Risultati per: Stroke

Circulation, Volume 146, Issue Suppl_1, Page A10664-A10664, November 8, 2022. Introduction:Social Determinants of Health (SDOH) contribute to the development of diseases and disproportionally affect minoritized groups. There is a paucity of information describing the relationship between SDOH, stroke/TIA and vascular risk factors (VRFs) in Hispanics/Latinos.Hypothesis:Unfavorable SDOH are associated with self-reported stroke/TIA and with increased VRFs.Methods:Cross-sectional data from cohort study of Hispanic Community Health Study/Study of Latinos (2014-2017). SDOH were assessed using questionnaires and previously validated scales. VRFs were hypertension, diabetes mellitus, hypercholesterolemia, smoking, at-risk alcohol use, and obesity. We investigated the association between the SDOH (individually and as count) and stroke/TIA using weighted complex survey multivariable logistic and linear regression analyses.Results:For individuals with stroke/TIA (weighted n=388), the mean age (58.9, 95% CI=56.4-61.5) differed from those without stroke/TIA (weighted n=11,210; 46.8, 95% CI=46.3-47.4). In bivariate analysis, income

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 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 A15640-A15640, November 8, 2022. Introduction:Determining stroke etiology is paramount to clinical management and prevention of recurrent strokes. Although stroke patients undergo extensive post-treatment work-ups, 30-40% of cases remain cryptogenic.Hypothesis:Engineered histomic features from digital pathology images of stroke blood clots collected during mechanical thrombectomy (MT) can be used to delineate stroke etiology.Methods:For clots retrieved from patients undergoing MT, etiology was determined by the trial of Trial of Org 10172 in Acute Stroke Treatment (TOAST) score. After sectioning and H&E staining, clot components (red blood cells-RBCs, fibrin-platelet regions-FP, and white blood cells-WBCs) were segmented from whole slide images. Histomic features were engineered to capture the structural distribution of RBC/FP regions throughout the clot. To measure clot WBC diversity, WBC instances were clustered into WBC “classes” based on texture, and summarized as a class frequency distribution (CFD). The three most significant RBC/FP and WBC features between large artery atherosclerosis (LAA) and cardioembolic (CE) cases were used to train a complement Naïve Bayes (CNB) model, which was then implemented to predict the etiology of cryptogenic cases.Results:In our data (n=53), 31 clots were CE, 8 were LAA, 4 were from strokes of other determined etiology, and 10 were cryptogenic. 17 significant RBC/FP features and 3 significant WBC CFDs were different between CE and LAA. The trained CNB model accurately classified CE vs. LAA with a validation AUC of 0.87±0.03, exhibiting superior performance to a model trained using common clot percent cellular composition metrics (AUC=0.69±0.16). Furthermore, we showed the potential to classify cryptogenic cases as CE or LAA.Conclusions:This first-of-its-kind, biologically-informed clot histomic pipeline captured significant information that may augment clinical and laboratory features used in stroke etiology classification.

Circulation, Volume 146, Issue Suppl_1, Page A15422-A15422, November 8, 2022. Background:Mechanical circulatory support (MCS) is increasingly being used as a bridge or destination therapy in advanced heart failure. Data on the risk of complications including stroke are limited.Methods:The National Inpatient Database (NIS) from 2002-2019 was analyzed to identify patients with stroke and classified based on MCS use into MCS and no-MCS groups. Using a linear regression model, trends of stroke were obtained.Result:On trend analysis, there was a steep increase in the incidence of stroke from 2002-2013 (MCS: 21% to 41% and no-MCS: 20% to 36%) with a decline in the trend by 2019 in MCS group compared to no-MCS group (38% vs. 44%). Annual trends of stroke in impella, extracorporeal membrane oxygenation (ECMO), intra-aortic balloon pump (IABP) and left ventricular assist device (LVAD) had initial increasing trends from 2002-2013 (1% to 18%, 2.5% to 40%, 24% to 44% and 14% to 40% respectively). Patients on LVAD had a plateaued rate from 2014-2019 (40% to 46%) while the rate in impella and ECMO continued to increase exponentially from 2014-2019 (18% to 81% and 40% to 58% respectively). Conversely, there has been a decline in the trend in IABP by 2019 (32%).Conclusion:The risk of stroke in patients with the use of mechanical circulatory support devices increased exponentially until 2013 and has shown a declining trend thereafter.

