Abstract 3735: Utility A Second 24-hours Holter Monitoring For The Diagnosis Of Paroxismal Atrial Fibrillation After An Acute Stroke

Stroke ◽  
2012 ◽  
Vol 43 (suppl_1) ◽  
Author(s):  
Elisa Correas Callero ◽  
Patricia Martinez-Sanchez ◽  
Daniel Prefasi Gomar ◽  
Blanca Fuentes Gimeno ◽  
Gerardo Ruiz Ares ◽  
...  

OBJETIVE: to assess the utility of a second 24-hours Holter monitoring for the diagnosis of paroxysmal atrial fibrillation (PAF) in patients with suspected cardioembolic ischemic stroke. METHODS: prospective study of ischemic stroke patients (brain infarction/TIA) treated in a Stroke Center (June 2010-February 2011). A first 24-hours Holter monitoring was performed if PAF was suspected and, if it was negative, a second 24-hours Holter monitoring was performed. Variables analyzed: demographic data, vascular risk factors, stroke severity and etiological subtype, presence of carotid plaques by duplex ultrasound, enlarged left atrial by transthoracic/transesophageal echocardiography and presence of chronic/acute brain infarctions by neuroimaging (CT/MRI). RESULTS: 219 patients included, mean age 69.8 (SD 13.5) years, 55.3% male. 17.8% have previous atrial fibrillation (AF). In 14 (6.4%) patients AF was diagnosed by ECG on admission or by serial ECG in the Stroke Unit. 24-hours Holter was performed in 101 patients to assess the presence of PAF, 85 cases during hospitalization and 16 at the outpatient clinic. This 24-hours Holter diagnosed PAF in 28.7% (29/101) of patients. A second 24-hours Holter was performed at the outpatient clinic in 21 cryptogenic brain ischemia patients. The mean time from the first to the second Holter was 143.3 (SD 72.2) days. This second 24-hours Holter detected PAF in 2 (9.5%) patients. CONCLUSION: a second 24-hours Holter monitoring at the outpatient clinic could detect PAF in almost 10% of cryptogenic ischemic stroke patients.

Stroke ◽  
2013 ◽  
Vol 44 (suppl_1) ◽  
Author(s):  
Daniel Prefasi ◽  
Patricia Martinez-Sanchez ◽  
Ana Rodriguez-Sanz ◽  
Blanca Fuentes ◽  
Gerardo Ruiz-Ares ◽  
...  

BACKGROUND: Our knowledge of the presence of atrial fibrillation (AF) in young stroke patients is scarce. Our objective was to analyze the frequency of AF in ischemic stroke (IS) patients up to 50 years of age and its relationship with stroke severity and outcomes. METHODS: Prospective observational study of consecutive IS patients up to 50 years of age admitted to a stroke center during a five-year period (2007-2011). A complete cardiology study was performed with daily electrocardiogram (ECG) and cardiac monitoring for 72 hours as well as echocardiography. In cases of stroke of unknown etiology, a 24-hour Holter monitoring was performed, which was repeated as necessary. We analyzed baseline data, previously or newly diagnosed AF, structural heart disease (SHD) (valvulopathy/cardiomyopathy), stroke severity on admission measured by the NIHSS (moderate-severe stroke if NIHSS≥5) and 3-month outcomes according to the mRS (good outcome if mRS ≤2). AF was classified as AF associated with SHD (AF-SHD) and AF not associated with SHD (AF-NSHD). RESULTS: One hundred fifty-seven patients were included (mean age 41.1 years, 58.6% male). Sixteen subjects (10.2%) presented AF, 5 with AF-NSHD and 11 with AF-SHD. AF was previously known in 10 patients (6.4%), 2 with AF-NSHD and 8 with AF-SHD. A multivariate analysis showed an independent association between AF and moderate-severe IS (OR 3.882, 95%CI: 1.277-11.799), but AF was not an independent prognostic factor. CONCLUSION: AF is present in up to 10% of young patients with IS and is associated with increased NIHSS scores.


Stroke ◽  
2016 ◽  
Vol 47 (suppl_1) ◽  
Author(s):  
Ethem Murat Arsava ◽  
Ezgi Yetim ◽  
Ugur Canpolat ◽  
Necla Ozer ◽  
Kudret Aytemir ◽  
...  

