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Background and purpose Growing evidence suggests that atrial cardiomyopathy may play an essential role in thrombosis and ischemic stroke. The aim of this systematic review and meta-analysis was to quantify the values of cardiomyopathy markers for predicting ischemic stroke risk. Methods PubMed, Embase, and the Cochrane Library were searched for longitudinal cohort studies evaluating the association between cardiomyopathy markers and incident ischemic stroke risk. Results We included 25 cohort studies examining electrocardiographic, structural, functional, and serum biomarkers of atrial cardiomyopathy involving 262,504 individuals. P-terminal force in the precordial lead V1 (PTFV1) was found to be an independent predictor of ischemic stroke as both a categorical variable (HR 1.29, CI 1.06–1.57) and a continuous variable (HR 1.14, CI 1.00–1.30). Increased maximum P-wave area (HR 1.14, CI 1.06–1.21) and mean P-wave area (HR 1.12, CI 1.04–1.21) were also associated with an increased risk of ischemic stroke. Left atrial (LA) diameter was independently associated with ischemic stroke as both a categorical variable (HR 1.39, CI 1.06–1.82) and a continuous variable (HR 1.20, CI 1.06–1.35). LA reservoir strain independently predicted the risk of incident ischemic stroke (HR 0.88, CI 0.84–0.93). N-terminal pro-brain natriuretic peptide (NT-proBNP) was also associated with incident ischemic stroke risk, both as a categorical variable (HR 2.37, CI 1.61–3.50) and continuous variable (HR 1.42, CI 1.19–1.70). Conclusion Atrial cardiomyopathy markers, including electrocardiographic markers, serum markers, LA structural and functional markers, can be used to stratify the risk of incident ischemic stroke.

Introduction: Stress hyperglycaemia is common in stroke. Recently, the stress hyperglycaemia ratio (SHR) has been proposed as a novel marker for stress hyperglycaemia and found to be associated with adverse outcomes in many diseases. However, data regarding the impact of the SHR on ischaemic stroke, especially in young adults, are limited. Therefore, the aim of this study was to investigate whether the SHR is associated with stroke severity and adverse outcomes in young adults with ischaemic stroke or transient ischaemic attack (TIA). Methods: We retrospectively recruited patients aged 18–45 years with acute ischaemic stroke or TIA. The SHR was calculated as fasting blood glucose (FBG) divided by glycated haemoglobin. The primary and secondary outcomes were 90-day poor functional outcomes and stroke severity on admission, respectively. Multivariable logistic regression, restricted cubic spline models, and subgroup analysis were performed to validate the relationship between the SHR and ischaemic stroke or TIA in young adults. Results: A total of 687 young adults (mean age 36.9 years) were recruited. Among them, 119 (17.3%) patients had prior diabetes, and 568 (82.7%) did not. The SHR was significantly associated with stroke severity and poor functional outcome. Compared with patients with lower SHR values, patients with higher SHR values were more likely to have moderate-to-severe stroke. The multivariable-adjusted OR (95% CI) was 1.70 (1.21–2.39) after adjusting for all potential confounders excluding FBG and 1.50 (1.03–2.17) after FBG adjustment. The restricted cubic spline showed a J-shaped association between the SHR and moderate-to-severe stroke. Compared with patients with lower SHR values, patients with higher SHR values were more likely to have poor functional outcome at 90-day follow-up. The multivariable-adjusted OR (95% CI) was 1.95 (1.12–3.41) after adjusting for all potential confounders excluding FBG and 1.84 (1.01–3.36) after FBG adjustment. A J-shaped association was found between the SHR and poor functional outcomes at the 90-day follow-up. In the subgroup analysis, SHR was independently associated with more severe stroke (OR, 1.79, 95% CI, 1.18–2.72) and poor functional outcomes (OR, 2.11, 95% CI, 1.32–3.35) in nondiabetic patients but not in diabetic patients in multivariate logistic analysis. Despite this, the interaction effects of prior diabetes on the association between the SHR and stroke severity and poor functional outcomes did not reach statistical significance. Conclusion: The SHR is independently related to more severe stroke and an increased risk of poor functional outcomes among young adults with ischaemic stroke or TIA.

