Pub Date : 2024-10-03DOI: 10.1016/j.jstrokecerebrovasdis.2024.108033
R.R. M.M. Knapen MD , M. Celen MD , F. Benali MD, PhD , R.J. van Oostenbrugge MD, PhD , W.H. van Zwam MD, PhD , C. van der Leij MD, PhD
Introduction
Despite literature suggesting benefits of a balloon guide catheter (BGC) in stroke thrombectomy, BGCs are not routinely used. This study aimed to get insights in the use of a BGC and the reasons (not) to inflate the balloon.
Methods
Data were used of the Maastricht Stroke Quality Registry (MaSQ-Registry), a prospective registry for quality purposes of stroke patients treated between September 2020-February 2023. Additionally, a Dutch nationwide questionnaire was sent among all stroke treating physicians of the Dutch Society of Interventional Radiology (NVIR). Information on the use and reasons for selecting a (non-)BGC and using the BGC was collected.
Results
Out of 511 patients registered in the MaSQ-Registry, 458 were included. In 69% (n=317) of the patients a BGC was used; in 68% (n=214) the balloon was not inflated. In 95% of the posterior circulation occlusions a non-BGC was used.
In total 47 treating physicians from sixteen stroke centers responded to the questionnaire. 51% (n=24) preferred a non-BGC and 30% (n=14) never used a BGC. 52% and 18% of the BGC-users estimated they inflate the balloon in 80-100% and 0-20% of the times, respectively. The main reasons reported for not inflating the balloon were when the BGC was occlusive (47%) or not placeable (34%) in the carotid artery.
Conclusion
This study shows variation in the use of (non-)BGC use with and without inflated balloon among treating physicians in the Netherlands, highlighting current limited consensus regarding the use of (non-)BGCs among stroke treating physicians.
{"title":"The use of a (non-) balloon guide catheter in endovascular stroke treatment, a registry of real-life use and nationwide questionnaire","authors":"R.R. M.M. Knapen MD , M. Celen MD , F. Benali MD, PhD , R.J. van Oostenbrugge MD, PhD , W.H. van Zwam MD, PhD , C. van der Leij MD, PhD","doi":"10.1016/j.jstrokecerebrovasdis.2024.108033","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2024.108033","url":null,"abstract":"<div><h3>Introduction</h3><div>Despite literature suggesting benefits of a balloon guide catheter (BGC) in stroke thrombectomy, BGCs are not routinely used. This study aimed to get insights in the use of a BGC and the reasons (not) to inflate the balloon.</div></div><div><h3>Methods</h3><div>Data were used of the Maastricht Stroke Quality Registry (MaSQ-Registry), a prospective registry for quality purposes of stroke patients treated between September 2020-February 2023. Additionally, a Dutch nationwide questionnaire was sent among all stroke treating physicians of the Dutch Society of Interventional Radiology (NVIR). Information on the use and reasons for selecting a (non-)BGC and using the BGC was collected.</div></div><div><h3>Results</h3><div>Out of 511 patients registered in the MaSQ-Registry, 458 were included. In 69% (n=317) of the patients a BGC was used; in 68% (n=214) the balloon was not inflated. In 95% of the posterior circulation occlusions a non-BGC was used.</div><div>In total 47 treating physicians from sixteen stroke centers responded to the questionnaire. 51% (n=24) preferred a non-BGC and 30% (n=14) never used a BGC. 52% and 18% of the BGC-users estimated they inflate the balloon in 80-100% and 0-20% of the times, respectively. The main reasons reported for not inflating the balloon were when the BGC was occlusive (47%) or not placeable (34%) in the carotid artery.</div></div><div><h3>Conclusion</h3><div>This study shows variation in the use of (non-)BGC use with and without inflated balloon among treating physicians in the Netherlands, highlighting current limited consensus regarding the use of (non-)BGCs among stroke treating physicians.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"33 12","pages":"Article 108033"},"PeriodicalIF":2.0,"publicationDate":"2024-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142378614","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-02DOI: 10.1016/j.jstrokecerebrovasdis.2024.108050
Ling Wang , Aohan Li , ChenNing Zhang , Xudong Ding , Huili Xu
Background
Sialorrhea is a common concern in patients with swallowing disorders after stroke. Atropine sulfate blocks the muscarinic receptors in the salivary glands and leads to reduced saliva production.
Objective
The present study aimed to assess the safety, efficacy, and tolerability of sublingual administration of atropine eye drops for treating sialorrhea after stroke.
Design
This was a prospective cohort study.
Setting
This study was conducted at Xiangyang No. 1 People's Hospital, Hubei University of Medicine, Hubei Province, China.
Population
Stroke patients with sialorrhea were analyzed.
Methods
One hundred stroke patients with sialorrhea were randomly assigned to the control group and the test group (n = 50 per group). The control group received routine swallowing rehabilitation training and neuromuscular electrical stimulation. The test group received therapy with 1% atropine eye drops, wherein one drop was administered sublingually 3 times per day. The Sialorrhea Scoring Scale and the incidence of adverse events were used to compare the severity of sialorrhea in the two groups.
Results
The mean (standard deviation) sialorrhea score improved from 5.12 for the control group with routine rehabilitation training to 3.94 for the test group with atropine eye drop administration (P < 0.01). No significant differences in the incidence of adverse events were observed between the two groups.
Conclusions
The sublingual administration of 1% atropine eye drops three times per day can reduce the degree of sialorrhea to an extent more than that achieved with routine rehabilitation training; thus, this approach is effective, safe, and minimally invasive for treating sialorrhea after stroke.
