A new machine learning model to predict the prognosis of cardiogenic brain infarction.

Cardiogenic cerebral infarction (CCI) is a disease in which the blood supply to the blood vessels in the brain is insufficient due to atherosclerosis or stenosis of the coronary arteries in the patient's heart, which leads to neurological deficits. To predict the pathogenic factors of cardiogenic cerebral infarction, this paper proposes a machine learning based analytical prediction model. 494 patients with CCI who were hospitalized for the first time were consecutively included in the study between January 2017 and December 2021, and followed up every three months for one year after hospital discharge. Clinical, laboratory and imaging data were collected, and predictors associated with relapse and death in CCI patients at six months and one year after discharge were analyzed using univariate and multivariate logistic regression methods, meanwhile established a new machine learning model based on the enhanced moth-flame optimization (FTSAMFO) and the fuzzy K-nearest neighbor (FKNN), called BITSAMFO-FKNN, which is practiced on the dataset related to patients with CCI. Specifically, this paper proposes the spatial transformation strategy to increase the exploitation capability of moth-flame optimization (MFO) and combines it with the tree seed algorithm (TSA) to increase the search capability of MFO. In the benchmark function experiments FTSAMFO beat 5 classical algorithms and 5 recent variants. In the feature selection experiment, ten times ten-fold cross-validation trials showed that the BITSAMFO-FKNN model proved actual medical importance and efficacy, with an accuracy value of 96.61%, sensitivity value of 0.8947, MCC value of 0.9231, and F-Measure of 0.9444. The results of the trial showed that hemorrhagic conversion and lower LVDD/LVSD were independent risk factors for recurrence and death in patients with CCI. The established BITSAMFO-FKNN method is helpful for CCI prognosis and deserves further clinical validation.

Relationship between serum TC,TG,and ox-LDL levels and vulnerable carotid plaque in patients with acute non-cardiogenic cerebral infarction / 中风与神经疾病杂志

@#Objective To investigate the relationship between serum total cholesterol(TC),triglyceride(TG),and oxidized low-density lipoprotein(ox-LDL) levels and vulnerable carotid plaques in patients with acute non-cardiogenic cerebral infarction. Methods According to the stability of carotid plaques,103 patients with acute non-cardiogenic cerebral infarction were divided into stable group(n=61) and vulnerable group(n=42). The basic data and laboratory indicators of the two groups were compared. A multivariable logistic regression analysis was used to determine risk factors for the formation of vulnerable carotid artery plaques. Results Compared with the stable group,the vulnerable group showed significantly higher proportions of diabetes mellitus,hypertension,and hyperlipidemia,significantly higher levels of serum TC,TG,ox-LDL,and low-density lipoprotein cholesterol(LDL-C),and a significantly lower level of serum high-density lipoprotein cholesterol(HDL-C)(all P<0.05). The receiver operating characteristic curve analysis revealed that serum TC,TG,LDL-C,HDL-C,and ox-LDL could all be used to predict the formation of vulnerable carotid plaques in patients with acute non-cardiac cerebral infarction(all P<0.05). The multivariable logistic regression analysis demonstrated that diabetes mellitus,hypertension,hyperlipidemia,TC≥5.455 mmol/L,TG≥1.305 mmol/L,LDL-C≥2.655 mmol/L,HDL-C≤1.230 mmol/L,and ox-LDL≥457.765 μg/L were risk factors for vulnerable carotid plaques in patients with acute non-cardiogenic cerebral infarction(all P<0.05). Conclusion Various factors can drive the formation of vulnerable carotid plaques in patients with acute non-cardiogenic cerebral infarction. TC,TG,and ox-LDL are closely related to vulnerable plaque formation.

Relationship between Neurological Deterioration and Blood Pressure/Heart Rate Variability in Patients with Acute Cerebral Infarction.

