Relationship between silent brain infarction, periventricular hyperintensity and blood pressure.

Background/Aim. A certain percentage of patients with asymptomatic carotid stenosis have an unstable carotid plaque. For these patients it is possible to register by modern imaging methods the existence of lesions of the brain parenchyma - the silent brain infarction. These patients have a greater risk of ischemic stroke. The aim of this study was to analyze the connection between the morphology of atherosclerotic carotid plaque in patients with asymptomatic carotid stenosis and the manifestation of silent brain infarction, and to analyze the influence of risk factors for cardiovascular diseases on the occurrence of silent brain infarction and the morphology of carotid plaque. Methods. This retrospective study included patients who had been operated for high grade (> 70%) extracranial atherosclerotic carotid stenosis at the Clinic for Vascular and Transplantation Surgery of the Clinical Center of Vojvodina over a period of 5 years. The patients analyzed had no clinical manifestation of cerebrovascular insufficiency of the carotid artery territory up to the time of operation. The classification of carotid plaque morphology was carried out according to the Gray-Weale classification, after which all the types were subcategorized into two groups: stable and unstable. Brain lesions were verified using preoperative imaging of the brain parenchyma by magnetic resonance. We analyzed ipsilateral lesions of the size > or = 3 mm. Results. Out of a 201 patients 78% had stable plaque and 22% unstable one. Unstable plaque was prevalent in the male patients (male/female ratio = 24.8% : 17.8%), but without a statistically significant difference (p > 0.05). The risk factors (hypertension, nicotinism, hyperlipoproteinemia, and diabetes mellitus) showed no statistically significant impact on carotid plaque morphology and the occurrence of silent brain infarction. Silent brain infarction was detected in 30.8% of the patients. Unstable carotid plaque was found in a larger percentage of patients with silent brain infarction (36.4% : 29.3%) but without a significant statistical difference (p > 0.05). Conclusions. Even though silent brain infarction is more frequent in patients with unstable plaque of carotid bifurication, the difference is of no statistical significance. The effects of the number and type of risk factors bear no statistical significance on the incidence of morphological asymptomatic carotid plaque.

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Abstract 2791: Silent Brain Infarction Predicts Cardiovascular Events And Mortality In Long-term Hemodialysis Patients

Circulation ◽

10.1161/circ.116.suppl_16.ii_620 ◽

2007 ◽

Vol 116 (suppl_16) ◽

Author(s):

Toru Aoyama ◽

Hideki Ishii ◽

Hiroshi Takahashi ◽

Takanobu Toriyama ◽

Toru Aoyama ◽

...

Keyword(s):

Proportional Hazards ◽

Brain Infarction ◽

Cox Proportional Hazards ◽

Powerful Predictor ◽

Cardiac Events ◽

Cox Proportional Hazards Models ◽

Silent Brain Infarction ◽

Cv Disease ◽

Overall Mortality

Background: The cardiovascular (CV) events and mortality are significantly higher in hemodialysis (HD) patents compared to the general population. Although it is of clinical concern to predict the occurrence of CV events in long-term HD patients, more powerful predictor has under exploration. We investigated as to whether silent brain infarction (SBI) would be a predictable factor for future CV events and mortality in a large cohort of patients with long-term HD patients. Methods: After cranial magnetic resonance imaging to detect SBI, 202 long-term HD patients (7.1 ± 5.9 years) without symptomatic stroke were prospectively followed up until the incident of CV events (stroke, cardiac events, and death). We analyzed the prognostic role of SBI in CV events with the Kaplan-Meier method and Cox proportional hazards analysis. Results: The prevalence of SBI was quite higher compared to the previous reports (71.8% in all the patients). In overall patients, 60 patients suffered from CV disease (31 for coronary artery disease, 7 for congestive heart failure, 14 for symptomatic stroke) and 29 patients died (16 for CV death) during a follow up period (mean= 23 ± 13 months). In subgroup analysis regarding the presence of SBI, CV event-free survival rate for 4 years was significantly lower in the patients with SBI compared to those without SBI (54.6% vs. 86.7%, p=0.0003). CV and overall mortality were also significantly higher in SBI patients compared with No-SBI patients (CV mortality; 20.5 % vs. 4.3 %, overall mortality; 29.0% vs. 9.1% p< 0.01, respectively). Cox proportional hazards models showed that the presence of SBI was a significant predictor of cerebrovascular and CV events and CV and overall mortality even after adjustment for other CV risk factors listed on the Table . Conclusion: SBI detected with MRI would be powerful predictor of CV events and mortality in long-term HD patients. Hazard ratio (HR) of SBI for future events and mortality

