bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 2607: A GWAS From The Vitamin Intervention For Stroke Prevention (VISP) Clinical Trial Identifies Variants That Contribute To Recurrent Stroke And Combined Vascular Endpoints
Authors: Keene Keith L , Chen Fang , Chen Wei-Min , Hsu Fang-Chi , Mychaleckyj Josyf C , Doheny Kimberly F , Adams Marcia , Laurie Cathy C , Gogarten Stephanie M , Heagerty Patrick J , Bookman Ebony B , Worrall Bradford B , Sale Michele M ,   GARNET Collaborative Rsch Group
Published: March 2022

We have performed a genome-wide association study (GWAS), using the Illumina Omni 1M SNP platform, in 2,100 stroke patients from the Vitamin Intervention for Stroke Prevention (VISP) trial. VISP was a controlled, double blinded clinical trial, designed to determine whether the daily intake of high dose folic acid, vitamins B6 and B12 reduce recurrent cerebral infarction. Extensive quality control (QC) measures were performed, resulting in a total of 737,081 SNPs for analysis. Principal Component Analysis (PCA), implemented in KING, was utilized to address confounders due to population substructure. We performed genome wide association (survival) analyses for recurrent stroke and combined vascular endpoints (stroke, MI, and CHD death), using stratified Cox model. Clinic sites were treated as strata and age, sex, treatment arm, and the top 10 principal components were used as covariates for these analyses. There is no inflation in our GWAS scan results, with GC lambda values of 1.008 and 0.995 for recurrent stroke and combined vascular endpoints, respectively. For recurrent stroke, we observed association with two SNPs that reached genome wide significance (≤10
-8
). Both SNPs were located in a gene sparse region of chromosome 1p31 (P=1.73×10
-8
; beta=-0.64; P=3.43×10
-8
; beta=-0.62). Two additional SNPs approached genome wide significance, one located in the same 1p31 region (P=7.60×10
-7
) and the second located in the
GMPR
gene (P=8.69×10
-7
). Variants in the
GMPR
gene region have been associated with LDL-cholesterol measures in previous GWAS. While no SNPs reached genome wide significance for combined vascular endpoints, six SNPs approached genome wide significance (P values ranging from 9.51×10
-6
to 2.56×10
-7
). These variants are located in genes that have implications in vascular disease. In particular,
GPR37L1
has been identified as a potential target for heart failure in mouse expression studies while
NSMAF
may play a role in regulating TNF-induced cellular responses (e.g. inflammation). Additionally,
ILDR2
is located in a region that has shown previous linkage for hypertension, suggesting potential biological implications for these variants in relation to stroke and vascular disease. Our GWAS scans represent the first large scale genetic association study of recurrent stroke and combined vascular events. Our findings have identified novel associations for genes that contribute to recurrent stroke and composite vascular endpoints.
Abstract 2641: Natural Killer Cell Receptors Distribution In Patients With Carotid Atherosclerosis According To Clinical Expressivity
Authors: Martinez-Rodriguez Jose E , Font Carla , Roquer Jaume , LÓpez-Botet Miguel
Published: March 2022

Background:
Natural killer (NK) cells are lymphocytes involved in innate immune defence against viral infections whose function is controlled by a balance of inhibitory and activating NK receptors (NKR), shared by some T cell subsets. Healthy individuals infected with human cytomegalovirus (HCMV), a pathogen related to the development of atherosclerosis, display variable increased proportions of NK cells expressing the CD94/NKG2C activating receptor specific for HLA-E. On the other hand, some infections including HCMV may also increase the numbers of NK and T cells bearing LILRB1, an inhibitory receptor specific for HLA class I molecules expressed at late differentiation stages. LILRB1+ NK and T cells have been recently associated to acute myocardial infarction and carotid intima-media thickness, supporting the infectious burden hypothesis in the pathogenesis of atherosclerosis.

Objective:
To evaluate NKR expression (NKG2C, NKG2A, LILRB1 and KIRs) in patients with carotid atherosclerosis according to their clinical expressivity seeking for a potential marker of high-risk carotid plaques.

Patients and methods:
Peripheral blood was drawn from 30 patients with carotid stenosis higher than 50% classified as asymptomatic (n=11) and symptomatic (transient ischemic attack, n=10; acute ischemic stroke, n=9). HCMV serology and plasma levels of CRP were analysed in all patients. NKR expression by NK cells and CD8+ T lymphocytes were evaluated by immunofluorescence staining and flow cytometry analysis.

Results:
Twenty-nine patients with carotid atherosclerosis were HCMV+. NKG2C expression by NK cells was similar in asymptomatic and symptomatic patients (17.6% ± 18.0 vs. 20 ± 19.2, p 0.7); moreover, both groups displayed as well a comparable distribution of other NKR, including LILRB1, by NK cells and CD8+ T lymphocytes. Yet, a positive correlation between the proportions of NKG2C+ NK cells and CRP plasma levels (Spearman correlation coefficient 0.5, p<0.05) was observed in symptomatic patients. In addition, LILRB1 expression by CD8+ T lymphocytes was directly related with age in the group of symptomatic patients (r 0.7, p<0.001) but not in asymptomatic patients (r 0.1, p=0.8).

Conclusion:
Patients at increased risk of developing an acute stroke secondary to carotid atherosclerosis display an NKR expression pattern that might be linked to chronic inflammation; its putative relationship with the infectious burden hypothesis deserves further attention.
Abstract 2642: The Impact of Chronic Kidney Disease on Carotid Atherosclerosis in a General Japanese Urban Population: the Suita Study
Authors: Ohara Tomoyuki , Kokubo Yoshihiro , Toyoda Kazunori , Koga Masatoshi , Nakamura Satoko , Nagatsuka Kazuyuki , Minematsu Kazuo , Miyamoto Yoshihiro
Published: March 2022

Introduction:
Chronic kidney disease (CKD) is an independent risk factor for cardiovascular disease and stroke. However, few studies have examined the association between CKD and carotid atherosclerosis as a subclinical study in general populations. We hypothesized that CKD was a strong predictor for carotid atherosclerosis and the predictive power was more accentuated with higher blood pressure (BP).