OBJECTIVES: Neurological deterioration (ND) during hospitalization is an independent predictor of poor prognosis after stroke. Risk factors affecting early ND within 48 h post stroke have been intensively investigated, while few data are available on those for late ND after transfer to a wheelchair. Therefore, it was investigated whether hemodynamic factors may affect the late ND during hospitalization. MATERIALS AND METHODS: A retrospective study was conducted on 135 patients with atherothrombotic or cardiogenic cerebral infarction who were admitted to our hospital between April 1st, 2014 and July 31st, 2017. During hospitalization, average, maximum, and minimum values were determined for systolic blood pressure (sBP), diastolic BP (dBP), and heart rate (HR), respectively.135 patients were classified into two groups; ND (+) group, in which modified Barthel index score at the time of transfer to a wheelchair showed five points or more decrease between wheelchair transfer and discharge, and ND (-) group, which did not. Vital indices were compared between the two groups and subjected to ROC-curve analysis. RESULTS: The ND (+) group included 32 patients, and the ND (-) 103. Significant differences were found between the groups in four items; sBPmin (p = 0.029), dBPmin (p = 0.019), HRave (p = 0.028), and HRmax (p < 0.01). The ND (+) group showed lower sBPmin and dBPmin, and higher HRave and HRmax than the ND (-) group. CONCLUSIONS: Late ND after transfer to a wheelchair is related to the vital indices during hospitalization and should be cautiously managed to prevent late ND.

Bridging therapy and direct mechanical thrombectomy in the treatment of cardiogenic cerebral infarction with anterior circulation macrovascular occlusion.

BACKGROUND: Intravenous thrombolysis is an important treatment for cerebral infarction. However, it is difficult to achieve good results if the patient is complicated with anterior circulation macrovascular occlusion. In addition, the vascular recanalization rate is low, so mechanical thrombectomy, that is, bridging therapy, is needed. AIM: To investigate the efficacy and safety of bridging therapy and direct mechanical thrombectomy in the treatment of cardiogenic cerebral infarction with anterior circulation macrovascular occlusion. METHODS: Ninety-six patients in our hospital with cardiogenic cerebral infarction with anterior circulation macrovascular occlusion from January 2017 to July 2020 were divided into a direct thrombectomy group (n = 48) and a bridging group (n = 48). Direct mechanical thrombectomy was performed in the direct thrombectomy group, and bridging therapy was used in the bridging treatment group. Comparisons were performed for the treatment data of the two groups (from admission to imaging examination, from admission to arterial puncture, from arterial puncture to vascular recanalization, and from admission to vascular recanalization), vascular recanalization rate, National Institutes of Health Stroke Scale (NIHSS) and Glasgow Coma Scale (GCS) scores before and after treatment, prognosis and incidence of adverse events. RESULTS: In the direct thrombectomy group, the time from admission to imaging examination was 24.32 ± 8.61 min, from admission to arterial puncture was 95.56 ± 37.55 min, from arterial puncture to vascular recanalization was 54.29 ± 21.38 min, and from admission to revascularization was 156.88 ± 45.51 min, and the corresponding times in the bridging treatment group were 25.38 ± 9.33 min, 100.45 ± 39.30 min, 58.14 ± 25.56 min, and 161.23 ± 51.15 min; there were no significant differences between groups (P=0.564, 0.535, 0.426, and 0.661, respectively). There was no significant difference in the recanalization rate between the direct thrombectomy group (79.17%) and the bridging group (75.00%) (P = 0.627). There were no significant differences between the direct thrombectomy group (16.69 ± 4.91 and 12.12 ± 2.07) and the bridging group (7.13 ± 1.23 and (14.40 ± 0.59) in preoperative NIHSS score and GCS score (P = 0.200 and 0.203, respectively). After the operation, the NIHSS scores in both groups were lower than those before the operation, and the GCS scores were higher than those before the operation. There was no significant difference in NIHSS and GCS scores between the direct thrombectomy group (6.91 ± 1.10 and 14.19 ± 0.65) and the bridging group (7.13 ± 1.23 and 14.40 ± 0.59) (P = 0.358 and 0.101, respectively). There was no significant difference in the proportion of patients who achieved a good prognosis between the direct thrombectomy group (52.08%) and the bridging group (50.008%) (P = 0.838). There was no significant difference in the incidence of adverse events between the direct thrombectomy group (6.25%) and the bridging group (8.33%) (P = 0.913). CONCLUSION: Bridging therapy and direct mechanical thrombectomy can safely treat cardiogenic cerebral infarction with anterior circulation macrovascular occlusion, achieve good vascular recanalization effects and prognoses, and improve the neurological function of patients.

