Clinical outcomes of acute stroke patients with atrial fibrillation

Background and purpose: The impact of albuminuria on clinical outcomes in acute cardioembolic stroke is not fully investigated. We assessed whether high spot urine albumin/creatinine ratio (ACR) was associated with clinical outcomes in acute stroke with non-valvular atrial fibrillation (NVAF). Methods: From 2011 to 2014, we enrolled acute ischemic stroke/TIA patients with NVAF in the SAMURAI-NVAF study, which is a multicenter, observational study. Patients with complete ACR values were included in the analysis. They were divided into the N (normal, ACR < 30mg/g) and the H (high, ACR ≥ 30mg/g) groups. Clinical outcomes were neurological deterioration (an increase of NIHSS ≥1 point during the initial 7 days) and poor outcome (mRS of 4-6 at 3 months). Results: Of 558 patients (328 men, 77±10 y) who were included, 271 and 287 were assigned to the H group and the N group, respectively. As compared with patients in the N group, those in the H group were more frequently female (52 vs 31%, p < 0.001) and older (80±10 vs 75±10 y, p < 0.001). On admission, patients in the H group more frequently had diabetes (28 vs 17%, p = 0.003), less frequently had paroxysmal AF (68 vs 57%, p = 0.009), had higher levels of SBP (157±28 vs 151±24 mmHg, p = 0.003), NIHSS score (11 vs 5, p < 0.001), CHA2DS2-VASc score (6 vs 5, p < 0.001), plasma glucose (141±62 vs 132±41 mg/dL, p = 0.04), and brain natriuretic peptide (348±331 vs 259±309 pg/mL, p = 0.002), and had lower levels of hemoglobin (13±2 vs 14±2 g/dL, p = 0.02), and estimated glomerular filtration ratio (eGFR) (60±24 vs 66±20 mL/min/1.73m2 p = 0.002). On imaging studies, patients in the H group more frequently had large infarct (29 vs 20 %, p = 0.02) and culprit artery occlusion (64 vs 48%, p < 0.001). Neurological deterioration (14 vs 4%, p < 0.001) and poor outcome (49 vs 24%, p < 0.001) were more frequently observed in the H group. On multivariate regression analysis adjusted for significant confounders and reperfusion therapy, the H group was associated with neurological deterioration (OR 2.43; 95% CI 1.14-5.5; p = 0.02) and poor outcome (OR 2.75; 95% CI 1.45-5.2; p = 0.002), although eGFR was not significantly related to either. Conclusion: High ACR, a marker of albuminuria, was independently associated with unfavorable outcomes in acute stroke patients with NVAF.

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Abstract 180: The Growth Rate of Early DWI Lesions is Highly Variable and Associated with Penumbral Salvage and Clinical Outcomes Following Endovascular Reperfusion

Stroke ◽

10.1161/str.44.suppl_1.a180 ◽

2013 ◽

Vol 44 (suppl_1) ◽

Author(s):

Hayley M Wheeler ◽

Michael Mlynash ◽

Manabu Inoue ◽

Aaryani Tipirneni ◽

John Liggins ◽

...

Keyword(s):