Methods:
Study participants (35 to 93 years of age; 1,844 women and 1,602 men) who gave written informed consent were randomly selected from a general urban population. Carotid atherosclerosis was evaluated by high-resolution ultrasonography (7.5MHz). Max-IMT was defined as the maximum IMT in the entire scanned area. Stenosis was defined as a condition in which a plaque occupied ≥25% of the lumen circumference of an artery on a cross-sectional scan. Glomerular filtration rate (GFR) [mL/min/1.73m
2
] was estimated using the Modification of Diet in Renal Disease study equation and subjects were divided into 4 categories according to GFR (≥90, 60 to 89, 50 to 59, and <50 mL/min/1.73m
2
). CKD was defined as an estimated GFR <60 mL/min/1.73m
2
. BP category (optimal, normal, and high-normal BP, and hypertension) was defined on the basis of the ESH-ESC 2007 criteria. The association of GFR category with the carotid atherosclerosis index and the impact of BP category on the index in the subjects with and without CKD were investigated by logistic regression analysis adjusting for confounding factors.

Results:
CKD was identified in 13.2% (16.2% for men and 10.5% for women). Compared with the subjects for GFR ≥90, the Max-IMT was significantly greater and the prevalence of stenosis was significantly higher (OR 1.91, 95% CIs 1.16 to 3.14) in the subjects with GFR <50. As for the impact of BP category on carotid atherosclerosis, multivariable-adjusted Max-IMTs in subjects with hypertension were significantly greater than in those with optimal BP. This result was more evident in CKD subjects, especially in women. The impact of high-normal BP and hypertension on stenosis were more evident in subjects with CKD (ORs [95% CIs]: 1.58 [1.08 to 2.31] in non-CKD/high-normal BP, 2.74 [1.63 to 4.61] in CKD/high-normal BP, 1.94 [1.36 to 2.77] in non-CKD/hypertension, and 2.36 [1.49 to 3.73] in CKD/hypertension vs. non-CKD/optimal BP as a reference).

Conclusions:
CKD was associated with an increased risk for carotid atherosclerosis in a general urban Japanese population. Furthermore, the association between BP and carotid atherosclerosis may be evident by CKD. To prevent the carotid atherosclerosis, it is necessary for subjects with CKD to control their BP by lifestyle modification and proper clinical treatment.
Abstract 2646: Haptoglobin 2 Allele Associates with Symptomatic Carotid Stenosis and Major Cardiovascular Events
Authors: Ijas Petra , Luoma Petri , Saksi Jani , Tuimala Jarno , Nuotio Krista , Soinne Lauri , Jauhiainen Matti , Kaste Markku , Kovanen Petri T , Lindsberg Perttu J
Published: March 2022

Objectives:
Haptoglobin (Hp) is a plasma protein which binds free hemoglobin (Hb) protecting tissues from iron-induced oxidative damage and promoting Hb clearance via macrophage CD163 receptor. There are two common alleles for Hp (Hp 1 and Hp 2), which influence it’s capacity to bind Hb and induce downstream signaling via CD163+ macrophages. We have previously shown that the CD163-heme oxygenase-1 (HO1) pathway is upregulated in symptomatic carotid stenosis (CS) and other groups have associated the Hp 2-2 genotype with cardiovascular complications in diabetics. Here, our objective was to study whether Hp polymorphism influences the risk of symptomatic CS and major cardiovascular events in the general population.

Methods:
We genotyped Hp polymorphism in 90 patients with a high-grade CS (≥ 70%) from Helsinki Carotid Endarterectomy Study (HeCES) and in 1426 individuals with carotid ultrasound examination data from the Health 2000 Survey, an epidemiological cross-sectional health survey carried out in Finland in the year 2000.

Results:
In the Health 2000 population, the Hp genotype frequencies were 0.170 (Hp 1-1), 0.445 (Hp 1-2) and 0.386 (Hp 2-2) consistent with Hardy-Weinberg equilibrium and with those reported from caucasian populations. In the CS patients, the genotype frequencies were skewed towards the Hp 2-2 genotype but not significantly. However, among the patients with symptomatic CS (ipsilateral TIA or stroke), the frequency of Hp 2-2 genotype was significantly higher than in the control population (0.528 vs 0.386,
P
=0.044). Hp genotypes correlated with HO1 protein expression in the plaque (r=0.46,
P
= 0.038) but not with iron. In the Health 2000 population, Hp 2 allele was associated with an increased risk of major cardiovascular events (major coronary heart disease event, ischemic stroke or TIA; 13.3% vs 8.3,
P
=0.032) and the increased risk was present regardless of diabetes. Hp 2 allele was not associated with carotid IMT or presence of plaques.

Conclusions:
Hp 2 allele associates with the risk of symptomatic CS and major ischemic cardiovascular events. This is likely due to the defective ability of Hp 2 to block oxidative reactions mediated by iron/heme, to clear free Hb present in intraplaque hemorrhages as well as the effects of the Hb-Hp 2 complex on intracellular signaling cascades via the CD163 receptor.
Abstract 2661: Unique Attributes Of Asian-Indian Stroke/Transient Ischemic Attack (TIA) Patients: Results of a Prospective Multi-ethnic Hospital-based Registry
Authors: Sen Souvik , Reddy P Leema , Poole Roxanne D , Paolini Stephanie , Grewal Raji P
Published: March 2022

Introduction:
The New Jersey Neuroscience Institute (NJNSI) serves the Middlesex County, NJ which, has a population of 750,000 (68.4% white, 7.3% Asian-Indian, 9.1% African-American, 15.2% others; 13.6% Hispanic of any race, based on 2000 US Census). This prospective multi-ethnic hospital-based registry provides a unique opportunity to study Asian-Indian stroke/TIA patients.