The effect of rosuvastatin on cardiogenic cerebral infarction.

OBJECTIVE: To investigate the effect of rosuvastatin on cardiogenic cerebral infarction and its related effects on patients' neurological function, lipid levels, inflammatory factor levels, and oxidative stress status. METHODS: 300 patients with cardiogenic cerebral infarction were recruited as the study cohort and randomly divided into an observation group and a control group. Routine treatment, including urinary kallikrein injections and bayaspirin tablets were given to the patients in the control group for one month. Rosuvastatin was given once a day in addition to the treatment the control group received to the patients in the observation group, also for one month. The two groups' treatment efficacies were compared. Also, the two groups' NIHSS and mRS scores, lipid and inflammatory factor levels, and their oxidative stress statuses were also compared. RESULTS: The total effective rate in the observation group was significantly higher than it was in the control group (74.0% vs 84.7%, P=0.023). The NIHSS and mRS scores in the observation group were significantly lower than they were in the control group (all P<0.001). Compared with their levels after the treatment in the control group, the cholesterol (TC), triglyceride (TG), and low-density lipoprotein cholesterol (LDL-C) levels in the observation group were significantly decreased and the high-density lipoprotein cholesterol (HDL-C) was significantly increased (all P<0.001). Moreover, after the treatment, the inflammatory factors, such as the tumor necrosis factor-alpha (TNF-α) and C-reactive protein (CRP) levels, and the oxidative stress status, such as the oxidatively modified low density lipoprotein (ox-LDL) levels, were significantly lower than they were in the control group, but the superoxide dimutase (SOD) levels were significantly higher. CONCLUSIONS: Rosuvastatin remarkably improves the treatment efficacy and neurological function in cardiogenic cerebral infarction patients, and is associated with the improvement of the lipid levels, the inflammatory response, and the oxidative stress status.

Motor Function and Activities of Daily Living Recovery after Cardiogenic Internal Carotid Artery Infarction: A Retrospective Cohort study.

OBJECTIVES: this study determines recovery in physical activity and activities of daily living in the early stages after cardiogenic internal carotid artery infarction. MATERIALS AND METHODS: this retrospective comfort study compares assessment data for 334 patients: 150 patients had atherosclerotic infarction (67 internal carotid artery, 87 middle cerebral artery) and 180 had cardiogenic infarction (32 internal carotid artery infarction, 148 middle cerebral artery). We used Brunnstrom recovery score, posture assessment scale for stroke, and functional independence measure. RESULTS: on initial assessment, median Brunnstrom recovery for the cardiogenic internal carotid artery infarction group was I-II in the upper limb, I in the finger, I-II in the lower limb, and IV or higher in all other groups. The median Postural Assessment Scale for Stroke score for the cardiogenic internal carotid artery infarction group was 0; all other groups scored 14 or higher. The median Functional Independence Measure for the cardiogenic internal carotid artery infarction group was 18 (maximum of 100) and the median score for other infarct groups was 25-50 (maximum 126), with P < .01. After a month, final assessment results for the cardiogenic internal carotid artery infarction group were much lower than for the other groups. Only both internal carotid artery infarctions were compared. Atherosclerotic infarctions showed recovery across assessments, except understanding, onset, and memory (P < .01), and cardiogenic infarctions did not change from the initial assessment in all criteria assessed. CONCLUSIONS: adapting cardiogenic internal carotid artery infarction as a stroke recovery model is difficult.

