Abstract WP183: Spontaneous Echo Contrast is Associated With Larger Cerebral Infarction Volume in Stroke Patients With Atrial Fibrillation

Introduction: The presence of spontaneous echo contrast (SEC) on transesophageal echocardiography (TEE) is associated with increased thrombogenecity and a risk factor of thromboembolism. The increased thrombogenecity in SEC may produce larger intracardiac thrombi, which result in larger cerebral infarctions and severe stroke. Hypothesis: We hypothesized that infarction volume will be larger in stroke patients with SEC than in those without SEC. Methods: This was a post-hoc analysis using a prospective cohort of acute ischemic stroke. This study included patients with nonvalvular atrial fibrillation (NVAF) who underwent TEE and diffusion weighted imaging (DWI) from Jan. 2008 to Dec. 2014. The volume of cerebral infarction on DWI was measured semi-automatically using 3-dimensional software by an investigator who was blinded to clinical information. The infarction volume was compared between patients with SEC and those without. Results: Of 4252 considered patients, 889 patients had NVAF. After excluding 449 patients without TEE and 39 patients without DWI, 401 patients were included for analysis. Of them, SEC was found in 181 patients (45.1%, 82 mild, 35 moderate, and 64 severe SEC). Infarction volume was larger for the patients with SEC than those without SEC (median [interquartile range], 7226.8 mm 3 [1218.1-28804.6] vs. 4756.8 mm 3 [672.8-14887.8], p=0.015). Infarction volume also increased with SEC severity (p=0.006). Initial National Institute of Health Stroke Scale scores were higher for the patients with SEC than those without SEC (median [interquartile range], 5.0 [2.0-12.0] vs. 3.0 [1.0-8.0]. p=0.008). On multivariate analysis, infarction volume was independently associated with the presence of SEC (p=0.014). Conclusion: Among stroke patients with NVAF, those with co-existing SEC had larger cerebral infarction, which may account for severe stroke. This may be related with increased thrombogenecity in patients with SEC.

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Abstract TP178: Thrombi Occluding the Intracranial Artery Are Larger in Stroke Patients With Atrial Fibrillation in the Presence of Spontaneous Echo Contrast

Stroke ◽

10.1161/str.48.suppl_1.tp178 ◽

2017 ◽

Vol 48 (suppl_1) ◽

Author(s):

Kyoungsub Kim ◽

Joonsang Yoo ◽

Hyo Suk Nam ◽

Young Dae Kim ◽

Geu-Ru Hong ◽

...

Keyword(s):

Atrial Fibrillation ◽

Thrombus Formation ◽

Linear Regression Analysis ◽

Three Dimensional ◽

Positive Association ◽

Intracranial Artery ◽

Stroke Patients ◽

Severe Stroke ◽

Spontaneous Echo Contrast ◽

Scale Scores

Introduction: Spontaneous echo contrast (SEC) is frequently observed in patients with atrial fibrillation (AF). SEC represents red blood cell aggregates associated with increased thrombogenecity, which may produce larger thrombus formation. This can result in larger infarctions and severe stroke. Hypothesis: Thrombus characteristics occluding the intracranial artery may differ between AF patients with concomitant SEC and those without. Methods: This was a post hoc analysis of prospective cohort. Acute stroke patients with non-valvular AF who underwent transesophageal echocardiography and thin-section (1 or 1.25 mm) noncontrast CT between January 2008 and December 2014 were considered for this study. The volume and the density of thrombus were measured semi-automatically using three-dimensional image software, and compared between the patients with SEC and those without. Results: Among 368 patients considered, thrombus was identified in 135 patients. Of the135 patients, 67 (49.6%) had SEC. The frequency of SEC was not different between patients with identified thrombi and those without (P=0.146). Thrombus volume was larger in the patients with SEC than those without (median [interquartile range], 75.0 mm 3 [46.1-142.9] versus 55.9 mm 3 [30.3-91.8]; P=0.013). As the degree of SEC increased, the thrombus volume increased (P=0.025). On multivariate analysis, the presence of SEC was independently associated with thrombus volume. (P=0.008) . Linear regression analysis showed positive association between initial National Institute of Health Stroke Scale scores and thrombus volume (P<0.001). However, thrombus density was not different between patients with SEC and those without (P=0.226). Conclusions: This study suggests that increased thromogenecity by SEC in patients with AF might produce larger intracardiac thrombi and embolization, which resulted in larger thrombi occluding the intracranial artery and more severe stroke.

