bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract P667: Clinical Variables, Electrocardiogram Parameters and Blood Biomarkers Associated With Atrial Fibrillation Detection in the First Year After Ischaemic Stroke - A Systematic Review and Meta-Analysis
Authors: Cameron Alan , Cheng Huen Ki , Lee Ren Ping , Khashayar Pouria , Hall Mark , Doherty Daniel , Quinn Terence J , Abdul-rahim Azmil H , Dawson Jesse
Published: March 2021

Introduction:
Cardiac monitoring is performed to detect atrial fibrillation (AF) after stroke. Identifying patients at high or low risk of AF may allow cardiac monitoring approaches to be tailored on a more personalised basis. We performed a systematic review and meta-analysis to identify variables associated with AF detection after ischaemic stroke.

Methods:
We followed the Cochrane Collaboration Guidelines and retrieved 8503 studies. After screening, 35 studies were selected and 68 variables were assessed. We assessed 41 clinical variables, 20 ECG parameters and 7 blood biomarkers associated with AF detection >30 seconds duration in the first year after stroke. Comprehensive Meta-analysis software was used to generate an odds ratio and Forest plot for each variable. Studies were assessed for quality using the Quality in Prognostic Studies (QUIPS) tool.

Results:
The 35 studies included 12010 patients and AF was detected in 1551 patients (13%). Of the 68 variables assessed, 20 were associated with increased odds of AF, 5 were associated with reduced odds of AF and 43 were not associated with AF (Figure 1). The variables most strongly associated with AF detection (odds ratio >3.00) were older age, patients who received IV thrombolytic therapy, maximum P-wave duration, premature atrial complexes, P-wave dispersion, P-wave index, QTc interval and brain natriuretic peptide. Risk of bias was low in 3 studies, moderate in 24 studies and high in 8 studies.

Conclusions:
We have identified clinically applicable variables that can stratify the probability of AF detection after stroke. Our results will help guide more personalised approaches to cardiac monitoring for AF detection after stroke.
Abstract P669: Aortic Stenosis and the Risk of Spontaneous Intracerebral Hemorrhage
Authors: Witsch Jens , Zhang Cenai , Navi Babak B , Merkler Alexander E , Murthy Santosh B , Kamel Hooman , Parikh Neal S
Published: March 2021

Introduction:
Aortic stenosis (AS) is known to cause mechanical degradation of von Willebrand factor, resulting in an increased risk of gastrointestinal bleeding, also known as Heyde syndrome. We hypothesized that AS is also associated with an increased risk of nontraumatic intracerebral hemorrhage (ICH).

Methods:
We performed a retrospective cohort study of Medicare beneficiaries using a 5% sample of inpatient and outpatient claims from1/1/2008-9/30/2015. Based on prior validation, we ascertained AS based on at least one inpatient or two outpatient claims with ICD-9-CM diagnosis code 395.0 in any position. ICH was identified through a validated ICD-9-CM diagnosis code algorithm. We used survival statistics to determine incidence rates and Cox proportional hazard analyses to examine associations. In prespecified models, we controlled for age, gender, race, bleeding risk (HAS-BLED and ATRIA scores), and common indications for antithrombotic treatment (atrial fibrillation, coronary artery disease, peripheral vascular disease, venous thromboembolism).

Results:
Among 1,785,836 Medicare beneficiaries, the mean age was 73.5 years (SD, 7.7) and 57.0% were women. AS was diagnosed in 6,157 (0.34%) patients. During a mean of 4.7 years (SD, 2.2) of follow-up, 28,309 (1.6%) were hospitalized with ICH. The incidence of ICH was 5.9 (95% CI, 4.9-7.2) per 1,000 person-years in those with AS compared to 3.4 (95% CI, 3.4-3.4) per 1,000 person-years in those without. After adjustment for demographics, AS was associated with an increased risk of ICH (HR, 1.31; 95% CI, 1.09-1.59). This association was not statistically significant after adjusting additionally for HAS-BLED score components (HR 1.15, 95% CI 0.95-1.39) or ATRIA score components (HR 1.18, 95% CI 0.98-1.43). Effect sizes were further attenuated after adjusting for indications for antithrombotic drugs in addition to the HAS-BLED score (HR, 0.90; 95% CI, 0.74-1.09) and ATRIA score (HR, 0.90; 95% CI, 0.73-1.08).

Conclusions:
Medicare beneficiaries with AS faced an elevated risk of ICH. However, comorbid conditions that require the use of antithrombotic drugs accounted for the observed association, making an independent association between AS and ICH unlikely.
Abstract P674: Markers of Atherosclerotic Disease but Not Small Vessel Disease Predict Neurologic Deterioration in Acute Lacunar Strokes
Authors: Yang Dixon , Cutting Shawna M , Raz Eytan , Torres Jose L , Mac Grory Brian C , Scher Erica , Pirooz Sahnaz , De Havenon Adam H , Ishida Koto , Furie Karen L , Gutierrez Jose , Elkind Mitchell S , Yaghi Shadi
Published: March 2021

Introduction:
Neurologic deterioration (ND) occurs in a quarter of acute lacunar infarct patients and may lead to severe disability. The underlying pathophysiology of ND in these patients is not clearly understood. We sought to identify risk factors and clinical characteristics associated with ND.

Methods:
This retrospective study included consecutive patients admitted to NYU Langone Medical Center and Brown University for lacunar-type strokes from 2017-2019. Lacunar infarct was defined as subcortical infarct <1.5cm on CT or <2cm on diffusion-weighted imaging without significant stenosis (>50%) in the parent vessel and no cardioembolic source. Available non-invasive imaging (CTA or MRA) was reviewed by a neuroradiologist or vascular neurologist to determine the presence or absence of stenosis (<50%) or luminal irregularity without stenosis in the stem artery segment at the location of the perforator corresponding to the infarct. Fazekas score was determined from available MRI T2 images. We defined ND as those with any neurologic deterioration during their hospitalization referable to lacunar stroke and not related to a medical or non-cerebrovascular neurological complication. We compared clinical and radiographic characteristics of those with and without ND.

