scholarly journals Additional clinical and instrumental laboratory markers of the main pathogenetic variants of ischemic stroke.

2018 ◽  
Vol 96 (3) ◽  
pp. 240-247
Author(s):  
A. A. Kulesh ◽  
Y. A. Golosova ◽  
L. I. Syromyatnikova ◽  
V. V. Shestakov
Keyword(s):  
Ischemic Stroke ◽  
Cardiovascular Risk ◽  
Recurrent Stroke ◽  
Hemorrhagic Transformation ◽  
Point Of View ◽  
Genetic Features ◽  
Cardiac Ejection Fraction ◽  
Intracranial Arteries ◽  
Computer Tomogram ◽  
Internal Carotid Arteries

Atherothrombotic stroke (ATI), cardioembolic stroke (CEI) and lacunar stroke (LI) are the main pathogenetic variants of ischemic stroke and differ not only in the final mechanism of formation of the ischemic focus, but also in the systemic disorders underlying them. Material and methods. 384 patients were examined in acute ischemic stroke using standard methods. All patients were evaluated for total cardiovascular risk with the use of scales ASCORE, CHA2DS2-VASc, Essen and the scale of recurrent stroke . Results. ATI was diagnosed in 268 (70%) patients, 70 (18%) patients, 46 (12%) patients. The highest rate on the scale of relapse of stroke is typical for patients with CEI, the lowest - for patients with LI. Patients with ATI had a high score on THE ascore scale. The highest rate on the scale CHA2DS2-VASc was observed in patients with CEI, the lowest - in patients with LI. Other indicators informative for differentiation of the studied types of AI are age, gender, Smoking, congestive heart failure, lipid profile, presence and size of cerebral infarction on computer tomogram on admission, involvement of vertebrobasilar pool, hemorrhagic transformation of the lesion, the thickness of the intima - media, degree of stenosis of internal carotid arteries, stenosis of intracranial arteries, cardiac ejection fraction, time from stroke to admission to hospital, hemiplegia, neglect syndrome, speech disorder, as well as neurological deficit on the NIHSS scale. Discussion. Patients with studied pathogenetic variants of ischemic stroke differed in severity and representation of cardiovascular risk factors, clinical picture and outcome of the disease, which confirms the point of view of phenotypic independence of ATI, KEI and LEE, probably due to genetic features.

Abstract T P15: Could Intra-Arterial Thrombolysis Safely Enhance Efficacy of Mechanical Thrombectomy for Acute Ischemic Stroke?

Stroke ◽  
2014 ◽  
Vol 45 (suppl_1) ◽  
Author(s):  
Yi Zhang ◽  
Adam Kelly ◽  
Wan Tang ◽  
Robert Griggs ◽  
Henry Wang ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Mechanical Thrombectomy ◽  
Mortality Rates ◽  
Hemorrhagic Transformation ◽  
Large Vessel Occlusion ◽  
Vessel Occlusion ◽  
Procedure Duration ◽  
Intracranial Arteries ◽  
Arterial Thrombolysis ◽  
Median Admission

Background: Occlusion of large intracranial arteries is associated with disability and death. In this study we assess whether intra-arterial thrombolysis(IAT) safely enhances efficacy of mechanical thrombectomy. Method: We studied consecutive patients with acute large vessel occlusion. We compared 2 groups:(1) thrombectomy plus IAT and(2) thrombectomy alone (non-IAT). Recanalization was defined by TIMI ≥ 2. Results: Between 12/2007 and 10/2012, 87 patients(age 67±16years) received 88 thrombectomy procedures. The median admission NIHSS was18. Forty six cases were treated IAT. Overall recanalization was 60%. Recanalization was seen more frequently in cases using IAT (72%) compared to non-IAT(48%)( p=0.02 ). IAT tended to associate with fewer numbers of arterial attempts than non-IAT (2.37±1.76 vs. 3.07± 1.98) (p=0.08) but longer procedure duration(119± 53 minutes vs. 90± 55 minutes)( p=0.02 ). The rate of symptomatic hemorrhagic transformation, in-hospital and 3 month mortality rates were not significantly different between IAT and non-IAT(p=0.90, p=0.99 and p=0.72), respectively. Conclusions: During mechanical thrombectomy, IAT is associated with increased recanalization rate and longer procedure duration. Mechanical thrombectomy with concomitant IAT appeared relatively safe.

