Abstract WP209: Relationship Between Liver Fibrosis and Ischemic Stroke Subtype

Background: Liver disease has been associated with cardiac structural abnormalities and atrial fibrillation. We hypothesized that advanced liver fibrosis - commonly subclinical in the general population - is associated with cardioembolic stroke subtype. Secondarily, we hypothesized an association with cryptogenic stroke, based on its suspected embolic etiology. Methods: Among patients prospectively enrolled in the Cornell AcutE Stroke Academic Registry (CAESAR) from 2011-2016, we selected patients who had liver function tests within 7 days of admission. We calculated each patient’s Fibrosis-4 score, a validated, non-invasive liver fibrosis score derived from age, transaminase values, and platelet count. The primary exposure was advanced liver fibrosis, defined using a validated threshold of > 3.25; these patients were compared to patients without liver fibrosis. The primary outcome was cardioembolic stroke subtype, adjudicated using TOAST classification. The secondary outcome was cryptogenic subtype. We used logistic regression to separately evaluate the association between advanced liver fibrosis and these stroke subtypes, as compared to non-cardioembolic stroke. Models were adjusted for demographics, atrial fibrillation, hypertension, diabetes, dyslipidemia, coronary artery disease, congestive heart failure, peripheral vascular disease, and chronic kidney disease. Results: Among 1,586 ischemic stroke patients in our study, the mean age was 71 (SD, 15) years, and 50% were women. Overall, 18% had liver fibrosis; 34% and 27% of strokes were cardioembolic and cryptogenic, respectively. Advanced liver fibrosis was associated with cardioembolic stroke after adjusting for demographics and vascular risk factors (odds ratio [OR], 3.8; 95% confidence interval [CI], 2.1-6.9) compared to patients without liver fibrosis. There was a significant, albeit attenuated, association with cryptogenic stroke (OR, 1.9; 95% CI, 1.0-3.4). Conclusion: Advanced liver fibrosis is associated with cardioembolic stroke and, to a lesser degree, cryptogenic stroke. Whether liver fibrosis is a marker or independent causal factor of cardioembolism is to be determined.

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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 W MP65: Moderate to Severe Left Atrial Enlargement is Associated with Cardioembolic or Cryptogenic Stroke Recurrence in a Multiethnic Cohort: The Northern Manhattan Study

Stroke ◽

10.1161/str.46.suppl_1.wmp65 ◽

2015 ◽

Vol 46 (suppl_1) ◽

Author(s):

Shadi Yaghi ◽

Yeseon P Moon ◽

Consuelo Mora-McLaughlin ◽

Joshua Z Willey ◽

Marco R Di Tullio ◽

...

Keyword(s):

Atrial Fibrillation ◽

Ischemic Stroke ◽

Left Atrial ◽

Recurrent Stroke ◽

Cryptogenic Stroke ◽

Cardioembolic Stroke ◽

Stroke Recurrence ◽

Stroke Patients ◽

Stroke Subtypes ◽

Multiethnic Cohort

Background: While left atrial (LA) enlargement increases incident stroke risk, the association with recurrent stroke is unclear. Our aim was to determine the association of LA enlargement (LAE) with stroke recurrence risk and recurrent stroke subtypes likely related to embolism (cryptogenic or cardioembolic). Methods: We enrolled 655 first ischemic stroke patients in the Northern Manhattan Stroke Study. LA size was measured by two-dimensional echocardiogram as part of the clinical evaluation and patients were followed annually for up to 5 years. LA size adjusted for sex and body surface area was categorized into three groups: normal (52.7%), mild LAE (31.6%), and moderate to severe LAE (15.7%). The outcomes were total recurrent stroke, and recurrent combined cryptogenic or cardioembolic stroke. Cox proportional hazard models assessed the association between LA size and risk of stroke recurrence. Results: Of 655 patients, LA size data was present in 529 (81%). Mean age was 69 ± 13 years; 46% were male and 18% had atrial fibrillation. Over a median of 4 years, recurrent stroke occurred in 83 patients (16%), 29 were cardioembolic or cryptogenic stroke. After adjusting for baseline demographics and risk factors including atrial fibrillation and congestive heart failure, compared to normal LA size, moderate to severe LAE was associated with greater risk of recurrent combined cardioembolic or cryptogenic stroke (adjusted HR 2. 99, 95% CI 1. 10 to 8.13), but not with risk of total stroke recurrence (adjusted HR 1.18, 95% CI 0.60 to 2.32). Mild LAE was not associated with either total stroke recurrence or the combined recurrent cryptogenic or cardioembolic stroke subtypes. Conclusion: Moderate to severe LAE is an independent marker of recurrent cardioembolic or cryptogenic stroke in a multiethnic cohort of ischemic stroke patients. Future research is needed to determine if anticoagulant use reduces the risk of recurrence in ischemic stroke patients with moderate to severe LAE.

