Multimodal Retinal Imaging for Detection of Ischemic Stroke

Background: This study aims to evaluate ocular changes in patients with ischemic stroke using multimodal imaging and explore the predictive value of ocular abnormalities for ischemic stroke.Methods: A total of 203 patients (ischemic stroke group, 62; control group, 141) were enrolled in this study. Basic data from patients, including age; gender; height; weight; history of hypertension, hyperlipidemia, diabetes, alcohol use, and coronary heart disease; and smoking status, were collected. Consequently, Doppler color ultrasound, color fundus photography, and optical coherence tomography (OCT) examinations were conducted. Differences in traditional risk factors and ocular parameters between the two groups were compared, and binary logistic regression was used for multivariate analysis.Results: The central retinal artery equivalent (CRAE) in the ischemic stroke group was 150.72 ± 20.15 μm and that in the control group was 159.68 ± 20.05 μm. The difference was statistically significant (P = 0.004). Moreover, the subfoveal choroidal thickness (SFChT) in the ischemic stroke group was 199.90 ± 69.27 μm and that in the control group was 227.40 ± 62.20 μm. The difference was statistically significant (P = 0.006). Logistic regression results showed that smoking [odds ratio (OR) = 2.823; 95% confidence interval (95% CI) = 1.477–5.395], CRAE (OR = 0.980; 95% CI = 0.965–0.996), and SFChT (OR = 0.994; 95% CI = 0.989–0.999) are associated with increased risk of ischemic stroke when ocular parameters were combined with traditional risk factors. The area under the receiver operating characteristic (ROC) curve was 0.726, which shows good diagnostic accuracy.Conclusion: SFChT may be a diagnostic marker for early detection and monitoring of ischemic stroke. Combined with traditional risks, retinal artery diameter, and choroidal thickness, the prediction model can improve ischemic stroke prediction.

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Risk Factors of Recurrent Ischemic Events after Acute Noncardiogenic Ischemic Stroke

Current Pharmaceutical Design ◽

10.2174/1381612825666191029103756 ◽

2020 ◽

Vol 25 (45) ◽

pp. 4827-4834 ◽

Cited By ~ 1

Author(s):

Limin Zhang ◽

Xingang Li ◽

Dongzhi Wang ◽

Hong Lv ◽

Xuezhong Si ◽

...

Keyword(s):

Risk Factors ◽

Logistic Regression ◽

Regression Analysis ◽

Ischemic Stroke ◽

Operating Characteristic ◽

Control Group ◽

Case Group ◽

Stroke Patients ◽

Clopidogrel Therapy ◽

Ischemic Events

Background: A considerable proportion of acute noncardiogenic ischemic stroke patients continue to experience recurrent ischemic events after standard therapy. Aim: We aimed to identify risk factors for recurrent ischemic event prediction at an early stage. Methods : 286 non-cardioembolic ischemic stroke patients with the onset of symptoms within 24 hours were enrolled. Vascular risk factors, routine laboratory data on admission, thromboelastography test seven days after clopidogrel therapy and any recurrent events within one year were assessed. Patients were divided into case group (patients with clinical adverse events, including ischemic stokes, transient ischemic attack, myocardial infarction and vascular related mortality) and control group (events-free patients). The risk of the recurrent ischemic events was determined by the receiver operating characteristic curve and multivariable logistic regression analysis. Results: Clinical adverse events were observed in 43 patients (case group). The mean levels of Mean Platelet Volume (MPV), Platelet/Lymphocyte Ratio (PLR), Lymphocyte Count (LY) and Fibrinogen (Fib) on admission were significantly higher in the case group as compared to the control group (P<0.001). Seven days after clopidogrel therapy, the ADP-induced platelet inhibition rate (ADP%) level was lower in the case group, while the Maximum Amplitude (MA) level was higher in the case group as compared to the control group (P<0.01). The Area Under the Curve (AUC) of receiver operating characteristic(ROC) curve of LY, PLR, , Fib, MA, ADP% and MPV were 0.602, 0.614, 0.629, 0.770, 0.800 and 0.808, respectively. The logistic regression analysis showed that MPV, ADP% and MA were indeed predictive factors. Conclusion: MPV, ADP% and MA were risk factors of recurrent ischemic events after acute noncardiogenic ischemic stroke. Urgent assessment and individual drug therapy should be offered to these patients as soon as possible.