Results:
Among 242 lacunar stroke patients (mean age 68.9±12.2 years, 43.8% women, 61.2% white, 12.8% black, and 13.2% Hispanic), we identified 46 (19%) with ND. There were no demographic differences between those with and without ND. Those with ND were more likely to have systemic atherosclerotic disease (34.8% vs 19.9%, p=0.049) and higher low-density lipoprotein (111 vs 100 mg/dL, p=0.034). Those with ND had less white matter disease on MRI (lower Fazekas score) and were less likely to have chronic lacunes than those without ND. We did not find any association between radiographic subclinical perforator atherosclerotic disease and ND (odds ratio [95% confidence interval]: 1.83 [0.81-4.14], p=0.147).

Conclusions:
In this multi-ethnic population, patients with neurologic deterioration following an acute lacunar stroke were more likely to have markers of atherosclerotic disease and less likely to have imaging findings suggestive of chronic small vessel disease.
Abstract P677: Ischemic Stroke, Depressed Ejection Fraction, and Sinus Rhythm: Prevalence, Practice Patterns, and Outcomes
Authors: Sharma Richa , Sugeng Lissa , Sheth Kevin N , Jasne Adam , Baker Anna , Mac Grory Brian C , Stretz Christoph , Furie Karen L , yaghi shadi , Schwamm Lee H , Kleindorfer Dawn , Sucharew Heidi , Coleman Elisheva R , Mackey Jason , Walsh Kyle B , Flaherty Matthew L , Haverbusch Mary , De Los Rios La Rosa Felipe
Published: March 2021

Introduction:
After WARCEF, there is limited data about the epidemiology and treatment strategies for patients after an acute ischemic stroke (AIS) with existing or new left ventricular cardiomyopathy (CM) and sinus rhythm (SR). We aim to estimate prevalence, describe treatment practice, and analyze antithrombotic strategies.

Methods:
We calculated the prevalence of CM (ejection fraction or EF ≤40%) and SR among AIS patients with EF measurements and the frequency of anticoagulation upon discharge at Massachusetts General Hospital (MGH), Rhode Island Hospital (RIH), Yale-New Haven Hospital (YNHH), and the Greater Cincinnati/Northern Kentucky Stroke Study (GCNKSS). We collected longitudinal outcome data for patients with AIS, CM, and SR at RIH and YNHH spanning 2014-2018 and computed the hazard of a combined outcome of AIS, intracranial hemorrhage, major hemorrhage, myocardial infarction, and death up to 12 months after AIS by anticoagulation status.

Results:
Of 11,996 AIS patients with documented EF at the 4 sites, 693 had CM and SR (MGH N=333/5481, GCNKSS N=250/3284, RIH N=30/1549, YNHH N=80/1682). The pooled percentage of AIS patients with CM and SR was 5% (95% C.I. 3-7%, I
2
=96.5%). Mean age was 67 years (SD 14.2), 47.1% were female, 31.9% had pre-stroke CM, and mean NIHSS was 7.1 (SD 7.1). Among survivors, 241 were discharged on anticoagulation, 326 on antiplatelet, and 38 on neither. There was heterogeneity by site in the proportion discharged with an anticoagulant versus an antiplatelet only (MGH 49.8%, GCNKSS 29.6%, RIH 32.3%, YNHH 36.7%, p<0.0001). Patients discharged with an anticoagulant versus antiplatelet were significantly more likely to be male, privately insured, have no history of hypertension, hyperlipidemia, or peripheral arterial disease, have a lower EF, have a mural thrombus, and a higher NIHSS scale. In the longitudinal cohort (N=85, 32 anticoagulated, outcomes=12), patients discharged on anticoagulation were less likely to have a composite outcome (log-rank p=0.0409).

Conclusions:
AIS patients have concomitant cardiomyopathy and post-stroke antithrombotic prescription practice varies. Further study is needed to determine the association between post-stroke anticoagulation and subsequent ischemic and hemorrhagic events.
Abstract P678: Elevated Neutrophil to Lymphocyte Ratio Associated With Increased Risk of Recurrent Vascular Events in Older Minor Stroke or TIA Patients
Authors: Chan Ka Lung , Feng Xueyan , Ip Bonaventure , Huang Shangmeng , Sze Ho Ma , Fan Florence SY , Ip Hing Lung , Huang Li’an , Mok Vincent CT , Soo Yannie OY , Leung Thomas W , Leng Xinyi
Published: March 2021

Background:
The risk of recurrent stroke following a minor stroke or transient ischemic attack (TIA) is high, when inflammation might play an important role. We aimed to evaluate the value of neutrophil-to-lymphocyte ratio (NLR) in predicting composite cardiovascular events in patients with minor stroke and TIA.

Methods:
Consecutive patients with acute minor stroke or TIA admitted within 24 hours of symptoms onset during a 5-year period in a prospective stroke registry were analyzed. We calculated the NLR dividing absolute neutrophil count by absolute lymphocyte count tested within 24 hours of admission. NLR ≥ 4th quartile was defined as high NLR. A composite outcome was defined as ischemic stroke, acute coronary syndrome or vascular death within 1 year. We investigated associations between NLR and the composite outcome in univariate and multivariate analyses, among all patients and in those aged over 60 years (i.e., older patients).