Circulation, Volume 146, Issue Suppl_1, Page A14942-A14942, November 8, 2022. Background, hypothesis:Gyrencephalic large-animal models of acute ischemic stroke (AIS) such as swine gain attention in translating preclinical to clinical stroke research, with brain anatomy similar to humans. Most swine models employ young animals with AIS by permanent occlusion (P-AIS). This does not reflect the, often elderly, stroke patient. Therefore, recanalized AIS (R-AIS) in adult mini-pigs could improve preclinical to clinical translation.Methods:Anesthetized adult (2 yrs) Aachen mini-pigs (n=6) underwent craniotomy to occlude right-side middle cerebral arteries (MCA) with aneurysm clips. Clips were released at 4 hrs to allow recanalization for 2-4 hrs (R-AIS, n=4) or left in place until sacrifice (P-AIS, n=1). 3D angiography confirmed occlusion and recanalization. Infarct size was determined by TTC staining and expressed as % infarct per hemisphere (median, min-max). Qualitative neurovascular histology was performed in HE-stained sections of ischemic and remote (contralateral) tissue.Results:All animals survived until end-of-procedure. In 4 of 5 animals R-AIS successfully induced cortical infarcts (infarct size, 16.2% [9.1%-25.2%]). R-AIS was unsuccessful in 1 animal, with a smallstriatuminfarct (2.7%) without cortical involvement and unclear angiographic occlusion. P-AIS (n=1) resulted in 12.7% infarct. Assessment of ischemic (TTC-neg) tissue revealed characteristic histology of ischemia/reperfusion-derived neurovascular damage, including erythrocyte extravasation, vasostasis, increased perivascular space and intravascular platelet/fibrin aggregates (Figure 1) in all animals. Remote tissue did not show any of these features.Conclusions:Adult Aachen mini-pigs can be used for acute ischemic stroke modelling and display characteristic neurovascular features associated with ischemia and reperfusion. They may serve as a model for translational therapeutic neuro(vascular)-protective research.

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 A11278-A11278, November 8, 2022. Introduction:Post-stroke depression (PSD) is a common neuropsychiatric complication of stroke with a high incidence of 31% and that is associated with poor functional outcomes and increased mortality. Its pathophysiology is poorly understood, however, evidence suggests that neuroinflammation in reaction to the stroke could play a role in the development of PSD.Hypothesis:To compare C-reactive protein (CRP), and homocysteine (Hcy) levels in post-stroke patients with and without depression.Methods:We systematically searched all electronic databases from inception until May 30th 2022 comparing baseline CRP and Hcy.Results:A total of 12 studies with 3,154 Patients were included in this analysis. The mean age of the overall cohort was 64.8 years with PSD patients appearing to be older than non-PSD patients (mean 67.3 years vs 63.8 years). In terms of gender distribution, there were more females in the PSD group compared with non-PSD groups (48.9% vs 40.7%). PSD patients were more likely to be widowed (18% vs 7.25%) and had a family history of psychiatric disorder (10.4% vs 4.4%) compared to non-PSD patients. Patients with PSD had higher levels of baseline CRP [SMD 0.86, (95% CI 0.65 to 1.08), p

Circulation, Volume 146, Issue Suppl_1, Page A10863-A10863, November 8, 2022. Introduction:Patients (pts) with left ventricular (LV) dysfunction are at increased stroke risk even in absence of LV thrombus (LVT), but conventional indices such as ejection fraction (LVEF) have limited predictive value. Cardiac MRI (CMR) enables precise assessment of LV function and infarction, providing utility to test novel markers for stroke risk.MethodsThe population comprised pts with LVEF

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 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 A13921-A13921, November 8, 2022. Introduction:Globally, stroke is one of the top five leading causes of death. Although it was being mostly reported in the elderly population, recently a significant number of young adults are being diagnosed with stroke. The increasing prevalence of comorbidities like diabetes, & hypertension, along with a rise in substance use disorders (SUDs) could be attributed to increased stroke diagnosis among young adults.Aims & Objectives:The aims of the study include an evaluation of the prevalence of stroke in the US population & prevalence of SUDs amongst patients with a history of Stroke.Methods:Our population was obtained from the National Health and Nutrition Examination Survey (NHANES) from 2013 to 2018. We identified respondents who were diagnosed with stroke & SUDs based on the questionnaire. We performed univariate analysis using chi-square & Mann-Whitney tests using SAS software (Version 9.4). A p-value of $100,000).(p

