Risultati per: Stroke

Circulation, Volume 150, Issue Suppl_1, Page A4140775-A4140775, November 12, 2024. Background:Stroke is the leading cause of neurological disability worldwide and contributes substantially to mortality. Colchicine is a microtubule inhibitor that has anti-inflammatory properties. In recent years, colchicine has been investigated as a potential therapeutic agent for reducing the risk of adverse cardiovascular events. Few studies have reported the risks of stroke with colchicine, with controversial results to date.Aim:This meta-analysis aimed to compare the efficacy of colchicine versus placebo for stroke prevention.Methods:We conducted a comprehensive systematic search of the major databases from inception until May 3, 2024, to identify randomized controlled trials (RCTs) comparing colchicine to placebo. Risk ratios (RR) with 95% confidence intervals (CI) were pooled using an inverse-variance random-effects model. Statistical significance was set at p < 0.05.Results:We included 13 RCTs with 13629 patients (6823: Colchicine and 6806: Placebo). The mean age in the Colchicine group was 62.1 ± 9.4 years and in the placebo group was 62.4 ± 9.1 years. Colchicine was associated with a significantly lower risk of stroke [RR: 0.51; 95% CI: -0.32, 0.80; p=0.003] than placebo. However, the risk of all-cause mortality [RR: 1.01; 95% CI: 0.66, 1.54; p=0.97] was similar between the two groups.Conclusion:This study demonstrated the efficacy of colchicine in reducing the risk of stroke. However, colchicine did not reduce the risk of all-cause mortality. Future RCTs are required to investigate this risk reduction on a larger, multicenter scale.

Circulation, Volume 150, Issue Suppl_1, Page A4137985-A4137985, November 12, 2024. Background:Childhood cancer survivors (CCS) frequently show poor exercise performance, but its pathophysiology and clinical significance are poorly understood.Methods:Poor exercise performers, defined as peak oxygen consumption (VO2)/kg < 80% of predicted maximum VO2/kg, were enrolled, including 40 CCS (20 males, 20 females) and 32 controls (15 males, 17 females) from 79 CCS and 147 age-matched controls, respectively. Peak and submaximal CPET parameters were compared between CCS and controls with poor exercise performance. Submaximal slope parameters represent a trend up to anaerobic threshold (AT).Results:Ages and anthropometric measurements (weight, height, and body mass index) were comparable between CCS and controls in both sexes (Table 1). Both resting and peak heart rate (HR) were significantly higher in CCS than in controls in males. There was no significant difference in peak VO2/kg, peak oxygen pulse (OP)/kg, peak respiratory exchange ratio, or VO2/kg at AT (VAT/kg) between CCS and controls in both sexes. Peak work rate (WR/kg) was significantly lower in CCS compared with that in controls in both sexes, suggesting reduced muscle strength in CCS. Figure 1 demonstrates decreased muscle mass/strength in CCS than in controls. In males, Δ[VO2/kg]/ ΔHR was significantly lower in CCS than in controls, indicating limited stroke volume reserve (SVR) in male CCS. In female, although there was no significant difference in Δ[VO2/kg]/ΔHR between CCS and controls, HR-dependency expressed by ΔHR/Δ[WR/kg] was significantly higher in CCS than in controls, suggesting impaired SVR. ΔVO2/ΔWR, a marker for physical conditioning, was comparable between CCS and controls in both sexes.Conclusions:Poor exercise performance in CCS is characterized mainly by decreased muscle mass/strength and impaired SVR for both sexs. Impaired SVR may be an early sign of subclinical cardiotoxicity. Poor exercise performance in CCS should be improved to prevent future cardiovascular complications.

