scholarly journals Associated Factors and Long-Term Prognosis of 24-Hour Worsening of Arterial Patency After Ischemic Stroke

Stroke ◽  
2019 ◽  
Vol 50 (10) ◽  
pp. 2752-2760 ◽  
Author(s):  
João Pedro Marto ◽  
Dimitris Lambrou ◽  
Ashraf Eskandari ◽  
Stefania Nannoni ◽  
Davide Strambo ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Multivariable Analysis ◽  
Vascular Imaging ◽  
Stroke Severity ◽  
Modified Rankin Scale ◽  
Long Term Outcome ◽  
Long Term Prognosis ◽  
The Impact ◽  
Arterial Patency

Background and Purpose— Early arterial recanalization in acute ischemic stroke is strongly associated with better outcomes. However, early worsening of arterial patency was seldom studied. We investigated potential predictors and long-term prognosis of worsening of arterial patency at 24 hours after stroke onset. Methods— Patients from the Acute Stroke Registry and Analysis of Lausanne registry including admission and 24-hour vascular imaging (computed tomography or magnetic resonance angiography) were included. Worsening of arterial patency was defined as a new occlusion and significant stenosis in any extracranial or intracranial artery, comparing 24 hours with admission imaging. Variables associated with worsening of arterial patency were assessed by stepwise multiple logistic regression. The impact of arterial worsening on 3-month outcome was investigated with an adjusted modified Rankin Scale shift analysis. Results— Among 2152 included patients, 1387 (64.5%) received intravenous thrombolysis and endovascular treatment, and 65 (3.0%) experienced 24-hour worsening of arterial patency. In multivariable analysis, history of hypertension seemed protective (adjusted odds ratio [aOR], 0.45; 95% CI, 0.27–0.75) while higher admission National Institutes of Health Stroke Scale (aOR, 1.06; 95% CI, 1.02–1.10), intracranial (aOR, 4.78; 95% CI, 2.03–11.25) and extracranial stenosis (aOR, 3.67; 95% CI, 1.95–6.93), and good collaterals (aOR, 3.71; 95% CI, 1.54–8.95) were independent predictors of worsening of arterial patency. Its occurrence was associated with a major unfavorable shift in the distribution of the modified Rankin Scale at 3 months (aOR, 5.97; 95% CI, 3.64–9.79). Conclusions— Stroke severity and admission vascular imaging findings may help to identify patients at a higher risk of developing worsening of arterial patency at 24 hours. The impact of worsening of arterial patency on long-term outcome warrants better methods to detect and prevent this early complication.

scholarly journals Preconditioning by Preceding Ischemic Cerebrovascular Events

2021 ◽  
Author(s):  
Pamela N. Correia ◽  
Ivo A. Meyer ◽  
Ashraf Eskandari ◽  
Michael Amiguet ◽  
Lorenz Hirt ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
University Hospital ◽  
Stroke Severity ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Stroke Registry ◽  
Cerebral Ischemic ◽  
The Impact ◽  
Ischemic Events

Background Emerging yet contrasting evidence from animal and human studies associates ischemic preconditioning with improvement of subsequent stroke severity, although long‐term outcome remains unclear. The purpose of this study was to analyze how preceding cerebral ischemic events influence subsequent stroke severity and outcome. Methods and Results Data for this retrospective cohort study were extracted from ASTRAL (Acute Stroke Registry and Analysis of Lausanne). This registry includes a sample of all consecutive patients with acute ischemic strokes admitted to the stroke unit and/or intensive care unit of the Lausanne University Hospital, Switzerland. We investigated associations between preceding ischemic events (transient ischemic attacks or ischemic strokes) and the impact on subsequent stroke severity and clinical improvement within 24 hours, measured through National Institute of Health Stroke Scale, as well as 3‐month outcome, determined through a shift in the modified Rankin Scale. Of 3530 consecutive patients with ischemic stroke (43% women, median age 73 years), 1001 (28%) had ≥1 preceding cerebral ischemic events (45% transient ischemic attack, 55% ischemic stroke; 31% multiple events). After adjusting for multiple prehospital, clinical, and laboratory confounders, admission stroke severity was significantly lower in patients preconditioned through a preceding ischemic event, but 24‐hour improvement was not significant and 3‐month outcome was unfavorable. Conclusions Preceding ischemic events were independently associated with a significant reduction in subsequent stroke severity but worsened long‐term clinical outcome. These results, if confirmed by future randomized studies, may help design neuroprotective strategies. The unfavorable effect on stroke outcome is probably a consequence of the cumulative disability burden after multiple ischemic events.

