Abstract WP226: Short Lasting Runs (<30 sec) of Atrial Fibrillation are More Commonly Observed in Ischemic Stroke Patients in Comparison to Controls

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.

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Abstract 13201: Atrial Fibrillation Detection in Community Ischemic Stroke Patients is Improved With Implantable Cardiac Monitors

Circulation ◽

10.1161/circ.142.suppl_3.13201 ◽

2020 ◽

Vol 142 (Suppl_3) ◽

Author(s):

Jia Guo ◽

James R Brorson ◽

Andrew Beaser ◽

Zaid A Aziz ◽

Cevher Ozcan ◽

...

Keyword(s):

Atrial Fibrillation ◽

Ischemic Stroke ◽

Community Setting ◽

Prior History ◽

Stroke Patients ◽

Logrank Test ◽

Data Set ◽

Kaplan Meier ◽

History Of ◽

Artery Disease

Introduction: Although implantable cardiac monitors (ICM) improve atrial fibrillation (AF) detection relative to Holters or other extended ambulatory cardiac monitors (EACMs) (e.g., 30-day event monitors or outpatient telemetry) in clinical trials, data are limited on their performance in the community setting. We investigated AF detection in ischemic stroke patients and subsequent initiation of oral anticoagulation (OAC) in a real-world setting. Methods: We identified patients with ischemic stroke (2010-2015) in IBM MarketScan, a national prospectively acquired data set in whom Holters, EACMs, or ICMs were ordered. We further selected patients with no prior history of AF or OAC and continuous database enrollment 6 mos pre- and 24 mos post monitoring. Propensity score matching (PSM) was used to adjust for baseline characteristics differences between monitoring types. Logrank test was used to compare the Kaplan-Meier (KM) curves for AF detection and OAC initiation in patients with AF. Results: A total of 6,287 patients were analyzed: 4,107 Holter (age 63±14 yrs, 46% female, 28% coronary artery disease [CAD], 71% hypertension [HTN]), 1,829 EACM (age 61±14 yrs, 49% female, 27% CAD, 73% HTN), and 351 implanted with ICM (age 63±13 yrs, 51% female, 38% CAD, 82% HTN). After 1:1 PSM, the Holter-ICM cohort comprised of 664 patients and the EACM-ICM cohort comprised of 676 patients. In the Holter-ICM pair, 2 yr AF diagnoses rate was 14.5% for Holter vs 38.3% for ICM (logrank p<0.01, Panel A). In the EACM-ICM pair, 2 yr AF diagnoses rate was 15.4% for EACM vs 38.2% for ICM (logrank p<0.01, Panel B). Initiation of OAC in AF patients by 2 yrs was 41.7% for Holters vs 49.6% for ICMs (logrank p=0.30, Panel C) and 61.5% for EACM vs 49.6% for ICM (logrank p=0.16, Panel D). Conclusion: In community patients with ischemic stroke with no history of AF or prior OAC, rates of OAC initiation are comparable between monitoring types when AF is detected, and ICM outperforms Holter and EACM for the detection of AF.

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Abstract 1122‐000214: Clinical Factors Associated rTPA Administration in Acute Ischemic Stroke Patients with History of Atrial Fibrillation

Stroke: Vascular and Interventional Neurology ◽

10.1161/svin.01.suppl_1.000214 ◽

2021 ◽

Vol 1 (S1) ◽

Author(s):

Chase A Rathfoot ◽

Camron Edressi ◽

Carolyn B Sanders ◽

Krista Knisely ◽

Nicolas Poupore ◽

...

