Embolic stroke of undetermined source correlates to atrial fibrosis without atrial fibrillation

Neurology ◽  
2019 ◽  
Vol 93 (4) ◽  
pp. e381-e387 ◽  
Author(s):  
Karman Tandon ◽  
David Tirschwell ◽  
W.T. Longstreth ◽  
Bryn Smith ◽  
Nazem Akoum
Keyword(s):  
Risk Factors ◽  
Atrial Fibrillation ◽  
Stroke Risk ◽  
Embolic Stroke ◽  
Cardioembolic Stroke ◽  
Healthy Controls ◽  
Atrial Fibrosis ◽  
Stroke Risk Factors ◽  
Causal Pathway

ObjectiveTo examine the hypothesis that atrial fibrosis and associated atrial cardiopathy may be in the causal pathway of cardioembolic stroke independently of atrial fibrillation (AF) by comparing atrial fibrosis burden between patients with embolic stroke of undetermined source (ESUS), patients with AF, and healthy controls.MethodsWe used late-gadolinium-enhancement MRI to compare atrial fibrosis in 10 patients with ESUS against 10 controls (no stroke, no AF) and 10 patients with AF. Fibrosis was compared between groups, controlling for stroke risk factors.ResultsMean age was 51 ± 15 years, and 43% of participants were female. Patients with ESUS had more atrial fibrosis than controls (16.8 ± 5.7% vs 10.6 ± 5.7%, p = 0.019) and similar fibrosis compared to patients with AF (17.8 ± 4.8%, p = 0.65). Odds ratios of ESUS per quartile of fibrosis were 3.22 (95% CI [CI] 1.11–9.32, p = 0.031, unadjusted) and 3.17 (95% CI 1.05–9.52, p = 0.041, CHA2DVASc score adjusted). Patients with >12% fibrosis had a higher percentage of ESUS (77.8% vs 27.3%, p = 0.02), and patients with >20% fibrosis had the highest proportion of ESUS (4 of 5).ConclusionsPatients with ESUS exhibit similar atrial fibrosis compared to patients with AF and more fibrosis than healthy controls. Fibrosis is associated with ESUS after controlling for stroke risk factors, supporting the hypothesis that fibrosis is in the causal pathway of cardioembolic stroke independently of AF. Prospective studies are needed to assess the role of anticoagulation in primary and secondary stroke prevention in patients with high atrial fibrosis.

Abstract T P153: Women and Men with Ischemic Stroke in SiGN Have Different Subtype Distributions and Risk Factors

Stroke ◽  
2014 ◽  
Vol 45 (suppl_1) ◽  
Author(s):  
Kathryn M Rexrode ◽  
Braxton D Mitchell ◽  
Kathleen A Ryan ◽  
Steven J Kittner ◽  
Hakan Ay ◽  
...  
Keyword(s):  
Risk Factors ◽  
Ischemic Stroke ◽  
Stroke Risk ◽  
Cardioembolic Stroke ◽  
Relative Distribution ◽  
Large Artery ◽  
Stroke Risk Factors ◽  
Stroke Subtypes ◽  
Small Artery Occlusion ◽  
Ischemic Stroke Risk

Introduction: The relative distribution of stroke risk factors, as well as ischemic stroke subtypes, in women compared with men is not well described. Hypothesis: We hypothesized that the distribution of ischemic stroke risk factors and subtypes would differ by sex, with a later onset in women and greater proportion of comorbidities. Methods: The NINDS Stroke Genetics Network (SiGN) consortium was established to evaluate genetic risk factors for ischemic stroke. A total of 23 separate studies performed Causative Classification of Stroke (CCS) typing using standardized criteria on ischemic stroke cases and contributed data on risk factors. We compared the distribution of ischemic stroke risk factors and CCS phenotypes between men and women with ischemic stroke. Results: Of the 16,228 ischemic strokes in SiGN, 8005 (49.3%) occurred in women. Median age at stroke was older in female than male stroke cases (73 vs. 66 years) (p=<0.0001). Among stroke cases, women were more likely than men cases to have hypertension or atrial fibrillation and less likely to have diabetes or coronary artery disease, or to smoke (p <0.003 for all). The distribution of stroke subtypes also differed by sex, with women less likely than men to have large artery infarction and small artery occlusion, and more likely to have cardioembolic stroke and undetermined stroke due to incomplete work-up (p values all <0.0001; see Table). Results were similar when the distribution of stroke subtypes was examined for those <70 years and ≥70 years, except for cardioembolic stroke remaining more common only among women ≥70. Conclusions: In this large group of carefully phenotyped ischemic strokes, the distribution of ischemic stroke subtypes and risk factor profiles differ significantly by sex. Evaluation of the causes of these differences may highlight areas for improved prevention and risk reduction in both genders.

