Lambl's Excrescences: Association with Cerebrovascular Disease and Pathogenesis

Background: Lambl's excrescences (LEx) are detected by transesophageal echocardiography (TEE) and are characterized as thin, elongated, and hypermobile structures located at the leaflets' coaptation point of the heart valves. The association of LEx with cerebrovascular disease (CVD) is still undefined and yet patients with LEx and suspected CVD receive unproven effective antiplatelet or anticoagulant therapy or even undergo valve surgery. Also, the association of LEx with aging and atherogenic, inflammatory, or thrombogenic parameters has not been reported. Methods: Seventy-seven patients with systemic lupus erythematosus (SLE) (71 women, age 37 ± 12 years) and 26 age- and sex-matched healthy controls (22 women, age 34 ± 11 years) prospectively underwent routine history and physical exam, transcranial Doppler, brain MRI, TEE, carotid duplex, and clinical and laboratory evaluations of atherogenesis, inflammation, platelet activity, coagulation, and fibrinolysis. Subjects without stroke/TIA on enrollment (with and without LEx) had a median follow-up of 57 months. Results: On enrollment, 33 (43%) of 77 patients had CVD manifested as acute stroke/TIA (23 patients), cerebromicroembolism by transcranial Doppler (17 patients), or cerebral infarcts by MRI (14 patients). Mitral or aortic valve LEx were equally frequent in healthy controls (46%) as in patients with and without any CVD (39 and 43%), stroke/TIA (35 and 43%), cerebromicroembolism (41 and 42%), or cerebral infarcts (36 and 43%) (all p ≥ 0.72). Also, other mechanisms for CVD other than LEx such as Libman-Sacks vegetations, patent foramen ovale or interatrial septal aneurysm, aortic or carotid atherosclerosis, or thrombogenesis were found in ≥94% of patients with CVD. In addition, 36 subjects with and 44 without LEx had similar low incidence of stroke/TIA (1 (1.3%) and 2 (2.5%), respectively, p = 1.0) during follow-up. Finally, LEx were not associated with aging, atherogenic risk factors, atherosclerosis, inflammation, or thrombogenesis. Conclusions: In this study, LEx are similarly prevalent in healthy controls and SLE patients, are not associated with CVD, and are not associated with pathogenic risk factors. Therefore, the study findings suggest that LEx may not be cardioembolic substrates, may not represent pathologic valve structures, and may not require therapy.

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Cerebral infarcts associated with migraine: Clinical features, risk factors and follow-up

Journal of Neurology ◽

10.1007/bf00886872 ◽

1996 ◽

Vol 243 (7) ◽

pp. 511-515 ◽

Cited By ~ 31

Author(s):

R. A. H. Hoekstra-van Dalen ◽

J. P. M. Cillessen ◽

L. J. Kappelle ◽

J. Gijn

Keyword(s):

Risk Factors ◽

Clinical Features ◽

Cerebral Infarcts

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Abstract WP244: Applicability of the Compass Trial Criteria Among Stable Outpatients With Established Atherothrombotic Disease or Major Risk Factors

Stroke ◽

10.1161/str.51.suppl_1.wp244 ◽

2020 ◽

Vol 51 (Suppl_1) ◽

Author(s):

Carlos Cantu-Brito ◽

Erwin Chiquete ◽

Jose L Ruiz-Sandoval ◽

Fernando Flores-Silva

Keyword(s):