Results:
Overall, 841 patients (median age 68 years; 60.4% males) were recruited. No significant independent association was found between NLR and the composite outcome in multivariate analysis in the overall cohort. Among the 612 older patients (median age 73 years; 59.2% males), the median NLR was 2.76 (interquartile range 1.96-4.00) and 148 (24.2%) patients had high NLR. The composite outcome occurred in 77 (12.6%) older patients, who were more likely to have a high NLR (39.0% versus 22.1%; p=0.001) than those without a composite outcome. In multivariate logistic regression, high NLR (adjusted odds ratio 2.00; 95% confidence interval 1.07-3.75; p=0.031) was independently associated with the composite outcome in older patients.

Conclusions:
In older patients with acute minor stroke or TIA, a higher NLR is an independent predictor of subsequent cardiovascular events, indicating inflammation as an important factor and potential therapeutic target for secondary prevention of such patients.
Abstract P680: Stroke, Stroke Risk Factors and Physical Activity Among Overweight and Obese Women of Reproductive Age
Authors: Christopher Kara M , Muthukrishnan Meera , Shrestha Anupama , Xaverius Pamela , Ilorah Chike , Linares Guillermo , Edgell Randall C
Published: March 2021

Background:
Stroke is a concern for women of reproductive age, as pregnant women have an increased risk of stroke. Primary prevention is critical to reducing this burden among this group. High physical activity levels (compared to low physical activity levels) can decrease stroke risks in adults, though this is not well-researched among women of reproductive age.

Methods:
Using NHANES 2013-2017 data, we examined the impact of physical activity on self-reported stroke and risk factors for stroke among overweight and obese women of reproductive age (20-44) using logistic regression models. Covariates include age, race, and smoking status. Risk factors examined were stroke history, hypertension, elevated total cholesterol, LDL cholesterol, triglycerides, and blood glucose levels.

Results:
Logistic regression models showed that getting at least 150 minutes of exercise per week reduced the odds of having elevated glucose levels by 58% (aOR=0.425, 95% CI=0.19-0.95). While physical activity did not show any significant differences in the other stroke risk factors, there was a trend toward a lower percentage of women having hypertension and elevated triglycerides if they were physically active. Further, compared to white women, Black women had nearly two times higher odds of having hypertension (aOR=1.97, 95%CI 1.41-2.76).

Conclusions:
Previous studies show that increasing physical activity can lower stroke risk, including lowering blood pressure and insulin levels. While our results show lower blood glucose among physically active overweight or obese women of reproductive age, a similar effect was not seen for hypertension. In this population, hypertension may result in adverse maternal outcomes such as pre-eclampsia, eclampsia or stroke during pregnancy, should a woman become pregnant. This demonstrates the importance of managing stroke-related risk factors during a woman’s reproductive years.
Abstract P681: Implementation of Stroke Prevention Interventions in Low- and Middle-Income Countries: A Scoping Review
Authors: Ryan Nessa , Rebello Vida , Gutierrez Desiree , Washburn Kameko , Zevallos Barboza Alvaro , Drum Emily , Perez Hector , Boden-Albala Bernadette
Published: March 2021

Background:
Stroke is the second leading cause of death globally and an increasing concern in low- and middle-income countries (LMIC) where, due to limited capacity to treat stroke, preventative efforts are critically important. Although some research on evidence-based interventions for stroke prevention in LMIC exists, there remains a significant gap in understanding of their implementation across various contexts in LMIC.

Objectives:
In this scoping review, our objective was to identify and synthesize the implementation outcomes (using Proctor et al.’s taxonomy, 2011) for stroke prevention interventions, as well as to describe the diverse interventions employed.

Methods:
Eligible studies were empirical, focused on implementation of stroke prevention programs or policies, and occurred in at least one LMIC. Five databases were searched, including PubMed, PsycINFO, CINAHL, EMBASE, and Web of Science. Two reviewers independently assessed studies for selection and charted data; discrepancies were resolved through discussion with a third reviewer until consensus was reached. Narrative synthesis was used to analyze and interpret the findings.

Results:
Studies were predominantly focused in Asia, targeting primary or secondary prevention, and facility-based. Interventions were conducted at the level of individual (n=11), system (n=12), or both (n=4). Various implementation outcomes were reported, most commonly cost (n=10), acceptability (n=7), fidelity (n=7), and feasibility (n=6), but also adoption (n=4), penetration (n=3), appropriateness (n=1), and sustainability (n=1).

Conclusions:
Findings highlight the breadth of evidence-based interventions for stroke prevention available to implement in LMIC settings, including culturally acceptable education interventions, cost-effective medications, and community-based interventions implemented by community health workers. Implementation outcomes remain under-reported, and more rigorous research is needed to better plan and evaluate the implementation of these interventions to prevent stroke.
Abstract P682: Risk of All Cause Stroke and Major Bleeding Events When Switching From Warfarin to Apixaban in Patients With Advanced Chronic Kidney Disease and Prevalent Atrial Fibrillation
Authors: Garlo Katherine , Mavrakanas Thomas , Burdick Elisabeth , Wang Wei , Charytan David
Published: March 2021

Introduction:
Apixaban is the preferred direct acting oral anticoagulant in patients with chronic kidney disease (CKD). Reporting on the incidence of all cause stroke and major bleeding after switching from warfarin to apixaban in patients with prevalent atrial fibrillation (AF) and CKD are limited.

Methods:
Individuals with stage 4-5 CKD not on dialysis and prevalent non valvular AF on warfarin who switched to apixaban were identified from the United States Data Renal System from Jan 1,2012-Dec 31, 2015. The incidences of combined all cause stroke, transient ischemic attack, or systemic thromboembolism and major bleeding events were estimated. Outcomes were compared between individuals switching to apixaban and continuing on warfarin using logistic regression and survival analyses adjusted with inverse probability treatment weighting. Individuals were censored at anticoagulation discontinuation, discontinuous Medicare part D, dialysis, kidney transplant, a 2
nd
switch in anticoagulant, or death.