{"title":"Sublingual administration of atropine eye drops for treating sialorrhea after stroke: A randomized controlled trial","authors":"Ling Wang , Aohan Li , ChenNing Zhang , Xudong Ding , Huili Xu","doi":"10.1016/j.jstrokecerebrovasdis.2024.108050","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2024.108050","url":null,"abstract":"<div><h3>Background</h3><div>Sialorrhea is a common concern in patients with swallowing disorders after stroke. Atropine sulfate blocks the muscarinic receptors in the salivary glands and leads to reduced saliva production.</div></div><div><h3>Objective</h3><div>The present study aimed to assess the safety, efficacy, and tolerability of sublingual administration of atropine eye drops for treating sialorrhea after stroke.</div></div><div><h3>Design</h3><div>This was a prospective cohort study.</div></div><div><h3>Setting</h3><div>This study was conducted at Xiangyang No. 1 People's Hospital, Hubei University of Medicine, Hubei Province, China.</div></div><div><h3>Population</h3><div>Stroke patients with sialorrhea were analyzed.</div></div><div><h3>Methods</h3><div>One hundred stroke patients with sialorrhea were randomly assigned to the control group and the test group (<em>n</em> = 50 per group). The control group received routine swallowing rehabilitation training and neuromuscular electrical stimulation. The test group received therapy with 1% atropine eye drops, wherein one drop was administered sublingually 3 times per day. The Sialorrhea Scoring Scale and the incidence of adverse events were used to compare the severity of sialorrhea in the two groups.</div></div><div><h3>Results</h3><div>The mean (standard deviation) sialorrhea score improved from 5.12 for the control group with routine rehabilitation training to 3.94 for the test group with atropine eye drop administration (<em>P</em> < 0.01). No significant differences in the incidence of adverse events were observed between the two groups.</div></div><div><h3>Conclusions</h3><div>The sublingual administration of 1% atropine eye drops three times per day can reduce the degree of sialorrhea to an extent more than that achieved with routine rehabilitation training; thus, this approach is effective, safe, and minimally invasive for treating sialorrhea after stroke.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"33 12","pages":"Article 108050"},"PeriodicalIF":2.0,"publicationDate":"2024-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142376319","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Evidence is scarce regarding prognostic value of site-specific muscle mass in geriatric stroke survivors. We aim to assess the association between four measures of muscle mass, namely the skeletal muscle mass index of the limbs (SMI), upper limb SMI (USMI), lower limb SMI (LSMI), and trunk muscle mass index (TMI), and the functional prognosis in stroke patients.
Methods
This study conducted a retrospective cohort analysis involving post-acute stroke inpatients. Muscle mass data were obtained through bioelectrical impedance analysis and computed by dividing each muscle mass by the square of the height. The study outcomes included the Functional Independence Measure (FIM) motor at discharge and FIM-motor gain. Multiple regression analysis was conducted to assess the association between SMI, USMI, LSMI, and TMI with outcomes, while adjusting for confounding factors.
Results
A total of 701 patients (mean age 72.8 years, 374 males) were analyzed. As a result, LSMI (β = 0.089, P = 0.003) and SMI (β = 0.083, P = 0.008) were significantly associated in the FIM-motor at discharge, with LSMI showing a stronger association. USMI (β = 0.019, P = 0.521) and TMI (β = 0.035, P = 0.231) showed no significant association. LSMI (β = 0.124, P = 0.003) and SMI (β = 0.116, P = 0.008) were significantly associated with FIM-motor gain; however, USMI (β = 0.027, P = 0.521) and TMI (β = 0.049, P = 0.231) showed no significant association with FIM-motor gain.
Conclusions
Differential associations were observed between site-specific muscle mass and functional prognosis in post-stroke patients. Among these, lower limb muscle mass was most strongly associated with activities of daily living (ADL) recovery.
背景：有关老年中风幸存者特定部位肌肉质量预后价值的证据很少。我们旨在评估四肢骨骼肌质量指数（SMI）、上肢骨骼肌质量指数（USMI）、下肢骨骼肌质量指数（LSMI）和躯干肌肉质量指数（TMI）这四项肌肉质量指标与中风患者功能预后之间的关系：本研究对急性脑卒中后住院患者进行了回顾性队列分析。肌肉质量数据通过生物电阻抗分析获得，计算方法是每块肌肉质量除以身高的平方。研究结果包括出院时的功能独立性测量（FIM）运动和 FIM 运动增益。研究人员进行了多元回归分析，以评估 SMI、USMI、LSMI 和 TMI 与结果之间的关联，同时对混杂因素进行了调整：共对 701 名患者（平均年龄 72.8 岁，男性 374 名）进行了分析。结果显示，LSMI（β=0.089，P=0.003）和 SMI（β=0.083，P=0.008）与出院时的 FIM 运动显著相关，其中 LSMI 的相关性更强。USMI（β=0.019，P=0.521）和TMI（β=0.035，P=0.231）无明显相关性。LSMI（β=0.124，P=0.003）和SMI（β=0.116，P=0.008）与FIM运动增益显著相关；然而，USMI（β=0.027，P=0.521）和TMI（β=0.049，P=0.231）与FIM运动增益无显著相关：结论：卒中后患者特定部位的肌肉质量与功能预后之间存在差异。结论：卒中后患者特定部位肌肉质量与功能预后之间存在差异，其中下肢肌肉质量与日常生活活动（ADL）恢复的关系最为密切。
{"title":"Site-specific skeletal muscle mass and functional prognosis in geriatric stroke patients","authors":"Kenichiro Maekawa RPT , Yoshihiro Yoshimura MD, PhD , Fumihiko Nagano RPT , Ayaka Matsumoto RPh , Kota Hori MD , Sayuri Shimazu RD , Ai Shiraishi RDH , Yoshifumi Kido OTR , Takahiro Bise RPT , Aomi Kuzuhara RPT , Takenori Hamada ST , Kouki Yoneda RD","doi":"10.1016/j.jstrokecerebrovasdis.2024.108049","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2024.108049","url":null,"abstract":"<div><h3>Background</h3><div>Evidence is scarce regarding prognostic value of site-specific muscle mass in geriatric stroke survivors. We aim to assess the association between four measures of muscle mass, namely the skeletal muscle mass index of the limbs (SMI), upper limb SMI (USMI), lower limb SMI (LSMI), and trunk muscle mass index (TMI), and the functional prognosis in stroke patients.</div></div><div><h3>Methods</h3><div>This study conducted a retrospective cohort analysis involving post-acute stroke inpatients. Muscle mass data were obtained through bioelectrical impedance analysis and computed by dividing each muscle mass by the square of the height. The study outcomes included the Functional Independence Measure (FIM) motor at discharge and FIM-motor gain. Multiple regression analysis was conducted to assess the association between SMI, USMI, LSMI, and TMI with outcomes, while adjusting for confounding factors.