Abstract P491: Serum Fatty Acids Concentrations and Compositions, Lipids Concentrations and Their Correlation in Acute Ischemic Stroke Patients Aged 50 Years or Older

Circulation ◽  
2020 ◽  
Vol 141 (Suppl_1) ◽  
Author(s):  
Takahisa Mori ◽  
Kazuhiro Yoshioka

Background: Compositions of serum fatty acids (s-FAs), such as palmitic acid (PA), oleic acid (OlA), linoleic acid (LiA) and docosahexaenoic acid (DHA), and their correlation with serum lipids (s-LPs), such as total cholesterol (T-CHO) and triglycerides (TG), have been reported in healthy young or middle subjects. However, little is known about s-FAs features in acute ischemic stroke (AIS) patients. Hypothesis: Serum FAs features in AIS elderly patients are different from those in healthy young subjects and concentrations of s-FAs provide different correlation with s-LPs from compositions. Methods: We conducted a cross-sectional study of patients aged 50 years or older who were admitted to our institution between August 2016 and July 2019 within 24 hours of first AIS onset. We evaluated concentrations and compositions of s-FAs and their association with s-LPs, age and ischemic stroke subtype. Results: Three hundred sixty-six patients met our inclusive criteria. Their average age was 74.7 years, median T-CHO and TG were 203.5 and 102 mg/dl, respectively and median concentrations of PA, OlA, LiA and DHA were 642.5, 566.0, 723.0 and 129.8 μg/ml, respectively, and their median or mean compositions were 23.6, 20.9, 26.5 and 4.7 %, respectively. Concentrations of s-FAs had positive correlation with s-LPs. Concentrations of s-LPs and most of s-FAs had negative correlation with age. In stroke subtype of large-artery atherosclerosis or small-vessel occlusion (LAA_SVO) and in stroke subtype of cardioembolism or others (CE_O), mean age was 72.6 and 76.4 years (p<0.001), median TCHO was 214 and 194 mg/dl (p<0.0001), median TG was 113 and 95 mg/dl (p<0.05), median PA was 678.8 and 611.2 μg/ml (p<0.0001), median OlA was 613.8 and 532.4 μg/ml (p<0.001), median LiA was 767.2 and 696.1 μg/ml (p<0.001), and mean DHA was 131.4 and 127.9 μg/ml (ns). Compositions of PA, OlA, LiA and DHA had no correlation with T-CHO and compositions of PA and OlA had positive correlation with TG, whereas compositions of LiA and DHA had negative correlation with TG. Compositions of OlA had negative correlation with age, whereas DHA composition had positive correlation with age. There was little difference of compositions between stroke subtypes. Conclusions: In first AIS elderly patients, concentrations of most of s-FAs had positive correlation with s-LPs. In LAA_SVO, patients were younger and their concentrations of s-LPs and most of s-FAs were larger than in CE_O. On the other hand, correlation of s-FAs compositions with s-LPs was not constant and there was little difference of compositions between ischemic stroke subtypes.

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Alexander Allen ◽  
Katarina Dakay ◽  
Brittany Ricci ◽  
Andrew Chang ◽  
Brian Mac Grory ◽  
...  

Introduction: Intravenous alteplase improves functional outcome in patients with acute ischemic stroke. While patients often have better outcomes, other patients may experience recurrent or worsening symptoms. We sought to determine the association between stroke subtype and neurologic deterioration in this study cohort. Methods: Data were abstracted from a prospective quality improvement registry at a comprehensive stroke center. Patients with symptomatic intracranial hemorrhage, no follow-up imaging, code status change to comfort measures only in the first 24 hours, or stroke mimics were excluded. Recurrent cerebrovascular events (RCVE) were defined as any new or worsening symptoms due to cerebral ischemia in the absence of intracranial hemorrhage or an alternative etiology such as infection or seizure. We compared demographic factors, vascular comorbidities, admission blood pressure, medications, use and timing of antithrombotics during hospitalization, admission NIH stroke scale, endovascular intervention, stroke subtype [Cardioembolic, large artery atherosclerosis, small vessel disease, cryptogenic, and other defined (such as dissection, hypercoagulability, cancer related, illicit drug use)], and good 90-day outcome (mRS 0-1) between the two groups using Fisher’s exact test and t-test as indicated. We then performed multivariable logistic regression analyses to determine associations between stroke subtypes and RCVE. Results: We identified 705 patients treated with tPA, and 606 met the inclusion criteria. The rate of RCVE was 5.8% (35/606). In multivariable analyses, when compared to cardioembolic/cryptogenic stroke, RCVE was more common in small vessel disease (adjusted OR 9.51 p=0.029), large vessel disease (adjusted OR 5.60, p=0.033), and other stroke mechanisms (adjusted OR 11.29, p=0.019). RCVE was associated with more disability at 90 days when compared to non-RCVE (median mRS 4, IQR 3 vs. median mRS 3, IQR 2, p = 0.016). Conclusions: Non-cryptogenic/Non-cardioembolic stroke subtypes are associated with early RCVE, and RCVE is associated with long term disability. Studies are needed to confirm our findings and test interventions optimizing stroke prevention strategies in these subtypes.


