| Pathophysiological determinants of worse stroke outcome in atrial fibrillation. | |
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MedLine Citation:
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PMID: 20693794 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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BACKGROUND: The reasons for worse outcome following ischemic stroke in patients with atrial fibrillation (AF) remain unclear. We aimed to elucidate the pathophysiological determinants of poorer stroke outcome in patients with AF using systematic MRI data from the Echoplanar Imaging Thrombolytic Evaluation Trial (EPITHET). METHODS: Comparisons of infarct size, hypoperfusion volume, infarct growth, arterial occlusion, recanalization, reperfusion, hemorrhagic transformation and stroke severity were made between patients with and without AF enrolled in the EPITHET study. RESULTS: AF was present in 42 of 101 patients. At baseline, AF patients were older (79 vs. 73 years, p = 0.02), had more severe neurological impairment (National Institutes of Health Stroke Scale score 16 vs. 11, p = 0.006), larger infarcts (29 vs. 15 ml, p = 0.04) and greater volumes of more severe hypoperfusion (T(max) > or =8 s, perfusion-weighted imaging volume 70 vs. 43 ml, p = 0.01) compared to patients without AF. There were no significant differences in arterial occlusion site, infarct growth, recanalization or reperfusion. At outcome, AF patients had larger infarcts (52 vs. 16 ml, p = 0.05), more severe hemorrhagic transformation (29 vs. 5%, p = 0.002 for parenchymal hematomas), greater disability (modified Rankin Scale score 4 vs. 3, p = 0.03) and higher mortality rates (31 vs. 12%, p = 0.04). AF was an independent predictor of parenchymal hematoma (OR = 6.90, 95% CI = 1.57-30.25), but not mortality (OR = 2.56, 95% CI = 0.83-7.85). CONCLUSIONS: Patients with AF have worse clinical and imaging outcomes following ischemic stroke. This study suggests that the adverse effect of AF is due to greater volumes of more severely hypoperfused tissue, leading to larger infarct size and greater risk of severe hemorrhagic transformation. |
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Authors:
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Hans T H Tu; Bruce C V Campbell; Soren Christensen; Marnie Collins; Deidre A De Silva; Kenneth S Butcher; Mark W Parsons; Patricia M Desmond; P Alan Barber; Christopher R Levi; Christopher F Bladin; Geoffrey A Donnan; Stephen M Davis; |
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Publication Detail:
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Type: Clinical Trial, Phase II; Journal Article; Multicenter Study; Research Support, Non-U.S. Gov't Date: 2010-08-05 |
Journal Detail:
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Title: Cerebrovascular diseases (Basel, Switzerland) Volume: 30 ISSN: 1421-9786 ISO Abbreviation: Cerebrovasc. Dis. Publication Date: 2010 |
Date Detail:
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Created Date: 2010-09-03 Completed Date: 2011-01-04 Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 9100851 Medline TA: Cerebrovasc Dis Country: Switzerland |
Other Details:
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Languages: eng Pagination: 389-95 Citation Subset: IM |
Copyright Information:
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Copyright (c) 2010 S. Karger AG, Basel. |
Affiliation:
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Department of Medicine, Royal Melbourne Hospital, University of Melbourne, Grattan Street, Parkville, Vic. 3050, Australia. |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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Aged Aged, 80 and over Arterial Occlusive Diseases / pathology, physiopathology* Atrial Fibrillation / complications, physiopathology* Cerebral Hemorrhage / pathology, physiopathology* Cerebral Infarction / pathology, physiopathology* Double-Blind Method Female Fibrinolytic Agents / therapeutic use Humans Magnetic Resonance Imaging Male Middle Aged Prognosis Prospective Studies Severity of Illness Index Stroke / drug therapy, etiology, physiopathology* Tissue Plasminogen Activator / therapeutic use |
| Chemical | |
Reg. No./Substance:
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0/Fibrinolytic Agents; EC 3.4.21.68/Tissue Plasminogen Activator |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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