The Pathophysiological Mechanism Is an Independent Predictor of Long-Term Outcome in Stroke Patients with Large Vessel Atherosclerosis

Background: Atrial fibrillation (AF) shares several risk factors with atherosclerosis. We investigated the association between total carotid plaque number (TPN) and long-term prognosis in ischemic stroke patients with AF. Methods: A total of 392 ischemic stroke patients with AF who underwent carotid ultrasonography were enrolled. TPN was assessed using B-mode ultrasound. The patients were categorized into two groups according to best cutoff values for TPN (TPN ≤ 4 vs. TPN ≥ 5). The long-term risk of major adverse cardiovascular events (MACE) and mortality according to TPN was investigated using a Cox hazard model. Results: After a mean follow-up of 2.42 years, 113 patients (28.8%) had developed MACE and 88 patients (22.4%) had died. MACE occurred more frequently in the TPN ≥ 5 group than in the TPN ≤ 4 group (adjusted hazard ratio [HR], 1.50; 95% confidence interval [CI], 1.01–2.21; p < 0.05). Moreover, the TPN ≥ 5 group showed an increased risk of all-cause mortality (adjusted HR, 2.69; 95% CI, 1.40–5.17; p < 0.05). TPN along with maximal plaque thickness and intima media thickness showed improved prognostic utility when added to the variables of the CHAD2DS2-VASc score. Conclusion: TPN can predict the long-term outcome of ischemic stroke patients with AF. Adding TPN to the CHAD2DS2-VASc score increases the predictability of outcome after stroke.

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4035 Astrocyte LDLR-Related Protein 1 Increases Cytokine Sensitivity – The Role of Glia in Recovery after Brain Damage

Journal of Clinical and Translational Science ◽

10.1017/cts.2020.56 ◽

2020 ◽

Vol 4 (s1) ◽

pp. 3-3

Author(s):

Sadiya Ahmad ◽

Pamela Reed ◽

Shane Sprauge ◽

Naomi Sayre

Keyword(s):

Plasma Membrane ◽

Treatment Options ◽

Significant Loss ◽

Null Mouse ◽

Dependent Manner ◽

Related Protein ◽

Stroke Patients ◽

Term Outcome ◽

Long Term Outcome

OBJECTIVES/GOALS: The limited treatment options for ischemic stroke patients have resulted in stroke being a leading cause of death and the primary cause of long-term disability in the U.S. Finding effective treatment options requires a better fundamental understanding of the ongoing processes that contribute to poor long-term outcome. METHODS/STUDY POPULATION: Expression of Apolipoprotein E4 predisposes stroke patients to poor long-term outcome. This study aims to test one possible mechanism by which ApoE4 contributes to cognitive decline after stroke. Here, we examine the effect of a major ApoE4 receptor, low-density lipoprotein receptor related protein 1 (LRP1) on sensitivity to stress in astrocytes. LRP1 binds and moves extracellular ligands and plasma membrane proteins into the endocytic system. Others have shown that LRP1 regulates cell-surface TNF receptor (TNFR1) in non-astrocytic cells. We propose That LRP1 similarly regulates TNFR1 in the central nervous system to attenuate inflammatory response after stroke. Studies have shown that ApoE4 slows the recycling of endocytic LDL receptors. We hypothesize that ApoE4 inhibits the ability of LRP1 to remove TNFR1 from the plasma membrane. This is expected to increase cytokine sensitivity, resulting in worse outcome after stroke. We investigated the effect of LRP1 on astrocyte TNFα signaling and response in immortalized ApoE null mouse astrocytes subjected to lentiviral-mediated knockdown of LRP1. The astrocyte response to TNFα stimulation was tested in a time dependent manner using Western blotting of NFkB pathway components, which are the downstream mediators of TNFα signaling. We also tested astrocyte viability after prolonged TNFα stimulation using Alamar Blue reagent. We found that LRP1 deficient cells have increased phosphorylation of NFkB upon TNFα stimulation, and that loss of LRP1 resulted in significant loss of astrocyte viability after prolonged stimulation. RESULTS/ANTICIPATED RESULTS: Altogether, our results indicate that loss of LRP1 renders astrocytes more sensitive to TNFα. Future experiments will focus on testing the influence of LRP1 on recovery after middle cerebral artery occlusion in mice. DISCUSSION/SIGNIFICANCE OF IMPACT: These studies will elucidate how astrocyte-LRP1 contributes to outcome after stroke, and helps us to understand one potential way that ApoE4 exerts pathological effects. A better understanding of the long-term processes after stroke will allow identification of therapies which improve the morbidity and mortality associated with stroke. CONFLICT OF INTEREST DESCRIPTION: NA.

