bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract WP136: Perfusion and Plaque Evaluation in Symptomatic Middle Cerebral Arterial Athrosclerotic Stenosis: Characterization With Multimodel MRI
Authors: Lyu Jinhao , Ma Ning , Ma Xiaoxiao , Ma Lin , Miao Zhongrong , Lou Xin
Published: June 2021

Objevtive:
We investigated the baseline demographics of patients with severe unilateral middle cerebral artery(MCA) athrosclerotic stenosis using multimodel MRI and tired to find out the hemodynamic and plaque features of patients who had recurrent stroke.

Methods:
This retrospective study had recruited consecutive patients with severe unilateral MCA athrosclerotic stenosis at 2 centers. All patients were performed arterial spin labeling(ASL) with post labeling delay(PLD) of 1.5s and 2.5s, MR angiography and high-resolution MRI. Hypoerfusion volume ratio (HVR) was calculated as [hypoperfusion volume at 2.5s / hypoperfusion volume at 1.5s X 100%]. Plaques enhancement at maximal lumen narrowing were graded from 0(none enhancement) to 3(signal intensity as high as post-contrast pituitary). In patients who had conducted conventional angiography, Spearman correlation was analyzed between collateral grades and HVR. Baseline characteristics were compared between patients with 1 year follow up ischemic events(event+) and without(event-), then multivariable logistic analysis was performed.

Results:
Thirty-seven patients (47.1±11.8 years; 25 men) were included in this study. HVR was with a mean of 24.9±23.6% and ranged from 0% to 93%. In 17 patients (50.47±7.23 years; 12 men) who had underwent conventional angiography, HVR was significantly correlated with collateral grading (r=-0.40, p=0.0493). In 1 year follow up, 7 patients had recurrent events in the same territory. NIHSS, HVR was significantly higher in Event+ group(p<0.05) and no significantly difference was detected in plaque enhancement grade as well as age, risk factors, qualifying event and time from symptom onset to imaging. In multivariable analysis, HVR >50% was significantly associated with recurrent stroke(OR=13.714, 95% confidence interval: 1.061-177.320, p=0.045) after adjusted by NIHSS and plaque enhancement grade.

Conclusion:
Multimodel MRI may be a promising approach to explore the mechanism of ischemic stroke in patients with intracranial artery stenosis. HVR obtained from 2 PLD ASL is associated with collateral circulation and may be predictable for recurrent stroke.This work was supported by the National Natural Science Foundation of China (Grant number: 81471390).
Abstract WP141: Genetic Polymorphisms Influence Carotid Atherosclerosis
Authors: Arias Eugenia , Martinetto Horacio , Arakaki Naomi , Sevlever Gustavo E , Ameriso Sebastian F
Published: June 2021

Introduction:
Genetic susceptibility affects atherosclerosis in humans. Polymorphisms of genes of angiotensin-converting enzyme (ACE), lipoprotein APOE (APOE), IL1 receptor antagonist (IL1Ra) and myeloperoxidase (MPO) are associated with several components of atherosclerotic disease. We evaluated allelic and genotypic frequencies and their association with age at presentation, vascular risk factors, and presence of symptoms in subjects with carotid atherosclerosis.

Methods:
We studied Argentine patients with severe carotid atherosclerosis and controls from the general population. Age, vascular risk factors and presence of neurological symptoms were recorded. DNA was obtained from peripheral blood and PCR or PCR-RFLP were used to typify ACE, APOE, IL1Ra, and MPO genes. Allelic and genotypic frequencies were compared and genotypic susceptibility variants were established. Chi-square and good fit test were applied for differences between expected and observed frequencies.

Results:
There were 137 patients, 36 women and 101 men, aged 67±8 years. Symptomatic subjects younger than 60 years had higher frequency of the alleles ACE-DD, associated to vasoconstriction, endothelial proliferation, oxidation, and apoptosis (p<0.01); IL1RN-12/22, associated to inflammation and apoptosis (p<0.01); and MPO*GA/AA, associated to less oxidative response and proatherogenic (p<0.05). Subjects older than 60 years had a genetic profile similar to the general population without atherosclerosis, with similar prevalence of ACE-ID/II, IL1RN-11, and MPO-GG and a higher frequency of APOE23, 24 and 34m. Independent associations of ACE*D and IL1RN*2 with dyslipidemia and of MPO-GA and APOE-34 with hypertension were observed.

Conclusions:
Subjects with carotid atherosclerosis are genetically different from the general population. Carriers of certain gene variants were predominant among atherosclerotic subjects, suggesting susceptibility, and others were more prevalent in controls, suggesting protection. Some polymorphisms and their combinations are associated with occurrence of symptomatic disease at an earlier age. The genetic profile of older patients does not substantially differ from the general population.
Abstract WP144: Ultrasound Criteria for Assessment of Vertebral Artery Origins
Authors: Rice Cory , Strohm Tamara , Raber Larry , Katzan Irene , Hussain Muhammad Shazam , Uchino Ken
Published: June 2021

Introduction:
We sought to validate ultrasound as a reliable means of assessing vessel stenosis of vertebral artery origins.

Methods:
We reviewed 1135 patient charts with ultrasound of the posterior circulation performed 2008-2015 in our Neurovascular Laboratory Imaging Institute. Inclusion criteria consisted of ultrasound and digital subtraction angiography (DSA) performed within three months as well as absence of prior stent placement, resulting in 218 vessels in 133 patients. Using DSA as the gold standard, we determined sensitivity and specificity of ultrasound in detecting occlusion at vertebral artery origin. All patients with non-occluded vertebral artery origins without stent were evaluated for degree of stenosis on DSA, and compared to mean flow velocity (MFV) on ultrasound.