Circulation, Volume 150, Issue Suppl_1, Page A4145568-A4145568, November 12, 2024. Background:Embolic stroke of undetermined source (ESUS) is a nonlacunar ischemic stroke with no clear cause, having a 4%-5% annual recurrence rate. The potential benefits of direct oral anticoagulants (DOACs) relative to aspirin in patients with ESUS remain unclear.Objective:We aimed to perform a systematic review and meta-analysis to determine the efficacy of the DOACs in secondary prevention for patients with ESUS compared with aspirin.Methods:MEDLINE, Embase, Cochrane, and ClinicalTrias.gov were searched for RCTs comparing DOACs versus aspirin for secondary stroke prevention after ESUS. We performed a systematic review and meta-analysis following the Preferred Reporting Items for Systematic Review (PRISMA) and Cochrane guidelines. Statistical analysis was performed using R software 4.3.2. A random-effects model was employed to measure mean differences and hazard ratios (HR) with 95% confidence intervals (CI).Results:We included 4 RCTs comprising 13,970 patients. The median age was 67 years (IQR 65.5-68.2), 61% were male, 76% had hypertension, and 51% had diabetes. DOACs were administered to 50% of the participants. No significant difference was found between groups for stroke recurrence [RR 0.95 (95% CI 0.8-1.11) p=0.52; I2=0%]. Death from any cause [HR 1.11 (95% CI 0.87-1.42) p=0.38; I2=0%], cardiovascular death [HR 1.08 (95% CI 0.61-1.94) p=0.77; I2=18%] and myocardial infarction [HR 0.92 (95% CI 0.54-1.54) p=0.76; I2=16%] were also similar between groups. However, there was a significant increase in clinically relevant non-major bleeding for patients treated with DOACs [HR 1.53 (95% CI 1.22-1.92) p

Circulation, Volume 150, Issue Suppl_1, Page A4146972-A4146972, November 12, 2024. Introduction:Acute ischemic stroke (AIS) represents a significant long-term complication following cardiac surgery, often linked with unfavorable outcomes. Left atrial (LA) mechanics, notably LA strain, have been identified as predictors for both stroke and atrial fibrillation in various populations. However, conflicting evidence exists regarding the clinical relevance of postoperative atrial fibrillation (POAF), and its contribution to the relationship between LA mechanics and ischemic stroke remains uncertain.Objective:Our study examined the significance of left atrial strain parameters as autonomous predictors of acute ischemic stroke (AIS) among patients undergoing coronary artery bypass grafting (CABG). Additionally, we investigated the association between AIS and postoperative atrial fibrillation (POAF) in CABG patients.Methods and Materials:For a retrospective cohort analysis, we enrolled patients undergoing isolated coronary artery bypass grafting between 2021 and 2023. Transthoracic echocardiography was conducted preoperatively. The main outcome assessed was ischemic stroke. We explored the relationship between left atrial (LA) reservoir strain and ischemic stroke using uni- and multivariable Cox proportional hazards regression models, with adjustments for postoperative atrial fibrillation.Results:We analyzed a cohort comprising 410 patients, among whom 78 (19%) developed postoperative atrial fibrillation (POAF). Over a median follow-up period of 1.4 years, 19 patients (4.6%) experienced ischemic stroke. In univariable analysis, a significant association was observed between left atrial (LA) reservoir strain and ischemic stroke (hazard ratio [HR] 1.34, 95% confidence interval [CI] 0.97–1.23, p < 0.005) per 1% absolute decrease. Even after adjusting for factors including LA volume index (LAVi) and prior stroke, LA reservoir strain remained a significant predictor of ischemic stroke (HR 1.07, 95% CI 1.01–1.21, p < 0.005 per 1% absolute decrease; HR 3.6, 95% CI 1.23–11.04, p < 0.005 for < vs. >median). The inclusion of POAF as a covariate did not affect the significance of LA reservoir strain in the model.Conclusion:Our study concluded that among patients who underwent CABG, LA reservoir strain independently predicted ischemic stroke over the long term.

Circulation, Volume 150, Issue Suppl_1, Page A4139501-A4139501, November 12, 2024. Background:Atrial fibrillation (AF) is a major risk factor for ischemic stroke. Prior studies have shown that reduced blood flow velocity in the left atrial appendage, measured by the invasive transesophageal echocardiography (TEE) procedure, is associated with higher stroke risk. However, TEE is an invasive procedure with inherent risks. In this study, we aimed to investigate whether transmitral atrial flow velocity (MVA) obtained through the non-invasive transthoracic echocardiography (TTE) technique could also predict the risk of stroke in patients with AF.Methods:We conducted a longitudinal cohort study of 10,150 patients with paroxysmal AF who underwent TTE to assess MVA. The patients were followed up from January 2010 to December 2021, with the primary outcome being hospitalization for ischemic stroke.Results:Over a mean follow-up of 4.26±3.52years, 2419 (23.8%) patients developed ischemic strokes (5.59% per 100 person-years). Patients with MVA < 50 cm/s had a higher stroke incidence rate than those with MVA ≥ 50 cm/s (6.57% vs 5.47%, P