Author(s):  
Abhishek Miryala ◽  
Mahendra Javali ◽  
Anish Mehta ◽  
Pradeep R. ◽  
Purushottam Acharya ◽  
...  

Abstract Background The precise timings of evoked potentials in evaluating the functional outcome of stroke have remained indistinct. Few studies in the Indian context have studied the outcome of early prognosis of stroke utilizing evoked potentials. Objective The aim of this study was to determine somatosensory evoked potentials (SSEPs) and brain stem auditory evoked potentials (BAEPs), their timing and abnormalities in acute ischemic stroke involving the middle cerebral artery (MCA) territory and to correlate SSEP and BAEP with the functional outcome (National Institutes of Health Stroke Scale (NIHSS), modified Rankin scale (mRS) and Barthel’s index) at 3 months. Methods MCA territory involved acute ischemic stroke patients (n = 30) presenting consecutively to the hospital within 3 days of symptoms onset were included. Details about clinical symptoms, neurological examination, treatment, NIHSS score, mRS scores were collected at the time of admission. All patients underwent imaging of the brain and were subjected to SSEP and BAEP on two occasions, first at 1 to 3 days and second at 4 to 7 days from the onset of stroke. At 3 months of follow-up, NIHSS, mRS, and Barthel’s index were recorded. Results P37 and N20 amplitude had a strong negative correlation (at 1–3 and 4–7 days) with NIHSS at admission, NIHSS at 3 months, mRS at admission, and mRS at 3 months and a significant positive correlation with Barthel’s index (p < 0.0001). BAEP wave V had a negative correlation (at 1–3 and 4–7 days) with NIHSS at admission, NIHSS at 3 months, mRS at admission, and mRS at 3 months and a positive correlation with Barthel’s index (p < 0.0001). Conclusion SSEP abnormalities recorded on days 4 to 7 from onset of stroke are more significant than those recorded within 1 to 3 days of onset of stroke; hence, the timing of 4 to 7 days after stroke onset can be considered as better for predicting functional outcome.


2018 ◽  
Vol 80 (1-2) ◽  
pp. 106-114 ◽  
Author(s):  
Pil-Wook Chung ◽  
Byung-Woo Yoon ◽  
Yeong-Bae Lee ◽  
Byoung-Soo Shin ◽  
Hahn Young Kim ◽  
...  

Although statins are established therapy for the secondary prevention of ischemic stroke, factors associated with adherence to statin treatment following ischemic stroke are not well known. To address this, we assessed the 6-month statin adherence using 8-item Morisky Medication Adherence Scale-8 in patients with acute ischemic stroke. Of 991 patients, 65.6% were adherent to statin at 6-month after discharge. Multiple logistic regression analysis showed that patients’ awareness of hyperlipidemia (OR 1.62; 95% CI 1.07–2.43), large artery stroke subtype (versus non-large artery stroke, OR 1.79; 95% CI 1.19–2.68), and alcohol drinking habits (OR 1.64; 95% CI 1.06–2.53) were positively associated, while high statin dose (versus low dose, OR 0.6; 95% CI 0.40–0.90) and higher daily number of medication pills (OR 0.93; 95% CI 0.88–0.97) were found to have a negative association with self-reported good adherence to statin medication after acute ischemic stroke. However, stroke severity and diagnosis of hyperlipidemia were not associated with adherence. These results suggest that educational and motivational interventions may enhance statin adherence because modifiable factors were associated with statin adherence.