Results:
Among 218 vertebral artery origins evaluated, ultrasound showed sensitivity of 85.7% (95% confidence interval (CI) 69.7-95.2%) for occlusion and specificity of 99. 5% (95%CI 96.9-99.9%). Among 126 arteries without occlusion, <50% stenosis had average MFV 39.5 cm/s (SD 19.9), 50-69% stenosis had average MFV 69.2 cm/s (SD 34.7), and severe 70-99% stenosis had average MFV 129 cm/s (SD 30.65), p<0.001 by Kruskal-Wallis test. For detecting ≥70% stenosis, c-statistic of ROC curve was 0.81, and MFV of 70 cm/s has 82% sensitivity and 88% specificity of ≥70% stenosis.

Conclusion:
Ultrasound has good sensitivity and excellent specificity for detecting vertebral origin occlusion. Flow velocity can be used to screen for severe stenosis of vertebral artery at origin.
Abstract WP148: Basilar Artery Displacement is Associated with Migraine with Aura
Authors: Zhang Cen , Cucchiara Brett L , Detre John
Published: June 2021

Background:
Cerebrovascular dysregulation has long been associated with migraine pathophysiology, possibly mediated by hypoperfusion and/or endothelial dysfunction triggering cortical spreading depression. Vessel tortuosity has also been associated with altered hemodynamics and endothelial function. We sought to examine whether basilar artery (BA) tortuosity was altered in migraine.

Methods:
We performed the Anatomy and Cerebral Hemodynamic Evaluation of Migraine (ACHE-M) study, a prospective, observational, case-control study including high-resolution MR angiography, arterial spin labeled perfusion MRI, and structural MRI. Migraine with aura (MWA), migraine without aura (MwoA), and control subjects between the age of 25-50 were enrolled in a 1:1:1 ratio. Subjects with manifest vascular disease of any type were excluded. Vertebral and basilar artery diameters and BA total lateral displacement from MRI were correlated with regional perfusion and T2/FLAIR white matter lesions that were assessed using methods similar to the Cerebral Abnormalities in Migraine Epidemiologic Risk Analysis study.

Results:
163 subjects were included (52 control/52 MWA/ 58 MwoA). Mean age was 33 ± 6 years, and 78% were female. BA diameter was similar across groups (3.6 ± 0.6 mm in all 3 groups). BA displacement was similar in MwoA (5.1±3.0 mm) and controls (4.9±3.1 mm), but tended to be greater in MWA (6.3±3.8 mm, p=0.055 vs. controls). In multivariate analysis incorporating migraine status, age, and sex, BA displacement was significantly associated with MWA (p=0.019), age (p<0.001), and sex (p=0.046). BA displacement was also significantly greater with increasing migraine frequency (p=0.003). There was no association with displacement and posterior cerebral artery territory cerebral blood flow or overall white matter lesion burden.

Conclusions:
Basilar artery lateral displacement is associated with MWA as well as headache frequency, but this association does not appear to be mediated by cerebral hypoperfusion. Further investigation of the physiological consequences of basilar artery lateral displacement may lead to new insights into the mechanisms of migraine.
Abstract WP153: Severe Obstructive Sleep Apnea is Associated With Presence of Intracranial Cerebral Atherosclerosis
Authors: Song Tae-Jin , Chang Yoonkyung , Kim Yong-Jae , Lee Hyang Woon
Published: June 2021

Background and significance:
Intracranial cerebral atherosclerosis (ICAS) is closely associated with risk of cerebrovascular diseases, especially in Asian populations. Obstructive sleep apnea (OSA) is associated with systemic atherosclerosis, but it is not clear whether OSA is an independent risk factor of ICAS. We aimed to investigate the association between ICAS and apnea-hypopnea index (AHI), representing severity of OSA, in suspected OSA patients.

Methods:
We included 142 patients who suspected OSA from Ewha Sleep Center who underwent brain MR angiography (MRA) and polysomnography (PSG). We also investigated the presence and burden of ICAS on MRA and AHI on PSG.

Results:
The mean patient age was 59.7 ± 13.1 years, and 54.2% (77/142) were male. The mean AHI was 19.8 ± 20.9, and 17 patients (12.0%) had ICAS. Higher AHI was noted in patients with ICAS compared to those without ICAS (38.2 ± 27.1 vs. 17.3 ± 18.7, p = 0.023). The burden of ICAS was positively correlated with severity of OSA (p for trend = 0.013)(Figure 1). In multivariable binary logistic analyses, after adjusting for age, sex, hypertension, hyperlipidemia, smoking, arousal index and minimum SaO
2
, severe OSA was independently related with presence of ICAS (odds ratio (OR): 14.05, 95% confidence interval (CI): 1.28 - 153.64,
p
= 0.030). Likewise, in multivariable ordinal logistic regression analyses, severe OSA was marginally associated with burden of ICAS (OR: 8.47, 95% CI: 0.74 - 95.77,
p
= 0.084).

Conclusion:
Our findings suggest that severe OSA is associated with presence of ICAS in patients with suspected OSA.
Abstract WP154: Forced- and Voluntary-Rate Aerobic Exercise Training Improve Cardiovascular Function in Individuals With Chronic Stroke
Authors: Linder Susan , Rosenfeldt Anson , Bazyk Andrew , Lee John , Blohm Marcus , Penko Amanda , Alberts Jay
Published: June 2021

Introduction:
Aerobic exercise (AE) has been shown to be efficacious in improving cardiovascular function following stroke; however, it is not routinely incorporated into post-stroke rehabilitation. Two modes of aerobic stationary bicycling (forced and voluntary rate) were applied to individuals with chronic stroke as part of a study to determine the effects of AE on motor recovery and cardiovascular function, compared to a no exercise control group. We hypothesized that both modes of AE training would elicit similar improvements in cardiorespiratory function, while no improvement would be evident in the control group.

