Stroke and Vascular Neurology最新文献

{"title":"Low LDL-C level and intracranial haemorrhage risk after ischaemic stroke: a prospective cohort study.","authors":"Jie Xu,&nbsp;Zimo Chen,&nbsp;Meng Wang,&nbsp;Jinglin Mo,&nbsp;Jing Jing,&nbsp;Gulbahram Yalkun,&nbsp;Liye Dai,&nbsp;Xia Meng,&nbsp;Hao Li,&nbsp;Zixiao Li,&nbsp;Yongjun Wang","doi":"10.1136/svn-2022-001612","DOIUrl":"https://doi.org/10.1136/svn-2022-001612","url":null,"abstract":"<p><strong>Background and purpose: </strong>The Treat Stroke to Target trial has confirmed the benefit of targeting low-density lipoprotein cholesterol (LDL-C) of <1.8 mmol/L in patients who had an ischaemic stroke (IS). However, haemorrhagic risk brought by this target level (<1.8 mmol/L) or even lower level (<1.4 mmol/L) of LDL-C should also be concerned. In this study, we aimed to demonstrate whether low LDL-C could increase the intracranial haemorrhage risk following IS.</p><p><strong>Methods: </strong>Patients who had an IS from China Stroke Center Alliance programme with complete baseline information were prospectively enrolled. 793 572 patients who had an IS were categorised into 6 groups according to LDL-C level (<1.40 mmol/L, 1.40-1.79 mmol/L, 1.80-2.59 mmol/L, 2.60-2.99 mmol/L, 3.00-4.89 mmol/L, ≥4.90 mmol/L). The study outcome was defined as intracranial haemorrhage identified during hospitalisation. Logistic regression model was used to examine the association between different LDL-C levels and risk of intracranial haemorrhage.</p><p><strong>Results: </strong>Compared with patients of LDL-C=1.80-2.59 mmol/L, both subgroups of LDL-C<1.40 mmol/L and LDL-C=1.40-1.79 mmol/L showed significantly higher risk of intracranial haemorrhage (OR=1.26, 95% CI=1.18 to 1.35; OR=1.22, 95% CI=1.14 to 1.30, respectively). Interaction effect was found to exist between the subgroups of intravenous thrombolytic therapy (p=0.04), rather than the subgroups of age, sex and body mass index. Moreover, the sensitivity analyses indicated that even patients who had an IS with minor stroke still suffered from the increased intracranial haemorrhage risk related to low LDL-C level.</p><p><strong>Conclusions: </strong>Among patients who had an IS, the low LDL-C level (<1.4 mmol/L or <1.8 mmol/L) at baseline is associated with increased risk of intracranial haemorrhage during acute stage. While actively lowering LDL-C level for patients who had an IS, clinicians should also concern about the haemorrhagic risk associated with low LDL-C level.</p>","PeriodicalId":22021,"journal":{"name":"Stroke and Vascular Neurology","volume":"8 2","pages":"127-133"},"PeriodicalIF":5.9,"publicationDate":"2023-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/df/bd/svn-2022-001612.PMC10176994.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9912789","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Associations of HDL-C/LDL-C with myocardial infarction, all-cause mortality, haemorrhagic stroke and ischaemic stroke: a longitudinal study based on 384 093 participants from the UK Biobank.","authors":"Shiqi Yuan,&nbsp;Xiaxuan Huang,&nbsp;Wen Ma,&nbsp;Rui Yang,&nbsp;Fengshuo Xu,&nbsp;Didi Han,&nbsp;Tao Huang,&nbsp;MIn Peng,&nbsp;Anding Xu,&nbsp;Jun Lyu","doi":"10.1136/svn-2022-001668","DOIUrl":"https://doi.org/10.1136/svn-2022-001668","url":null,"abstract":"<p><strong>Objective: </strong>To explore the correlations of high-density lipoprotein cholesterol (HDL-C)/low-density lipoprotein cholesterol (LDL-C) with myocardial infarction (MI), all-cause mortality, haemorrhagic stroke and ischaemic stroke, as well as the joint association of genetic susceptibility and HDL-C/LDL-C with the MI risk.