Keyword(s):

Atrial Fibrillation ◽

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Medical History ◽

Clinical Decision Making ◽

Past Medical History ◽

Clinical Factors ◽

Stroke Patients ◽

Factors Associated ◽

History Of

Introduction : Previous research into the administration of rTPA therapy in acute ischemic stroke patients has largely focused on the general population, however the comorbid clinical factors held by stroke patients are important factors in clinical decision making. One such comorbid condition is Atrial Fibrillation. The purpose of this study is to determine the clinical factors associated with the administration of rtPA in Acute Ischemic Stroke (AIS) patients specifically with a past medical history of Atrial Fibrillation (AFib). Methods : The data for this analysis was collected at a regional stroke center from January 2010 to June 2016 in Greenville, SC. It was then analyzed retrospectively using a multivariate logistic regression to identify factors significantly associated with the inclusion or exclusion receiving rtPA therapy in the AIS/AFib patient population. This inclusion or exclusion is presented as an Odds Ratio and all data was analyzed using IBM SPSS. Results : A total of 158 patients with Atrial Fibrillation who had Acute Ischemic Strokes were identified. For the 158 patients, the clinical factors associated with receiving rtPA therapy were a Previous TIA event (OR = 12.155, 95% CI, 1.125‐131.294, P < 0.040), the administration of Antihypertensive medication before admission (OR = 7.157, 95% CI, 1.071‐47.837, P < 0.042), the administration of Diabetic medication before admission (OR = 13.058, 95% CI, 2.004‐85.105, P < 0.007), and serum LDL level (OR = 1.023, 95% CI, 1.004‐1.042, P < 0.16). Factors associated with not receiving rtPA therapy included a past medical history of Depression (OR = 0.012, 95% CI, 0.000‐0.401, P < 0.013) or Obesity (OR = 0.131, 95% CI, 0.034‐0.507, P < 0.003), Direct Admission to the Neurology Floor (OR = 0.179, 95% CI, 0.050‐0.639, P < 0.008), serum Lipid level (OR = 0.544, 95% CI, 0.381‐0.984, P < 0.044), and Diastolic Blood Pressure (OR = 0.896, 95% CI, 0.848‐0.946, P < 0.001). Conclusions : The results of this study demonstrate that there are significant associations between several clinical risk factors, patient lab values, and hospital admission factors in the administration of rTPA therapy to AIS patients with a past medical history of Atrial Fibrillation. Further research is recommended to determine the extent and reasoning behind of these associations as well as their impact on the clinical course for AIS/AFib patients.

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Abstract WP190: Clinical Features of Sarcoid Patients With Ischemic Stroke

Stroke ◽

10.1161/str.47.suppl_1.wp190 ◽

2016 ◽

Vol 47 (suppl_1) ◽

Author(s):

Ahmed Z Obeidat ◽

Heidi Sucharew ◽

Charles J Moomaw ◽

Dawn O Kleindorfer ◽

Brett M Kissela ◽

...

Keyword(s):

Ischemic Stroke ◽

Current Knowledge ◽

Case Reports ◽

Brain Mri ◽

Sporadic Case ◽

Prior History ◽

Stroke Patients ◽

Stroke Subtype ◽

Stroke Event ◽

History Of

Background: Current knowledge on ischemic stroke in sarcoid patients stems from sporadic case reports. The mechanism is thought to be related to granulomatous involvement of brain vasculature. However, clinical, demographic, and radiographic features of sarcoid patients with ischemic stroke are lacking. If sarcoid patients are at higher risk for ischemic stroke event, we hypothesized that the risk factors for ischemic stroke and stroke subtype distribution would differ between sarcoid and non-sarcoid ischemic stroke patients. Methods: Cases of ischemic stroke were identified for the years 2005 and 2010 from the population-based Greater Cincinnati/Northern Kentucky Stroke Study (population 1.3 million). Ischemic stroke cases were physician study confirmed and patients with a history of sarcoid were identified through medical chart review. Clinical variables were compared between stroke patients with history of sarcoid and those with no prior sarcoid history. Results: A total of 4258 cases of ischemic stroke were identified; of them, only 18 had prior diagnosis of sarcoid (0.04%). Brain MRI showed diffusion restriction in 14 out of 15 (93%) MRIs performed in sarcoid patients. The table presents risk factor and subtype data on sarcoid patients compared with non-sarcoid patients. Conclusions: We identified only a few cases of prior sarcoid history in our two-year ascertainment of ischemic stroke patients in our population. In comparison with stroke patients with no prior history of sarcoid, the sarcoid patients tended to be of younger age at presentation, female, have a history of diabetes and hyperlipidemia, and more likely of African descent, perhaps related to the diagnosis of sarcoid itself. We were unable to detect differences in stroke subtype distributions between sarcoid and non-sarcoid ischemic stroke patients.