Hypothesis:
There are differences of stroke risk factors/subtypes between Asian-Indian and Caucasian stroke/TIA patient groups, in light of similar differences noted in the African-American and Hispanic groups individually in relation to the Caucasian group.

Methods:
Between 1998 and 2009, data on stroke risk factors and stroke subtypes were collected on 1100 consecutive stroke/TIA patients (1037 or 94.3% non-Hispanic; 63 or 5.7% Hispanic) admitted to the NJNSI. Of the non-Hispanics, 768 (74.1%) were Caucasian, 99 (9.6%) Asian-Indian, 139 (13.4%) African-American, 31 (3.0%) were others. Stroke risk factors assessed included age, gender, hypertension, diabetes, atrial fibrillation evaluated by 48-hour Holter monitor, hyperlipidemia evaluated by fasting lipid profile, prevalent coronary artery disease, smoking history, alcohol use, carotid stenosis (>70%) evaluated by duplex ultrasound, fasting homocysteine level and stroke subtypes (using TOAST classification). Asian-Indians, African-American and Hispanic groups were individually compared with the Caucasian group (control) in this study using odds ratio (OR) analyses and X2 test for categorical variables and t-test for continuous variables.

Results:
The Asian-Indian group was younger (66±12 vs 72±14, p <0.001), higher proportion of males (OR 2.1, p=0.001) and diabetes (OR 2.3, p< 0.001); lower proportion of atrial fibrillation (OR 0.2, p<0.001), smokers (OR 0.3, p<0.001), Alcohol users (OR 0.4, p=0.003) and higher fasting plasma homocysteine level (17.2±20.3 vs 11.9±7.4, p=0.002). There were fewer strokes related to cardioembolism (OR 0.2, p<0.0001) and a higher number of strokes related to small vessel occlusive disease (OR 2.4, p = 0.001). The African-American group had lower proportion of carotid stenosis (OR 0.5, p=0.007) and atrial fibrillation (OR 0.6, p=0.034). African-American group had higher levels of fasting triglyceride level (Median 92 vs 122 mg/dL). The Hispanic group resembled the Asian-Indian group in that they were younger (64±16 vs 72±14, p< 0.001), had a higher proportion of diabetes (OR 1.7, p=0.039), lower proportion of atrial fibrillation (OR 0.5, p=0.037) than the Caucasian group.

Conclusions:
The Asian-Indian stroke/TIA group in this community has unique attributes in respect to stroke risk factors and stroke subtype. There are few similarities in the stroke risk factors with the Hispanic stroke/TIA group.
Abstract 2666: Oral Care Protocol Reduces Risk of Aspiration Pneumonia in Acute Stroke Patients
Authors: Klassman Lynn , Deranleau-Urban Lisa
Published: March 2022

Background:
Swallowing is a complex process. Dysphagia, or impaired swallowing, may result in aspiration and can significantly contribute to morbidity and mortality. Approximately 25-70% of patients with stroke have dysphagia. Dysphagia and dependency for feeding/oral care are important risk factors in the development of aspiration pneumonia, which can delay patient functional recovery. Hospital acquired pneumonia (HAP) prevention studies have focused on critical care environments with intubated patients. Far fewer studies have investigated non-intubated patients, however the same physiologic principles apply.

Purpose:
The purpose of this program is to present an evidence-based practice initiative implemented utilizing ventilator-associated pneumonia (VAP) oral care techniques in the non-intubated, at risk stroke population.

Methods:
A multidisciplinary educational approach was utilized to implement a comprehensive oral care program recommended by the Centers for Disease Control and Prevention (CDC). Care practices include all patients, regardless of mental status, have their teeth brushed at least twice daily. Additionally, patients at risk who are eating, have their teeth brushed prior to meals and then mouth cleansed and moisturized after meals. Patients with altered mental status who are NPO receive oral care every 2-4 hours using swabs/cleanser and moisturizer.

Results:
Aspiration pneumonia rate of stroke patients on the neuro/stroke unit was tracked. Pre-implementation aspiration pneumonia rates were 4% (128 patients). Post implementation aspiration pneumonia rates were reduced to 1.4% (268 patients).

Conclusion:
Prevention of hospital acquired pneumonia is essential and has been shown to improve outcomes. A team approach is vital in providing oral care and preventing potential aspiration pneumonia. A nursing-led research study will be undertaken to further explore this topic.
Abstract 2669: Stroke Outcome After Intravenous Thrombolysis. The Stroke Etiology Does Not Matter.
Authors: Fuentes Blanca , MartÍnez-Sánchez Patricia , Alonso de Leciñana MarÍa , Egido Jose , Reig Gemma , DÍaz-Otero Fernando , Sanchez Victor , Simal Patricia , Ximenez-Carrillo Alvaro , GarcÍa-Pastor Andrés , Ruiz-Ares Gerardo , GarcÍa-GarcÍa Ana , Masjuan Jaime , Vivancos-Mora Jose , Gil-Nuñez Antonio C , DÍez-Tejedor Exuperio ,   Madrid Stroke Network
Published: March 2022

Objectives:
To identify possible diferences in stroke outcome related to stroke etiology in acute ischemic stroke (IS) patients who receive intravenous thrombolysis (IVT).