Yanfang Liu,1– 3,* Xinmin Liu,1,2,* Jiaokun Jia,1– 3 Jiahuan Guo,1,2 Guangshuo Li,1,2 Xingquan Zhao1– 4 1Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, People’s Republic of China; 2China National Clinical Research Center for Neurological Diseases, Beijing, People’s Republic of China; 3Research Unit of Artificial Intelligence in Cerebrovascular Disease, Chinese Academy of Medical Sciences, Beijing, People’s Republic of China; 4Beijing Institute of Brain Disorders, Collaborative Innovation Center for Brain Disorders, Capital Medical University, Beijing, People’s Republic of China*These authors contributed equally to this workCorrespondence: Xingquan Zhao, Email zxq@vip.163.comBackground and Purpose: There is limited available evidence for the relationship between uric acid (UA) levels and ischemic stroke in young adults. We aimed to explore the association between UA levels and acute ischemic stroke (AIS) in young patients.Materials and Methods: This was a prospective and observational study. We recruited young patients aged 18– 45 years with AIS at our tertiary hospital. Patients were categorized into four groups according to quartiles of UA levels. The primary outcome was functional outcome at 3 months. The secondary outcomes included stroke severity, in-hospital complications, and functional outcome at discharge. Modified Rankin Scale (mRS) scores were used to assess functional outcome as poor (mRS=2-6) or favorable(mRS=0-1).Results: A total of 636 patients were enrolled in the current analysis. The four groups were defined as follows: Q1≤ 289.8 μmol/L, 289.8 μmol/ L

Serum phosphate is an essential nutrient that plays multiple physiological roles in cardiovascular function. The aim of this study was to investigate the association between serum phosphate and stroke severity and prognosis in ischemic stroke and transient ischemic attack (TIA) among young adults.We retrospectively recruited patients with acute ischemic stroke and TIA aged 18-45 years. The primary outcome was 90-day poor functional outcome (modified Rankin Scale score of 2-6). The secondary outcomes included stroke severity (NIHSS ≥5 was defined as moderate to severe stroke) and poor functional outcome at hospital discharge. A total of 687 patients with a mean age of 36.8 years were enrolled. Lower serum phosphate levels were significantly associated with more severe stoke (P for trend = 0.017). Compared with the fourth quartile, the odds ratio (95% CI) of the first quartile was 1.85 (1.19-3.22) for moderate to severe stroke. After adjusting for confounders other than stroke severity, the odds ratio (95% CI) of the first quartile was 1.74 (1.06-2.86) for poor functional outcome at hospital discharge and 1.90 (1.09-3.31) at 90-day follow-up compared with the fourth quartile. However, the significant association between serum phosphate and poor functional outcomes disappeared after stroke severity was further adjusted.Serum phosphate is more likely a marker of stroke severity than a contributor to poor functional outcomes after ischemic stroke and TIA in young adults. Lower serum phosphate levels were associated with more severe stroke.

Carotid atherosclerosis, including carotid artery intima-media thickness, plaques, and stenosis, is an important risk factor for stroke. However, the association between hemoglobin AA total of 3528 participants without diabetes from the China National Stroke Screen Survey program were enrolled in this study. cIMT was measured using duplex ultrasound examination. Logistic regression models were used to assess the association between HbAIn this large-scale and cross-sectional study, high-normal HbA

