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Stroke: Risk Factors, Mechanisms, Outcomes and Ethnicity
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Stroke: Risk Factors, Mechanisms, Outcomes and Ethnicity

A special issue of Journal of Cardiovascular Development and Disease (ISSN 2308-3425). This special issue belongs to the section "Stroke and Cerebrovascular Disease".

Deadline for manuscript submissions: 30 August 2024 | Viewed by 6241

Special Issue Editor

Dr. Narayanaswamy Venketasubramanian

E-Mail Website
Guest Editor
Raffles Neuroscience Centre, Raffles Hospital, Singapore 188770, Singapore
Interests: stroke; neurosonology; neuroepidemiology; clinical trials
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

Stroke is a major cause of death and disability globally. Well-known risk factors include hypertension, diabetes mellitus, hyperlipidemia, and cigarette smoking, in addition to aging, gender, and lifestyle factors. It is more often a complex interplay of these known factors as well as unknown ones, or one mechanistic cause rather than another, that places one person at a higher risk for stroke compared to another. New mechanisms including genetic causes are being uncovered with more detailed investigation and research. Stroke outcomes also vary greatly, ranging from no or minimal disability to severe disability or even death, which may be due not just to premorbid status, stroke severity, acute treatment, and environment (e.g., organized stroke care), but also due to the interplay between risk factors, mechanisms, and other post-stroke interventions. An emerging issue has been the differences observed in different ethnicities who appear to be living in a similar environment.

This Special Issue focuses on sharing new insights into stroke risk factors, mechanisms, and outcomes that offer new knowledge and challenge existing paradigms, with the ultimate aims of reducing occurrence, improving care, and reducing the burden of stroke for the patient, family, society, and healthcare systems globally. Papers that investigate inter-ethnic differences are especially welcome.

Dr. Narayanaswamy Venketasubramanian
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Journal of Cardiovascular Development and Disease is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2700 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • stroke
  • ethnicity
  • risk factors
  • mechanisms
  • outcome
  • prognosis

Published Papers (4 papers)