</p><p><strong>Methods and results: </strong>This study selected 384 093 participants from the UK Biobank (UKB) database. First, restricted cubic splines indicated non-linear associations of HDL-C/LDL-C with MI, ischaemic stroke and all-cause mortality. Second, a Cox proportional-hazards model indicated that compared with HDL-C/LDL-C=0.4-0.6, HDL-C/LDL-C<0.4 and >0.6 were correlated with all-cause mortality (HR=0.97 for HDL-C/LDL-C<0.4, 95% CI=0.939 to 0.999, p<0.05; HR=1.21 for HDL-C/LDL-C>0.6, 95% CI=1.16 to 1.26, p<0.001) after full multivariable adjustment. HDL-C/LDL-C<0.4 was correlated with a higher MI risk (HR=1.36, 95% CI=1.28 to 1.44, p<0.05) and ischaemic stroke (HR=1.12, 95% CI=1.02 to 1.22, p<0.05) after full multivariable adjustment. HDL-C/LDL-C>0.6 was associated with higher risk haemorrhagic stroke risk after full multivariable adjustment (HR=1.25, 95% CI=1.03 to 1.52, p<0.05). Third, after calculating the coronary heart disease Genetic Risk Score (CHD-GRS) of each participant, the Cox proportional-hazards model indicated that compared with low CHD-GRS and HDL-C/LDL-C=0.4-0.6, participants with a combination of high CHD-GRS and HDL-C/LDL-C<0.4 were associated with the highest MI risk (HR=2.45, 95% CI=2.15 to 2.8, p<0.001). Participants with HDL-C/LDL-C<0.4 were correlated with a higher MI risk regardless of whether they had a high, intermediate or low CHD-GRS.</p><p><strong>Conclusion: </strong>In UKB participants, HDL-C/LDL-C ratio of 0.4-0.6 was correlated with lower MI risk, all-cause mortality, haemorrhagic stroke and ischaemic stroke. Participants with HDL-C/LDL-C<0.4 were correlated with a higher MI risk regardless of whether they had a high, intermediate or low CHD-GRS. The clinical significance and impact of HDL-C/LDL-C need to be further verified in future studies.</p>","PeriodicalId":22021,"journal":{"name":"Stroke and Vascular Neurology","volume":"8 2","pages":"119-126"},"PeriodicalIF":5.9,"publicationDate":"2023-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/7a/6f/svn-2022-001668.PMC10176979.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9917807","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Measures of intracranial compartments in acute intracerebral haemorrhage: data from the Rapid Intervention with Glyceryl Trinitrate in Hypertensive Stroke-2 Trial (RIGHT-2).","authors":"Kailash Krishnan,&nbsp;Zhe Kang Law,&nbsp;Lisa J Woodhouse,&nbsp;Rob A Dineen,&nbsp;Nikola Sprigg,&nbsp;Joanna M Wardlaw,&nbsp;Philip M Bath","doi":"10.1136/svn-2021-001375","DOIUrl":"https://doi.org/10.1136/svn-2021-001375","url":null,"abstract":"<p><strong>Background and purpose: </strong>Intracerebral haemorrhage volume (ICHV) is prognostically important but does not account for intracranial volume (ICV) and cerebral parenchymal volume (CPV). We assessed measures of intracranial compartments in acute ICH using computerised tomography scans and whether ICHV/ICV and ICHV/CPV predict functional outcomes. We also assessed if cistern effacement, midline shift, old infarcts, leukoaraiosis and brain atrophy were associated with outcomes.</p><p><strong>Methods: </strong>Data from 133 participants from the Rapid Intervention with Glyceryl Trinitrate in Hypertensive Stroke-2 Trial trial were analysed. Measures included ICHV (using ABC/2) and ICV (XYZ/2) (by independent observers); ICHV, ICV and CPV (semiautomated segmentation, SAS); atrophy (intercaudate distance, ICD, Sylvian fissure ratio, SFR); midline shift; leukoaraiosis and cistern effacement (visual assessment). The effects of these measures on death at day 4 and poor functional outcome at day 90 (modified Rankin scale, mRS of >3) was assessed.