Circulation, Volume 150, Issue Suppl_1, Page A4139838-A4139838, November 12, 2024. INTRODUCTION:Stroke is the most common cause of adult disability and has a significant impact on the quality of life(QOL) of survivors and caregivers.It is important to implement a tailored intervention that could improve caregiver preparedness for the transition home after a stroke.A patient-and caregiver-centred educational approach,which directly involves caregivers,may have better long-term results.In the light of a recent review,it was identified that it improves dyadic QOL if teletraining and telesupport interventions are developed simultaneously and early in the transition of care from hospital to home.AIM:Is to investigate whether, from 0 to 3 months after hospital discharge, preparation by video-training and telesupport moderates the QOL over time of caregivers of stroke survivors.METHODS:A multicentre longitudinal study was carried out in 6 Italian centres, with video-training before discharge and supported by care transition nurses.Data were collected through interviews starting in January 2024.The WHOQOL-BRIEF was used for QOL and the Caregiver Preparedness Scale and Preparedness Assessment For The Transition Home for preparedness, the care problems of the family nucleus were investigated Caregiver Strain Index,the Multidimensional Scale of Perceived Social Support was used for perceived social support,burden was investigated with the Caregiver Burden Inventory and finally mutuality between caregiver and stroke survivor was investigated with the Mutuality Scale.The structural equation modeling was estimated using the Maximum Likelihood with robust standard method with NLMINB optimization used by Mplus.RESULT A total of 27 dyads were enroled,88% of the caregivers were female.The model showed a good fit to the data(X2(84)=90.5,p=.295,SRMR = .096,RMSEA=.031,CFI=.996,TLI= .995).Support had a significant positive effect on QOL(β= .4304,p < .001), while evolution showed a significant negative effect on QOL(β = -.3258,p = .001).The perceived burden did not have a significant effect on QOL(β = .0258, p = .707).Support had a significant negative effect on evolution(β =-.2407,p = .036),whereas perceived burden showed a nonsignificant effect on evolution(β = .1483,p= .111).DISCUSSION:The model describes how teletrainig and telesupport improves caregivers' QOL as early as 3 months after hospital discharge,compared with previous studies where QOL with traditional supportive interventions or training improves but not significantly or with longer time frames.

Circulation, Volume 150, Issue Suppl_1, Page A4116285-A4116285, November 12, 2024. Background:Low molecular weight heparin (LMWH) is the preferred anticoagulant for venous thromboembolism (VTE) prophylaxis in patients with ischemic stroke and reduced mobility. However, some patients may have indications for early direct oral anticoagulants (DOACs) and are continued on this therapy rather than transitioning to LMWH. Whether outcomes differ between these groups is unknown. We compared the safety and efficacy of early DOACs versus LMWH from a large retrospective database.Methods:Patients within the TriNetX Research Network receiving either DOACs or LMWH within 72 hours of ischemic stroke and a Modified Rankin Scale of 4-5 were included. A 1:1 propensity score matching analysis was performed using 27 covariables including demographic information, comorbidities, and medications. Chi-square and independentt-tests were used in bivariable analyses. Outcomes were all-cause mortality, VTE, intracranial and extracranial hemorrhage at 30 and 90 days.Results:Of 5,492 propensity-matched patients, mean age was 73±13, and 43% were male. Mortality in the DOAC group was significantly lower than in the LMWH group at 30 days (RR=0.59, 95% CI: 0.51-0.69) and 90 days (RR=0.63, 95% CI: 0.56-0.71). Risk of VTE was not significantly different at 30 days (RR=0.80, 95% CI: 0.43-1.50) or 90 days (RR=0.74, 95% CI: 0.45-1.22). Risk of intracranial hemorrhage was not significantly different at 30 days (RR=0.81, 95% CI: 0.36-1.80) or 90 days (RR=0.62, 95% CI: 0.34-1.15).Conclusions:In patients with acute ischemic stroke and reduced mobility, early use of DOACs was associated with lower mortality compared to early use of LMWH.