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Abstract WP255: Can Normal Electrocardiogram Rule Out Newly Diagnosed Atrial Fibrillation in Ischemic Stroke Patients

Stroke ◽

10.1161/str.51.suppl_1.wp255 ◽

2020 ◽

Vol 51 (Suppl_1) ◽

Author(s):

Joshua Santucci ◽

Takashi Shimoyama ◽

Ken Uchino

Keyword(s):

Atrial Fibrillation ◽

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Cryptogenic Stroke ◽

Cardiac Monitoring ◽

Large Artery ◽

Newly Diagnosed ◽

Stroke Patients ◽

Stroke Subtype ◽

History Of

Introduction: Electrocardiogram (ECG) findings of premature atrial contraction and prolonged PR interval are associated with risk of onset atrial fibrillation (AF) in cryptogenic stroke. We sought to see if normal ECG and AF incidence is incompletely understood. Methods: From a prospective single-hospital stroke registry from 2018, we identified ischemic stroke patients who had ECG done on admission for review. We excluded patients with AF on admission ECG, history of AF, and implanted device with cardiac monitoring capability. Normal ECG was interpreted based on the standardized reporting guidelines for ECG studies evaluating risk stratification of emergency department patients. Stroke subtype was diagnosed according to the TOAST classification: large artery atherosclerosis (LAA), small vessel occlusion (SVO), cardioembolism, others/undetermined and embolic stoke of undetermined source (ESUS) criteria. We compared the incidence of newly diagnosed AF during hospitalization and from outpatient cardiac event monitoring between normal and abnormal ECG. Results: Of the 558 consecutive acute ischemic stroke patients, we excluded 135 with AF on admission ECG or history of AF and 9 with implanted devices. Of the remaining 414 patients that were included in the study, ESUS (31.2%) was the most frequent stroke subtype, followed by LAA (30.0%), SVO (14.0%), others/undetermined (15.7%), and cardioembolism (9.2%). Normal ECG was observed in 125 patients (30.2%). Cardioembolic subtype was less frequent in the normal versus abnormal ECG group (1.6% vs. 12.5%, p<0.001). New AF was detected in 17/414 patients (4.1%) during hospitalization. Of these 17 patients, none had normal ECG (0/125) and all had abnormal ECG (17/289, 5.9%) (p=0.002). After discharge, of 111 patients undergoing 4-week outpatient cardiac monitoring, new AF was detected in 16 (14.4%). Of these 16 patients, only 1 had a normal ECG (1/35, 2.9%) while 15 had abnormal ECG (15/76, 19.7%) (p=0.02). Conclusions: Normal ECG at admission for acute ischemic stroke is associated with low likelihood of detection of new atrial fibrillation in either the inpatient or outpatient setting.

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Abstract TP215: Clinical Utility of Hypercoagulability Screening in Young Adults With Ischemic Stroke

Stroke ◽

10.1161/str.48.suppl_1.tp215 ◽

2017 ◽

Vol 48 (suppl_1) ◽

Author(s):

Setareh Salehi Omran ◽

Michael P Lerario ◽

Alexander E Merkler ◽

Gino Gialdini ◽

Antonio Moya ◽

...

Keyword(s):

