Comment on “Predictors of left atrial thrombus in acute ischemic stroke patients without atrial fibrillation: a single-center cross-sectional study”

SUMMARY INTRODUCTION: The present study aimed to determine independent predictors of left atrial thrombus (LAT) in acute ischemic stroke (AIS) patients without atrial fibrillation (AF) using transesophageal echocardiography (TEE). METHODS: In this single-center, retrospective study, we enrolled 149 consecutive AIS patients. All of the patients underwent a TEE examination to detect LAT within 10 days following admission. Multivariate logistic regression analysis was performed to assess independent predictors of LAT. RESULTS: Among all cases, 14 patients (9.3%) had a diagnosis of LAT based on the TEE examination. In a multivariate analysis, elevated mean platelet volume (MPV), low left-ventricle ejection fraction (EF), creatinine, and reduced left-atrium appendix (LAA) peak emptying velocity were independent predictors of LAT. The area under the receiver operating characteristic curve analysis for MPV was 0.70 (95%CI: 0.57-0.83; p = 0.011). With the optimal cut-off value of 9.45, MPV had a sensitivity of 71.4% and a specificity of 63% to predict LAT. CONCLUSION: AIS patients with low ventricle EF and elevated MPV should undergo further TEE examination to verify the possibility of a cardio-embolic source. In addition, this research may provide novel information with respect to the applicability of MPV to predict LAT in such patients without AF.

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Gender Differences in the Age-Stratified Prevalence of Risk Factors in Korean Ischemic Stroke Patients: A Nationwide Stroke Registry-Based Cross-Sectional Study

International Journal of Stroke ◽

10.1111/ijs.12146 ◽

2013 ◽

Vol 9 (6) ◽

pp. 759-765 ◽

Cited By ~ 20

Author(s):

Tai Hwan Park ◽

Youngchai Ko ◽

Soo Joo Lee ◽

Kyung Bok Lee ◽

Jun Lee ◽

...

Keyword(s):

Risk Factors ◽

Gender Differences ◽

Ischemic Stroke ◽

Cross Sectional Study ◽

Sectional Study ◽

Stroke Patients ◽

Cross Sectional ◽

Stroke Registry

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Diagnostic accuracy of D-dimer to detect left atrial thrombus in patients with atrial fibrillation: a systematic review and meta-analysis

European Heart Journal ◽

10.1093/eurheartj/ehab724.0485 ◽

2021 ◽

Vol 42 (Supplement_1) ◽

Author(s):

C Diaz-Arocutipa ◽

A.C Gonzales-Luna ◽

A Branez-Condorena ◽

A.V Hernandez

Keyword(s):

Atrial Fibrillation ◽

Diagnostic Accuracy ◽

Left Atrial ◽

Meta Analysis ◽

Characteristic Curve ◽

Left Atrial Thrombus ◽

Summary Receiver Operating Characteristic ◽

Atrial Thrombus ◽

Cross Sectional ◽

D Dimer

Abstract Background There is limited evidence on the use of biomarkers to diagnose left atrial thrombus in atrial fibrillation. Purpose We evaluated the diagnostic accuracy of D-dimer to detect left atrial thrombus in patients with atrial fibrillation. Methods We searched four electronic databases from inception to December 16, 2020 for observational studies evaluating diagnostic accuracy of D-dimer. Reference standard was left atrial thrombus detected by transesophageal echocardiography. Study quality was assessed with the QUADAS-2 tool. We performed a bivariate random-effects meta-analysis to calculate the pooled sensitivity and specificity with their 95% confidence intervals (95% CI). In addition, a summary receiver operating characteristic curve and optimal cut-off were estimated. Results Eleven cross-sectional studies involving 4380 patients were included. The mean age ranged from 49.8 to 74.1 years and 70% of patients were men. Left atrial thrombus was present in 7% of cases. In seven studies, the pooled sensitivity of D-dimer at 500 ng/mL was 53% (95% CI, 26–79%) and the pooled specificity was 92% (95% CI, 80–97%). The pooled sensitivity of age-adjusted D-dimer was 35% (95% CI, 18–57%) and the pooled specificity was 100% (95% CI, 100–100%) in two studies. The optimal cut-off was 390 ng/mL in 10 studies with a pooled sensitivity of 68% (95% CI, 44–85%) and a pooled specificity of 73% (95% CI, 54–86%). The risk of bias was low or unclear for all domains. Concerns regarding applicability were generally low for almost all studies Conclusion Our meta-analysis suggests that D-dimer has the potential to be useful to the detection of left atrial thrombus in patients with atrial fibrillation. FUNDunding Acknowledgement Type of funding sources: None.

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Mutually Risk Roles of Oral Cleanliness and Stroke-associated Pneumonia in Patients with Acute Ischemic Stroke: A Cross-Sectional Study

10.21203/rs.3.rs-42112/v1 ◽

2020 ◽

Author(s):

Xiaohua Yang ◽

Huijuan Chen ◽

Wanling Yang ◽

Bin Deng ◽

Jialing Zheng ◽

...

Keyword(s):

Risk Factors ◽

Logistic Regression ◽

Ischemic Stroke ◽

Dental Caries ◽

Acute Ischemic Stroke ◽

Oral Hygiene ◽

Cross Sectional Study ◽

Sectional Study ◽

Stroke Patients ◽

Cross Sectional

Abstract Background: Stroke-associated pneumonia (SAP) is a major complication after stroke, oral microorganisms are important contributors to SAP. Here, we aimed to investigate whether the oral hygiene was associated with SAP and related risk factors of them in patients with acute ischemic stroke. Methods: We performed a cross-sectional study that recruited 331 patients with acute ischemic stroke from two medical centers. A series of assessments were performed to evaluate the neurological status and habits of oral hygiene. According to whether the oral hygiene was abnormal and SAP occurred, univariate analyses were performed in cohort 1 (normal / abnormal oral hygiene groups) and cohort 2 (SAP / non-SAP groups). Multiple logistic regression analyses were conducted to confirm risk factors of oral cleanliness and SAP in stroke patients. Results: A total of 12 and 8 independent variables were included in the model 1 and 2 analysis. After adjusting for confounders, multivariable logistic regression analysis showed that oral cleanliness was not only closely related to SAP (OR=2.219, P=0.026), dental caries (OR=1.292, P=0.005) and age (OR=1.030, P=0.006) in model 1, but also an independent risk factor for predicting SAP (OR=1.678, P=0.001) in model 2. Barthel index was a protective factor for oral cleanliness (OR=0.986, P=0.019) and SAP (OR=0.977, P=0.002) in ischemic stroke patients. Conclusions: Mutually primary risk roles of abnormal oral cleanliness and SAP exist in patients with acute ischemic stroke. Dental caries and aging are important risk factors for oral health disorders. Improving the activities of daily living would have protective effects on both oral hygiene and SAP prevention in stroke patients.

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