scholarly journals Ischemic stroke on hormonal contraceptives: Characteristics, mechanisms and outcome

2021 ◽  
pp. 239698732110195
Author(s):  
P Correia ◽  
S Machado ◽  
I Meyer ◽  
M Amiguet ◽  
A Eskandari ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Ischemic Stroke ◽  
Tobacco Use ◽  
Migraine With Aura ◽  
Hormonal Contraceptives ◽  
Stroke Severity ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Female Patients

Introduction Systemic contraceptives increase the risk of ischemic stroke but little is known about the characteristics, mechanisms and long-term outcome post stroke of patients on hormonal contraception. We sought to To assess characteristics and outcome of acute ischemic stroke (AIS) in young women using systemic hormonal contraceptives (SHC) and compare them to strokes in non-contraceptive users. Patients and methods Using the Acute STroke Registry and Analysis of Lausanne (ASTRAL), we analyzed demographics, risk factors, clinical, radiological and treatment data of consecutive female patients of <50 years between 2003 to 2015. We compared groups with and without SHC in a logistic regression analysis. Results Of the 179 female patients of <50 years during the observation period, 57 (39.6%) used SHC, 71.9% of whom, a combined oral contraceptive pill. On logistic regression contraceptive users were significantly younger but had comparable stroke severity. They had less migraine with aura and tobacco use, and more hyperlipidaemia. Also, contraceptive users had significantly less intra and extracranial stenosis and occlusion on arterial imaging, but more focal hypoperfusion on CT-perfusion. Undetermined mechanism of stroke was more frequent with SHC users, whereas rare mechanisms were more frequent in non-users. The contraceptive user group had a more favourable adjusted 12-month outcome with significantly fewer ischemic recurrences after stopping systemic contraception in all. Conclusion Contraceptive users with ischemic strokes are younger and have lesser tobacco use and migraine with aura and more hyperlipidemia. Their stroke mechanism is more often undetermined using a standardised work-up, and their adjusted long-term outcome is more favourable with less stroke recurrence.

scholarly journals Prognostic Value of the Acute-to-Chronic Glycemic Ratio at Admission in Heart Failure: A Prospective Study

2021 ◽  
Vol 11 (1) ◽  
pp. 6
Author(s):  
Mª José Carrera ◽  
Pedro Moliner ◽  
Gemma Llauradó ◽  
Cristina Enjuanes ◽  
Laura Conangla ◽  
...  
Keyword(s):  
Heart Failure ◽  
Multivariable Analysis ◽  
Acute Hyperglycemia ◽  
Glucose Levels ◽  
Long Term Prognosis ◽  
Shape Curve ◽  
A Prospective Study ◽  
The Impact ◽  
The Relationship