</p><p><strong>Results: </strong>ICV was significantly different between XYZ and SAS: mean (SD) of 1357 (219) vs 1420 (196), mean difference (MD) 62 mL (p<0.001). There was no significant difference in ICHV between ABC/2 and SAS. There was very good agreement for ICV measured by SAS, CPV, ICD, SFR, leukoaraiosis and cistern score (all interclass correlations, n=10: interobserver 0.72-0.99, intraobserver 0.73-1.00). ICHV/ICV and ICHV/CPV were significantly associated with mRS at day 90, death at day 4 and acute neurological deterioration (all p<0.05), similar to ICHV. Midline shift and cistern effacement at baseline were associated with poor functional outcome but old infarcts, leukoaraiosis and brain atrophy were not.</p><p><strong>Conclusions: </strong>Intracranial compartment measures and visual estimates are reproducible. ICHV adjusted for ICH and CPV could be useful to prognosticate in acute stroke. The presence of midline shift and cistern effacement may predict outcome but the mechanisms need validation in larger studies.</p>","PeriodicalId":22021,"journal":{"name":"Stroke and Vascular Neurology","volume":"8 2","pages":"151-160"},"PeriodicalIF":5.9,"publicationDate":"2023-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/c7/99/svn-2021-001375.PMC10176998.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9610965","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cilostazol and isosorbide mononitrate for the prevention of progression of cerebral small vessel disease: baseline data and statistical analysis plan for the Lacunar Intervention Trial-2 (LACI-2) (ISRCTN14911850).","authors":"Philip M Bath,&nbsp;Iris Mhlanga,&nbsp;Lisa J Woodhouse,&nbsp;Fergus Doubal,&nbsp;Katherine Oatey,&nbsp;Alan A Montgomery,&nbsp;Joanna M Wardlaw","doi":"10.1136/svn-2022-001816","DOIUrl":"https://doi.org/10.1136/svn-2022-001816","url":null,"abstract":"<p><strong>Background: </strong>Cerebral small vessel disease (SVD) causes lacunar strokes (25% of all ischaemic strokes), physical frailty and cognitive impairment and vascular and mixed dementia. There is no specific treatment to prevent progression of SVD.</p><p><strong>Methods: </strong>The LACunar Intervention Trial-2 is an investigator-initiated prospective randomised open-label blinded-endpoint phase II feasibility study assessing cilostazol and isosorbide mononitrate for preventing SVD progression. We aimed to recruit 400 patients with clinically evident lacunar ischaemic stroke and randomised to cilostazol, isosorbide mononitrate, both or neither, in addition to guideline secondary ischaemic stroke prevention, in a partial factorial design. The primary outcome is feasibility of recruitment and adherence to medication; key secondary outcomes include: drug tolerability; recurrent vascular events, cognition and function at 1 year after randomisation; and safety (bleeding, falls, death). Data are number (%) and median (IQR).</p><p><strong>Results: </strong>The trial commenced on 5 February 2018 and ceased recruitment on 31 May 2021 with 363 patients randomised, with the following baseline characteristics: average age 64 (56.0, 72.0) years, female 112 (30.9%), stroke onset to randomisation 79.0 (27.0, 244.0) days, hypertension 267 (73.6%), median blood pressures 143.0 (130.0, 157.0)/83.0 (75.0, 90.0) mm Hg, current smokers 67 (18.5%), educationally achieved end of school examinations (A-level) or higher 118 (32.5%), modified Rankin scale 1.0 (0.0, 1.0), National Institutes Health stroke scale 1.0 (1.4), Montreal Cognitive Assessment 26.0 (23.0, 28.0) and total SVD score on brain imaging 1.0 (0.0, 2.0). This publication summarises the baseline data and presents the statistical analysis plan.