3254Manifestations of myocardial fibrosis in the standard 12-lead electrocardiogram

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
L Holmstrom ◽  
T Kentta ◽  
A Haukilahti ◽  
L Pakanen ◽  
H Huikuri ◽  
...  
Keyword(s):  
Myocardial Fibrosis ◽  
Statistical Significance ◽  
Qrs Complex ◽  
T Wave ◽  
Group 4 ◽  
Qrs Prolongation ◽  
Increased Risk ◽  
Group 3 ◽  
Group 2 ◽  
Group 1

Abstract Background Myocardial fibrosis has substantial role in sudden cardiac deaths (SCD). Major challenge in preventing SCDs is early recognition of vulnerable patients with fibrotic cardiomyopathy. Our aim was to find manifestations of myocardial fibrosis in 12-lead electrocardiogram (ECG). Methods Study population is based on the Fingesture study, which has gathered data from 5,869 consecutive autopsied SCD victims between 1998 and 2017 in Finland. The degree of fibrosis was determined based on the histological samples taken from the heart during autopsy and was categorized into four groups; 1) no fibrosis, 2) scattered mild fibrosis, 3) moderate patchy fibrosis and 4) substantial fibrosis. We were able to collect pre-mortem 12-lead ECGs from 1,100 SCD victims. Ischemic cardiomyopathy was the cause of death in 689 cases and 411 had nonischemic cardiomyopathy at autopsy in the group where ECG was available. Results Mean age of the study subjects was 66±13 years and 75% were male. At least some amount of myocardial fibrosis was present in 92% of the victims. QRS duration in ECG correlated with the degree of fibrosis in autopsy as follows; 96±21ms in group 1 (n=93), 97±20ms in group 2 (n=357), 103±26ms in group 3 (n=506) and 108±27ms in group 4 (n=144; p<0.001, β=0.153). Prevalence of fragmented QRS complex was higher among victims with severe fibrosis (40% in group 1, 43% in group 2, 60% in group 3 and 65% in group 4; p<0.001). Additionally, inferolateral T-wave inversions were more common in groups with increasing amount of myocardial fibrosis (5.4% in group 1, 13.2% in group 2, 20.4% in group 3 and 31.9% in group 4; p<0.001). Associations were visible in both ischemic and nonischemic SCDs but reached statistical significance only among ischemic SCD victims. Heart rate corrected JT interval and Sokolow-Lyon index had no linear correlation with the degree of fibrosis. Conclusions Myocardial fibrosis was associated with QRS prolongation, T-wave inversions and QRS fragmentation among SCD victims. Fibrosis did not manifest as clearly in ECG among patients with nonischemic cardiomyopathies as among ischemic SCD victims. The results may explain the increased risk for SCD in patients with abnormal QRS complex or inverted T waves providing means for recognizing patients with underlying fibrotic cardiomyopathy. Acknowledgement/Funding Sigrid Juselius Foundation, Foundation of Cardiac Research, Paavo Nurmi Foundation and Paulo foundation, Finland

scholarly journals Prevention of Delayed Nausea: A University of Rochester Cancer Center Community Clinical Oncology Program Study of Patients Receiving Chemotherapy

2012 ◽  
Vol 30 (27) ◽  
pp. 3389-3395 ◽  
Author(s):  
Joseph A. Roscoe ◽  
Charles E. Heckler ◽  
Gary R. Morrow ◽  
Supriya G. Mohile ◽  
Shaker R. Dakhil ◽  
...  
Keyword(s):  
Statistical Significance ◽  
Cancer Center ◽  
Double Blind ◽  
Group 4 ◽  
Community Clinical Oncology Program ◽  
Delayed Nausea ◽  
Group 3 ◽  
Group 2 ◽  
Mean Differences ◽  
Group 1