Acute hyperglycemia has been associated with worse prognosis in patients hospitalized for heart failure (HF). Nevertheless, studies evaluating the impact of glycemic control on long-term prognosis have shown conflicting results. Our aim was to assess the relationship between acute-to-chronic (A/C) glycemic ratio and 4-year mortality in a cohort of subjects hospitalized for acute HF. A total of 1062 subjects were consecutively included. We measured glycaemia at admission and estimated average chronic glucose levels and the A/C glycemic ratio were calculated. Subjects were stratified into groups according to the A/C glycemic ratio tertiles. The primary endpoint was 4-year mortality. Subjects with diabetes had higher risk for mortality compared to those without (HR 1.35 [95% CI: 1.10–1.65]; p = 0.004). A U-shape curve association was found between glucose at admission and mortality, with a HR of 1.60 [95% CI: 1.22–2.11]; p = 0.001, and a HR of 1.29 [95% CI: 0.97–1.70]; p = 0.078 for the first and the third tertile, respectively, in subjects with diabetes. Additionally, the A/C glycemic ratio was negatively associated with mortality (HR 0.76 [95% CI: 0.58–0.99]; p = 0.046 and HR 0.68 [95% CI: 0.52–0.89]; p = 0.005 for the second and third tertile, respectively). In multivariable analysis, the A/C glycemic ratio remained an independent predictor. In conclusion, in subjects hospitalized for acute HF, the A/C glycemic ratio is significantly associated with mortality, improving the ability to predict mortality compared with glucose levels at admission or average chronic glucose concentrations, especially in subjects with diabetes.

Effect of Pancreatic Fistula on Recurrence and Long-Term Prognosis of Periampullary Adenocarcinomas after Pancreaticoduodenectomy

2016 ◽  
Vol 82 (12) ◽  
pp. 1187-1195 ◽  
Author(s):  
Pablo E. Serrano ◽  
Dowan Kim ◽  
Peter T. Kim ◽  
Paul D. Greig ◽  
Carol-Anne Moulton ◽  
...  
Keyword(s):  
Lymph Nodes ◽  
Pancreatic Fistula ◽  
Multivariable Analysis ◽  
Disease Free Survival ◽  
Tumor Grade ◽  
Free Survival ◽  
Resection Margin Status ◽  
Long Term Prognosis ◽  
The Impact

Pancreatic fistula (PF) is common after pancreaticoduodenectomy (PD). Its effect on recurrence and survival is not known. Retrospective study of patients undergoing PD for periampullary adenocarcinomas (2000–2012). Standard statistical analyses were performed to determine the impact of PF on disease-free survival (DFS) and overall survival (OS). There were 634 PDs (pancreatic adenocarcinoma: 347, other periampullary adenocarcinomas: 287). Any-grade PF developed in 81/634 (13%). Perioperative mortality rate was 1.7 per cent (11/634), higher in patients with PF (10 vs 0.5%, P < 0.001). In multivariable analysis, PF significantly reduced DFS in pancreatic [hazard ratio (HR) = 1.6, 95% confidence-interval (CI): 1.1–2.6, P = 0.043] but not in other periampullary adenocarcinomas [HR = 1.3 (95% CI: 0.8–2.2), P = 0.45]. Positive lymph nodes, margins, and high-grade histology were associated with decreased DFS and OS. Adjuvant therapy was associated with improved OS in pancreatic [HR = 0.7 (95% CI: 0.5–0.9), P = 0.02] but not in other periampullary adenocarcinomas [HR = 1.14 (95% CI: 0.8–1.7), P = 0.49]. PF did not alter OS in either group. After PD, PF is associated with decreased DFS in pancreatic but not in other periampullary adenocarcinomas. This decrease DFS did not alter OS. Tumor grade, lymph nodes, and resection margin status are associated with DFS and OS.

scholarly journals Prognostic Significance of Prolonged Corrected QT Interval in Acute Ischemic Stroke

2021 ◽  
Vol 12 ◽  
Author(s):  
Sung-Ho Ahn ◽  
Ji-Sung Lee ◽  
Young-Hak Kim ◽  
Mi-Sook Yun ◽  
Jung-Hee Han ◽  
...  
Keyword(s):  
Heart Rate ◽  
Sex Differences ◽  
Ischemic Stroke ◽  
Cardiovascular Risk ◽  
Acute Ischemic Stroke ◽  
Stroke Severity ◽  
Qtc Interval ◽  
The Impact ◽  
Long Term Mortality