Growth Rate ◽

Acute Stroke ◽

Clinical Outcomes ◽

Endovascular Therapy ◽

Symptom Onset ◽

Growth Rates ◽

Initial Growth ◽

Stroke Patients ◽

Final Volume ◽

Favorable Clinical Response

Background: The degree of variability in the rate of early DWI expansion has not been well characterized. We hypothesized that Target Mismatch patients with slowly expanding DWI lesions have more penumbral salvage and better clinical outcomes following endovascular reperfusion than Target Mismatch patients with rapidly expanding DWI lesions. Methods: This substudy of DEFUSE 2 included all patients with a clearly established time of symptom onset. The initial DWI growth rate was determined from the baseline scan by assuming a volume 0 ml just prior to symptom onset. Target Mismatch patients who achieved reperfusion (>50% reduction in PWI after endovascular therapy), were categorized into tertiles according to their initial DWI growth rates. For each tertile, penumbral salvage (comparison of final volume to the volume of PWI (Tmax > 6 sec)/ DWI mismatch prior to endovascular therapy), favorable clinical response, and good functional outcome (see figure for definitions) were calculated. We also compared the growth rate in patients with the Target mismatch vs. Malignant Profile. Results: 64 patients were eligible for this study. Target mismatch patients (n=44) had initial growth rates (range 0 to 43 ml/hr, median of 3 ml/hr) that were significantly less than the growth rates in Malignant profile (n=7) patients (12 to 92 ml/hr, median 39 ml/hr; p < 0.001). In Target mismatch patients who achieved reperfusion (n=30), slower early DWI growth rates were associated with better clinical outcomes (p<0.05) and a trend toward more penumbral salvage (n=27, p=0.137). Conclusions: The growth rate of early DWI lesions in acute stroke patients is highly variable; Malignant profile patients have higher growth rates than other MRI profiles. Among Target Mismatch patients, a slower rate of DWI growth is associated with a greater degree of penumbral salvage and improved clinical outcomes following endovascular reperfusion.

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Assessment of serum IgG titers to various periodontal pathogens associated with atrial fibrillation in acute stroke patients

Journal of Stroke and Cerebrovascular Diseases ◽

10.1016/j.jstrokecerebrovasdis.2021.106301 ◽

2022 ◽

Vol 31 (3) ◽

pp. 106301

Author(s):

Tomohisa Nezu ◽

Naohisa Hosomi ◽

Shiro Aoki ◽

Hiromi Nishi ◽

Masahiro Nakamori ◽

...

Keyword(s):

Atrial Fibrillation ◽

Acute Stroke ◽

Periodontal Pathogens ◽

Stroke Patients ◽

Serum Igg

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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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Abstract W P48: Flair Vessel Hyper-intensities Could Predict Target Mismatch Signs in Acute Stroke Patients

Stroke ◽

10.1161/str.46.suppl_1.wp48 ◽

2015 ◽

Vol 46 (suppl_1) ◽

Author(s):

Manabu Inoue ◽

Michael Mlynash ◽

Carlo W Cerada ◽

Nishant K Mishra ◽

Soren Christensen ◽

...

Keyword(s):

Clinical Outcome ◽

Acute Stroke ◽

Clinical Outcomes ◽

Pooled Analysis ◽

Stroke Patients ◽

Good Clinical Outcome ◽

Kappa Score ◽

Early Reperfusion ◽

Diffusion Weighted Images ◽

Fluid Attenuated Inversion Recovery

Background and purpose: Fluid-attenuated inversion recovery (FLAIR) vessel hyper-intensities (FVH) have been hypothesized to have a positive correlation with good collaterals and more favorable clinical outcomes in acute stroke patients. We assessed if FVH predict the Target mismatch profile (TMM) and clinical outcomes in the DEFUSE studies. Methods: Patients with technically adequate baseline diffusion weighted images (DWI), perfusion images (PWI), and FLAIR images were included in this pooled analysis of the DEFUSE 1 and 2 studies. The FVH sign was defined as visible hyper-intense vessels on FLAIR images and assessed at basal ganglia levels by two independent raters. Clinical outcomes were assessed using modified Rankin Scale (mRS) at 90 days. The Target mismatch profile was based on baseline DWI and PWI volumes using automated software (RAPID). Results: Seventy seven patients met the inclusion criteria. Median time (IQR) from symptom onset to baseline MRI was 4.6 hours (3.9 - 5.4) and median (IQR) DWI lesion was 13.1 (5.0 - 32.0) ml. Of these, 66 patients (86%) had the FVH sign. Kappa score for inter-rater agreement was 0.621 (95CI: 0.33 - 0.91). Seventy (74%) cases with FVH had TMM profile vs. 33% of No FVH patients (p=0.023). Good clinical outcome (mRS 0-2) did not differ (50% with FVH vs. 73% without FVH, p=0.203). Only 38% of the patients with FVH had good angiographic collaterals and the rate of early reperfusion did not differ (45% with FVH vs. 25% without FVH, p=0.45). Conclusions: FVH is common in acute stroke patients (86%) and is associated with the Target Mismatch profile. However, FVH was not associated with favorable angiographic collaterals, good clinical outcome or early reperfusion in the DEFUSE 1 and 2 cohorts.

