David L Tirschwell's research while affiliated with University of Washington Seattle and other places
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Publications (350)
Methamphetamine (meth) is a potent and addictive central nervous system stimulant with increasing use. Stroke is one severe possible complication of meth use. Due to high levels of manufacturing in Mexico, the western United States has experienced greater consequences of meth use. The literature reviewed herein is comprised of case studies and seri...
Introduction:
The benefits and risks of HMG-CoA reductase inhibitor (statin) drugs in survivors of intracerebral hemorrhage (ICH) are unclear. Observational studies suggest an association between statin use and increased risk of lobar ICH, particularly in patients with apolipoprotein-E (APOE) ε2 and ε4 genotypes. There are no randomized controlled...
Background and objectives:
Cardiovascular disease contributes significantly to disease burden among many Indigenous populations. However, data on stroke incidence in Indigenous populations are sparse. We aimed to investigate what is known of stroke incidence in Indigenous populations of countries with a very high Human Development Index (HDI), loc...
Importance
Atrial cardiopathy is associated with stroke in the absence of clinically apparent atrial fibrillation. It is unknown whether anticoagulation, which has proven benefit in atrial fibrillation, prevents stroke in patients with atrial cardiopathy and no atrial fibrillation.
Objective
To compare anticoagulation vs antiplatelet therapy for s...
Introduction: No guidelines exist regarding imaging after mechanical thrombectomy (MT) for acute ischemic stroke (AIS). Dual Energy Head CT (DECT) can differentiate between contrast staining and intracranial hemorrhage (ICH). We obtained routine DECT for AIS patients immediately following MT. We aimed to understand the impact of DECT on clinical ma...
Introduction: Intraventricular hemorrhage (IVH), a common complication of intracerebral hemorrhage (ICH), can occur with little or no associated ICH (mostly IVH, mIVH). mIVH is reported to have better outcomes than IVH associated with substantial ICH. Few data exist describing outcomes from mIVH, especially more severe cases.
Hypothesis: Using the...
Background: Atrial cardiopathy is associated with incident ischemic stroke in the absence of clinical atrial fibrillation in prospective cohorts. Whether biomarkers of atrial cardiopathy predict recurrent stroke is less clear.
Methods: In the ARCADIA trial, a multicenter randomized trial of apixaban versus aspirin in patients with cryptogenic strok...
Introduction: Serum remnant lipoprotein particle cholesterol (RLP-C), which includes very-low density lipoproteins (VLDL) and its lipolytic products, contributes to atherosclerotic plaque formation. Novel methods for estimating RLP-C and VLDL-cholesterol (VLDL-C) from a serum fasting lipid profile (FLP) have been proposed (Figure). 1,2,3 We evaluat...
Introduction: Defining the specific underlying pathophysiology of ischemic stroke is critical for minimizing the risk of recurrent events with personalized secondary prevention treatments. A notable portion of ischemic strokes are classified as embolic stroke of undetermined source (ESUS), leaving these patients without optimal treatment tailored t...
Background
Progression of intracranial atherosclerotic disease (ICAD) is associated with ischemic stroke events and can be quantified with three‐dimensional (3D) intracranial vessel wall (IVW) MRI. However, longitudinal 3D IVW studies are limited and ICAD evolution remains relatively unknown.
Purpose
To evaluate ICAD changes longitudinally and to...
Background
Stroke is a sudden-onset, uncontrollable event; stroke-related stress may impede rehabilitation and recovery. Lifetime stress may sensitize patients to experiencing greater stroke-related stress and indirectly affect outcomes. We examine lifetime stress as predictor of poststroke acute stress and examine lifetime and acute stress as pred...
Background: The modified Rankin Scale (mRS), which measures degree of disability in daily activities, is the most common outcome measure in stroke research. Quality of life (QoL), however, is impacted by factors other than disability. The goal of this study was to assess the correlation between functional dependence and a more patient-centered QoL...
Background
In 2017 the CDC issued an alert that, after decades of consistent decline, the stroke death rate levelled off in 2013, particularly in younger individuals and without clear origin. The objective of this analysis is to understand whether social determinants of health have influenced trends in stroke mortality.