Circulation, Volume 146, Issue Suppl_1, Page A13949-A13949, November 8, 2022. Introduction:Prolonged and intensified rhythm monitoring is recommended to detect atrial fibrillation (AF) in patients with cryptogenic stroke (CS). Continuous monitoring using implantable cardiac monitors (ICM) results in AF detection rates of up to 30%. Although higher age has been identified as an independent risk factor for AF after CS, there are no specific recommendations for the implantation of ICM in younger patients.Hypothesis:AF dectection in young patients (< 60 years) with CS and continuous rhythm monitoring is low.Methods:From 02/2014 to 11/2021, 186 patients (mean age 65 ± 12 years) with cryptogenic stroke were included in this analysis. All patients underwent 72-h ECG monitoring, transcranial Doppler Ultrasound and transthoracic echocardiography according to current guidelines. Follow-up was performed by means of a regular outpatient presentation every three months and included medical history, physical examination, and interrogation of the ICM. AF was defined as any episode of absolute arrhythmia >30 seconds.Results:AF was detected in 62 patients (33 %) during a mean follow-up of 36 ± 23 months. AF was found in 6 % (3/52), 27 % (17/62), 56 % (31/55) and 65 % (11/17) (p < 0.001) in patients aged < 60 years, 60-69 years, 70-79 years and ≥ 80 years, respectively (see Figure 1). All patients with AF under 60 years had an impaired systolic left ventricular function (left ventricular ejection fraction < 50 %).Conclusions:In cryptogenic stroke patients, detection of Atrial Fibrillation by implantable cardiac monitors increases with advanced age. In patients younger than 60 years, Atrial Fibrillation was only detected in patients with impaired systolic left ventricular function. The diagnostic benefit of ICM implantation in young patients with cryptogenic stroke and preserved LV function is limited. Possibly positive predictors for AF detection should be identified and considered in the decision to implant cardiac monitors.

Circulation, Volume 146, Issue Suppl_1, Page A11204-A11204, November 8, 2022. Introduction:Perioperative stroke is one of the most devastating events after surgery. To prevent perioperative stroke and stratify the patients at risk, several prediction models or scores based on the preoperative factors were suggested. However, there had been never reported a prediction model using intraoperative physiologic parameters.Aim:We aimed to develop a prediction model for perioperative stroke by analyzing pre- and intraoperative factors using machine learning techniques.Methods:This retrospective cohort study included patients who underwent non-cardiac surgery between 2016 and 2019 at Seoul National University Hospital. Perioperative stroke was defined as a newly developed ischemic lesion at diffusion weighted imaging within 30 days after surgery. Preoperative factors were age, risk factors and laboratory data. Intraoperative variables were blood pressure, heart rate, saturation monitoring value, total amount of fluid and urine volume during surgery. We developed a random forest based prediction model composed of pre- and intraoperative factors and compared with a model consisting of only preoperative features. We validated the model in an external cohort of patients at another hospital between 2020 and 2021.Results:A total of 15752 patients were included in the development cohort, and 109 patients had perioperative stroke. In external validation cohorts, stroke occurred in 11 of 449 patients. The area under the receiver operating characteristics curves (AUC) for integrated models using pre- and intraoperative parameters was significantly higher than that of model using only preoperative factors, as shown in figure(0.822, 95% confidence interval, 0.760-0.883,p

Circulation, Volume 146, Issue Suppl_1, Page A13083-A13083, November 8, 2022. Introduction:Elevated lipoprotein (a) [Lp(a)] plasma levels are causally associated with CAD. The association between Lp(a) and stroke is however less clear. The SPARCL trial has demonstrated the superiority of 80mg atorvastatin to placebo for the prevention of stroke in patients with recent stroke or TIA. The aim of the current study was to investigate if Lp(a) is predictive of recurrent cerebrovascular and incident coronary events in these patients.Methods:Lp(a) concentration and apolipoprotein(a) [apo(a)] isoform size, a strong determinant of Lp(a) plasma levels, were measured by LC-HRMS in samples collected at baseline from 2814 SPARCL participants (1418 randomized to atorvastatin & 1396 to placebo). Within each treatment arm, we compared patients in the highest quartile ( >84.0nmol/L) with those in the lowest quartiles of Lp(a) concentrations and patients in the lowest quartile (

Circulation, Volume 146, Issue Suppl_1, Page A9746-A9746, November 8, 2022. Introduction:Amyloidosis can disrupt several tissues, including the heart, causing various cardiac arrhythmias. Factors influencing the presence of Atrial Fibrillation in the elderly with amyloidosis admitted for Acute Ischemic Stroke (AIS) have been sparsely studied.Methods:Elderly patients of ages 60 and more with a diagnosis of amyloidosis and a principal diagnosis of Acute Ischemic Stroke (I63.x) were filtered from the 2019 National Inpatient Sample (NIS). All forms of Atrial Fibrillation and multiple risk factors were also identified via their appropriate codes provided by HCUP and based on recommendations from past studies.Results:Our analysis found 1570 elderly amyloidosis patients admitted for AIS in 2019. Among them, 490 cases (31.2%) also had a diagnosis of Atrial Fibrillation. Predictors of atrial fibrillation included hypertension (aOR 1.543, p=0.024), chronic pulmonary disease (aOR 1.541, p