Risk Factors ◽

Young Adults ◽

Ischemic Stroke ◽

Clinical Management ◽

Medical Center ◽

Cryptogenic Stroke ◽

Young Patients ◽

Hypercoagulable State ◽

Secondary Outcome ◽

Stroke Subtype

Introduction: We aimed to evaluate the ability of current genetic and serological testing to diagnose clinically relevant thrombophilic states in young adults with ischemic stroke. Methods: We performed a retrospective cohort study of patients aged 18 to 65 years who presented to Weill Cornell Medical Center between 2011 and 2014 with an ischemic stroke and had laboratory testing for a hypercoagulable state within six months of the index stroke. A hypercoagulable state was diagnosed by the criteria listed in Table 1. The primary outcome was any positive thrombophilia test. The secondary outcome was a change in clinical management based on the thrombophilia testing, defined as a change in antithrombotic selection or patent foramen ovale (PFO) closure. Using Fisher’s exact or Mann-Whitney U tests, we assessed whether the following prespecified risk factors were associated with our outcomes: age, sex, prior venous thromboembolism, family history of stroke, stroke subtype, and presence of PFO. Results: Of 146 ischemic stroke patients who met inclusion criteria, the mean age was 47 (±10) years and 47% were women. Of these patients, 61 (42.0%, 95% CI 33.7-49.9%) had at least one positive thrombophilia test and 8 (5.5%, 95% CI 1.7-9.2%) had a resultant change in management. A cryptogenic stroke subtype was documented in 87 patients, of whom 40 (46.0%, 95% CI 35.3-56.7%) had an abnormal hypercoagulability screen and 5 (5.7%, 95% CI 0.8-10.7%) had a change in management. There was no association between cryptogenic stroke subtype and a positive hypercoagulability test (p=0.2). No prespecified risk factors were associated with a positive hypercoagulability screen or a change in clinical management. Conclusions: Hypercoagulability screening among young patients with cryptogenic stroke changed clinical management in roughly one of every twenty patients tested. Cryptogenic stroke subtype and other clinical factors were not associated with a positive hypercoagulable screen.

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Abstract WMP62: PR Interval Prolongation and Cryptogenic Stroke: A Multicenter Retrospective Study

Stroke ◽

10.1161/str.48.suppl_1.wmp62 ◽

2017 ◽

Vol 48 (suppl_1) ◽

Author(s):

Mayra J Montalvo ◽

Prasanna Tadi ◽

Alexander Merkler ◽

Gino Gialdini ◽

Sheryl Martin-Schild ◽

...

Keyword(s):

Ischemic Stroke ◽

Rhode Island ◽

Medical Center ◽

Cryptogenic Stroke ◽

Cardioembolic Stroke ◽

Interval Prolongation ◽

Stroke Subtype ◽

Ischemic Stroke Subtype ◽

Pr Interval ◽

Univariate Analyses

Background: Atrial dysfunction or “cardiopathy” has been recently proposed as a mechanism in cryptogenic stroke. A prolonged PR interval may reflect impaired atrial conduction and thus may be a useful biomarker of atrial cardiopathy. We aim to compare the prevalence of PR interval prolongation in patients with cryptogenic stroke (CS) when compared to known non-cryptogenic non-cardioembolic stroke (NCNCS) subtypes. Methods: We retrospectively analyzed prospective ischemic stroke databases and included consecutive patients between December 1 st , 2013 and August 31 st , 2015 in three comprehensive stroke centers (Rhode Island Hospital, Hartford Hospital, and Tulane University Medical Center). Consecutive patients 18 years or older with a discharge diagnosis of ischemic non-cardioembolic stroke were included. The main outcome was ischemic stroke subtype (CS vs. NCNCS). We compared PR intervals as a continuous and categorical variable (< 200 ms; ≥ 200 ms) and other clinical and demographic factors between the two groups and used multivariate regression analyses including age and other factors deemed significant on univariate analyses to determine the association between PR interval prolongation and CS. Results: We identified 644 patients with ischemic non-cardioembolic stroke (224 CS and 420 NCNCS). The PR interval was longer in patients with CS vs NCNCS (175.4 ± 35.2 ms vs. 166.5 ± 27.7 p = 0.005). After adjusting for factors that were found to be significant in univariate analyses, a prolonged PR interval was independently associated with CS (Odds Ratio: 1.70; 95% CI 1.08-2.70; p=0.022). The association was more pronounced when excluding patients on atrio-ventricular nodal blocking agents (OR=2.64, 95% CI 1.44-4.83, p=0.002). Conclusions: A prolonged PR interval is associated with CS and may be a biomarker of atrial cardiopathy in patients with cryptogenic stroke. This association needs to be confirmed in prospective neuro-epidemiological cohorts.

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Abstract WMP64: Utility of Left Atrial Abnormality on Admission Electrocardiography in Acute Ischemic Stroke

Stroke ◽

10.1161/str.48.suppl_1.wmp64 ◽

2017 ◽

Vol 48 (suppl_1) ◽

Author(s):

Yukio Sugiyama ◽

Nobuyuki Ohara ◽

Kotaro Watanabe ◽

Junya Kobayashi ◽

Daisuke Takahashi

Keyword(s):

