Assessment of serum IgG titers to various periodontal pathogens associated with atrial fibrillation in acute stroke patients

Background and purpose: The impact of albuminuria on clinical outcomes in acute cardioembolic stroke is not fully investigated. We assessed whether high spot urine albumin/creatinine ratio (ACR) was associated with clinical outcomes in acute stroke with non-valvular atrial fibrillation (NVAF). Methods: From 2011 to 2014, we enrolled acute ischemic stroke/TIA patients with NVAF in the SAMURAI-NVAF study, which is a multicenter, observational study. Patients with complete ACR values were included in the analysis. They were divided into the N (normal, ACR < 30mg/g) and the H (high, ACR ≥ 30mg/g) groups. Clinical outcomes were neurological deterioration (an increase of NIHSS ≥1 point during the initial 7 days) and poor outcome (mRS of 4-6 at 3 months). Results: Of 558 patients (328 men, 77±10 y) who were included, 271 and 287 were assigned to the H group and the N group, respectively. As compared with patients in the N group, those in the H group were more frequently female (52 vs 31%, p < 0.001) and older (80±10 vs 75±10 y, p < 0.001). On admission, patients in the H group more frequently had diabetes (28 vs 17%, p = 0.003), less frequently had paroxysmal AF (68 vs 57%, p = 0.009), had higher levels of SBP (157±28 vs 151±24 mmHg, p = 0.003), NIHSS score (11 vs 5, p < 0.001), CHA2DS2-VASc score (6 vs 5, p < 0.001), plasma glucose (141±62 vs 132±41 mg/dL, p = 0.04), and brain natriuretic peptide (348±331 vs 259±309 pg/mL, p = 0.002), and had lower levels of hemoglobin (13±2 vs 14±2 g/dL, p = 0.02), and estimated glomerular filtration ratio (eGFR) (60±24 vs 66±20 mL/min/1.73m2 p = 0.002). On imaging studies, patients in the H group more frequently had large infarct (29 vs 20 %, p = 0.02) and culprit artery occlusion (64 vs 48%, p < 0.001). Neurological deterioration (14 vs 4%, p < 0.001) and poor outcome (49 vs 24%, p < 0.001) were more frequently observed in the H group. On multivariate regression analysis adjusted for significant confounders and reperfusion therapy, the H group was associated with neurological deterioration (OR 2.43; 95% CI 1.14-5.5; p = 0.02) and poor outcome (OR 2.75; 95% CI 1.45-5.2; p = 0.002), although eGFR was not significantly related to either. Conclusion: High ACR, a marker of albuminuria, was independently associated with unfavorable outcomes in acute stroke patients with NVAF.

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Optimising management of anti-coagulation in acute stroke patients presenting in atrial fibrillation

Journal of the Neurological Sciences ◽

10.1016/j.jns.2019.10.454 ◽

2019 ◽

Vol 405 ◽

pp. 18-19

Author(s):

E. Feldano ◽

B. Ramasubbu ◽

E. Barrie ◽

S. Ghosh

Keyword(s):

Atrial Fibrillation ◽

Acute Stroke ◽

Stroke Patients

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Clinical outcomes of acute stroke patients with atrial fibrillation

Expert Review of Cardiovascular Therapy ◽

10.1586/erc.09.11 ◽

2009 ◽

Vol 7 (4) ◽

pp. 371-374 ◽

Cited By ~ 20

Author(s):

Chee W Khoo ◽

Gregory YH Lip

Keyword(s):

Atrial Fibrillation ◽

Acute Stroke ◽

Clinical Outcomes ◽

Stroke Patients

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Novel composite score to predict atrial Fibrillation in acute stroke patients

International Journal of Cardiology ◽

10.1016/j.ijcard.2016.02.002 ◽

2016 ◽

Vol 209 ◽

pp. 184-189 ◽

Cited By ~ 11

Author(s):

Woo-Keun Seo ◽

Sung-Hoon Kang ◽

Jin-Man Jung ◽

Jeong-Yoon Choi ◽

Kyungmi Oh

Keyword(s):

Atrial Fibrillation ◽

Acute Stroke ◽

Composite Score ◽

Stroke Patients

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Abstract 163: Carotid Stenosis and Stroke Recurrence in Minor Stroke Patients With Atrial Fibrillation

Stroke ◽

10.1161/str.45.suppl_1.163 ◽

2014 ◽

Vol 45 (suppl_1) ◽

Author(s):

Shigeru Fujimoto ◽

Masato Ohsaki ◽

Masaya Kumamoto ◽

Takao Ishitsuka ◽

Takanari Kitazono

Keyword(s):

