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  • 1
    Online Resource
    Online Resource
    Relationship between Presence of Visceral Infarction and Functional Outcome among Patients with Acute Ischemic Stroke
    S. Karger AG ; 2020
    In:  Cerebrovascular Diseases Vol. 49, No. 3 ( 2020), p. 316-320
    Details
    In: Cerebrovascular Diseases, S. Karger AG, Vol. 49, No. 3 ( 2020), p. 316-320
    Abstract: 〈 b 〉 〈 i 〉 Introduction: 〈 /i 〉 〈 /b 〉 Evidence of visceral infarction is often found in patients with acute ischemic stroke. It remains uncertain whether there exists a relationship between visceral infarction and functional outcomes among patients with stroke. 〈 b 〉 〈 i 〉 Objective: 〈 /i 〉 〈 /b 〉 The aim of this study was to evaluate whether evidence of visceral infarction is associated with functional outcomes among patients with stroke. 〈 b 〉 〈 i 〉 Methods: 〈 /i 〉 〈 /b 〉 Among patients with acute ischemic stroke enrolled in the Cornell AcutE Stroke Academic Registry (CAESAR) from 2011 through 2016, we included those with a contrast-enhanced abdominal computed tomographic scan within 1 year of admission. Our outcome was ambulatory status at discharge from acute stroke hospitalization, categorized as walking without assistance, walking with assistance, and unable to walk. We used ordinal logistic regression to examine the association between visceral infarction and discharge ambulatory status after adjustment for demographics, stroke risk factors, stroke severity (NIH Stroke Scale), and stroke subtype. 〈 b 〉 〈 i 〉 Results: 〈 /i 〉 〈 /b 〉 Among 2,116 ischemic stroke patients registered in CAESAR from 2011 to 2016, 259 had contrast-enhanced abdominal computed tomographic imaging, of whom 48 (19%) had evidence of visceral infarction. After adjustment for demographics, stroke risk factors, stroke severity, and stroke subtype, the presence of visceral infarction was associated with a worse ambulatory status at discharge (global OR for better ambulatory status, 0.4; 95% CI, 0.2–1.0, 〈 i 〉 p = 〈 /i 〉 0.046). 〈 b 〉 〈 i 〉 Conclusions: 〈 /i 〉 〈 /b 〉 We found that the presence of visceral infarction was associated with poor functional outcomes at the time of hospital discharge. These findings suggest that such findings are not necessarily benign and are at the least a marker of poor outcomes.
    Type of Medium: Online Resource
    ISSN: 1015-9770 , 1421-9786
    URL: Article
    DOI: 10.1159/000508826
    Language: English
    Publisher: S. Karger AG
    Publication Date: 2020
    detail.hit.zdb_id: 1482069-9
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  • 2
    Online Resource
    Online Resource
    Abstract 117: Relationship Between Presence of Visceral Infarction and Functional Outcome Among Patients with Acute Ischemic Stroke
    Ovid Technologies (Wolters Kluwer Health) ; 2019
    In:  Stroke Vol. 50, No. Suppl_1 ( 2019-02)
    Details
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 50, No. Suppl_1 ( 2019-02)
    Abstract: Background: Evidence of visceral infarction is often found in patients with acute ischemic stroke, and appears to be more common among patients with embolic stroke subtypes. It remains uncertain whether there exists a relationship between visceral infarction and functional outcomes among patients with stroke. Methods: Among patients with acute ischemic stroke enrolled in the Cornell AcutE Stroke Academic Registry (CAESAR) from 2011 through 2016, we included those with a contrast-enhanced abdominal computed tomographic scan within 1 year of admission. Our outcome was ambulatory status at discharge from the acute stroke hospitalization, defined as walking without assistance, walking with assistance, and unable to walk. We used ordinal logistic regression to examine the association between visceral infarction and discharge ambulatory status after adjustment for demographics, stroke risk factors, stroke severity (NIH Stroke Scale score) and stroke subtype. Results: Among 2,116 ischemic stroke patients registered in CAESAR from 2011-2016, 228 had contrast-enhanced abdominopelvic computed tomographic imaging, of whom 40 (18%) had evidence of visceral infarction. Among the 188 patients without visceral infarction, 125 (66%) patients were discharged walking without assistance, 34 (18%) patients could walk with assistance, and 29 (15%) patients could not walk. In comparison, among the 40 patients with visceral infarction, 18 (45%) patients were discharged walking without assistance, 9 (23%) patients could walk with assistance, and 13 (33%) patients could not walk. After adjustment for demographics, stroke risk factors, stroke severity and stroke subtype, the presence of visceral infarction was associated with a worse ambulatory status (global OR for better ambulatory status, 0.3; 95% CI, 0.1-0.8). Conclusions: We found that the presence of visceral infarction, which is often incidentally detected on imaging among stroke patients, was associated with poor functional outcomes at the time of hospital discharge. These findings suggest that such incidental findings are not benign and are at the least a marker of poor outcomes.