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P1879Characterization of cardiac diagnostic care pathways by indication and physician specialty in a real-world dataset of 314,554 patients

European Heart Journal ◽

10.1093/eurheartj/ehz748.0627 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

S Landman ◽

S Sarkar

Keyword(s):

Ischemic Stroke ◽

Care Pathway ◽

Holter Monitoring ◽

Prior History ◽

Care Pathways ◽

Loop Recorder ◽

External Loop ◽

History Of ◽

To Receive ◽

Term Monitoring

Abstract Background A variety of modalities exist for diagnosing cardiac arrhythmias via ambulatory ECG recording. These can range from short-term (i.e. ≤48 hours) holter monitoring, medium-term external monitoring for up to 30 days, and long-term monitoring via an implantable cardiovascular monitor (ICM). Purpose To quantify the prevalence of different diagnostic care pathways for cardiac arrhythmias in a large, real-world dataset. Methods A de-identified database of aggregated EHR data from 2015–2017 was used to identify patients with any procedure or service received for an ambulatory cardiac diagnostic monitor. Three categories of diagnostic monitoring technologies were identified: (1) Holter monitoring for up to 48 hours, (2) External ECG and event monitoring for up to 30 days via external loop recorder, mobile cardiac telemetry (MCT), or other external ECG recording device, and (3) ICMs. Patients with their first monitor in 2015 or later were selected. The number of patients that had their initial monitor in each of the different categories were quantified, as well as the number that followed a care pathway progression from shorter-term to longer-term monitoring. Patients were grouped by clinical history (syncope or ischemic stroke diagnosis codes in the 6 months prior) as well as by whether they had a clinical interaction with an electrophysiologist (EP) at any point in their care pathway. Results A total of 314,554 patients were identified with a mean follow-up duration of 340.1±232.5 days. The initial monitor type used across all patients was 68.8% holter, 27.7% extended holter/MCT/external loop recorder, and 3.5% ICMs. 5.1% of all patients received multiple categories of monitoring. 50,812 patients had a prior history of syncope, 46.4% of which were seen by an EP. 28,374 patients had a prior history of ischemic stroke, with 50.9% seen by an EP. The figure shows that patients seen by an EP are more likely to receive ICMs than those not seen by an EP (20.6% vs. 3.8% for syncope; 25.3% vs. 5.7% for stroke; both p<0.001). Patients seen by an EP are also more likely to receive multiple categories of progressively-longer monitoring than those not seen by an EP (10.4% vs. 4.6% for syncope; 8.3% vs. 4.0% for stroke; both p<0.001). Conclusion Cardiac diagnostic care pathways for syncope and ischemic stroke are significantly different between those patients that are seen by an EP versus those that are not. Relatively few patients overall received multiple types of cardiac diagnostic monitoring. Acknowledgement/Funding Medtronic

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HUBUNGAN ANTARA RIWAYAT PENYAKIT JANTUNG DENGAN TINGKAT KEPARAHAN STROKE ISKEMIK AKUT PERTAMA KALI

Majalah Kedokteran Neurosains Perhimpunan Dokter Spesialis Saraf Indonesia ◽

10.52386/neurona.v37i1.101 ◽

2019 ◽

Vol 37 (1) ◽

Author(s):

Ignatius Ivan ◽

Budi Riyanto Wreksoatmodjo ◽

Octavianus Darmawan

Keyword(s):