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Research

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10 pages, 620 KiB  
Article
Left Ventricular Diastolic Dysfunction Is Associated with Poor Functional Outcomes after Endovascular Thrombectomy
by Tony Y. W. Li, Emma M. S. Toh, Ying Ying Koh, Aloysius S. T. Leow, Bernard P. L. Chan, Hock-Luen Teoh, Raymond C. S. Seet, Anil Gopinathan, Cunli Yang, Vijay K. Sharma, Leonard L. L. Yeo, Mark Y. Chan, William K. F. Kong, Kian-Keong Poh, Benjamin Y. Q. Tan and Ching-Hui Sia
J. Cardiovasc. Dev. Dis. 2024, 11(3), 87; https://doi.org/10.3390/jcdd11030087 - 05 Mar 2024
Viewed by 882
Abstract
Introduction: With the advent of endovascular thrombectomy (ET), patients with acute ischaemic strokes (AIS) with large vessel occlusion (LVO) have seen vast improvements in treatment outcomes. Left ventricular diastolic dysfunction (LVDD) has been shown to herald poorer prognosis in conditions such as myocardial [...] Read more.
Introduction: With the advent of endovascular thrombectomy (ET), patients with acute ischaemic strokes (AIS) with large vessel occlusion (LVO) have seen vast improvements in treatment outcomes. Left ventricular diastolic dysfunction (LVDD) has been shown to herald poorer prognosis in conditions such as myocardial infarction. However, whether LVDD is related to functional recovery and outcomes in ischaemic stroke remains unclear. We studied LVDD for possible relation with clinical outcomes in patients with LVO AIS who underwent ET. Methods: We studied a retrospective cohort of 261 LVO AIS patients who had undergone ET at a single comprehensive stroke centre and correlated LVDD to short-term mortality (in-hospital death) as well as good functional recovery defined as modified Rankin Scale of 0–2 at 3 months. Results: The study population had a mean age of 65-years-old and were predominantly male (54.8%). All of the patients underwent ET with 206 (78.9%) achieving successful reperfusion. Despite this, 25 (9.6%) patients demised during the hospital admission and 149 (57.1%) did not have good function recovery at 3 months. LVDD was present in 82 (31.4%) patients and this finding indicated poorer outcomes in terms of functional recovery at 3 months (OR 2.18, 95% CI 1.04–4.54, p = 0.038) but was not associated with increased in-hospital mortality (OR 2.18, 95% CI 0.60–7.99, p = 0.240) after adjusting for various confounders. Conclusion: In addition to conventional echocardiographic indices such as left ventricular ejection fraction, LVDD may portend poorer outcomes after ET, and this relationship should be investigated further. Full article
(This article belongs to the Special Issue Stroke: Risk Factors, Mechanisms, Outcomes and Ethnicity)
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10 pages, 257 KiB  
Article
Pre-Stroke Loop Diuretics and Anemia in Elderly Patients Are Associated Factors of Severe Renal Dysfunction at the Time of Acute Stroke Onset
by Takahisa Mori, Tetsundo Yano, Kazuhiro Yoshioka and Yuichi Miyazaki
J. Cardiovasc. Dev. Dis. 2023, 10(9), 405; https://doi.org/10.3390/jcdd10090405 - 19 Sep 2023
Viewed by 1181
Abstract
Background: Severe renal dysfunction (SRD), an advanced stage of chronic kidney disease (CKD), can limit the treatment options for acute stroke (AS) patients. Therefore, it is important to investigate the associated factors of SRD in AS patients to inhibit CKD progression to SRD [...] Read more.
Background: Severe renal dysfunction (SRD), an advanced stage of chronic kidney disease (CKD), can limit the treatment options for acute stroke (AS) patients. Therefore, it is important to investigate the associated factors of SRD in AS patients to inhibit CKD progression to SRD before AS. Sex differences exist in the renal function. Therefore, we investigated the frequency of SRD and its associated factors among AS patients by sex. Methods: Our cross-sectional study included patients admitted within 24 h of AS onset between 2013 and 2019 with available pre-stroke medication information. We used the Cockcroft–Gault equation for calculating the creatinine clearance (Ccr) and defined SRD as a Ccr < 30 mL/min. We performed multivariable logistic regression analysis to identify the independent factors associated with SRD. Results: Out of 4294 patients, 3472 matched our criteria. Of these, 1905 (54.9%) were male, with median ages of 75 and 81 years for males and females, respectively. The frequency of SRD was 9.7% in males and 18.7% in females. Loop diuretics and anemia were associated factors of SRD. Conclusions: Pre-stroke loop diuretics and anemia in elderly patients were associated factors of SRD in both sexes. Individualized drug therapy and anemia management are essential to prevent SRD. Full article
(This article belongs to the Special Issue Stroke: Risk Factors, Mechanisms, Outcomes and Ethnicity)
16 pages, 1509 KiB  
Article
Textural Analysis of the Hyperdense Artery Sign in Patients with Acute Ischemic Stroke Predicts the Outcome of Thrombectomy
by Lucian Mărginean, Rares Cristian Filep, Bogdan Andrei Suciu, Tudor G. Jovin, Paul-Andrei Ștefan, Roxana-Adelina Lupean, Eliza Mihaela Arbănași, Emil Marian Arbănași, Diana Roxana Opriș, Alexander Niklas Timm, Rareș Vodă and Vlad Vunvulea
J. Cardiovasc. Dev. Dis. 2023, 10(9), 359; https://doi.org/10.3390/jcdd10090359 - 24 Aug 2023
Viewed by 988
Abstract
Textural analysis is pivotal in augmenting the diagnosis and outcomes of endovascular procedures for stroke patients. Due to the detection of changes imperceptible to the human eye, this type of analysis can potentially aid in deciding the optimal type of endovascular treatment. We [...] Read more.
Textural analysis is pivotal in augmenting the diagnosis and outcomes of endovascular procedures for stroke patients. Due to the detection of changes imperceptible to the human eye, this type of analysis can potentially aid in deciding the optimal type of endovascular treatment. We included 40 patients who suffered from acute ischemic stroke caused by large vessel occlusion, and calculated 130 different textural features based on the non-enhanced CT scan using an open-source software (3D Slicer). Using chi-squared and Mann–Whitney tests and receiver operating characteristics analysis, we identified a total of 21 different textural parameters capable of predicting the outcome of thrombectomy (quantified as the mTICI score), with variable sensitivity (50–97.9%) and specificity (64.6–99.4%) rates. In conclusion, CT-based radiomics features are potential factors that can predict the outcome of thrombectomy in patients suffering from acute ischemic stroke, aiding in the decision between aspiration, mechanical, or combined thrombectomy procedure. Full article
(This article belongs to the Special Issue Stroke: Risk Factors, Mechanisms, Outcomes and Ethnicity)
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Review

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24 pages, 1855 KiB  
Review
Diagnosis and Management of Atrial Fibrillation in Acute Ischemic Stroke in the Setting of Reperfusion Therapy: Insights and Strategies for Optimized Care
by Jay Patel and Sonu M. M. Bhaskar
J. Cardiovasc. Dev. Dis. 2023, 10(11), 458; https://doi.org/10.3390/jcdd10110458 - 12 Nov 2023
Viewed by 2760
Abstract
Reperfusion therapy in the form of intravenous thrombolysis (IVT) and endovascular thrombectomy (EVT) has revolutionised the field of stroke medicine. Atrial fibrillation (AF) patients constitute a major portion of the overall stroke population; however, the prevalence of AF amongst acute ischemic stroke (AIS) [...] Read more.
Reperfusion therapy in the form of intravenous thrombolysis (IVT) and endovascular thrombectomy (EVT) has revolutionised the field of stroke medicine. Atrial fibrillation (AF) patients constitute a major portion of the overall stroke population; however, the prevalence of AF amongst acute ischemic stroke (AIS) patients receiving reperfusion therapy remains unclear. Limitations in our understanding of prevalence in this group of patients are exacerbated by difficulties in appropriately diagnosing AF. Additionally, the benefits of reperfusion therapy are not consistent across all subgroups of AIS patients. More specifically, AIS patients with AF often tend to have poor prognoses despite treatment relative to those without AF. This article aims to present an overview of the diagnostic and therapeutic management of AF and how it mediates outcomes following stroke, most specifically in AIS patients treated with reperfusion therapy. We provide unique insights into AF prevalence and outcomes that could allow healthcare professionals to optimise the treatment and prognosis for AIS patients with AF. Specific indications on acute neurovascular management and secondary stroke prevention in AIS patients with AF are also discussed. Full article
(This article belongs to the Special Issue Stroke: Risk Factors, Mechanisms, Outcomes and Ethnicity)
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