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Abstract WP398: Timing of Starting Doacs and Short- and Long-Term Clinical Outcomes for Acute Ischemic Stroke Patients With Nonvalvular Atrial Fibrillation: The Samurai-nvaf Study

Stroke ◽

10.1161/str.49.suppl_1.wp398 ◽

2018 ◽

Vol 49 (Suppl_1) ◽

Author(s):

Tadataka Mizoguchi ◽

Masahito Takagi ◽

Shoichiro Sato ◽

Hiroshi Yamagami ◽

Toshihiro Ide ◽

...

Keyword(s):

Atrial Fibrillation ◽

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Clinical Outcomes ◽

Stroke Patients ◽

Nonvalvular Atrial Fibrillation ◽

Short And Long Term

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Optimising management of anti-coagulation in acute stroke patients presenting in atrial fibrillation

Journal of the Neurological Sciences ◽

10.1016/j.jns.2019.10.454 ◽

2019 ◽

Vol 405 ◽

pp. 18-19

Author(s):

E. Feldano ◽

B. Ramasubbu ◽

E. Barrie ◽

S. Ghosh

Keyword(s):

Atrial Fibrillation ◽

Acute Stroke ◽

Stroke Patients

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Novel composite score to predict atrial Fibrillation in acute stroke patients

International Journal of Cardiology ◽

10.1016/j.ijcard.2016.02.002 ◽

2016 ◽

Vol 209 ◽

pp. 184-189 ◽

Cited By ~ 11

Author(s):

Woo-Keun Seo ◽

Sung-Hoon Kang ◽

Jin-Man Jung ◽

Jeong-Yoon Choi ◽

Kyungmi Oh

Keyword(s):

Atrial Fibrillation ◽

Acute Stroke ◽

Composite Score ◽

Stroke Patients

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Glycemic variability of acute stroke patients and clinical outcomes: a continuous glucose monitoring study

Therapeutic Advances in Neurological Disorders ◽

10.1177/17562864211045876 ◽

2021 ◽

Vol 14 ◽

pp. 175628642110458

Author(s):

Lina Palaiodimou ◽

Vasileios-Arsenios Lioutas ◽

Vaia Lambadiari ◽

Aikaterini Theodorou ◽

Marios Themistocleous ◽

...

Keyword(s):

Acute Stroke ◽

Clinical Outcomes ◽

Continuous Glucose Monitoring ◽

Glucose Monitoring ◽

Glycemic Variability ◽

Standard Of Care ◽

Stroke Patients ◽

Neurological Improvement ◽

Finger Prick ◽

Before And After

Introduction: Glycemic variability (GV) has been associated with worse prognosis in critically ill patients. We sought to evaluate the potential association between GV indices and clinical outcomes in acute stroke patients. Methods: Consecutive diabetic and nondiabetic, acute ischemic or hemorrhagic stroke patients underwent regular, standard-of-care finger-prick measurements and continuous glucose monitoring (CGM) for up to 96 h. Thirteen GV indices were obtained from CGM data. Clinical outcomes during hospitalization and follow-up period (90 days) were recorded. Hypoglycemic episodes disclosed by CGM but missed by finger-prick measurements were also documented. Results: A total of 62 acute stroke patients [48 ischemic and 14 hemorrhagic, median NIHSS score: 9 (IQR: 3–16) points, mean age: 65 ± 10 years, women: 47%, nondiabetic: 79%] were enrolled. GV expressed by higher mean absolute glucose (MAG) values was associated with a lower likelihood of neurological improvement during hospitalization before and after adjusting for potential confounders (OR: 0.135, 95% CI: 0.024–0.751, p = 0.022). There was no association of GV indices with 3-month clinical outcomes. During CGM recording, 32 hypoglycemic episodes were detected in 17 nondiabetic patients. None of these episodes were identified by the periodic blood glucose measurements and therefore they were not treated. Conclusions: Greater GV of acute stroke patients may be related to lower odds of neurological improvement during hospitalization. No association was disclosed between GV indices and 3-month clinical outcomes.

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