OBJECTIVETo investigate predictors of left ventricular mass corrected for height (LVMI) and left ventricular hypertrophy in patients who were found to be normotensive with both office and 24-h ...ambulatory blood pressure (BP) measurements.
METHODSA total of 805 consecutive patients were analyzed. All patients underwent office BP measurements, 24-h ambulatory BP monitoring, laboratory measurements for cardiovascular risk factors and echocardiography. Individuals with both office and ambulatory normotension were characterized as true normotensive.
RESULTSLVMI was found to be 34.5 ± 10.9 g/m in normal-weight patients and 48.7 ± 13.0 g/m in obese patients (P < 0.0001). LVMI was found to be 41.7 ± 10 g/m in overweight patients, significantly lower than the values of obese patients (P < 0.005) and higher than the values of normal-weight patients (P < 0.001). These results remained significant even after adjustment for age, sex, daytime and nighttime SBP, daytime and nighttime DBP, daytime and nighttime BP variability and daytime and nighttime pulse pressure (PP). In a multivariate analysis model, in which LVMI was the dependent variable and office SBP, office DBP, daytime and nighttime SBP and DBP, daytime and nighttime PPs and variabilities, day–night SBP ratio, fasting serum glucose, triglycerides, total cholesterol, age and BMI were inserted as independent variables with weighted least squares regression by sex, the predictors of LVMI were age, BMI and daytime PP (r = 0.31). Left ventricular hypertrophy was 17.67 times more likely in obese patients as compared with normal-weight true normotensive individuals.
CONCLUSIONObesity may represent a significant cardiovascular risk factor even in normotensive individuals. Other predictors of LVMI were ageing and daytime PP.
Abstract only Introduction: The RoPE score calculates the probability that patent foramen ovale (PFO) is causally related to stroke (PFO attributable fraction, PFO-af), based on PFO prevalence in ...patients with cryptogenic stroke compared with that in control subjects. The latter has been estimated at 25%; however, PFO prevalence in nonselected populations varies widely. Since PFO prevalence in Greeks remains unknown, we aimed to define it and to calculate PFO-af stratified by RoPE score in a cohort of patients with embolic stroke of undetermined source (ESUS). Methods: Right-to-left cardiac shunt (RLS) was detected according to the international consensus criteria in healthy subjects (H, n=115, women=65) and patients with ESUS (n=84, women=42) ≤55 years old. Each subject underwent unilateral middle cerebral artery transcranial Doppler (TCD) recording (Sonaratek, Natus) with a 2-MHz probe after infusion of agitated saline, at rest and after a controlled Valsalva maneuver. We characterized RLS as large (>20 microbubbles or curtain), moderate (10<x≤20) and minimal (≤10). Statistical comparisons were performed using the Fisher’s exact test. We dichotomized patients with ESUS and PFO into high (>median) and low (≤median) RoPE score groups and calculated the corresponding PFO-af. Results: RLS was detected in 43.5% (50/115) of H and 50% (42/84) of ESUS. Large RLS tended to occur more often in ESUS compared to H 29.8% (25/84) vs 18.3% (21/115); p=0.06. The RoPE score median in patients with ESUS and RLS was 8 (interquartile range: 7,9). Patients with high RoPE score (9-10) had PFO-af of 64.4 whereas patients with low score (0-8) had PFO-af of 4.4. For any individual stratum up to RopE score 6, the PFO-af was null. Conclusions: The prevalence of RLS in Greeks is quite higher than the average used by the RoPE study. Despite a 50% chance of having RLS of any size, patients with ESUS have large RLS at least 60% more often than the general population. We suggest that optimal calculation of the PFO-af corresponding to RoPE score strata relies on the accurate estimation of PFO prevalence in national/ethnic populations. The proposed RoPE score cutoff of >6 for having a probable PFO-related stroke may overestimate the probability in patients deriving from populations with high RLS prevalence.
Abstract only Background: Recent extended window (EW) trials support the benefit of mechanical thrombectomy (MT) in anterior circulation emergent large vessel occlusions (ELVO). However, only up to ...1.7% of consecutive acute ischemic strokes (AIS) were eligible for EW-MT using clinical trial selection criteria. We examined eligibility and outcomes of EW-MT in consecutive ELVOs using pragmatic selection criteria. Methods: We prospectively evaluated consecutive patients presenting between 6-24 hours that underwent MT using selection criteria consisting of only non-contrast CT (ASPECTS > 6), CTA occlusion + good collateral scores (JNIS 2016;8:559-562). Effectiveness outcomes included TICI 2b-3 and 3-month modified Rankin Scores (mRS); safety outcomes included in-hospital mortality and symptomatic intracerebral hemorrhage (sICH). Results: 767 consecutive AIS patients presented within 6-24 hour window, and of these 48 (6%) anterior circulation ELVOs underwent MT (mean age 63±17 years; 56% men; median NIHSS 16 IQR 10-19; median groin puncture to recanalization 53 minutes IQR 41-85). Median ASPECTS was 9 (IQR 8-10), and 79% (n=38) of patients had good CTA collateral grade. Occlusions were primarily M1 MCA (46%), with 29% tandem occlusions. Successful recanalization (mTICI 2b or 3) was achieved in 73% (n=35), while 6% (n=3) of patients developed sICH. In-hospital mortality was 25% (n=12), however 40% (n=19) achieved 3-month mRS 0-2. Conclusions: The use of standard of care CT/CTA yields an acceptable rate of MT eligibility, allowing a group of patients facing likely death or severe disability to obtain reasonable safety and effectiveness outcomes.