Circulation, Volume 150, Issue Suppl_1, Page A4144305-A4144305, November 12, 2024. Background and Purpose:Transfemoral access (TFA) has been the standard for neuro-interventional procedures, but it carries risks such as pseudoaneurysm formation and arterial occlusion. Transradial access (TRA) is a newer alternative that may reduce these complications. This study aims to compare the clinical outcomes of TRA versus TFA in mechanical thrombectomy (MT) for acute ischemic stroke (AIS).Methods:A systematic review and meta-analysis was conducted following PRISMA guidelines. Databases searched included PubMed/MEDLINE, Cochrane Library, and Google Scholar up to April 7, 2024. A random-effects model was used for analysis, and study quality was assessed using the Newcastle-Ottawa Scale and Cochrane Risk of Bias (RoB 2) tool.Results:The search identified 1389 records, and 13 studies (12 observational, 1 RCT) with 4803 patients (TRA: 855, TFA: 3948) were included. TRA showed no significant difference in successful recanalization (TICI 2b-3) compared to TFA [RR: 0.98; 95% CI: 0.94 – 1.03]. Complete recanalization (TICI 3) was also similar [RR: 1.08; 95% CI: 0.96 – 1.21]. Fluoroscopy time, reported by four studies, showed no significant difference [RR: -1.76; 95% CI: -7.54 – 4.02]. Hospital stay duration from three studies was comparable [MD: -0.52; 95% CI: -1.25 – 0.21]. The access-to-perfusion time reported by ten studies showed no significant difference [MD: -1.70; 95% CI: -8.11 – 4.72]. The mean number of passes from eight studies showed no significant difference [MD: 0.10; 95% CI: -0.06 – 0.27].Procedural complications were lower in the TRA group but not statistically significant [6.09% vs. 8.77%, RR: 0.71; 95% CI: 0.46 – 1.09]. TRA had significantly fewer access site complications [RR: 0.23; 95% CI: 0.08 – 0.62]. Symptomatic intracranial hemorrhage from seven studies showed no significant difference [RR: 1.0; 95% CI: 0.72 – 1.38]. NIHSS score at discharge showed no significant difference [MD: 1.31; 95% CI: -2.14 – 4.76]. In-hospital mortality from two studies showed no significant difference [RR: 0.56; 95% CI: 0.26 – 1.20]. Ninety-day mortality from three studies showed no significant difference [RR: 1.15; 95% CI: 0.98 – 1.36].Conclusion:TRA is as effective as TFA for MT in AIS and significantly reduces the risk of access site complications. Further large-scale RCTs are warranted to confirm these findings and refine the clinical guidelines for optimal access strategy in neuro-interventional procedures.

Circulation, Volume 150, Issue Suppl_1, Page A4139631-A4139631, November 12, 2024. Background:Several studies have explored the association between sleep duration and cardiovascular outcomes, but the results have been contradictory. Additionally, there are limited studies conducted within the Asian population.Goal:This study aims to assess the relationship between sleep duration and cardiovascular outcomes in the Asian population.Methods:This cross-sectional study used data from a survey of employees at the Electricity Generating Authority of Thailand (EGAT). Baseline demographics, sleep history, and the presence of cardiovascular diseases were collected in 2012. Self-reported usual sleep and wake times were used to calculate sleep duration. Participants were categorized into 3 groups based on sleep duration: short (< 6 hours), normal (6-8 hours), and long ( > 8 hours). Logistic regression analysis was used to assess the association between sleep duration and cardiovascular outcomes, with the normal sleep duration group as a reference. Adjustments were made for variables as shown in the table.Results:Among 1571 participants enrolled, 6%, 77%, and 17% were categorized into the short, normal, and long sleep duration groups, respectively. The mean (SD) age was 69 (4.6) years, and 73% were male, consistent across all groups. The median (IQR) sleep duration was 5 (4.5-5.0) hours, 7 (6.5-8.0) hours, and 9 (8.5-9.5) hours for the short, normal, and long sleep duration groups. Among these three groups, participants in the long sleep duration group had higher levels of HbA1C (p=0.049) and triglyceride (p=0.005), but a lower level of HDL cholesterol (p=0.003). Multiple logistic regression analysis demonstrated that long sleep duration was significantly associated with stroke, with an odd ratio (OR) of 3.25 (95% CI 1.27-8.36), and showed a non-significant trend towards a higher risk of coronary heart disease. We found no significant association between short sleep duration and cardiovascular outcomes.Conclusion:Long sleep duration is associated with an increased risk of cardiovascular diseases, especially stroke. Additional studies with larger sample sizes are needed to investigate the effects of short sleep duration.

