scholarly journals Detection of Atrial Fibrillation Among Patients With Stroke Due to Large or Small Vessel Disease: A Meta‐Analysis

2016 ◽  
Vol 5 (9) ◽  
Author(s):  
Jelle Demeestere ◽  
Steffen Fieuws ◽  
Maarten G. Lansberg ◽  
Robin Lemmens
Keyword(s):  
Atrial Fibrillation ◽  
Small Vessel Disease ◽  
Meta Analysis ◽  
Small Vessel ◽  
Vessel Disease

scholarly journals The Omega-3 Fatty Acid Eicosapentaenoic Acid (EPA) Correlates Inversely with Ischemic Brain Infarcts in Patients with Atrial Fibrillation

Nutrients ◽  
2021 ◽  
Vol 13 (2) ◽  
pp. 651
Author(s):  
Martin F. Reiner ◽  
Philipp Baumgartner ◽  
Andrea Wiencierz ◽  
Michael Coslovsky ◽  
Nicole R. Bonetti ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Fatty Acid ◽  
Small Vessel Disease ◽  
Small Vessel ◽  
Omega 3 ◽  
Total N ◽  
Ischemic Brain ◽  
Omega 3 Fatty Acid ◽  
Vessel Disease ◽  
Brain Infarcts

The omega-3 fatty acid (n-3 FA) eicosapentaenoic acid (EPA) reduces stroke in patients with atherosclerotic cardiovascular disease. Whether EPA affects stroke or cerebral small vessel dis-ease in patients with atrial fibrillation (AF) remains uncertain. EPA, docosahexaenoic acid (DHA), docosapentaenoic acid (DPA), and alpha-linolenic acid (ALA) were determined by gas chromatography in 1657 AF patients from the Swiss Atrial Fibrillation study. All patients underwent brain MRI to detect ischemic brain infarcts, classified as large noncortical or cortical infarcts (LNCCIs); markers of small vessel disease, classified as small noncortical infarcts (SNCIs), number of microbleeds, and white matter lesion (WML) volumes. Individual and total n-3 FAs (EPA + DHA + DPA + ALA) were correlated with LNCCIs and SNCIs using logistic regression, with numbers of microbleeds using a hurdle model, and WML volumes using linear regression. LNCCIs were detected in 372 patients (22.5%). EPA correlated inversely with the prevalence of LNCCIs (odds ratio [OR] 0.51 per increase of 1 percentage point EPA, 95% confidence interval [CI] 0.29–0.90). DPA correlated with a higher LNCCI prevalence (OR 2.48, 95%CI 1.49–4.13). No associations with LNCCIs were found for DHA, ALA, and total n-3 FAs. Neither individual nor total n-3 FAs correlated with markers of small vessel disease. In conclusion, EPA correlates inversely with the prevalence of ischemic brain infarcts, but not with markers of small vessel disease in patients with AF.

Abstract T MP57: Coexisting Cerebrovascular Disease and Risk of Occult Atrial Fibrillation in Patients With Embolic Stroke of Undetermined Source

Stroke ◽  
2015 ◽  
Vol 46 (suppl_1) ◽  
Author(s):  
Esther Rojo ◽  
María Sandín-Fuentes ◽  
Ana I Calleja ◽  
Gabriel Largaespada ◽  
Elisa Cortijo ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Secondary Prevention ◽  
Cerebrovascular Disease ◽  
Cox Regression ◽  
Small Vessel Disease ◽  
Brain Magnetic Resonance Imaging ◽  
Embolic Stroke ◽  
Small Vessel ◽  
Large Artery ◽  
Vessel Disease

Background and objective: Secondary prevention after embolic stroke of undetermined source (ESUS) remains a clinical problem. Presence of asymptomatic cerebral large-artery atherosclerosis or small vessel disease could be aprioristically taken as an indicator of a lower risk for an occult cardiac source of emboli, thus influencing our secondary prevention strategy. We aimed to study the relationship between presence and degree of coexisting cerebrovascular disease and the risk of occult paroxysmal atrial fibrillation (OPAF) in ESUS patients. Methods: Longitudinal prospective study in patients fulfilling ESUS criteria after complete neurovascular and cardiac diagnostic workup, who were implanted with a subcutaneous REVEAL-XT loop-recorder to detect OPAF and followed-up for≥ 6 months. At baseline, cerebral large-artery atherosclerosis was assessed with cervical and transcranial ultrasound. Brain magnetic resonance imaging was used to evaluate small vessel disease. Periventricular (PV) and subcortical (SC) white matter hiperintensities (WMH) were categorized using the Fazekas score. Results: We studied 136 ESUS patients from October 2010 to December 2013 (71 men, mean age 67), who were followed-up for a mean time of 594 days. OPAF was detected in 56 (41%) of them. No relationship was found between extracranial or intracranial atherosclerosis and OPAF. Kaplan-Meier curves and crude Cox-regression analyses found associations between OPAF risk and age, smoking, CHA2DS2VASC score, presence of lacunar infarctions, and presence and degree of PVWMH & SCWMH. A multivariable-adjusted Cox regression model identified grade 2-3 PVWMH (HR 3.6, [2.0-6.5], p<0.001) and age as independent predictors of OPAF. Conclusion: Coexisting small vessel disease, specifically in the form of periventricular WMH, is a predictor of OPAF in ESUS patients. Presence of large-artery atherosclerosis does not lower the risk for OPAF. Therefore, OPAF should be actively pursued in ESUS patients regardless the coexistence of asymptomatic cerebrovascular disease.

