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Multivariable Prediction Model for Futile Recanalization Therapies in Patients With Acute Ischemic Stroke

Meinel, Thomas Raphael ; Lerch, Christine ; Fischer, Urs ; [et al.]

Ovid Technologies (Wolters Kluwer Health) ; 2022

In: Neurology Vol. 99, No. 10 ( 2022-09-06)

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In: Neurology, Ovid Technologies (Wolters Kluwer Health), Vol. 99, No. 10 ( 2022-09-06)

Type of Medium: Online Resource

ISSN: 0028-3878 , 1526-632X

URL: Article

DOI: 10.1212/WNL.0000000000200815

RVK:

XA 10000

Language: English

Publisher: Ovid Technologies (Wolters Kluwer Health)

Publication Date: 2022

detail.hit.zdb_id: 1491874-2

detail.hit.zdb_id: 207147-2

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Chronic cerebral infarctions and white matter lesions link to long‐term survival after a first ischemic event: A cohort study

Schilter, Marina ; Epstein, Alessandra ; Vynckier, Jan ; [et al.]

Wiley ; 2022

In: Journal of Neuroimaging Vol. 32, No. 6 ( 2022-11), p. 1134-1141

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In: Journal of Neuroimaging, Wiley, Vol. 32, No. 6 ( 2022-11), p. 1134-1141

Abstract: To investigate the association of different phenotypes, count, and locations of chronic covert brain infarctions (CBI) with long‐term mortality in patients with first‐ever manifest acute ischemic stroke (AIS) or transient ischemic attack (TIA). Additionally, to analyze their potential interaction with white matter hyperintensities (WMH) and predictive value in addition to established mortality scores. Methods Single‐center cohort study including consecutive patients with first‐ever AIS or TIA with available MRI imaging from January 2015 to December 2017. Blinded raters adjudicated CBI phenotypes and WMH (age‐related white matter changes score) according to established definitions. We compared Cox regression models including prespecified established predictors of mortality using Harrell's C and likelihood ratio tests. Results A total of 2236 patients (median [interquartile range] age: 71 [59‐80] years, 43% female, National Institutes of Health Stroke Scale: 2 [1‐6], median follow‐up: 1436 days, 21% death during follow‐up) were included. Increasing WMH (per point adjusted Hazard Ratio [aHR] = 1.29 [1.14‐1.45]), but not CBI (aHR = 1.21 [0.99‐1.49] ), were independently associated with mortality. Neither CBI phenotype, count, nor location was associated with mortality and there was no multiplicative interaction between CBI and WMH ( p 〉 .1). As compared to patients without CBI or WMH, patients with moderate or severe WMH and additional CBI had the highest hazards of death (aHR = 1.62 [1.23‐2.13]). The Cox regression model including CBI and WMH had a small but significant increment in Harrell's C when compared to the model including 14 clinical variables (0.831 vs. 0.827, p 〈 .001). Discussion WMH represent a strong surrogate biomarker of long‐term mortality in first‐ever manifest AIS or TIA patients. CBI phenotypes, count, and location seem less relevant. Incorporation of CBI and WMH slightly improves predictive capacity of established risk scores.

Type of Medium: Online Resource

ISSN: 1051-2284 , 1552-6569

URL: Issue

URL: Article

DOI: 10.1111/jon.v32.6

DOI: 10.1111/jon.13033

Language: English

Publisher: Wiley

Publication Date: 2022

detail.hit.zdb_id: 1071724-9

detail.hit.zdb_id: 2035400-9

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Chronic Covert Brain Infarctions and White Matter Hyperintensities in Patients With Stroke, Transient Ischemic Attack, and Stroke Mimic

Epstein, Alessandra ; Schilter, Marina ; Vynckier, Jan ; [et al.]

Ovid Technologies (Wolters Kluwer Health) ; 2022

In: Journal of the American Heart Association Vol. 11, No. 3 ( 2022-02)

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In: Journal of the American Heart Association, Ovid Technologies (Wolters Kluwer Health), Vol. 11, No. 3 ( 2022-02)

