Sex Differences in Outcomes of Acute Myocardial Injury After Stroke.

BACKGROUND: Sex differences in presentation, treatment, and prognosis of cardiovascular disorders are well recognized. Although an association between acute myocardial injury and mortality after ischemic stroke has been demonstrated, it is unclear whether prevalence and outcome of poststroke acute myocardial injury differ between women and men. METHODS AND RESULTS: We prospectively screened consecutive patients with acute ischemic stroke and serial high-sensitivity cardiac troponin T measurements admitted to our center. Acute myocardial injury was defined as at least 1 high-sensitivity cardiac troponin T value above the upper reference limit (14 ng/L) with a rise/fall of >20%. Rates of acute myocardial injury were also calculated using sex-specific high-sensitivity cardiac troponin T cutoffs (women upper reference limit, 9 ng/L; men upper reference limit, 16 ng/L). Logistic regression analyses were performed to evaluate the association between acute myocardial injury and outcomes. Of 1067 patients included, 494 were women (46%). Women were older, had a higher rate of known atrial fibrillation, were more likely to be functionally dependent before admission, had higher stroke severity, and more often had cardioembolic strokes (all P values <0.05). The crude prevalence of acute myocardial injury differed by sex (29% women versus 23% men, P=0.024). Statistically significant associations between acute myocardial injury and outcomes were observed in women (7-day in-hospital mortality: adjusted odds ratio [aOR], 3.2 [95% CI, 1.07-9.3]; in-hospital mortality: aOR, 3.3 [95% CI, 1.4-7.6]; modified Rankin Scale score at discharge: aOR, 1.6 [95% CI, 1.1-2.4]) but not in men. The implementation of sex-specific cutoffs did not increase the prognostic value of acute myocardial injury for unfavorable outcomes. CONCLUSIONS: The prevalence of acute myocardial injury after ischemic stroke and its association with mortality and greater disability might be sex-dependent. REGISTRATION: URL: https://www.clinicaltrials.gov; Unique identifier: NCT03892226.

Frequency, associated variables, and outcomes of acute myocardial injury according to the fourth Universal Definition of Myocardial Infarction in patients with acute ischemic stroke.

Background: Myocardial injury as indicated by elevation of cardiac troponin levels is common after acute ischemic stroke (AIS) and linked to poor outcomes. Previous studies rarely reported on serial hs-cTn measurements to distinguish whether myocardial injury is acute or chronic. Thus, little is known about frequency, associated variables, and outcome of acute myocardial injury in AIS. Methods and patients: In this single-centered observational cohort study, from 01/2019 to 12/2020, consecutive patients with neuroimaging-confirmed AIS <48 h after symptom onset, and serial troponin measurements within the first 2 days after admission (Roche Elecsys®, hs-cardiac troponin T) were prospectively registered. Acute myocardial injury was defined according to the fourth Universal Definition of Myocardial Infarction (troponin above the upper reference limit and rise/fall>20%). Outcomes of interest were in-hospital mortality and unfavorable functional status at discharge (modified Rankin Scale >1). Results: Out of 1067 analyzed patients, 25.3% had acute myocardial injury, 40.4% had chronic myocardial injury and 34.3% had no myocardial injury. Older age, higher stroke severity, thrombolytic treatment, and impaired kidney function were independently associated with acute myocardial injury. In-hospital mortality was higher in patients with acute myocardial injury than in those without (13% vs 3%, adjusted OR, 2.9% [95% CI, 1.6-5.5]). Compared with no myocardial injury, both acute and chronic myocardial injury were associated with unfavorable functional status at discharge (adjusted OR, 1.6 [95% CI, 1.1-2.5] and OR, 1.7 [95% CI, 1.2-2.4], respectively). Conclusions: A quarter of patients with AIS have evidence of acute myocardial injury according to the fourth Universal Definition of Myocardial Infarction. The strong association with in-hospital mortality highlights the need for clinical awareness and future studies on underlying mechanisms.

Sub-10 nm Silicon Nanopillar Fabrication Using Fast and Brushless Thermal Assembly of PS-b-PDMS Diblock Copolymer.

A new approach to obtaining spherical nanodomains using polystyrene-block-polydimethylsiloxane (PS-b-PDMS) is proposed. To reduce drastically the process time, we blended a copolymer with cylindrical morphology with a PS homopolymer. Adding PS homopolymer into a low-molar-mass cylindrical morphology PS-b-PDMS system drives it toward a spherical morphology. Besides, by controlling the as-spun state, spherical PDMS nanodomains could be kept and thermally arranged. This PS-homopolymer addition allows not only an efficient, purely thermal arrangement process of spheres but also the ability to work directly on nontreated silicon substrates. Indeed, as shown by STEM measurements, no PS brush surface treatment was necessary in our study to avoid a PDMS wetting layer at the interface with the Si substrate. Our approach was compared to a sphere-forming diblock copolymer, which needs a longer thermal annealing. Furthermore, GISAXS measurements provided complete information on PDMS sphere features. Excellent long-range order spherical microdomains were therefore produced on flat surfaces and inside graphoepitaxy trenches with a period of 21 nm, as were in-plane spheres with a diameter of 8 nm with a 15 min thermal annealing. Finally, direct plasma-etching transfer into the silicon substrate was demonstrated, and 20 nm high silicon nanopillars were obtained, which are very promising results for various nanopatterning applications.

Pulsed transfer etching of PS-PDMS block copolymers self-assembled in 193 nm lithography stacks.

This work presents the graphoepitaxy of high-χ block copolymers (BCP) in standard industry-like lithography stacks and their transfer into the silicon substrate The process includes conventional 193 nm photolithography, directed self-assembly of polystyrene-block-polydimethylsiloxane (PS-b-PDMS) and pulsed plasma etching to transfer the obtained features into the substrate. PS-b-PDMS has a high Flory-Huggins interaction parameter (high-χ) and is capable of achieving sub-10 nm feature sizes. The photolithography stack is fabricated on 300 mm diameter silicon wafers and is composed of three layers: spin-on-carbon (SoC), silicon-containing anti-reflective coating (SiARC) and 193 nm photolithography resist. Sixty-nanometer-deep trenches are first patterned by plasma etching in the SiARC/SoC stack using the resist mask. The PS-b-PDMS is then spread on the substrate surface. Directed self-assembly (DSA) of the BCP is induced by a solvent vapor annealing process and PDMS cylinders parallel to the substrate surface are obtained. The surface chemistry based on SoC permits an efficient etching process into the underlying silicon substrate. The etching process is performed under dedicated pulsed plasma etching conditions. Fifteen nanometer half-pitch dense line/space features are obtained with a height up to 90 nm.