Purpose We conducted a double-blind randomized clinical trial of the following four regimens for controlling delayed nausea (DN): group 1: palonosetron + dexamethasone on day 1 with prochlorperazine on days 2 and 3; group 2: granisetron + dexamethasone on day 1 with prochlorperazine on days 2 and 3; group 3: aprepitant + palonosetron + dexamethasone on day 1 with aprepitant + dexamethasone on days 2 and 3; and group 4: palonosetron + dexamethasone on day 1 with prochlorperazine + dexamethasone on days 2 and 3. Patients and Methods Chemotherapy-naive patients received doxorubicin, epirubicin, cisplatin, carboplatin, or oxaliplatin. The primary end point was average nausea assessed four times daily on days 2 and 3. Primary analyses were whether nausea control would be improved by using palonosetron versus granisetron on day 1 (group 1 v group 2); by adding dexamethasone on days 2 and 3 (group 1 v group 4); and by using aprepitant versus prochlorperazine (group 3 v group 4). Statistical significance was set at P = .017. Results Two hundred thirty-four, 234, 241, and 235 evaluable patients were accrued to groups 1, 2, 3, and 4, respectively. Adjusted mean differences for the three planned analyses were as follows: palonosetron versus granisetron: −0.01 (95% CI, −0.23 to 0.20; P = .72); adding dexamethasone on days 2 and 3: 0.20 (95% CI, −0.02 to 0.41; P = .01); and using aprepitant versus prochlorperazine: −0.03 (95% CI, −0.24 to 0.19; P = .56). Conclusion The addition of dexamethasone on days 2 and 3 reduced DN. Palonosetron and granisetron have similar effects on DN. The beneficial effect of adding aprepitant for control of DN was the same as adding prochlorperazine.

scholarly journals Helicobacter pylori infection and increased diabetes prevalence were the risks of colorectal adenoma: a systematic review and meta-analysis

2019 ◽  
Author(s):  
Horng-Yuan Wang ◽  
Ying-Chun Lin ◽  
Chieh-Chang Chen ◽  
Ming-Jen Chen ◽  
Ming-Shiang Wu ◽  
...  
Keyword(s):  
Colorectal Adenoma ◽  
Meta Analysis ◽  
Diabetes Prevalence ◽  
Group 4 ◽  
Increased Risk ◽  
Group 3 ◽  
Group 2 ◽  
H Pylori ◽  
Adenoma Risk ◽  
Group 1

Abstract Background Helicobacter pylori (H. Pylori) infection and hyperglycemia may be associated with an increased risk of colorectal neoplasm. However these two factors affect colorectal neoplasm remain controversial. We aimed to carry out a meta-analysis to evaluate the study population diabetes prevalence rate and H. pylori infection rate with colorectal adenoma risk. Methods We conducted a systemic research through English databases for medical reports. We also recorded the diabetes prevalence and H. pylori infection prevalence in each study. We classified these studies into 4 subgroups as their background population diabetes prevalence < 6%(Group 1); between 6 to 8%(Group 2); between 8 to 10 %(Group 3) and more than 10%(Group 4). The random effects model had used to calculate pooled prevalence estimates with 95% confidence interval [CI]. Results Twenty seven studies were finally eligible for meta-analysis. The random-effects model of meta-analysis was chosen, showing pooled odds ratio (OR) equal to 1.51 (95 % CI 1.39–1.63). The subgroup meta-analyses showed in Group 1 the H. pylori infection associated colorectal adenoma risk OR was 1.24 (95 % CI 0.86–1.78). As diabetes rate exceed 6%, the H. pylori infection became more significant increased risk of colorectal adenoma (Group 2: OR 2.16 (95 % CI 1.61–2.91); Group 3: OR 1.40 (95 % CI 1.24–1.57); Group 4: OR 1.52 (95 % CI 1.46–1.57)). Conclusions The results of this meta-analysis showed DM prevalence would affect the risk factor of colorectal adenoma with H. pylori infection.

scholarly journals MBCL-52. ENDOCRINE PROFILE AFTER MEDULLOBLASTOMA TREATMENT

2020 ◽  
Vol 22 (Supplement_3) ◽  
pp. iii398-iii399
Author(s):  
Miriam Pavon-Mengual ◽  
Helen Curry ◽  
Vrinda Saraff ◽  
Zainaba Mohamed ◽  
Helen Benghiat ◽  
...  
Keyword(s):  
Statistical Significance ◽  
Hormone Replacement ◽  
Sex Hormone ◽  
Hormone Deficiency ◽  
National Guidelines ◽  
Group 4 ◽  
Endocrine Profile ◽  
Group 3 ◽  
Group 2 ◽  
Group 1