Methods:
Twenty-five individuals with chronic stroke were randomized to complete forced-rate aerobic exercise (FE, n=8), voluntary-rate aerobic exercise (VE, n=8), or no AE (n=9). All AE sessions were 45 minutes in length and occurred on a semi-recumbent cycle ergometer. All participants also completed upper extremity task practice, as the study was investigating the neuroplastic effects of AE on motor recovery. Participants in all groups underwent time-matched interventions, 3 times per week for 8 weeks. An exercise stress test and six-minute walk test were completed at baseline and end of treatment (EOT).

Results:
Individuals in the FE and VE groups exercised at mean intensities of 56.5% and 55.9% of heart rate reserve, respectively. Peak oxygen consumption improved significantly from baseline to EOT for the FE and VE groups by 1.1 and 2.4 mL/kg/min, respectively, with no change in the control group. Ventilatory threshold improved by a mean of 1.1 mL/kg/min in FE participants, was unchanged in VE participants, and decreased by 1.5 mL/kg/min for those in the control group. Heart rate (HR) response during each stage of the stress test improved for 75% of the FE and VE participants and 44% of control group participants. During the 6-minute walk test, the FE, VE, and control groups improved by a mean of 190, 132, and 90 feet, respectively.

Conclusions:
Individuals with chronic stroke tolerated both modes of intensive AE. The 8-week intervention elicited improvements in peak oxygen consumption, HR response, and activity tolerance. Both FE and VE were efficacious in improving cardiovascular fitness, while simultaneously enhancing motor recovery.
Abstract WP160: Delirium in Right Hemisphere Stroke
Authors: Rostanski Sara K , Pavol Marykay A , Barbaro Marissa , Kim Minji , Marshall Randolph S , Barrett A M
Published: June 2021

Introduction:
Delirium, a disorder of attention and arousal, poses a large public health burden. Inattention and fluctuating cognitive status, two primary delirium symptoms, also occur when specialized right brain systems are impaired. Although right hemisphere stroke may predispose to delirium, systematic assessment methods and management of these patients are not yet available. We sought to characterize the incidence of delirium in right hemisphere stroke patients and explore whether stroke localization was associated with delirium.

Methods:
We identified consecutive patients admitted to our stroke service with acute right hemisphere stroke over a 6-month period from our prospective stroke registry. We reviewed the medical record for core delirium symptoms: inattention, cognitive fluctuation, and either disorganized thinking, or altered level of consciousness. Delirium was assessed by systematically screening for trigger words. We compared baseline characteristics with Fisher’s exact and t-tests and assessed relation of stroke localization to delirium with logistic regression.

Results:
Of 105 patients with acute right hemisphere stroke, 27 (26%) had delirium. Delirium patients were older (mean age 78 vs. 68, p<0.01), more likely to have dementia (30% vs. 5%, p<0.01) and prior stroke (52% vs. 28%, p=0.03). Median length of stay was longer (5 vs. 3 days, p<0.01), and discharge home less likely (37% vs. 64%, p=0.01) in those with delirium. Delirium patients more often had strokes involving the parietal lobe (44% vs. 17%, p<0.01). In a multivariable model, parietal localization strongly predicted incident delirium (OR 3.6 95%CI 1.1-11.3, p=0.03) adjusting for age, baseline NIHSS, and premorbid dementia.

Conclusion:
The high delirium incidence we found supports routine delirium screening in acute stroke patients. Stroke localization may be one factor to incorporate into screening tools. Studies to prospectively identify and treat delirium in both right and left hemisphere stroke patients are warranted.
Abstract WP167: Timed Up and Go Test With an Obstacle (TUGO): Reliability and Its Association With Motor Functions in People With Chronic Stroke
Authors: Ng Shamay S
Published: June 2021

Introduction:
Negotiating obstacles during walking is challenging and demanding for stroke survivors and it is a common cause of falls. As ability to negotiate obstacles is essential for community ambulation and functional independence in stroke survivors, assessing the ability to negotiate obstacles should be a crucial element in stroke rehabilitation.

The Timed Up and Go Test with an Obstacle (TUGO), which is the modified from the Timed Up and Go (TUG) test, could be used to assess the ability to negotiate obstacles. In TUGO, subjects were required to stand up from a chair, walk forward for 5 meters, step over a 5-cm height obstacle which is placed at the end of 5-meter walkway, turn 180
0
, step over the obstacle again, walk back and sit down on the chair as fast as possible. Time required to complete the task was recorded by a stopwatch.

The objectives of this study were to investigate the reliability of TUGO and its correlation with motor functions in people with chronic stroke.

Method:
This study was a cross-sectional study with 30 people with chronic stroke. TUGO completion times was administered along with Fugl-Meyer motor assessment for the lower extremities (FMA-LE), Berg Balance Scale (BBS) and timed Up and Go test (TUG). FMA-LE, BBS and TUG were used to assess motor control of the affected lower limb, clinical balance performance and functional mobility respectively. The TUGO was conducted in 2 separate sessions with 5-7days apart by 2 independent assessors.

Result:
TUGO completion times demonstrated excellent intra-rater, inter-rater and test-restest reliabilities, with intraclass correlation coefficients (ICCs) of 0.955-1.000. Significant correlations were also found between TUGO completion times and FMA-LE scores, BBS scores and TUG times respectively.