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/str.50.suppl_1.117
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2019
    detail.hit.zdb_id: 1467823-8
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  • 3
    Online Resource
    Online Resource
    Restarting Anticoagulant Therapy After Intracranial Hemorrhage : A Systematic Review and Meta-Analysis
    Ovid Technologies (Wolters Kluwer Health) ; 2017
    In:  Stroke Vol. 48, No. 6 ( 2017-06), p. 1594-1600
    Details
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 48, No. 6 ( 2017-06), p. 1594-1600
    Abstract: The safety and efficacy of restarting anticoagulation therapy after intracranial hemorrhage (ICH) remain unclear. We performed a systematic review and meta-analysis to summarize the associations of anticoagulation resumption with the subsequent risk of ICH recurrence and thromboembolism. Methods— We searched published medical literature to identify cohort studies involving adults with anticoagulation-associated ICH. Our predictor variable was resumption of anticoagulation. Outcome measures were thromboembolic events (stroke and myocardial infarction) and recurrence of ICH. After assessing study heterogeneity and publication bias, we performed a meta-analysis using random-effects models to assess the strength of association between anticoagulation resumption and our outcomes. Results— Eight studies were eligible for inclusion in the meta-analysis, with 5306 ICH patients. Almost all studies evaluated anticoagulation with vitamin K antagonists. Reinitiation of anticoagulation was associated with a significantly lower risk of thromboembolic complications (pooled relative risk, 0.34; 95% confidence interval, 0.25–0.45; Q =5.12, P for heterogeneity=0.28). There was no evidence of increased risk of recurrent ICH after reinstatement of anticoagulation therapy, although there was significant heterogeneity among included studies (pooled relative risk, 1.01; 95% confidence interval, 0.58–1.77; Q =24.68, P for heterogeneity 〈 0.001). No significant publication bias was detected in our analyses. Conclusions— In observational studies, reinstitution of anticoagulation after ICH was associated with a lower risk of thromboembolic complications and a similar risk of ICH recurrence. Randomized clinical trials are needed to determine the true risk–benefit profile of anticoagulation resumption after ICH.
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/STROKEAHA.116.016327
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2017
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  • 4
    Online Resource
    Online Resource
    Machine Learning Prediction of Stroke Mechanism in Embolic Strokes of Undetermined Source
    Ovid Technologies (Wolters Kluwer Health) ; 2020
    In:  Stroke Vol. 51, No. 9 ( 2020-09)
    Details
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 51, No. 9 ( 2020-09)
    Abstract: One-fifth of ischemic strokes are embolic strokes of undetermined source (ESUS). Their theoretical causes can be classified as cardioembolic versus noncardioembolic. This distinction has important implications, but the categories’ proportions are unknown. Methods: Using data from the Cornell Acute Stroke Academic Registry, we trained a machine-learning algorithm to distinguish cardioembolic versus non-cardioembolic strokes, then applied the algorithm to ESUS cases to determine the predicted proportion with an occult cardioembolic source. A panel of neurologists adjudicated stroke etiologies using standard criteria. We trained a machine learning classifier using data on demographics, comorbidities, vitals, laboratory results, and echocardiograms. An ensemble predictive method including L1 regularization, gradient-boosted decision tree ensemble (XGBoost), random forests, and multivariate adaptive splines was used. Random search and cross-validation were used to tune hyperparameters. Model performance was assessed using cross-validation among cases of known etiology. We applied the final algorithm to an independent set of ESUS cases to determine the predicted mechanism (cardioembolic or not). To assess our classifier’s validity, we correlated the predicted probability of a cardioembolic source with the eventual post-ESUS diagnosis of atrial fibrillation. Results: Among 1083 strokes with known etiologies, our classifier distinguished cardioembolic versus noncardioembolic cases with excellent accuracy (area under the curve, 0.85). Applied to 580 ESUS cases, the classifier predicted that 44% (95% credibility interval, 39%–49%) resulted from cardiac embolism. Individual ESUS patients’ predicted likelihood of cardiac embolism was associated with eventual atrial fibrillation detection (OR per 10% increase, 1.27 [95% CI, 1.03–1.57]; c-statistic, 0.68 [95% CI, 0.58–0.78]). ESUS patients with high predicted probability of cardiac embolism were older and had more coronary and peripheral vascular disease, lower ejection fractions, larger left atria, lower blood pressures, and higher creatinine levels. Conclusions: A machine learning estimator that distinguished known cardioembolic versus noncardioembolic strokes indirectly estimated that 44% of ESUS cases were cardioembolic.