Circulation, Volume 150, Issue Suppl_1, Page A4142236-A4142236, November 12, 2024. Background:Early aspirin is standard of care after acute ischemic stroke (AIS). There is increased incidence of venous thromboembolism (VTE) in patients with AIS and reduced mobility, but thromboprophylaxis with low molecular weight heparin (LMWH) must be weighed against the risk of bleeding. We compared safety and efficacy of early aspirin with or without LMWH in AIS and reduced mobility.Methods:Patients with AIS and Modified Rankin Scale of 4-5 were identified in the TriNetX Research Database. Patients were categorized as either aspirin alone or aspirin plus LMWH within 72 hours of AIS. We excluded patients receiving any other anticoagulant, thrombolytic agents, or with history of long-term anticoagulation or atrial fibrillation. Bivariable analysis was performed with chi-square and independentt-tests. Cohorts were then 1:1 propensity score-matched by 26 relevant covariables including demographics, comorbidities, and medications. Outcomes were all-cause mortality, VTE, intracranial hemorrhage, and extracranial hemorrhage at 30 and 90 days.Results:We included 2,572 patients in each cohort. Mean age and SD was 71±13, and 48% were male. There was no significant difference in all-cause mortality in patients treated with aspirin alone versus aspirin plus LMWH at 30 days (RR=1.1, 95% CI: 0.91-1.3) or 90 days (RR=1.2, 95% CI: 0.98-1.3). Similarly, the risks of VTE and intracranial or extracranial hemorrhage were not significantly different at either timepoint.Conclusions:In patients with AIS and reduced mobility, the early addition of LMWH to aspirin may have similar risks of bleeding, all-cause mortality, and VTE.

Circulation, Volume 150, Issue Suppl_1, Page A4142294-A4142294, November 12, 2024. Background:The 2021 AHA/ASA stroke guideline highlighted the importance of identifying clinical factors to discern patients with embolic stroke of undetermined source (ESUS) who may benefit from anticoagulation as a key area for future investigation.Research Question:Which subsets of patients with ESUS potentially benefit from anticoagulation for secondary prevention?Aims:To identify potential subsets of ESUS who may benefit from direct oral anticoagulants (DOAC).Methods:Electronic databases were searched from January 1st, 2014 to May 10th, 2024 to identify randomized controlled trials (RCTs) comparing DOACs and aspirin for secondary prevention after ESUS. The efficacy outcome was comparative ischemic stroke recurrence between DOACs and aspirin. The safety outcome was major bleeding.Random-effects meta-analysis using restricted maximum likelihood method was performed, with a prespecified subgroup analysis based on participants with evidence of patent foramen ovale (PFO) and with signs of, or risk factors for atrial cardiopathy.Results:We identified four RCTs including 13,970 participants. Overall, DOAC did not lead to a significant reduction in the unselected ESUS population (RR, 0.92; 95% CI, 0.80 to 1.05; I2= 0%; Figure A). In patients with signs of or risk factors for atrial cardiopathy, there was a significant 16% reduction in recurrent ischemic stroke with DOAC (RR, 0.84; 95% CI, 0.70 to 0.99; I2= 0%; Figure A). Notably, a significant 36% reduction in stroke recurrence was observed in the subgroup using criteria more specific to atrial pathology for signs of atrial cardiopathy (RR, 0.64; 95% CI, 0.43 to 0.97; I2= 25%; Figure A). Conversely, no difference was noted in the subgroup using cardiac biomarkers criteria for signs of atrial cardiopathy (RR, 1.05; 95% CI, 0.78 to 1.43; I2= 0%; Figure A). The risk of major bleeding outside ICH was significantly higher with DOACs than with aspirin (RR, 1.63; 95% CI, 1.08 to 2.47; I2= 0%; Figure B).Conclusions:The use of DOAC was associated with a significantly lower risk of ischemic stroke recurrence in patients with ESUS presenting with signs of or risk factors for atrial cardiopathy, especially in those meeting criteria more specific to atrial pathology.