Methods
We performed a longi...
Mutations in a diverse set of driver genes increase the fitness of haematopoietic stem cells (HSCs), leading to clonal haematopoiesis1. These lesions are precursors for blood cancers2-6, but the basis of their fitness advantage remains largely unknown, partly owing to a paucity of large cohorts in which the clonal expansion rate has been assessed b...
Chronic liver disease is a major public health burden worldwide1. Although different aetiologies and mechanisms of liver injury exist, progression of chronic liver disease follows a common pathway of liver inflammation, injury and fibrosis2. Here we examined the association between clonal haematopoiesis of indeterminate potential (CHIP) and chronic...
Background:
Plasma proteomics may elucidate novel insights into the pathophysiology of ischemic stroke (IS), identify biomarkers of IS risk, and guide development of nascent prevention strategies. We evaluated the relationship between the plasma proteome and IS risk in the population-based Cardiovascular Health Study (CHS).
Methods:
Eligible CHS...
Objective:
Although intravenous Alteplase (IV-tPA) has a beneficial effect on functional outcome after ischemic stroke (IS), prior studies of IV-tPA's impact on post-stroke mortality did not have sufficient representation of more severe stroke.
Methods:
We determined if the interaction between baseline NIH Stroke Scale (NIHSS) and IV-tPA modifie...
Background: Identification of novel biomarkers of cerebral small vessel disease is critical to elucidate pathophysiology and guide therapeutic development for prevention. We evaluated plasma proteomic associations of clinically asymptomatic, covert brain infarction (cBI) and white matter hyperintensity (WMH) burden on cranial magnetic resonance ima...
Introduction: Despite known socioeconomic and health disparities affecting Indigenous populations in developed countries, stroke incidence data are sparse. With Indigenous Advisory Board oversight, we undertook a systematic review to compare Indigenous with non-Indigenous stroke incidence rates in countries with a very high Human Development Index...
Objective: Improve the institution of NIH Stroke scale (NIHSS) and outcomes of Stroke codes in low English proficiency population (LEP) at a comprehensive stroke center.
Background: LEP individuals are those with limited ability to read, write, speak, or understand English. The 2000 national census showed 47 million U.S. citizens/residents aged 5 y...
Meta-analysis of whole genome sequencing/whole exome sequencing (WGS/WES) studies provides an attractive solution to the problem of collecting large sample sizes for discovering rare variants associated with complex phenotypes. Existing rare variant meta-analysis approaches are not scalable to biobank-scale WGS data. Here we present MetaSTAAR, a po...
Objectives
Based on a 16-year case series, we sought lessons about diagnosis and treatment of cerebral fat embolism syndrome.
Materials and methods
Using discharge codes at a Level 1 Trauma Center, we performed a retrospective chart review of clinical characteristics, diagnostic studies, treatments, and outcome in cerebral fat embolism syndrome....
Background
The objective of this study is to describe incidence and factors associated with early withdrawal of life-sustaining therapies based on presumed poor neurologic prognosis (WLST-N) and practices around multimodal prognostication after out-of-hospital cardiac arrest (OHCA).Methods
We performed a subanalysis of a randomized controlled trial...
Large-scale whole-genome sequencing studies have enabled analysis of noncoding rare-variant (RV) associations with complex human diseases and traits. Variant-set analysis is a powerful approach to study RV association. However, existing methods have limited ability in analyzing the noncoding genome. We propose a computationally efficient and robust...
Integrating genetic information with metabolomics has provided new insights into genes affecting human metabolism. However, gene-metabolite integration has been primarily studied in individuals of European Ancestry, limiting the opportunity to leverage genomic diversity for discovery. In addition, these analyses have principally involved known meta...
Analyses of data from genome-wide association studies on unrelated individuals have shown that, for human traits and diseases, approximately one-third to two-thirds of heritability is captured by common SNPs. However, it is not known whether the remaining heritability is due to the imperfect tagging of causal variants by common SNPs, in particular...