</p><p><strong>Summary: </strong>The trial is currently in follow-up which will complete on 31 May 2022 with results expected in October 2022.</p><p><strong>Trial registration number: </strong>ISRCTN14911850.</p>","PeriodicalId":22021,"journal":{"name":"Stroke and Vascular Neurology","volume":"8 2","pages":"134-143"},"PeriodicalIF":5.9,"publicationDate":"2023-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/6c/e8/svn-2022-001816.PMC10176977.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9561352","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Deep white matter hyperintensity is spatially correlated to MRI-visible perivascular spaces in cerebral small vessel disease on 7 Tesla MRI.","authors":"Yajing Huo,&nbsp;Yilin Wang,&nbsp;Cen Guo,&nbsp;Qianyun Liu,&nbsp;Lili Shan,&nbsp;Mingyuan Liu,&nbsp;Haibo Wu,&nbsp;Guanwu Li,&nbsp;Huihui Lv,&nbsp;Lingdan Lu,&nbsp;Yintin Zhou,&nbsp;Jianfeng Feng,&nbsp;Yan Han","doi":"10.1136/svn-2022-001611","DOIUrl":"https://doi.org/10.1136/svn-2022-001611","url":null,"abstract":"<p><strong>Background: </strong>The association between perivascular space (PVS) and white matter hyperintensity (WMH) has been unclear. Normal-appearing white matter (NAWM) around WMH is also found correlated with the development of focal WMH. This study aims to investigate the topological connections among PVS, deep WMH (dWMH) and NAWM around WMH using 7 Tesla (7T) MRI.</p><p><strong>Methods: </strong>Thirty-two patients with non-confluent WMHs and 16 subjects without WMHs were recruited from our department and clinic. We compared the PVS burden between patients with and without WMHs using a 5-point scale. Then, the dilatation and the number of PVS within a radius of 1 cm around each dWMH were compared with those of a reference site (without WMH) in the contralateral hemisphere. In this study, we define NAWM as an area within the radius of 1 cm around each dWMH. Furthermore, we assessed the spatial relationship between dWMH and PVS.</p><p><strong>Results: </strong>Higher PVS scores in the centrum semiovale were found in patients with >5 dWMHs (median 3) than subjects without dWMH (median 2, p = 0.014). We found there was a greater dilatation and a higher number of PVS in NAWM around dWMH than at the reference sites (p<0.001, p<0.001). In addition, 79.59% of the dWMHs were spatially connected with PVS.</p><p><strong>Conclusion: </strong>dWMH, NAWM surrounding WMH and MRI-visible PVS are spatially correlated in the early stage of cerebral small vessel disease. Future study of WMH and NAWM should not overlook MRI-visible PVS.</p>","PeriodicalId":22021,"journal":{"name":"Stroke and Vascular Neurology","volume":"8 2","pages":"144-150"},"PeriodicalIF":5.9,"publicationDate":"2023-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/4d/49/svn-2022-001611.PMC10176991.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9557815","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"<i>NOTCH2NLC</i> expanded GGC repeats in patients with cerebral small vessel disease.","authors":"Yun-Chao Wang,&nbsp;Yu Fan,&nbsp;Wen-Kai Yu,&nbsp;Si Shen,&nbsp;Jia-Di Li,&nbsp;Yuan Gao,&nbsp;Yan Ji,&nbsp;Yu-Sheng Li,&nbsp;Lu-Lu Yu,&nbsp;Zi-Chen Zhao,&nbsp;Shan-Shan Li,&nbsp;Yao Ding,&nbsp;Chang-He Shi,&nbsp;Yu-Ming Xu","doi":"10.1136/svn-2022-001631","DOIUrl":"https://doi.org/10.1136/svn-2022-001631","url":null,"abstract":"<p><strong>Objective: </strong>GGC repeat expansions in the human-specific <i>NOTCH2NLC</i> gene have been reported as the cause of neuronal intranuclear inclusion disease (NIID). Given the clinical overlap of cognitive impairment in NIID and cerebral small vessel disease (CSVD), both diseases have white matter hyperintensity on T2-fluid-attenuated inversion recovery sequences of brain MRI, and white matter hyperintensity is a primary neuroimaging marker of CSVD on MRI. Therefore, we hypothesised that the GGC repeat expansions might also contribute to CSVD. To further investigate the relationship between <i>NOTCH2NLC</i> GGC repeat expansions and CSVD, we performed a genetic analysis of 814 patients with the disease.