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Sex Differences in the Association between Liver Fibrosis and Clinical Outcomes in Acute Cardioembolic Stroke Patients with Nonvalvular Atrial Fibrillation

10.21203/rs.3.rs-378462/v1 ◽

2021 ◽

Author(s):

Lei Yang ◽

Ke Gao ◽

Xin-Ye Yao ◽

Yong-lan Tang ◽

Wan-Ying Yang ◽

...

Keyword(s):

Atrial Fibrillation ◽

Liver Fibrosis ◽

Clinical Outcomes ◽

Normal Liver ◽

Advanced Fibrosis ◽

Stroke Patients ◽

Short Term ◽

Nonvalvular Atrial Fibrillation ◽

Severe Stroke ◽

Advanced Liver Fibrosis

Abstract Background: Liver cirrhosis is a confirmed risk factor for clinical outcomes of stroke patients. However, the contribution of liver fibrosis to cardioembolic stroke (CES) and its short-term outcomes are poorly understood. This study aimed to investigate the association between liver fibrosis and short-term clinical outcomes of acute CES patients, due to nonvalvular atrial fibrillation (NVAF), as well as the impacts of sex on the association. Methods: Using data of 522 patients with NVAF admitted within 48 hours after acute symptom of CES onset. We calculated Fibrosis-4 score (FIB-4) and defined liver fibrosis as: likely advanced fibrosis (FIB-4>3.25), indeterminate (FIB-4, 1.45-3.25), unlikely advanced fibrosis (FIB-4<1.45). We investigated the impact of liver fibrosis degree on stroke severity, major disability at discharge and all cause death at 90 days stratified by sex. Results: Among 522 acute CES patients with NVAF, the mean FIB-4 on admission reflected intermediate fibrosis with largely normal liver enzymes. After adjusting for all confounders, multivariate analyses revealed that likely advanced liver fibrosis was associated with severe stroke (OR=2.21, 95% CI: 1.04-3.54), major disability at discharge (OR=4.59, 95% CI: 1.88-11.18), and 90-days mortality (HR=1.25, 95% CI: 1.10-1.56). Further grouped by sex, these associations were stronger in males but not significant in females.Conclusions: In patients with largely normal liver enzyme, likely advanced liver fibrosis is associated with severe stroke, major disability and all cause death after acute CES due to NVAF, and the association unfolded more obvious in males, but not for females.

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Relationship between Plasma D-Dimer Level and Cerebral Infarction Volume in Patients with Nonvalvular Atrial Fibrillation

Cerebrovascular Diseases ◽

10.1159/000345336 ◽

2013 ◽

Vol 35 (1) ◽

pp. 64-72 ◽

Cited By ~ 27

Author(s):

Mari Matsumoto ◽

Manabu Sakaguchi ◽

Shuhei Okazaki ◽

Shigetaka Furukado ◽

Masafumi Tagaya ◽

...

Keyword(s):

Atrial Fibrillation ◽

Cerebral Infarction ◽

Nonvalvular Atrial Fibrillation ◽

Infarction Volume ◽

D Dimer

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Sex Differences in the Association Between Liver Fibrosis and Clinical Outcomes in Acute Cardioembolic Stroke Population With Nonvalvular Atrial Fibrillation

10.21203/rs.3.rs-255507/v1 ◽

2021 ◽

Author(s):

Lei Yang ◽

Ke Gao ◽

Xin-Ye Yao ◽

Yong-lan Tang ◽

Wan-Ying Yang ◽

...