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Elevated Plasma Homocysteine Levels and Risk of Silent Brain Infarction in Elderly People

Stroke ◽

10.1161/01.str.32.5.1116 ◽

2001 ◽

Vol 32 (5) ◽

pp. 1116-1119 ◽

Cited By ~ 86

Author(s):

Toshifumi Matsui ◽

Hiroyuki Arai ◽

Takefumi Yuzuriha ◽

Hiroshi Yao ◽

Masakazu Miura ◽

...

Keyword(s):

Elderly People ◽

Brain Infarction ◽

Plasma Homocysteine ◽

Elevated Plasma ◽

Silent Brain Infarction

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Silent brain infarction after minimally invasive cardiac surgery with retrograde perfusion

10.22541/au.158981358.84615395 ◽

2020 ◽

Author(s):

Shuhei Nishijima ◽

Yoshitsugu Nakamura ◽

Daiki Yoshiyama ◽

Yuto Yasumoto ◽

Miho Kuroda ◽

...

Keyword(s):

Cardiac Surgery ◽

Minimally Invasive ◽

Brain Infarction ◽

Minimally Invasive Cardiac Surgery ◽

Retrograde Perfusion ◽

Silent Brain Infarction

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Association of the miR-146a , miR-149 , miR-196a2 , and miR-499 Polymorphisms With Ischemic Stroke and Silent Brain Infarction Risk

Arteriosclerosis Thrombosis and Vascular Biology ◽

10.1161/atvbaha.112.300251 ◽

2013 ◽

Vol 33 (2) ◽

pp. 420-430 ◽

Cited By ~ 83

Author(s):

Young Joo Jeon ◽

Ok Joon Kim ◽

Su Yeoun Kim ◽

Seung Hun Oh ◽

Doyeun Oh ◽

...

Keyword(s):

Ischemic Stroke ◽

Brain Infarction ◽

Silent Brain Infarction

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Blood Pressure and Heart Rate Measures Associated With Increased Risk of Covert Brain Infarction and Worsening Leukoaraiosis in Older Adults

Arteriosclerosis Thrombosis and Vascular Biology ◽

10.1161/atvbaha.117.309298 ◽

2017 ◽

Vol 37 (8) ◽

pp. 1579-1586 ◽

Cited By ~ 11

Author(s):

Lester Y. Leung ◽

Traci M. Bartz ◽

Kenneth Rice ◽

James Floyd ◽

Bruce Psaty ◽

...

Keyword(s):

Blood Pressure ◽

Older Adults ◽

Heart Rate ◽

Brain Infarction ◽

Increased Risk

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Abstract TP164: Blood Pressure and Heart Rate Measures and Risk of Covert Brain Infarction and Worsening White Matter in Older Adults

Stroke ◽

10.1161/str.48.suppl_1.tp164 ◽

2017 ◽

Vol 48 (suppl_1) ◽

Author(s):

Lester Y Leung ◽

Traci M Bartz ◽

Kenneth Rice ◽

James Floyd ◽

Bruce Psaty ◽

...

Keyword(s):