Ischaemic stroke: common causes

2017 ◽  
Author(s):  
Hugh Markus ◽  
Anthony Pereira ◽  
Geoffrey Cloud
Keyword(s):  
Atrial Fibrillation ◽  
Heart Disease ◽  
Ischaemic Stroke ◽  
Small Vessel Disease ◽  
Small Vessel ◽  
Large Artery ◽  
Lacunar Stroke ◽  
Vessel Disease ◽  
Common Causes ◽  
Artery Disease

This chapter on common causes of ischaemic stroke reviews the major pathologies underlying ischaemic stroke, namely large-artery disease, cardioembolism, and small-vessel disease. Large-vessel extra- and intracranial atherosclerotic cerebrovascular disease is covered. Cardioembolic aetiologies of stroke including atrial fibrillation and valvular heart disease are discussed. Small-vessel disease causing lacunar stroke and possible heterogonous pathologies underlying this subtype are covered. Dolichoectasia of arteries as a potential cause of stroke and the newer concept of embolic stroke of undetermined source are also discussed.

scholarly journals Cerebral blood flow in small vessel disease: A systematic review and meta-analysis

2016 ◽  
Vol 36 (10) ◽  
pp. 1653-1667 ◽  
Author(s):  
Yulu Shi ◽  
Michael J Thrippleton ◽  
Stephen D Makin ◽  
Ian Marshall ◽  
Mirjam I Geerlings ◽  
...  
Keyword(s):  
Blood Flow ◽  
Cerebral Blood Flow ◽  
White Matter ◽  
Small Vessel Disease ◽  
Meta Analysis ◽  
Small Vessel ◽  
White Matter Hyperintensity ◽  
Cross Sectional ◽  
Vessel Disease ◽  
Cross Sectional Studies

White matter hyperintensities are frequent on neuroimaging of older people and are a key feature of cerebral small vessel disease. They are commonly attributed to chronic hypoperfusion, although whether low cerebral blood flow is cause or effect is unclear. We systematically reviewed studies that assessed cerebral blood flow in small vessel disease patients, performed meta-analysis and sensitivity analysis of potential confounders. Thirty-eight studies ( n = 4006) met the inclusion criteria, including four longitudinal and 34 cross-sectional studies. Most cerebral blood flow data were from grey matter. Twenty-four cross-sectional studies ( n = 1161) were meta-analysed, showing that cerebral blood flow was lower in subjects with more white matter hyperintensity, globally and in most grey and white matter regions (e.g. mean global cerebral blood flow: standardised mean difference−0.71, 95% CI −1.12, −0.30). These cerebral blood flow differences were attenuated by excluding studies in dementia or that lacked age-matching. Four longitudinal studies ( n = 1079) gave differing results, e.g., more baseline white matter hyperintensity predated falling cerebral blood flow (3.9 years, n = 575); cerebral blood flow was low in regions that developed white matter hyperintensity (1.5 years, n = 40). Cerebral blood flow is lower in subjects with more white matter hyperintensity cross-sectionally, but evidence for falling cerebral blood flow predating increasing white matter hyperintensity is conflicting. Future studies should be longitudinal, obtain more white matter data, use better age-correction and stratify by clinical diagnosis.

scholarly journals Blood Pressure Variability and Cerebral Small Vessel Disease

Stroke ◽  
2020 ◽  
Vol 51 (1) ◽  
pp. 82-89 ◽  
Author(s):  
Yuan Ma ◽  
Alex Song ◽  
Anand Viswanathan ◽  
Deborah Blacker ◽  
Meike W. Vernooij ◽  
...  
Keyword(s):  
Blood Pressure ◽  
White Matter ◽  
Odds Ratio ◽  
White Matter Hyperintensities ◽  
Small Vessel Disease ◽  
Meta Analysis ◽  
Random Effect ◽  
Cerebral Small Vessel Disease ◽  
Small Vessel ◽  
Vessel Disease

Background and Purpose— Blood pressure (BP) variability may increase the risk of stroke and dementia. It remains inconclusive whether BP variability is associated with cerebral small vessel disease, a common and potentially devastating subclinical disease that contributes significantly to both stroke and dementia. Methods— A systematic review and meta-analysis of prospective cohort studies that examined the association between BP variability and the presence or progression of established markers of cerebral small vessel disease, including white matter hyperintensities, lacunes, and microbleeds on magnetic resonance imaging. We searched MEDLINE, EMBASE, and Web of Science. Ten studies met the criteria for qualitative synthesis and 7 could be included in the meta-analysis. Data were synthetized using random-effect models. Results— These studies included a total of 2796 individuals aged 74 (mean) ±4 (SD) years, with a median follow-up of 4.0 years. A one SD increase in systolic BP variability was associated with increased odds of the presence or progression of white matter hyperintensities (odds ratio, 1.26 [95% CI, 1.06–1.50]). The association of systolic BP variability with the presence of lacunes (odds ratio, 0.93 [95% CI, 0.74–1.16]) and the presence of microbleeds (odds ratio, 1.13 [95% CI, 0.89–1.44]) were not statistically significant. Conclusions— A larger BP variability may be associated with a higher risk of having a higher burden of white matter hyperintensities. Targeting large BP variability has the potential to prevent cerebral small vessel disease and thereby reducing the risk of stroke and dementia. The potential issue of reverse causation and the heterogeneity in the assessment of cerebral small vessel disease markers should be better addressed in future studies.

scholarly journals Cognitive impairment in sporadic cerebral small vessel disease: A systematic review and meta‐analysis

2020 ◽  
Author(s):  
Olivia K. L. Hamilton ◽  
Ellen V. Backhouse ◽  
Esther Janssen ◽  
Angela C. C. Jochems ◽  
Caragh Maher ◽  
...  
Keyword(s):  
Systematic Review ◽  
Cognitive Impairment ◽  
Small Vessel Disease ◽  
Meta Analysis ◽  
Cerebral Small Vessel Disease ◽  
Small Vessel ◽  
Vessel Disease
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