Atrial Fibrillation ◽

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Left Atrial ◽

Strong Predictor ◽

Multiple Logistic Regression Analysis ◽

Cryptogenic Stroke ◽

P Wave ◽

Cardioembolic Stroke ◽

Ecg Monitoring

Introduction and Hypothesis: Clinical categorization of ischemic stroke is very important to select the antithrombotic therapy for preventing the recurrent stokes. However, about 25% of ischemic stroke is the stroke for undetermined cause, termed as cryptogenic stroke. Recently, proactive detecting of paroxysmal atrial fibrillation (PAF) in cryptogenic stroke has gained attention. P-wave terminal force in lead V1 (PTFV1) of electrocardiography (ECG) is a specific indicator of left atrial abnormality. In this study, we tested PTFV1 for the utility of PAF detection and further clinical categorization in acute ischemic stroke. Methods: One hundred forty eight consecutive acute ischemic stroke patients were admitted to our hospital from September 2014 to March 2016. We included 105 patients (mean age 72.8±13.4 years), who had sinus rhythm on admission 12-lead ECG without atrial fibrillation, or cardiac pacing. PTFV1 (mmхsec) of participants was assessed, and had analyzed the association with PAF detection in a 24-hour ECG monitoring and clinical categories of ischemic stroke. Results: PTFV1 was significantly higher in the patients with PAF (n=11) than in those without PAF (0.049±0.024 vs 0.031±0.027; p<0.05). Multiple logistic regression analysis revealed that PTFV1 was an independent predictor for PAF detection (odds ratio, 1.46; 95% confidence interval, 1.02-2.08; p<0.05). According to the clinical categorization, PTFV1 of cardioembolic stroke (0.061±0.022) was significantly higher, compared to lacunar stroke (0.018±0.019; p<0.01), atherothrombotic stroke (0.035±0.026; p<0.05), and cryptogenic stroke (0.031±0.029; p<0.05). The proportion of patients with left atrial abnormality defined by PTFV1 (≧0.04), was 10 out of 11 (91%) for cardioembolic stroke, and 10 out of 27 (37%) for cryptogenic stroke. Conclusions: PTFV1 on admission ECG in acute ischemic stroke was a strong predictor for PAF detection and cardioembolic stroke diagnosis. Extended ECG monitoring may be useful in cryptogenic stroke with left atrial abnormality defined by PTFV1.

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Atrial Fibrillation Risk and Discrimination of Cardioembolic From Noncardioembolic Stroke

Stroke ◽

10.1161/strokeaha.120.028837 ◽

2020 ◽

Vol 51 (5) ◽

pp. 1396-1403 ◽

Cited By ~ 1

Author(s):

Shaan Khurshid ◽

Ludovic Trinquart ◽

Lu-Chen Weng ◽

Olivia L. Hulme ◽

Wyliena Guan ◽

...

Keyword(s):

Atrial Fibrillation ◽

Ischemic Stroke ◽

Electronic Health Record ◽

Cardioembolic Stroke ◽

Risk Scores ◽

Health Record ◽

Stroke Subtype ◽

Aging Research ◽

Genomic Epidemiology ◽

Electronic Health

Background and Purpose— Classification of stroke as cardioembolic in etiology can be challenging, particularly since the predominant cause, atrial fibrillation (AF), may not be present at the time of stroke. Efficient tools that discriminate cardioembolic from noncardioembolic strokes may improve care as anticoagulation is frequently indicated after cardioembolism. We sought to assess and quantify the discriminative power of AF risk as a classifier for cardioembolism in a real-world population of patients with acute ischemic stroke. Methods— We performed a cross-sectional analysis of a multi-institutional sample of patients with acute ischemic stroke. We systematically adjudicated stroke subtype and examined associations between AF risk using CHA 2 DS 2 -VASc, Cohorts for Heart and Aging Research in Genomic Epidemiology-AF score, and the recently developed Electronic Health Record–Based AF score, and cardioembolic stroke using logistic regression. We compared the ability of AF risk to discriminate cardioembolism by calculating C statistics and sensitivity/specificity cutoffs for cardioembolic stroke. Results— Of 1431 individuals with ischemic stroke (age, 65±15; 40% women), 323 (22.6%) had cardioembolism. AF risk was significantly associated with cardioembolism (CHA 2 DS 2 -VASc: odds ratio [OR] per SD, 1.69 [95% CI, 1.49–1.93]; Cohorts for Heart and Aging Research in Genomic Epidemiology-AF score: OR, 2.22 [95% CI, 1.90–2.60]; electronic Health Record–Based AF: OR, 2.55 [95% CI, 2.16–3.04]). Discrimination was greater for Cohorts for Heart and Aging Research in Genomic Epidemiology-AF score (C index, 0.695 [95% CI, 0.663–0.726]) and Electronic Health Record–Based AF score (0.713 [95% CI, 0.681–0.744]) versus CHA 2 DS 2 -VASc (C index, 0.651 [95% CI, 0.619–0.683]). Examination of AF scores across a range of thresholds indicated that AF risk may facilitate identification of individuals at low likelihood of cardioembolism (eg, negative likelihood ratios for Electronic Health Record–Based AF score ranged 0.31–0.10 at sensitivity thresholds 0.90–0.99). Conclusions— AF risk scores associate with cardioembolic stroke and exhibit moderate discrimination. Utilization of AF risk scores at the time of stroke may be most useful for identifying individuals at low probability of cardioembolism. Future analyses are warranted to assess whether stroke subtype classification can be enhanced to improve outcomes in undifferentiated stroke.