Abstract: This study was conducted to compare frequencies of chronic brain infarctions (CBIs) and white matter hyperintensities (WMHs) as well as their associations with established early recurrence risk scores in patients with transient ischemic attack (TIA) and stroke mimics compared with ischemic stroke. Methods and Results Single‐center cohort study including consecutive patients with TIA, stroke mimics, and acute ischemic stroke, with available magnetic resonance imaging from January 2015 to December 2017. Blinded raters adjudicated WMH (age‐related white matter changes score) and CBI according to established definitions. A total of 2112 patients (median [Q1–Q3] age 71 [59–80] years, 43% women, National Institutes of Health Stroke Scale score of 2 [1–7], 80% ischemic stroke, 18% TIA, 2% stroke mimics) were included. While CBIs were present in only 10% of patients with stroke mimic, they were detected in 28% of TIAs and 38% of ischemic strokes ( P 〈 0.001). WMHs were less pronounced (0, 0–1) in patients with stroke mimic, but there was no difference between TIA (1, 1–2) and ischemic stroke (0, 1–2) patients. CBIs (adjusted odds ratio, 0.3; 95% CI, 0.1–0.9) were associated with a lower rate of stroke mimic as the final diagnosis, while WMHs were not (adjusted odds ratio per point, 1.3; 95% CI, 0.7–2.2). WMH (β per point, 0.4; 95% CI, 0.3–0.6) and presence of CBI (β, 0.6; 95% CI, 0.3–0.9) were associated with a higher cardiovascular risk profile according to the ABCD3‐I score. The accuracy of prediction was good for high‐risk TIA (cross‐validated area under the receiver operating characteristic curve, 0.89; 95% CI, 0.79–0.93) on the basis of brain imaging, age, and sex. Conclusions CBI and WMH differ between patients with stroke mimic and patients with TIA/ischemic stroke and are closely associated with established recurrence risk scores. Prospective studies need to clarify whether including brain frailty markers may contribute to the refinement of current management algorithms and risk stratifications.

Type of Medium: Online Resource

ISSN: 2047-9980

URL: Article

DOI: 10.1161/JAHA.121.024191

Language: English

Publisher: Ovid Technologies (Wolters Kluwer Health)

Publication Date: 2022

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Association of Chronic Covert Cerebral Infarctions and White Matter Hyperintensities With Atrial Fibrillation Detection on Post‐Stroke Cardiac Rhythm Monitoring: A Cohort Study

Amberger, Ulfrid ; Lippert, Julian ; Mujanovic, Adnan ; [et al.]

Ovid Technologies (Wolters Kluwer Health) ; 2022

In: Journal of the American Heart Association Vol. 11, No. 24 ( 2022-12-20)

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In: Journal of the American Heart Association, Ovid Technologies (Wolters Kluwer Health), Vol. 11, No. 24 ( 2022-12-20)

Abstract: This study was conducted to explore the association of different phenotypes, count, and location of chronic covert brain infarctions (CBIs) with detection of atrial fibrillation (AF) on prolonged post‐stroke cardiac rhythm monitoring (PCM). Methods and Results We conducted a cohort single‐center study of consecutive first‐ever ischemic stroke or transient ischemic attack patients undergoing PCM between January 2015 and December 2017. We blindly rated CBI phenotypes according to established definitions and white matter hyperintensities (WMHs) according to the age‐related white matter changes rating scale. We used (multiple) regression models to assess the association of the imaging biomarkers and incident AF on PCM. A total of 795 patients (median [interquartile range]) aged 69 (57–78) years, 41% women, median National Institutes of Health Stroke Scale score 2 (0–5), median PCM duration 14 (7–14) days, and AF detection in 61 patients (7.7%) were included. On univariate analysis, WMHs (per point odds ratio, 1.35 [95% CI, 1.03–1.78] ) but not CBIs (odds ratio, 0.90 [95% CI, 0.52–1.56]) were associated with AF detection. Neither CBI phenotype, count, nor location were associated with AF detection. After adjustment for age, hypertension, and stroke severity, neither increasing WMHs (per point adjusted odds ratio, 0.85 [95% CI, 0.60–1.20] ) nor CBIs (adjusted odds ratio, 0.60 [95% CI, 0.33–1.09]) were independently associated with AF detection. Conclusions Although WMHs and CBIs represent surrogate biomarkers of vascular risk factors, neither WMHs nor CBIs, including their phenotypes, count, and location, were independently associated with AF detection on PCM. In patients with manifest ischemic stroke or transient ischemic attack, the presence of imaging biomarkers of chronic ischemic injury does not seem promising to further refine prediction tools for AF detection on PCM.

Type of Medium: Online Resource

ISSN: 2047-9980

URL: Article

DOI: 10.1161/JAHA.122.026962

Language: English

Publisher: Ovid Technologies (Wolters Kluwer Health)

Publication Date: 2022

detail.hit.zdb_id: 2653953-6

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