Myocardial Infarction ◽

Heart Failure ◽

Atrial Fibrillation ◽

Heart Disease ◽

Ischemic Stroke ◽

National Institutes Of Health ◽

Stroke Severity ◽

Stroke Patients ◽

Severe Stroke ◽

History Of

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

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Epidemiology of Sports Related Concussion in Brazilian Jiu-Jitsu: A Cross-Sectional Study

Sports ◽

10.3390/sports7020053 ◽

2019 ◽

Vol 7 (2) ◽

pp. 53 ◽

Cited By ~ 2

Author(s):

Matthew Spano ◽

Donald Risucci ◽

Mill Etienne ◽

Kristina Petersen

Keyword(s):

Wide Spectrum ◽

Female Gender ◽

The United States ◽

Cross Sectional Study ◽

Lifetime Prevalence ◽

Prior History ◽

Return To Sports ◽

Sectional Study ◽

Cross Sectional ◽

History Of

Brazilian Jiu-Jitsu (BJJ) is a rapidly growing grappling sport with a wide spectrum of participants. This cross-sectional study examined the lifetime prevalence of concussion in adult BJJ practitioners in the United States using a 17-item survey. A total of 778 (11.4% female) BJJ practitioners with a median age of 31 years completed the survey. Overall, the lifetime prevalence of the self-reported BJJ-related concussion was 25.2%. However, the prevalence was higher among females than males (43.0% versus 22.9%; X2(1,740) = 15.129; p < 0.001). Factors independently associated with significantly increased odds of having sustained a BJJ-related concussion included a prior history of concussion (OR 1.76, 95% CI 1.14–2.74; p = 0.011) and female gender (OR 1.95, 95% CI 1.04–3.65; p = 0.037). The median return to sports time was three days, with 30.3% of participants returning on the same day as being concussed. The present study represents the first epidemiological research examining the concussions in BJJ. The results underscore the need for increased education on concussions and return to sports guidelines among BJJ coaches and practitioners.

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Abstract TMP14: Thrombolysis in Ischemic Stroke Patients with Prior History of Intracranial Hemorrhage

Stroke ◽

10.1161/str.49.suppl_1.tmp14 ◽

2018 ◽

Vol 49 (Suppl_1) ◽

Author(s):

Stacy Y Chu ◽

Samuel Sommaruga ◽

David Hwang ◽

Jennifer Dearborn ◽

Lauren Sansing ◽

...

Keyword(s):

Ischemic Stroke ◽

Intracranial Hemorrhage ◽

Prior History ◽

Stroke Patients ◽

History Of

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Hypercoagulable States and Stroke: A Selective Review

CNS Spectrums ◽

10.1017/s109285290001021x ◽

2005 ◽

Vol 10 (7) ◽

pp. 567-578 ◽

Cited By ~ 24

Author(s):

Steven R. Levine

Keyword(s):

Ischemic Stroke ◽

Cryptogenic Stroke ◽

Clinical Trial Data ◽

Epidemiological Studies ◽

Hypercoagulable State ◽

Prior History ◽

Clinical Approach ◽

Stroke Patients ◽

Increased Risk ◽

History Of

AbstractBlood disorders have been implicated in ~5% to 10% of ischemic stroke, with an increased frequency in younger patients. Most disorders are associated with an increased thrombotic tendency and, therefore, an increased risk of ischemic stroke. Less commonly, a bleeding diathesis may predispose a patient to intracranial hemorrhage. While many conditions predisposing to thrombosis have been associated with stroke, there are relatively few prospective, epidemiological studies addressing hypercoagulable states and arterial stroke compared with the number of studies on the genetic thrombophilias, which are predominantly associated with venous thrombosis. When ordering tests of coagulation in stroke patients, one should keep in mind whether the results will influence therapy and/or patient outcome. It is generally not advocated to screen all stroke patients for a “hypercoagulable workup”. Typically, patients to be screened for coagulation defects will have a prior history of one or more unexplained thromboembolic events. The yield for diagnosing a hypercoagulable state is typically greatest for young stroke patients or those with a family history of thrombosis and who have no other explanations for their stroke (cryptogenic stroke). The yield in typically low in unselected ischemic stroke patients and older patients. Treatment of a first stroke with a documented hypercoagulable state is typically long-term or indefinite duration warfarin, although there is a paucity of clinical trial data supporting this clinical approach.