Methods:
Multicenter Stroke Register with prospective inclusion of consecutive acute IS patients treated with IVT according to SITS-MOST criteria in five acute stroke units in the same city. We compared neurological improvement within the first 24 hours (baseline-24 hours NIHSS) and at day 7 (baseline-7 day NIHSS) as well as functional outcome at 3 months measured by the modified Rankin Scale (mRS) among the different etiological stroke subtypes.

Results:
Of the total of 1429 patients included. 617 (43.2%) had cardioembolic IS, 334 (23.4%) had a IS of unknown origin, 174 (12.2%) had large vessel disease (LVD) with arterial stenosis, 171 (12%) LVD with no significant stenosis, 72 (5%) were IS of uncommon origin and 61 (4.3%) were lacunar infarction. Patients with lacunar infarction had the lower stroke severity (median NIHSS 6) whilst cardioembolic IS were the most severe (median NIHSS 15) (p<.001). No differences in NIHSS improvement at 24 hours from baseline were found among groups (LVD with arterial stenosis 3.4; LVD without arterial stenosis 4.7; cardioembolism 4.6; lacunar infarction 3.8; uncommon origin 3.6; unknown origin 3.9; p=0.141). At day seven patients with cardioembolism had the highest improvement in NIHSS from baseline (6.7) whilst those with lacunar infarction improved least (4.4) (p=0.02). Patients with LVD with arterial stenosis (OR 051; 95%IC 0.34-0.77) and those with IS of uncommon origin (OR 0.50; 95%IC 0.28-0.89) were the less prone to get a significant neurological improvement at day seven after adjustment for age, gender, vascular risk factors and stroke severity on admission. At 3 months up to 50.6% of patients with LVD and arterial stenosis, 34.5% with LVD without arterial stenosis, 46.2% cardioembolic IS, 15.1% lacunar infarction, 38.6% IS of uncommon origin and 37.7% of unknown etiology had mRS>2. Nevertheless, adjusted multivariate analysis showed no influence of stroke etiological subtype on stroke outcome (mRS) at 3 months.

Conclusion:
The stroke etiological subtype does not determine differences in IS outcome at 3 months after IVT, although those patients with LVD with arterial stenosis or of uncommon origin improve less than the other etiologies at day 7.
Abstract 2694: Trajectory and Predictors of Functional Recovery after Subarachnoid Hemorrhage
Authors: Navi Babak B , Kamel Hooman , Hemphill J. C , Smith Wade S
Published: March 2022

Background:
SAH frequently causes severe disability or death. Although there are extensive data on predictors of survival after SAH, there are few data on the trajectory and predictors of functional recovery after hospital discharge.

Methods:
We prospectively gathered data from October 2009 to April 2010 on consecutive patients with non-traumatic SAH who survived to hospital discharge. Functional outcomes based on the modified Rankin Scale (mRS) score were calculated at discharge from chart review and at six months via a standardized telephone interview. Good functional status was defined as an mRS score of 0 to 2, and poor status as an mRS score of 3 to 6. Descriptive statistics were used to assess the trajectory of functional recovery from hospital discharge to 6 months, and ordinal logistic regression was used to identify clinical factors associated with recovery, defined as the difference between the 6-month and discharge mRS scores.

Results:
Sixty-six of 70 patients hospitalized with SAH during the study period had 6-month outcome data, and 53 (80%) survived to hospital discharge and were included in our analysis. Mean age was 54 (13) years, and 33 (62%) were women. Median (IQR) Hunt-Hess grade, Fisher score, and GCS at presentation were 2 (2-4), 3 (2-4), and 15 (9-15), respectively. SAH was due to aneurysms (79%), perimesencephalic hemorrhages (9%), and other causes (12%). Most patients were discharged home (70%). Median (IQR) mRS score was 3 (2-4) at discharge and 2 (1-2) at 6 months. Of the 29 patients with poor functional status at discharge, 16 (55%) improved to good functional status at 6 months (
Figure
). Patients had greater odds of improvement between their discharge and 6-month mRS scores if they were older (OR per decade 2.2, 95% CI 1.4-3.5), had hydrocephalus (OR 7.7, 95% CI 1.7-35.2), had higher Hunt-Hess grades (OR per point 2.3, 95% CI 1.2-4.5), or were discharged to home (OR 10.1, 95% CI 1.9-53.8), while higher Fisher scores were associated with less recovery (OR per point 0.4, 95% CI 0.2-0.7).

Conclusions:
A substantial proportion of patients with SAH who have disability at discharge have significant functional recovery at 6 months.
Abstract 2696: Contrast Induced Nephropathy Is Associated With Poor Outcomes In IV t-PA Treated Patients
Authors: Mir Osman , Wu Tzu-Ching , Canseco Devry S , Peng Hui , Grotta James C , Savitz Sean
Published: March 2022

Background:
Given the rise in the use of multimodal Computerized Tomography (CT) including CT angiography (CTA) and CT Perfusion (CTP) for acute ischemic stroke(AIS), there has been growing concern about Contrast induced nephropathy (CIN). Reduced renal function has been shown to be an independent prognostic factor in cerebrovascular disease and long term mortality. The purpose of this study was to assess the impact of CIN on clinical outcome in AIS patients treated with IV t-PA.

Methods:
We performed a retrospective chart review of our prospectively gathered stroke registry and identified patients who were treated with IV t-PA and underwent a CTA and/or CTP as part of their acute stroke evaluation from 1/07 to 6/11. CIN was defined as rise of Creatinine over baseline by 25% within 3 days of contrast administration. Outcome measure was discharge mRS. We compared outcomes in those with CIN to patients that did not develop CIN. Multivariable logistic regression was built with factors that had p<.2 on univariate analysis. All tests were two-sided and P-values <.05 were considered significant.