Conclusion:
TUGO is a reliable, valid and easy-to-administer clinical assessment for assessing the ability to negotiate obstacles in people with chronic stroke.
Abstract WP169: Patients With Aphasia Demonstrate Variability in Regional Functional Recruitment in Correct Naming Task
Authors: Wabnitz Ashley , Marebwa Barbara , Basilakos Alexandra , Rorden Chris , Fridriksson Julius , Bonilha Leonardo
Published: June 2021

Approximately 20-40% of stroke survivors suffer from aphasia, the partial or complete loss of language processing. It has been observed that patients with aphasia will typically make the same number of naming errors every time tested, but the objects that are named correctly or incorrectly will vary. These errors are therefore not linked to specific objects, but are instead related to faulty language processing. It remains poorly understood how the language processing can vary between right or wrong to enable correct naming. Here, we use functional imaging to identify processing patterns that lead to successful language production in patients with chronic aphasia. This could provide a potentially meaningful target for future rehabilitation methods.

Methods:
We analyzed data from 36 individuals with chronic aphasia who completed a picture-naming task while undergoing functional neuroimaging. After mapping the functional data to the AICHA atlas, regional activation signal was analyzed for each response type (correct, semantic paraphasia, or phonemic paraphasia). We performed a ttest looking for significant differences in activation at particular regions of interest for correct naming compared to semantic and phonemic paraphasias for each individual.

Results:
Individuals recruit variable regions for correctly named objects. There are some regions that stand out as being statistically significant (p ≤ 0.05) for correct productions compared to semantic and phonemic paraphasias across several subjects (e.g., insular regions were statistically significant for 8/36 subjects and superior temporal sulcus for 9/36 subjects). Also, there is variability in whether the regions that were statistically different were peri-lesional or in unaffected, healthy tissue.

Discussion:
There is evidence that individualized functional recruitment utilized by people with chronic aphasia allows for correctly naming objects. This pattern is unique and widely variable across subjects, due in large part to differences in lesion size and location. However, individuals recruit a particular network of peri-lesional and preserved brain tissue that is different for correctly naming objects compared to incorrectly naming objects (with semantic or phonemic paraphasias)
Abstract WP173: Women Have More Severe Post-Stroke Fatigue Than Men
Authors: Balucani Clotilde , Singer Jonathan , Stefanov Dimitre , Gilles Nadege , Huang Alisen , Mlabasati Jack , Halcket Douglas , Toy Gregory , Weingast Sarah , Levine Steven R
Published: June 2021

Background:
Gender-related differences in stroke are issues of increasing interest. Post- stroke fatigue (PSF) is a frequently reported symptom affecting stroke survivors and is a predictor for death and increased disability.

Aims:
To evaluate gender differences and predictors in PSF in an urban predominantly minority cohort.

Methods:
Two-center, IRB approved, prospective study serving primarily African/Caribbean Americans. Eligible patients included ischemic stroke within 3 years. Aphasia, dementia or pre-existing depression were exclusions. PSF was assessed by Fatigue Assessment Score (FAS); depression by the Beck Depression Inventory (BDI). Primary outcome was FAS log-transformed due to its skewed distribution. Multiple linear regression determined gender differences in PSF, adjusted for prior stroke, diabetes (DM), atrial fibrillation (AF), hypertension (HTN) and the following dichotomized predictors: stroke severity (NIHSS >2), BDI score (≥11), age (≥55), and time from stroke onset (>30 days). First-order interactions between gender and other predictors were investigated. Chi square test was used to test for gender differences in the distribution of the other categorical predictors. P<0.05 was considered significant.

Results:
150 patients, mean age 66 years (SD=13, range 30-93); 82 (55%) women. Higher rates of prior stroke (44% vs 28%, p=0.04) and AF (15% vs 4%, p=0.04) were present in women than in men. No gender differences were observed for the other predictors. We found that female gender was associated with 18% (95% CI: 4%-33%, p=0.009) higher levels of PSF, adjusted for other predictors. Two other predictors were associated with greater PSF severity: BDI ≥11 with 34% (95% CI: 14%-57%, p=0.0005) and NIHSS>2 with 14% (95% CI: 0.3%-29%, p=0.045) increase in the PSF. However, HTN was associated with 24% (95% CI: 9%-37%, p=0.004) decreased PSF severity. The 8 included predictors explained 30% of the variability in the PSF severity.

Conclusions:
In our urban, predominately minority cohort, women had more severe PSF than men. As the basis for PSF remains to be elucidated, our data suggest that gender-specific factors may modulate the magnitude of PSF. The protective effect of HTN on PSF severity is unclear and deserves further study.
Abstract WP174: Intensive Phonology Treatment Promotes Recovery in Reading in Chronic Aphasia Post Stroke
Authors: Shamapant Shilpa , Bennett Sarah
Published: June 2021

Therapies specifically targeting naming deficits are common because these deficits remain one of the most common and pervasive deficits seen in post-stroke aphasia (Goodglass & Wingfield, 1997). Past studies have used single lexical item retrieval (Nickels, 2002) as the framework for both semantic and phonological treatment. The efficacy of this technique is unclear when applied to reading, writing, and lexical retrieval deficits (Boyle, 2004a, 2004b; Coelho, McHugh, & Boyle, 2000). This study aimed to resolve these issues by implementing an easy to replicate design with a randomized control trial.

12 subjects enrolled in intensive speech therapy at Austin Speech Labs were selected for the study. They were randomly assigned to a Semantic (ST) (n=6) or phonological treatment (PT) (n=6) group. Subjects received comprehensive pre and post-testing using the Western Aphasia Battery-Revised (WAB-R), Boston Naming Test (BNT). The subject’s phonological awareness was assessed using subtests of Psycholinguistic Assessment of Language Processing in Aphasia (PALPA).Each participant attended three hours of therapy for a total of 40 hours of therapy.

PT: The first eight weeks focused on mastering individual consonants and vowels and blending sounds to read single words. The second 8-week module focused on training consonants clusters, and spelling.

ST: The first and second module focused on describing object attributes to aid reading, naming, and writing.

