scholarly journals Stroke Severity Modified the Effect of Chronic Atrial Fibrillation on the Outcome of Thrombolytic Therapy

2021 ◽  
Author(s):  
Rui Shao ◽  
Zengna Wang ◽  
Hongfeng Shi ◽  
Yan Li ◽  
Yingle Zhuang ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Thrombolytic Therapy ◽  
Treatment Strategies ◽  
Multivariate Logistic Regression Analysis ◽  
Chronic Atrial Fibrillation ◽  
Stroke Severity ◽  
Modified Rankin Scale ◽  
Roc Curve Analysis ◽  
Nihss Score ◽  
The Impact

Abstract Background There is conflicting information regarding the impact of chronic atrial fibrillation (AF) on the outcomes of thrombolyzed patients with stroke. This study was designed to identify high-risk patients with chronic AF who had undergone thrombolysis treatment and to explore whether the baseline National Institutes of Health Stroke Scale (NIHSS) could be used to distinguish poor clinical outcomes in thrombolyzed patients. Methods A total of 164 acute ischemic stroke patients with chronic AF were enrolled in this study. The patients were categorized as having poor or favorable outcomes. A favorable 90-day outcome was defined as a modified Rankin Scale (mRS) score ≤ 2. Results Our study showed that the baseline NIHSS score of patients with poor functional recovery (mRS > 2) was significantly higher than that of patients with favorable outcomes (median 16 vs 12). Receiver operating characteristic (ROC) curve analysis of modified Rankin Scale(mRS) scores showed that a baseline NIHSS score of 14 was the optimal threshold for predicting unfavorable outcomes in patients with chronic AF. Multivariate logistic regression analysis showed that baseline NIHSS score > 14 was independently associated with poor outcomes (odds ratio = 4.182, 95% confidence interval 2.092–8.361). Conclusions Our study showed that stroke severity modified the effect of chronic AF on the outcome of thrombolytic therapy. The approach of stratifying stroke severity may be used to evaluate treatment strategies for decision making in intravenous thrombolytic therapy for acute stroke with chronic AF.

scholarly journals The relationship of the serum endocan level with the CHA2DS2-VASc score in patients with paroxysmal atrial fibrillation

2021 ◽  
Vol 73 (1) ◽  
Author(s):  
Gökhan Ceyhun
Keyword(s):  
Atrial Fibrillation ◽  
Paroxysmal Atrial Fibrillation ◽  
Stroke Risk ◽  
Low Density Lipoprotein ◽  
Multivariate Logistic Regression Analysis ◽  
Density Lipoprotein ◽  
Roc Curve Analysis ◽  
Reactive Protein ◽  
Relationship Of ◽  
The Relationship

Abstract Background In this study considering the relationship between serum endocan and CHA2DS2-VASc score, we assumed that endocan level could be a new biomarker for stroke risk in patients with paroxysmal atrial fibrillation (PAF). It was examined that endocan could be an alternative to determine the risk of stroke and anticoagulation strategy in patients with PAF. The CHA2DS2-VASc scores were calculated for 192 patients with PAF, and their serum endocan levels were measured. The patients were divided into two groups as those with low to moderate (0-1) and those with high (≥ 2) CHA2DS2-VASc scores, and the endocan levels were compared between these two groups. Results The serum endocan level was significantly higher in the high CHA2DS2-VASc score group (p < 0.001). In the multivariate logistic regression analysis, endocan, C-reactive protein, and low-density lipoprotein were found to be independent determinants of the CHA2DS2-VASc score. The predictive value of endocan was analyzed using the ROC curve analysis, which revealed that endocan predicted a high stroke risk (CHA2DS2-VASc ≥ 2) at 82.5% sensitivity and 71.2% specificity at the cutoff value of 1.342. Conclusion This study indicates that endocan is significantly associated with CHA2DS2-VASc score. We demonstrated that endocan could be a new biomarker for the prediction of a high stroke risk among patients diagnosed with PAF.