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Abstract T P158: Prolonged Atrial Electrical Mechanical Delay on Echocardiography in Patients With Cryptogenic Stroke

Stroke ◽

10.1161/str.45.suppl_1.tp158 ◽

2014 ◽

Vol 45 (suppl_1) ◽

Author(s):

Dae-Hyun Kim ◽

Seong-HO Choi ◽

Jong-Seong Park ◽

Hyun-Wook Nagh ◽

Jae-Kwan Cha

Keyword(s):

Risk Factors ◽

Atrial Fibrillation ◽

Body Mass Index ◽

Logistic Regression ◽

Regression Analysis ◽

Body Mass ◽

Cryptogenic Stroke ◽

Control Group ◽

Lower Body ◽

Stroke Group

Backgrounds and Purpose: One quarter of strokes are cryptogenic, and subclinical atrial fibrillation may be a common etiologic factor. Prolonged atrial electrical-mechanical delay was known as a predictor of paroxysmal atrial fibrillation (AF). We evaluated whether the prevalence of prolonged atrial electrical-mechanical delay suggesting the presence of atrial substrates for paroxysmal AF may be higher in patients with cryptogenic stroke. Methods: We retrospectively reviewed data from patients with ischemic stroke who were admitted to our hospital between January 2011 and December 2012, and selected patients with cryptogenic stroke who underwent echocardiography. Patients who underwent echocardiography for health care examination were enrolled in control group. Age, sex and underlying risk factors were matched in two groups. Atrial electrical-mechanical delay (PA interval) was defined as the time interval (msec) from the initiation of P wave on surface electrocardiogram to the initiation of trans-mitral inflow on pulse wave Doppler echocardiogram during late diastole. Clinical significance of PA interval was evaluated. Results: Total 130 patients in cryptogenic stroke group and 130 persons in control group were enrolled. Mean age was 63 ± 11 years and 176 (68%) were male. The PR interval (178 ± 27 vs. 165 ± 27 msec, p < 0.0001) and PA interval (74 ± 15 vs. 61 ± 13 msec, p < 0.0001) were longer in cryptogenic stroke patients. The body mass index (23 ± 3 vs. 24 ± 3, p = 0.043) was lower and mitral E/E’ ratio (8.8 ± 3.0 vs. 8.0 ± 2.6 msec, p < 0.0001) was higher in cryptogenic stroke group. Prolonged PR (OR: 1.019, CI: 1.009 - 1.029, p < 0.0001) and PA (OR: 1.068, CI: 1.045 - 1.093, p < 0.0001) intervals, and lower body mass index (OR: 0.919, CI: 0.846 - 0.998) were risk factors for cryptogenic stroke in univariate logistic regression analysis. Prolonged PA (OR: 1.060, CI: 1.035 - 1.086, p < 0.0001) and PR (OR: 1.019, CI: 1.004 - 1.034, p = 0.011) intervals, and lower body mass index (OR: 0.845, CI: 0.764 - 0.935, p = 0.001) were risk factors for cryptogenic stroke in multivariate logistic regression analysis. Conclusion: The prevalence of prolonged atrial electrical-mechanical delay suggesting atrial substrates for paroxysmal AF was higher in patients with cryptogenic stroke.

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Comparison of risk factors for ischemic stroke and coronary events in a population-based cohort

BMC Cardiovascular Disorders ◽

10.1186/s12872-021-02344-4 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Iram Faqir Muhammad ◽

Yan Borné ◽

Suneela Zaigham ◽

Martin Söderholm ◽

Linda Johnson ◽

...

Keyword(s):