Results:
1762 individuals with advanced CKD with AF were on warfarin; 71 (4.0%) switched to apixaban (57.8% male, mean age 78.2 years (SD ±6.6), 78.9% white, mean CHA
2
DS
2
-VASc 5.0 (SD ±1.5), mean HAS-BLED 2.2 (SD ±0.5) and 1691 (41.3%) continued warfarin (47.6% male, mean age 80.1 years (SD ±8.7), 87.9% white, mean CHA
2
DS
2
-VASc 5.5 (SD ±1.6), mean HAS-BLED 2.5 (SD ±0.8). Incidence of all cause stroke in the apixaban switch and warfarin continuation groups were 0.020/patient year (95%CI 0.002- 0.123) and 0.061/patient year (95%CI 0.054-0.068) (p=0.211). Incidence of major bleeding in the two groups were 0.018/patient year (95% CI 0.002 - 0.125) and 0.045 (95% CI 0.033 - 0.044) (p =0.438). The risk of all cause stroke (OR 0.06; 95% CI 0.01-0.45; HR 0.18 (95%CI 0.03-1.35)) and major bleeding (OR 0.09; 95%CI 0.01-0.68; HR is 0.31 95%CI (0.04-2.27)) were lower in the apixaban switch compared to the warfarin continuation group.

Conclusions:
The incidence and risk of all cause stroke and major bleeding are lower in individuals with stage4-5 CKD and prevalent AF who switch from warfarin to apixaban versus continuing on warfarin. Data are limited by few events and short duration on apixaban.
Abstract P688: North Dakota Mission: Lifeline Stroke Public Awareness Survey Campaign Results Indicate Significant Improvements
Authors: Cook Mindy , Sather Jeffrey A , Drofa Alexander , Meyer Chrissy , Pietrzak Janna
Published: March 2021

The American Heart Association (AHA) Mission: Lifeline Stroke program is a 3-year initiative in North Dakota which aims to improve guideline-based care of stroke patients. Improving outcomes involves widespread awareness of stroke symptoms, early recognition, and timely access to emergency health care services.

The purpose was to evaluate effectiveness of the public awareness campaign through a pre and post survey in 2018 and 2020 which assessed knowledge of the F.A.S.T acronym, actions and behaviors when stroke is suspected, and media preferences.

The AHA commissioned Marketing & Advertising Business Unlimited, Inc., to conduct four hundred phone interviews in 2018 and 2020. Residents were randomly selected from a list of 24,000 landlines and 8,000 mobile phones. Data was weighted by gender, age, and region to conform to the latest statewide census. The survey had a 4.9% margin of error and a 95% confidence interval.

Respondents reported having learned the signs and symptoms of stroke increased from 47.0% in 2018 to 68.3% in 2020. Awareness of symptoms changed as follows from 2018 to 2020: face related 30.0% to 43.1%; arm related 17.0% to 32.8%; speech related 39.0% to 41.0%. When asked what they would do first if stroke was suspected “Call 9-1-1- immediately” 64.0% to 70.7%, assess for F.A.S.T. symptoms then call 9-1-1 3% to 14.2%, drive themselves to the hospital 14% to 7.3% respectively in 2018 to 2020 . When asked if It would be better to transport someone experiencing stroke symptoms to a hospital by personal vehicle because driving could be faster than an ambulance in 2020 65% urban and 46% rural respondents disagreed.

Media preferences were: 1) F.A.S.T. acronym over other longer options, 2) visuals with real humans 3) tagline “Care Starts When You Call”. In 2020 60% of respondents recalled advertisements about stroke signs and symptoms in the past 12 months. They recalled seeing messaging on: TV: 74.1%, Facebook: 20.1%, Radio: 19.1%, Billboard: 14.1%.

Overall, the ND M:L public awareness communications were shown to have improved stroke symptom awareness and inclination to activate emergency services during a potential stroke. A preference for private vehicle presentation was noted in the rural cohort where transport time appears to be an influencing factor.
Abstract P689: Do Cyclic Patterns of Stroke Code Activation Occur in a Comprehensive Stroke Center?
Authors: Labin Edward , Meyer Dawn M , Shifflett Benjamin , Meyer Brett C , Modir Royya F
Published: March 2021

Background:
The effects of circadian rhythm on stroke can include increases in morning heart rate, blood pressure, catecholamines, platelet aggregation, and hypercoagulability and might correlate with higher numbers of morning strokes. We assessed time of day and frequency of stroke code activation for a potential role of circadian rhythm in stroke risk.

Methods:
A retrospective analysis of prospectively collected data from an IRB approved stroke registry, from July 2004 to July 2020, was performed. Codes were included where stroke codes were activated with last known well (LKW) <6 hours to limit the effect of wake-up strokes and equalize changing practice patterns over time. Subjects were divided into four epochs based on code activation: Night (00:00-05:59), Morning (06:00-11:59), Afternoon (12:00-17:59), and Evening (18:00-23:59). Confirmed diagnosis of stroke, baseline blood pressure (SBP & DBP), heart rate (HR), and PTT were compared. Chi squared was used to compare categorical data and t test for continuous.

Results:
A total of 5,366 subjects were identified. Stroke code activations differed across epochs (Night n=312, 5.81%; Morning n=1439, 26.82%; Afternoon n=2207, 41.13%; Evening n=1408, 26.24%: p<0.0001). In the subset analysis of true strokes, activations also differed across epochs (Night n=125, 5.26%; Morning n= 831, 34.95%; Afternoon n=934, 39.28%; Evening n=488, 20.52%: p<0.0001). Overall, SBP was different with Evening highest and Morning lowest (x 151.6, x 148.2;p=0.01). Overall DBP showed Night highest and Afternoon lowest (x 83.9, x 81;p=0.002). Heart rate showed Night highest and Morning lowest (x 84.9, x 81.6;p=0.002).