An independent T-test (p-value of .05) was used to examine significant differences found in the post-test scores between each group. A paired t-test (p-value=. 05) was run to determine significant differences in pre and post-test scores across both treatment groups. The majority of

participants showed increases between pre and post-testing in all subtests. The phonology group showed significant increases in letter length spelling, letter sounding, spoken and written letter matching, and syllable length reading PALPA subtests. The Semantic group showed significant increases in the WAB verbal commands and repetition subtests as well as the PALPA and spoken and written letter matching subtest.

Conclusion:
Phonology focused treatment appears to be beneficial despite differences in underlying impairments.
Abstract WP183: Spontaneous Echo Contrast is Associated With Larger Cerebral Infarction Volume in Stroke Patients With Atrial Fibrillation
Authors: Heo JoonNyung , Kim Kyoungsub , Yoo Joonsang , Kim Young Dae , Nam Hyo Suk , Heo Ji Hoe
Published: June 2021

Introduction:
The presence of spontaneous echo contrast (SEC) on transesophageal echocardiography (TEE) is associated with increased thrombogenecity and a risk factor of thromboembolism. The increased thrombogenecity in SEC may produce larger intracardiac thrombi, which result in larger cerebral infarctions and severe stroke.

Hypothesis:
We hypothesized that infarction volume will be larger in stroke patients with SEC than in those without SEC.

Methods:
This was a post-hoc analysis using a prospective cohort of acute ischemic stroke. This study included patients with nonvalvular atrial fibrillation (NVAF) who underwent TEE and diffusion weighted imaging (DWI) from Jan. 2008 to Dec. 2014. The volume of cerebral infarction on DWI was measured semi-automatically using 3-dimensional software by an investigator who was blinded to clinical information. The infarction volume was compared between patients with SEC and those without.

Results:
Of 4252 considered patients, 889 patients had NVAF. After excluding 449 patients without TEE and 39 patients without DWI, 401 patients were included for analysis. Of them, SEC was found in 181 patients (45.1%, 82 mild, 35 moderate, and 64 severe SEC). Infarction volume was larger for the patients with SEC than those without SEC (median [interquartile range], 7226.8 mm
3
[1218.1-28804.6] vs. 4756.8 mm
3
[672.8-14887.8], p=0.015). Infarction volume also increased with SEC severity (p=0.006). Initial National Institute of Health Stroke Scale scores were higher for the patients with SEC than those without SEC (median [interquartile range], 5.0 [2.0-12.0] vs. 3.0 [1.0-8.0]. p=0.008). On multivariate analysis, infarction volume was independently associated with the presence of SEC (p=0.014).

Conclusion:
Among stroke patients with NVAF, those with co-existing SEC had larger cerebral infarction, which may account for severe stroke. This may be related with increased thrombogenecity in patients with SEC.
Abstract WP189: The Association of Blood Pressure Control with Belief of Self-Efficacy in Preventing Stroke
Authors: Howard Virginia J , Kleindorfer Dawn O , Allen Shauntice , Aycock Dawn M , Anderson Aaron A , Howard George
Published: June 2021

Background:
Hypertension (HTN), including uncontrolled HTN, is one of the greatest contributors to stroke risk. A Risk Behavior Diagnosis Scale (RBD) was used to assess individual perceptions of stroke including efficacy for managing HTN associated with stroke risk.

Methods:
Data came from the 10-year risk factor telephone interview and in-home assessment of REGARDS participants. REGARDS is a national, population-based, longitudinal study of black and white adults ≥ 45 years, enrolled 2003-2007. Participants were asked about agreement with four constructs of RBD: response efficacy (controlling my BP is effective in preventing stroke), self-efficacy (having skills to control my BP to prevent stroke), severity (belief that stroke is extremely harmful), and susceptibility (it is likely I will have a stroke.) Analysis was restricted to 8,269 individuals with self-reported physician-diagnosis of HTN. BP control was defined as SBP < 140 mmHg or DBP < 90 mmHg. Logistic regression was used to examine the association of hypertension control with agreement with each construct, adjusting for demographics, socioeconomic factors, and history of previous stroke.

Results:
Of those who reported HTN, 6,799 (82%) had controlled HTN. In the multivariable model, control of BP was strongly associated with agreement with “having the skills to control BP to prevent stroke” (OR = 1.37; 95% CI: 1.13 - 1.66). There were no associations (p > 0.05) between hypertension control and agreement with any other constructs (see table.)

Conclusions:
Among persons with self-reported HTN, those who agreed they had the skills to control their blood pressure to prevent stroke were more likely to have their hypertension controlled. Although self-efficacy is difficult to influence, strategies to improve skills and confidence related to BP management may improve BP control.
Abstract WP190: Excessive Daytime Sleepiness and Depression in Stroke Survivors
Authors: Pham Quynh Huong , Sharrief Anjail , Savitz Sean , Sarraj Amrou , Fournier Lauren , Vahidy Farhaan , Abada Sharon
Published: June 2021

Introduction:
Excessive daytime sleepiness (EDS) and post-stroke depression (PSD) are risk factors for stroke morbidity and mortality. EDS is commonly seen after stroke, but is not routinely assessed after stroke. EDS may be related to sleep disordered breathing (SDB) including obstructive and central sleep apneas, but can also occur in the absence of SDB. The relationship between EDS and PSD is not well understood.

Hypothesis:
We sought to assess the association between EDS and PSD. We hypothesized that patients with EDS are more likely to demonstrate symptoms of moderate to severe depression compared to patients without EDS.