Risk Factors ◽

Ischemic Stroke ◽

Inflammatory Markers ◽

Cox Regression ◽

Population Based ◽

Cox Regression Analysis ◽

Hazard Ratios ◽

The Difference ◽

Coronary Events ◽

Traditional Risk Factors

Abstract Background Although coronary events (CE) and ischemic stroke share many risk factors, there are also some important differences. The aim of this paper was to assess the association of risk factors in relation to incident CE and ischemic stroke and to evaluate the heterogeneity in patterns of risk factors between the two outcomes. Method Traditional risk factors and inflammatory markers associated with coronary events and ischemic stroke were measured in the Malmö Diet and Cancer Cohort (MDCS, n = 26 519), where a total of 2270 incident ischemic stroke and 3087 incident CE occurred during a mean follow up time 19 ± 6 years, and in relation to inflammatory markers in the cardiovascular sub-cohort (MDC-CV, n = 4795). Cox regression analysis was used to obtain hazard ratios. A modified Lunn-McNeil competing risk analysis was conducted to assess the significance of any differences in risk profiles of these outcomes. Results Most cardiovascular risk factors were associated both with incident CE and ischemic stroke. However, current smoking, ApoB, low ApoA1, male sex and education level of ≤ 9 years of schooling were preferentially associated with CE compared to ischemic stroke. Conversely, age showed a stronger association with ischemic stroke than with CE. Conclusion CE and ischemic stroke have broadly similar risk factors profiles. However, there are some important differential associations, as well as substantial differences in the magnitude of the association. These could reflect the distinct biology of atherogenesis in different vascular beds. The difference in the determinants highlights the importance of looking at CE and ischemic stroke, two manifestations of cardiovascular disease, separately.

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Association of Protein Z Deficiency with Retinal Artery and Vein Occlusion.

Blood ◽

10.1182/blood.v104.11.3510.3510 ◽

2004 ◽

Vol 104 (11) ◽

pp. 3510-3510

Author(s):

Maya Koren-Michowitz ◽

Eva Eting ◽

Yulia Voltchek ◽

Naomi Rahimi-Levene ◽

Osnat Garach-Jehoshua ◽

...

Keyword(s):

Risk Factors ◽

Ischemic Stroke ◽

Study Group ◽

Protein Z ◽

Low Protein ◽

Vein Occlusion ◽

Increased Risk ◽

Significant Difference ◽

Retinal Artery ◽

Traditional Risk Factors

Abstract Central retinal vein occlusion (CRVO) and central retinal artery occlusion (CRAO) are common disorders mainly associated with traditional risk factors for atherosclerosis. There is no clear correlation between thrombophilia and CRVO. However it was suggested that hyperhomocysteinemia and the presence of antiphospholipid antibodies are risk factors for the development of CRAO. Protein Z is a vitamin K dependent cofactor for the inactivation of activated factor X (Xa) by the protein Z dependent protease inhibitor (ZPI). Protein Z deficiency presumably promotes thrombosis, in particular arterial thrombosis, as suggested by an association between low plasma protein Z levels and ischemic stroke. The similarity between risk factors for ischemic stroke and CRVO / CRAO and the fact that low protein Z levels are associated with an increased risk for ischemic stroke has led us to assess protein Z levels in patients with CRVO and CRAO. Plasma samples from 29 patients with CRVO and 7 patients with CRAO (total study group= 36, mean age 60±11) were screened for protein Z levels by ELISA. Study group was also screened for the presence of lupus anticoagulant (LAC) by the kaolin clotting time (KCT) index and the dilute Russells’ viper venum test (DRVVT), for activated protein C resistance (APCR) and anticardiolipin antibodies (ACA). Levels of protein Z were compared with a control group of 42 healthy individuals (mean age 43±11). Patients with CRAO and history of ischemic stroke or an embolic source were excluded. Thirty patients in the study group had traditional risk factors for atheroscalerosis including hypertension, diabetes mellitus, hyperlipidemia and smoking and 6 patients had none. There was no significant difference in protein Z levels between the whole study group patients and controls (1995±810 vs. 2010±603 ng/ml p=0.922). However, patients with no risk factors for CRVO/CRAO had significantly lower protein Z levels than controls (1379±682 vs. 2010±603 ng/ml p=0.022) and patients with risk factors (1379±682 vs. 2118±785 ng/ml p=0.04). In the study group three patients had abnormal APCR and 6 had positive LAC. There was no correlation between low protein Z levels and the presence of LAC, APCR or ACA, or a correlation between low protein Z levels and the specific diagnosis (CRVO or CRAO) or age. The data show that low protein Z levels may be an additional risk factor for CRVO and CRAO in patients without traditional risk factors for these disorders. The association should be explored in a larger group of patients.