Stroke ◽  
2012 ◽  
Vol 43 (suppl_1) ◽  
Author(s):  
Michael Katsnelson ◽  
Tatjana Rundek ◽  
Ralph Sacco ◽  
Hannah Gardener ◽  
Shaneela Malik ◽  
...  

Objectives: Identification of gene variants of stroke subtypes is important for the development of tailored ischemic stroke therapies among various ethnic groups. Valid and reliable determination of ischemic stroke subtype is essential for achieving this goal and to standardize a classification scheme across multi-center studies and different populations. Causative Classification System for Ischemic Stroke (CCS) is a novel computerized subclassification tool developed to improve reliability and accuracy of classifying stroke types. The CCS algorithm relies on both phenotypic and causative stroke variables. A Hispanic subset of the SiGN, an important and distinct target population with greater risk of certain stroke subtypes, was evaluated with Trial of Org 10172 in Acute Stroke Treatment (TOAST) and CCS and the agreement between the two classification systems was analyzed. Methods: Over 6000 subjects at 15 sites across US and Europe were enrolled, with TOAST and CCS locally adjudicated. Blood collection and central data quality control (10% central readjudication) were performed on all participants. A subset of Hispanics was analyzed for the purpose of this study and the agreement between the TOAST and CCS were assessed by kappa statistic. Findings: Hispanics (n=595, 10.9%) compared to non-Hispanics (n=5457) were more likely to be younger (63.7 vs. 64.0), male (55% vs. 46%) and have fewer of the traditional stroke risk factors HTN (54% vs. 64%), Afib (11% vs. 14%), DM(23% vs. 25%), CAD(16% vs. 20%) and smoking(19% vs. 22%). While the TOAST showed no differences between stroke subtypes for Hispanic vs. non-Hispanics, in CCS, Hispanics were classified with more of large vessel (22% vs. 20%), cardioembolic (37% vs. 30%) and small vessel strokes (13% vs. 9%) and fewer with undetermined etiology (28% vs. 40%) as compared to non-Hispanics. TOAST and CCS offered moderate correlation across all stroke types in Hispanics: kappa of 0.66 for large artery atherosclerosis, 0.58 for cardioembolic, and 0.58 for small artery occlusion. Conclusion: CCS offers a more sensitive and accurate system for subphenotyping of strokes in Hispanics who tended to have relatively fewer risk factors and unclassified strokes. Further studies correlating the two classification systems and their relation to genotyping data are warranted.


Stroke ◽  
2014 ◽  
Vol 45 (suppl_1) ◽  
Author(s):  
Yasuhisa Akaiwa ◽  
Hiroki Takano ◽  
Hiroyuki Arakawa ◽  
Itaru Ninomiya ◽  
Masahiro Uemura ◽  
...  

Background: : Intake of omega-3 polyunsaturated fatty acids, such as EPA, has been reported to have protective effects on various diseases including ischemic stroke. However, there have been few studies concerning the effect of omega-3 polyunsaturated fatty acids on hemorrhagic stroke. We studied associations of serum levels of EPA with stroke subtypes including primary ICH Methods: We have examined serum EPA and arachidonic acid (AA) levels in routine practice since 2009. To calibrate the EPA values, we calculated EPA/AA ratio. A total of 212 consecutive acute stroke patients and 27 control subjects were included. The patients 40 years old or younger were excluded. Ischemic stroke subtypes were determined based on TOAST criteria. Primary ICH was classified into lobar or nonlobar types, according to the region of the brain in which it occurred. Results: Of all the 157 ischemic stroke patients (female 47, mean age 72.9 years), 62 were classified with cardioembolic stroke (CES), 25 large-artery atherosclerotic (LAA), 22 small-vessel disease (SVD), and 48 other/undetermined causes (O/U). Of all the 55 ICH patients (female 23, mean age 71.0), 34 patients had nonlobar type, and 21 had lobar one. There were no significant intergroup differences in the mean EPA/AA ratio (p=0.525) among CES (EPA/AA= 0.67±0.42), LAA (0.70±0.30), SVD (0.65±0.45), O/U (0.62±0.38), nonlobar ICH (0.51±0.30), lobar ICH (0.64±0.33), and control (0.60±0.42) groups. However, the EPA/AA ratio of the nonlobar ICH group was considerably low. The EPA/AA ratio of the nonlobar ICH group was significantly (p=0.033) lower than that of the whole other groups (0.65±0.39) and significantly (p=0.003) lower than that of the entire ischemic stroke groups (0.67±0.40). Although the significant differences between the nonlobar ICH and the whole ischemic groups were also observed in systolic and diastolic blood pressure (195±37/107±25 mmHg vs 159±35/82±19 mmHg, p<0.001), multiple linear regression analyses showed the association between the EPA/AA and nonlobar ICH was independent from the blood pressure. Conclusions: Although the strongest risk factor for nonlobar ICH is hypertension, low EPA/AA ratio might play a role in the development of nonlobar ICH.