</div></div><div><h3>Results</h3><div>A total of 701 patients (mean age 72.8 years, 374 males) were analyzed. As a result, LSMI (β = 0.089, P = 0.003) and SMI (β = 0.083, P = 0.008) were significantly associated in the FIM-motor at discharge, with LSMI showing a stronger association. USMI (β = 0.019, P = 0.521) and TMI (β = 0.035, P = 0.231) showed no significant association. LSMI (β = 0.124, P = 0.003) and SMI (β = 0.116, P = 0.008) were significantly associated with FIM-motor gain; however, USMI (β = 0.027, P = 0.521) and TMI (β = 0.049, P = 0.231) showed no significant association with FIM-motor gain.</div></div><div><h3>Conclusions</h3><div>Differential associations were observed between site-specific muscle mass and functional prognosis in post-stroke patients. Among these, lower limb muscle mass was most strongly associated with activities of daily living (ADL) recovery.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"33 12","pages":"Article 108049"},"PeriodicalIF":2.0,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142373577","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-30DOI: 10.1016/j.jstrokecerebrovasdis.2024.108032
Idha Sood , Ranjit J Injety , Amtul Farheen , Setareh Kamali , Ann Jacob , Kyle Mathewson , Brian H Buck , Mahesh P Kate
Objective
Quantitative electroencephalography (QEEG) is a non-invasive, reliable and easily accessible modality to assess neuronal activity. QEEG in acute stroke may predict short and long-term functional outcomes. The role of individual indices has not been studied in a meta-analysis. We aim to assess individual QEEG-derived indices to predict post-stroke disability.
Methods
We included studies (sample size ≥ 10) with stroke patients who underwent EEG and a follow-up outcome assessment was available either in the form of modified Rankin scale (mRS) or National Institute of Stroke scale (NIHSS) or Fugl-Meyer scale (FMA). QEEG indices analysed were delta-alpha ratio (DAR), delta-theta-alpha-beta ratio (DTABR), brain symmetry index (BSI) and pairwise derived brain symmetry (pdBSI).
Results
Nine studies (8 had only ischemic stroke, and one had both ischemic and haemorrhagic stroke), including 482 participants were included for meta-analysis. Higher DAR was associated with worse mRS (n=300, Pearson's r 0.26, 95 % CI 0.21-0.31). Higher DTABR was associated with worse mRS (n=337, r=0.32, 95 % CI 0.26-0.39). Higher DAR was associated with higher NIHSS (n=161, r=0.42, 95 % CI0.24-0.6). Higher DTABR was associated with higher NIHSS (n=158, r=0.49, 95 % CI 0.31-0.67).
Conclusions
QEEG-derived indices DAR and DTABR have the potential to assess post-stroke disability. Adding QEEG to the clinical and imaging biomarkers in the acute phase may help in better prediction of post-stroke recovery.
Registry
PROSPERO 2022 CRD42022292281
目的：定量脑电图（QEEG）是一种评估神经元活动的无创、可靠且易于获取的模式。QEEG 可预测急性中风的短期和长期功能预后。荟萃分析尚未研究个体指数的作用。我们的目的是评估 QEEG 衍生的单个指数，以预测脑卒中后的残疾情况：方法：我们纳入了对接受脑电图检查的脑卒中患者进行的研究（样本量≥ 10），这些患者的随访结果评估采用改良兰金量表（mRS）或美国国家卒中研究所量表（NIHSS）或 Fugl-Meyer 量表（FMA）的形式。分析的QEEG指数包括δ-α比值（DAR）、δ-θ-α-β比值（DTABR）、脑对称性指数（BSI）和成对衍生脑对称性指数（pdBSI）：9项研究（8项仅涉及缺血性中风，1项涉及缺血性和出血性中风）共纳入482名参与者进行荟萃分析。较高的 DAR 与较差的 mRS 相关（n=300，Pearson's r 0.26，95% CI 0.21-0.31）。较高的 DTABR 与较差的 mRS 相关（n=337，r=0.32，95% CI 0.26-0.39）。DAR越高，NIHSS越高（n=161，r=0.42，95% CI0.24-0.6）。较高的 DTABR 与较高的 NIHSS 相关（n=158，r=0.49，95% CI 0.31-0.67）：结论：QEEG衍生指数DAR和DTABR具有评估卒中后残疾的潜力。结论：QEEG衍生指数DAR和DTABR具有评估卒中后残疾的潜力，在急性期将QEEG加入临床和影像学生物标记物有助于更好地预测卒中后的恢复情况：PERCOMO 2022 CRD42022292281。
{"title":"Quantitative electroencephalography to assess post-stroke functional disability: A systematic review and meta-analysis","authors":"Idha Sood , Ranjit J Injety , Amtul Farheen , Setareh Kamali , Ann Jacob , Kyle Mathewson , Brian H Buck , Mahesh P Kate","doi":"10.1016/j.jstrokecerebrovasdis.2024.108032","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2024.108032","url":null,"abstract":"<div><h3>Objective</h3><div>Quantitative electroencephalography (QEEG) is a non-invasive, reliable and easily accessible modality to assess neuronal activity. QEEG in acute stroke may predict short and long-term functional outcomes. The role of individual indices has not been studied in a meta-analysis. We aim to assess individual QEEG-derived indices to predict post-stroke disability.</div></div><div><h3>Methods</h3><div>We included studies (sample size ≥ 10) with stroke patients who underwent EEG and a follow-up outcome assessment was available either in the form of modified Rankin scale (mRS) or National Institute of Stroke scale (NIHSS) or Fugl-Meyer scale (FMA). QEEG indices analysed were delta-alpha ratio (DAR), delta-theta-alpha-beta ratio (DTABR), brain symmetry index (BSI) and pairwise derived brain symmetry (pdBSI).</div></div><div><h3>Results</h3><div>Nine studies (8 had only ischemic stroke, and one had both ischemic and haemorrhagic stroke), including 482 participants were included for meta-analysis. Higher DAR was associated with worse mRS (n=300, Pearson's r 0.26, 95 % CI 0.21-0.31). Higher DTABR was associated with worse mRS (n=337, <em>r</em>=0.32, 95 % CI 0.26-0.39). Higher DAR was associated with higher NIHSS (n=161, <em>r</em>=0.42, 95 % CI0.24-0.6). Higher DTABR was associated with higher NIHSS (n=158, <em>r</em>=0.49, 95 % CI 0.31-0.67).</div></div><div><h3>Conclusions</h3><div>QEEG-derived indices DAR and DTABR have the potential to assess post-stroke disability. Adding QEEG to the clinical and imaging biomarkers in the acute phase may help in better prediction of post-stroke recovery.</div></div><div><h3>Registry</h3><div>PROSPERO 2022 CRD42022292281</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"33 12","pages":"Article 108032"},"PeriodicalIF":2.0,"publicationDate":"2024-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142367339","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-30DOI: 10.1016/j.jstrokecerebrovasdis.2024.108046
Aqsa Munir MBBS , Hanzala Ahmed Farooqi MBBS , Rayyan Nabi MBBS , Ummulkiram Hasnain MBBS , Marium Khan MBBS
Background
Stroke remains the second leading cause of death worldwide, with a 20 % risk of recurrence within 5 years. Preventing secondary stroke events is crucial for patient management. Kraft et al. highlighted the potential of telemedicine in secondary prevention, but noted the need for further research. Our study incorporates recent trials to provide an updated analysis of telemedical strategies in stroke prevention.