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FGB -455 G>A and GP IIIa PIA1/A2 polymorphisms in a group of Romanian stroke patients

Revista Romana de Medicina de Laborator ◽

10.1515/rrlm-2016-0002 ◽

2016 ◽

Vol 24 (1) ◽

pp. 45-54

Author(s):

Felicia Maria Petrişor ◽

Andreea Cătană ◽

Dragoş Horea Mărginean ◽

Adrian Pavel Trifa ◽

Radu Anghel Popp ◽

...

Keyword(s):

Risk Factors ◽

Logistic Regression ◽

Regression Analysis ◽

Ischemic Stroke ◽

Logistic Regression Analysis ◽

Positive Association ◽

Variant Allele ◽

Control Group ◽

Stroke Patients ◽

Pcr Rflp

Abstract Introduction: Being a multifactorial disease, stroke is one of a major causes of death and disability worldwide. Several genetic polymorphisms have been associated with stroke etiophatology and FGB −455 G>A and GP IIIa PIA1/A2 are among them. In the present study, we investigated the association between FGB −455 G>A and GP IIIa PIA1A2 polymorphisms and the risk of ischemic stroke in a group of Romanian stroke patients. Subjects and methods: This case-control study included 148 patients with ischemic stroke and 150 healthy age, sex and ethnically matched unrelated controls. FGB −455G>A and GP IIIa PIA1A2 genotyping was carried out using PCR-RFLP. The association of FGB −455G>A and GP IIIa PIA1A2 polymorphisms and cardiovascular risk factors with ischemic stroke was tested using logistic regression analysis. Results: Molecular analysis did not reveal an increased frequency of the FGB -455 G>A variant allele and GP IIIa PIA1/A2 variant allele in the study group compared to the control group (p = 0.140, OR = 0.750, 95% CI = 0.522 - 1.077; p = 0.823, OR = 0.944, 95% CI = 0.558 - 1.599 respectively). Furthermore, after performing logistic regression analysis adjusted for the known risk factors, a positive association with stroke was found in smokers (p = 0.026, OR = 1.800, 95% CI = 1.071 - 3.024) Conclusions: No association was found between FGB −455 G>A and GP IIIa PIA1/A2 polymorphisms and ischemic stroke in the studied population.

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Traditional risk factors and combined genetic markers of recurrent ischemic stroke in adults

Journal of Thrombosis and Haemostasis ◽

10.1111/jth.15448 ◽

2021 ◽

Author(s):

Lamia M’barek ◽

Salma Sakka ◽

Fatma Megdiche ◽

Nouha Farhat ◽

Khadija Maalla ◽

...

Keyword(s):

Risk Factors ◽

Ischemic Stroke ◽

Genetic Markers ◽

Traditional Risk Factors

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Association of Hypertriglycerideamia with Ischaemic Stroke

Bangladesh Journal of Neuroscience ◽

10.3329/bjn.v32i1.57411 ◽

2016 ◽

Vol 32 (1) ◽

pp. 34-38

Author(s):

Biplob Kumar Das ◽

Kanak Jyoti Mondal

Keyword(s):