Clinicians commonly use verbal and nonverbal measures to test fluency in patients with epilepsy, either during routine cognitive assessment or as part of pre- and postsurgical evaluation. We ...hypothesized that patients with mesial temporal lobe epilepsy (TLE) with hippocampal sclerosis would perform worse than patients with lateral TLE in both verbal and design fluency.
We assessed semantic, phonemic, and nonverbal fluency in 49 patients with TLE: 31 with lateral TLE and 18 with mesial TLE plus hippocampal sclerosis. We also gave non-fluency cognitive measures: psychomotor speed, attentional set shifting, selective attention, abstract reasoning, verbal and visual episodic memory, and incidental memory.
Patients with mesial TLE performed significantly worse on figural fluency than patients with lateral TLE. Even though group differences on verbal fluency measures were not significant, the patients with mesial TLE had a pattern of poorer performance. The patients with mesial TLE scored significantly worse on measures of selective attention, verbal episodic memory, and incidental memory.
Our study underlines differences in cognitive function between patients with mesial and lateral TLE, particularly in figural fluency. Although we cannot directly assess the role of the hippocampus in cognitive aspects of creative and divergent thinking related to figural fluency, the cognitive discrepancies between these two TLE groups could be ascribed to the mesial TLE hippocampal pathology shown in our study and addressed in the literature on hippocampal involvement in divergent thinking. Our findings could benefit cognitive rehabilitation programs tailored to the needs of patients with TLE.
Introduction
Intraparenchymal hemorrhage (IPH) is a serious medical condition with high morbidity. Hydrocephalus complicates the course of IPH recovery and frequently necessitates permanent ...cerebrospinal fluid (CSF) diversion by ventriculoperitoneal shunting (VPS). Risk factors for VPS have not been studied in adults after IPH. This is a nonrandomized retrospective study aimed to determine risk factors for VPS among IPH patients seen at Barrow Neurological Institute over a 2-year period.
Methods
Chart review collected pertinent demographic and radiological data for all IPH patients. This data underwent statistical analysis to discover those factors associated with VPS requirements. A predictive shunting instrument was then constructed to determine those patients at greatest risk of VPS requirement.
Results
Initial Glasgow Coma Scale score < 9 (
P
= 0.033), abundant blood in the lateral ventricle (
P
= 0.016), ICP elevations > 25 mmHg (
P
= 0.016), persistent ICP elevations > 20 mmHg (
P
= 0.017), and thalamic IPH location (
P
= 0.009) were associated with VPS on univariate analysis. Thalamic IPH location (
P
= 0.025) and ICP > 25 mm Hg (
P
= 0.025) were associated with VPS on multivariate analysis. Application of a predictive shunting instrument to the cohort had positive predictive value of 100% and a negative predictive value of 81%.
Conclusion
A predictive shunting instrument utilizing GCS score, lateral ventricle blood, ICP measurement, and the presence of hydrocephalus may predict those patients at risk for VPS or identify those patients requiring additional CSF drainage strategies.
Vitamin D receptor’s (VDR) genotypes have been associated both with the development of bone disease and the pathogenesis of multiple sclerosis (MS). We aimed to evaluate the association between the ...presence of Bsm1 restriction fragment length polymorphism of VDR and bone loss in ambulatory patients with MS. This cross-sectional study included 82 adult patients with relapsing-remitting MS. Fasting blood samples were obtained for biochemical–hormonal assessment and genotyping. Bone mineral density (BMD) was assessed at the lumbar spine (LS) and the femoral neck (FN), using dual energy X-ray absorptiometry. Possible associations between VDR’s genotypes and BMD levels as well as biochemical and hormonal indices were evaluated. Among premenopausal women and men, carriers of the B allele exhibited higher BMD and
Z
score at the FN and a trend toward higher BMD at the LS, compared to patients with the bb genotype, after adjusting for age, BMI, sex, EDSS scoring, interferon administration, duration of MS and total steroids intake. Among postmenopausal women, the presence of the B allele was not associated with BMD or
T
score at any site, whereas carriers of the B allele exhibited higher levels of calcium (
p
value 0.008, univariate). No other significant differences were exhibited between levels of electrolytes, parathormone, 25-hydroxyvitamin D
3
and the genotype of VDR, in any of the groups. VDR’s Bsm1 polymorphism is associated with a mild effect on BMD in younger patients with MS. Larger studies are necessary to corroborate these findings.