Blood Pressure ◽

Older Adults ◽

Heart Rate ◽

White Matter ◽

Cardiovascular Health ◽

Brain Infarction ◽

Health Study ◽

Cardiovascular Health Study ◽

Mri Findings ◽

Increased Risk

Introduction: Covert brain infarction (CBI) and worsening white matter grade (WMG) on serial MRI are associated with increased risk for ischemic stroke and dementia. Hypothesis: We sought to evaluate the association of various measures of blood pressure and heart rate with these MRI findings. Methods: In the Cardiovascular Health Study, a longitudinal cohort study of cardiovascular disease in older adults, we used relative risk regression to assess the risk of incident CBI and worsening WMG associated with mean, variability, and trend in systolic blood pressure (SBP), diastolic blood pressure (DBP), and heart rate (HR) measured at four or more annual clinic visits between two brain MRIs. We included participants who underwent both brain MRIs and had no change in antihypertensive medication status, no CBI on the initial MRI, and no stroke before the follow-up MRI. Results: Among 897 eligible participants, incident CBI occurred in 15% and worsening WMG in 27%. Mean SBP mean was strongly associated with increased risk for incident CBI (RR per 10 mmHg 1.29; 95% CI, 1.13-1.47), and DBP mean was strongly associated with increased risk for worsening WMG (RR per 10 mmHg 1.43; 95% CI, 1.23-1.67). DBP variability may be associated with incident CBI (RR per 10 mmHg 1.71; 95% CI, 1.10-2.65), The HR measures were not associated with these MRI findings. Conclusions: Elevated mean levels of blood pressure contribute to covert cerebrovascular diseases. Control of mean blood pressure levels, even in older adults, remains a high priority for prevention of vascular brain injury.

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Abstract 135: Examining the Information Loss Between Neuroimages and Neuroimaging Reports for Detection of Silent Brain Infarcts and White Matter Disease Using Artificial Intelligence Technologies

Stroke ◽

10.1161/str.51.suppl_1.135 ◽

2020 ◽

Vol 51 (Suppl_1) ◽

Author(s):

Lester Y Leung ◽

Sunyang Fu ◽

Jason Nelson ◽

David F Kallmes ◽

Patrick H Luetmer ◽

...

Keyword(s):

White Matter ◽

Language Processing ◽

Interrater Reliability ◽

Medical Center ◽

Brain Infarction ◽

White Matter Disease ◽

Standardized Protocol ◽

Cohort Identification ◽

Silent Brain Infarction ◽

Good For

Background: Real world studies of silent brain infarction (SBI) and white matter disease (WMD) are impeded by challenges in cohort identification. Natural language processing (NLP) from imaging reports may facilitate future studies. However, electronic health records can be heterogeneous and the process of interpreting neuroimages and generating reports can vary. Understanding knowledge representation and relationships between neuroimages and imaging reports is crucial for using NLP to facilitate disease management and cohort identification. Methods: A balanced sample of head neuroimages (CT, MRI) of patients >50 years without clinical histories of symptomatic stroke, TIA, or dementia were obtained at Mayo Clinic and Tufts Medical Center. A team of 4 radiology residents performed report interpretation (RI) on 1000 reports according to a standardized protocol for the presence of SBIs, the presence of WMD, and WMD grade. A random subsample of 400 was doubly read for interrater reliability. For benchmarking, a team of 4 neuroradiologists directly reviewed and described findings on a subsample of 182 images, each doubly read. We assessed interrater reliability for direct review (DR) and RI, and agreement between these 2 information sources. An NLP algorithm was developed to review and extract findings from 1000 imaging reports. Results: For DR, interrater reliability was moderate for SBIs and WMD (k = 0.53, 95% CI 0.43-0.64 and k = 0.47, 95% CI 0.33-0.61) and good for WMD grade (Spearman 0.71, p<0.001). For RI, interrater reliability for SBIs, WMD and WMD grade was good (k = 0.88, 95% CI 0.80-0.97; k = 0.98, 95% CI 0.97-1.00; and Spearman = 0.985, p<0.001, respectively). Agreement between DR and RI was good for SBIs (k = 0.77, 95% CI 0.67-0.86) and WMD (k = 0.65, 95% CI 0.54-0.77). Spearman rank correlations comparing WMD grade interpretation DR to RI was 0.60 (p<0.001). In identifying the presence of SBIs and WMDs, the accuracy of the NLP algorithm was 0.991 and 0.994, respectively. Conclusion: For the presence of SBI and WMD, and WMD grade, agreement between RI and DR was similar to agreement between 2 neuroradiologists directly reviewing neuroimages. It is highly feasible to use NLP to identify patients with SBIs and WMDs for clinical studies.

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Abstract TP571: Coated-Platelets, RANTES and IL-7 Correlate With Silent Brain Infarction in Carotid Stenosis

Stroke ◽

10.1161/str.50.suppl_1.tp571 ◽

2019 ◽

Vol 50 (Suppl_1) ◽

Author(s):

Mohamad Khattab ◽

Andrea Vincent ◽

Calin Prodan ◽

Sardar Ijaz ◽

Muhammad Bajwa ◽

...

Keyword(s):

Carotid Stenosis ◽

Brain Infarction ◽

Silent Brain Infarction

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