Welcome to the WSC 2022 Interactive Program

Background and Aims

The incidence of clinical autopsies is declining worldwide, although the body and brain autopsies are the ultimate yardstick of diagnostic and therapeutic activity. The authors analyse the body and brain autopsy findings of two groups of acute ischemic stroke patients: a/. 534 acute stroke patients without iv. thrombolysis and fatal outcome and b./136 patients with iv. thrombolysis and fatal outcome.

Results

a./In the group of 534 patients (without thrombolysis) 26 patients (4.9%), had systemic neoplasms diagnosed in the clinical stage; however, 8 (1.5%) malignant tumours were only detected during autopsy. Eighty (15%) thromboembolic events, 73 (13.6%) pneumonias were detected only during autopsy. 189 patients had premortem CT. From the 189 patients 66 (34.9%) hemorrhagic transformation was revealed by the brain autopsy not yet present on the last premortal CT.

b./ In the group of 136 lysis patient with lethal outcome  18 thromboembolic findings (13%) were detected by body autopsy (10 remained undetected before death) 21 (15%) malignant tumors (5 undetected before death, 7.4%) and 16 pneumonias (11.7%) were diagnosed only by autopsy. Interestingly, from the 136 lysis patient (free from hemorrhagic transformation on the post-lysis CT) 70 (51%) had either hemorrhagic transformation or bleeding on the brain autopsy.

Conclusions

 Body and brain autopsies may reveal clinically silent diseases (eg, tumour), and contribute to precise number of stroke-related thromboembolic and pneumonia complications. The possible causes of higher rate of brain hemorrhagic complications in the lysis group compared to the non lysis group (51% vs 35%) will be discussed.

Background and Aims

In 18-33% of ischemic strokes,etiology remains cryptogenic.Some studies have shown an association between cryptogenic strokes(CS) and markers of atrial cardiopathy.Here we sought to compare atrial cardiopathy markers in cryptogenic strokes with cardioembolic strokes(CE) secondary to non-valvular atrial fibrillation(NVAF).

Methods

Single centre prospective study of patients with a diagnosis of cryptogenic strokes and cardioembolic strokes secondary to NVAF were recruited for the study from August 2021till February 2022.Atrial cardiopathy markers collected were N terminal-pro-Brain natriuretic peptide(NT-proBNP) ,ECG markers-p terminal force in V1(PTEF-V1),PR interval,P wave duration,presence of supraventricular ectopics/tachycardia,Left Atrial(LA) diameter and volume and Left ventricular ejection fraction by transthoracic echo.Comparisons were made clinical,imaging and cardiac markers in cryptogenic and cardioembolic groups.

Results

We had 66 subjects(16 cardioembolic and 50 cryptogenic strokes)in the study,with mean age 62.6 years.Imaging showed majority having a territorial/branch occlusion pattern of infarcts(53%).Among the cardiac parameters,common abnormality was elevated pro-BNP in 43.94% followed by prolonged P wave duration(33.93%) and LA volume >34 ml/m2(21.43%).Bivariate analysis showed that CAD,PTEF-V1,increased LA diameter and LV ejection fraction below 35% were more commonly associated with cardioembolic strokes.Higher LDL levels,anterior circulation strokes,combined watershed and embolic infarcts showed a significant association with cryptogenic strokes.Risk factor profile,age,gender,vessel occlusion,pro-BNP,LA volume,recurrence risk and short term(3 month)outcome did not show a difference between the 2 stroke subgroups.

Conclusions

Among the markers of atrial cardiopathy pro-BNP and LA volume were comparable between the cardioembolic and cryptogenic strokes,suggesting a possible cardiac substrate in the cryptogenic strokes which needs to be studied in larger population.

Background and Aims

Findings from randomized controlled trials and observational studies have yielded inconsistent results on the association between resting heart rate (RHR) and dementia. The present study was performed to estimate the causal effects of genetically predicted higher RHR on the risk of dementia.

Methods

We selected forty-three independent single-nucleotide polymorphisms that were associated with RHR (P < 5 × 10⁻⁸) as genetic instrument from a published genome-wide association study (GWAS) meta-analysis of 265,046 individuals. The generalized summary Mendelian randomization (GSMR) analysis was used to test the corresponding effects of RHR against three different outcomes: 1) AD diagnosis (International Genomics of Alzheimer's Project), 2) maternal family history of AD (UK Biobank), 3) paternal family history of AD (UK Biobank), and 4) combined meta-analysis including these three GWAS results. We also conducted further analyses adjusting RHR–modifying medication to test the possibility of reverse causal association.

Results

The results of GSMR showed no significantly causal associations of genetically predicted higher RHR and the risk of AD (β_GSMR = 0.12, p = 0.30). GSMR applied to the maternal family history of AD (β_GSMR = −0.18, p = 0.13) and to the paternal family history of AD (β_GSMR = −0.14, p = 0.39) showed the same results. Furthermore, the results were robust after adjusting for RHR-modifying drugs (β_GSMR = −0.03, p = 0.72).

Conclusions

Our study did not find evidence for a causal relationship between higher RHR and the risk of dementia. The results were established based on the application of complementary MR methods.

Background and Aims

Anticoagulation is underutilized in older AF patients. We aimed to examine the long-term effectiveness of switching appropriate older AF patients to anticoagulation in a real-world setting.

Methods

We conducted a multi-centered, prospective, single arm, interventional study from 5/2016 to 4/2019, recruiting 1002 older Chinese patients with non-valvular AF (NVAF) from specialist geriatrics and cardiology outpatient clinics from 6 hospitals in Hong Kong. Patients who were taking no antithrombotics or only antiplatelet (AP) agents at baseline were considered for switching to anticoagulation (AC). Outcomes included mortality, stroke or death, major adverse cardiovascular events (MACE), and major bleeding at 1-year.

Results

Of 1002 patients at baseline (mean age 84±7 years, 60% female, mean CHA₂DS₂-VASc 5.1, mean HAS-BLED 2.3), 530 (53%) were already taking AC (34% DOAC and 18% VKA). Of 472 patients who were not on AC (36% AP only and 11% none), 136 (29%) were switched to AC (93% DOAC, 7% VKA). Switching to AC was predicted by younger age, no prior ischaemic or haemorrhagic stroke, higher haemoglobin and renal function, fewer co-morbidities, and lower CHA₂DS₂-VASc. Compared to patients who were never on AC, those who were switched to AC had lower mortality (p<0.001), stroke or death (p<0.001), MACE (p<0.001), and non-significant trend of lower major bleeding (p=0.118), with results similar to those who were on AC from baseline. Switching to AC remained an independent predictor of mortality after adjusting for casemix.

Conclusions

From our real-world data, switching older NVAF patients to anticoagulation in the outpatient setting is feasible and associated with improved clinical outcomes at 1-year.