Methods:
We identified ischemic stroke patients from the outpatient clinic registry (06/2014 - 10/2015). We screened for depressive symptoms using the Patient Health Questionnaire-9 (PHQ-9; range 0-27, higher worse), and for EDS using the Epworth Sleepiness Scale (ESS; range 0-24, higher worse). Univariate and multivariate analyses were used to evaluate association between EDS and PHQ-9 (moderate to severe depression = PHQ-9 > 9). Regression analysis was also used to evaluate association between EDS and symptoms included in the PHQ-9.

Results:
Among 200 ischemic stroke patients, 166 completed ESS and PHQ-9 within 90 days of stroke occurrence. Mean age was 61.5 and 54.8% were male. EDS (ESS>9) and moderate to severe depression were each present in 28.9% of patients. Patients with EDS had 3.5 times odds of moderate to severe depression compared to patients without EDS (table 1). Moreover, EDS was associated with higher odds of anhedonia, impaired mood, sleep disturbance, low energy, poor appetite, and impaired concentration (table 1).

Conclusion:
The presence of EDS is associated with moderate to severe depression in stroke survivors. This is not related solely to SDB symptoms. Patients with fatigue and EDS should be screened for depression. Future studies are also needed to explore the role that SDB plays in this relationship.
Abstract WP192: Periventricular White Matter Hyperintensities Are Associated With Functional Decline: The Northern Manhattan Study
Authors: Dhamoon Mandip S , Cheung Ying-Kuen , Bagci Ahmet M , Marquez Chensy , Alperin Noam , Elkind Mitchell S , Sacco Ralph L , Wright Clinton B
Published: June 2021

Background:
We previously showed that overall brain white matter hyperintensity volume (WMHV) was associated with accelerated long-term functional decline. However, it was unclear whether WMHV in particular brain regions was more predictive of decline. We hypothesized that WMHV in particular brain regions would be more predictive of functional decline.

Methods:
In the Northern Manhattan MRI study, participants had brain MRI with axial T1, T2, and fluid attenuated inversion recovery sequences, with baseline interview and examination. Volumetric WMHV distribution across 14 brain regions (brainstem, cerebellum, and bilateral frontal, occipital, temporal, and parietal lobes, and bilateral anterior and posterior periventricular white matter [PVWM]) was determined separately by combining bimodal image intensity distribution and atlas based methods. Participants had annual functional assessments with the Barthel index (BI, range 0-100) over a mean of 7.3 years and were followed for stroke and myocardial infarction (MI). Due to multiple collinear variables, lasso regression was used to select regional WMHV variables, and adjusted generalized estimating equations models estimated associations with baseline BI and change over time.

Results:
Among 1195 participants, mean age was 71 (SD 9) years, 460 (39%) were male, 802 (67%) had hypertension and 224 (19%) diabetes. Using lasso regularization, only right anterior PVWM was selected, and each SD increase was associated with accelerated functional decline, of -0.95 additional BI points per year (95% CI -1.20, -0.70) in an unadjusted model, -0.92 points per year (95% CI -1.18, -0.67) with baseline covariate adjustment, and -0.87 points per year (95% CI -1.12, -0.62) after adjusting for stroke and MI. This decline was in addition to a mean decline of -1.13 (95% CI -1.29, -0.97), -1.19 (95% CI -1.36, -1.01), and -1.04 (95% CI -1.21, -0.88) BI points per year, respectively.

Conclusions:
In this large population-based study with long-term repeated measures of function, periventricular WMHV was particularly associated with accelerated functional decline. Periventricular WMHV may have a greater effect on mobility due to dysfunction in descending leg motor tracts.
Abstract WP196: Can being Married Save the Healthcare System Money? A Retrospective Analysis of Stroke Admission in US Military Health Care System
Authors: Blattner Matthew , Price James , Holtkamp John , Holtkamp Matthew
Published: June 2021

Introduction:
The role of gender and age is well documented with disparities noted in Duration of hospitalization, total Cost of hospitalization and Outcome in stroke patients. The military healthcare system database was reviewed to determine if marital status was risk factor for any of these three criteria.

Hypothesis:
We hypothesize that being unmarried would be correlated with an increase in Duration of hospitalization and total Cost of the hospitalization.

Methods:
Data was collected from the Defense Health Agency Military Mart (M2) database from fiscal year 2010 to 2016. The M2 database stores data including age, gender and marital status. Adult patients with a primary diagnosis of stroke at discharge (International Classification of Diseases, 9th Revision codes 434.91, 434.11 or 10
th
Revision code I63.9) were reviewed. Age, Gender and Marital Status were compared for Duration of hospitalization, total Cost of hospitalization and Outcome using Multivariable Analysis.

Results:
A total of 3,910 patients discharged from Military hospitals were identified. The Marital status of this sample was: Married 67.1%, Widowed 12.4%, Single 4.7%, Legally Separated 0.5%, and Unknown/Not Reported 4.7%. There was a significant correlation between Marital Status and Duration of hospitalization (average of 1.2 fewer hospital days/patient, P-value <0.01) and total Cost of hospitalization ($1,088 less/patient even after controlling for the shorter hospital stay (P-value <0.05). There was no significant correlation for Marital Status with Outcome. There was a significant correlation between age and increased Duration of hospitalization and worse Outcome. There was no correlation of age with total Cost of hospitalization when we controlled for duration of hospitalizing. There was no correlation for gender with for Duration of hospitalization or total Cost of hospitalization. There was a small, statistically significant correlation of female gender and worse Outcomes (p-value < 0.02).