Abstract BACKGROUND Treatment of medulloblastoma has evolved substantially with more chemotherapy, risk-adapted dosing of radiotherapy (RT) and new RT techniques. We present the endocrine profile for our patients treated over a 20-year period. METHODS The charts of patients treated for medulloblastoma between 1/1/00 and 31/12/19 were reviewed. 105 were available. Group 1 received chemotherapy alone, Group 2 received 23.4 Gy whole CNS RT with a posterior fossa (PF) boost to 54 Gy, Group 3 received &gt; 35 Gy whole CNS RT with PF boost to 54–59 Gy, Group 4 received PF RT to 54 Gy. All received chemotherapy according to national guidelines or clinical trials relevant at the time. RESULTS Group 1 (M:F 11:6, 7 survivors mean age 2 years range 1–7) had no endocrinopathies. At 5 years from diagnosis Group 2 (M:F 15:13) and Group 3 (M:F 35:14) had the following % RESULTS Survival 77:61; Growth Hormone deficiency 92:100; Thyroid deficiency 75:81; ACTH deficiency 42:33. Girls were more likely to need sex hormone replacement than boys. Group 4 (M:F 7:5 mean age 2) were all treated in the first decade. 3 survivors, one GH deficiency, one thyroxine deficiency, one both. CONCLUSIONS There is a trend to earlier endocrinopathies in the group 3 vs group 2 patients, but it does not reach statistical significance. Girls are more likely to need sex hormone replacement than boys. This investigation provides a contemporary profile of endocrinopathy after treatment for medulloblastoma that can be used for future comparisons.

scholarly journals Helicobacter pylori infection and increased diabetes prevalence were the risks of colorectal adenoma: a systematic review and meta-analysis

2019 ◽  
Author(s):  
Horng-Yuan Wang ◽  
Ying-Chun Lin ◽  
Chieh-Chang Chen ◽  
Ming-Jen Chen ◽  
Ming-Shiang Wu ◽  
...  
Keyword(s):  
Colorectal Adenoma ◽  
Meta Analysis ◽  
Diabetes Prevalence ◽  
Group 4 ◽  
Increased Risk ◽  
Group 3 ◽  
Group 2 ◽  
H Pylori ◽  
Adenoma Risk ◽  
Group 1

Abstract Background Helicobacter pylori (H. Pylori) infection and hyperglycemia may be associated with an increased risk of colorectal neoplasm. However these two factors affect colorectal neoplasm remain controversial. We aimed to carry out a meta-analysis to evaluate the study population diabetes prevalence rate and H. pylori infection rate with colorectal adenoma risk. Methods We conducted a systemic research through English databases for medical reports. We also recorded the diabetes prevalence and H. pylori infection prevalence in each study. We classified these studies into 4 subgroups as their background population diabetes prevalence < 6%(Group 1); between 6 to 8%(Group 2); between 8 to 10%(Group 3) and more than 10%(Group 4). The random effects model had used to calculate pooled prevalence estimates with 95% confidence interval [CI]. Results Twenty seven studies were finally eligible for meta-analysis. The random-effects model of meta-analysis was chosen, showing pooled odds ratio (OR) equal to 1.51 (95% CI 1.39–1.63). The subgroup meta-analyses showed in Group 1 the H. pylori infection associated colorectal adenoma risk OR was 1.24 (95% CI 0.86–1.78). As diabetes rate exceed 6%, the H. pylori infection became more significant increased risk of colorectal adenoma (Group 2: OR 2.16 (95% CI 1.61–2.91); Group 3: OR 1.40 (95% CI 1.24–1.57); Group 4: OR 1.52 (95% CI 1.46–1.57)). Conclusions The results of this meta-analysis showed DM prevalence would affect the risk factor of colorectal adenoma with H. pylori infection.

scholarly journals Can renal stone size and the use of the nephrolithometric system increase the efficacy of predicting the risk of failure of percutaneous nephrolithotripsy?

2017 ◽  
Vol 44 (6) ◽  
pp. 619-625
Author(s):  
EDUARDO MEDINA FELICI ◽  
ANDRÉ LUIZ LIMA DINIZ ◽  
TOMAS ACCIOLY SOUZA ◽  
LUCIANO ALVES FAVORITO ◽  
JOSÉ ANACLETO DUTRA RESENDE JÚNIOR
Keyword(s):  
Success Rate ◽  
Renal Stone ◽  
Statistical Significance ◽  
Stone Size ◽  
Group 4 ◽  
Group 3 ◽  
Group 2 ◽  
Percutaneous Nephrolithotripsy ◽  
Residual Fragments ◽  
Group 1