Circulation, Volume 150, Issue Suppl_1, Page A4135311-A4135311, November 12, 2024. Introduction:A double atrium septum is a rare congenital anomaly characterized by a double-walled atrial septum with persistent interatrial space. This could be an asymptomatic presentation but also serve as a nidus of thromboembolic complications. We hereby present a case of a 57-year-old female with a cryptogenic stroke found to have a patent foramen ovale and double atrial septum.Case Description:A 57 year-old-female with a past medical history of hypertension presented with acute complaints of word-finding difficulty, left-sided neck pain and lightheadedness after a head strike while swimming. She was found to have a right-sided cerebellar stroke. A carotid artery ultrasound showed no evidence of atherosclerotic disease. Her lipid profile was normal. A transthoracic echocardiogram showed a patent foramen ovale with a positive bubble study revealing a large right to left shunt with Valsalva. A transesophageal echocardiogram confirmed a patent foramen ovale with an incidental finding of a double atrial septum with extreme redundancy of septal issue. The patient had a surgical closure of the interatrial septum and resection of the accessory interatrial septum tissue. She developed chronic post-sternotomy pain and subsequently had sternal wire removal.Discussion:A double atrial septum is a rare congenital anomaly seen as two parallel interatrial septa accompanied by a distinct echo-lucent midline space that expands during systole and contracts during diastole. It can happen embryologically by either the abnormal development of the septum secundum, resorption failure of the superior portion of the septum primum, or the persistence of the left venous valve of the sinus venosus. Typically, individuals with double atrial septum are asymptomatic, but they may encounter cardioembolic events due to the potential thrombi formation in the interatrial space. Communication between the septa increases the likelihood of such events. Unlike atrial fibrillation/flutter, there are currently no established criteria for initiating anticoagulation therapy for double atrial septum, primarily due to its rarity. Some options include antiplatelet agents, oral anticoagulation therapy, and percutaneous or surgical PFO closure. Surgical closure provides a permanent closure of the defect, thereby preventing future paradoxical emboli without the potential risks associated with long-term anticoagulation.

Circulation, Volume 150, Issue Suppl_1, Page A4137927-A4137927, November 12, 2024. Background:Current clinical practice guidelines for atrial fibrillation (AF) recommend stroke risk stratification and the use of oral anticoagulants (OACs) for patients at risk. However, physicians’ recognition of patients’ stroke risk may differ from the calculated risk, and the effect of this discrepancy on subsequent care remains unknown.Aims:We aimed to document treating physicians’ estimations of individual patients’ stroke risk and assess its association with OAC utilization.Methods:A multicenter, prospective cohort study was conducted in two outpatient practices in Tokyo, Japan, between 2018 to 2020. Participants included patients with newly diagnosed AF or those referred for initial treatment for AF. Treating physicians were asked to document the patient’s estimated risk of stroke in numbers. The estimations were categorized as low risk (

Circulation, Volume 150, Issue Suppl_1, Page A4138333-A4138333, November 12, 2024. Introduction:Cardiovascular disease remains a considerable source of years of life lost. Thus, identification of possible risk factors and prevention strategies continues to be important. In adults, oral diseases are associated with the risk of cardiovascular disease, including ischemic heart disease (IHD), myocardial infarction (MI) and ischemic stroke (IS). Few studies have examined the effect of oral health in childhood on the risk of cardiovascular disease in adulthood, thus overlooking a potentially important avenue of early detection of high-risk individuals.Hypothesis:We hypothesize that poor childhood oral health is associated with IHD, MI, and IS in adulthood.Methods:Using nationwide Danish registry data from the National Child Odontology Register, National Patient Register, and the Central Person Register we followed individuals born between 1963 and 1972. Follow-up started in 1995 or by age 30 (whichever occurred last), and ended in 2018, where study participants were aged 46 to 56. Using Cox-proportional hazards modelling we examined the association of childhood oral health, defined as the highest registered level of dental caries and gingivitis for any one individual, with the occurrence of IHD, MI, and IS in adulthood. The highest achieved level of education between ages 25 and 30 was used as Cox-strata.Results:The study consisted of n = 569.057 individuals, 51.2% male, 48.8% female. The incidence of IHD was 26% (1.17; 1.86) higher in females with high levels of caries in childhood compared to those with low-level caries, 19% (1.08; 1.40) higher in males. Severe caries in childhood was associated with a 58% (1.19; 2.09) higher incidence of MI in females, 19% (1.01;1.42) higher in males, and a 45% (1.19; 1.78) higher incidence of IS, 52% (1.27; 1.81) in males. Females had a 52% (1.19; 1.94) higher incidence of MI, and males a 32% (1.15; 1.52) higher incidence of IS, if they had high levels of gingivitis as children (table 1).Conclusion:Poor oral health in childhood is associated with an increased incidence of IHD, MI, and IS, pointing to a potential new avenue for early identification of and prevention amongst high-risk individuals.