Conclusions:
This study found that most stroke code activations occur in Afternoons at this CSC. This may be due to patient level characteristics, bystander availability, or other factors. Future studies should assess multi-center data and include other circadian rhythm biomarkers.
Abstract P69: Clinical and Demographic Characteristics Associated With Cognitive Recovery During Stroke Inpatient Rehabilitation
Authors: Aggarwal Seema , Zhang Xu , Parker Dorothea , Taleb Shayandokht , wozny joseph , Wewior Natalia , Silos Christin , Paladugu Sreelekha , Ibrahim Lamya , Tariq Muhammad Bilal , Hsieh Billie , Norris Dominique , Verduzco-Gutierrez Monica , Savitz Sean I
Published: March 2021

Introduction:
We examined patient characteristics associated with cognitive improvement during inpatient rehabilitation.

Methods:
This was a retrospective review of clinical data from inpatient stroke rehabilitation units collected from 9/2017- 8/2019. Multiple and logistic regressions were used to examine the relationship between demographics, vascular risk factors and cognitive Functional Independence Measure (FIM) change scores on comprehension, expression, social interaction, problem solving, and memory in stroke patients, adjusted for cognitive FIM scores on admission.

Results:
The study cohort consisted of 680 patients with a mean age of 68 ± 14 years and median hospital LOS of 15 days. The percentage of patients that improved on comprehension, expression, social interaction, problem solving, and memory FIM scores was 61%, 65%, 62%, 64%, and 64%, respectively. Multiple regression analysis indicated that predictors of cognitive recovery included hypertension, stroke type, age, and NIHSS score. Specifically, hypertension predicted significantly less improvement on problem solving FIM scores (p=.033). Intracerebral hemorrhage (ICH) predicted significantly greater improvement on comprehension and problem solving FIM scores as compared to ischemic stroke (p=.047, p=.032, respectively). Compared to age < 65, age ≥ 65 predicted less improvement on comprehension, expression, and memory FIM scores (p<.001, p=.003, p<.001, respectively). NIHSS scores ≥ 21 predicted less improvement on comprehension, expression and problem solving FIM scores than NIHSS scores < 20 (p=.013, p=.017, p=.005, respectively). Logistic regression analysis suggested that the odds of cognitive improvement (defined as at least three FIM score changes ≥2) for ICH was 1.7 times greater than ischemic stroke (95% CI 1.07-2.72; Table 1).

Conclusion:
Hypertension, stroke type, age, and NIHSS score have profound impacts on cognitive recovery in during inpatient rehabilitation.
Abstract P690: Conversion From Prediabetes to Diabetes After Ischemic Stroke
Authors: de Havenon Adam H , Sheibani Nazanin , Muddasani Varsha , Wong Ka-ho
Published: March 2021

Introduction:
Type II diabetes mellitus is an established risk factor for ischemic stroke. Prediabetes, defined as hemoglobin A1C from 5.7 to 6.4%, is a significant and under-recognized contributor to stroke risk. Based on meta-analyses in the general population, the risk of progression from prediabetes is roughly 11%/year. To date, there has been only one prospective cohort study of 26 acute stroke patients which found a progression rate of 19% in 3 months.

Methods:
We conducted a retrospective chart review of acute ischemic stroke patients from 2013 to 2018 with prediabetes (A1C 5.7-6.4%) during hospitalization, as well as a follow up A1C at least 3 months later. Patients were excluded if they had a known diagnosis of diabetes or were on antidiabetic medication. Our primary outcome was incident diabetes (A1c>6.4). We evaluated potential predictors in logistic regression models and used a stepwise interactive process to create a final model, for which we report the area under the receiver operating curve (AUC).

Results:
We included 74 patients with a mean age of 66.1 years, 54% male, at a mean of 1.6 days from stroke onset to first A1c measurement, and a mean of 386 days to the follow-up A1c measurement. The conversion rate to diabetes was 10.8% (8/74) and 36.5% (27/74) of patients had an increase in A1c. The final predictive model for incident diabetes included discharge to home (vs. facility), 90-day mRS ≥2, baseline A1c ≥6, and median income by zip code of <$50,000/year, which yielded an AUC of 0.85.

Conclusion:
In this preliminary cohort, acute ischemic stroke patients with prediabetes have a rate of conversion to diabetes that is comparable to the general population. However, given that diabetes increases risk for stroke and recurrent stroke has significantly higher morbidity and mortality than primary stroke, this patient population warrants targeting to prevent conversion to diabetes. Further research into a predictive model such as ours, with an AUC of 0.85, could improve patient selection for diabetes prevention after acute ischemic stroke.
Abstract P692: This is Your Brain on Drugs: The Burden and Severity of Stroke Related to Substance Use and Infective Endocarditis
Authors: Lawler Thomas , Lee Jessica D
Published: March 2021

Background:
Substance abuse is a major health crisis in the US, with approximately 20 million people suffering from substance use disorders (SUD). The rate of opioid-related overdose deaths in Kentucky has climbrf from 1.3 per 100,000 persons in 1999 to a staggering 23.6 in 2016. SUD is a risk factor for infectious endocarditis (IE), an important cause of stroke in young patients. We previously reported that SUD in stroke is associated with poorer admission NIH stroke scales and longer lengths of stay (LOS) compared to patients without SUD.

Objective:
To describe the burden of stroke due to endocarditis in a regional population within Kentucky, and to compare outcomes of stroke in patients with SUD with or without evidence of IE.