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/STROKEAHA.120.029305
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2020
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  • 5
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    Online Resource
    Abstract WP209: Relationship Between Liver Fibrosis and Ischemic Stroke Subtype
    Ovid Technologies (Wolters Kluwer Health) ; 2020
    In:  Stroke Vol. 51, No. Suppl_1 ( 2020-02)
    Details
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 51, No. Suppl_1 ( 2020-02)
    Abstract: Background: Liver disease has been associated with cardiac structural abnormalities and atrial fibrillation. We hypothesized that advanced liver fibrosis - commonly subclinical in the general population - is associated with cardioembolic stroke subtype. Secondarily, we hypothesized an association with cryptogenic stroke, based on its suspected embolic etiology. Methods: Among patients prospectively enrolled in the Cornell AcutE Stroke Academic Registry (CAESAR) from 2011-2016, we selected patients who had liver function tests within 7 days of admission. We calculated each patient’s Fibrosis-4 score, a validated, non-invasive liver fibrosis score derived from age, transaminase values, and platelet count. The primary exposure was advanced liver fibrosis, defined using a validated threshold of 〉 3.25; these patients were compared to patients without liver fibrosis. The primary outcome was cardioembolic stroke subtype, adjudicated using TOAST classification. The secondary outcome was cryptogenic subtype. We used logistic regression to separately evaluate the association between advanced liver fibrosis and these stroke subtypes, as compared to non-cardioembolic stroke. Models were adjusted for demographics, atrial fibrillation, hypertension, diabetes, dyslipidemia, coronary artery disease, congestive heart failure, peripheral vascular disease, and chronic kidney disease. Results: Among 1,586 ischemic stroke patients in our study, the mean age was 71 (SD, 15) years, and 50% were women. Overall, 18% had liver fibrosis; 34% and 27% of strokes were cardioembolic and cryptogenic, respectively. Advanced liver fibrosis was associated with cardioembolic stroke after adjusting for demographics and vascular risk factors (odds ratio [OR], 3.8; 95% confidence interval [CI] , 2.1-6.9) compared to patients without liver fibrosis. There was a significant, albeit attenuated, association with cryptogenic stroke (OR, 1.9; 95% CI, 1.0-3.4). Conclusion: Advanced liver fibrosis is associated with cardioembolic stroke and, to a lesser degree, cryptogenic stroke. Whether liver fibrosis is a marker or independent causal factor of cardioembolism is to be determined.
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/str.51.suppl_1.WP209
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2020
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  • 6
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    Online Resource
    Risk of Ischemic Stroke in Patients With Coronavirus Disease 2019 (COVID-19) vs Patients With Influenza
    American Medical Association (AMA) ; 2020
    In:  JAMA Neurology Vol. 77, No. 11 ( 2020-11-01), p. 1366-
    Details
    In: JAMA Neurology, American Medical Association (AMA), Vol. 77, No. 11 ( 2020-11-01), p. 1366-
    Type of Medium: Online Resource
    ISSN: 2168-6149
    URL: Article
    DOI: 10.1001/jamaneurol.2020.2730
    Language: English
    Publisher: American Medical Association (AMA)
    Publication Date: 2020
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  • 7
    Online Resource
    Online Resource
    A Pooled Analysis of Diffusion-Weighted Imaging Lesions in Patients With Acute Intracerebral Hemorrhage
    American Medical Association (AMA) ; 2020
    In:  JAMA Neurology Vol. 77, No. 11 ( 2020-11-01), p. 1390-
    Details
    In: JAMA Neurology, American Medical Association (AMA), Vol. 77, No. 11 ( 2020-11-01), p. 1390-
    Type of Medium: Online Resource
    ISSN: 2168-6149
    URL: Article
    DOI: 10.1001/jamaneurol.2020.2349
    Language: English
    Publisher: American Medical Association (AMA)
    Publication Date: 2020
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  • 8
    Online Resource
    Online Resource
    Neutrophil–Lymphocyte Ratio and Perihematomal Edema Growth in Intracerebral Hemorrhage
    Ovid Technologies (Wolters Kluwer Health) ; 2017
    In:  Stroke Vol. 48, No. 9 ( 2017-09), p. 2589-2592
    Details
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 48, No. 9 ( 2017-09), p. 2589-2592