Results:
We identified 200 patients meeting our criteria; 10 patients developed CIN. Baseline demographics and risk factors are shown in the
table
. We found that there were statistically significant differences in baseline NIHSS (p= 0.030) and in death at discharge, (p=0.035) between patients who developed CIN and those who did not. CIN was significantly associated with death at discharge after adjustment for NIHSS (odds ratio [OR]= 4.78; 95% CI,1.06-21.46, p=0.04). In addition, patients with NIHSS ≥ 15 were more likely to develop CIN with OR of 5.14 [95% CI 1.28-20.58 (p = 0.02)]. Of note, all of the patients who developed CIN had eGFR ≥ 60.

Conclusion:
Development of CIN after multimodal CT in AIS patients treated with IV t-PA is associated with worse clinical outcomes after adjusting for stroke severity. Patients with NIHSS >15 in our dataset, despite normal renal function, were at risk for CIN. Because of the retrospective nature and small sample size of our study, we might have missed confounding variables that are associated with mortality in patients who developed CIN. However, with the increased use of CTA/P in AIS evaluation, a prospective study is needed to assess the predictors and impact of CIN on clinical outcome in patients treated with IV t-PA.
Abstract 2707: Social Determinants are Associated with Heat Shock Protein-70 in African American and Non-Hispanic White Women with Cardiovascular Disease
Authors: Saban Karen L , DeVon Holli A , Hoppensteadt-Moorman Debra A
Published: March 2022

Background:
African American (AA) women are nearly twice as likely as non-Hispanic White (NHW) women to develop cardiovascular disease (CVD). The additional burden of CVD borne by AA women is attributed to socioeconomic status, psychosocial stress, and greater numbers of risk factors. Compelling evidence demonstrates that inflammatory biomarkers, such as heat shock protein-70 (hsp-70) are associated with CVD risk. Yet, little is known about how social determinants, such as perceived discrimination, subjective social status, and socioeconomic status, contribute to these inflammatory markers in women with CVD.

Purpose:
The purpose of this pilot study was to examine the extent to which social determinants are associated with hsp-70 while controlling for age, race, and body mass index (BMI) in AA and NHW women with CVD.

Methods:
The sample was comprised of 10 AA and 21 NHW (mean age=68.7) undergoing elective percutaneous coronary intervention or carotid endarterectomy. Participants completed the MacArthur Scale of Subjective Social Status ladders for both Community and United States. In addition, the, DASDS-Major Life Discrimination, and sociodemographic survey were completed. A blood sample was collected prior to intervention and was analyzed for hsp-70.

Results:
Lower levels of subjective social status for community (r=-0.52, p=.02) and US (r= -0.43, p=.05) were associated with higher levels of hsp-70 controlling for age, race, and BMI. Further, greater reported frequency of major life discrimination (r=.520, p=.02) were related to elevated levels of hsp-70 adjusting for age, race, and BMI.

Conclusions:
Results indicate that social determinants, in particular subjective social status and perceived discrimination, are associated with the inflammatory biomarker, hsp-70. Our findings support the importance of social mediators in the inflammatory cascade. Although longitudinal studies with larger samples sizes are required to confirm these results, findings imply that social determinants, which may be amenable to nursing intervention, play a more important role in predicting inflammatory markers of CVD than race.
Abstract 2719: The Impact of Insurance Status on Post-Acute Care among Working Age Stroke Survivors
Authors: Skolarus Lesli E , Meurer William J , Burke James F , Prvu Bettger Janet , Lisabeth Lynda D
Published: March 2022

Background and Purpose:
Utilization of post-stroke rehabilitation is associated with improved functional outcomes. However, more than 20% of American adults under 65 are uninsured potentially leading to disparate utilization of post-acute care services. We sought to determine whether insurance status is associated with utilization and intensity of institutional post-acute care among working age stroke survivors.

Methods:
A retrospective cross-sectional study of ischemic stroke survivors under the age of 65 (n=33,917) from the 2004-2006 Nationwide Inpatient Sample (NIS) was conducted. Stroke survivors were categorized based on their insurance status as:1) private insurance; 2) Medicaid; 3) no insurance. Using hierarchical logistic regression models, we explored the association of insurance status and utilization of any institutional post-acute care (inpatient rehabilitation facility (IRF) or skilled nurse facility (SNF)) versus home. We then explored the association of insurance status and intensity of rehabilitation (IRF vs SNF) among those who utilized any institutional post-acute care. All models were controlled for patient factors including age, gender, comorbidities, length of stay, thrombolysis and hospital level factors including size, location, teaching status, region of the country, annual stroke discharges, annual stroke mortality and hospital uninsured.

Results:
Nineteen percent of the study population was uninsured while 20% were Medicaid enrollees. Median age of stroke survivors with private insurance was 56 (IQR 49-60) while that of the uninsured was 53 (IQR 47-59) and stroke survivors with Medicaid was 54 (IQR 47-60). Compared to those privately insured, uninsured stroke survivors were less likely to utilize any institutional post-acute care (adjusted OR=0.53, 95%CI 0.47-0.59). Conversely, stroke survivors with Medicaid were more likely to utilize any institutional post-acute care (adjusted OR=1.40, 95%CI 1.27-1.54) than privately insured stroke survivors. Among stroke survivors who utilized institutional post-acute care, uninsured (adjusted OR=0.48, 95%CI 0.36-0.64) and Medicaid stroke survivors (adjusted OR=0.27 95%CI 0.23-0.33) were less likely to utilize an IRF than a SNF compared to privately insured stroke survivors.

