The influence of embolization of internal carotid artery aneurysms on arterial tortuosity: a prospective cohort study.

PURPOSE: To compare quantitative tortuosity descriptors of Internal Carotid Artery (ICA) on aneurysmal and non-aneurysmal side before and after embolization of aneurysm and to determine possible factors associated with its change. MATERIAL AND METHODS: An analysis of 52 patients with intracranial aneurysm, treated with endovascular procedure, was performed. Based on their Digital Subtraction Angiography images, obtained prior to the procedure and after first follow-up examination, tortuosity of ICA, both on the side of embolization and on the other side was analysed. For each patient tortuosity descriptors were calculated: Relative Length, Sum of Angle Metrics, Triangular Index, Product of Angle Distance, and Inflection Count Metric. To represent changes in tortuosity, for each descriptor delta value (Δ) was defined as value of the descriptor prior to embolization - value of the descriptor on follow-up examination. RESULTS: In the follow-up We found no statistically significant changes in tortuosity on non-embolized side. On the embolized side SOAM (2.89±0.92 vs. 2.38±0.94;p<0.001), PAD (5.01±1.83 vs. 3.95±1.72 ;p<0.001) and ICM (12.18±4.55 vs. 9.76±4.04 vs.;p = 0.006) was significantly higher after embolization than before embolization. Mean ΔRelative Length (-0.02 [-0.045--0.002] vs. -0.01 [-0.02-0.003];p - 0.003),ΔProduct of Angle Distance (0.84 [0.30 - 1.82] vs. 0.10 [-0.001 - 1.10];p<0.001) and ΔInflection Count Metric (2.05 [0.42 - 3.50] vs. 0.27 [0.02 - 2.16];p = 0.004) were significantly higher on the embolized side. CONCLUSION: Following study showed that embolization may increase the tortuosity of ICA.

Predicting acute kidney injury onset with a random forest algorithm using electronic medical records of COVID-19 patients: the CRACoV-AKI model.

INTRODUCTION: Acute kidney injury (AKI) is a serious and common complication of SARS­CoV­2 infection. Most risk assessment tools for AKI have been developed in the intensive care unit or in elderly populations. As the COVID­19 pandemic is transitioning into an endemic phase, there is an unmet need for prognostic scores tailored to the population of patients hospitalized for this disease. OBJECTIVES: We aimed to develop a robust predictive model for the occurrence of AKI in hospitalized patients with COVID­19. PATIENTS AND METHODS: Electronic medical records of all adult inpatients admitted between March 2020 and January 2022 were extracted from the database of a large, tertiary care center with a reference status in Lesser Poland. We screened 5806 patients with SARS­CoV­2 infection confirmed with a polymerase chain reaction test. After excluding individuals with lacking data on serum creatinine levels and those with a mild disease course (<7 days of inpatient care), a total of 4630 records were considered. Data were randomly split into training (n = 3462) and test (n = 1168) sets. A random forest model was tuned with feature engineering based on expert advice and metrics evaluated in nested cross­validation to reduce bias. RESULTS: Nested cross­validation yielded an area under the curve ranging between 0.793 and 0.807, and an average performance of 0.798. Model explanation techniques from a global perspective suggested that a need for respiratory support, chronic kidney disease, and procalcitonin concentration were among the most important variables in permutation tests. CONCLUSIONS: The CRACoV­AKI model enables AKI risk stratification among hospitalized patients with COVID­19. Machine learning-based tools may thus offer additional decision­making support for specialist providers.

Can ß-blockers prevent intracranial aneurysm rupture? - insights from Computational Fluid Dynamics analysis.

AIM: Hypertension is a risk factor for intracranial aneurysm rupture. We analyzed whether the intake of drugs from specific classes of anti-hypertensive medications affects hemodynamic parameters of intracranial aneurysm dome. METHODS AND RESULTS: We recorded medical history including medications and the in-hospital blood pressure values. We then obtained 3D reconstruction of each patients' aneurysm dome and the feeding artery. Using OpenFOAM software we performed Computational Fluid Dynamics analysis of blood flow through the modeled structures. Blood was modeled as Newtonian fluid, using the incompressible transient solver. As the inlet boundary condition we used the patient-specific Internal Carotid Artery blood velocity waves obtained with Doppler ultrasound. We calculated haemodynamic parameters of the aneurysm dome. All presented analyses are cross-sectional.We included 72 patients with a total of 91 unruptured intracranial aneurysms. The history of ß-blocker intake significantly influenced hemodynamic parameters of aneurysm dome. The patients on ß-blockers had significantly smaller aneurysm domes (5.09 ± 2.11 mm vs. 7.41 ± 5.89 mm; p = 0.03) and did not have aneurysms larger than 10 mm (0% vs 17.0%; p = 0.01). In the Computational Fluid Dynamics analysis, walls of aneurysms in patients who took ß-blockers were characterized by lower Wall Shear Stress Gradient (1.67 ± 1.85 Pa vs. 4.3 ± 6.06 Pa; p = 0.03), Oscillatory Shear Index (0.03 ± 0.02 vs. 0.07 ± 0.10; p = 0.04) and Surface Vortex Fraction (16.2% ± 5.2% vs. 20.0% ± 6.8%; p<0.01). After controlling for covariates, we demonstrated difference of Surface Vortex Fraction (F[1, 48] = 4.36; p = 0.04) and Oscillatory Shear Index (F[1, 48] = 6.51; p = 0.01) between patients taking and not taking ß-blockers, respectively. CONCLUSION: Intake of ß-blockers might contribute to more favorable hemodynamics inside aneurysmal sac. Other antihypertensive medication classes were not associated with differences in intracranial aneurysm parameters.