Background and Purpose: The aim of this study was to determine the relationship between the heart rate-corrected QT (QTc) interval and the risk of incident long-term mortality in patients with acute ischemic stroke (AIS), considering the impact of sex differences on clinical characteristics, outcomes, and QTc intervals.Methods: We analyzed prospectively registered data included patients with AIS who visited the emergency room within 24 h of stroke onset and underwent routine cardiac testing, such as measurements of cardiac enzymes and 12-lead ECG. QTc interval was corrected for heart rate using Fridericia's formula and was stratified by sex-specific quartiles. Cox proportional hazards models were used to examine the association between baseline QTc interval and incident all-cause death.Results: A total of 1,668 patients with 1,018 (61.0%) men and mean age 66.0 ± 12.4 years were deemed eligible. Based on the categorized quartiles of the QTc interval, cardiovascular risk profile, and stroke severity increased with prolonged QTc interval, and the risk of long-term mortality increased over a median follow-up of 33 months. Cox proportional hazard model analysis showed that the highest quartile of QTc interval (≥479 msec in men and ≥498 msec in women; hazard ratio [HR]: 1.49, 95% confidence interval [CI]: 1.07–2.08) was associated with all-cause death. Furthermore, dichotomized QTc interval prolongation, defined by the highest septile of the QTc interval (≥501 ms in men and ≥517 m in women: HR: 1.33, 95% CI: 1.00–1.80) was significantly associated with all-cause mortality after adjusting for all clinically relevant variables, such as stroke severity.Conclusions: Prolonged QTc interval was associated with increased risk of long-term mortality, in parallel with the increasing trend of prevalence of cardiovascular risk profiles and stroke severity, across sex differences in AIS patients.

scholarly journals Association of liver cirrhosis with the prognosis of patients with intrahepatic cholangiocarcinoma: a SEER-based cohort study

2020 ◽  
Author(s):  
Wei Li ◽  
Hong Wu ◽  
Yange Zhang
Keyword(s):  
Liver Cirrhosis ◽  
Intrahepatic Cholangiocarcinoma ◽  
Multivariable Analysis ◽  
Fibrosis Score ◽  
Multivariable Analyses ◽  
Long Term Prognosis ◽  
The Impact ◽  
The Relationship ◽  
Interaction Test

Abstract Background The association of liver cirrhosis with the prognosis of intrahepatic cholangiocarcinoma (ICC) remains controversial. We aimed to evaluate the relationship between liver cirrhosis (fibrosis score) and the long-term prognosis of patients with ICC. Methods SEER 18 registry from 2004 to 2015 was queried for this study. Propensity score matching (PSM) was performed to eliminate possible bias. In addition, multivariable analysis was utilized to adjust for potential confounders. The interaction test was performed to explore the impact of each stratified factor on the relationship between FS and patient survival. Overall survival (OS) and disease-specific survival (DSS) were the major endpoints. Results During the study period, 359 patients (66.5%) with lower fibrosis score (LFS; F0-4) and 181 patients (33.5%) with higher fibrosis score (HFS; F5-6) were enrolled. In the multivariable adjusted cohort (OS: n = 540; DSS: n = 417), patients with HFS had worse OS (HR, 1.43; 95% CI, 1.10 to 1.85; P = 0.007) and DSS (HR, 1.46; 95% CI, 1.08 to 1.97; P = 0.013) compared to patients with LFS. In the propensity-matched cohort, patients with HFS still had worse OS (HR, 1.50; 95% CI, 1.08 to 2.09; P = 0.016) and DSS (HR, 1.54; 95% CI, 1.05 to 2.26; P = 0.026) compared to patients with LFS. In multivariable analyses stratified by clinicopathologic features, patients with HFS were found to have significantly worse OS and DSS compared to those with LFS across all the subgroups. Conclusion Our outcomes indicated that fibrosis score is an independent risk factor for both overall and tumor-specific survival of ICC patients.