Abstract P659: Pre-Stroke Chads 2 Scores Should Be Associated With Onset Severity and Functional Outcome in Acute Stroke Patients With Atrial Fibrillation During Oral Anticoagulants: A Sub-Analysis of PASTA Registry Study

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Kenichiro Sakai ◽  
Satoshi Suda ◽  
Masayuki Ueda ◽  
Yasuyuki Iguchi ◽  
Yoshiki Yagita ◽  
...  
Keyword(s):  
Functional Outcome ◽  
Oral Anticoagulants ◽  
Multivariate Logistic Regression Analysis ◽  
Cardioembolic Stroke ◽  
Nihss Score ◽  
Excellent Outcome ◽  
Outcome Group ◽  
Group 2 ◽  
Ischemic Attack ◽  
The Impact

Background and Purpose: The impact of CHADS 2 score on neurological severity in patients with stroke during oral anticoagulant (OAC) has not yet been elucidated. We investigated the association between pre-stroke CHADS 2 score and severity on admission and functional outcome in acute cardioembolic stroke due to AF during OAC. Methods: We conducted an investigator-initiated, multicenter, prospective, observational cohort study, PASTA registry. One thousand forty-three patients with transient ischemic attack, ischemic stroke, and ICH who were taking OACs were prospectively enrolled in 25 medical institutions throughout Japan. We compared the clinical characteristics including severity onset and discharge outcome between low CHADS 2 score group (<2), and high CHADS 2 score group (≥2) in patients with cardioembolic stroke due to AF. Result: A total of 548 patients (237 women; median age 80 [quartiles 74-85] years) were enrolled. Of these, there were 76 patients (14%) in low CHADS 2 group and 472 (86%) in high CHADS 2 score group (Fig A). Along with increase of pre-stroke CHADS 2 score, NIHSS score was gradually increased (Fig B). Low CHADS 2 score group was associate with good outcome than high CHADS 2 group (p<0.001, Fig C). Age (p<0.001), male (p<0.001), pre-stroke CHADS 2 score (p<0.001), and initial NIHSS score (p<0.001) were significantly higher in non-excellent outcome (mRS≥2) group than excellent outcome group (mRS<2). In contrast, creatinine clearance and body weight were higher in excellent outcome group (Both p<0.001). Multivariate logistic regression analysis indicated that high pre-stroke CHADS 2 score independently associated with higher NIHSS score (NIHSS score≥6; OR 1.55, 95%CI 1.02-2.36, p=0.041) and non-excellent outcome (OR 1.94, 95%CI 1.01-3.80, p=0.047). Conclusion: The present study suggests that the pre-stroke CHADS 2 score should be useful for the prediction of clinical outcomes in patients with cardioembolic stroke due to AF even taking OAC.

Abstract W P121: Stroke Severity in Men and Women: What Proportion of the Disparity Can Be Explained by Differences in Cardiovascular Risk Factors?

Stroke ◽  
2014 ◽  
Vol 45 (suppl_1) ◽  
Author(s):  
Karen C Albright ◽  
Amelia K Boehme ◽  
Bisakha Sen ◽  
Monica Aswani ◽  
Michael T Mullen ◽  
...  
Keyword(s):  
Risk Factors ◽  
Atrial Fibrillation ◽  
Sex Differences ◽  
Cardiovascular Risk ◽  
Black Women ◽  
Cardiovascular Risk Factors ◽  
Stroke Severity ◽  
Stroke Subtype ◽  
Oaxaca Decomposition ◽  
Nihss Score

Background: Prior studies have shown that women present with more severe stroke. It has been suggested that sex differences in stroke severity are related to age, stroke subtype, or cardiovascular risk factors. We aimed to determine the proportion of sex disparity in stroke severity that can be explained by differences in these variables using Oaxaca decomposition, an econometric technique which quantifies the differences between groups. Methods: White and Black ischemic stroke patients who presented to two academic medical centers in the US (2004-2011) were identified using prospective stroke registries. In-hospital strokes were excluded. Patient demographics and medical history were collected. Stroke severity was measured by NIHSS. Linear regression was used to determine if female sex was associated with NIHSS score. This model was then adjusted for potential confounders including: age, race, stroke subtype, and cardiovascular risk factors. Oaxaca decomposition was then used to determine the proportion of the observed sex differences in stroke severity that can be explained by these variables. Results: 4925 patients met inclusion criteria. Nearly half (n=2346) were women and 39% (n=1942) were Black. Women presented with more severe strokes (median NIHSS 8 vs. 6). In addition, women were older on average (68 vs. 63 years) with more frequent atrial fibrillation (18% vs. 13%), diabetes (34% vs. 30%), and hypertension (78% vs. 72%). Oaxaca decomposition revealed that age, race, atrial fibrillation, large vessel etiology, diabetes, hypertension account for only 63% of the sex differences seen in NIHSS score on presentation. Conclusion: In our biracial sample, women presented with more severe strokes than men. This difference remained significant even after adjustment for age, stroke subtype, and cardiovascular risk factors. Further, over 1/3 of the observed gender difference in stroke severity was unexplained.. Additional study is warranted to investigate the etiology of the gender differences in stroke severity.