Does atrial fibrillation still increase the risk of death? One-year follow-up results of the NOMED-AF study.

INTRODUCTION: Although atrial fibrillation (AF) is a well­known risk factor for ischemic stroke and hospitalization, its effect on mortality has not been clearly established. OBJECTIVES: We aimed to assess whether AF is an independent risk factor for death. A secondary objective was to evaluate the role of oral anticoagulation in the prevention of stroke and death in 1­year follow­up of patients included in the NOMED­AF (Noninvasive Monitoring for Early Detection of Atrial Fibrillation) study. PATIENTS AND METHODS: The NOMED­AF study included 3014 patients. The participants underwent continuous long­term electrocardiographic monitoring using a wearable vest for up to 30 days. The present analysis involved 2795 patients who completed the 1­year follow­up. The median (interquartile range) follow­up time was 365 (365-365) days. AF was diagnosed in 617 participants. RESULTS: Independent risk factors for death in the patients who completed the 1­year follow­up were AF, age equal to or above 65 years, and chronic kidney disease. The individuals with diagnosed AF had an almost 2­fold higher risk of death (odds ratio [OR], 1.7; 95% CI, 1.18-2.44; P <0.001) and a 2.5­fold higher risk of stroke (OR, 2.53; 95% CI, 1.41-4.44; P <0.001), as compared with those without an AF diagnosis. The participants with AF who received oral anticoagulants had an almost 5­fold lower risk of death than those who were not on anticoagulation (2.9% vs 14.2%, respectively; P <0.001). CONCLUSIONS: AF is an independent risk factor for death and cardiovascular hospitalization. The risk of death and stroke in patients with AF is significantly higher than in the patients without this arrhythmia. Oral anticoagulation in patients with AF significantly reduces the rates of death and stroke; however, its use is suboptimal in this group of patients.

Possible association between ß-blocker use and a risk of intracranial aneurysm rupture.

INTRODUCTION: Aneurysmal subarachnoid hemorrhage is a devastating type of stroke, associated with high mortality and morbidity. One of modifiable risk factors of aneurysm rupture is hypertension, however, it is still not clear whether any particular antihypertensive drugs play a significant role in the prevention of aneurysm rupture. OBJECTIVES: We decided to investigate whether there is any association between acetylsalicylic acid, α-blockers, ß­blockers, angiotensin­converting enzyme inhibitors, angiotensin II receptor blockers, calcium channel blockers, diuretics, statins, and anticoagulants and a risk of intracranial aneurysm rupture. PATIENTS AND METHODS: We retrospectively analyzed 334 patients with ruptured and unruptured intracranial aneurysm. Based on logistic regression models, we obtained unadjusted and adjusted odds ratios (ORs) of subarachnoid hemorrhage associated with the use of vasoactive medications and with indices of tortuosity. RESULTS: We found that ß­blocker intake was significantly related to higher tortuosity of the cerebral arteries. Also, the intake of ß­blockers (OR, 0.41; 95% CI, 0.21-0.77; P = 0.01) and statins (OR, 0.23; 95% CI, 0.05-0.68; P = 0.01) significantly decreased the risk of aneurysm rupture, a result driven by a decreased rupture risk of anterior circulation aneurysms. No such association was found for the posterior part of the cerebral circulation. CONCLUSIONS: Aneurysm located in the anterior cerebral circulation might be less likely to rupture if patients receive ß­blockers or statins.

Angiotensin-converting enzyme inhibitors and angiotensin-II-receptor antagonists modulate sodium handling based on endogenous lithium clearance.

BACKGROUND: Numerous studies based on assessment of lithium clearance demonstrated higher sodium reabsorption in renal proximal tubules in individuals with hypertension, overweight, obesity, metabolic syndrome, or diabetes. AIMS: We aimed to assess the influence of angiotensin-converting enzyme inhibitors (ACE-I) or angiotensin-II-receptor antagonists (ARB) treatment on sodium handling. METHODS: In a sample of 351Caucasian subjects without diuretic treatment with prevailing sodium consumption, we studied associations between renal sodium reabsorption in proximal (FPRNa) and distal (FDRNa) tubules assessed by endogenous lithium clearance and daily sodium intake measured by 24-hour excretion of sodium (UNaV), in the context of obesity and long-term treatment with ACE-I or ARB. RESULTS: In the entire study population, we found a strong negative association between FPRNa and ACE-I/ARB treatment (b = -19.5; SE = 4.9; P <0.001). Subjects with FPRNa above the median value showed a significant adverse association between FPRNa and age (b = -0.06; SE = 0.02; P = 0.003), with no association with ACE-I/ARB treatment (P = 0.68). In contrast, in subjects with FPRNa below the median value, we found a strongly significant adverse relationship between FPRNa and ACE-I/ARB treatment (b = -30.4; SE = 8.60; P <0.001), with no association with age (P = 0.32). CONCLUSIONS: ACE-I/ARB long-term treatment modulates FPRNa in the group with lower reabsorption, but not in that with higher than median value for the entire study population.