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  • 1
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    Online Resource
    Assessment of thrombus length in acute ischemic stroke by post-contrast magnetic resonance angiography
    BMJ ; 2018
    In:  Journal of NeuroInterventional Surgery Vol. 10, No. 8 ( 2018-08), p. 756-760
    Details
    In: Journal of NeuroInterventional Surgery, BMJ, Vol. 10, No. 8 ( 2018-08), p. 756-760
    Abstract: Post-contrast magnetic resonance angiography (PC-MRA) enables visualization of vessel segments distal to an intra-arterial thrombus in acute ischemic stroke. We hypothesized that PC-MRA also allows clot length measurement in different intracranial vessels. Methods Patients with MRI-confirmed ischemic stroke and intracranial artery occlusion within 24 hours of symptom onset were prospectively evaluated. PC-MRA was added to a standard stroke MRI protocol. Thrombus length was measured on thick slab maximum intensity projection images. Clinical outcome at hospital discharge was assessed by modified Rankin Scale (mRS). Results Thirty-four patients (median age 72 years) presenting with a median National Institutes of Health Stroke Scale score of 11 and a median onset to imaging time of 116 min were included. PC-MRA enabled precise depiction of proximal and distal terminus of the thrombus in 31 patients (91%), whereas in three patients (9%) PC-MRA presented a partial occlusion. Median thrombus length in patients with complete occlusion was 9.9 mm. In patients with poor outcome (mRS ≥3) median thrombus length was significantly longer than in those with good outcome (mRS ≤2;P=0.011). Conclusions PC-MRA demonstrates intra-arterial thrombus length at different vessel occlusion sites. Longer thrombus length is associated with poor clinical outcome. Clinical trial registration NCT02077582; Results.
    Type of Medium: Online Resource
    ISSN: 1759-8478 , 1759-8486
    URL: Article
    DOI: 10.1136/neurintsurg-2017-013454
    Language: English
    Publisher: BMJ
    Publication Date: 2018
    detail.hit.zdb_id: 2506028-4
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  • 2
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    Abstract TMP65: Sex Differences in Outcomes of Acute Myocardial Injury After Stroke
    Ovid Technologies (Wolters Kluwer Health) ; 2024
    In:  Stroke Vol. 55, No. Suppl_1 ( 2024-02)
    Details
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 55, No. Suppl_1 ( 2024-02)
    Abstract: Introduction: Sex differences in presentation, treatment, and prognosis of cardiovascular disorders are well recognized. Although an association between acute myocardial injury and mortality after ischemic stroke has been demonstrated, it is unclear whether prevalence and outcome of post-stroke acute myocardial injury differ between women and men. Methods: We prospectively screened consecutive patients with acute ischemic stroke and serial high-sensitivity cardiac troponin T (hs-cTnT) measurements admitted to our center (January 2019-December 2020). Acute myocardial injury was defined as at least one hs-cTnT value above the upper reference limit (URL=14 ng/L) with a rise/fall of 〉 20%. Additionally, rates of acute myocardial injury were calculated with sex-specific hs-cTnT cut-offs (women URL=9ng/L; men URL=16ng/L). Results: Of 1,067 patients included, 494 were women (46%). Women were older, had higher rate of known atrial fibrillation, were more likely to be functional dependent before admission, and had higher stroke severity (all p-values 〈 0.05). The prevalence of acute myocardial injury differed by sex (29% women vs 23% men, P =0.024). In multivariate analysis, statistically significant associations between acute myocardial injury and outcomes were observed in women (7-day mortality: aOR=3.2 [1.07-9.3]; in-hospital mortality: aOR=3.3 [1.4-7.6] ; mRS at discharge: aOR=1.6 [1.1-2.4]), but not in men (Fig.1). The implementation of sex-specific cut-offs did not increase the prognostic value of acute myocardial injury for unfavorable outcomes. The ROC-derived optimal cut-offs of hs-cTnT peak values for predicting of early mortality was higher than current URLs and sex-specific (women=29.5 ng/L vs men=66 ng/L; negative predictive value: 98.46% and 99.23%) (Fig.2). Conclusions: The prevalence of acute myocardial injury after ischemic stroke and its association with mortality and unfavorable functional outcome might be sex-dependent.