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Abstract P709: Risk Factors Associated With Atrial Fibrillation Detection by Mobile Cardiac Outpatient Telemetry Following Acute Ischemic Stroke

Stroke ◽

10.1161/str.52.suppl_1.p709 ◽

2021 ◽

Vol 52 (Suppl_1) ◽

Author(s):

Ovais Inamullah ◽

Alec McConnell ◽

Hussein Al-khalidi ◽

Gerald S Bloomfield ◽

Shreyansh Shah

Keyword(s):

Atrial Fibrillation ◽

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Patient Selection ◽

Left Atrial ◽

Cryptogenic Stroke ◽

Left Ventricular ◽

Stepwise Logistic Regression ◽

Internal Diameter ◽

Atrial Area

Background: Mobile Cardiac outpatient telemetry (MCOT) is often used for patients (pts) with cryptogenic ischemic stroke following hospital discharge to detect atrial fibrillation (AFib) but criteria for patient selection remains a subject of debate. Methods: We identified 297 pts hospitalized with acute ischemic stroke who had an inpatient transthoracic echocardiogram (TTE) and underwent MCOT upon discharge between 2016 and 2018 at a large academic comprehensive stroke center. Pts characteristics between AFib vs. no AFib were compared by Fisher’s exact test for categorical and Wilcoxon rank-sum test for continuous variables. A multivariable stepwise logistic regression model was developed to determine the predictors of AFib detection. Statistical hypotheses were tested as two-sided at 0.05 level of significance. Results: Of the 297 pts, AFib was detected in 24 (8.1%) on 30-day MCOT. Pts with AFib detected were older, white, and have had a larger left atrial area (Table). The final logistic model demonstrated that white race (vs. non-white) (OR 4.86, 1.53-15.41), left atrial area (OR 1.15, 1.05-1.25) and left ventricular internal diameter in diastole (OR 0.33, 0.16-0.67) were associated with AFib detection by MCOT. Conclusion: Although rates of AFib detection on 30-day MCOT post-discharge was low, there are important patient characteristics and TTE features that can improve patient selection. Further studies are needed to determine if this data can be used prospectively to clinically decide which pts with cryptogenic stroke should be given 30-day MCT to detect atrial fibrillation.

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IRMA study: Prevalence of subdiaphragmatic visceral infarction in ischemic stroke and atrial fibrillation

International Journal of Stroke ◽

10.1177/1747493016677983 ◽

2016 ◽

Vol 12 (4) ◽

pp. 421-424 ◽

Cited By ~ 1

Author(s):

David Weisenburger-Lile ◽

Delphine Lopez ◽

Stephanie Russel ◽

Jean-Emmanuel Kahn ◽

Ana Veiga Hellmann ◽

...

Keyword(s):

Atrial Fibrillation ◽

Ischemic Stroke ◽

High Risk ◽

Median Time ◽

Cryptogenic Stroke ◽

Abdominal Mri ◽

Frequent Localization

Background Occult atrial fibrillation (AF) may, in part, explain cryptogenic stroke. A 22% prevalence of subdiaphragmatic visceral infarction (SDVI) among patients with ischemic stroke (IS) due to AF has been reported, using abdominal MRI. We sought to assess the reproducibility of this method and to confirm that SDVI is more prevalent in cases of AF-caused IS than in IS of other etiologies. Methods In consecutive patients admitted to our hospital, we compared SDVI prevalence in three groups: patients with IS due to AF (IS+/AF+ group), patients with stroke of another determined cause (IS+/AF− group) and patients with AF without stroke (IS−/AF+ group). Results A total of 111 patients were included. The median time between inclusion and abdominal MRI was six days. SDVI was more frequent in the IS+/AF+ group ( n = 10; 21.3%), than in IS+/AF− ( n = 1; 3.3%) and IS−/AF+ ( n = 0) groups, p = 0.002. The most frequent localization was the kidney. Conclusions The prevalence of SDVI was higher among patients with AF-caused IS. In cases of cryptogenic stroke, a positive abdominal MRI may suggest occult AF as the cause and identify a high risk of AF in this subgroup of patients.

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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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