Background: Rapid Door in Door Out (DIDO) times at primary stroke centers (PSCs) continue to be a challenge. The AHA/ASA Western States Quality Task Force met between 2018-2020 to establish strategies that could be employed at most PSCs to decrease their DIDO times. We assessed the impact of these strategies on DIDO times in a health system with 13...
Background: Cerebrovascular complications (ischemic stroke (IS), intracerebral hemorrhage (ICH) or subarachnoid hemorrhage (SAH)) of infective endocarditis (IE) are common and substantially increase morbidity and mortality. We aimed to identify risk factors for stroke in a nationally representative population of hospitalized IE patients from the US...
Background: Recent data suggest biomarkers of atrial cardiopathy (ACP) can potentially identify a subset of patients with cryptogenic stroke who may benefit from anticoagulation. However, the specificity of these markers for atrial disease and their independence from measures of more global cardiac dysfunction remain unclear. We hypothesized that b...
Introduction: Atrial fibrillation (AF), a well-defined ischemic stroke (IS) risk factor whose prevalence increases with age, is associated with higher stroke severity. We aimed to evaluate stroke severity and hospital mortality in a nationally representative sample of AF-related IS patients.
Methods: We utilized data from the National (Nationwide)...
Introduction: Elevated N-terminal pro-brain natriuretic peptide (NT-proBNP) and prolonged P-wave terminal force in V1 (PTFV1) on 12-lead ECG are associated with increased risk of atrial fibrillation and stroke. Age is positively associated with NT-proBNP, men have lower levels than women, and Blacks have lower levels than Whites. Although both weig...
Introduction: Cognitive decline and dementia after stroke is a major public healthcare problem, with dementia risk doubling over time, affecting more than 2M people in the US, with no current treatment. Silent brain infarction has been associated with cognitive decline, especially among those at risk for cardio-embolism. The therapeutic challenge i...
Background: Studies have reported an association between lower socioeconomic status (SES) and an elevated risk of ischemic stroke. It is unclear whether low SES is correlated with a specific etiology of ischemic stroke. Few studies have investigated the relationship in LMIC nations with wide disparities in SES. We analyzed data from a hospital-base...
Background: Increased carotid intima-media thickness (cIMT) and moderate-severe carotid artery atherosclerosis (CAA≥50%) are associated with increased risk of stroke. We evaluated proteomic determinants of increased cIMT and CAA≥50% in the population-based Cardiovascular Health Study (CHS).
Methods: Eligible participants underwent carotid artery ul...
Introduction: Creatine kinase BB isoenzyme (CK-BB) levels in CSF after cardiac arrest (CA) have been shown to predict never awakening though have not been evaluated in patients treated with therapeutic hypothermia (TH). Clinically, CSF CK-BB is tested in those who have not already awakened and are suspected of having a poor prognosis. We aimed to e...
Introduction: After decades of consistent declines, stroke mortality started to level off beginning in 2013, with increases seen in younger stroke patients.
Methods: We performed a post hoc analysis of county-level stroke death rate per 100,000 adults, for ischemic and hemorrhagic stroke, from 1999-2018 using CDC estimates. We stratified by age 35-...
Introduction: Socioeconomic status (SES) is an upstream determinant of cerebrovascular disease comorbidities and subsequently ischemic stroke. Here we examined the association of SES and modifiable ischemic stroke risk factors.
Methods: Hospitalized ischemic stroke patient data from 10/1/2015 - 12/31/2018 was obtained via the Healthcare Cost and Ut...
Background: Stroke is a common cause of death in patients with left ventricular assist devices (LVADs) and there is wide variation around end-of-life care. Palliative care encounters (PCEs) are associated with 6% of all stroke-related hospitalizations in the US but little is known about the palliative care needs or practices of PCE after LVAD-relat...
Background: Intravenous Alteplase (tPA) has a clear benefit on functional outcome after ischemic stroke, but prior studies of its impact on post-stroke mortality have been underpowered, restricted to older Medicare patients, or did not have sufficient representation of patients with more severe stroke.
Methods: We explored if the interaction betwee...