</p><p><strong>Methods: </strong>We performed a comprehensive GGC repeat expansion screening in <i>NOTCH2NLC</i> from 814 patients with sporadic CSVD. Their Fazekas score was greater than or equal to 3 points. Repeat-primed PCR and fluorescence amplicon length analyses were performed to identify GGC repeat expansions, and whole-exome sequencing was used to detect any pathogenic mutation in previously reported genes associated with CSVD.</p><p><strong>Results: </strong>We identified nine (1.11%) patients with pathogenic GGC repeat expansions ranging from 41 to 98 repeats. The minor allele frequency of expanded GGC repeats in <i>NOTCH2NLC</i> was 0.55%.</p><p><strong>Conclusion: </strong>Our findings suggest that intermediate-length and longer-length GGC repeat expansions in <i>NOTCH2NLC</i> are associated with sporadic CSVD. This provides new thinking for studying the pathogenesis of CSVD.</p>","PeriodicalId":22021,"journal":{"name":"Stroke and Vascular Neurology","volume":"8 2","pages":"161-168"},"PeriodicalIF":5.9,"publicationDate":"2023-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/70/3d/svn-2022-001631.PMC10176980.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9557828","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Correction: <i>Cilostazol and isosorbide mononitrate for the prevention of progression of : baseline data and statistical analysis plan for the Lacunar Intervention Trial-2 (LACI-2) (ISRCTN14911850)</i>.","authors":"","doi":"10.1136/svn-2022-001816corr1","DOIUrl":"https://doi.org/10.1136/svn-2022-001816corr1","url":null,"abstract":"","PeriodicalId":22021,"journal":{"name":"Stroke and Vascular Neurology","volume":"8 2","pages":"e1"},"PeriodicalIF":5.9,"publicationDate":"2023-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/0e/f5/svn-2022-001816corr1.PMC10176987.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9464378","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Circulating endothelial microvesicles and their carried miR-125a-5p: potential biomarkers for ischaemic stroke.","authors":"Xiaotang Ma,&nbsp;Xiaorong Liao,&nbsp;Jiehong Liu,&nbsp;Yan Wang,&nbsp;Xiang Wang,&nbsp;Yanfang Chen,&nbsp;Xiaojian Yin,&nbsp;Qunwen Pan","doi":"10.1136/svn-2021-001476","DOIUrl":"https://doi.org/10.1136/svn-2021-001476","url":null,"abstract":"Background Endothelial microvesicles (EMVs) are closely associated with the status of endothelial cells (ECs). Our earlier study has shown that EMVs could exert protective roles in ECs by transferring their carried miR-125a-5p. However, whether circulating EMVs and their carried miR-125a-5p can be used as biomarkers in ischaemic stroke (IS) are remain unknown. Methods We recruited 72 subjects with IS, 60 subjects with high stroke risk and 56 age-matched controls. The circulating EMVs and their carried miR-125a-5p (EMV-miR-125a-5p) levels were detected. We used microRNA (miR) array to study expression changes of miRs in plasma EMVs samples of three IS patients and three matched healthy controls. Transient middle cerebral artery occlusion (tMCAO) was used to establish IS mouse model. Results EMVs level was obviously elevated in IS patients, with