Risk Factors ◽

Logistic Regression ◽

Ischaemic Stroke ◽

Significant Risk ◽

Serum Triglyceride ◽

Control Group ◽

Case Group ◽

Stepwise Logistic Regression ◽

Serum Triglyceride Level ◽

Analysis Model

Stroke is one of the foremost causes of morbidity, mortality and is a socioeconomic challenge. This is particularly true for developing countries like Bangladesh, where health support system including the rehabilitation system is not within the reach of common people. Hypertriglycerademia has an effective influence in the pathogenesis of Ischaemic Stroke (IS). So, the focus of this study was to evaluate and assess the association of serum triglyceride level in patients of IS. This case control study was carried out in the Department of Neurology in collaboration with Department of Biochemistry, BSMMU, Dhaka from July 2011 to June 2013. In this study, 60 diagnosed cases of ischaemic stroke patients and 60 age and sex matched healthy controls were enrolled. Risk factors of Ischemic Stroke (IS) patients were assessed ( adjusted Odds Ratio) in comparison with healthy adults. In this study, being married [OR. 1.95, 95% CI (0.40-9.42), p=0.409] , smoker [OR.1.65, 95% CI (0.57 - 4.82),p= 0.357], DM [OR. 1.48, 95% CI (0.36-6.06), p=0.582 ], IHD [OR. 1.51, 95% CI (0.29 – 7.89), p=0.624] , HTN [OR. 3.66, 95% CI (1.11–12.12), p=0.033] , overweight [OR.2.31, 95% CI (0.77 – 6.91), 0.135] and obesity [OR. 16.19, 95% CI (1.31–200.6), p=0.030] , increased level of serum TC [OR.8.24, 95% CI (2.07 – 32.83), p=0.003], TG [OR. 9.40, 95% CI (1.17 -75.86), p=0.035], LDL [OR. 0.45, 95% CI (0.10–2.05), p=0.308],and decreased level of HDL [OR. 3.37, 95% CI (1.03 - 12.25), p=0.045] were found as risk factors in developing IS. Independent t-test was done to find out the statistically significant differences of continuous variables like serum lipid profile between case and control group. The mean (SD) value of TG which is focus of this study, was found 237.67 (61.74) in case group, and 169.97 (26.95) in control group which was highly statistically significant (p < 0.0001). All of the significant variables were entered into stepwise logistic regression analysis model. From the logistic regression model, it can be finally concluded that hypertension, obesity, increased level of TC, increased level of TG and decreased level of HDL were statistically significant risk factors for development of IS. Bangladesh Journal of Neuroscience 2016; Vol. 32 (1): 34-38

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Factors associated with 90-day acute ischemic stroke in patients ≥70 years old with total hip arthroplasty for hip fracture

BMC Geriatrics ◽

10.1186/s12877-021-02728-3 ◽

2022 ◽

Vol 22 (1) ◽

Author(s):

Rui He ◽

Guoyou Wang ◽

Ting Li ◽

Huarui Shen ◽

LijuanZhang

Keyword(s):

Risk Factors ◽

Atrial Fibrillation ◽

Logistic Regression ◽

Ischemic Stroke ◽

Hip Fracture ◽

Total Hip Arthroplasty ◽

Older Age ◽

Factors Associated ◽

Independent Risk Factors ◽

D Dimer

Abstract Background Postoperative ischemic stroke is a devastating complication following total hip arthroplasty (THA). The purpose of the current study was to investigate the incidence of postoperative acute ischemic stroke (AIS) in patients ≥70 years old with THA for hip fracture after 90 days and independent risk factors associated with 90-day AIS. Methods A multicenter retrospective study was conducted, patients ≥70 years old with THA for hip fracture under general anesthesia were included from February 2017 to March 2020. Patients with AIS within 90 days after THA were identified as AIS group; patients with no AIS were identified as no AIS group. The baseline characteristics and risk factors were collected, multivariable logistic regression was used to identify independent risk factors of 90-dayAIS. Results: 2517 patients (mean age 76.18 ± 6.01) were eligible for inclusion in the study. 2.50% (63/2517) of patients had 90-day AIS. Compared with no AIS, older age, diabetes, hyperlipidemia, atrial fibrillation (AF) and higher D-dimer value were more likely in patients with AIS (P < 0.05), and anticoagulant use was fewer in patients with AIS. ROC curve analysis showed that the optimal cut point of D-dimer for AIS was D-dimer≥4.12 μg/ml. Multivariate logistic regression analysis showed that D-dimer≥4.12 μg/ml [adjusted odds ratio (aOR), 4.44; confidence interval (CI), 2.50–7.72; P < 0.001], older age (aOR, 1.08; 95%CI, 1.03–1.12; P < 0.001), hyperlipidemia (aOR, 2.28; 95%CI, 1.25–4.16; P = 0.007), atrial fibrillation (aOR, 5.84; 95% CI, 1.08–15.68; P = 0.001), and diabetes (aOR, 2.60; 95% CI, 1.56–4.39; P < 0.001) were associated with increased risk of 90-day AIS after THA. Conclusions In conclusion, we found that the incidence of 90-day AIS in patients≥70 years old with THA for hip fracture was 2.5%. Older age, diabetes, hyperlipidemia, AF and higher D-dimer value were independent risk factors for 90-day AIS in patients≥70 years old with THA for hip fracture.