To systematically compare 27 ICH models with regard to mortality and functional outcome at 1-month, 3-month and 1-year after ICH. The validation cohort was derived from the Beijing Registration of Intracerebral Hemorrhage. Poor functional outcome was defined as modified Rankin Scale score (mRS) ≥3 at 1-month, 3-month and 1-year after ICH, respectively. The area under the receiver operating characteristic curve (AUROC) and Hosmer-Lemeshow goodness-of-fit test were used to assess model discrimination and calibration. A total number of 1575 patients were included. The mean age was 57.2 ± 14.3 and 67.2% were male. The median NIHSS score on admission was 11 (IQR: 3-21). For predicting mortality at 3-month after ICH, AUROC of 27 ICH models ranged from 0.604 to 0.856. In pairwise comparison, the ICH-FOS (0.856, 95%CI = 0.835-0.878, P < 0.001) showed statistically better discrimination than other models for mortality at 3-month after ICH (all P < 0.05). For predicting poor functional outcome (mRS≥3) at 3-month after ICH, AUROC of 27 ICH models ranged from 0.602 to 0.880. In pairwise comparison with other prediction models, the ICH-FOS was superior in predicting poor functional outcome at 3-month after ICH (all P < 0.001). The ICH-FOS showed the largest Cox and Snell R-square. Similar results were verified for mortality and poor functional outcome at 1-month and 1-year after ICH. Several risk models are externally validated to be effective for risk stratification and outcome prediction after ICH, especially the ICH-FOS, which would be useful tools for personalized care and clinical trial in ICH.

Background: Studies showed that patients with hemorrhagic stroke are at higher risk of developing deep vein thrombosis (DVT) than those with ischemic stroke. We aimed to develop a risk score (intracerebral hemorrhage associated deep vein thrombosis score, ICH-DVT) for predicting in-hospital DVT after ICH. Methods: The ICH-DVT was developed based on the Beijing Registration of Intracerebral Hemorrhage, in which eligible patients were randomly divided into derivation (60%) and internal validation cohort (40%). External validation was performed using the iMCAS study (In-hospital Medical Complication after Acute Stroke). Independent predictors of in-hospital DVT after ICH were obtained using multivariable logistic regression and β-coefficients were used to generate scoring system of the ICH-DVT. The area under the receiver operating characteristic curve (AUROC) and the Hosmer-Lemeshow goodness-of-fit test was used to assess model discrimination and calibration. Findings: The overall in-hospital DVT after ICH was 6.3%,6.0%, and 5.7% in the derivation (n=1309), internal (n=655) and external (n=314) validation cohorts, respectively. A 31-point ICH-DVT was developed from the set of independent predictors including age, hematoma volume, subarachnoid extension, pneumonia, gastrointestinal bleeding and length of hospitalization. The ICH-DVT showed good discrimination (AUROC) in the derivation (0.81; 95%CI=0.79-0.83), internal (0.83, 95%CI=0.80-0.86) and external (0.88; 95%CI=0.84-0.92) validation cohorts. The ICH-DVT was well calibrated (Hosmer-Lemeshow test) in the derivation (P=0.53), internal (P=0.38) and external (P=0.06) validation cohorts. Interpretation: The ICH-DVT is a valid grading scale for predicting in-hospital DVT after ICH. Further studies on effect of the ICH-DVT on clinical outcomes after ICH are warranted. Funding Information: This study was sponsored by Capital health research and development of special (2011-2004-03) and Beijing Municipal Science & Technology Commission (Z131107002213009). This study was partially supported by the Nova Program of Beijing Science and Technology Commission (2008B30), National Natural Science Foundation of China (81471208, 81641162), Beijing highlevel healthy human resource project (014-3-033) and Shandong Province Key Innovation Project (2019JZZY020901). Declaration of Interests: All authors report no disclosures. Ethics Approval Statement: The study protocol was approved by the Institutional Review Board (IRB) of the Beijing Tiantan Hospital (KY2014-023-02). The iMCAS was approved by the ethics committee of Beijing Tiantan hospital. For the present study, only patients with ICH were included.