Conclusion:
The results suggest differences in utilization and intensity of institutional post-acute care for working age stroke survivors based on their insurance status. These findings are interesting in light of the Patient Protection and Affordable Care Act which will result in millions of uninsured individuals transitioning to Medicaid. On one hand our results suggest that this healthcare reform will result in increased utilization of institutional post-acute care among stroke survivors but on the other hand our results suggest that this rehabilitation may be less intense than if they were privately insured.
Abstract 2724: Comparison Of Hypertensive And Non-hypertensive Lacunar Infarcts
Authors: Park Jong-Moo , Kang Kyusik , Park Tai Hwan , Lee Kyung Bok , Koo Ja-Seong , Lee Soo Joo , Ko Youngchai , Cho Yong-Jin , Cha Jae-Kwan , Lee Jun , Yu Kyung-ho , Lee Byung-Chul , Lee Jisung , Lee Juneyoung , Han Moon-Ku , Bae Hee-Joon
Published: March 2022

Background:
Hypertension and arteriolosclerosis in perforating arteries are the most common hypothetical pathogenesis in lacunar infarcts so far. Few studies on non-hypertensives have been inconsistent, partly because of unavoidable misclassification of lacunar infarcts. Using a DWI MRI-based stroke classification algorithm, we aimed to compare the clinical and laboratory characteristics of patients with lacunar infarction by the presence of hypertension.

Methods:
A consecutive series of patients, who were hospitalized due to acute ischemic stroke to 9 centers that were participating in the ‘Clinical Research Center for Stroke’ program funded by the Korean government, were registered prospectively between April 2008 and March 2010. Lacunar infarct was defined as a single DWI lesion less than 2cm in perforator territories without relevant artery steno-occlusion or cardiac embolic sources. Correlates of nonhypertensive lacunar infarction were obtained by multiple logistic regression analysis.

Results:
Among 6696 stroke patients, 1340 (20.0%) showed lacunar infarcts. Lacunar infarct patients without hypertension showed less frequent diabetes mellitus, hyperlipidemia, previous stroke history, ischemic heart disease, prior use of antiplatelets, and prior use of statin than hypertensive patients with lacunar infarct. Body mass index, plasma glucose, and serum creatinine level were also lower, while smoking and HDL level were higher in non-hypertensive patients. Initial NIHSS score and the frequency of early neurological deterioration (NIHSS score increase 1 point or higher on discharge than initial) and good outcome (3month mRS ≤ 1) were not different in two groups. After multivariable analysis, age (odds ratio 0.987, 95% CI 0.977 to 0.998), diabetes (OR 0.665, 95% CI 0.487 to 0.907), stroke history (OR 0.512, 95% CI 0.358 to 0.733), and BMI (OR 0.899, 95% CI 0.862 to 0.938) seemed to be independent factors associated with lacunar infarct in nonhypertensives compared to lacunar infarction in hypertensives.

Conclusion:
This study shows that non-hypertensives with lacunar stroke seem to be younger, and have less frequent diabetes and stroke history, and lower BMI than hypertensives with lacunar stroke. Stroke severity and outcome were not different in lacunar infarct patients with or without hypertension.
Abstract 2756: Carotid Plaque Inflammation On
18
F-Fluorodeoxyglucose Positron Emission Tomography Predicts Early Stroke Recurrence- The Dublin Carotid Atherosclerosis Stroke Study
Authors: Marnane Michael , Merwick Aine , Sheehan Orla C , Hannon Niamh , Foran Paul , Grant Tim , Dolan Eamon , Moroney Joan , Murphy Sean , O'Rourke Killian , O'Malley Kevin , O'Donohoe Martin , McDonnell Ciaran , Noone Imelda , Barry Mary , Crowe Morgan , Kavanagh Eoin , O'Connell Martin , Kelly Peter J
Published: March 2022

Background
Symptomatic carotid stenosis is associated with a 3-fold risk of early stroke recurrence compared to other stroke subtypes. Current carotid imaging techniques rely on estimating plaque-related lumen narrowing but do not evaluate intra-plaque inflammation, a key mediator of plaque rupture and thromboembolism. Using combined
18
F-fluorodeoxyglucose positron emission tomography/CT (FDG-PET/CT) we investigated the relationship between inflammation-related FDG uptake and stroke recurrence.

Methods
Consecutive patients with a recent (median 6.5 days [IQR 4-8]) stroke, TIA, or retinal embolism and ipsilateral carotid stenosis ( ≥50%) were included. FDG uptake was quantified as mean standardised uptake values (SUV, g/ml). Patients were followed prospectively for stroke recurrence.

Results
60 patients were included (25 stroke, 29 TIA, 6 retinal embolism). 22% (13/60) had stroke recurrence within 90 days. FDG uptake in ipsilateral carotid plaque was greater in patients with early recurrent stroke (mean SUV 1.85 [SD 0.44] vs. 1.58 [SD 0.32] g/ml, p=0.02). On life-table analysis, 90-day recurrence rates with mean SUV greater than a 2.14g/ml threshold were 80% (CI 41.8-99.2%) versus 22.9% (CI 12.3-40.3%) with SUV ≤2.14g/ml (log-rank p<0.0001). In a Cox regression model including age and degree of stenosis (50-69% or ≥70%), mean plaque FDG uptake was the only independent predictor of stroke recurrence (adjusted hazard ratio 6.1, CI 1.3-28.8, p=0.02).