Stroke ◽  
2019 ◽  
Vol 50 (7) ◽  
pp. 1805-1811 ◽  
Author(s):  
Susumu Kobayashi ◽  
Shingo Fukuma ◽  
Tatsuyoshi Ikenoue ◽  
Shunichi Fukuhara ◽  
Shotai Kobayashi ◽  
...  

Background and Purpose— In Japan, nearly half of ischemic stroke patients receive edaravone for acute treatment. The purpose of this study was to assess the effect of edaravone on neurological symptoms in patients with ischemic stroke stratified by stroke subtype. Methods— Study subjects were 61 048 patients aged 18 years or older who were hospitalized ≤14 days after onset of an acute ischemic stroke and were registered in the Japan Stroke Data Bank, a hospital-based multicenter stroke registration database, between June 2001 and July 2013. Patients were stratified according to ischemic stroke subtype (large-artery atherosclerosis, cardioembolism, small-vessel occlusion, and cryptogenic/undetermined) and then divided into 2 groups (edaravone-treated and no edaravone). Neurological symptoms were evaluated using the National Institutes of Health Stroke Scale (NIHSS). The primary outcome was changed in neurological symptoms during the hospital stay (ΔNIHSS=NIHSS score at discharge−NIHSS score at admission). Data were analyzed using multivariate linear regression with inverse probability of treatment weighting after adjusting for the following confounding factors: age, gender, and systolic and diastolic blood pressure at the start of treatment, NIHSS score at admission, time from stroke onset to hospital admission, infarct size, comorbidities, concomitant medication, clinical department, history of smoking, alcohol consumption, and history of stroke. Results— After adjusting for potential confounders, the improvement in NIHSS score from admission to discharge was greater in the edaravone-treated group than in the no edaravone group for all ischemic stroke subtypes (mean [95% CI] difference in ΔNIHSS: −0.46 [−0.75 to −0.16] for large-artery atherosclerosis, −0.64 [−1.09 to −0.2] for cardioembolism, and −0.25 [−0.4 to −0.09] for small-vessel occlusion). Conclusions— For any ischemic stroke subtype, edaravone use (compared with no use) was associated with a greater improvement in neurological symptoms, although the difference was small (<1 point NIHSS) and of limited clinical significance.


Neurology ◽  
2020 ◽  
Vol 95 (16) ◽  
pp. e2178-e2191
Author(s):  
Tai Hwan Park ◽  
Jeong-Kon Lee ◽  
Moo-Seok Park ◽  
Sang-Soon Park ◽  
Keun-Sik Hong ◽  
...  

ObjectiveTo improve epidemiologic knowledge of neurologic deterioration (ND) in patients with acute ischemic stroke (AIS).MethodsIn this prospective observational study, we captured ND prospectively in 29,446 patients with AIS admitted to 15 hospitals in Korea within 7 days of stroke onset. ND was defined as an increase in NIH Stroke Scale (NIHSS) score ≥2 (total), or ≥1 (motor or consciousness), or any new neurologic symptoms. Change in incidence rate after stroke onset, causes, factors associated with ND, modified Rankin Scale (mRS) score at 3 months and 1 year, and a composite of stroke, myocardial infarction, and all-cause death at 1 year were assessed.ResultsND occurred in 4,299 (14.6%) patients. The highest rate, 6.95 per 1,000 person-hours incidence, was within the first 6 hours, which decreased to 2.09 within 24–48 hours, and 0.66 within 72–96 hours after stroke onset. Old age, female sex, diabetes, early arrival, large artery atherosclerosis as a stroke subtype, high NIHSS scores, glucose level, systolic blood pressure, leukocytosis at admission, recanalization therapy, TIA without a relevant lesion, and steno-occlusion of relevant arteries were associated with ND. The causes were stroke progression (71.8%) followed by recurrence (8.5%). Adjusted relative risks (95% CI) for poor outcome (mRS 3–6) at 3 months and 1 year were 1.75 (1.70–1.80) and 1.70 (1.65–1.75), respectively. The adjusted hazard ratio (95% CI) for the composite event was 1.59 (1.45–1.74).ConclusionsND should be taken into consideration as a factor that may influence the outcome in acute ischemic stroke.