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Background and purpose:
Intracranial atherosclerotic plaque features are potential factors associated with recurrent stroke, but previous studies only focused on a single lesion, and few studies investigated them with perfusion impairment. This study aimed to investigate the association among whole-brain plaque features, perfusion deficit, and str...
Background
Sleep-disordered breathing is a common disorder associated with significant morbidity. The genetic architecture of sleep-disordered breathing remains poorly understood. Through the NHLBI Trans-Omics for Precision Medicine (TOPMed) program, we performed the first whole-genome sequence analysis of sleep-disordered breathing.
Methods
The s...
Background and Purpose
Stroke is the leading cause of death and long-term disability worldwide. Previous genome-wide association studies identified 51 loci associated with stroke (mostly ischemic) and its subtypes among predominantly European populations. Using whole-genome sequencing in ancestrally diverse populations from the Trans-Omics for Prec...
Background
We assessed whether key biomarkers of endothelial activation and hemostasis/thrombosis were elevated in individuals receiving effective antiretroviral therapy (ART) in the year before ischemic stroke.
Methods
We conducted a case-control study nested in the CNICS cohort, comparing 42 adjudicated cases with ischemic stroke to 83 controls...
Background and Objectives
In ischemic stroke (IS) patients, intravenous alteplase (tPA) and endovascular thrombectomy (EVT) reduce long-term disability, but their utilization has not been fully optimized. Prior research has also demonstrated disparities in the use of tPA and EVT specific to sex, race/ethnicity, socioeconomic status, and geographic...
Fine-mapping to plausible causal variation may be more effective in multi-ancestry cohorts, particularly in the MHC, which has population-specific structure. To enable such studies, we constructed a large (n = 21,546) HLA reference panel spanning five global populations based on whole-genome sequences. Despite population-specific long-range haploty...
Objectives
Management of left ventricular assist device (LVAD)-associated intracranial hemorrhage (ICH) is complicated by the competing concerns of hematoma expansion and the risk of thrombosis. Strategies include reversal or withholding of anticoagulation (AC) and neurosurgical (NSG) interventions. The consequences of these decisions can significa...
Objectives
The authors sought to examine the long-term cognitive outcome of patients with continuous flow left ventricular assist device (CF-LVAD).
Background
Data on long-term neurocognitive outcome in LVAD are limited. We examined the neurocognitive outcome of patients who received a CF-LVAD as destination therapy.
Methods
Patients with HeartWa...
Purpose of Review
Antiplatelet therapy remains the standard of care in secondary stroke prevention for non-cardioembolic ischemic stroke and transient ischemic attack. We aim to examine the use of antiplatelet agents in secondary prevention through highlighting relevant clinical trials and meta-analyses as well as providing commentary regarding our...
The American Heart Association/American Stroke Association released the adult stroke rehabilitation and recovery guidelines in 2016. A working group of stroke rehabilitation experts reviewed these guidelines and identified a subset of recommendations that were deemed suitable for creating performance measures. These 13 performance measures are repo...
Background
Left atrial cardiac disease is a suspected cause of embolic stroke of undetermined source (ESUS).
Aims
We tested the hypothesis that left atrial fibrosis quantified using late-gadolinium-enhancement MRI (LGE-MRI) predicts recurrent stroke or atrial fibrillation (AF) in patients with ESUS.
Methods
We compared atrial fibrosis in healthy...
Background
Studies demonstrate an association between visit-to-visit blood pressure variability (BPV) and cardiovascular events and death. We aimed to determine the long-term cardiovascular and mortality effects of BPV in midlife in participants with and without cardiovascular risk factors.
Methods
This is a post-hoc analysis of the Atherosclerosi...
Platelet aggregation at the site of atherosclerotic vascular injury is the underlying pathophysiology of myocardial infarction and stroke. To build upon prior GWAS, here we report on 16 loci identified through a whole genome sequencing (WGS) approach in 3,855 NHLBI Trans-Omics for Precision Medicine (TOPMed) participants deeply phenotyped for plate...