Abstract TP421: Ischemic Preconditioning From Preceding Cerebrovascular Events in Stroke Patients

Stroke ◽  
2016 ◽  
Vol 47 (suppl_1) ◽  
Author(s):  
Pamela N Correia ◽  
Ivo A Meyer ◽  
Ashraf Eskandari ◽  
Michael Amiguet ◽  
Patrik Michel
Keyword(s):  
Ischemic Stroke ◽  
Ischemic Preconditioning ◽  
Multivariate Regression Analysis ◽  
Stroke Severity ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Cerebrovascular Events ◽  
Independent Association ◽  
Stroke Mechanism

Introduction: Preconditioning improves acute ischemic stroke (AIS) outcomes in animals and possibly in humans. The influence of a preceding ischemic event (PIE), such as a TIA or AIS occurring at different intervals, sites and for different durations, needs to be studied in humans. Hypothesis: We aimed to identify whether a PIE can have a preconditioning effect on a subsequent AIS. Methods: Using consecutive AIS from the ASTRAL registry we determined demographics, risk factors, past medical history,stroke mechanism,PIE and other features that were associated with initial stroke severity measured by NIHSS. We used a multivariate linear regression model with NIHSS as the dependent variable to compare groups with and without PIE. Results: Of 3501 consecutive AIS patients (43% females, median age 73 y), 996 (28.4%) had preceding PIEs (15.7% TIA, 12.9% ischemic stroke, 2.4% retinal ischemia, 8.8% multiple events). There were 162 acute PIE in the preceding 24 h, and 94 subacute PIE up to 7 d before the stroke, respectively with a median delay between the PIE and the subsequent stroke of 180 days.Results of the adjusted multivariate regression analysis are shown as forest plots below. Conclusions: In patients with AIS, we found an independent association between lesser stroke severity and PIE, suggesting a possible beneficial role of ischemic preconditioning in stroke in humans. The effect of timing, severity,location of PIE and long-term outcome of such patients needs to be analyzed in further studies.

scholarly journals The association of diabetes with ischemic stroke and transient ischemic attacks in a tertiary center in Saudi Arabia

2020 ◽  
Vol 40 (6) ◽  
pp. 449-455
Author(s):  
Bareen Homoud ◽  
Alanoud Alhakami ◽  
Malak Almalki ◽  
Miselareem Shaheen ◽  
Alaa Althubaiti ◽  
...  
Keyword(s):  
Saudi Arabia ◽  
Ischemic Stroke ◽  
Diabetic Patients ◽  
Stroke Severity ◽  
Large Artery ◽  
Modified Rankin Scale ◽  
Transient Ischemic Attacks ◽  
Stroke Patients ◽  
Tertiary Center ◽  
The Impact