A Case of Cardiogenic Cerebral Infarction after Repair of the Post-Myocardial Infarction Ventricular Septal Perforation / 日本心臓血管外科学会雑誌

Post-myocardial infarction ventricular septal perforation (VSP) is one of the lethal complications of transmural myocardial infarction. Although the treatment of VSP mostly requires surgical procedures using heterologous pericardium, thromboembolism rarely occurs in patients who undergo VSP repair. Herein we report the case of a patient who died of sudden massive cerebral infarction two weeks after the surgery. The autopsy findings revealed concaved mural LV thrombus in the dissected heart. It is suspected that the patient died of extensive cerebral infarction due to thromboembolic occlusion of the carotid or central cerebral artery. In the postoperative period after VSP repair, several risk factors for thrombus formation may occur, such as postoperative hypercoagulability due to systemic inflammation by the high operative invasiveness, the presence of foreign material in the impaired left ventricle, or pericardial patch suturing methods. Our clinical experience indicates that meticulous postoperative management may be needed, keeping LV thrombus formation in mind after VSP repair.

Risk factors and localization of silent cerebral infarction in patients with atrial fibrillation.

BACKGROUND: It is important to identify the risk factors and localization of silent cerebral infarction (SCI), especially in younger patients with atrial fibrillation (AF). OBJECTIVE: The purpose of this study was to examine the characteristics and risk factors for SCI in AF patients, with particular attention to localization of SCI. METHODS: The study enrolled 286 consecutive neurologically asymptomatic patients who underwent AF ablation from January 2014 to July 2017 (age 61.7 ± 10.2 [SD] years; 208 male and 78 female). All patients underwent magnetic resonance imaging (MRI) before ablation. RESULTS: SCIs were classified independently by 2 radiologists as follows: cardiogenic SCI in 19 (10.6%), lacunar SCI in 13 (8.9%), undetermined causes in 6 (1.6%), and no SCI in 248 (controls, 78.7%). Importantly, no patients with CHA2DS2-VASc score 0 had SCI on MRI. In univariable analysis, significant risk factors for lacunar SCI included age (P = .007), hypertension (P = .037), congestive heart failure (P = .040), left atrial (LA) diameter (P = .013), and cardio-ankle vascular index (P = .004). In multivariable analysis, significant risk factors for cardiogenic SCI were AF duration (odds ratio [OR] 1.01; 95% confidence interval [CI] 1.00-1.02; P = .038), ankle-brachial pressure index (OR 0.002; 95% CI 0-0.68; P = .030), and LA abnormality (OR 8.99; 95% CI 2.78-31.00; P <.001), defined by the presence of spontaneous echo contrast and/or decreased LA appendage emptying velocity. CONCLUSION: The study results indicate that among AF patients, SCIs localized in the cerebral cortex and cerebellum are frequently noted, for which cardiogenic mechanisms may be mainly involved; CHA2DS2-VASc score could be useful for screening SCI; and LA abnormality is the specific marker for cardiogenic SCI, providing useful information for risk stratification of SCI.

A case of recanalization of innominate artery and right middle cerebral artery embolism due to cardiogenic cerebral infarction with anticoagulation therapy.

An 80-year-old woman had an aortic valve replacement 1 month before admission and took warfarin for transient atrial fibrillation. She developed a disturbance of consciousness and left hemiplegia. On admission, the right radial artery was slightly palpable. Head MRI images showed a hyper-intense area in the right middle cerebral artery territory. MRA images showed an occlusion of the right M1 distal site and decreased signal at the right internal carotid artery. Contrast CT images of the ascending aorta showed an embolus in the innominate artery. She was diagnosed with an innominate artery saddle embolus and occlusion of the right cerebral artery due to cardiac embolism. She was treated with a heparin infusion and warfarin. She recovered consciousness and from hemiplegia gradually. Recanalization of the innominate artery and right cerebral artery was confirmed. In cases where the radial artery is slightly palpable, it is necessary to consider an innominate artery saddle embolus in addition to aortic dissection.

