outcome measures questionnaire global health survey (v1.2), Hospital Anxiety and Depression Scale, and the Fatigue Assessment Scale. We evaluated the acceptability (response rate), reliability (internal consistency), and construct validity (correlation with mRS and between scales) of each questionnaire.RESULTS:We included 355 patients in the analysis, response rate was patient-reported outcome measures questionnaire 71.3% (253), Hospital Anxiety and Depression Scale 70.7% (251), Fatigue Assessment Scale 71.8% (255), and self-assessed mRS 66.8% (237). PROMS internal consistency was good or excellent, while agreement between clinician and self-reported mRS was fair (k=0.34). Rate of abnormal PROMS scores were as follows (all responders versus clinician-reported mRS score 0–2): patient-reported outcome measures questionnaire mental health (43.1% versus 36.3%), physical health (48.6% versus 43.6%); Hospital Anxiety and Depression Scale-anxiety (21.9% versus 17.7%) and depression (17.1% versus 13.3%); and Fatigue Assessment Scale (40.8% versus 36.4%). PROMs scores correlated with clinician and self-reported mRS at 90 days.CONCLUSIONS:Evaluation of PROMs using a mobile-app-based communication system is a reliable and valid strategy to assess the outcome of patients from their perspective after a mild stroke or transient ischemic attack.

Stroke, Ahead of Print.

Stroke, Ahead of Print. BACKGROUND:Gender disparities among principal investigators of clinical trials (CT) can have implications regarding the areas of investigation, methods, conduct, trial enrollment, and interpretation of results. An estimation of the gender gap in the leadership of stroke-related CTs from North America has to date not been undertaken.METHODS:We extracted information about stroke-related CTs between 2011 and 2020 fromwww.Clinicaltrials.govand PubMed. We examined the gender distribution according to the academic credentials and the trial type. The gender of PIs and authors was determined using gender package in R, which identifies gender using historical data from the United States. Additionally, we obtained information from Association of American Medical Colleges and the Accreditation Council for Graduate Medical Education data resource books on the gender composition of full-time neurology faculty, neurology residents and vascular neurology fellows.RESULTS:In these analyses of 821 CTs registered on Clinicaltrials.gov and 110 trials published on PubMed, we found that gender disparity among the PIs, first and last authors have persisted over the last decade without any significant trend toward parity (P >0.05). On examining the gender distribution according to academic credentials and trial type, we found that men were over-represented in the sub-group of PIs with an MD degree (78.11% versus 21.87%;P