In modern Whole Genome Sequencing (WGS) epidemiological studies, participant-level data from multiple studies are often pooled and results are obtained from a single analysis. We consider the impact of differential phenotype variances by study, which we term ‘variance stratification’. Unaccounted for, variance stratification can lead to both decrea...
Importance
Elevated systolic blood pressure (SBP) after acute ischemic stroke and transient ischemic attack (TIA) is associated with future stroke risk.
Objective
To explore the association of dual antiplatelet therapy (DAPT) with stroke recurrence among patients with acute ischemic stroke and TIA with or without elevated baseline SBP.
Design, Se...
Atrial fibrillation (AF), persistent or paroxysmal with high frequency, is present and assumed to be the cause or a contributing factor in more than 20% of ischemic strokes in the US.¹ The prevalence of AF is accompanied by expanding evidence of infrequent and often shorter duration AF episodes in additional patients. Subclinical AF consists of asy...
Objective
To test the genetic contribution of rare missense variants in COL4A1 and COL4A2 in which common variants are genetically associated with sporadic intracerebral hemorrhage (ICH), we performed rare variant analysis in multiple sequencing data for the risk for sporadic ICH.
Methods
We performed sequencing across 559Kbp at 13q34 including COL...
Cardiac magnetic resonance imaging (MRI) has revealed fibrosis in embolic stroke of undetermined source (ESUS) patients comparable to levels seen in atrial fibrillation (AFib). We used computational modeling to understand the absence of arrhythmia in ESUS despite the presence of putatively pro-arrhythmic fibrosis. MRI-based atrial models were recon...
Background and Aims: Despite known Indigenous health and socioeconomic disadvantage in countries with a Very High Human Development Index, data on the incidence of stroke in these populations are sparse. With oversight from an Indigenous Advisory Board, we will undertake a systematic review of the incidence of stroke in Indigenous populations of de...
Background:
Most studies of stroke in people living with HIV (PLWH) do not use verified stroke diagnoses, are small, and/or do not differentiate stroke types and subtypes.
Setting:
CNICS, a U.S. multisite clinical cohort of PLWH in care.
Methods:
We implemented a centralized adjudication stroke protocol to identify stroke type, subtype, and pr...
Objective
To examine the outcomes of adult patients with spontaneous intracranial and subarachnoid hemorrhage diagnosed with comorbid COVID-19 infection in a large, geographically diverse cohort.
Methods
We performed a retrospective analysis using the Vizient Clinical Data Base. We separately compared two cohorts of patients with COVID-19 admitted...
Autosomal genetic analyses of blood lipids have yielded key insights for coronary heart disease (CHD). However, X chromosome genetic variation is understudied for blood lipids in large sample sizes. We now analyze genetic and blood lipid data in a high-coverage whole X chromosome sequencing study of 65,322 multi-ancestry participants and perform re...
Background
Sexual dysfunction affects at least one half of patients after a stroke. Problems related to sexual function are rarely assessed or addressed by physicians.
Objective
To determine the frequency and factors associated with sexual dysfunction among stroke survivors and self-reported barriers of physicians to discuss sexual dysfunction dur...
Background: Sexual dysfunction affects at least one half of patients after a stroke. Problems related to sexual function are rarely assessed or addressed by physicians.
Objective: To determine the frequency and factors associated with sexual dysfunction among stroke survivors and self-reported barriers of physicians to discuss sexual dysfunction du...
Background: Management of intracranial hemorrhage (ICH) in patients with left ventricular assist devices (LVADs) is complicated by the competing concerns of hematoma expansion and the risk of thrombotic events. Strategies include reversal or withholding of anticoagulation (AC) and neurosurgical (NSG) interventions. The consequences of these decisio...
Background
Type 2 diabetes mellitus (T2DM) has shown to be associated with carotid plaque vulnerability. However, the impact of T2DM on intracranial artery atherosclerosis is not well‐understood.
Purpose
To evaluate the association of diabetes and glycemic control with intracranial atherosclerotic plaque characteristics identified by three‐dimensi...