Abstract TMP110: Antithrombotic Therapy and Risk of Stroke Recurrence in Children With Congenital and Acquired Cardiac Disease

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Elizabeth Pulcine ◽  
Mike Seed ◽  
Leonardo Brandao ◽  
Mahmoud Slim ◽  
Manohar Shroff ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Antithrombotic Therapy ◽  
Recurrent Stroke ◽  
Hemorrhagic Transformation ◽  
Palliative Surgery ◽  
Left Ventricular ◽  
Stroke Recurrence ◽  
Inclusion Criteria ◽  
Arterial Ischemic Stroke

Background: Antithrombotic therapy (ATT) is currently recommended for stroke prevention in pediatric cardioembolic arterial ischemic stroke (CE-AIS) where the risk of recurrence is high. Methods: We conducted a retrospective study of a prospectively enrolled cohort of neonates and children with radiologically-confirmed cardioembolic arterial ischemic stroke (CE-AIS) from January 2003 - December 2017. We evaluated the clinical and radiographic predictors of hemorrhagic transformation (HT) and stroke recurrence to assess the safety and efficacy of ATT. Results: Eighty-two children met inclusion criteria [53.7% males and 28% neonates; median age 0.43 (IQR: 0.08 - 4.23) years]. Stroke recurred in 11 children at a median of 32 days (IQR: 5.5 - 93) from the index event. Most recurrent infarcts were silent (n=6; 54.5%) and found on follow-up neuroimaging with an average follow-up interval of 4.1 ±3 .5 years. Procedure-related recurrence took place in 1 (9.1%) child. Ten (90.9%) children were receiving antithrombotic therapy at the time of recurrence: 8 (72.7%) were on anticoagulant therapy (ACT) and 2 (18.2%) were on a combination of antiplatelet (ATP) and ACT. HT occurred in 20 of 82 children (24.4%), all of whom were receiving ACT, 5 (6.1%) of whom were symptomatic. Four (4.9%) had systemic hemorrhage. There was no difference in the frequency of stroke recurrence between those with and without HT [3 (15.0%) vs. 8 (12.9%); p=1.00]. Children with univentricular physiology were less likely to have HT [15% vs. 43.5%; p=0.03] and had higher rates of recurrent stroke, prior to definitive cardiac repair, despite receiving ATT. Stroke recurrence was highest in those with cyanotic congenital heart disease (CHD) pre-surgery (3/11), cyanotic CHD post-palliative surgery with residual right-to-left-shunt (3/11) and in those with cardiomyopathy (4/11). HT was not associated with ATP vs. ACT use nor combination therapy. Conclusion: ATT appears to be relatively safe in children with CE-AIS. However, ATT warrants further optimization to prevent stroke recurrence, particularly in those with single ventricle physiology and reduced left ventricular function.

Hyperuricemia as risk factor for cardiovascular disease – what’s new?

2020 ◽  
pp. 5-11
Author(s):  
Yu. V. Zhernakova
Keyword(s):  
Cardiovascular Disease ◽  
Chronic Kidney Disease ◽  
Uric Acid ◽  
Cardiovascular Risk ◽  
Epidemiological Studies ◽  
Point Of View ◽  
Medical Society ◽  
High Cardiovascular Risk ◽  
Management Algorithm ◽  
Russian Medical

A significant number of epidemiological studies have shown that hyperuricemia is highly associated with the risk of developing cardiovascular disease, chronic kidney disease, and diabetes. In this connection, increased attention is required to monitor serum uric acid levels in patients, not only from a rheumatological point of view, but also with regard to reducing cardiovascular and renal risks. This article is a review of studies on the association of hyperuricemia with cardiovascular risk and a new consensus for the management of patients with hyperuricemia and high cardiovascular risk, published in december 2019 by a group of experts of the Russian Medical Society for Arterial Hypertension, which, among other things, includes a management algorithm of this category of patients.

Cardiovascular Disease in Spondyloarthritides

2020 ◽  
Vol 18 (5) ◽  
pp. 473-487 ◽  
Author(s):  
Charalampos Papagoras ◽  
Paraskevi V. Voulgari ◽  
Alexandros A. Drosos
Keyword(s):  
Cardiovascular Disease ◽  
Cardiovascular Risk ◽  
Healthcare Providers ◽  
Cardiovascular Death ◽  
Point Of View ◽  
Treat To Target ◽  
Inflammatory Joint Diseases ◽  
Scientific Organizations ◽  
Increased Risk ◽  
Risk Patients