ABSTRACT BACKGROUND: Diabetes mellitus increases stroke risk 1.5 to 3 fold, particularly ischemic stroke. There is limited literature on the impact of diabetes on stroke patients in Saudi Arabia. OBJECTIVES: Determine the association of diabetes on the presentation, subtypes, in-hospital complications and outcomes of ischemic stroke and transient ischemic attacks (TIA). DESIGN: IRB approved, retrospective chart review. SETTING: Tertiary care center. PATIENTS AND METHODS: All adult patients with ischemic stroke or TIA aged 18 years or older admitted from January 2016 to December 2017 were included. MAIN OUTCOME MEASURES: Stroke severity at presentation, stroke-related complications, discharge disposition and discharge modified Rankin Scale (mRS) in relation to diabetes. SAMPLE SIZE: 802 patients. RESULTS: Among 802 cases, 584 (72.8%) had diabetes; the majority (63.1%) were males. The mean age was younger in the non-diabetic stroke group (54.6 [15.5] years vs. 63.3 [9.9], P <.001). Hypertension (83.6% vs 49.1%, P <.001), dyslipidemia (38.9% vs. 28.9%, P =.009), prior stroke (27.7% vs. 19.3% P =.014), and ischemic heart disease (20.4% vs. 7.8%, P <.001) were more common in diabetic patients whereas smoking was more common (19.3% vs. 11.1%, P =.003) in the non-diabetic patients. The commonest subtype of stroke was large artery disease followed by small vessel disease. Both were more common in diabetic vs. non-diabetic patients (55.8% vs. 44%, P =.003), and (16.6% vs. 11%, P =.05) respectively. Diabetic stroke patients were more likely to have lacunar stroke (16.4% versus 9.2%, P =.009). TIAs occurred more commonly in the non-diabetic group (26.1% vs. 13.7%, P <.001). Non-diabetic patients had a better outcome (mRS score of 0–2) at discharge (62.4% vs. 45.9%, P =.002). CONCLUSIONS: Almost three-fourth stroke patients were diabetic in our cohort. Diabetic stroke patients were older, had multiple vascular comorbid conditions, presented late to the hospital, and were likely to have more disability at the time of discharge. Large vessel atherosclerosis as well as lacunar infarctions were more common in diabetic stroke patients. LIMITATIONS: Missing data about time of presentation in few patients, missing modified Rankin Scale score at discharge. CONFLICT OF INTEREST: None.

scholarly journals Transcriptional Active Parvovirus B19 Infection Predicts Adverse Long-Term Outcome in Patients with Non-Ischemic Cardiomyopathy

Biomedicines ◽  
2021 ◽  
Vol 9 (12) ◽  
pp. 1898
Author(s):  
Felicitas Escher ◽  
Ganna Aleshcheva ◽  
Heiko Pietsch ◽  
Christian Baumeier ◽  
Ulrich M. Gross ◽  
...  
Keyword(s):  
Ischemic Cardiomyopathy ◽  
Transcriptional Activity ◽  
Cox Regression ◽  
Parvovirus B19 ◽  
Multivariable Analysis ◽  
Large Cohort ◽  
Long Term Outcome ◽  
Cox Regression Analysis ◽  
The Impact

Parvovirus B19 (B19V) is the predominant cardiotropic virus currently found in endomyocardial biopsies (EMBs). However, direct evidence showing a causal relationship between B19V and progression of inflammatory cardiomyopathy are still missing. The aim of this study was to analyze the impact of transcriptionally active cardiotropic B19V infection determined by viral RNA expression upon long-term outcomes in a large cohort of adult patients with non-ischemic cardiomyopathy in a retrospective analysis from a prospective observational cohort. In total, the analyzed study group comprised 871 consecutive B19V-positive patients (mean age 50.0 ± 15.0 years) with non-ischemic cardiomyopathy who underwent EMB. B19V-positivity was ascertained by routine diagnosis of viral genomes in EMBs. Molecular analysis of EMB revealed positive B19V transcriptional activity in n = 165 patients (18.9%). Primary endpoint was all-cause mortality in the overall cohort. The patients were followed up to 60 months. On the Cox regression analysis, B19V transcriptional activity was predictive of a worse prognosis compared to those without actively replicating B19V (p = 0.01). Moreover, multivariable analysis revealed transcriptional active B19V combined with inflammation [hazard ratio 4.013, 95% confidence interval 1.515–10.629 (p = 0.005)] as the strongest predictor of impaired survival even after adjustment for age and baseline LVEF (p = 0.005) and independently of viral load. The study demonstrates for the first time the pathogenic clinical importance of B19V with transcriptional activity in a large cohort of patients. Transcriptionally active B19V infection is an unfavourable prognostic trigger of adverse outcome. Our findings are of high clinical relevance, indicating that advanced diagnostic differentiation of B19V positive patients is of high prognostic importance.

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