scholarly journals CHA2DS2-VASc score, left atrial size and atrial fibrillation as stroke risk factors in the Tromsø Study

Open Heart ◽  
2016 ◽  
Vol 3 (2) ◽  
pp. e000439 ◽  
Author(s):  
Sweta Tiwari ◽  
Maja-Lisa Løchen ◽  
Bjarne K Jacobsen ◽  
Laila A Hopstock ◽  
Audhild Nyrnes ◽  
...  
Keyword(s):  
Risk Factors ◽  
Atrial Fibrillation ◽  
Left Atrial ◽  
Stroke Risk ◽  
Left Atrial Size ◽  
Stroke Risk Factors ◽  
Atrial Size

Abstract 18738: Use of Antithrombotic Therapies and Outcomes in Patients with Atrial Fibrillation and Heart Failure: Insights from the GARFIELD Registry

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Ramon Corbalan ◽  
Antonio C Pereira Barretto ◽  
Giuseppe Ambrosio ◽  
Wael Al Mahmeed ◽  
Jean-Yves Le Heuzey ◽  
...  
Keyword(s):  
Risk Factors ◽  
Heart Failure ◽  
Atrial Fibrillation ◽  
New York ◽  
Stroke Risk ◽  
Nyha Class ◽  
Heart Association ◽  
Class Iii ◽  
Stroke Risk Factor ◽  
Stroke Risk Factors

Background: Atrial fibrillation (AF) is commonly associated with heart failure (HF) and this combination is associated with a worse prognosis than either alone. However, it is unclear if these patients receive appropriate antithrombotic therapies and if they have a higher incidence of stroke or systemic embolism (SE). Methods: We compared clinical characteristics, antithrombotic therapies, and outcomes in patients with and without HF in the GARFIELD Registry, an ongoing, international, observational registry of consecutively recruited patients with newly diagnosed non-valvular AF and ≥1 additional stroke risk factor. A total of 12,458 prospective patients were enrolled in 30 countries between March 2010 and January 2013. Results are reported at 1-year follow-up. HF was defined at baseline as New York Heart Association (NYHA) I-II or III-IV. Antithrombotic therapy use and 1-year outcomes in patients with and without HF were analysed. Results: In total, 20% of patients had HF; they were older and had higher CHA2DS2-VASc and HAS-BLED scores compared with patients without HF. A higher proportion of patients with HF received antithrombotic therapies. The incidence of all-cause death was higher in HF patients than non-HF patients. Patients with NYHA class III-IV HF had a higher unadjusted incidence of all-cause death and stroke/SE compared with non-HF patients: 10.5 (95% confidence interval 8.8 to 12.7) vs 2.9 (2.7 to 3.2) per 100 person-years and 1.9 (1.2 to 3.0) vs 1.0 (0.8 to 1.2) per 100 person-years, respectively. Event rates slightly changed after adjustment for stroke risk factors. Conclusion: More AF patients with HF received antithrombotic therapies compared with those without HF. They also showed a higher incidence of all-cause death with increasing HF severity compared with AF patients without HF. After adjustment for stroke risk factors, this association was slightly attenuated.

Device-Detected Subclinical Atrial Fibrillation and Increased Stroke Risk

2020 ◽  
Author(s):  
Francesco Vetta
Keyword(s):  
Risk Factors ◽  
Atrial Fibrillation ◽  
Anticoagulant Therapy ◽  
Stroke Risk ◽  
The Elderly ◽  
Cerebrovascular Diseases ◽  
Technological Advancement ◽  
Risk Of Progression ◽  
Net Clinical Benefit