Atrial Fibrillation ◽

Acute Stroke ◽

Carotid Stenosis ◽

Positive Association ◽

Artery Stenosis ◽

Minor Stroke ◽

Stroke Recurrence ◽

Stroke Patients ◽

Antithrombotic Treatment ◽

D Dimer

Background & Purpose: Both atrial fibrillation (AF) and carotid stenosis (CS) can be associated with acute stroke recurrence and consequent bad outcome even in minor stroke. We investigated stroke recurrence and outcome in Japanese minor stroke patients with AF and/or CS. Subjects & Methods: Among the consecutive 6246 stroke patients who were admitted to the 7 stroke centers within 7 days after the onset, 634 patients with acute ischemic stroke with AF, the initial NIH stroke scale score of 7 or less, and prior modified Rankin scale (mRS) of 0 or 1 were included in the present study. We observed an acute stroke recurrence during 3 weeks. Results: Acute stroke recurrence was observed in 27 (4.3%) patients. Major cerebral artery stenosis of 50% or more in diameter was observed in 159 (25.1%) patients, and among them 43 (6.8%) had carotid stenosis. Any major artery stenosis was more frequent in patients with than without stroke recurrence (55.6% vs 23.7%, p=0.0002). Carotid stenosis was more frequent in patients with than without stroke recurrence (25.9% vs 5.9%, p<0.0001). The initial NIHSS score was not different between patients with and without an acute stroke recurrence. Dyslipidemia, diabetes mellitus, and history of brain hemorrhage were more frequent, and HDL cholesterol and estimated GFR values were lower, and HbA1c, fasting glucose, BUN, and D-dimer values were higher, intima-media thickness 0f the common carotid artery was thicker in patients with than without an acute stroke recurrence. On the multivariate analysis, carotid stenosis (OR 4.93, 95%CI 1.60~15.2) and D-dimer value (OR 1.13, 95%CI 1.00~1.28) had a positive association with an acute stroke recurrence. Among 43 patients with both AF and CS, 7 had an acute stroke recurrence. With regard to the acute antithrombotic treatment, 5 patients were treated with only anticoagulant agents and other 2 patients were treated with both anticoagulant and antiplatelet agents. Conclusions: Carotid stenosis was a significant predictor for an acute stroke recurrence in patients with atrial fibrillation. Optimal antithrombotic treatment in the acute phase in stroke patients with both AF and CS should be investigated.

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Newly Detected Atrial Fibrillation after Acute Stroke: A Narrative Review of Causes and Implications

Cardiology ◽

10.1159/000502971 ◽

2019 ◽

Vol 144 (3-4) ◽

pp. 112-121 ◽

Cited By ~ 1

Author(s):

Youcheng Wang ◽

Yongsheng Qian ◽

Daniel Smerin ◽

Shujuan Zhang ◽

Qingyan Zhao ◽

...

Keyword(s):

Atrial Fibrillation ◽

Ischemic Stroke ◽

Acute Stroke ◽

Adverse Outcomes ◽

Stroke Recurrence ◽

Stroke Patients ◽

Increased Risk ◽

Definition Of ◽

Humoral Regulation

Cardiac arrhythmias occur frequently in patients with acute stroke, with atrial fibrillation (AF) being the most common. Newly detected AF may lead to increased risk of ischemic stroke, which in turn generates stroke recurrence and adverse outcomes. Currently, most studies are focusing on the role of AF in ischemic stroke and attributing cryptogenic ischemic stroke to previously undetected AF. However, in these studies, subjects used to have neither symptoms of palpitation nor evidence of AF. A better understanding of this association will contribute to the management and therapy for patients after clinical decisions regarding stroke patients. Currently, the definition of newly detected AF has not come to an agreement, and the pathophysiology remains incompletely understood, possibly involving complex alterations in both the autonomic network and humoral regulation. Therefore, this review aims to introduce the definition and epidemiology of newly detected AF after stroke with updated information and elucidate the potential pathophysiology, such as autonomic imbalance, catecholamine surge, poststroke systematic inflammation, and microvesicles and microRNAs.

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Which Acute Stroke Patients with Atrial Fibrillation are Prescribed Warfarin Therapy? Results from One-Year's Experience in Dundee

Scottish Medical Journal ◽

10.1177/003693300004500404 ◽

2000 ◽

Vol 45 (4) ◽

pp. 110-112 ◽

Cited By ~ 1

Author(s):

J. Craig ◽

R.S. MacWalter ◽

B.M. Goudie

Keyword(s):

Atrial Fibrillation ◽

Ischaemic Stroke ◽

Acute Stroke ◽

Warfarin Therapy ◽

Anticoagulation Therapy ◽

Secondary Prophylaxis ◽

Stroke Patients ◽

Clinical Notes ◽

Recommended Treatment ◽

Warfarin Sodium

The recommended treatment of ischaemic stroke patients with atrial fibrillation (AF) is anticoagulation therapy with warfarin sodium and if this is contraindicated then aspirin should be used. The management of patients on warfarin therapy can be complicated and there is a risk of intra-cranial haemorrhage in elderly patients. However, these are the patients who stand to gain the most benefit from this treatment and therefore increased use of warfarin for secondary prophylaxis is likely to lead to a lower rate of subsequent admissions and less morbidity. The recommended treatment for these patients has often not been fully instigated in practice. This study was carried out in order to determine whether a group of patients admitted to a teaching hospital with diagnosis of ischaemic stroke and atrial fibrillation received appropriate antithrombotic therapy. Details of patients admitted with acute stroke during 1997 were obtained from the Dundee Stroke Database and information was extracted from the relevant clinical notes. Twenty-five out of 42 patients (60%) were considered eligible for anticoagulation and 14 out of those 25 (56%) were found to be on warfarin either on admission or subsequently. Of patients aged less than 75 years, 8/10 (80%) were on warfarin, whereas only 6/15 (40%) of those aged 75 years and older were being anticoagulated.

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