ABSTRACT Objective : to verify the association of success rate of percutaneous lithotripsy, Guy score and size of the stone. Methods: one hundred patients submitted to percutaneous nephrolithotripsy were evaluated. All stones were classified according to Guy Score. Patient free of stone was considered when residual fragments were ≤2mm. Results: according to guy Score, 54% were score 1 (Group 1), 18% score 2 (Group 2), 15% score 3 (Group 3), and 13% score 4 (Group 4). Success was observed in 77.77% in Group 1, 27.77% in group 2, 26.6% in Group 3, and 7.69% in Group 4. In patients with Guy score 1, there was statistical significance of prediction of free stone rate when evaluated according to the size of the stone. Among groups 2, 3 and 4 there was no statistical significance, but it was observed a trend in relation to stone size, the bigger the higher the chance of residual fragments. Conclusion: nephrolithometry by Guy Score and size of the stone are single predictors of success of percutaneous nephrolithotripsy. Stone size may influence success rate of patients with Guy Score 1.

Unfavourable Outcome and Heterogeneity of Partner Chromosomes in Chronic Lymphocytic Leukemia with 14q32/IGH Translocations.

Blood ◽  
2007 ◽  
Vol 110 (11) ◽  
pp. 4686-4686
Author(s):  
Francesco Cavazzini ◽  
Jose A. Hernandez ◽  
Alessandro Gozzetti ◽  
Antonella Russo Rossi ◽  
Ruana Tiseo ◽  
...  
Keyword(s):  
Statistical Significance ◽  
Hematological Parameters ◽  
Prognostic Significance ◽  
Risk Groups ◽  
Lymphocytic Leukemia ◽  
Group 4 ◽  
Group 3 ◽  
The Difference ◽  
Group 2 ◽  
Group 1

Abstract Translocations of 14q32/IgH have a low incidence in CLL. Partner chromosomes and the prognostic significance are poorly defined. Four hundred thirty cases of CLL seen at the Hospitals of Ferrara, Salamanca and Siena between 1992 and 2006 were studied. Inclusion criteria were: diagnosis of CD5/CD19+ CLL with k/λ restriction, cytogenetic/FISH data, immunophenotypic data, complete hematological and clinical data. Lymphomas in leukemic phase were excluded. FISH was performed for 17p13/TP53, 11q22.3/ATM, 6q21, chr 12 centromere, 13q14 and 14q32/IGH. Patients with no detectable aberration or isolated 13q− were included into a favourable cytogenetic group (group 1), those with +12, 6q− or 1–2 aberrations into an intermediate risk group (group 2) and those with 17p−, 11q−, ≥ 3 aberrations into an unfavourable group (group 3). Cases with 14q32/IGH translocation as primary chromosome change represented a specific category (group 4) and were studied with FISH probes for the detection of partners (BCL1, BCL2, BCL3, BCL6, c-MYC, BCL11A, PAX5, CCND3, CDK6). One hundred eighty-six cases were allocated into group 1; 158 into group 2; 64 into group 3, and 22 into group 4. Additional aberrations were found in a minority of cells in 8 patients in group 4. Being the aim of the study to assess whether the 14q32/IGH translocation represented an unfavourable parameter as compared with cases in the favourable or intermediate cytogenetic risk groups, cases within group 3 were excluded from the analysis and the data presented here will refer to 366 patients belonging to groups 1,2 and 4. Translocation partners of 14q32/IGH were identified in 9/22 cases: 2p13/BCL11A, (n 1); 6p21/CCND3 (n 1); 7q21/CDK6 (n 1); 18q21/BCL2 (n 6). Thirteen cases did not show involvement of the loci studied. Cases with 14q32/IGH translocations were characterized by typical morphology and classical immunophenotype (score 4–5 in 92% of the cases). Unmutated IGVH genes were found in 11/18 cases tested (61%); ZAP-70 was positive in 3/5 cases tested. Median age was 63.5 years (range 18–97), male:female ratio 240/126; 345 patients were in Rai stage 0-II, 21 were in stage 3–4; CD38 was positive in 137/366 cases. There was no difference between groups 1,2 and 4 for age, stage, male:female ratio, hematological parameters at diagnosis, IGVH mutations and ZAP70. CD38 was more positive in group 4 than in group 1 (p=0.028). There was no difference in survival and treatment free interval (TFI) when comparing cases in group 4 with and without additional aberrations. Cases in group 4 had a shorter TFI and a shorter survival when compared with group 1 (p=0.02) and group 2 (p=0.02). The difference maintained its statistical significance at multivariate analysis for TFI (p=0.02) along with stage (p<0.0001) and CD38 positivity (p<0.0001) and for survival (p=0.02) along with sex (p=0.006) and stage (p=0.0001). In conclusion, the 14q32/IGH translocation in CLL shows heterogeneity of partner chromosomes and it represents a cytogenetic marker predicting for an evolutive form of CLL.