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Geriatric Nutritional Risk Index is an Independent Predictor for Long-term Outcome in Patients Undergoing Open Bypass not Only for Critical Limb Ischemia but Also for Intermittent Claudication

European Journal of Vascular and Endovascular Surgery ◽

10.1016/j.ejvs.2019.06.1067 ◽

2019 ◽

Vol 58 (6) ◽

pp. e420-e421

Author(s):

Shinsuke Mii ◽

Atsushi Guntani ◽

Eisuke Kawakubo ◽

Hirofumi Shimazoe ◽

Masaru Ishida

Keyword(s):

Critical Limb Ischemia ◽

Independent Predictor ◽

Risk Index ◽

Limb Ischemia ◽

Nutritional Risk ◽

Geriatric Nutritional Risk Index ◽

Term Outcome ◽

Long Term Outcome ◽

Nutritional Risk Index

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D-dimer for prediction of long-term outcome in cryptogenic stroke patients with patent foramen ovale

Thrombosis and Haemostasis ◽

10.1160/th14-12-1040 ◽

2015 ◽

Vol 114 (09) ◽

pp. 614-622 ◽

Cited By ~ 5

Author(s):

Young Dae Kim ◽

Dongbeom Song ◽

Hyo Suk Nam ◽

Kijeong Lee ◽

Joonsang Yoo ◽

...

Keyword(s):

Ischaemic Stroke ◽

Patent Foramen Ovale ◽

Pulmonary Thromboembolism ◽

Cryptogenic Stroke ◽

Foramen Ovale ◽

Stroke Patients ◽

Term Outcome ◽

Long Term Outcome ◽

D Dimer

SummaryPatent foramen ovale (PFO) is a potential cause of cryptogenic stroke, given the possibility of paradoxical embolism from venous to systemic circulation. D-dimer level is used to screen venous thrombosis. We investigated the risk of embolism and mortality according to the presence of PFO and D-dimer levels in cryptogenic stroke patients. A total of 570 first-ever cryptogenic stroke patients who underwent transesophageal echocardiography were included in this study. D-dimer was assessed using latex agglutination assay during admission. The association of long-term outcomes with the presence of PFO and D-dimer levels was investigated. PFO was detected in 241 patients (42.3 %). During a mean 34.0 ± 22.8 months of follow-up, all-cause death occurred in 58 (10.2 %) patients, ischaemic stroke in 33 (5.8 %), and pulmonary thromboembolism in 6 (1.1 %). Multivariate Cox regression analysis showed that a D-dimer level of > 1,000 ng/ml was an independent predictor for recurrent ischaemic stroke in patients with PFO (hazard ratio 5.341, 95 % confidence interval 1.648–17.309, p=0.005), but not in those without PFO. However, in patients without PFO, a D-dimer level of > 1,000 ng/ml was independently related with all-cause mortality. The risk of pulmonary thromboembolism tended to be high in patients with high D-dimer levels, regardless of PFO. Elevated D-dimer levels in cryptogenic stroke were predictive of the long-term outcome, which differed according to the presence of PFO. The coexistence of PFO and a high D-dimer level increased the risk of recurrent ischaemic stroke. The D-dimer test in cryptogenic stroke patients may be useful for predicting outcomes and deciding treatment strategy.

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The Long Term Outcome of Stroke Patients Receiving Percutaneous Endoscopic Gastrostomy (PEG) Feeding

Age and Ageing ◽

10.1093/ageing/27.suppl_2.29-a ◽

1998 ◽

Vol 27 (suppl 2) ◽

pp. 29-29

Author(s):

N.R. Balcombe

Keyword(s):

Percutaneous Endoscopic Gastrostomy ◽

Stroke Patients ◽

Term Outcome ◽

Long Term Outcome ◽

Endoscopic Gastrostomy

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Seizures Do Not Affect Disability and Mortality Outcomes of Stroke: A Population-Based Study

Journal of Clinical Medicine ◽

10.3390/jcm8112006 ◽

2019 ◽

Vol 8 (11) ◽

pp. 2006 ◽

Cited By ~ 1

Author(s):

Giovanni Merlino ◽

Gian Luigi Gigli ◽

Francesco Bax ◽

Anna Serafini ◽

Elisa Corazza ◽

...

Keyword(s):

Multivariate Analysis ◽

Population Based ◽

Age Difference ◽

Stroke Patients ◽

Term Outcome ◽

Population Based Study ◽

Long Term Outcome ◽

Cerebrovascular Accidents ◽

Post Stroke

Although seizures are frequently seen after cerebrovascular accidents, their effects on long-term outcome in stroke patients are still unknown. Therefore, the aim of this study was to investigate the relationship between post-stroke seizures and the risk of long-term disability and mortality in stroke patients. This study is part of a larger population-based study. All patients were prospectively followed up by a face-to-face interview or a structured telephone interview. We enrolled 635 patients with first-ever stroke and without a history of seizures. Prevalence of ischemic stroke (IS) was 85.2%, while the remaining 14.8% of patients were affected by intracerebral hemorrhage (ICH). During the study period, 51 subjects (8%) developed post-stroke seizures. Patients with post-stroke seizures were younger, had a higher prevalence of ICH, had a more severe stroke at admission, were more likely to have an IS involving the total anterior circulation, and were more likely to have a lobar ICH than patients without seizures. Moreover, subjects with seizures had more frequently hemorrhagic transformation after IS and cortical strokes. At 24 months, the risk of disability in patients with seizures was almost twice than in those without seizures. However, the negative effect of seizures disappeared in multivariate analysis. Kaplan-Meier survival curves at 12 years were not significantly different between patients with and without post-stroke seizures. Using the Cox multivariate analysis, age, NIHSS at admission, and pre-stroke mRS were independently associated with all-cause long-term mortality. In our sample, seizures did not impair long-term outcome in patients affected by cerebrovascular accidents. The not significant, slight difference in favor of a better survival for patients with seizures may be attributed to the slight age difference between the two groups.

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