    Abstract: Although preclinical studies have shown inflammation to mediate perihematomal edema (PHE) after intracerebral hemorrhage, clinical data are lacking. Leukocyte count, often used to gauge serum inflammation, has been correlated with poor outcome but its relationship with PHE remains unknown. Our aim was to test the hypothesis that leukocyte count is associated with PHE growth. Methods— We included patients with intracerebral hemorrhage admitted to a tertiary-care stroke center between 2011 and 2015. The primary outcome was absolute PHE growth during 24 hours, calculated using semiautomated planimetry. Linear regression models were constructed to study the relationship between absolute and differential leukocyte counts (monocyte count and neutrophil–lymphocyte ratio) and 24-hour PHE growth. Results— A total of 153 patients were included. Median hematoma and PHE volumes at baseline were 14.4 (interquartile range, 6.3–36.3) and 14.0 (interquartile range, 5.9–27.8), respectively. In linear regression analysis adjusted for demographics and intracerebral hemorrhage characteristics, absolute leukocyte count was not associated with PHE growth (β, 0.07; standard error, 0.15; P =0.09). In secondary analyses, neutrophil–lymphocyte ratio was correlated with PHE growth (β, 0.22; standard error, 0.08; P =0.005). Conclusions— Higher neutrophil–lymphocyte ratio is independently associated with PHE growth. This suggests that PHE growth can be predicted using differential leukocyte counts on admission.
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/STROKEAHA.117.018120
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2017
    detail.hit.zdb_id: 1467823-8
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  • 9
    Online Resource
    Online Resource
    Association Between Systemic Amyloidosis and Intracranial Hemorrhage
    Ovid Technologies (Wolters Kluwer Health) ; 2022
    In:  Stroke Vol. 53, No. 3 ( 2022-03)
    Details
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 53, No. 3 ( 2022-03)
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/STROKEAHA.121.038451
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2022
    detail.hit.zdb_id: 1467823-8
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  • 10
    Online Resource
    Online Resource
    Abstract 121: Machine Learning Prediction of Stroke Mechanism in Embolic Strokes of Undetermined Source
    Ovid Technologies (Wolters Kluwer Health) ; 2019
    In:  Stroke Vol. 50, No. Suppl_1 ( 2019-02)
    Details
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 50, No. Suppl_1 ( 2019-02)
    Abstract: Introduction: Embolic strokes of undetermined source (ESUS) are thought to arise mostly from occult cardiac sources or large-artery atherosclerotic lesions and, less frequently, other causes. The proportions of such mechanisms remains unclear. Methods: We trained a machine learning algorithm to distinguish non-lacunar strokes caused by cardiac embolism versus large-artery atherosclerosis or other known causes (e.g., dissection), then applied the algorithm to ESUS cases to determine the predicted prevalence of cardiac embolism, which we focused on since it is plausibly a potential target for anticoagulation. We used data from the Cornell Acute Stroke Academic Registry (CAESAR), which includes all acute strokes at our hospital from 2011-2016. All variables measured during echocardiography were pulled directly from our image server (Xcelera, Philips Healthcare) and used as features to train the algorithm. Stroke etiologies were adjudicated by a panel of neurologists using TOAST and ESUS criteria. We excluded patients with an ejection fraction 〈 35% because it was highly collinear with a cardioembolic etiology. A gradient-boosted decision tree ensemble (XGBoost) was trained on a 90% random sample of patients with a known non-lacunar etiology. Random search and cross-validation were used to tune hyperparameters. Model performance was assessed in the 10% sample of held-out non-lacunar cases not used for model training. We then applied the final algorithm to the ESUS cases in our registry to determine the predicted label (cardioembolic or not). Results: Among 1,758 patients with echocardiograms and an ejection fraction 35% or greater, 497 had a cardioembolic etiology, 240 a large-vessel etiology, and 78 another known etiology. Our XGBoost algorithm had an area under the curve of 0.83 (± 0.06) for classifying these non-lacunar strokes as cardioembolic versus non-cardioembolic. When applied to our 520 ESUS cases, the algorithm classified 16% as cardioembolic. Conclusions: An echocardiogram-based prediction algorithm that accurately distinguished known cardioembolic versus non-cardioembolic strokes predicted that about one-sixth of our ESUS cases were cardioembolic.
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/str.50.suppl_1.121
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2019
    detail.hit.zdb_id: 1467823-8
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