Circulation, Volume 150, Issue Suppl_1, Page A4140882-A4140882, November 12, 2024. Introduction:Atrial fibrillation (A fib) is the most common arrhythmia affecting 1-2% of the general population. A fib is a well-established risk factor for ischemic strokes. In patients with nonvalvular A fib, the majority of embolic strokes are caused by thrombi development in the left atrial appendage. Systemic anticoagulation (AC) is effective in reducing stroke risk in patients with A fib. However, bleeding complications and medication nonadherence are barriers to effective AC. In these patients, left atrial appendage occlusion (LAAO) act as a form of nonpharmacologic treatment.Methods:We completed a retrospective descriptive study evaluating patients with a fib undergoing either open left atrial appendage closure or percutaneous occlusion. Patients were selected from the HCA database (Jan 2021-Jul 2023). ICD 10 codes were used to identify patients with documented a fib. Procedure ICD codes were used to identify patients that underwent percutaneous LAAO. Patients with documented STEMI, left ventricular thrombus, mechanical mitral or aortic valve replacement were excluded. 5,661 underwent percutaneous closure. Stroke readmissions were evaluated at 45, 90, and 180 days. Chi-square was used to evaluate for statistically significant differences.Results:Of the 5,661 patients 40 developed a stroke within 45 days, 38 within 90 days, and 26 within 180 days (P=.19) The average patient age was 76.1 years with STD 7.86. There were 2438 females and 3223 males.Discussion:Stroke occurrence was similar by day 90 as day 45. There was no statistical difference in stroke by day 180; however, the trend suggests a larger drop off in stroke readmission rates after day 90. Perhaps with a larger study, a significant effect may be detected. Currently AC is only recommended for 60 days post procedure. With clinical significance, future studies may be warranted to evaluate bleeding incidence during post procedure AC and the utility of extending therapy to 90 days.

Circulation, Volume 150, Issue Suppl_1, Page A4141914-A4141914, November 12, 2024. Introduction:Fluctuations of heart rate, or heart rate variability (HRV), contain important information about autonomic functions and regulations of the cardiovascular system. Heart rate fragmentation (HRF) is an inter-beat interval dynamics approach (Front Physiol, 2017 PMID: 29184505) that enhances analysis of short-term HRV. HRF has shown consistency with breakdown of neuroautonomic-electrophysiologic control system of the sino-atrial node. Here, we evaluate alterations of HRF metrics prior to, during the ischemic stroke and after reperfusion.Methods:We used the standard ischemic stroke model (intraluminal suture middle cerebral artery (MCA) occlusion) in adult male/female Sprague Dawley rats (n=11, 2-3 months old, weight: 296 ± 47 g, 27% female). The common carotid artery (CCA) was temporarily occluded while a suture was introduced to the internal carotid artery and advanced until it interrupted blood supply to MCA. We occluded the MCA for 1 hour followed by 3 hours of reperfusion (Fig.1). Electrocardiogram (ECG) was continuously measured throughout the surgeries. Post-surgery, the presence of cerebral infarction was confirmed by incubating brain slices in triphenyl tetrazolium chloride (TTC staining). HRF metrics were computed using 1-minute recordings of ECG at 3 time-points: a) baseline; b) 1 hour after MCA occlusion (pre-reperfusion); and c) 3 hours after reperfusion.Results:Significant differences (p