Risk Factors ◽

Cerebrovascular Disease ◽

Selection Criteria ◽

Vascular Risk Factors ◽

Cox Proportional Hazards Model ◽

Vascular Risk ◽

Similar Frequency ◽

History Of ◽

Atherothrombotic Disease

Background and Purpose: The objective of this study were to describe the proportion of patients eligible for the COMPASS trial among stable outpatients with either established atherothrombotic disease or major vascular risk factors, and to analyze 6-month incident stroke risk according vascular risk factors at baseline. Methods: We prospectively recruited 5,101 stable outpatients in 172 sites, within the Mexican INDAGA cohort study. Inclusion criteria were age >18 years and established atherothrombotic disease [history of either acute coronary syndromes (ACS), acute ischemic stroke (AIS)/transient ischemic attack (TIA) or peripheral artery disease (PAD)] or major vascular risk factors (age <55 years plus ≥2 major vascular risk factors, or age ≥55 years plus ≥1 vascular risk factors). Among these patients, we applied the selection criteria of the COMPASS trial for analysis, dividing the population in no COMPASS criteria met and COMPASS criteria met, and this last group subdivided among patients with previous AIS/TIA and without this antecedent, in order to stratify the risk for stroke during 6-month follow-up (incident AIS/TIA). Results: Among 5,101 stable outpatients with either established atherothrombotic disease (n=2,827) or major vascular risk factors (n=2,274), a total of 1,927 (37.8%) met COMPASS trial criteria: 1,054 (54.7%) with established cerebrovascular disease (past history of AIS/TIA) and 873 (45.3%) without. During 6-month follow-up, there were 89 incident AIS/TIA (39 AIS and 54 TIA): 1.7% among the whole population and 2.2% among the COMPASS subgroup. AIS/TIA occurred in a similar frequency among the COMPASS subgroup with established cerebrovascular disease (1.6%) and COMPASS without cerebrovascular disease (0.9%) (P=0.18). After a Cox-proportional hazards model, independent predictors of incident AIS/TIA were age ≥65 years (HR: 1.99, 95% CI: 1.29-3.07) and established cerebrovascular disease at baseline (HR: 1.61, 95% CI: 1.02-2.53). Conclusions: The majority of stable outpatients at vascular risk met COMPASS selection criteria and could be good candidates for low-dose rivaroxaban in addition to aspirin. Short-term predictors of AIS/TIA were old age and history of cerebrovascular disease

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Clinical Manifestations and Mechanisms of Autoimmune Disease-Related Multiple Cerebral Infarcts

Cell Transplantation ◽

10.1177/0963689719846838 ◽

2019 ◽

Vol 28 (8) ◽

pp. 1045-1052

Author(s):

Li-Li Sun ◽

Wen-Xiong Tang ◽

Min Tian ◽

Lu Zhang ◽

Zun-Jing Liu

Keyword(s):

Autoimmune Disease ◽

Autoimmune Diseases ◽

Lupus Erythematosus ◽

Transcranial Doppler ◽

Clinical Manifestations ◽

Cerebral Infarcts ◽

Acute Infarction ◽

Multiple Stroke ◽

Underlying Mechanisms ◽

Embolic Signals

It is important to investigate the clinical characteristics and identify the stroke mechanisms of patients with autoimmune disease-related stroke, which are necessary for early etiology diagnosis, accurate treatment and preventive strategies. In this article we retrospectively studied eight cases of acute ischemic stroke associated with autoimmune diseases, and without competing conventional stroke etiologies. The characteristics of stroke (clinical and radiological features), the laboratory tests especially serum D-dimer levels (as a marker of hypercoagulable state), and embolic signals on transcranial Doppler were evaluated for all eight patients. High-resolution magnetic resonance imaging (HRMRI), which can help to evaluate vasculitis was performed in four patients. The possible underlying mechanisms of these cases were discussed based on these manifestations. As a result, autoimmune diseases in our study included systemic lupus erythematosus ( n=5), mixed connective tissue disease ( n=1), central nervous system vasculitis ( n=1), and Takayasu arteritis ( n=1). All eight patients presented with acute infarction lesions in ≥2 vascular territories. Most patients presented with numerous small and medium infarction lesions located in the cortical and subcortical areas. Multiple stroke mechanisms were involved in these cases, including hypercoagulability ( n=4), cardiac embolism ( n=1) and vasculitis ( n=3). Embolic signals could be detected on transcranial Doppler in all three stroke mechanisms. In conclusion, our study revealed the characteristics of autoimmune disease-related stroke. For patients with multiple acute cerebral infarcts within non-single arterial territories, autoimmune disease is an important etiology not to be neglected. Multiple stroke mechanisms were involved in these cases.

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Risk factors for progression of carotid intima-media thickness in patients with systemic lupus erythematosus: protocol for an observational cohort study in China

BMJ Open ◽

10.1136/bmjopen-2019-030721 ◽

2019 ◽

Vol 9 (9) ◽

pp. e030721

Author(s):

Haiyu Pang ◽

Yicong Ye ◽

Faming Ding ◽

Mengtao Li ◽

Xinglin Yang ◽

...