Background: Intracranial hemorrhage (ICH) has a high mortality rate (up to 40% in some studies) with most deaths occurring after limitation of life-sustaining therapies. ICH is a feared complication of left ventricular assist device (LVADs) and challenges end-of-life decisions for patients, families, and health-care teams. Palliative care (PC) is c...
Objective:
To evaluate the effect of intensive rehabilitation on the modified Rankin Scale (mRS), a measure of activities limitation commonly used in acute stroke studies, and to define the specific changes in body structure/function (motor impairment) most related to mRS gains.
Methods:
Patients were enrolled >90 days post-stroke. Each was eval...
Background:
Rates of stroke are higher in people living with HIV compared with age-matched uninfected individuals. Causes of elevated stroke risk, including the role of viremia, are poorly defined.
Methods:
Between 1 January 2006 and 31 December 2014, we identified incident strokes among people living with HIV on antiretroviral therapy at five s...
Background
Studies have shown worse outcomes in patients with comorbid ischemic stroke (IS) and coronavirus disease 2019 (COVID-19), but have had small sample sizes.
Methods
We retrospectively identified patients in the Vizient Clinical Data Base® with IS as a discharge diagnosis. The study outcomes were in-hospital death and favorable discharge (...
Introduction: Late-gadolinium enhanced (LGE)-MRI has revealed atrial fibrotic remodeling in embolic stroke of undetermined source (ESUS) patients. Curiously, fibrosis levels in ESUS patients are the same as those observed in AF. A potential explanation is that ESUS patients have pre-clinical arrhythmic substrate, but lack the triggers needed to ini...
Background:
Little is known about adherence to American Heart Association/American Stroke Association (AHA/ASA) stroke performance measures in developing countries like Peru.
Aims:
We assessed adherence and determined factors associated with adherence to the AHA/ASA stroke performance measures at a reference center for neurological diseases in L...
Background
We aimed to compare the outcome of acute ischemic stroke (AIS) patients who received endovascular thrombectomy (EVT) with confirmed COVID-19 to those without.
Methods
We performed a retrospective analysis using the Vizient Clinical Data Base and included hospital discharges from April 1 to July 31 2020 with ICD-10 codes for AIS and EVT....
Objective
Studies indicate that functional outcome evolves in the year after ischemic stroke onset. However, the traditional outcome measure in stroke trials is the modified Rankin Scale (mRS) at 90 days from onset. To determine mRS fluctuations in the first year after stroke, we examined data from 3 major stroke trials.
Methods
In a secondary ana...
Background
Late-gadolinium enhanced (LGE)-MRI has revealed atrial fibrotic remodeling in embolic stroke of undetermined source (ESUS) patients comparable to that observed in atrial fibrillation (AFib) patients. The absence of AFib in ESUS patients may be due to differences in the fibrotic substrate characteristics or the lack of triggers needed to...
Large-scale whole-genome sequencing studies have enabled the analysis of rare variants (RVs) associated with complex phenotypes. Commonly used RV association tests have limited scope to leverage variant functions. We propose STAAR (variant-set test for association using annotation information), a scalable and powerful RV association test method tha...
Introduction
Patients with stroke-like symptoms may be underutilising emergency medical services and avoiding hospitalisation during the COVID-19 pandemic. We investigated a decline in admissions for stroke and transient ischaemic attack (TIA) and emergency department (ED) stroke alert activations.
Methods
We retrospectively compiled total weekly...
Neurological manifestations of SARS-CoV-2 infection described in isolated case reports and single institutions do not accurately reflect the clinical spectrum of disease across all geographies in a global pandemic. Data collected during peak of the Covid-19 pandemic from stroke centers in five states reveal few similarities to what has recently bee...
Modern medical therapies have substantially decreased the risk of cardiac and cerebral vascular events due to atherosclerosis, and these approaches largely apply to patients with atherosclerotic disease of the carotid artery. There is strong evidence for risk reduction in these patients via use of antihypertensives, statins, and in most cases antit...