The spondyloarthritides are a group of chronic systemic inflammatory joint diseases, the main types being ankylosing spondylitis (AS) and psoriatic arthritis (PsA). Evidence accumulating during the last decades suggests that patients with AS or PsA carry an increased risk for cardiovascular disease and cardiovascular death. This risk appears to be mediated by systemic inflammation over and above classical cardiovascular risk factors. The excess cardiovascular risk in those patients has been formally acknowledged by scientific organizations, which have called physicians’ attention to the matter. The application by Rheumatologists of new effective anti-rheumatic treatments and treat-to-target strategies seems to benefit patients from a cardiovascular point of view, as well. However, more data are needed in order to verify whether anti-rheumatic treatments do have an effect on cardiovascular risk and whether there are differences among them in this regard. Most importantly, a higher level of awareness of the cardiovascular risk is needed among patients and healthcare providers, better tools to recognize at-risk patients and, ultimately, commitment to address in parallel both the musculoskeletal and the cardiovascular aspect of the disease.

P2549The cardiovascular predictors of clinical outcomes in patients after ischemic stroke of undetermined etiology

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
A Bielecka-Dabrowa ◽  
P Gasiorek ◽  
A Sakowicz ◽  
M Banach
Keyword(s):  
Ischemic Stroke ◽  
Independent Predictor ◽  
Reference Group ◽  
Peak Velocity ◽  
Recurrent Stroke ◽  
Mitral Annular Velocity ◽  
Kaplan Meier ◽  
Unfavourable Prognosis ◽  
Undetermined Etiology

Abstract Purpose The study aimed to identify echocardiographic, hemodynamic and biochemical predictors of unfavourable prognosis after ischemic strokes of undetermined etiology (ESUS) in patients (pts) at age <65. Methods Out of 520 ischemic stroke pts we selected 64 pts diagnosed with ESUS [mean age 54 (SD: 47–58) years, 42% males] and additional 36 without stroke but with similar risk profile, which were treated as a reference group [age 53 (SD: 47–58) years, 61% males]. All pts underwent echocardiography, non-invasive assessment of hemodynamic parameters using SphygmoCor tonometer (Atcor Med., Australia), HDL subfraction distribution using Lipoprint (Quantimetrix) as well as measurements of selected biomarkers. Follow-up was 12 months. Results At 12-month follow-up 9% of patients had died, and recurrent ischemic stroke also occurred in 9% of patients - only in the ESUS group (Figure). Patients who died had significantly lower levels of LDL and HDL cholesterol (included HDL-8 and -9 subfractions) and higher level of triglicerides (p=0.01, p=0.01, and p=0.02; respectively), lower level of adiponectin (p=0.01), lower value of mean early diastolic (E') mitral annular velocity (p=0.04) and lower diastolic blood pressure (p=0.04). The atrial fibrillation (AF) occurred in 10% of pts during the 12 months (log-rang, p=0.254) (Figure). The log-rank test showed that ESUS group had a significantly poorer outcome of AF in the first 2 months after hospitalization compared to reference group (11% vs 5%, p=0.041). Based on a Kaplan-Meier analysis, the outcome of re-hospitalizationin the 1st year was 28% (18/64) in the ESUS group and 17% (6/36); log-rank, p=0.058. In the multivariate analysis mean early diastolic (E') mitral annular velocity (odds ratio [OR] 0.75, 95% confidence interval [CI]: 0.6–0.94; p=0.01) was significantly associated with CV hospitalizations assessed at 12-month follow-up. The only independent predictor of AF occurrence in the 12-month follow-up was lower value of Tissue Doppler-derived right ventricular systolic excursion velocity S' (OR 0.65, 95% Cl 0.45–0.93; p=0.01). The only independent predictor of recurrent stroke was the ratio of peak velocity of early diastolic transmitral flow to peak velocity of early diastolic mitral annular motion as determined by pulsed wave Doppler (E/E') (OR 0.75, 95% CI: 0.6–0.94; p=0.01). E/E' ratio was also independently associated with composite endpoint consisting of death, hospitalization and recurrent stroke (OR 1.90, 95% CI 1.1–3.2, p=0.01). Kaplan-Meier Analysis - survival and AF Conclusions The indices of diastolic dysfunction are significantly associated with unfavourable prognosis after ESUS. There is a robust role for outpatient cardiac monitoring especially during first 2 months after ESUS to detect potential AF. Acknowledgement/Funding The study was financed by research grants no. 502-03/5-139-02/502-54-229-18 of the Medical University of Lodz

scholarly journals AB0191 ON WHICH FACTOR TO ACT TO REDUCE CARDIOVASCULAR RISK IN PATIENTS WITH RHEUMATOID ARTHRITIS?