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Osteosarcopenia in chronic pancreatitis

Terapevticheskii arkhiv ◽

10.26442/00403660.2021.08.200971 ◽

2021 ◽

Vol 93 (8) ◽

pp. 869-875

Author(s):

Irina V. Kozlova ◽

Anna P. Bykova

Keyword(s):

Risk Factors ◽

Body Mass Index ◽

Chronic Pancreatitis ◽

Body Mass ◽

Assessment Tool ◽

Reproductive Function ◽

Enzyme Linked Immunosorbent Assay ◽

Control Group ◽

Colon Mucosa ◽

Traditional Risk Factors

Aim. To determine clinical features and some mechanisms of osteosarcopenia development in patients with chronic pancreatitis (CP). Materials and methods. A casecontrol study was conducted on the basis of the Saratov State Clinical Hospital 5 in 20152018 of patients with CP. In a study of 161 patients with CP included, the control group 30 healthy individuals. Patients were divided into groups according to the etiology of CP: 79 with toxic-metabolic CP, 82 with biliary CP. To determine the risks of low-energy fractures, 154 patients were tested with the Fracture risk assessment tool (FRAX). Along with the standard examination, 30 patients with CP dual-energy X-ray absorptiometry was performed. To assess the state of skeletal muscles, body mass index was determined, hand-held dynamometry was performed, and a set of Short Physical Performance Battery (SPPB) tests was used. Along with the assessment of traditional risk factors for osteosarcopenia gender, age, state of reproductive function in women, body mass index, functional state of the pancreas (pancreas) the quantitative content of interleukins (IL)-2, 6, 8 in in colonic biopsies was analyzed by enzyme-linked immunosorbent assay (ELISA). Results. Bone disorders, according to densitometry, was detected in 70.0% of patients with CP, in 13.3% of the control group. Presarcopenia was detected in 62 (38.5%) patients with CP, sarcopenia in 34 (21.1%), in the control group presarcopenia and sarcopenia were not detected. Sarcopenia was statistically significantly more common in toxic-metabolic CP than in biliary CP (2=11.6; p0.001). Correlations of the lumbar spine T-score and IL-6 (r=-0.29; p=0.03), IL-8 (r=-0.29; p=0.04) were revealed. Correlations between sarcopenia and the concentration of cytokines in the in the colon mucosa in CP were determined (IL-2: r=0.44; p0.001; IL-6: r=0.48; p0.001; IL-8: r=0.42; p0.001). Conclusion. The development of osteopenia and sarcopenia syndromes in CP is interrelated and associated with both traditional risk factors and an increased concentration of cytokines in the in the colon mucosa.

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Clinical Impact of Estradiol/Testosterone Ratio in Patients with Acute Ischemic Stroke

10.21203/rs.3.rs-33503/v3 ◽

2020 ◽

Author(s):

Jung-Won Choi ◽

In Woo Ryoo ◽

Jun Yeong Hong ◽

Kyung-Yul Lee ◽

Hyo Suk Nam ◽

...

Keyword(s):

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Sex Hormones ◽

Control Group ◽

Control Groups ◽

Sexual Hormones ◽

Stroke Group ◽

Male Patients ◽

And Control

Abstract Background: Sex hormones may be associated with a higher incidence of ischemic stroke or stroke-related events. In observational studies, lower testosterone concentrations are associated with infirmity, vascular disease, and adverse cardiovascular risk factors. Currently, female sexual hormones are considered neuroprotective agents. The purpose of this study was to assess the role of sex hormones and the ratio of estradiol/testosterone (E/T) in patients with acute ischemic stroke (AIS).Methods: Between January 2011 and December 2016, 146 male patients with AIS and 152 age- and sex-matched control subjects were included in this study. Sex hormones, including estradiol, progesterone, and testosterone, were evaluated in the AIS patient and control groups. We analyzed the clinical and physiological levels of sex hormones and hormone ratios in these patients.Results: The E/T ratio was significantly elevated among patients in the stroke group compared to those in the control group (P = 0.001). Categorization of data into tertiles revealed that patients with the highest E/T ratio were more likely to have AIS [odds ratio (OR) 3.084; 95% Confidence interval (CI): 1.616-5.886; P < 0.001) compared with those in the first tertile. The E/T ratio was also an independent unfavorable outcome predictor with an adjusted OR of 1.167 (95% CI: 1.053-1.294; P = 0.003).Conclusions: These findings support the hypothesis that increased estradiol and reduced testosterone levels are associated with AIS in men.

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