Conclusions:
Unmarried status is an independent risk factor for increased Duration of hospitalization and total Cost of hospitalization. Older age is a risk factor for increased Duration of hospitalization and worse Outcome. Female gender is a risk factor for worse Outcomes.
Abstract WP197: Increased Carotid Intima-Media Thickness is Associated ith Incident Coronary Heart Disease and Stroke in a Japanese General Population With a 12.6-year Follow-up: The Suita Study
Authors: Kokubo Yoshihiro , Watanabe Makoto , Higashiyama Aya , Nakao Yoko M. , Takegami Misa , Miyamoto Yoshihiro
Published: June 2021

Introduction:
Carotid intima-media thickness (IMT) is increasingly used as a subclinical marker of cardiovascular disease. However, few studies have examined the association between IMT and incident coronary heart disease (CHD) and stroke in non-Westerners. We assessed the hypothesis that carotid atherosclerosis is a predictor of CHD and stroke events in a general urban Japanese population.

Methods:
We studied 4,751 Japanese (2181 men and 2570 women, mean age 59.8 years, without stroke or CHD at the baseline) who completed a baseline survey and carotid atherosclerosis in the Suita Study, and were then followed for an average of 12.6 years. Carotid atherosclerosis was evaluated by high-resolution ultrasonography with atherosclerotic indexes of IMT in the common carotid artery (CCA) and the carotid artery bulb. Mean IMT was defined as the mean of the IMT of the proximal and distal walls for both sides of the CCA at a point 10 mm proximal to the beginning of the dilation of each carotid artery bulb. Max-CCA and Max-Bulb were defined as the maximum IMT in the CCA and bulb areas, respectively. We used adjusted Cox proportional-hazards models to compare the risk of CHD and stroke by use of mean and maximum carotid IMT in the CCA and bulb areas.

Results:
During the follow-up, we documented 145 cerebral infarctions, 58 hemorrhagic strokes, 20 unclassified strokes, and 159 CHD. The adjusted hazard ratios (HRs; 95% confidence intervals [CI], P for trend [P trend]) in the fourth quartile (≥ 0.95 mm) of the mean IMT for strokes, cerebral infarction, and CHD were 3.13 (1.48-6.63, P trend = 0.002), 3.34 (1.33-8.37, P trend = 0.002), and 1.93 (0.96-3.88, P trend <0.0001), respectively, compared with the first quartile (<0.775 mm). The adjusted HRs (95% CI) in the fourth quartiles of Max-CCA (≥1.10 mm) and Max-BIF (≥1.55 mm) were 2.48 (1.10-5.62, P trend = 0.07) and 3.28 (1.40-7.69, P trend <0.0001) in stroke, 1.87 (0.75-4.659, P trend = 0.07) and 2.83 (1.05-7.63, P trend = 0.005) in cerebral infarction, and 3.07 (1.18-8.04, P trend <0.0001) and 6.01 (2.02-17.9, P trend <0.0001) in CHD, respectively, compared with the first quartiles (<0.9 mm).

Conclusions:
Carotid IMT, especially Max-BIF was a strong predictor of stroke, cerebral infarction, and CHD in a Japanese urban general population.
Abstract WP198: Sex Differences in Outcomes After Stroke in Patients With Diabetes in Ontario, Canada
Authors: Dhamoon Mandip S , Liang John W , Zhou Limei , Stamplecoski Melissa , Kapral Moira , Shah Baiju R
Published: June 2021

Background:
Diabetes is a cardiovascular disease risk factor that exerts a higher risk for coronary heart disease and stroke among females compared to males. Outcomes after first stroke in those with diabetes are not well characterized, especially by sex and age, and studies have been limited by short follow-up and biased samples. We sought to calculate the sex- and age-specific risk of cardiovascular outcomes after ischemic stroke among those with diabetes using a study with full population coverage.

Methods:
Using population-based demographic and administrative health care databases in Ontario, Canada, we selected all patients with diabetes hospitalized with first ischemic stroke between 4/1/2002 and 3/31/2012. Participants were followed for death, stroke, and myocardial infarction (MI). Kaplan-Meier survival analysis and Fine-Gray competing risk models were used to estimate hazards and adjusted hazards of outcomes by sex and age strata. Models were adjusted for demographics and vascular risk factors. Sensitivity analysis including adjustment for medication use was performed in those aged >=65 years.

Results:
There were 25495 ischemic stroke patients with diabetes. The incidence of death was higher in women than in men (14.08 per 100 person-years [95% CI 13.73-14.44] vs. 11.89 [11.60-12.19]), but was lower after adjustment for age and other risk factors (adjusted hazard ratio [HR] 0.95 [0.92-0.99]). The incidence of recurrent stroke was similar in women and men, but men were more likely to be readmitted for MI (1.99 per 100 person-years [1.89-2.10] vs 1.58 [1.49-1.68] among females). In multivariable models, females had a lower risk of readmission for any event (HR 0.96 [95% CI 0.93-0.99]).

Conclusions:
In this retrospective study with full population coverage among diabetics with index stroke in Ontario, there was a higher unadjusted rate of death among females compared to males, and higher unadjusted incidence of MI among males. In adjusted models, females had a lower risk of death compared to males, although the increased risk of MI among males persisted. These findings confirm and quantify sex differences in outcomes after stroke in patients with diabetes.
Abstract WP200: Temporal Trends in Public Awareness of the Reperfusion Therapy in Acute Ischemic Stroke Patients in Japan
Authors: Wada Kuniyasu , Terasaki Tadashi , Namitome Satoshi , Nagao Yoichiro , Shindo Seigo , Ando Yukio
Published: June 2021

Background and Purpose:
Prevention of stroke and increase in the speed of hospital presentation after the onset both depend on the awareness of stroke in general population. We investigated the chronological change of stroke awareness after the approval of the intravenous alteplase treatment in Japan, and aimed to clarify the effective method for public education about stroke.

Methods:
The questionnaire survey for all subjects who subscribed for the complete health screening checkup program of our hospital has been conducted in 2006 (a year after the approval of the intravenous alteplase treatment in Japan) and 2014. Then, we compared them.