Cerebral Infarction Arising from Takotsubo Cardiomyopathy: Case Report and Literature Review.

Although most patients with takotsubo cardiomyopathy have a favorable outcome, complications are not uncommon. Recent studies have reported an increase in incidence of cardioembolic complications; however, the association between takotsubo cardiomyopathy and stroke, in particular thromboembolic cerebral infarction, remains unclear. We reported a 44-year-old woman who had a cerebral infarction resulting from takotsubo cardiomyopathy. She had felt chest discomfort a few days prior to infarction, and later developed left hemiparesis. Head magnetic resonance imaging (MRI) revealed acute infarction in the right insular cortex and occlusion of the right middle cerebral artery at the M2 segment. Echocardiogram revealed a takotsubo-like shape in the motion of the left ventricular wall, and coronary angiography showed neither coronary stenosis nor occlusion. Cerebral infarction resulting from takotsubo cardiomyopathy was diagnosed and treatment with anticoagulant was started. MRI on the eighth day after hospitalization showed recanalization of the right middle cerebral artery and no new ischemic lesions. The findings of the 19 previously published cases who had cerebral infarction resulting from takotsubo cardiomyopathy were also reviewed and showed the median interval between takotsubo cardiomyopathy and cerebral infarction was approximately 1 week and cardiac thrombus was detected in 9 of 19 patients. We revealed that thromboembolic events occurred later than other complications of takotsubo cardiomyopathy and longer observation might be required due to possible cardiogenic cerebral infarction. Anticoagulant therapy is recommended for patients with takotsubo cardiomyopathy with cardiac thrombus or a large area of akinetic left ventricle.

Comparative study of intravenous thrombolysis treatment of cardiogenic cerebral infarction and noncardiac cerbral infarction / 实用医学杂志

Objective To compare the efficacy and safety of intravenous thrombolysis on cardiogenic cerebral infarction and noncardiac infarction by recombinant tissue plasminogen activator (rt-PA). Methods Comparations of NIHSS, mRS and adverse events before and after treatment were made between the cardiogenic group and the noncardiac group. Results No significant differences in the NIHSS and mRS were found between the two groups. The incidence of brain hernia and dermatorrhagia in the cardiogenic group was higher than that in the noncardiac group. Conclusion Rt-PA therapy in cardiogenic cerebral infarction was effective and safe in spite of higher incidence of hemorrhage and brain hernia.

A retrospective study on patients with stroke and non-rheumatic atrial fibrillation treated with anticoagulation / 中国综合临床

Objective To investigate the current statues of anticoagulation therapy for ischemic stroke patients with atrial fibrillation(AF) and compared the difference with guidelines.Methods Three hundred and fifty-eight patients with cerebral infarction and atrial fibrillation in Xinhua Hospital Affiliated to Shanghai Jiaotong University from Jan.2008 to Jun.2012 were selected as our subjects.The data related to the antithrombotic therapy were collected and analyzed.Results Among patients with ischemic stroke,the rate of preexisting AF was 70.9％ (254/358),and warfarin taken rate was 4.3％ (11/254) before stroke onset.Of warfarin taken patients,INR were less than 1.5.Of all out hospitalized patients,20.9％ (68/326) were treated with warfarin therapy.There were the negative correlation between warfarin usage and HAS-BLED score,MRS score,antiplatelet drugs (OR =-1.974,-0.725,-4.170,P ＜ 0.05 or P ＜ 0.01).Among patients with warfarin usage in hospital,33.8％ of subjects (23/68) still remain on warfarin even out of hospital.The medium dosage was 2.5 mg (1.25-3.75 mg),and INR was controlled at ranged of 1.5-3.1.Periods of warfarin therapeutic range (TTR) was (61.6 ± 21.2)％.Conclusion The anticoagulation treatment rate and INR were lower in patients cerebral infarction with atrial fibrillation.Warfar might no be universal use due to the bleeding concerns and un-onvenience of monitoring INR.