Abstract 14134: The Impact of Ablation for Atrial Fibrillation on Dementia Incidence in Patients With and Without Depression

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Heidi T May ◽  
Tami L Bair ◽  
Stacey Knight ◽  
Jeffrey L Anderson ◽  
Joseph B Muhlestein ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Treatment Strategies ◽  
Brain Perfusion ◽  
Cardiovascular Comorbidities ◽  
Incident Dementia ◽  
History Of ◽  
The Impact ◽  
Mean Time ◽  
History Of Depression

Introduction: Studies have previously shown that atrial fibrillation (AF) is associated with dementia. The mechanisms are likely multifactorial, but may involve treatment strategies that include anticoagulation use and rhythm management, particularly when used early. Patients that have earlier-life depression are at risk of dementia. However, depression diagnosis in AF patients may indicate a patient at higher risk of developing dementia and whether treatments ameliorate that risk is unknown. Methods: A total of 132,703 AF patients without a history of dementia were studied. History of depression was determined at the time of AF diagnosis. Patients were deemed as having a follow-up ablation if it occurred prior to a dementia diagnosis. Patients were stratified into 4 groups based on depression history and follow-up ablation status: no depression, ablation (n=5,960); no depression, no ablation (n=106,986); depression, ablation (n=923); and depression, no ablation (n=18,834). Patients were followed for 5-year incidence of dementia. Results: A total of 14.9% (n=19,757) pts had a history of depression at the time of AF diagnosis. The mean time between depression and AF diagnoses was 4.9±4.8 years. Patients with depression were younger (68±15 vs. 71±14 years), more likely to be female (62% vs. 44%), and had more cardiovascular comorbidities. Mean time to ablation was 1.3±1.4 days (median: 7.7 months) from AF diagnosis. Frequencies of 5-year dementia were: no depression, ablation=1.6%; no depression, no ablation=5.2%; depression, ablation=4.7%; and depression, no ablation=9.7%, p<0.0001. Multivariable comparisons between the groups are shown in the Figure. Conclusion: In AF patients with and without depression, ablation was associated with a lower risk of incident dementia. Rhythm control approaches that improve long-term brain perfusion may represent a means to impact cognitive declines in patients at higher risk because of earlier-life depression.

The Impact of New and Emerging Clinical Data on Treatment Strategies for Atrial Fibrillation

2010 ◽  
pp. no-no ◽  
Author(s):  
ERIC N PRYSTOWSKY ◽  
JOHN CAMM ◽  
GREGORY Y.H. LIP ◽  
MAURITS ALLESSIE ◽  
JEAN-FRANÇOIS BERGMANN ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Clinical Data ◽  
Treatment Strategies ◽  
The Impact

scholarly journals Who Is Classified as Untestable on Brief Cognitive Screens in an Acute Stroke Setting?

Diagnostics ◽  
2019 ◽  
Vol 9 (3) ◽  
pp. 95 ◽  
Author(s):  
Emma Elliott ◽  
Bogna A. Drozdowska ◽  
Martin Taylor-Rowan ◽  
Robert C. Shaw ◽  
Gillian Cuthbertson ◽  
...  
Keyword(s):  
Cognitive Assessment ◽  
Odds Ratio ◽  
National Institutes Of Health ◽  
Screening Tests ◽  
Stroke Severity ◽  
Modified Rankin Scale ◽  
Cognitive Screening ◽  
Dementia Diagnosis ◽  
Nihss Score ◽  
Test Completion