Methods
We reviewed and analyzed RCTs and observational studies from PubMed, Cochrane, Google Scholar, and Clinicaltrials.gov (May 19, 2016 - March 20, 2024) comparing telephone-based follow-up to standard care in stroke patients. The meta-analysis focused on SBP changes within 12 months. We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) and observational studies, sourced from PubMed, Cochrane, Google Scholar, and ClinicalTrials.gov (May 19, 2016 – March 20, 2024). We compared telephone-based follow-up to standard care in stroke patients, and the primary outcome was systolic blood pressure (SBP) changes within 12 months.
Results
Our systematic review included data from 21,904 patients. The meta-analysis focused on studies with comparable systolic blood pressure (SBP) data. It involved 3,501 individuals in the control group and 3,485 in the experimental group. The analysis revealed a significant reduction in SBP with telemedicine strategies for secondary stroke prevention, with a p-value of 0.003. Additionally, a systemic review of the included studies demonstrated that these strategies improved medication adherence, lifestyle habits, and physical performance, positively correlating with better health outcomes and reduced mortality risk.
Conclusion
With the inclusion of recent clinical trials, our updated systematic review and meta-analysis concludes that telemedicine supports secondary prevention in cerebrovascular diseases, particularly blood pressure control. While telemedicine may have a role in reducing recurrent stroke risk, we believe further studies with longer follow-up periods are needed to validate the role of telemedical strategies in reducing recurrence rates.
{"title":"Telemedical strategies for improving systolic blood pressure control in secondary prevention of cerebrovascular events-a systematic review and meta-analysis","authors":"Aqsa Munir MBBS , Hanzala Ahmed Farooqi MBBS , Rayyan Nabi MBBS , Ummulkiram Hasnain MBBS , Marium Khan MBBS","doi":"10.1016/j.jstrokecerebrovasdis.2024.108046","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2024.108046","url":null,"abstract":"<div><h3>Background</h3><div>Stroke remains the second leading cause of death worldwide, with a 20 % risk of recurrence within 5 years. Preventing secondary stroke events is crucial for patient management. Kraft et al. highlighted the potential of telemedicine in secondary prevention, but noted the need for further research. Our study incorporates recent trials to provide an updated analysis of telemedical strategies in stroke prevention.</div></div><div><h3>Methods</h3><div>We reviewed and analyzed RCTs and observational studies from PubMed, Cochrane, Google Scholar, and Clinicaltrials.gov (May 19, 2016 - March 20, 2024) comparing telephone-based follow-up to standard care in stroke patients. The meta-analysis focused on SBP changes within 12 months. We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) and observational studies, sourced from PubMed, Cochrane, Google Scholar, and ClinicalTrials.gov (May 19, 2016 – March 20, 2024). We compared telephone-based follow-up to standard care in stroke patients, and the primary outcome was systolic blood pressure (SBP) changes within 12 months.</div></div><div><h3>Results</h3><div>Our systematic review included data from 21,904 patients. The meta-analysis focused on studies with comparable systolic blood pressure (SBP) data. It involved 3,501 individuals in the control group and 3,485 in the experimental group. The analysis revealed a significant reduction in SBP with telemedicine strategies for secondary stroke prevention, with a p-value of 0.003. Additionally, a systemic review of the included studies demonstrated that these strategies improved medication adherence, lifestyle habits, and physical performance, positively correlating with better health outcomes and reduced mortality risk.</div></div><div><h3>Conclusion</h3><div>With the inclusion of recent clinical trials, our updated systematic review and meta-analysis concludes that telemedicine supports secondary prevention in cerebrovascular diseases, particularly blood pressure control. While telemedicine may have a role in reducing recurrent stroke risk, we believe further studies with longer follow-up periods are needed to validate the role of telemedical strategies in reducing recurrence rates.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"33 12","pages":"Article 108046"},"PeriodicalIF":2.0,"publicationDate":"2024-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142367340","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Aneurysmal Subarachnoid Hemorrhage (aSAH) poses a significant health burden globally, necessitating a deeper understanding of its etiology and potential preventive strategies. Recent research has suggested a possible link between gut microbiota composition and the risk of vascularity, prompting investigation into this association using Mendelian Randomization (MR) analysis. Here, we aimed to elucidate the causal relationship between gut microbiota composition and aSAH risk utilizing MR analysis.