Background: The role of short-lasting (<30 sec) runs of atrial fibrillation (AF) in ischemic stroke pathophysiology is currently unknown. Although these non-sustained attacks are considered as a risk factor for future development of longer lasting, classical AF episodes, prior research has highlighted that associated clinical stroke features are not entirely similar between these two types of arrhythmias. In this study we determined the prevalence of short-lasting AF in stroke-free controls and compared it to a consecutive series of ischemic stroke patients. Methods: A total 235 controls, without any prior history stroke or AF, were evaluated with ECG and 24-hour Holter monitoring for the presence of <30-sec or ≥30-sec lasting AF episodes. The results were compared to a consecutive series of ischemic stroke patients without prior history of AF (n=456). Univariate and multivariate analyses were performed to determine demographic and cardiovascular factors related to <30-sec lasting AF and its association with ischemic stroke. Results: Expectedly, the frequency of newly diagnosed ≥30-sec lasting AF, detected either on ECG or Holter monitoring, was significantly higher in patients with ischemic stroke (18% vs. 2%; p<0.01). Non-sustained AF was positively related to old age (p<0.01), female gender (p=0.01) and hypertension (p<0.01) in univariate analyses. In multivariate analyses, after adjustment for demographic and cardiovascular risk factors, presence of non-sustained AF was significantly higher among both cryptogenic (OR 1.78; 95% CI 1.02-3.10) and non-cryptogenic (OR 1.84; 95% CI 1.15-2.94) stroke patients with respect to controls. Conclusion: Our study shows a higher prevalence of non-sustained AF episodes in ischemic stroke patients in comparison to controls. Whether this cross-sectional association translates into causality in terms of stroke pathophysiology will be the subject of future studies.


Stroke ◽  
2012 ◽  
Vol 43 (suppl_1) ◽  
Author(s):  
Patricia Martinez-Sanchez ◽  
Elisa Correas Callero ◽  
Andres Cruz Herranz ◽  
Blanca Fuentes Gimeno ◽  
Angel Martin Montes ◽  
...  

INTRODUCTION: The yield of serial electrocardiograms (ECG) plus 72-hour cardiac monitoring and Holter monitoring in detection of paroxysmal atrial fibrillation (PAF) is not well known. METHODS: consecutive patients with stroke or transient ischemic attack (TIA) admitted to a Stroke Unit (SU) during January 2009-June 2010 were studied. Patients underwent serial ECG and cardiac monitoring in the first 72 hours. Furthermore, 24-hours Holter monitoring were performed in patient with brain ischemia of unknown origin or if cardiac embolism was suspected. The presence of atrial fibrillation (AF) and PAF was recorded. RESULTS: 537 patients were included, 59.6% males. Mean age 69.1 (SD 13.5) years. Previous AF was present in 15.8% patients. ECG on admission showed not previously known AF in 22 (4%) patients. Cardiac monitoring and serial ECG in the SU detected PAF in 12 (2.2%) cases more. 24-hours Holter monitoring was completed in 156 patients, in 42 cases PFA was detected, of them 6 had been previously detected by serial ECG/cardiac monitoring. One case of PAF detected by serial ECG was not confirmed by Holter monitoring. In total, 10.8% of patients were diagnosed with new PAF. In multivariate analyses, NIHSS on admission (OR 1.1 for each 1 point increase; 95% CI, 1-1.2), enlarged left atrial (OR 5.8; 95% CI, 2.8-12), absence of carotid plaques by duplex ultrasound (OR 2.1; 95% CI 1-4.4) and hyperlipidemia (OR 2.4; 95% CI 1.119-5) were predictors of PAF. CONCLUSIONS: 24-hours Holter monitoring increased by 6 fold the detection of PAF as compared to ECG plus cardiac monitoring in acute stroke patients. Stroke severity, enlarged left atrial, absence of carotid plaques and hyperlipidemia are associated with PAF.


Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Cynthia Bautista ◽  
Sally Gerard

Background/Purpose: Stroke is the fifth leading cause of death and Diabetes is the seventh leading cause of death in the United States. Diabetes is an independent risk factor for stroke. Diabetes is a common co-morbidity in stroke patients and is associated with poor outcomes after stroke. Get with the Guidelines - Stroke (GWTG-S) Registry database provides a rich opportunity to look at disease-specific data and find opportunities for improving care. The purpose of this study was to examine specific elements of acute ischemic stroke care in patients with diabetes using the GWTG-S at Comprehensive and Primary Stroke Centers in Northeast of America. Methods: A retrospective, descriptive study at both a Comprehensive and Primary Stroke Center. The analysis focused on patients with ischemic stroke and diabetes entered in the GWTG-S from January 1, 2015, to December 31, 2017. Data were analyzed looking at measures specific to stroke and the presence of diabetes. General demographic data were examined to compare populations and quality outcome measures. Results: The sample of patients with ischemic stroke and diabetes was over 1,000 patient’s at the two sites (Comprehensive site N = 804, Primary site N = 203) Incidence of ischemic stroke with diabetes at the two sites were 32% and 26%, respectively. Demographic data were similar in most categories including age, race, and gender. Significant differences were found in regard to the type of insurance. Stroke care outcomes indicated thrombolytic administration rates were the same at 8%. Diabetes care outcomes indicated patients discharged on insulin occurred in 18% to 26% of the sample. Conclusion/Implications for Practice: Ischemic stroke patients with diabetes were shown to receive similar care at both a comprehensive and primary care stroke center. There were no differences between centers in thrombolysis treatment for ischemic stroke patients with diabetes. Several opportunities for improvement in diabetes-related care need to be addressed.


2020 ◽  
Vol 11 (01) ◽  
pp. 156-159
Author(s):  
Bindu Menon ◽  
Krishnan Ramalingam ◽  
Rajeev Kumar

Abstract Background The role of oxidative stress in neuronal injury due to ischemic stroke has been an interesting topic in stroke research. Malondialdehyde (MDA) has emerged as a sensitive oxidative stress biomarker owing to its ability to react with the lipid membranes. Total antioxidant power (TAP) is another biomarker to estimate the total oxidative stress in stroke patients. We aimed to determine the oxidative stress in acute stroke patients by measuring MDA and TAP. Materials and Methods MDA and TAP were determined in 100 patients with ischemic stroke and compared with that in 100 age- and sex-matched healthy adults. Demographic data, stroke severity measured by the National Institutes of Health Stroke Scale (NIHSS), and disability measured by the Barthel index (BI) were recorded. The association of MDA and TAP with other variables was analyzed by paired t-test. Results Of the whole sample, 74% represented males. The mean NIHSS score was 13.11 and BI was 38.87. MDA was significantly higher in stroke patients (7.11 ± 1.67) than in controls (1.64 ± 0.82; p = 0.00). TAP was significantly lower in stroke patients (5.72 ± 1.41) than in controls (8.53 ± 2.4; p = 0.00). The lipid profile and blood sugar levels were also significantly higher in stroke patients. There was no association of MDA and TAP with other variables. Conclusion We found that oxidative stress was associated with acute ischemic stroke. However, we could not establish an association between oxidative stress and the severity of acute stroke.


Author(s):  
Ignatius Ivan ◽  
Budi Riyanto Wreksoatmodjo ◽  
Octavianus Darmawan