Methods:
This is a single center, retrospective chart review of patients with SUD and stroke. Subjects included adults age
>
18 years, who received the diagnosis of acute stroke, and were identified as an illicit drug user based on either urine drug testing or provided history in the medical record, admitted between October 2015 and May 2019. Data elements collected included length of stay (LOS), admission/discharge NIH stroke scale scores, drug use history, laboratory data, discharge modified Rankin Scores, intracerebral hemorrhage (ICH) scores, and discharge status.

Results:
We identified 197 (M=157, 74.6%) SUD/IE-, and 116 (M=81, 69.8%) SUD/IE+ stroke cases. SUD+/IE+ cases were younger with a mean age of 36.53 +/- 8.94, as compared to SUD+/IE-, mean age of 54.94 +/-12.01 (p<0.0001). Ischemic stroke was more common than ICH in both groups. While admission NIHSS scores were similar in the two groups, SUD+/IE+ patients had longer lengths of stay (29.60 +/-25.73 days vs. 11.65 +/-16.95, p<0.0001), and experienced greater mortality, with 38 deaths (32.8% SUD+/IE+) as compared to 20 (10.2%) in the SUD+/IE- group, p<0.0001. An additional 16 (13.8%) patients IE+ were discharged to hospice, compared to 8 (4.1%) in the IE- group, p=0.003.

Conclusion:
Within our regional population, there is a high burden of SUD-related infective endocarditis and stroke, which is associated with poorer outcomes and increased mortality. Further study is warranted to examine the socioeconomic factors influencing SUD in our population to reduce overall disease burden.
Abstract P694: Predictors of Outcome in Subarachnoid Hemorrhage Patients: Observations From the Chinese Stroke Center Alliance
Authors: Liu Jingyi , Liu Liping
Published: March 2021

Background and Purpose:
The morbidity and mortality of subarachnoid hemorrhage in China have improved due to clear diagnosis, active treatment, and better management of accompanying complications. Considering these improvements, it is not clear if the previously identified independent predictors of negative outcomes have changed. The aim of this study was to identify the independent predictors of being discharged home from hospital in subarachnoid hemorrhage patients.

Methods:
Data from subarachnoid hemorrhage patients who were admitted to participating hospitals in the Chinese Stroke Center Alliance between June 2015 and November 2017 were analyzed. Univariate and multivariate logistic regression models were generated to identify independent predictors of patient discharged home from hospital.

Results:
A total of 10763 patients (median age 60 yrs, female 59.1%) were analyzed. In-hospital mortality was observed in 327 (3%) patients. At discharge, 7652 (73.3%) patients returned home from hospital. The independent predictors of being discharged home were systolic blood pressure (odds ratio [OR], 0.996; 95% confidence interval [CI], 0.994-0.998;
P
<0.0001), fasting blood glucose (OR, 0.952; 95% CI, 0.936-0.969;
P
<0.0001), endovascular treatment (OR, 2.097; 95% CI, 1.838-2.392;
P
<0.0001), joint therapy (OR, 1.977; 95% CI, 1.007-3.882;
P=
0.0476), need for cerebrospinal fluid diversion (OR, 0.039; 95% CI, 0.014-0.109;
P
<0.0001), hydrocephalus (OR, 0.605; 95% CI, 0.478-0.767; p<0.0001), seizure (OR, 0.635; 95% CI, 0.451-0.894; p=0.0093), pulmonary complications (OR, 0.339; 95% CI, 0.221-0.52; p<0.0001), and length of stay (OR, 1.086; 95% CI, 1.08-1.093; p<0.0001).

Conclusions:
These data suggest that endovascular and joint intervention are associated with favorable outcomes, whereas potentially modifiable risk factors of poorly controlled blood pressure, glucose level, seizure, and pulmonary complications are associated with unfavorable outcomes. Understanding the reasons why patients requiring cerebrospinal fluid diversion have 25.781-fold higher adjusted odds of poor outcome at discharge may be beneficial.
Abstract P699: Trends in Ischemic Stroke Risk Factors and Outcomes in a Rural Population in the United States
Authors: Chaudhary Durgesh , Khan Ayesha , Shahjouei Shima , Gupta Mudit , Lambert Clare , Avula Venkatesh , Schirmer Clemens M , Holland Neil , Griessenauer Christoph J , Azarpazhooh M. Reza , Li Jiang , Abedi Vida , Zand Ramin
Published: March 2021

Introduction:
The stroke mortality rate has gradually declined due to improved interventions and controlled risk factors. We investigated the trends in stroke risk factors and outcomes among a rural population in the United States between 2004 and 2018.

Methods:
We built a comprehensive stroke database called “Geisinger NeuroScience Ischemic Stroke (GNSIS)” for this study. Clinical data were extracted from multiple sources, including electronic health records and quality data.

Results:
Our cohort comprised of 8,561 consecutive ischemic stroke patients (mean age: 70.1±13.9 years, men: 51.6%, 95.1% Caucasian). Hypertension was the most prevalent risk factor (75.2%). The rate of hypertension, diabetes, dyslipidemia, and history of stroke increased significantly over the fifteen years window. The one-year recurrence and mortality rates were 6.3% and 15.8%, respectively. Although the one-year stroke recurrence increased from 2004 to 2018 (Cochran-Armitage test Z = -3.66, p<0.001), the one-year stroke mortality rate decreased significantly (Cochran-Armitage test Z = 2.39, p=0.008). Age >65 years, atrial fibrillation or flutter, heart failure, and prior ischemic stroke were independently associated with one-year all-cause mortality in stratified Cox proportional hazards model. In the Fine-Gray competing risk model, diabetes mellitus and age <65 years was found to be associated with one-year ischemic stroke recurrence. In the logistic regression, chronic kidney disease (CKD), diabetes, and prior ischemic stroke were predictors of one-year recurrence while age >65 years, atrial fibrillation or flutter, CKD, heart failure, prior hemorrhagic and ischemic stroke, history of neoplasm, myocardial infarction, and rheumatic diseases were predictors of one-year mortality.