Methods
We employed four distinct MR methodologies, including inverse variance weighted (IVW), MR-Egger, weighted median, and weighted mode, to assess the causal nexus between gut microbiota composition and aSAH risk. Genetic instrumental variables (IVs) associated with gut microbiome composition were selected from a comprehensive multiethnic genome-wide association study (GWAS) involving 18,473 individuals across diverse geographic regions. Sensitivity analyses were conducted to detect potential heterogeneity and pleiotropy.
Results
Our Mendelian Randomization (MR) analyses unveiled a substantial and statistically significant causal relationship between gut microbiota composition and the risk of Aneurysmal Subarachnoid Hemorrhage (aSAH). Employing the Inverse Variance Weighted (IVW) method, we observed negative associations between aSAH and specific taxonomic levels of gut microbiota. Specifically, the IVW approach identified significant associations with one order, Victivallales (PIVW=0.047, OR: 0.78, 95 % CI: 0.62-0.99), one family, Porphyromonadaceae (PIVW=0.03, OR: 0.64, 95 % CI: 0.43-0.95), one class, Lentisphaeria (PIVW=0.047, OR: 0.78, 95 % CI: 0.62-0.99), and three genera: Bilophila (PIVW=0.02, OR: 0.68, 95 % CI: 0.50-0.93), Fusicatenibacter (PIVW=0.04, OR: 0.69, 95 % CI: 0.49-0.98), and Ruminococcus1 (PIVW=0.01, OR: 0.51, 95 % CI: 0.32-0.84). These findings were consistent across various MR methodologies, underscoring the robustness of our results. Sensitivity analyses further validated the stability of our findings, with no evidence of heterogeneity or pleiotropy detected.
Conclusion
Our study provides compelling evidence supporting a causal relationship between gut microbiota composition and the risk of aSAH. These findings underscore the potential therapeutic implications of modulating gut microbiota to prevent and manage aSAH. Further research is warranted to explore the underlying mechanisms and develop targeted interventions aimed at mitigating aSAH risk through gut microbiota modulation.
{"title":"Causal relationships between gut microbiota and Aneurysmal Subarachnoid Hemorrhage: A Bidirectional Mendelian Randomization Study","authors":"Heng Lin, Yanqing Yin, Jie Li, Siwei Liu, Xiaoao Long, Zhuangbin Liao","doi":"10.1016/j.jstrokecerebrovasdis.2024.108030","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2024.108030","url":null,"abstract":"<div><h3>Background and Purpose</h3><div>Aneurysmal Subarachnoid Hemorrhage (aSAH) poses a significant health burden globally, necessitating a deeper understanding of its etiology and potential preventive strategies. Recent research has suggested a possible link between gut microbiota composition and the risk of vascularity, prompting investigation into this association using Mendelian Randomization (MR) analysis. Here, we aimed to elucidate the causal relationship between gut microbiota composition and aSAH risk utilizing MR analysis.</div></div><div><h3>Methods</h3><div>We employed four distinct MR methodologies, including inverse variance weighted (IVW), MR-Egger, weighted median, and weighted mode, to assess the causal nexus between gut microbiota composition and aSAH risk. Genetic instrumental variables (IVs) associated with gut microbiome composition were selected from a comprehensive multiethnic genome-wide association study (GWAS) involving 18,473 individuals across diverse geographic regions. Sensitivity analyses were conducted to detect potential heterogeneity and pleiotropy.</div></div><div><h3>Results</h3><div>Our Mendelian Randomization (MR) analyses unveiled a substantial and statistically significant causal relationship between gut microbiota composition and the risk of Aneurysmal Subarachnoid Hemorrhage (aSAH). Employing the Inverse Variance Weighted (IVW) method, we observed negative associations between aSAH and specific taxonomic levels of gut microbiota. Specifically, the IVW approach identified significant associations with one order, Victivallales (P<sub>IVW</sub>=0.047, OR: 0.78, 95 % CI: 0.62-0.99), one family, Porphyromonadaceae (P<sub>IVW</sub>=0.03, OR: 0.64, 95 % CI: 0.43-0.95), one class, Lentisphaeria (P<sub>IVW</sub>=0.047, OR: 0.78, 95 % CI: 0.62-0.99), and three genera: Bilophila (P<sub>IVW</sub>=0.02, OR: 0.68, 95 % CI: 0.50-0.93), Fusicatenibacter (P<sub>IVW</sub>=0.04, OR: 0.69, 95 % CI: 0.49-0.98), and Ruminococcus1 (P<sub>IVW</sub>=0.01, OR: 0.51, 95 % CI: 0.32-0.84). These findings were consistent across various MR methodologies, underscoring the robustness of our results. Sensitivity analyses further validated the stability of our findings, with no evidence of heterogeneity or pleiotropy detected.</div></div><div><h3>Conclusion</h3><div>Our study provides compelling evidence supporting a causal relationship between gut microbiota composition and the risk of aSAH. These findings underscore the potential therapeutic implications of modulating gut microbiota to prevent and manage aSAH. Further research is warranted to explore the underlying mechanisms and develop targeted interventions aimed at mitigating aSAH risk through gut microbiota modulation.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"33 12","pages":"Article 108030"},"PeriodicalIF":2.0,"publicationDate":"2024-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142367338","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-28DOI: 10.1016/j.jstrokecerebrovasdis.2024.108028
Khaled Gharaibeh MD , Nameer Aladamat MD , Aizaz Ali MD , Adam T. Mierzwa MD , Hira Pervez MD , Mouhammad Jumaa MD , Syed Zaidi MD
Objectives
Patients with cerebral venous thrombosis (CVT) may present with early intracerebral hemorrhage (EICH). The objective of this study was to identify predictors for EICH in CVT patients via a systematic review and meta-analysis of observational studies. Additionally, we aimed to evaluate the clinical outcomes associated with the presence of EICH in these patients.
Methods
Literature search on PubMed, EMBASE and Cochrane Library databases from inception up to 1 February 2024 was conducted. Five studies with predictors of EICH were included in qualitative synthesis and meta-analysis.