ASSOCIATION BETWEEN HISTORY OF HEART DISEASE AND SEVERITY OF ACUTE FIRST-EVER ISCHEMIC STROKEABSTRACTIntroduction: History of heart disease such as atrial  fibrillation, angina pectoris, myocardial infarction, heart failure has a role on ischemic stroke severity.Aim: This research aims to find the association between history of heart disease and stroke severity using NIHSS score on acute ischemic stroke patients in Atma Jaya hospital during 2014-2018.Method: This research used cross-sectional method with two-sided fisher’s exact test. With total sampling, samples retrieved from secondary sources in Atma Jaya hospital during 2014-2018 resulting 236 subjects. Stroke severity measured by NIHSS score during admission, categorized with severe stroke (15-42) and non-severe stroke (0-14).Result: There is a significant association between history of AF (p=0.046) on first-ever ischemic stroke severity. Acute first-ever ischemic stroke patients who are  >18 years old with history of AF has a tendency of 5,2 times to have severe stroke compared with patients without AF. Other history of heart disease has no significant association towards stroke severity.Discussion: In accordance with previous research, our findings suggest a significant association between history of atrial fibrillation and acute first-ever ischemic stroke severity in which there is a tendency of more severe stroke compared wth patients without AF. Unlike previous findings, this research shows no significant association between history of heart failure and stroke severity due to limited data characteristic  of ejection fraction preventing us to include patient with ejection fraction below 30%. This limitation may also allow history of angina pectoris and myocardial infarction to be insignificant.Keywords:  Atrial  fibrillation,  heart  failure,  ischemic  stroke,  myocardial  infarction,  National  Institutes  of Health Stroke ScaleABSTRAKPendahuluan: Riwayat penyakit jantung seperti atrial fibrilasi, angina pektoris, infark miokardium, gagal jantung memiliki peran terhadap keparahan stroke iskemik.Tujuan: Mengetahui hubungan riwayat penyakit jantung dengan tingkat keparahan stroke berdasarkan skor NIHSS pada pasien stroke iskemik akut di RS Atma Jaya pada tahun 2014-2018.Metode: Penelitian potong lintang terhadap data sekunder pasien stroke iskemik pertama kali yang dirawat di RS Atma Jaya pada tahun 2014-2018. Keparahan stroke diukur berdasarkan National Institutes of Health Stroke Scale (NIHSS) masuk dengan kategori severe stroke (skor 15-42) dan non-severe stroke (0-14). Dilakukan uji Fisher dua sisi untuk menilai hubungan.Hasil: Terdapat 236 subjek dengan mayoritas hubungan riwayat AF (p=0,046) terhadap tingkat keparahan stroke. Pasien berumur >18 tahun yang mengalami stroke iskemik akut pertama kali dengan riwayat AF akan berpeluang 5,2 kali lebih tinggi untuk mengalami severe stroke dibandingkan jika tanpa riwayat AF. Riwayat penyakit jantung lain tidak memiliki hubungan signifikan terhadap tingkat keparahan stroke.Diskusi: Terdapat hubungan yang signifikan antara riwayat AF terhadap tingkat keparahan stroke, terutama pada subjek dengan severe stroke jika dibandingkan pasien tanpa riwayat AF. Tidak ditemukan hubungan signifikan antara penyakit jantung yang lain dikarenakan keterbatasan data penelitian.Kata kunci: Atrial fibrilasi, gagal jantung, infark miokardium, National Institutes of Health Stroke Scale, stroke iskemik


2018 ◽  
Vol 28 (2) ◽  
pp. 1-6
Author(s):  
Achinta Kumar Mallick ◽  
Md Kafil Uddin ◽  
Md Ahmed Ali ◽  
Pijus Kumar Kundu ◽  
Sheikh Mohammad Emdadul Haque ◽  
...  

Atrial fibrillation (AF) is a common arrhythmia and a major risk factor for ischemic stroke, especially in the elderly. Patients with nonvalvular AF have a 5-fold excess risk of stroke. However, population-based data are scarce in patients who have experienced a first-ever ischemic stroke in the presence of AF regarding long-term risk of stroke recurrence and case-fatality rate. Aim of the study is to find out the outcome of ischemic stroke patients with Atrial Fibrillation. It was a descriptive type cross sectional study where 125 diagnosed cases of ischemic stroke were included. Presence of atrial fibrillation was detected by electrocardiogram. They were divided into two groups – those with atrial fibrillation and those without. Comparison was done between the two group in term of recurrence, mortality and clinical improvement. Atrial fibrillation was present in 22 (17.6%) of 125 patients with ischemic stroke. Those with AF were more frequently male, aged 45 years and older. The presence of AF was associated with high 3 months (Χ2 =4.562, df = 1, p<0.05) and 6 months mortality (Χ2 =7.868, df = 1, p<0.05), with a higher stroke recurrence rate within the first 6 months follow-up (22.7% versus 7.8% (<0.05)). At 3 months follow up clinical deterioration was noted in 9.1% patient with atrial fibrillation compared to 2.9% patients who had no arrhythmia(p<0.01) and at 6 months follow up clinical deterioration was noted in 18.2% patient with atrial fibrillation compared to 4.9% patients who had no arrhythmia(p<0.01). Ischemic stroke patients with atrial fibrillation had significant mortality within the study period compared to those without atrial fibrillation. Significant deterioration in clinical outcome was noted in atrial fibrillation group after six months. Recurrence was more in ischemic stroke patients with atrial fibrillation. Multivariate linear regression analysis shows atrial fibrillation as well as CKD, Diabetes mellitus and smoking as independent risk factor for recurrence. In conclusion, patients who had an ischemic stroke with accompanying atrial fibrillation had higher mortality, grave stroke severity, more recurrences and poorer functional status than those without atrial fibrillation.TAJ 2015; 28(2): 1-6


Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Gregoire Boulouis ◽  
Arne Lauer ◽  
Ahmer Khawdja Siddiqui ◽  
Andreas Charidimou ◽  
Robert Regenhardt ◽  
...  