Results:
The response rates to the questionnaire were 78% (1,893 respondents /2,433 subjects) in 2006 and 60% (1,413 respondents/2,362 subjects) in 2014. While the public knowledge of stroke risk factors and symptom had not been changed, the respondents who know the name and the way of alteplase treatment had increased during the survey period (12% vs.25%; p<0.001). On the other hand, 55% of the respondents know the endovascular thrombectomy for ischemic stroke in 2014 (no data in 2006). In addition, the respondents who answer “immediate” after the symptom onset for the question about a time to need for decision of consultation had increased (22% vs. 26%; p=0.0075). The majority of the respondents tend to get more information from mass media than medical source.

Conclusion:
The public knowledge of stroke risk factors and symptom had not changed. However, the awareness of the reperfusion therapy and the necessity of haste in acute stroke have improved during the survey period. Therefore, to emphasize the early arrival to stroke centers and specific treatment should be more effective in public education and campaign for stroke.
Abstract WP201: Sub-analysis of Japanese Versus Non-japanese on Background Characteristics and One-year Outcomes in Tiaregistry.org
Authors: Uchiyama Shinichiro , Hoshino Takao , Sissani Leila , Kamiyama Kenji , Nakase Taizen , Nagata Ken , Kitagawa Kazuo , Minematsu Kazuo , Yamagami Hiroshi , Nakagawara Jyoji , Todo Kenichi , Okada Yasushi , Yamaguchi Takenori , Amarenco Pierre
Published: June 2021

Background and Purpose:
TIAregistry.org is an international prospective registry in patients with TIA or minor stroke (mRS 0 or 1) within 7 days after the onset. Main analysis of one-year follow-up data have been reported (N Engl J Med 2016;374:1533-42). We performed Japanese vs non-Japanese sub-analysis on the baseline and one-year follow-up data.

Methods:
Patients were classified into two groups according to their countries of origin (Japanese and non-Japanese). All comparisons between the two groups were adjusted on age, sex and mRS. Variables included demographic characteristics, intracranial and extracranial arterial stenosis, acute infarcts, TOAST classification, ABCD
2
score, and time to first contact. We compared the 1-year event rates of cardiovascular death, non-fatal stroke, and non-fatal acute coronary syndrome between the two groups using Cox proportional hazard models.

Results:
A total of 4,583 patients were included in the analysis. From them, 345 (7.5%) were Japanese. Proportion of patients with mRS 1 was higher in Japanese (58.5% vs 27.9%, p <0.001). The prevalence of acute infarct was higher for Japanese (73.9% vs 29.8%, p <0.001). Intracranial arterial stenosis >50% was more common in Japanese (19.6% vs 12.9%, p = 0.01). Distribution of ABCD
2
score was also different between Japanese and non-Japanese (20.1% vs 33.5% in scores 0-3, 28.6% vs 18.3% in scores 6 and 7, p = 0.02 in total). Time to first contact <24 hours was fewer in Japanese (80.0% vs 88.2%, P <0.001). Composite event rate of cardiovascular death, nonfatal stroke, nonfatal acute coronary syndrome was 7.7% in Japanese and 6.0% in non-Japanese (p = 0.18), while nonfatal stroke rate was higher for the Japanese patients (7.5% vs 4.4%, p = 0.008).

Conclusions:
Higher risk conditions in baseline characteristics as well as delay of time to contact, and a higher one-year stroke rate were identified in Japanese patients enrolled in this registry.
Abstract WP202: Cardiac and Brain Structure and Function Associations: The Atherosclerosis Risk in Communities (ARIC) Study
Authors: Johansen Michelle C , Shah Amil , Griswold Michael , Lirette Seth , Mosley Thomas H , Solomon Scott , Gottesman Rebecca
Published: June 2021

Background:
Heart failure (HF) is a disease that impacts many organs, but the effect on the brain remains poorly understood. To explore associations with subclinical disease, in the Atherosclerosis Risk in Communities (ARIC) study, we evaluated the relationship between cardiac dysfunction on echocardiography and vascular lesions on brain MRI.

Methods:
A cross-sectional analysis between subclinical cardiac and brain markers was performed using echo and brain MRI data from the 5
th
visit of the ARIC study (n=1974), a community-based biracial cohort study. LV structure was assessed using wall thickness (mm) and mass index (g/m
2
), while diastolic function was assessed as LA volume index (g/m2). MRI was evaluated for presence/size/location/number of infarcts and white matter hyperintensities (WMH). Demographic and vascular risk factors (including hypertension) were considered as covariates in statistical models.

Results:
In adjusted models, worse LV structure was significantly associated with the presence of WMH as well as infarction. WMH was 0.66 cm
3
greater (95%CI [0.11, 1.21]) for every 1 mm increase in wall thickness, and 0.65 cm
3
greater (95%CI [0.27, 1.03]) for every 10g/m
2
increase in LV mass index. Odds of infarction increased (OR 1.11, 95%CI [1.02, 1.21]), per 1 mm thicker LV wall increase as well as with larger LV mass (per 10 g/m
2
) (OR 1.08, 95%CI [1.02, 1.14]). The rate of accumulating additional cortical infarcts was increased by 2.4% (95%CI 1.01, 1.04) per ml/m
2
increase in LA volume index, a marker of LV diastolic function. The rate of accumulation of lacunar infarcts was increased by 1.5% per ml/m2 increase in LA volume index (95% CI [1.00, 1.03]). No significant interactions were detected by race.

Conclusions:
Among participants in a large cohort study, subclinical changes in markers of LV structure were associated with increased odds of infarction and volume of WMH even when controlling for hypertension. Our findings could suggest that the brain represents another end-organ at risk among patients with even early stages of heart failure.