Conclusion:
Although stroke mortality has decreased, stroke recurrence and several vascular risk factors have significantly increased in our rural population between 2004-2018. Older age, atrial fibrillation or flutter, heart failure, and prior ischemic stroke were independently associated with one-year all-cause mortality while diabetes mellitus and age less than 65 years were predictors of ischemic stroke recurrence.
Abstract P707: Trends, Predictors and Outcomes of Cerebrovascular Disease Amongst Patients With Thrombotic Microangiopathy
Authors: Patel Priyadarshee , Patel Urvish K , Vanessa Graca , Patel Abhinav , Chacko Davis , Hashmi Syed Salman Hamid , Bandaru Tejaswini , Bhushan Tanushri , Martin Mehwish , Patel Achint , Lunagaria Abhishek
Published: March 2021

Background:
Thrombotic Microangiopathy (TMA) is a rare disorder affecting the coagulation system causing microangiopathic thrombus formation within various blood vessels including the cerebral arteries. It may be seen in association with thrombocytopenia, anemia, purpura and kidney failure as well as complications of various systemic viral illnesses. We sought to estimate the trends, predictors, and outcomes of CeVD in patients having ™ from a nationally representative database of the USA.

Methods:
In this cross-sectional study, we identified hospitalization with TM using ICD-9/10-CM from the National Inpatient Sample (NIS) for the years 2008-2017. Prevalence of CeVD was identified by validated ICD-9/10-CM codes. We utilized Cochran Armitage trend test and multivariable survey logistic regression models to analyze temporal trends, outcomes and predictors of any CeVD in TM patients.

Results:
Out of a total 58,850 hospitalizations among TMA patients, 4,668 (7.9%) developed CeVD. Prevalence of CeVD increased from 6.2% in 2008 to 8.2% in 2017 (pTrend<0.001). Patients who developed CeVD were older and more likely to be female. In multivariable regression analysis, increasing age (OR 1.2; 95%CI 1.1-1.2; p<0.0001); females (OR 1.3; 95%CI 1.1-1.6;p<0.0004); African American (OR 1.4; 95%CI 1.2-1.7;p<0.001) and hypertension (OR 1.3; 95%CI 1.1-1.6; p<0.0001). CeVD was also associated with higher length of stay (18 vs 12 days; p<0.001). Additionally, CeVD was associated with higher in-hospital mortality (aOR 2.1; 95%CI 1.7-2.5; p<0.001) and discharge to facility (aOR 3.0; 95%CI 2.4-3.5; p<0.001) after adjusting with confounders.

Conclusion:
We observed the mildly incremental prevalence of CeVD among TMA patients. We were able to identify the TMA patient population susceptible to CeVD, most commonly occurring in older, females and African Americans. CeVD was also associated with significantly poor outcomes in TM. These findings may pose similarities to other systemic viral illness-induced thrombotic microangiopathy such as COVID-19. Further studies are required to improve the outcomes of these susceptible patient populations.
Abstract P708: Artificial Intelligence Enabled-Electrocardiography for the Detection of Cerebral Infarcts in Patients With Atrial Fibrillation
Authors: Weil Erika , Noseworthy Peter , Rabinstein Alejandro , Friedman Paul , Lopez Camden , Attia Itzhak , Yao Xiaoxi , Siontis Konstantino , Kremers Walter , Christopoulos Georgios , Mielke Michelle , Vemuri Prashanthi , Jack Clifford , Knopman David , Petersen Ronald , Graff-Radford Jonathan
Published: March 2021

Background:
Atrial fibrillation (AF) is an established risk factor for ischemic stroke, but it can be paroxysmal and may go undiagnosed. An artificial intelligence (AI)-enabled ECG acquired during normal sinus rhythm was recently shown to detect silent AF. The objective of this study was to determine if AI-ECG AF score is associated with presence of cerebral infarcts.

Methods:
Participants from a population-based study ages 30 to 95 years with T2 fluid attenuation inversion recovery (FLAIR) MRI obtained between October 10, 2011, and November 2, 2017 were considered for inclusion. Participants without ECG were excluded. AI-ECG score was calculated using most recent ECG with normal sinus rhythm at the time of MRI. Presence of infarcts was determined on FLAIR MRI scans. Logistic regression was run to evaluate the relationship between AI-ECG AF score and presence of cerebral infarcts. Similar analyses were performed using history of AF rather than AI-ECG AF score as predictor. Age and sex were included as covariates. We also examined whether a high-threshold AI-ECG score was associated with infarcts. In a prior study, an AI-ECG AF score > 0.5 was associated with a cumulative incidence of AF of 21.5% at 2 years and 52.2% at 10 years.

Results:
This study included 1,373 individuals. Average age was 69.6 years and 53% of participants were male. There were 136 (10%) individuals with ECG-confirmed AF; 1237 (90%) participants had no AF history. Of participants with AF, 23% (n=31) were on anticoagulation, 47% (n=64) were on antiplatelet and 18% (n=24) were on dual therapy. Only 1.3% (n=16) of patients without AF were on anticoagulation and 47% (n=578) were on antiplatelet therapy. Ischemic infarcts were detected in 214 (15.6%) patients. As a continuous measure AI-ECG was associated with infarcts but not after adjusting for age and sex (p=0.46). AI-ECG AF score > 0.5 was associated with infarcts (
p
< 0.001); even after adjusting for age and sex (
p
= 0.03). History of AF was also associated with infarcts after adjusting for age and sex (
p
= 0.018).