Introduction: When transferred from a referring hospital (RH) to a thrombectomy capable stroke center (TCSC), patients with initially favorable imaging profile (ASPECT score ≥6) often demonstrate infarct progression significant enough to make them ineligible at arrival. We sought to determine the clinical and imaging factors associated with this phenomenon in transferred ischemic stroke patients. Methods: We identified adult stroke patients transferred from one of 30 RH between 2010 and 2016 for which (1) a RH computed tomography (CT) and (2) a CT Angiography (CTA) at arrival were available for review. ASPECT scores were evaluated by 2 raters. The adequacy of leptomeningeal collateral flow was rated as none/poor, decreased, adequate or augmented per the Maas et al (Stroke 2009), modified scale. ASPECTS decay was defined as an ASPECT initial score ≥6 worsening between RH and TCSC CTs to a score <6. Results: A total of 330 patients were included in the analysis (mean age 70.2 ± 14.2, 43.3% females). Univariable subgroup analyses showed that patients with ASPECTs decay were more likely to be females (55% vs 40%, p=0.02), not on anticoagulants (4% vs 15%, p=0.01), and with higher initial NIHSS (Median [IQR] 19 [15.3-22] vs 11 [6-17], p<0.001), hyperdense vessel sign on initial CT (71% vs 26%, p<0.001) and poor collaterals on CTA (72% vs 19%, p<0.001). In multivariable models, higher NIHSS, lower baseline ASPECTs, CTA evidence of a proximal occlusion, and none/poor collaterals were strong predictors of ASPECTs decay, with collateral status demonstrating the highest odds ratio (aOR 10.3, 95%CI: [4.1-29], p<0.001). Similar results were found after stratification by vessel occlusion level. Conclusion: In ischemic stroke patients transferred for thrombectomy, poor collateral flow, stroke severity and proximal vascular occlusion, but not time interval, are the main determinants of ASPECTs decay.


Stroke ◽  
2013 ◽  
Vol 44 (suppl_1) ◽  
Author(s):  
Andrea Rocco ◽  
Fam Geraldine ◽  
Peter Ringleb ◽  
Simon Nagel

Background: The value of CRP in stroke patients undergoing thrombolysis, in the acute and subacute phase of ischemic stroke as a prognostic tool for outcome is unclear, since conflicting reports exist. Aim of our study was to explore the role of admission CRP and follow-up CRP between day 1 and 7, for outcome and mortality in stroke patients treated with rtPa. Methods: From March 1998 to 2011 all patients admitted to our hospital and undergoing thrombolysis for acute ischemic stroke were included into an open, prospective database. Stroke severity was assessed using the NIHSS. In all patients CRP levels was measured upon admission in the emergency room, after 24 hours from the acute event and in the following days. CT scan before treatment and routine brain CT scan 24-36 h after thrombolysis were performed. Symptomatic haemorrhage (sICH) was defined according to ECASS II criteria. Functional outcome was assed by mRS at three months and divided into independent (mRS0-2) and dependent (mRS 3-5). Results: In total, 1292 patients were registered in our database. About 70% of patients had an increase of CRP values in the first 7 days after admission. Infection occurred in 22% of patients and about 25% had a large brain infarction (>1/3 of vessel territory). sICH occurred in 6.7% of patients. Follow-up CRP levels between day 1 and 7 were significantly associated with cardio embolic stroke (p=0.033), infarct size (p<0.001), infection (p<0.001), symptomatic haemorrhage (p<0.001), independent (p<0.001), dependent outcome (p<0.001) and mortality (p<0.001). CRP values between day 1 and 7 (OR 2.824 CI95%; 1.534 - 5.201, p=0.001), infarct size (OR 2.254; CI95% 1.480 - 3.432, p<0.001), infection (OR1.752; CI95% 1.100 - 2.789, p=0.018) and NIHSS (OR 1.043; CI95% 1.016 - 1.069, p=0.001) were independent predictors for dependent outcome. Admission CRP values were not independently associated with outcome and mortality after multivariate logistic regression analysis. Conclusion: Together with know predictors like infarct size, NIHSS and infections, maximally elevated CRP levels within day 1 and 7 were strongly and independently associated with long-term outcome in thrombolyzed stroke patients after correction for baseline variables.


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