Full completion of cognitive screening tests can be problematic in the context of a stroke. Our aim was to examine the completion of various brief cognitive screens and explore reasons for untestability. Data were collected from consecutive stroke admissions (May 2016–August 2018). The cognitive assessment was attempted during the first week of admission. Patients were classified as partially untestable (≥1 test item was incomplete) and fully untestable (where assessment was not attempted, and/or no questions answered). We assessed univariate and multivariate associations of test completion with: age (years), sex, stroke severity (National Institutes of Health Stroke Scale (NIHSS)), stroke classification, pre-morbid disability (modified Rankin Scale (mRS)), previous stroke and previous dementia diagnosis. Of 703 patients admitted (mean age: 69.4), 119 (17%) were classified as fully untestable and 58 (8%) were partially untestable. The 4A-test had 100% completion and the clock-draw task had the lowest completion (533/703, 76%). Independent associations with fully untestable status had a higher NIHSS score (odds ratio (OR): 1.18, 95% CI: 1.11–1.26), higher pre-morbid mRS (OR: 1.28, 95% CI: 1.02–1.60) and pre-stroke dementia (OR: 3.35, 95% CI: 1.53–7.32). Overall, a quarter of patients were classified as untestable on the cognitive assessment, with test incompletion related to stroke and non-stroke factors. Clinicians and researchers would benefit from guidance on how to make the best use of incomplete test data.

Changes in Activated Thrombin-Activatable Fibrinolysis Inhibitor Levels Following Thrombolytic Therapy in Ischemic Stroke Patients Correlate with Clinical Outcome

2016 ◽  
Vol 42 (5-6) ◽  
pp. 404-414 ◽  
Author(s):  
Marie-Christine Alessi ◽  
Christophe Gaudin ◽  
Philippe Grosjean ◽  
Valérie Martin ◽  
Serge Timsit ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Thrombolytic Therapy ◽  
Clinical Severity ◽  
Tissue Type ◽  
Stroke Severity ◽  
Thrombin Activatable Fibrinolysis Inhibitor ◽  
Nihss Score ◽  
Multicenter Observational Study ◽  
Fibrinolysis Inhibitor ◽  
Prospective Longitudinal

Background and Purpose: Thrombin-activatable fibrinolysis inhibitor (TAFI) activation following thrombolysis may affect thrombolysis effectiveness in acute ischemic stroke (AIS). To support this hypothesis, we propose to study the relationship between TAFI consumption, activated/inactivated TAFI (TAFIa/ai) and stroke severity and outcome in 2 groups of AIS patients, one treated and one untreated with intravenous recombinant tissue type plasminogen activator (rt-PA). Methods: In this prospective, longitudinal, multicenter, observational study, we aimed to study the association between TAFIa/ai and stroke outcome. TAFI levels were sequentially measured in patients treated with intravenous rt-PA thrombolysis (T), and in patients not given any thrombolytic therapy (NT). Baseline reference values were established in healthy subjects matched for age and gender. The National Institutes of Health Stroke Scale (NIHSS) score assessed at baseline and on day 2 was dichotomized into 2 severity groups (0-7 vs. >7). The modified Rankin Scale (mRS) score at day 90 was dichotomized for favorable (0-1) and unfavorable (2-6) outcomes. Results: A total of 109 patients were included, with 41 receiving rt-PA. At admission, patients had higher TAFIa/ai levels than reference. A significant increase in TAFIa/ai levels was observed at the end of thrombolysis (mean change from baseline of 963%) and lasted up to 4 h (191%). Higher TAFIa/ai levels were associated with a more severe day 2 NIHSS score (p = 0.0098 at T2h post thrombolysis) and an unfavorable mRS score from T48h (p = 0.0417) to day 90 (p = 0.0046). In NT patients, higher TAFIa/ai levels at admission were associated with a more severe stroke, as assessed by day 2 NIHSS score (p = 0.0026) and mRS score (p = 0.0003). Conclusion: These data demonstrate a consistent relationship between TAFI levels and early clinical severity during rt-PA treatment.

The Impact of Left Atrial Size on Long-Term Outcome of Catheter Ablation of Chronic Atrial Fibrillation

2009 ◽  
Vol 20 (11) ◽  
pp. 1211-1216 ◽  
Author(s):  
LI-WEI LO ◽  
YENN-JIANG LIN ◽  
HSUAN-MING TSAO ◽  
SHIH-LIN CHANG ◽  
AMEYA R. UDYAVAR ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Catheter Ablation ◽  
Left Atrial ◽  
Chronic Atrial Fibrillation ◽  
Left Atrial Size ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Atrial Size ◽  
The Impact

scholarly journals Irradiation-Induced Nasopharyngeal Necrosis in Newly Diagnosed Nasopharyngeal Carcinoma Treated by Intensity-Modulated Radiation Therapy: Clinical Characteristics and the Influence of Treatment Strategies