2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 1119.3-1120
Author(s):  
L. Nacef ◽  
H. Ferjani ◽  
H. Riahi ◽  
Y. Mabrouk ◽  
E. Labbene ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Cardiovascular Risk ◽  
Disease Activity ◽  
Carotid Arteries ◽  
Internal Carotid ◽  
Intima Media Thickness ◽  
Active Smoking ◽  
Media Thickness ◽  
Modifiable Factors ◽  
Internal Carotid Arteries

Background:Patients with rheumatoid arthritis (RA) are at higher cardiovascular risk (CVR) than the general population due to chronic inflammation. Several factors, both modifiable and non-modifiable, can increase this risk. Intima-media thickness (IMT) was considered as a marker for atherosclerosis.Objectives:This study aimed to identify predictor factors of increasing IMT.Methods:The prospective study was carried out on patients with RA who met the 2010 American College of Rheumatology (ACR)/European League Against Rheumatism (EULAR) classification criteria. These patients were followed in the rheumatology department of the Kassab Institute. The socio-demographic data, biological and immunological parameters were collected.Framingham’s score quantified the cardiovascular risk at 10-years. Carotid Ultrasonography (US) using a high resolution B mode carotid measured intima-media thickness (IMT) as a subclinical marker of atherosclerosis. Carotid US was performed in the supine position, according to American Society of Echocardiography guidelines. IMT was measured in the left (LCC) and right (RCC) common carotid arteries, the left (LIC) and right (RIC) internal carotid arteries, and the left (LEC) and right (RIC) internal carotid arteries. An increased IMT was defined as ≥0.9 mm.We analyzed data by the SPSS statistical package. A p-value <0.05 was considered significant.Results:Of the 47 patients surveyed, 78.7% were female. The mean age was 52.5 ±11.06 [32-76]. The duration disease was 86.25 ±63 months [5-288] and was erosive in 81.6% of cases. The rheumatoid factor (RF) was positive in 57.8% of patients, and citrullinated antipeptide antibodies (ACPA) were present in 62.2%. Eight patients had a previous CV history (hypertension, diabetes or dyslipidemia) and 16.4% were active smokers. Among women, 43.6% were postmenopausal. ITM was significantly higher in men at LIC (0.037) and LEC (0.025). Older age was associated with increased ITM in LIC (p=0.046; r=0.295), LEC (p=0.05; r=0.412), RCC (p=0.034; r=0.317), and REC (p=0.009; r=0.382). The ITM for LCC, LIC, LEC, RCC, RIC, and REC was higher in postmenopausal women, with no significant difference (p=0.782, p=0.208, p=0.877, r=0.734, p=0.808, p=0.437, respectively).Among the modifiable factors, active smoking was associated with a higher ITM at the REC level (p=0.047). However, weight was not associated with an increased ITM (LCC: p=0.092; LIC: p=0.985; LEC: p=0.952; RCC: p=0.744; RIC: p=0.210; REC: p=0.510). In our study, there was no significant association between DAS28 disease activity or inflammatory marks and ITM (LCC: p=0.784; LIC: p=0.316; LEC: p=0.420; RCC: p=0.784; RIC: p=0.484; REC: p=0.754).Conclusion:In our study, the non-modifiable factors associated with increased ITM were advanced age and male gender. The modifiable factor impacting ITM was primarily active smoking. Surprisingly, disease activity and biological inflammation did not influence ITM.References:[1]S. Gunter and al. Arterial wave reflection and subclinical atherosclerosis in rheumatoid arthritis. Clinical and experimental rheumatology 2018; 36: clinical e.xperimental.[2]Aslan and al. Assessment of local carotid stiffness in seronegative and seropositive rheumatoid Arthritis. Scandinavian cardiovascular journal, 2017.[3]Martin i. Wah-suarez and al, carotid ultrasound findings in rheumatoid arthritis and control subjects: a case-control study. Int j rheum dis. 2018;1–7.Disclosure of Interests:None declared

scholarly journals Stress hyperglycemia as a prognostic factor in acute ischemic stroke patients: a prospective observational cohort study

2021 ◽  
Vol 13 (1) ◽  
Author(s):  
Hanaa A. El-Gendy ◽  
Mahmoud A. Mohamed ◽  
Amr E. Abd-Elhamid ◽  
Mohammed A. Nosseir
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Prognostic Value ◽  
Area Under The Curve ◽  
Hemorrhagic Transformation ◽  
Diabetic Patients ◽  
Stroke Patients ◽  
Stress Hyperglycemia ◽  
Discrimination Power ◽  
Observational Cohort