Keyword(s):

Risk Factors ◽

Systemic Lupus Erythematosus ◽

Informed Consent ◽

Lupus Erythematosus ◽

Intima Media Thickness ◽

Carotid Intima Media Thickness ◽

Systemic Lupus ◽

Media Thickness ◽

Artery Disease

IntroductionAccelerated atherosclerosis is a major complication of systemic lupus erythematosus (SLE), and it leads to increased cardiovascular morbidity and mortality in patients with SLE. This study aimed to investigate the natural progression of carotid intima-media thickness (CIMT), and to examine the risk factors for progression of CIMT and atherosclerotic plaques based on a Chinese SLE cohort.Methods and analysisParticipants were continuously enrolled as outpatients of the Department of Rheumatology in Peking Union Medical College Hospital (PUMCH) from October 2013 to December 2016. Inclusion criteria were as follows: (1) age ≥18 years, (2) fulfilment of clinical classification criteria of SLE and (3) provision of signed written informed consent. Patients with clinically overt coronary artery disease, a history of cardiovascular disease (previous stroke, heart failure, myocardial infarction, angina or symptomatic peripheral artery disease) and malignancy, and pregnant/lactating women were excluded. The primary outcome is progression of CIMT from baseline. A total of 440 patients with SLE will be enrolled. Participants will receive follow-up surveys ~5 years after their baseline visit. A standard structural survey form, including demographic data, medical history, clinical and laboratory assessments and CIMT measurement, is planned for data collection at baseline and follow-up. The risk prediction model for progression of CIMT will be created by using a mixed effect model.Ethics and disseminationThe study protocol was approved by the institutional review board of PUMCH (S-599). Informed consent was obtained from all participants according to the Declaration of Helsinki on Biomedical Research Involving Human Studies. All data will be managed confidentially according to guidelines and legislation. Dissemination will include publication of scientific papers and/or presentations of the study findings at international conferences.

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Impact of the new American College of Cardiology/American Heart Association definition of hypertension on atherosclerotic vascular events in systemic lupus erythematosus

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2019-216764 ◽

2020 ◽

Vol 79 (5) ◽

pp. 612-617 ◽

Cited By ~ 2

Author(s):

Konstantinos Tselios ◽

Dafna D Gladman ◽

Jiandong Su ◽

Murray Urowitz

Keyword(s):

Risk Factors ◽

Systemic Lupus Erythematosus ◽

Lupus Erythematosus ◽

American Heart Association ◽

American Heart ◽

Heart Association ◽

Cerebrovascular Event ◽

Systemic Lupus ◽

Vascular Events

BackgroundThe 2017 American College of Cardiology/American Heart Association guidelines defined hypertension at ≥130/80 mm Hg. Studies on patients with connective tissue diseases were not considered. Our aim was to assess the impact of this definition on atherosclerotic vascular events (AVEs) in systemic lupus erythematosus.Patients methodsIndividuals from the Toronto Lupus Clinic with at least 2 years of follow-up and no prior AVE were divided in three groups according to their mean blood pressure (BP) over that period (≥140/90 mm Hg, 130-139/80-89 mm Hg and <130/80 mm Hg). They were followed until the first occurrence of an AVE (fatal or non-fatal coronary artery disease, cerebrovascular event and peripheral vascular disease) or last visit. Groups were compared as per the baseline atherosclerotic risk factors. A multivariable time-dependent analysis was performed to adjust for the presence of other risk factors.ResultsOf 1532 patients satisfying the inclusion criteria, 155 (10.1%) had a BP ≥140/90 mm Hg, 316 (20.6%) 130–139/80–89 mm Hg and 1061 (69.3%) were normotensives. After a mean follow-up of 10.8 years, 124 AVEs were documented. The incidence rates were 18.9, 11.5 and 4.5 per 1000 patient-years for the three groups, respectively (p=0.0007 between the 130–139/80–89 mm Hg group and the normotensives). A mean BP of 130–139/80–89 mm Hg over the first 2 years was independently associated with the occurrence of AVEs (HR 1.73, 95% CI 1.13 to 2.65, p=0.011).ConclusionPatients with lupus with a sustained mean BP of 130–139/80–89 mm Hg over 2 years had a significantly higher incidence of AVEs compared with normotensive individuals. This BP level should be the target for antihypertensive therapy to minimise their cardiovascular risk.

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Impact of Cerebrovascular Disease on the Surgical Treatment of Idiopathic Normal Pressure Hydrocephalus

Neurosurgery ◽

10.1227/01.neu.0000230259.49167.95 ◽

2006 ◽

Vol 59 (3) ◽

pp. 545-552 ◽

Cited By ~ 17

Author(s):

Diego Spagnoli ◽

Lucia Innocenti ◽

Lorenzo Bello ◽

Mauro Pluderi ◽

Susanna Bacigaluppi ◽

...