Keyword(s):

Atrial Fibrillation ◽

Liver Fibrosis ◽

Clinical Outcomes ◽

Cardioembolic Stroke ◽

Advanced Fibrosis ◽

Short Term ◽

Nonvalvular Atrial Fibrillation ◽

Severe Stroke ◽

Advanced Liver Fibrosis ◽

The Impact

Abstract Background: Liver cirrhosis is a confirmed risk factor for worse clinical outcomes of stroke, however the contribution of liver fibrosis to cardioembolic stroke (CES) and its short-term outcomes are poorly understood. This study aimed to investigate whether liver fibrosis is associated with more severe stroke, worse short-term clinical outcomes of acute CES, due to nonvalvular atrial fibrillation (NVAF), as well as the impact of sex on the association. Methods: Using data of 522 patients with NVAF admitted within 48 hours after acute symptom of CES onset. We calculated Fibrosis-4 score (FIB-4) and defined liver fibrosis as: likely advanced fibrosis (FIB-4>3.25), indeterminate (FIB-4, 1.45-3.25), unlikely advanced fibrosis (FIB-4<1.45). We invested the impact of liver fibrosis degree on stroke severity on admission, major disability at discharge and all cause death at 90 days stratified by sex. Results: Among 522 acute CES patients with NVAF, the mean FIB-4 on admission reflected intermediate fibrosis, whereas liver enzymes were largely normal. After adjusting for possible confounders, multivariate analyses revealed that likely advanced liver fibrosis was associated with severe stroke (OR=2.21, 95% CI: 1.04-3.54), major disability at discharge (OR=4.59, 95% CI: 1.88-11.18), and 90-days mortality (HR=1.25, 95% CI: 1.10-1.56). Further grouped by sex, these associations were stronger in males but not significant in females.Conclusions: In patients with largely normal liver enzyme, likely advanced liver fibrosis is associated with severe stroke, major disability and all cause death after acute CES due to NVAF; the association unfolded more obvious in males, but not for females.

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Abstract TP120: Plasma D-dimer Level and Cerebral Infarction Volume in Patients With Nonvalvular Atrial Fibrillation

Stroke ◽

10.1161/str.44.suppl_1.atp120 ◽

2013 ◽

Vol 44 (suppl_1) ◽

Author(s):

Mari Matsumoto ◽

Manabu Sakaguchi ◽

Shuhei Okazaki ◽

Shigetaka Furukado ◽

Masafumi Tagaya ◽

...

Keyword(s):

Risk Factors ◽

Atrial Fibrillation ◽

Blood Pressure ◽

Functional Outcome ◽

National Institutes Of Health ◽

Nonvalvular Atrial Fibrillation ◽

Nihss Score ◽

Significant Difference ◽

Infarction Volume ◽

D Dimer

Introduction and Hypothesis: The purpose of this study was to investigate the association between plasma D-dimer level at admission and infarct size in non-valvular atrial fibrillation (NVAF) patients. Methods: We identified 124 patients with consecutive ischemic stroke and NVAF who were admitted within 48 hours of symptom onset. We measured infarction volume from CT taken after 3±1 days from the onset. Relationships were analysed between infarction volume, risk factors, preadmission medications and admission conditions. We also assessed the functional outcome by tertile of D-dimer level (≦ 0.83, 0.83-2.16, ≧ 2.16 μg/mL) in patients with preadmission modified Rankin Scale (mRS) score of 0-1. Results: Infarction volume significantly correlated with D-dimer level (r=0.309, p < 0.001) (Figure 1), systolic blood pressure (r=0.201, p=0.026), diastolic blood pressure (r=0.283, p=0.002), National Institutes of Health Stroke Scale (NIHSS) score on admission (r=0.546, p < 0.001) and mRS score at discharge (r=0.557, p<0.001). Multivariate regression analyses showed that the D-dimer level was significantly associated with infarction volume (p=0.043) after adjustment with known risk factors. In patients with a preadmission mRS score of 0-1 patients (n=108), D-dimer level was significantly associated with NIHSS score at admission (r=0.318, p<0.001) and mRS score at discharge (r=0.310, p=0.001).Significant difference existed among tertiles (p = 0.003)(Figure 2). Conclusions: Plasma D-dimer level on admission is significantly related to infarction volume and functional outcome, following cardioembolic stroke in NVAF patients.

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