Results
Pooled analysis demonstrated a statistically significant association between female gender and EICH (odd ratios (OR) = 1.51, 95 % confidence interval (CI) = 1.23-1.85, p < 0.01). The ICH patients had higher likelihood of seizures (OR = 3.07, 95 % CI = 1.69-5.58, p < 0.01), focal neurological deficits (OR = 4.07, 95 % CI = 2.57-6.44, p < 0.01), and decreased level of consciousness (OR = 3.89, 95 % CI = 2.53-5.87, p < 0.01). Superior Sagittal Sinus thrombosis was associated with higher likelihood of EICH (OR: 1.49, 95 % CI 1.05-2.13, P = 0.03). No statistically significant association was demonstrated between presence of EICH and pregnancy, presence of hematological diseases or thrombophilia, or other site of venous thrombosis (deep venous system, or multiple sinuses involvement). Furthermore, patients who exhibited early EICH were notably less likely to attain a favorable functional outcome (mRS 0-2) (OR: 0.28; 95 % CI 0.16–0.49; p < 0.001).
Conclusion
This meta-analysis demonstrates that among CVT patients, female patients with new onset seizures, focal neurological deficits and decreased level of consciousness are more likely to present with EICH
{"title":"Predictors of early intracerebral hemorrhage in patients with cerebral sinus venous thrombosis: Systematic review and meta-analysis","authors":"Khaled Gharaibeh MD , Nameer Aladamat MD , Aizaz Ali MD , Adam T. Mierzwa MD , Hira Pervez MD , Mouhammad Jumaa MD , Syed Zaidi MD","doi":"10.1016/j.jstrokecerebrovasdis.2024.108028","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2024.108028","url":null,"abstract":"<div><h3>Objectives</h3><div>Patients with cerebral venous thrombosis (CVT) may present with early intracerebral hemorrhage (EICH). The objective of this study was to identify predictors for EICH in CVT patients via a systematic review and meta-analysis of observational studies. Additionally, we aimed to evaluate the clinical outcomes associated with the presence of EICH in these patients.</div></div><div><h3>Methods</h3><div>Literature search on PubMed, EMBASE and Cochrane Library databases from inception up to 1 February 2024 was conducted. Five studies with predictors of EICH were included in qualitative synthesis and meta-analysis.</div></div><div><h3>Results</h3><div>Pooled analysis demonstrated a statistically significant association between female gender and EICH (odd ratios (OR) = 1.51, 95 % confidence interval (CI) = 1.23-1.85, p < 0.01). The ICH patients had higher likelihood of seizures (OR = 3.07, 95 % CI = 1.69-5.58, p < 0.01), focal neurological deficits (OR = 4.07, 95 % CI = 2.57-6.44, p < 0.01), and decreased level of consciousness (OR = 3.89, 95 % CI = 2.53-5.87, p < 0.01). Superior Sagittal Sinus thrombosis was associated with higher likelihood of EICH (OR: 1.49, 95 % CI 1.05-2.13, P = 0.03). No statistically significant association was demonstrated between presence of EICH and pregnancy, presence of hematological diseases or thrombophilia, or other site of venous thrombosis (deep venous system, or multiple sinuses involvement). Furthermore, patients who exhibited early EICH were notably less likely to attain a favorable functional outcome (mRS 0-2) (OR: 0.28; 95 % CI 0.16–0.49; p < 0.001).</div></div><div><h3>Conclusion</h3><div>This meta-analysis demonstrates that among CVT patients, female patients with new onset seizures, focal neurological deficits and decreased level of consciousness are more likely to present with EICH</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"33 12","pages":"Article 108028"},"PeriodicalIF":2.0,"publicationDate":"2024-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142332391","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-28DOI: 10.1016/j.jstrokecerebrovasdis.2024.108040
Juan Antonio Pozo Putalivo MD, Martin Grecco MD, Guillermo Pablo Povedano MD, Mauricio De Sampaio MD, Sofia Caporale MD, Santajuliana Franco MD
<div><h3>Introduction</h3><div>Cardiovascular disease remains a leading cause of morbidity and mortality worldwide, with many individuals presenting with acute ischemic stroke or transient ischemic attack (AIS/TIA) due to underlying vascular risk factors (VRF). While these patients typically undergo routine evaluations for acute treatment, the prevention of these conditions is often underestimated. This study reports the prevalence of non-optimized VRF and estimates their degree of avoidability in a cohort of patients treated in a tertiary care center following AIS/TIA.</div></div><div><h3>Methods</h3><div>This retrospective study enrolled patients older than 18 years who experienced AIS/TIA over a two-year period. Preventability was defined as the degree to which an acute cerebrovascular event could have been prevented if the VRF had been appropriately treated. Using the variables determined at the onset of AIS or TIA, we developed a 10-point scale to classify the degree of preventability (not preventable [score of 0], low preventability [score of 1–3], and high preventability [score of 4 or higher]). We further defined sub-scores based on the effectiveness of treatment of high blood pressure [HBP] (0-2 points), dyslipidemia [DLP] (0-2 points), atrial fibrillation [AF] (1 point), active smoking [AS] (1 point), obesity (1 point), previous coronary heart disease [CHD] (1 point), and previous AIS/TIA (2 points). Demographic factors, etiologies, and imaging findings were evaluated, tabulated independently, and subsequently correlated with clinical findings extracted from the available patient records.</div></div><div><h3>Results</h3><div>Of the 395 patients (334 with AIS and 61 with TIA), 376 (95.19 %) exhibited some degree of preventability, whereas 19 (4.81 %) presented with a nonpreventable event. In total, 296 (74.94 %) presented a low preventable event, and 80 (20.25 %) presented a high preventable event. Applying the Chi-square test of independence to stroke etiology highlighted cardio-aortic embolism and large artery atherosclerosis as groups with a significantly higher burden of risk factors necessitating intervention, while patients with stroke of other etiologies had more adequate control of VRF. In terms of stroke severity, as determined by the National Institutes of Health Stroke Scale (NIHSS), patients with NIHSS scores >5 were more likely to experience preventable events. According to the ABCD2 score, higher risk scores were significantly associated with a higher preventive factor burden; however, age, sex, vascular territory, and Canadian TIA scores were not related to the prevention of AIS/TIA.</div></div><div><h3>Conclusions</h3><div>The high percentage of preventable events reflects the need to study other factors that may contribute to unhealthy lifestyles in this population. Potential reasons for poor health include high levels of stress, sleep deprivation, working conditions and an unhealthy diet. Further studies are required