2021 ◽  
Vol 2021 ◽  
pp. 1-9
Author(s):  
Qi Wang ◽  
Yi-Qun Zhang ◽  
Han-Cheng Qiu ◽  
Yin-Dan Yao ◽  
Ao-Fei Liu ◽  
...  

Objective. To assess whether the effectiveness and safety of recanalization therapy for acute ischemic stroke (AIS) caused by large-artery occlusion (LAO) differ between patients aged 60–79 years and patients aged ≥80 years. Methods. We analyzed prospective data of patients with LAO (≥60 years) who underwent recanalization therapy at the Department of Vascular Neurosurgery, New Era Stroke Care and Research Institute, PLA Rocket Force Characteristic Medical Center, from November 2013 to July 2017. The data were compared between elderly patients (60–79 years) and very elderly patients (≥80 years). The effectiveness of recanalization therapy was evaluated using the 90-day modified Rankin scale (mRS) score, while safety was assessed by the rates of symptomatic intracranial hemorrhage (SICH) and mortality within 30 days. Results. A total of 151 patients with AIS induced by LAO were included in this study. Seventy-three patients (48.3% [73/151]) had an overall favorable outcome (mRS score 0–2) after treatment. A higher proportion of patients in the elderly group showed a favorable outcome compared with the very elderly group (58.6% [34/58] vs. 41.6% [39/93], respectively; P = 0.046 ). The incidence of SICH (12.7% vs. 16.13%, respectively; P = 0.561 ) and mortality (10.3% vs. 7.5%, respectively; P = 0.548 ) within 30 days was not significantly different between the two groups. Conclusion. Recanalization treatment of LAO is more effective in elderly patients compared with very elderly patients, while the safety of recanalization treatment is comparable between these two groups.


Neurology ◽  
2021 ◽  
pp. 10.1212/WNL.0000000000012729
Author(s):  
Jun Young Chang ◽  
Wook-Joo Kim ◽  
Jee Hyun Kwon ◽  
Ji Sung Lee ◽  
Beom Joon Kim ◽  
...  

ObjectiveWe evaluated the association between admission HbA1c and subsequent risk of composite vascular events, including stroke, myocardial infarction, and vascular death, in patients with acute ischemic stroke and diabetes.MethodsPatients who had a transient ischemic attack or an acute ischemic stroke within 7 days of symptom onset, and diabetes were included in a retrospective cohort design using the stroke registry of the Clinical Research Center for Stroke in Korea. The association between admission HbA1c and composite vascular events, including stroke, myocardial infarction (MI), and vascular death, during one-year follow-up was estimated using the Fine-Gray model. The risk of composite vascular events according to the ischemic stroke subtype was explored using fractional polynomial and linear-quadratic models.ResultsOf the 18567 patients, 1437 developed composite vascular events during follow-up. In multivariable analysis using HbA1c as a categorical variable, the risk significantly increased at a threshold of 6.8%–7.0%. The influence of admission HbA1c level on the risk of composite vascular events was pronounced particularly among those in whom fasting glucose at admission was ≤130 mg/dL. The optimal ranges of the HbA1c associated with minimal risks for composite vascular events was the lowest for the small vessel occlusion subtype (6.6, [95% confidence internal [CI], 6.3–6.9]), compared to the large artery atherosclerosis (7.3 [95% CI, 6.8–7.9]) or the cardioembolic subtype (7.4[95% CI, 6.3–8.5]).ConclusionIn patients with ischemic stroke and diabetes, the risks of composite vascular events were significantly associated with admission HbA1c. The optimal range of the admission HbA1c was below 6.8%–7.0%, and were different according to the ischemic stroke subtype.


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