Conclusion
In recently-symptomatic carotid stenosis, inflammation-related FDG uptake was associated with early stroke recurrence, independent of the degree of stenosis. Plaque FDG-PET may identify patients at highest risk for stroke recurrence, who may be selected for immediate revascularisation or intensive medical treatment.
Abstract 2768: Comparison of Arterial Spin Labeling with Perfusion-weighted Imaging for Defining Perfusion-Diffusion Mismatch in Stroke Patients
Authors: Zaharchuk Greg , El-Mogy Ibraheem S , Albers Gregory W
Published: March 2022

Background:
Reperfusion in stroke patients with a perfusion-diffusion (PWI-DWI) mismatch leads to better clinical outcomes (
1
). Because some patients cannot receive gadolinium contrast agents, we examined whether the ASL-DWI mismatch was equivalent to the PWI-DWI mismatch in patients with acute ischemia.

Methods:
We retrospectively analyzed all patients scanned at a single institution during 2010 who met the following criteria: technically adequate DWI, ASL, and PWI images; >10 ml lesion on ADC maps; onset of symptoms within 5 days; scanned at 1.5T. Automated software (RAPID) (
2
) was used to determine the volume of the DWI and PWI lesions and to classify into one of three categories using revised DEFUSE criteria (
3
): mismatch (PWI>1.8 DWI lesion size and >10 ml absolute difference), matched (1.8 DWI>PWI>0.7 DWI lesion size or <10 ml), and reperfused (PWI<0.7 DWI lesion size and >10 ml). This was considered the gold standard read. ASL-DWI status was determined using visual observation by two radiologists blinded to clinical data and each other’s reading. After this, a consensus was determined. Agreement between the two radiologists for ASL-DWI mismatch status and for consensus ASL-DWI versus PWI-DWI status was measured using kappa statistics.

Results:
44 studies in 43 patients met the above criteria, and had the following demographic and imaging features: mean age 59±16 yrs; 22 men, mean DWI lesion size 66±56 ml (range: 10-243 ml), mean PWI Tmax>6 sec lesion size 64±64 ml (range 0-219 ml), time from last seen normal 37±24 hrs (range 2-111 hrs). Agreement between the two readers for rating the ASL-DWI mismatch was excellent (unweighted kappa 0.92 [95% CI 0.80-1.0]). Agreement between categorization of the two modalities (consensus ASL-DWI and gold-standard PWI-DWI) was moderate (unweighted kappa 0.35 [95% CI: 0.13-0.57]). Exact agreement was present in 57% of cases (25/44). Most of the time, when there was disagreement, ASL tended to overestimate the size of the perfusion lesion compared with PWI Tmax. If the groups are dichotomized between mismatch and either matched or reperfusion, the sensitivity and specificity of ASL-DWI mismatch classification is 63% and 81%, respectively. If ASL-DWI does not show a mismatch, it is almost always correct (29/32 cases, NPV 91%). If ASL-DWI does show a mismatch, a PWI-DWI mismatch is present about half the time (5/12, PPV 42%).

Conclusion:
For the purposes of treatment, ASL-DWI mismatch classification using qualitative visual observation generally agrees with PWI-DWI mismatch status using Tmax>6 sec. Disagreements were typically related to ASL overestimation of the PWI lesion size. Although promising, improved methodology may be required before ASL can be used routinely in acute stroke trials.
Abstract 2777: Delayed Cerebral Infarction after Aneurysmal Subarachnoid Hemorrhage is Predictive of Neurological and Cognitive Outcomes, but not Quality of Life Outcomes
Authors: Wong George K ,   Cognitive Dysfunction after Aneurysm SubarachnoidHaemorrhage Investigators
Published: March 2022

Background and purpose:
In an attempt to resolve the inconsistency of results in aneurysmal subarachnoid hemorrhage clinical trials to reduce delayed cerebral ischemia and improve clinical outcome, an international panel has suggested future clinical trials to target the surrogate outcome of delayed cerebral infarction (dCI), based on studies on the prognostic value of dCI in neurological outcome. Few studies examined the prognostic values of dCI in cognitive and quality of life outcomes, which were considered to be more sensitive to the long term burden.

Methods:
Episode and 3-month outcome data of a 4-center Hong Kong prospective observational study are analyzed. dCI is defined as new cerebral infarction identified on computed tomography after exclusion of procedure-related infarctions. Delayed ischemic neurological deficit (DIND) is defined as clinical deterioration presumably caused by delayed cerebral ischemia after exclusion of other potential causes of clinical deterioration. Outcomes include modified Rankin Scale, Lawton Instrumental Activity of Daily Living, in-patient mortality, Montreal Cognitive Assessment, Mini-Mental State Examination, Stroke-specific Quality of Life Scale, Short Form-36. Relationships of delayed cerebral infarction or delayed ischemic neurological deficit with outcomes are examined using nonparametric Kendall’s rank correlation (tau). The study is registered in ClinicalTrials.gov, U.S. National Institute of Health (
NCT01038193
).

Results:
One hundred and fifty-eight patients are included in the current study. Age (mean+/-SD) are 54+/-11 years. Admission WFNS grade is I to II, III to IV, and V in 68%, 18%, and 14% of patients respectively. Fisher CT grade is III in 47% of patients while intraventricular hemorrhage and/or intracerebral hematoma are present in 52% of patients. dCI and/or DIND are present in 26% of patients. dCI is significantly correlated with modified Rankin Scale, in-patient mortality, Montreal Cognitive Assessment, and Mini-Mental State Examination, but not Stroke-specific Quality of Life Scale and Short Form-36. Presence of DIND is significantly correlated with modified Rankin Scale and Lawton Instrumental Activity of Daily Living, but not with cognitive and quality of life outcomes.