{"title":"Preventability of ischemic stroke/transient ischemic attack in a tertiary care center in Argentina","authors":"Juan Antonio Pozo Putalivo MD, Martin Grecco MD, Guillermo Pablo Povedano MD, Mauricio De Sampaio MD, Sofia Caporale MD, Santajuliana Franco MD","doi":"10.1016/j.jstrokecerebrovasdis.2024.108040","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2024.108040","url":null,"abstract":"<div><h3>Introduction</h3><div>Cardiovascular disease remains a leading cause of morbidity and mortality worldwide, with many individuals presenting with acute ischemic stroke or transient ischemic attack (AIS/TIA) due to underlying vascular risk factors (VRF). While these patients typically undergo routine evaluations for acute treatment, the prevention of these conditions is often underestimated. This study reports the prevalence of non-optimized VRF and estimates their degree of avoidability in a cohort of patients treated in a tertiary care center following AIS/TIA.</div></div><div><h3>Methods</h3><div>This retrospective study enrolled patients older than 18 years who experienced AIS/TIA over a two-year period. Preventability was defined as the degree to which an acute cerebrovascular event could have been prevented if the VRF had been appropriately treated. Using the variables determined at the onset of AIS or TIA, we developed a 10-point scale to classify the degree of preventability (not preventable [score of 0], low preventability [score of 1–3], and high preventability [score of 4 or higher]). We further defined sub-scores based on the effectiveness of treatment of high blood pressure [HBP] (0-2 points), dyslipidemia [DLP] (0-2 points), atrial fibrillation [AF] (1 point), active smoking [AS] (1 point), obesity (1 point), previous coronary heart disease [CHD] (1 point), and previous AIS/TIA (2 points). Demographic factors, etiologies, and imaging findings were evaluated, tabulated independently, and subsequently correlated with clinical findings extracted from the available patient records.</div></div><div><h3>Results</h3><div>Of the 395 patients (334 with AIS and 61 with TIA), 376 (95.19 %) exhibited some degree of preventability, whereas 19 (4.81 %) presented with a nonpreventable event. In total, 296 (74.94 %) presented a low preventable event, and 80 (20.25 %) presented a high preventable event. Applying the Chi-square test of independence to stroke etiology highlighted cardio-aortic embolism and large artery atherosclerosis as groups with a significantly higher burden of risk factors necessitating intervention, while patients with stroke of other etiologies had more adequate control of VRF. In terms of stroke severity, as determined by the National Institutes of Health Stroke Scale (NIHSS), patients with NIHSS scores >5 were more likely to experience preventable events. According to the ABCD2 score, higher risk scores were significantly associated with a higher preventive factor burden; however, age, sex, vascular territory, and Canadian TIA scores were not related to the prevention of AIS/TIA.</div></div><div><h3>Conclusions</h3><div>The high percentage of preventable events reflects the need to study other factors that may contribute to unhealthy lifestyles in this population. Potential reasons for poor health include high levels of stress, sleep deprivation, working conditions and an unhealthy diet. Further studies are required","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"33 12","pages":"Article 108040"},"PeriodicalIF":2.0,"publicationDate":"2024-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142332404","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-28DOI: 10.1016/j.jstrokecerebrovasdis.2024.108037
M. Cernigliaro , C. Stanca , M. Spinetta , SM. Tettoni , M. Sassone , A. Siani , C. Coda , D. Laganà , R. Minici , C. Airoldi , G. Campone , R. Di Fiore , A. Galbiati , G. Guzzardi , A. Carriero
Decision making and patient selection for isolated occlusion of the M2 segment of the middle cerebral artery is challenging, with the efficacy of treatment for such distal occlusions still controversial in recent studies, as occlusion in such small and thin vessels tends to manifest with less severe symptoms initially and hold higher surgical risks. It is even less clear which endovascular technique is more effective for this type of occlusion, with the choice usually left to the radiologist's preference. We conducted a controlled prospective study of consecutive patients presenting to Novara Hospital with an acute M2 occlusion diagnosed at the AngioCt and, following a predetermined randomization, we divided them into two treatment arms with either stent retriever aspiration (SRa) or direct aspiration (DA). All patients were examined on admission, at discharge and after 3 months, and clinical data as well as mRS and NIHSS scale scores were recorded. Our primary aim was to evaluate the difference in recanalization rate in the two groups by comparing the angiographic eTICI obtained with the two techniques. We then investigated whether there were differences in clinical outcomes and complications. Our data confirm a good recanalization rate with an eTICI ≥ 2b in 76.19% of patients in the cohort. An overall good outcome was achieved in 57% of patients as ∆NIHSS and in 50.79% of patients considering mRS. We found no statistically significant difference in recanalization rate nor higher complication rate in either the SRa or DA group. Both techniques are safe, effective and can be considered equally.