scholarly journals Helicobacter pylori infection and increased diabetes prevalence were the risks of colorectal adenoma: a systematic review and meta-analysis

2019 ◽  
Author(s):  
Horng-Yuan Wang ◽  
Ying-Chun Lin ◽  
Chieh-Chang Chen ◽  
Ming-Jen Chen ◽  
Ming-Shiang Wu ◽  
...  
Keyword(s):  
Colorectal Adenoma ◽  
Meta Analysis ◽  
Diabetes Prevalence ◽  
Group 4 ◽  
Increased Risk ◽  
Group 3 ◽  
Group 2 ◽  
H Pylori ◽  
Adenoma Risk ◽  
Group 1

Abstract Background Helicobacter pylori (H. Pylori) infection and hyperglycemia may be associated with an increased risk of colorectal neoplasm. However these two factors affect colorectal neoplasm remain controversial. We aimed to carry out a meta-analysis to evaluate the study population diabetes prevalence rate and H. pylori infection rate with colorectal adenoma risk. Methods We conducted a systemic research through English databases for medical reports. We also recorded the diabetes prevalence and H. pylori infection prevalence in each study. We classified these studies into 4 subgroups as their background population diabetes prevalence < 6%(Group 1); between 6 to 8%(Group 2); between 8 to 10 %(Group 3) and more than 10%(Group 4). The random effects model had used to calculate pooled prevalence estimates with 95% confidence interval [CI]. Results Twenty seven studies were finally eligible for meta-analysis. The random-effects model of meta-analysis was chosen, showing pooled odds ratio (OR) equal to 1.51 (95 % CI 1.39–1.63). The subgroup meta-analyses showed in Group 1 the H. pylori infection associated colorectal adenoma risk OR was 1.24 (95 % CI 0.86–1.78). As diabetes rate exceed 6%, the H. pylori infection became more significant increased risk of colorectal adenoma (Group 2: OR 2.16 (95 % CI 1.61–2.91); Group 3: OR 1.40 (95 % CI 1.24–1.57); Group 4: OR 1.52 (95 % CI 1.46–1.57)). Conclusions The results of this meta-analysis showed DM prevalence would affect the risk factor of colorectal adenoma with H. pylori infection.

scholarly journals THE EFFECT OF DIFFERENT IRRIGANTS WITH OR WITHOUT ULTRASONIC ACTIVATION ON ROOT DENTIN MICROHARDNESS

2021 ◽  
Vol 27 (1) ◽  
pp. 3534-3538
Author(s):  
Irina Tsenova-Ilieva ◽  
◽  
Emilia Karova ◽  
Keyword(s):  
Sodium Hypochlorite ◽  
Statistical Significance ◽  
Treatment Success ◽  
Control Group ◽  
Ultrasonic Activation ◽  
Group 4 ◽  
Root Dentin ◽  
Group 3 ◽  
Group 2 ◽  
Group 1

Purpose: The aim of this in vitro study was to evaluate the effect of different irrigation regimens of root dentin microhardness. Materials and methods: Twenty extracted, single-rooted, non-endodontically treated upper incisors were decoronated and further sectioned longitudinally in buccolingual direction. The surfaces of all forty samples were polished, evenly distributed into four groups (n=10) and then immersed in the following solutions: group 1: 2% sodium hypochlorite for 2 minutes followed by 17% EDTA for 2 minutes; group 2: 2% sodium hypochlorite for 2 minutes followed by 17% EDTA for 2 minutes, both ultrasonically activated; group 3: 5.25% sodium hypochlorite for 2 minutes followed by 17% EDTA for 2 minutes; group 4: distilled water (control group). Afterwards, the samples were dried and subjected to microhardness testing by using 300g load with a dwell time of 20 seconds. The averaged values of each sample’s Vicker’s hardness numbers were calculated and statistically analyzed. Results: All irrigation regimens significantly decreased the mean hardness of dentin when compared to the control group 4 (p<0.05). Pair-wise comparison between the values of Group 1, Group 2, Group 3 resulted in no statistical significance (p>0.05) regardless of the concentration and the ultrasonic activation of the solutions. Conclusions: The dentin microhardness was decreased regardless of the irrigation protocols used. Additional studies should clarify the clinical relevance of the compromised mechanical properties of dentin tissue and their relationship with the overall treatment success.