Abstract Background Hyperglycemia is a risk factor for infarct expansion and poor outcome for both diabetic and non-diabetic patients. We aimed to study the prognostic value of stress hyperglycemia on the outcome of acute ischemic stroke patients as regards National Institutes of Health Stroke Scale (NIHSS) as a primary outcome. Results Patients with high random blood sugar (RBS) on admission showed significantly higher values of both median NIHSS score and median duration of hospital stay. There were significant associations between stress hyperglycemia and the risk of 30-day mortality (p < 0.001), the need for mechanical ventilation (p < 0.001) and vasopressors (p < 0.001), and the occurrence of hemorrhagic transformation (p = 0.001). The 24-h RBS levels at a cut off > 145 mg/dl showed a significantly good discrimination power for 30-day mortality (area under the curve = 0.809). Conclusions Stress hyperglycemia had a prognostic value and was associated with less-favorable outcomes of acute stroke patients. Therefore, early glycemic control is recommended for those patients.

scholarly journals Phthalide derivative CD21 attenuates tissue plasminogen activator-induced hemorrhagic transformation in ischemic stroke by enhancing macrophage scavenger receptor 1-mediated DAMP (peroxiredoxin 1) clearance

2021 ◽  
Vol 18 (1) ◽  
Author(s):  
Dong-Ling Liu ◽  
Zhi Hong ◽  
Jing-Ying Li ◽  
Yu-Xin Yang ◽  
Chu Chen ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Brain Injury ◽  
Middle Cerebral Artery ◽  
Combined Treatment ◽  
Scavenger Receptor ◽  
Hemorrhagic Transformation ◽  
Microglial Cells ◽  
Peroxiredoxin 1 ◽  
Macrophage Scavenger Receptor ◽  
Tissue Plasminogen

Abstract Background Hemorrhagic transformation (HT) is a critical issue in thrombolytic therapy in acute ischemic stroke. Damage-associated molecular pattern (DAMP)-stimulated sterile neuroinflammation plays a crucial role in the development of thrombolysis-associated HT. Our previous study showed that the phthalide derivative CD21 attenuated neuroinflammation and brain injury in rodent models of ischemic stroke. The present study explored the effects and underlying mechanism of action of CD21 on tissue plasminogen activator (tPA)-induced HT in a mouse model of transient middle cerebral artery occlusion (tMCAO) and cultured primary microglial cells. Methods The tMCAO model was induced by 2 h occlusion of the left middle cerebral artery with polylysine-coated sutures in wildtype (WT) mice and macrophage scavenger receptor 1 knockout (MSR1−/−) mice. At the onset of reperfusion, tPA (10 mg/kg) was intravenously administered within 30 min, followed by an intravenous injection of CD21 (13.79 mg/kg/day). Neuropathological changes were detected in mice 3 days after surgery. The effect of CD21 on phagocytosis of the DAMP peroxiredoxin 1 (Prx1) in lysosomes was observed in cultured primary microglial cells from brain tissues of WT and MSR1−/− mice. Results Seventy-two hours after brain ischemia, CD21 significantly attenuated neurobehavioral dysfunction and infarct volume. The tPA-infused group exhibited more severe brain dysfunction and hemorrhage. Compared with tPA alone, combined treatment with tPA and CD21 significantly attenuated ischemic brain injury and hemorrhage. Combined treatment significantly decreased Evans blue extravasation, matrix metalloproteinase 9 expression and activity, extracellular Prx1 content, proinflammatory cytokine mRNA levels, glial cells, and Toll-like receptor 4 (TLR4)/nuclear factor κB (NF-κB) pathway activation and increased the expression of tight junction proteins (zonula occludens-1 and claudin-5), V-maf musculoaponeurotic fibrosarcoma oncogene homolog B, and MSR1. MSR1 knockout significantly abolished the protective effect of CD21 against tPA-induced HT in tMCAO mice. Moreover, the CD21-induced phagocytosis of Prx1 was MSR1-dependent in cultured primary microglial cells from WT and MSR1−/− mice, respectively. Conclusion The phthalide derivative CD21 attenuated tPA-induced HT in acute ischemic stroke by promoting MSR1-induced DAMP (Prx1) clearance and inhibition of the TLR4/NF-κB pathway and neuroinflammation.

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