Keyword(s):

Risk Factors ◽

Cerebrovascular Disease ◽

Vascular Disease ◽

Normal Pressure Hydrocephalus ◽

Normal Pressure ◽

Short Term ◽

Long Term Follow Up ◽

Short And Long Term

Abstract OBJECTIVE: The influence of cerebrovascular disease (CVD) on the short- and long-term results of surgery was evaluated in a series of consecutive patients with idiopathic normal-pressure hydrocephalus (iNPH). METHODS: Patients with suspected iNPH admitted to our department between June 1996 and June 2003 were evaluated with four clinical and handicap scales. CVD and risk factors for vascular disease were rated. All patients underwent intracranial pressure monitoring via a spinal catheter. Sixty-six patients received a ventriculoperitoneal shunt with a programmable valve. Prospective assessments were programmed at 2 weeks and 3 months after surgery (short-term follow-up). Long-term follow-up evaluations were arranged in June 2004 with patients and/or relatives and health/home care assistants. RESULTS: At the short-term follow-up examination, a significant clinical improvement was globally present in 89% of the patients (P < 0.05). CVD, such as leucoaraiosis or previous strokes, were present in 71% of the patients. Patients both with and without CVD and/or risk factors for vascular disease presented a significant improvement (P < 0.05) after shunting; 85 and 100% of the patients with and without CVD, respectively. At the long-term follow-up examination (mean, 52 ± 24.8 mo), 24% of the patients were dead and 8% had experienced stroke. Globally, 60% of the patients were still improved (P < 0.05); 52 and 79% of the patients with and without CVD, respectively. CONCLUSION: A high success rate in treatment of iNPH is possible in patients with and without CVD. Despite poorer short- and long-term treatment outcome of iNPH patients with CVD, a long-lasting improvement in their quality of life favors surgery.

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Evolution of retinal changes measured by optical coherence tomography in the assessment of hydroxychloroquine ocular safety in patients with systemic lupus erythematosus

Lupus ◽

10.1177/0961203319829826 ◽

2019 ◽

Vol 28 (4) ◽

pp. 555-559 ◽

Cited By ~ 6

Author(s):

D Martín-Iglesias ◽

J Artaraz ◽

A Fonollosa ◽

A Ugarte ◽

A Arteagabeitia ◽

...

Keyword(s):

Risk Factors ◽

Optical Coherence Tomography ◽

Lupus Erythematosus ◽

Pigment Epithelium ◽

Retinal Pigment ◽

Optical Coherence ◽

The Mean ◽

Sd Oct

Objective The objective of this report is to analyse retinal changes over a five-year period, assessed by spectral domain-optical coherence tomography (SD-OCT), in patients from the Lupus-Cruces cohort treated with hydroxychloroquine (HCQ). Methods SD-OCT screening was performed annually between 2012 and 2017. Average macular thickness (AMT), ganglion cell layer thickness (GCLT) and qualitative data of retinal pigment epithelium (RPE) and external retina (ExtR) were collected prospectively. We compared data from 2012 (first) and 2017 (second) SD-OCT. Results We studied 110 patients and 195 eyes. No cases of HCQ toxicity were detected. At the time of the second SD-OCT, 99% patients had taken a daily dose of HCQ ≤5 mg/kg/day. The median time on HCQ was 133 months. The mean AMT and GCLT were significantly lower in both eyes at the second SD-OCT; however, all the differences were clinically insignificant at less than 1%. Qualitative analysis of RPE and ExtR showed no significant changes. Similar results were found among patients with risk factors for retinopathy. The comparison of patients with and without risk factors showed no differences. Conclusions This study shows clinically irrelevant retinal changes in an SLE cohort on HCQ treatment over a five-year follow-up. Our findings support the safety of long-term HCQ at doses ≤5 mg/kg/day.

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PM327 Attributable Risk of Coronary and Cerebrovascular Disease Risk Factors: 5 year follow-up of 9,700 subjects in Chile (FONIS SA09I222)

Global Heart ◽

10.1016/j.gheart.2014.03.1684 ◽

2014 ◽

Vol 9 (1) ◽

pp. e128-e129 ◽

Cited By ~ 1

Author(s):

MTeresa Lira ◽

Sonia Kunstmann ◽

Gloria Icaza ◽

Loreto Nuñez ◽

MCristina Escobar ◽

...