the highest level in acute stage, and was positively related to carotid plaque, carotid intima–media thickness (IMT), National Institutes of Health Stroke Scale (NIHSS), infarct volume. On the contrary, we observed that EMV-miR-125a-5p level was obviously reduced in IS, with the lowest level in acute stage, and was negatively correlated with carotid plaque, IMT, NIHSS scores, infarct volume. EMVs and EMV-miR-125a-5p levels were closely related with large artery atherosclerosis subgroup. Importantly, EMVs and EMV-miR-125a-5p levels could serve as independent risk factors, and receiver operating characteristic curve achieved an area under curve (AUC) of 0.720 and 0.832 for IS, respectively, and elevated to 0.881 after their combination. In IS mouse model, control EMVs or n-EMVs administration could decrease the infarct volume and neurological deficit score, while increase the cerebral blood flow of IS mice compared with vehicle group, while IS EMVs or oxygen and glucose deprivation (OGD)-EMVs administration aggravated the tMCAO induced ischaemic injury. In addition, we observed that OGD EMVmiR-125a-5p could partially ameliorate the OGD EMVs induced brain injury after IS. Conclusions These findings demonstrate that circulating EMVs and EMV-miR-125a-5p are closely related with the occurrence, progress, subtypes and severity of IS, and they can serve as innovative biomarkers and therapeutic targets for IS, especially when they are combined.","PeriodicalId":22021,"journal":{"name":"Stroke and Vascular Neurology","volume":"8 2","pages":"89-102"},"PeriodicalIF":5.9,"publicationDate":"2023-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/12/86/svn-2021-001476.PMC10176997.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9561334","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Somatic mutation contributing to clonal haematopoiesis is a risk factor of recurrent stroke in first-ever acute ischaemic stroke: a prospective cohort study.","authors":"Xin Qiu,&nbsp;Yalun Dai,&nbsp;Si Cheng,&nbsp;Hong-Qiu Gu,&nbsp;Yong Jiang,&nbsp;Xia Meng,&nbsp;Yilong Wang,&nbsp;Xingquan Zhao,&nbsp;Yingyu Jiang,&nbsp;Zhe Xu,&nbsp;Xinying Huang,&nbsp;Meng Wang,&nbsp;Tian Jie Lyu,&nbsp;Yubo Wang,&nbsp;Jiaxu Weng,&nbsp;Lingyun Cui,&nbsp;Yi Shangguan,&nbsp;Hao Li,&nbsp;Yongjun Wang,&nbsp;Zixiao Li","doi":"10.1136/svn-2022-001756","DOIUrl":"https://doi.org/10.1136/svn-2022-001756","url":null,"abstract":"<p><strong>Background: </strong>Somatic mutation contributes to clonal haematopoiesis of indeterminate potential (CHIP) is related to age and associated with a higher risk of stroke and atherosclerotic cardiovascular disease. Here, we investigated the prognostic significance of CHIP in a large first-ever acute ischaemic stroke (AIS) cohort and explored the underlying mechanisms.</p><p><strong>Methods: </strong>We studied a prospective cohort of 6016 patients who had a first-ever AIS in China. Whole-genome sequencing was performed to identify CHIP. High-sensitivity C reactive protein (hs-CRP) levels above 3 mg/L at baseline were defined as hyperinflammation. Recurrent stroke during the 3-month follow-up was the primary outcome.</p><p><strong>Results: </strong>Among the 6016 patients who had a first-ever AIS, with a median age was 62 years (IQR, 54.0‒70.0), 3.70% were identified as CHIP carriers. The most common mutations occurred in the <i>DNMT3A</i> (30.0%) and <i>TET2</i> (11.4%) genes. During a follow-up of 3 months, the presence of CHIP was associated with recurrent stroke (HR 1.62, 95% CI 1.04 to 2.51, p=0.03), recurrent ischaemic stroke (HR 1.64, 95% CI 1.04 to 2.58, p=0.03) and combined vascular events (HR 1.58, 95% CI 1.02 to 2.44, p=0.04) after adjusting for hsCRP levels at baseline in patients who had a first-ever AIS. Subgroup analysis demonstrated that CHIP was only associated with recurrent stroke when patients under hyperinflammation (OR 3.10, 95% CI 1.92 to 5.00, p<0.001) but not in those without hyperinflammation (OR 0.18, 95% CI 0.03 to 1.04, p=0.06, P_interaction=0.002).