Hyperhomocysteinemia has been recognised as an independent cardiovascular risk factor, while statins have been reported to have pleiotropic effects other than lipid lowering. In our study we sought ...to evaluate the possible effect of short-term administration of simvastatin on homocysteine (Hcy) and other established serum proatherogenic and inflammatory markers in essential hypertensive patients. Our study population consisted of 18 untreated mild essential hypertensive patients (9 men, mean age: 51.2±10.9 years, office blood pressure = 149/96 mmHg). All subjects received simvastatin (40mg/day) for a period of 1 month. Venous blood samples were drawn before and after the period of treatment with simvastatin in order to evaluate lipid, lipoprotein-a (Lp-a), apolipoprotein A1 (ApoA1), apolipoprotein B (ApoB), fibrinogen, uric acid, homocysteine, folic acid, vitamin B12, high sensitivity-CRP (hsCRP) levels, by standard methodology. For the pooled population BMI was 27.2±3.6 kg/m2, left ventricular mass index was 106±35.1 g/m2, relative wall thickness was 0.45±0.07 and hsCRP levels were 1.5±0.3 mg/l. After 1 month on simvastatin, there was a significant reduction in total cholesterol (215.1±40.7 vs 156.0±29.2 mg/dl, p<0.001), triglycerides (114.1±30.9 vs 89.6±27.8 mg/dl, p<0.05), LDL (141.4±29 vs 89.6±21.6 mg/dl, p<0.001), ApoB (101.6±19.2 vs 71.8±15 mg/dl, p<0.001), uric acid (5.8±1.2 vs 5.4±1.1 mg/dl, p<0.05), homocysteine (13.6±7.3 vs 12.7±7.4 μmol/l, p<0.05). In all subjects, apoA1 and hs-CRP did not exhibit any statistically significant attenuation (p=NS, for all cases). Moreover, the reduction of Hcy serum levels was not correlated with the observed reductions in total cholesterol, triglycerides, LDL, ApoB and uric acid values (p=NS, for all cases). Even in newly diagnosed essential hypertensive subjects, short-term administration of simvastatin resulted in a significant and independent attenuation of Hcy serum levels. These findings may elucidate the diverse pathophysiological mechanisms by which statins reduce cardiovascular risk, in this setting.
Statins have been reported to improve blood pressure control in essential hypertensive subjects via diverse pathophysiological mechanisms, while salt sensitivity is an emerging cardiovascular risk ...factor. In this study, we sought to investigate the possible effects of short-term administration of simvastatin on blood pressure levels in salt sensitive and salt resistant essential hypertensive subjects. Eighteen untreated mild essential hypertensive patients (9 men, age 51.2±10.9 years) were screened for salt sensitivity by means of an established protocol. All subjects underwent 24h ambulatory BP monitoring before and after 1 month of treatment with simvastatin (40mg/day). Venous blood samples were drawn before and after statin administration period for determination of lipid, lipoprotein-a, apolipoprotein A1 and apolipoprotein B levels. For the pooled population BMI was 27.2±3.6 kg/m2, left ventricular mass index was 106±35.1 g/m2 and relative wall thickness was 0.45±0.07. Four patients were classified as salt sensitive (SS) (2 men, 60±9 years), while 14 were salt resistant (SR) (7 men, 60±10 years). After 1 month on simvastatin, only SS patients, presented significant reductions in office systolic BP (155±12.9 vs 130±18.2 mmHg, p<0.05), 24-h diastolic BP (85.9±5.7 vs 76.3±4.3 mm Hg, p<0.05), 24-h mean BP (104.4±5.1 vs 93.3±7.5 mm Hg, p<0.05), daytime diastolic BP (89.1±7.6 vs 78.9±6 mm Hg, p<0.05), daytime mean BP (107.5±8.5 vs 95.1±8.3 mm Hg, p<0.05), while patients in the SR group did not exhibit any significant reduction in 24h BP levels (p=NS). Moreover, there was no correlation between the reductions of 24h BP in the SS group and the reductions of the lipid parameters (p=NS). In newly diagnosed essential hypertensive subjects, short-term administration of simvastatin resulted in a significant attenuation of BP values in salt sensitive hypertensives, independently of lipid lowering, suggesting a possible link between salt sensitivity and the pleiotropic mechanisms of statins action. These findings suggest that salt sensitive patients may benefit more from the pleiotropic effects of statins, in the same setting.
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