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ISCHEMIC STROKE

The Professional Medical Journal ◽

10.29309/tpmj/2018.25.01.543 ◽

2018 ◽

Vol 25 (01) ◽

pp. 84-89

Author(s):

Muhammad Naveed Alam ◽

Tahir Habib Rizvi ◽

Memoona Alam ◽

Muhammad Tahir

Keyword(s):

Risk Factors ◽

Heart Failure ◽

Atrial Fibrillation ◽

Congestive Heart Failure ◽

Ischemic Stroke ◽

Artery Bypass ◽

Bypass Grafting ◽

Contributing Factors ◽

Cross Sectional ◽

History Of

Objectives: To determine the frequency and contributing factors of atrialfibrillation in patients with first ischemic stroke. Methodology: This study included 150 patientswith first acute ischemic stroke. All the patients had electrocardiography to detect the presenceof atrial fibrillation. The patients were also labeled for risk factors like hypertension, congestiveheart failure, smoking, and hyperthyroidism, etc. Setting: Mayo Hospital Lahore. Duration ofStudy: 1st January 2013 to 30th June 2013. Type: Descriptive Cross Sectional. Results: Atrialfibrillation was present among 22 (14.6%) patients. Among patients with atrial fibrillation,smoking, congestive heart failure and hypertension were the most frequent risk factors whichwere present in 11 (50%), 6 (27%), and 5 (22.7%) patients, respectively. Conclusion: Frequencyof atrial fibrillation among patients with first ischemic stroke was high. Smoking, congestiveheart failure and history of coronary artery bypass grafting are frequent risk factors.

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Presence of Atrial Fibrillation in Stroke Patients With Patent Foramen Ovale: Systematic Review and Meta-Analysis

Frontiers in Neurology ◽

10.3389/fneur.2021.613758 ◽

2021 ◽

Vol 12 ◽

Author(s):

Jessie Ze-Jun Chen ◽

Vincent N. Thijs

Keyword(s):

Atrial Fibrillation ◽

Ischemic Stroke ◽

Confidence Interval ◽

Lower Risk ◽

Patent Foramen Ovale ◽

Cryptogenic Stroke ◽

Foramen Ovale ◽

Stroke Patients ◽

Loop Recorder ◽

Cross Sectional

Purpose: Patent foramen ovale (PFO) is associated with ischemic stroke, especially in patients with embolic stroke of undetermined source. This study aims to evaluate the presence of atrial fibrillation (AF) in ischemic stroke patients with PFO.Methods: We systematically searched EMBASE and MEDLINE databases on May 21, 2020 for studies that analyzed the presence of AF in patients with PFO. The primary outcome was the presence of AF in patients with PFO compared with those without. Outcomes were pooled using a random-effects model using the method of DerSimonian and Laird. We recorded demographic characteristics and the methods used for AF detection in the studies included (unspecified, history/medical records review, ECG, Holter monitor, or loop recorder).Results: A total of 14 studies and 13,245 patients fulfilled the entry criteria. The average age was 61.2 years and 41.3% of the participants were female. There was a lower risk of AF in patients with PFO compared with those without (RR 0.52, 95% confidence interval, 0.41–0.63, p < 0.001). There was no evidence of heterogeneity. The lower risk of AF was found in cross-sectional and longitudinal studies and in studies stratified by average age (<60 or ≥60) and in cryptogenic stroke. Meta-regression by PFO detection technique suggested that studies using transoesophageal echocardiogram for PFO detection reported higher risk of AF (1.39, 95% confidence interval 1.14–1.70, p = 0.004).Conclusion: The presence of a PFO in patients with ischemic stroke/TIA may be associated with a lower risk of AF. Few studies have estimated the risk of future AF in patients with PFO.

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