Conclusion:
AI-ECG AF score and history of AF were associated with presence of cerebral infarcts after adjusting for age and sex. This tool could be useful in select patients with cryptogenic stroke but further investigation would be required.
Abstract P710: Using Dictionary Learning to Determine Differences in Vasculature Between Males and Females to Understand Gender Differences in Stroke
Authors: Mendoza Steve , Chien Aichi
Published: March 2021

Introduction:
Between males and females, there is a variation in stroke incidence, with males having a stroke incidence 33% higher than women. This difference may be partly due to gender differences in vascular regions between males and females. We
hypothesize
that statistically significant population differences in vasculature may be identified and measured through image analysis methods.

Methods:
We have developed and verified a scalable big data image-processing pipeline for magnetic resonance angiography (MRA), without relying on a MRI registration intermediary, and allowing for multi-modality analysis. Our approach uses dictionary learning to find differences between groups by comparing projections of 3D images from each individual. It enables the degree of regional variation between population groups to be visualized as a color map overlaid on a representative template of the Circle of Willis (CoW).

Results:
Analyzing a dataset of MRA images from 42 patients (25 female, 17 male), we found the group of females to have larger ICA and more likely to have a complete CoW. The figure presents a heat map of differences between male and female patients from our analysis.

Conclusion:
The gender differences we found with this new method are consistent with previous research. This multi-modality population level analysis tool may be used to analyze stroke imaging data and extract key global differences. With big data available today, it can be used to quantify statistical differences in vasculature between populations, to gain insight for better stroke diagnosis or treatment.
Abstract P711: Factors Affecting Intracranial Aneurysm Incidence and Phenotypes at Risk of Rupture in Autosomal Dominant Polycystic Kidney Disease
Authors: Lee Chan-Hyuk , Ryu Hyunjin , Ahn Curie , Kang Hyun-Seung , Jeong Seul-Ki , Jung Keun-Hwa
Published: March 2021

Background:
Autosomal dominant polycystic kidney disease (ADPKD) is an autosomal dominant genetic disorder in which cysts of various sizes invade the renal parenchyma. Intracranial aneurysms occur in 8-12% of ADPKD patients, which is approximately 3-4 times the rate of the healthy population. However, research on factors related to aneurysm incidence and rupture in patients with ADPKD is insufficient.

Objective:
We analyzed the factors associated with risk of aneurysm incidence and phenotype in ADPKD patients.

Methods:
From the ADPKD registry in the tertiary hospital, we screened patients with cerebral angiography enrolled between January 2007 and May 2017. Then, 926 enrolled patients were classified into three groups according to the intracranial aneurysm incidence and phenotype (multiplicity, size, location): no intracranial aneurysm (Group 1); low-risk intracranial aneurysm (Group 2); high-risk intracranial aneurysm (Group 3). We analyzed the difference of patients’ demographic factors, cardiovascular risk factors, laboratory data, echocardiographic data, and imaging data between groups.

Results:
The prevalence [C1] of intracranial aneurysm in ADPKD patients was 16.0%. Aneury[C2] sm-positive group (Group 2 and 3, n=148) was significantly older (p<0.001) and had a greater proportion of females (p<0.001) than patients in the aneurysm-negative group (Group 1, n=778). Compared to Group 1, Group 3 was significantly associated with age (odds ratio (OR) 1.027, p=0.007), female sex (OR 3.184, p<0.001), dyslipidemia (OR 0.460, P=0.001), basilar artery dolichoectasia (OR 8.443, p=0.016), and mitral inflow deceleration time (OR 1.005, p=0.039).

Conclusion:
Factors associated with a high-risk aneurysms were age, sex, dolichoectasia, dyslipidemia, and mitral inflow deceleration time in ADPKD patients. Identification of these factors would help detect high risk aneurysms and manage the aneurysms in ADPKD patients.
Abstract P715: Vertebral Artery Occlusive Dissection Score in Acute Ischemic Stroke
Authors: Ikenouchi Hajime , Yoshimura Sohei , Miwa Kaori , Chiba Tetsuya , Hosoki Satoshi , Ihara Masafumi , Toyoda Kazunori , Koga Masatoshi
Published: March 2021

Background and purpose:
The discrimination of vertebral artery (VA) occlusive dissection from other etiologies is critical for acute stroke management but sometimes difficult. We aimed to assess the factors associated with VA occlusive dissection and develop the discrimination score.

Methods:
We examined consecutive patients with acute posterior ischemic stroke due to unilateral VA occlusion from our prospective stroke registry between 2012 and 2019. Unilateral VA occlusion was confirmed by magnetic resonance angiography and cervical ultrasonography. The diagnosis of VA dissection was based on the magnetic resonance imaging or digital subtraction angiography. Dissection score was developed from associated factors to discriminate VA occlusive dissection by logistic regression analysis. Discriminative performance was analyzed by receiver operating curve (ROC) analysis.

Results:
Consecutive 84 patients (70±13 years; male, 77%) involved 16 (19%) with VA occlusive dissection. On logistic regression analysis, each of younger age (
≤
70 years), absence of hypertension, absence of dyslipidemia, head or neck pain, medullary infarction and non-dominance side VA occlusion were significantly associated with VA occlusive dissection (Table). Dissection score was created with these factors by assigning respective points based on the corresponding regression coefficients, and the score were ranged from 0 to 9 (Table). High discriminative performance for VA occlusive dissection was observed (area under the curve: 0.91) and optimal cut-off value was 5 or more (accuracy, 79%; sensitivity, 94%; specificity, 75%).

Conclusions:
In patients with acute posterior ischemic stroke due to unilateral VA occlusion, dissection score had high discriminative performance for diagnosing VA dissection.