Keyword(s):

Risk Factors ◽

Cerebrovascular Disease ◽

Disease Risk ◽

Attributable Risk

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Increased risk of ischemic heart disease after kidney donation

Nephrology Dialysis Transplantation ◽

10.1093/ndt/gfab054 ◽

2021 ◽

Author(s):

Anders J Haugen ◽

Stein Hallan ◽

Nina E Langberg ◽

Dag Olav Dahle ◽

Hege Pihlstrøm ◽

...

Keyword(s):

Heart Disease ◽

Ischemic Heart Disease ◽

Cerebrovascular Disease ◽

Ischemic Heart ◽

Kidney Donation ◽

Baseline Body Mass Index ◽

Healthy Controls ◽

Kidney Donors ◽

Increased Risk

Abstract Background Previous reports suggest increased risk of hypertension and cardiovascular mortality after kidney donation. In this study we investigate occurrence of ischemic heart disease and cerebrovascular disease, diabetes and cancer in live kidney donors compared with healthy controls eligible for donation. Methods Different diagnoses were assessed in 1029 kidney donors and 16084 controls. The diagnoses at follow-up were self-reported for the controls and registered by a physician for the donors. Stratified logistic regression was used to estimate associations with various disease outcomes, adjusted for gender, age at follow up, smoking at baseline, body mass index at baseline, systolic blood pressure at baseline and time since donation. Results The mean (standard deviation) observation time was 11.3 (8.1) years for donors versus 16.4 (5.7) years for controls. Age at follow-up was 56.1 (12.4) years in donors vs 53.5 (11.1) years in controls and 44% of donors were males vs 39.3% in the controls. At follow up 35 (3.5%) of the donors had been diagnosed with ischemic heart disease versus 267 (1.7%) of the controls. Adjusted odds ratio for ischemic heart disease was 1.64 (confidence interval 1.10-2.43, P = 0.01) in donors compared with controls. There were no significant differences for the risks of cerebrovascular disease, diabetes or cancer. Conclusions During long-term follow-up of kidney donors we find an increased risk of ischemic heart disease compared to healthy controls. This information may be important in the follow-up and selection process of living kidney donors.

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Skeletal muscle function and need for long-term care of urban elderly people in Japan (the Bunkyo Health Study): a prospective cohort study

BMJ Open ◽

10.1136/bmjopen-2019-031584 ◽

2019 ◽

Vol 9 (9) ◽

pp. e031584 ◽

Cited By ~ 3

Author(s):

Yuki Someya ◽

Yoshifumi Tamura ◽

Hideyoshi Kaga ◽

Shuko Nojiri ◽

Kazunori Shimada ◽

...

Keyword(s):

Risk Factors ◽

Insulin Sensitivity ◽

Muscle Strength ◽

Cerebrovascular Disease ◽

Muscle Mass ◽

Muscle Function ◽

Long Term Care ◽

Brain Mri ◽

Term Care

PurposeThe proportion of elderly individuals (age ≥65 years) in Japan reached 27.7% in 2017, the highest in the world. A serious social problem in a super-aged society is the rise in the number of elderly people who need long-term care (LTC), which is mainly due to cerebrovascular disease, dementia, age-related frailty, falls and fractures, and joint disease. We hypothesised that decreased muscle mass, muscle strength and insulin sensitivity are the common risk factors for these diseases related to needing LTC. We developed a prospective cohort study of elderly subjects in an urban community to test this hypothesis. The primary objective is to prospectively investigate associations between muscle mass, muscle strength, and insulin sensitivity and incidence of main disease and risk factors of needing LTC. The primary outcomes are the incidence of cerebrovascular disease and cognitive decline.ParticipantsParticipants were 1629 people aged 65–84 years living in 13 communities in an urban area (Bunkyo-ku, Tokyo, Japan). Average age was 73.1±5.4 years.Findings to dateWe obtained baseline data on cognitive function, cerebral small vessel disease (SVD) determined by brain MRI, body composition, bone mineral density, arteriosclerosis, physical function, muscle mass, muscle strength and insulin sensitivity. Mild cognitive impairment and dementia were observed in 18.1% and 3.3% of participants, respectively. The prevalence of cerebral SVD was 24.8%. These characteristics are similar to those previously reported in elderly Japanese subjects.Future plansWe will ask participants about their health status, including incidence of cerebrovascular disease, falls, fractures and other diseases every year by mail. We plan to re-evaluate cognitive function, brain MRI parameters and other parameters at 5 and 10 years after the baseline evaluation. We will evaluate whether low muscle function (muscle mass, muscle strength or insulin sensitivity) is a risk factor for cognitive decline or cerebrovascular disease.

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