Conclusion:
Delayed cerebral infarction can act as surrogate outcome for both neurological and cognitive outcomes. However, the lack of correlations to both generic and disease-specific quality of life measures suggest that some significant outcome determinants of aneurysmal subarachnoid hemorrhage, such as neuropsychiatric outcomes, cannot be captured by dCI alone and should be further investigated. Moreover, delayed cerebral infarction after aneurysmal subarachnoid hemorrhage and ischemic stroke may carry different pathophysiological meanings.
Abstract 2802: Age and Stroke Severity Influence the Association between Blood Pressure Variability and Stroke Recovery
Authors: Bhattacharya Pratik , Arul Shankar , Rukmangadachar Lokesh , Vikraman Sundeep , Shankar Lakshmi , Chaturvedi Seemant , Madhavan Ramesh
Published: March 2022

Blood pressure elevations after ischemic stroke are regarded as the body's response to maintain cerebral perfusion. Extremes of blood pressure have correlated with poor stroke recovery. Recently, blood pressure variability was shown to predict outcome better than mean blood pressures. Variables such as age, National Institute of Health stroke scale (NIHSS) and diabetes are established predictors of poor outcome and may potentially affect the degree of blood pressure variability. Our hypothesis was that age, NIHSS and diabetes would influence the association between blood pressure variability and stroke recovery.

Methods:
a retrospective chart review of consecutive patients discharged with an acute ischemic stroke based on ICD-9 codes was conducted. Successive blood pressure recordings during the 1st 5 days of hospitalization were noted. Blood pressure variability was calculated for systolic, diastolic and mean arterial pressures separately using published methods. Demographics, comorbidities, and modified Rankin score (mRS) at discharge were abstracted.

Results:
The study included 295 stroke patients, (median age 60 years; median NIHSS of 4.0). Age >60, NIHSS 4-9, NIHSS ≥ 10 and diabetes were associated with poor recovery (mRS 3-6). The mean pressures in the study group ranged from 105-195 mmHg for systolic blood pressure (SBP), 51-159 mm Hg for diastolic blood pressure and 70-163 mm Hg for mean arterial pressure. The median variability for SBP was 21.0mmHg; diastolic blood pressure was 12.7mmHg; mean arterial pressure was 13.6mmHg. Subjects with higher SBP variability (greater than the median of 21.0) had significantly higher rates of poor recovery. Stratifying by age, the association of SBP variability and poor outcome was significant for age > 60(OR: 2.16; 95%CI 1.06-4.38) but not for the younger subgroup with age≤ 60. Stratifying by stroke severity, the association of SBP variability and poor recovery was significant for NIHSS 4-9 (OR 3.41; 95%CI 1.55-8.23). All patients with high SBP variability in the NIHSS ≥ 10 group had poor recovery. The association was also significant in the subgroup without diabetes (OR 1.97; 95%CI 1.10-3.51), not in the subgroup of diabetic patients. Overall, the odds of a poor recovery due to high SBP variability were highest among subjects > 60 years with moderate to high NIHSS.

Conclusions:
SBP variability in acute ischemic stroke is especially harmful among the elderly, nondiabetic and the more severe strokes. Extreme caution is advised when prescribing blood pressure lowering medications in these subgroups.
Abstract 2813: Acute Tele-Stroke-Service by Stroke Neurologists: Reliability of Clinically Relevant CT-Findings
Authors: Bodechtel Ulf , Puetz Volker , Dzialowski Imanuel , Gerber Johannes , Schimmel Eik , Schneider Hauke , Wolz Martin , von Kummer Ruediger
Published: March 2022

Background:
The Stroke East Saxony Network (SOS-NET) provides tele-consultations for acute stroke patients presenting to local hospitals in eastern Saxony, Germany. Experienced stroke neurologists perform tele-consultations 24/7. They take a clinical history, perform a video examination and a standardized evaluation of acute cerebral CT including Alberta Stroke Program Early CT Score (ASPECTS) before suggesting further management. We assessed the diagnostic accuracy and clinical impact of CT evaluation by stroke neurologists in this acute tele-stroke-service.

Methods:
To assess the diagnostic accuracy of stroke neurologists in CT-interpretation, two experienced neuroradiologists re-evaluated all CT scans of tele-consultations in 2009 blinded to clinical findings. We defined discrepant findings as deviations in the ASPECTS >1 or if differential diagnoses like tumor or intracranial hemorrhage (ICH) were not detected by the stroke neurologists. To assess the clinical impact, all discrepant results were subsequently discussed and re-evaluated of all involved neurologists and neuroradiologists regarding its possible influence on therapeutic decisions and on patients’ outcome.

Results:
In 2009, we performed 583 tele-consultations (353 ischemic strokes, 119 primary ICH and 111 stroke mimics). In 102 patients with ischemic stroke (29%) thrombolysis was performed with eight bleeding complications (7.8%). The neuroradiologists detected discrepant findings in 44 CT scans (7.5%), however corrected, their image interpretation if unblinded to the clinical information in four patients. We regarded the diagnostic inaccuracy by neurologist as clinically relevant in nine patients (1.5%). In one patient, the stroke neurologist missed a small chronic subdural hematoma. The patient did not receive thrombolysis because of mild clinical findings. Consequently, the false diagnosis did not affect treatment and clinical outcome in this patient. Furthermore, stroke neurologists missed extensive early ischemic changes in the middle cerebral artery territory in eight patients and recommended thrombolytic therapy. We observed symptomatic ICH in five of these patients (62.5%; 0.9% of the total cohort).

Conclusion:
Trained stroke neurologists had a high diagnostic accuracy in CT interpretation in acute tele-stroke-service, compared to experienced neuroradiologists. Clinically relevant misinterpretations of the CT scans were rare (1.5%). However, regarding the potential risk of thrombolytics, stroke neurologists should continuously be trained in interpreting CT scans of acute stroke patients.