</p><p><strong>Conclusion: </strong>Our results suggest that somatic mutations contributing to CHIP increase the risk of short-term recurrent stroke in patients who had a first-ever AIS. Hyperinflammation may be important in the relationship between CHIP and recurrent stroke.</p>","PeriodicalId":22021,"journal":{"name":"Stroke and Vascular Neurology","volume":"8 2","pages":"103-110"},"PeriodicalIF":5.9,"publicationDate":"2023-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/9d/03/svn-2022-001756.PMC10176982.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9929030","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"ADVISING score: a reliable grading scale based on injury and response for intracerebral haemorrhage.","authors":"Yan Wan,&nbsp;Hongxiu Guo,&nbsp;Shaoli Chen,&nbsp;Jiang Chang,&nbsp;David Wang,&nbsp;Rentang Bi,&nbsp;Man Li,&nbsp;Ke Shi,&nbsp;Zhaowei Wang,&nbsp;Daokai Gong,&nbsp;Jingwen Xu,&nbsp;Quanwei He,&nbsp;Bo Hu","doi":"10.1136/svn-2022-001707","DOIUrl":"https://doi.org/10.1136/svn-2022-001707","url":null,"abstract":"<p><strong>Background: </strong>Intracerebral haemorrhage (ICH) is the most devastating form of stroke causing high morbidity and mortality. We aimed to develop a novel clinical score incorporating multisystem markers to predict functional dependence at 90 days after ICH.</p><p><strong>Methods: </strong>We analysed data from Chinese Cerebral Hemorrhage: Mechanism and Intervention study. Multivariable logistic regression analysis was used to identify the factors associated with 90-day functional dependency (the modified Rankin Scale ≥3) after ICH and develop the ADVISING scoring system. To test the scoring system, a total of 2111 patients from Hubei province were included as the training cohort, and 733 patients from other three provinces in China were included as an external validation cohort.</p><p><strong>Results: </strong>We found nine variables to be significantly associated with functional dependency and included in the ADVISING score system: age, deep location of haematoma, volume of haematoma, National Institutes of Health Stroke Scale, aspartate transaminase, international normalised ratio, neutrophil-lymphocyte ratio, fasting blood glucose and glomerular filtration rate. Individuals were divided into 12 different categories by using these nine potential predictors. The proportion of patients who were functionally dependent increased with higher ADVISING scores, which showed good discrimination and calibration in both the training cohort (C-statistic, 0.866; p value of Hosmer-Lemeshow test, 0.195) and validation cohort (C-statistic, 0.884; p value of Hosmer-Lemeshow test, 0.853). The ADVISING score also showed better discriminative performance compared with the other five existing ICH scores (p<0.001).</p><p><strong>Conclusions: </strong>ADVISING score is a reliable tool to predict functional dependency at 90 days after ICH.</p>","PeriodicalId":22021,"journal":{"name":"Stroke and Vascular Neurology","volume":"8 2","pages":"111-118"},"PeriodicalIF":5.9,"publicationDate":"2023-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/29/d8/svn-2022-001707.PMC10176996.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9557095","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}