2021 ◽  
Author(s):  
Yi Xu ◽  
Yang Liu ◽  
Zekun Wang ◽  
Jingbo Wang ◽  
Jianghu Zhang ◽  
...  
Keyword(s):  
Nasopharyngeal Carcinoma ◽  
Clinical Characteristics ◽  
Propensity Scores ◽  
Treatment Strategies ◽  
Multivariate Logistic Regression Analysis ◽  
Intensity Modulated Radiotherapy ◽  
Progression Free Survival ◽  
Intensity Modulated ◽  
The Impact ◽  
Accumulated Dose

Abstract Purpose: To define the clinical characteristics of irradiation-induced nasopharyngeal necrosis (INN) after intensity-modulated radiotherapy (IMRT) and identify the influence of treatment strategies on INN in primary nasopharyngeal carcinoma (NPC) patients.Patients and methods: From 2008 to 2019, NPC patients pathologically diagnosed with INN after primary IMRT were reviewed. Those patients were matched with propensity scores for patients without INN in our center. The impact of treatment strategies on INN occurrence was assessed using univariate and multivariate logistic regression analysis. Results: The incidence rate of INN was 1.9% among the primary NPC population, and 53 patients with INN were enrolled. Headache and foul odor were the main symptoms, and 71.7% of cases had pseudomembrane during or at the end of radiotherapy. All patients were in early or middle stage INN, and no one presented with skull-based osteoradionecrosis. Then 212 non-INN patients were included based on propensity scores match. Overall survival (p=0.248) and progression-free survival (p=0.266) curves were similar between the INN and non-INN groups. Treatment strategies including combining chemotherapy or molecular targeted therapy with radiotherapy were not associated with INN occurrence, while boost dose (OR 7.360; 95% CI 2.301-23.547; P = 0.001) was a predictor factor for it. However, the optimal threshold for an accumulated dose to predict INN's occurrence was failed to determine.Conclusion: In the IMRT era, the severity of INN in primary NPC patients is lessened. This study showed that treatment strategies contributed little to develop INN, while the accumulated dose of radiation may relate to its occurrence.

Long-term prognosis of de novo atrial fibrillation during acute myocardial infarction: the impact of anti-thrombotic treatment strategies

2020 ◽  
Author(s):  
Felix Hofer ◽  
Niema Kazem ◽  
Andreas Hammer ◽  
Feras El-Hamid ◽  
Lorenz Koller ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Atrial Fibrillation ◽  
Acute Myocardial Infarction ◽  
Cardiovascular Mortality ◽  
Patient Population ◽  
De Novo ◽  
Treatment Strategies ◽  
Increased Risk ◽  
The Impact

Abstract Aims While the prognosis of patients presenting with de novo atrial fibrillation (AF) during the acute phase of myocardial infarction has been controversially discussed, it seems intuitive that affected individuals have an increased risk for both thrombo-embolic events and mortality. However, profound data on long-term outcome of this highly vulnerable patient population are not available in current literature. Therefore, we aimed to investigate the impact of de novo AF and associated anti-thrombotic treatment strategies on the patient outcome from a long-term perspective. Methods and results Patients presenting with acute myocardial infarction, treated at the Medical University of Vienna, were enrolled within a clinical registry and screened for the development of de novo AF. After discharge, participants were followed prospectively over a median time of 8.6 years. Primary study endpoint was defined as cardiovascular mortality. Out of 1372 enrolled individuals 149 (10.9%) developed de novo AF during the acute phase of acute myocardial infarction. After a median follow-up time of 8.6 years, a total of 418 (30.5%) died due to cardiovascular causes, including 93 (62.4%) in the de novo AF subgroup. We found that de novo AF was significantly associated with long-term cardiovascular mortality with an adjusted HR of 1.45 (95% CI 1.19–2.57; P &lt; 0.001). While patients with de novo AF were less likely to receive a triple anti-thrombotic therapy as compared to patients with pre-existing AF at time of discharge, this therapeutic approach showed a strong and inverse association with mortality in de novo AF, with an adj. HR of 0.86 (95% CI 0.45–0.92; P = 0.012). Conclusion De novo AF was independently associated with a poor prognosis with a 67% increased risk of long-term cardiovascular mortality. Intensified anti-thrombotic treatment in this high-risk patient population might be considered.

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