The corona virus 2019 (COVID-19) pandemic requires drastic changes in allocation of resources which can affect the delivery of stroke care, and many providers are seeking guidance. As caregivers, we are guided by 3 distinct principles that will occasionally conflict during the pandemic: (1) We must ensure the best care for those stricken with COVID...
Background: The availability of intravenous tissue plasminogen activator (IV-tPA) remains limited worldwide, especially in low-income countries, where the burden of disability due to ischemic stroke is the highest. Aims: To evaluate outcomes and safety of IV-tPA at the only Peruvian reference institute for neurologic diseases. Methods: We conducted...
Objective
Observational studies point to an inverse correlation between LDL cholesterol levels and risk of intracerebral hemorrhage (ICH), but it remains unclear whether this association is causal. We tested the hypothesis that genetically‐elevated LDL is associated with reduced risk of ICH.
Methods
We constructed one polygenic risk score (PRS) pe...
Purpose
Despite reductions in major adverse events with the latest generation of left ventricular assist devices (LVADs), the incidence of stroke remains high. The timing of anticoagulation resumption is controversial. We aim to explore practices of anticoagulation management following ischemic stroke in LVAD patients and identify optimal strategie...
Purpose
Decisions regarding if or when to resume antithrombotics (anticoagulation or antiplatelets) after intracranial hemorrhage (ICH) in patients with left ventricular devices (LVADs) remain controversial and available data to guide management is limited. We aim to explore antithrombotic practices following ICH in LVAD patients and identify most...
Background:
The availability of intravenous tissue plasminogen activator (IV-tPA) remains limited worldwide, especially in low-income countries, where the burden of disability due to ischemic stroke is the highest.
Aims:
To evaluate outcomes and safety of IV-tPA at the only Peruvian reference institute for neurologic diseases.
Methods:
We cond...
Purpose
Data on long-term cognitive outcome in patients with LVAD is limited. We examined the neurocognitive outcome in patients receiving the HeartwareTM HVADTM system for destination therapy.
Methods
HVAD patients enrolled in the ENDURANCE and ENDURANCE Supplemental trials were eligible. Cognition domains were evaluated through 24 months with Ho...
Objective: As part of our efforts in ongoing quality improvement, we aimed to identify characteristics associated with puncture to first pass (PTFP) in patients with acute ischemic stroke undergoing thrombectomy, potentially finding opportunities to improve time to treatment.
Methods: All patients who had thrombectomies at Harborview Medical Center...
Introduction:
Elevated serum apolipoprotein B and the apolipoprotein B/A1 ratio have been associated with ischemic stroke and intracranial atherosclerotic disease. We sought to assess the relationship between serum levels of apolipoprotein B, apolipoprotein A1, and the apolipoprotein B/A1 ratio with ischemic stroke subtypes and large artery athero...
Background: Research has shown that increased blood pressure variability (BPV) correlates with worse outcome after stroke. However, the mechanism is unknown.
Methods: In this secondary analysis of the Albumin in Acute Ischemic Stroke (ALIAS) trial, we calculated BPV for SBP over the first 120 hours. The primary outcome was 90-day modified Rankin Sc...
Background: Increased blood pressure variability (BPV) has been associated with stroke risk, but never specifically in patients with diabetes.
Methods: This is a secondary analysis of the Action to Control Cardiovascular Risk in Diabetes Follow-On Study (ACCORDION), the long term follow-up extension of ACCORD. Visit-to-visit BPV was analyzed using...
Citations
... This non-invasive measurement uses transthoracic rather than transesophageal echo and may be preferable to less sensitive measurements including monitoring for AF. The ARCADIA trial with randomization of 100 patients on apixaban or aspirin assessed if one is superior in preventing stroke recurrence in patients with atrial cardiopathy, and found no superiority of apixaban [7]. There was also no difference in bleeding episodes. ...
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... Patients with diabetes had a 6.7% increase in wall thickness and a 6.6% decrease in lumen area at follow-up. 62 Larger studies with 3T HR-MRI may confirm if maximal medical therapy can be tailored to morphological changes in the plaque and arterial wall. ...