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/str.55.suppl_1.TMP65
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2024
    detail.hit.zdb_id: 1467823-8
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  • 3
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    Online Resource
    Cardiomyocyte Injury Following Acute Ischemic Stroke: Protocol for a Prospective Observational Cohort Study
    JMIR Publications Inc. ; 2021
    In:  JMIR Research Protocols Vol. 10, No. 2 ( 2021-2-5), p. e24186-
    Details
    In: JMIR Research Protocols, JMIR Publications Inc., Vol. 10, No. 2 ( 2021-2-5), p. e24186-
    Abstract: Elevated cardiac troponin, which indicates cardiomyocyte injury, is common after acute ischemic stroke and is associated with poor functional outcome. Myocardial injury is part of a broad spectrum of cardiac complications that may occur after acute ischemic stroke. Previous studies have shown that in most patients, the underlying mechanism of stroke-associated myocardial injury may not be a concomitant acute coronary syndrome. Evidence from animal research and clinical and neuroimaging studies suggest that functional and structural alterations in the central autonomic network leading to stress-mediated neurocardiogenic injury may be a key underlying mechanism (ie, stroke-heart syndrome). However, the exact pathophysiological cascade remains unclear, and the diagnostic and therapeutic implications are unknown. Objective The aim of this CORONA-IS (Cardiomyocyte injury following Acute Ischemic Stroke) study is to quantify autonomic dysfunction and to decipher downstream cardiac mechanisms leading to myocardial injury after acute ischemic stroke. Methods In this prospective, observational, single-center cohort study, 300 patients with acute ischemic stroke, confirmed via cerebral magnetic resonance imaging (MRI) and presenting within 48 hours of symptom onset, will be recruited during in-hospital stay. On the basis of high-sensitivity cardiac troponin levels and corresponding to the fourth universal definition of myocardial infarction, 3 groups are defined (ie, no myocardial injury [no cardiac troponin elevation], chronic myocardial injury [stable elevation] , and acute myocardial injury [dynamic rise/fall pattern]). Each group will include approximately 100 patients. Study patients will receive routine diagnostic care. In addition, they will receive 3 Tesla cardiovascular MRI and transthoracic echocardiography within 5 days of symptom onset to provide myocardial tissue characterization and assess cardiac function, 20-min high-resolution electrocardiogram for analysis of cardiac autonomic function, and extensive biobanking. A follow-up for cardiovascular events will be conducted 3 and 12 months after inclusion. Results After a 4-month pilot phase, recruitment began in April 2019. We estimate a recruitment period of approximately 3 years to include 300 patients with a complete cardiovascular MRI protocol. Conclusions Stroke-associated myocardial injury is a common and relevant complication. Our study has the potential to provide a better mechanistic understanding of heart and brain interactions in the setting of acute stroke. Thus, it is essential to develop algorithms for recognizing patients at risk and to refine diagnostic and therapeutic procedures. Trial Registration Clinicaltrials.gov NCT03892226; https://www.clinicaltrials.gov/ct2/show/NCT03892226. International Registered Report Identifier (IRRID) DERR1-10.2196/24186
    Type of Medium: Online Resource
    ISSN: 1929-0748
    URL: Article
    DOI: 10.2196/24186
    Language: English
    Publisher: JMIR Publications Inc.
    Publication Date: 2021
    detail.hit.zdb_id: 2719222-2
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  • 4
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    Online Resource
    Frequency, associated variables, and outcomes of acute myocardial injury according to the fourth Universal Definition of Myocardial Infarction in patients with acute ischemic stroke
    SAGE Publications ; 2022
    In:  European Stroke Journal Vol. 7, No. 4 ( 2022-12), p. 413-420
    Details
    In: European Stroke Journal, SAGE Publications, Vol. 7, No. 4 ( 2022-12), p. 413-420
    Abstract: Myocardial injury as indicated by elevation of cardiac troponin levels is common after acute ischemic stroke (AIS) and linked to poor outcomes. Previous studies rarely reported on serial hs-cTn measurements to distinguish whether myocardial injury is acute or chronic. Thus, little is known about frequency, associated variables, and outcome of acute myocardial injury in AIS. Methods and patients: In this single-centered observational cohort study, from 01/2019 to 12/2020, consecutive patients with neuroimaging-confirmed AIS 〈 48 h after symptom onset, and serial troponin measurements within the first 2 days after admission (Roche Elecsys ® , hs-cardiac troponin T) were prospectively registered. Acute myocardial injury was defined according to the fourth Universal Definition of Myocardial Infarction (troponin above the upper reference limit and rise/fall 〉 20%). Outcomes of interest were in-hospital mortality and unfavorable functional status at discharge (modified Rankin Scale 〉 1). Results: Out of 1067 analyzed patients, 25.3% had acute myocardial injury, 40.4% had chronic myocardial injury and 34.3% had no myocardial injury. Older age, higher stroke severity, thrombolytic treatment, and impaired kidney function were independently associated with acute myocardial injury. In-hospital mortality was higher in patients with acute myocardial injury than in those without (13% vs 3%, adjusted OR, 2.9% [95% CI, 1.6–5.5]). Compared with no myocardial injury, both acute and chronic myocardial injury were associated with unfavorable functional status at di scharge (adjusted OR, 1.6 [95% CI, 1.1–2.5] and OR, 1.7 [95% CI, 1.2–2.4] , respectively). Conclusions: A quarter of patients with AIS have evidence of acute myocardial injury according to the fourth Universal Definition of Myocardial Infarction. The strong association with in-hospital mortality highlights the need for clinical awareness and future studies on underlying mechanisms.
    Type of Medium: Online Resource
    ISSN: 2396-9873 , 2396-9881
    URL: Article
    DOI: 10.1177/23969873221120159
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2022
    detail.hit.zdb_id: 2851287-X
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