Atrial fibrillation (AF) is one of the major causes of stroke. Data from the literature show that among the causes of stroke 60% is attributable to cerebrovascular diseases, 15% to AF, while about 25% of cases do not identify recognizable causes. The technological advancement of cardiac implanted electronic devices has enabled the identification of subclinical atrial fibrillation (SCAF). The literature shows that SCAF is very frequent in the elderly population and that it represents a risk factors for the onset of stroke or systemic embolic disease, regardless of other cardiovascular risk factors. While for clinical atrial fibrillation (AF) the advantages of anticoagulant therapy based on the CHA2DS2-VASCscore have been well established, much less is known about the usefulness of anticoagulant therapy in the case of SCAF. The role of the CHA2DS2-VASCscore is much debated, although recently a study has clearly shown that the number and duration of SCAF episodes together with the CHA2DS2-VASC score plays an important role in determining the risk of progression to a persistent AF. Based on these data, the ongoing ARTESIA and AFNET-NOAH studies will provide us with data to evaluate the net clinical benefit of anticoagulation in SCAF.

scholarly journals Role of the Gut Microbiota in Ischemic Stroke

2017 ◽  
Vol 01 (04) ◽  
pp. E287-E293 ◽  
Author(s):  
Katarzyna Winek ◽  
Ulrich Dirnagl ◽  
Andreas Meisel
Keyword(s):  
Risk Factors ◽  
Experimental Data ◽  
Central Nervous System ◽  
Gut Microbiota ◽  
Stroke Risk ◽  
Stroke Outcome ◽  
Stroke Risk Factors ◽  
The Central Nervous System ◽  
Peripheral Immune Response

AbstractRecent studies have provided evidence for the role of the gut microbiota in the homeostasis of the central nervous system (CNS) and in the pathophysiology of its disorders, e. g. by regulation of the peripheral immune response. In this article, we discuss the importance of the gut microbiota in stroke by providing a summary of available clinical and experimental data suggesting that 1) stroke changes the gut microbiome, 2) microbiota modulates stroke outcome and 3) microbiota plays an important role in the pathogenesis of stroke (risk factors). Currently available clinical and experimental evidence suggests an important role of gut microbiota in stroke and promises clinically relevant discoveries within coming years.

Stroke and thromboembolism in atrial fibrillation: A systematic review of stroke risk factors, risk stratification schema and cost effectiveness data

2008 ◽  
Vol 99 (02) ◽  
pp. 295-304 ◽  
Author(s):  
Michael Hughes ◽  
Gregory Y. H. Lip ◽  
Keyword(s):  
Risk Factors ◽  
Atrial Fibrillation ◽  
Systematic Review ◽  
Cost Effectiveness ◽  
Risk Stratification ◽  
Antithrombotic Therapy ◽  
Stroke Risk ◽  
Patient Characteristics ◽  
Left Ventricular ◽  
Stroke Risk Factors

SummaryThe risk of stroke in atrial fibrillation (AF) needs to be assessed in each patient to determine the clinical and cost-effectiveness of thromboprophylaxis, with the aim of appropriate use of antithrombotic therapy. To achieve this, stroke risk factors in AF populations need to be identified and stroke risk stratification models have been devised on the basis of these risk factors. In this article, we firstly provide a systematic review of studies examining the attributable stroke risk of various clinical, demographic and echocardiographic patient characteristics in AF populations. Secondly, we performed a systematic review of published stroke risk stratification models, in terms of the results of the review of stroke risk factors and their ability to accurately discriminate between different levels of stroke risk. Thirdly, we review the health economic evidence relating to the cost-effectiveness of anticoagulation and antiplatelet therapy as thromboprophylaxis in AF patients. The studies included in the systematic review of stroke risk factors identified history of stroke or TIA, increasing age, hypertension and structural heart disease (left-ventricular dysfunction or hypertrophy) to be good predictors of stroke risk in AF patients. The evidence regarding diabetes mellitus, gender and other patient characteristics was less consistent. Three stroke risk stratification models were identified that were able to discriminate between different categories of stroke risk to at least 95% accuracy. Few models had addressed the cumulative nature of risk factors where a combination of risk factors would confer a greater risk than either factor alone. In patients at high risk of stroke, anticoagulation is cost effective, but not for those with a low risk of stroke. With the evidence available for stroke risk factors and the various alternative stroke risk stratification models, a review of these models in terms of the evidence on which they are devised and their performance in representative AF populations is important. The appropriate administration of thromboprophylaxis in AF patients would need to balance the risks and benefits of antithrombotic therapy with its cost-effectiveness.

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