{"title":"StentRetriever- aspiration (SRa) vs direct aspiration (DA) in the treatment of acute M2 segment occlusion of middle cerebral artery: A single center randomized prospective study","authors":"M. Cernigliaro , C. Stanca , M. Spinetta , SM. Tettoni , M. Sassone , A. Siani , C. Coda , D. Laganà , R. Minici , C. Airoldi , G. Campone , R. Di Fiore , A. Galbiati , G. Guzzardi , A. Carriero","doi":"10.1016/j.jstrokecerebrovasdis.2024.108037","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2024.108037","url":null,"abstract":"<div><div>Decision making and patient selection for isolated occlusion of the M2 segment of the middle cerebral artery is challenging, with the efficacy of treatment for such distal occlusions still controversial in recent studies, as occlusion in such small and thin vessels tends to manifest with less severe symptoms initially and hold higher surgical risks. It is even less clear which endovascular technique is more effective for this type of occlusion, with the choice usually left to the radiologist's preference. We conducted a controlled prospective study of consecutive patients presenting to Novara Hospital with an acute M2 occlusion diagnosed at the AngioCt and, following a predetermined randomization, we divided them into two treatment arms with either stent retriever aspiration (SRa) or direct aspiration (DA). All patients were examined on admission, at discharge and after 3 months, and clinical data as well as mRS and NIHSS scale scores were recorded. Our primary aim was to evaluate the difference in recanalization rate in the two groups by comparing the angiographic eTICI obtained with the two techniques. We then investigated whether there were differences in clinical outcomes and complications. Our data confirm a good recanalization rate with an eTICI ≥ 2b in 76.19% of patients in the cohort. An overall good outcome was achieved in 57% of patients as ∆NIHSS and in 50.79% of patients considering mRS. We found no statistically significant difference in recanalization rate nor higher complication rate in either the SRa or DA group. Both techniques are safe, effective and can be considered equally.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"33 12","pages":"Article 108037"},"PeriodicalIF":2.0,"publicationDate":"2024-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142332405","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-28DOI: 10.1016/j.jstrokecerebrovasdis.2024.108045
Morin Beyeler MD , Anokhi Pawar BS , Eric Buffle MD , Cenai Zhang MS , Vanessa Liao BS , Ava L. Liberman MD , Thomas Pabst MD , Martin D. Berger MD , Simon Jung MD , Hooman Kamel MD , Babak B. Navi MD MS
Background
Cancer is associated with an increased risk of atrial fibrillation. Whether cancer is also associated with atrial cardiopathy, another atrial pathology associated with heightened ischemic stroke risk, is uncertain.
Methods
We conducted a retrospective cross-sectional study among consecutive patients hospitalized with acute ischemic stroke at a quaternary care center in New York, United States from 2011 through 2016. The study exposure was active cancer. The study outcome was atrial cardiopathy, defined as a left atrial volume index ≥35 mL/m2 on echocardiography. We used multivariable logistic regression, adjusting for baseline characteristics, to evaluate the relationship between cancer (active or historical) and atrial cardiopathy. We performed a subgroup analysis among patients with embolic stroke of undetermined source (ESUS).
Results
The final cohort included 1104 patients with acute ischemic stroke, of whom 10 % had active cancer and 47 % had atrial cardiopathy. Patients with atrial cardiopathy, compared to those without, were older (median age, 77 versus 68 years), and more frequently had hypertension, coronary disease, and atrial fibrillation. Active cancer was present in 9.6 % of patients with atrial cardiopathy (n = 50/520) and 10.4 % of patients without (n = 61/584). There was no association between active cancer and atrial cardiopathy among the overall ischemic stroke cohort (adjusted odds ratio [OR], 0.91; 95 % confidence interval [CI], 0.60-1.37) nor in patients with ESUS (aOR, 0.64; 95 % CI, 0.30-1.36). When the cancer exposure was broadened to include any history of cancer (n = 236, 21.4 %), there still was no significant association with atrial cardiopathy (aOR, 0.93; 95 % CI, 0.68-1.25).
Conclusions
When defining atrial cardiopathy by left atrial volume, we did not find an association between cancer and atrial cardiopathy in patients with ischemic stroke, including among those with ESUS. Future studies, evaluating other atrial cardiopathy biomarkers and settings, are needed to further investigate any potential link between cancer and atrial cardiopathy.
{"title":"Cancer and left atrial enlargement in patients with ischemic stroke","authors":"Morin Beyeler MD , Anokhi Pawar BS , Eric Buffle MD , Cenai Zhang MS , Vanessa Liao BS , Ava L. Liberman MD , Thomas Pabst MD , Martin D. Berger MD , Simon Jung MD , Hooman Kamel MD , Babak B. Navi MD MS","doi":"10.1016/j.jstrokecerebrovasdis.2024.108045","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2024.108045","url":null,"abstract":"<div><h3>Background</h3><div>Cancer is associated with an increased risk of atrial fibrillation. Whether cancer is also associated with atrial cardiopathy, another atrial pathology associated with heightened ischemic stroke risk, is uncertain.</div></div><div><h3>Methods</h3><div>We conducted a retrospective cross-sectional study among consecutive patients hospitalized with acute ischemic stroke at a quaternary care center in New York, United States from 2011 through 2016. The study exposure was active cancer. The study outcome was atrial cardiopathy, defined as a left atrial volume index ≥35 mL/m<sup>2</sup> on echocardiography. We used multivariable logistic regression, adjusting for baseline characteristics, to evaluate the relationship between cancer (active or historical) and atrial cardiopathy. We performed a subgroup analysis among patients with embolic stroke of undetermined source (ESUS).</div></div><div><h3>Results</h3><div>The final cohort included 1104 patients with acute ischemic stroke, of whom 10 % had active cancer and 47 % had atrial cardiopathy. Patients with atrial cardiopathy, compared to those without, were older (median age, 77 versus 68 years), and more frequently had hypertension, coronary disease, and atrial fibrillation. Active cancer was present in 9.6 % of patients with atrial cardiopathy (<em>n</em> = 50/520) and 10.4 % of patients without (<em>n</em> = 61/584). There was no association between active cancer and atrial cardiopathy among the overall ischemic stroke cohort (adjusted odds ratio [OR], 0.91; 95 % confidence interval [CI], 0.60-1.37) nor in patients with ESUS (aOR, 0.64; 95 % CI, 0.30-1.36). When the cancer exposure was broadened to include any history of cancer (<em>n</em> = 236, 21.4 %), there still was no significant association with atrial cardiopathy (aOR, 0.93; 95 % CI, 0.68-1.25).</div></div><div><h3>Conclusions</h3><div>When defining atrial cardiopathy by left atrial volume, we did not find an association between cancer and atrial cardiopathy in patients with ischemic stroke, including among those with ESUS. Future studies, evaluating other atrial cardiopathy biomarkers and settings, are needed to further investigate any potential link between cancer and atrial cardiopathy.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"33 12","pages":"Article 108045"},"PeriodicalIF":2.0,"publicationDate":"2024-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142332388","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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