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... Lifestyle changes such as decreased physical activity and increased intake of highcaloric food, salt, saturated fats, and trans fatty acids have increased the prevalence of thromboembolic or atherosclerotic events, such as acute ischemic stroke (AIS) and myocardial infarction, in the Western world in recent decades and, more recently, in developing countries [1]. However, due to better preventative measures such as antithrombotic drugs, anticoagulation, statins, antidiabetics, and antihypertensives, stroke incidence and stroke mortality have decreased over the last decades but may be reversing again [2]. Despite these trends, AIS remains one of the five most common causes of death in the US and Europe [3]. ...
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... To test this hypothesis, we leveraged the passenger-approximated clonal expansion rate (PACER) method to estimate CHIP expansion rate in 4,370 individuals from the National Heart, Lung, and Blood Institute (NHLBI) Trans-Omics for Precision Medicine (TOPMed) cohort 18 . In previous studies 18,19 , CHIP was identified by the presence of a CHIP driver mutation from a list of identified CHIP mutations with at least three reads, which has been shown to accurately capture CHIP across large-scale biobanks 20 . ...
... 1,2 An age-related disorder, CHIP is rare in the young but its prevalence increases rapidly in older adults, with at least 10% of individuals aged 65 and older affected. 3,4 Recent studies have identified a causal role for CHIP in several chronic diseases of aging including atherosclerotic cardiovascular disease [5][6][7][8] , heart failure 9-13 , gout 14 , liver fibrosis and cirrhosis 15 , osteoporosis 16 , and chronic obstructive pulmonary disorder (COPD). 17 CHIP is also recognized as a risk factor for acute kidney injury (AKI) severity and non-recovery. ...
... 14 These non-invasive tests could offer valuable insights into brain functionality. In a recent study conducted by Kalani et al., 15 the relationship between the plasma proteome and IS risk was investigated using data from the Cardiovascular Health Study (CHS). The findings shed light on significant associations between specific plasma proteins and IS risk, presenting an opportunity for future advancements in stroke prevention and management. ...
... Meta-analysis is a powerful tool for synthesizing the effects of interest across multiple similar individual studies (Borenstein et al., 2021;Brockwell and Gordon, 2001). Established meta-analysis techniques use summary statistics to resolve the difficulties in accessing individual-level data (Der-Simonian and Laird, 1986;Mantel and Haenszel, 1959;Lu and Ades, 2004;Li et al., 2023;Zhu et al., 2015). Fixed-effects meta-analysis stands out as the most widely-used and robust method for combining findings from multiple genetic studies (Pfeiffer et al., 2009). ...
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... The stakes are high; if clinicians or surrogates have an inaccurately pessimistic prognosis, it can mean withdrawing life-sustaining therapies from patients who might otherwise recover. [17][18][19][20][21][22][23] An inaccurately optimistic prognosis can lead to prolonged and costly care that ultimately provides little benefit and may cause unwarranted cost and suffering. 24 ...
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... First, studies have transitioned from single-population investigations to well-powered studies of mega-biobanks or multiple diverse cohorts due in part to sequencing cost reductions 68 (Fig. 3a). Second, high-throughput sequencing technologies and bioinformatics tools 69,70 have facilitated a shift from focusing solely on common coding variants to exploring the complex polygenic architecture across diverse populations, as well as rare coding, non-coding and structural variants [71][72][73][74][75][76][77][78] (Fig. 3b). Third, the functional effects of germline variants with phenotypic associations are now explored through the integration of techniques such as single-cell sequencing, CRISPR, Hi-C, assay for transposase-accessible chromatin with sequencing (ATAC-seq), chromatin immunoprecipitation followed by sequencing (ChIP-seq) and spatial molecular profiling [79][80][81][82][83][84][85][86] (Fig. 3c and Box 1). ...
... Most included publications were case reports (21 publications) and three publications had relatively large datasets (patient numbers 24-39) [11,27,28]. When the MRI sequence was stipulated in the manuscript for detecting NCWMH (63 patients), the total number of patients in this review by sequence was DWI in 24, T2WI in 57, and FLAIR in 10 patients ( Table 1). ...
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