Relationship Between Smoking and Bleeding on Probing

2012 ◽  
Vol 38 (5) ◽  
pp. 581-586 ◽  
Author(s):  
João Gustavo Oliveira de Souza ◽  
Marco Aurélio Bianchini ◽  
Cimara Fortes Ferreira
Keyword(s):  
Dental Implant ◽  
Statistical Significance ◽  
Bleeding On Probing ◽  
Periodontal Tissues ◽  
Group 4 ◽  
Group 3 ◽  
Group 2 ◽  
Bacterial Plaque ◽  
Periodontal Probing ◽  
Group 1

The objective of this study was to assess and compare bone loss (BL) around the dental implant platform as well as the presence of bacterial plaque (PBP), bleeding on probing (BOP), and periodontal probing depths (PD) of teeth and dental implants of smokers and nonsmokers. Three hundred forty-seven teeth and 98 implants of 20 randomly selected patients were assessed (12 smokers and 8 nonsmokers). The specimens were divided into 4 groups according to the site probed. Group 1 included smoker implant sites, group 2 included smoker tooth sites, group 3 included nonsmoker implant sites, and group 4 included nonsmoker tooth sites. The presence/absence of visible bacterial plaque, presence/absence of BOP, PD ≤ 3 mm or &gt;3 mm, and BL around the dental implant platform were the data assessed. The PBP and BL showed statistical significance between smokers and nonsmokers. Bleeding on probing and PD ≤ 3 mm showed statistical significance between groups 1, 3, and 4. Comparing sites with BOP and PD &gt; 3 mm, there was no statistical significance except for group 1, which did not present sites with these characteristics. Comparing sites with BOP and PD ≤ 3 mm, there was statistical significance between group 2 and groups 3 and 4. When comparing the prevalence of sites without BOP and PD &gt; 3 mm, there was statistical significance between groups 1, 3, and 4. Smoking promotes a greater BL around the dental implant platform and results in vasoconstriction of the peri-implant and periodontal tissues.

scholarly journals Association of early and later depressive symptoms with functional outcome after ischemic stroke

2021 ◽  
Author(s):  
Anna Maria Lopatkiewicz ◽  
Joanna Pera ◽  
Agnieszka Slowik ◽  
Tomasz Dziedzic
Keyword(s):  
Ischemic Stroke ◽  
Depressive Symptoms ◽  
Functional Outcome ◽  
Psychiatric Symptoms ◽  
Post Stroke ◽  
Group 4 ◽  
Increased Risk ◽  
Group 3 ◽  
Group 2 ◽  
Group 1

Abstract Background Post-stroke depressive symptoms (DS) can be chronic or transient, occurring shortly or long after stroke and lasting only few months. It remains unclear if the prognosis differs between patients with DS in the acute phase of stroke and those who develop DS several months later. We aimed to determine whether outcomes vary among patients with different trajectories of post-stroke depressive symptoms. Methods Of 698 enrolled patients with ischemic stroke, we included 335 participants (median age: 68, 48% female) who were assessed for DS both 8 days and 3 months post-stroke. We divided patients into 4 groups: without greater DS (Group 1), only earlier DS (Group 2), only later DS (Group 3), and persistent DS (Group 4). Logistic regression was used to determine the association between DS and 3- and 12-month functional outcome. Results Group 2 was predominantly female and had the highest rate of previous stroke or transient ischemic attack. Group 3 was more likely to suffer from delirium and more severe stroke. Group 4 had the highest frequency of vascular risk factors, pre-morbid psychiatric symptoms, and cognitive decline. In multivariate analysis, Group 3, but not Groups 2 and 4, had an increased risk of poor 3- and 12-month functional outcome (adjusted OR 2.59, 95% CI 1.64–4.07, P < 0.01 and OR 3.97, 95% CI 2.32–6.76, P < 0.01, respectively) compared with Group 1. Conclusions Different trajectories of post-stroke DS are related to different outcomes. Patients who only have later DS also have the worst prognosis.

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