Background: Despite advances in medical knowledge, treatment for ICH remains strictly supportive with not many evidence-based interventions currently available. Stroke associated pneumonia (SAP) is a common medical complication after stroke and has significant impact on stroke outcomes. In the study, we aimed to systematically compare discrimination and calibration of clinical scores with regard to in-hospital SAP after ICH. Methods: The validation cohort was derived from the Beijing Registration of Intracerebral Hemorrhage. The SAP was diagnosed according to the criteria for hospital-acquired pneumonia of Center for Disease Control and Prevention. Five clinical scores were included in the study: the ICH-APS-A, ICH-ASP-B, ISAN, ACCD4 and PASS score. Discrimination was assessed by calculating the area under the receiver operating characteristic curve (AUROC). Pairwise AUROC was compared by using Delong’s method. Calibration was assessed by performing the Hosmer-Lemeshow goodness-of-fit test and plot of observed versus predicted risk according to 10 deciles of the predicted risk. The Cox and Snell R-square and Nagelkerke R-square of the Hosmer-Lemeshow goodness-of-fit test were calculated. Results: A total number of 1964 patients were enrolled. The mean age was 56.8±14.4 and 67.6% were male. The median admission NIHSS was 11 (IQR: 3-21). The median length of stay (LOS) was 16 days (IQR: 8-22). A total number of 575 (29.2%) patients was diagnosed with in-hospital SAP after ICH. The AUROC of five clinical scores ranged from 0.732 to 0.800. In pairwise comparison, the ICH-APS-B (0.800, 95% CI=0.780-0.820, PConclusion: Several models are externally validated to be effective for risk stratification and outcome prediction for in-hospital SAP after ICH, which would be useful tools for personalized care and clinical trials in prevention of SAP after ICH.

Background: Several prognostic models have been developed for spontaneous intracerebral hemorrhage (ICH); however, none of them have been consistently used in routine clinical practice or clinical research. In the study, we systematically compared 27 ICH models with regard to mortality and functional outcome at 1-month, 3-month and 1-year after ICH. Methods: The validation cohort was derived from the Beijing Registration of Intracerebral Hemorrhage. Poor functional outcome was defined as modified Rankin Scale score (mRS) ≥3 at 1-month, 3-month and 1-year after ICH, respectively. The area under the receiver operating characteristic curve (AUROC) and Hosmer-Lemeshow goodness-of-fit test were used to assess model discrimination and calibration. Moderate, good, excellent and outstanding discrimination were predefined as AUROC of 0.75-0.79, 0.80-0.84, 0.85-0.89 and above 0.90, respectively.Results: A total number of 1575 patients were included. The mean age was 57.2±14.3 and 67.2% were male. The median NIHSS score on admission was 11 (IQR: 3-21). For predicting mortality at 3-month after ICH, AUROC of 27 ICH models ranged from 0.604 to 0.856. One model showed excellent discrimination; fifteen models demonstrated good discrimination; and seven models demonstrated moderate discrimination. In pairwise comparison, the ICH-FOS (0.856, 95%CI=0.835-0.878, P0.05) for mortality and poor functional outcome at 3-month after ICH, however, the ICH-FOS showed the largest Cox and Snell R-square. Similar results were verified for mortality and poor functional outcome at 1-month and 1-year after ICH. Conclusion: Several risk models are externally validated to be effective for risk stratification and outcome prediction after ICH, especially the ICH-FOS, which would be useful tools for personalized care and clinical trial in ICH.

This study was based on 95391 participants (18–98 years old) from the Kailuan study, which assessed all-cause mortality in a community-based population in northern China according to estimated glomerular filtration rate (eGFR) by the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) formula and proteinuria estimated from urine dipstick results. Data were analysed based on Cox proportional hazards models with adjustment for relevant confounders, and the results were expressed as hazard ratios (HRs) with 95% confidence intervals (CIs). During eight years of follow-up, a total of 6024 participants died. The two indicators, eGFR 2 and the presence of proteinuria, were independently associated with all-cause mortality. Compared with eGFR ≥45 ml/min/1.73 m2 with negative proteinuria, HRs of all-cause mortality were 1.26 (95% CI 1.10–1.44) for eGFR 2 without proteinuria, 1.95 (1.78–2.14) for eGFR ≥45 ml/min/1.73 m2 with proteinuria, and 2.63 (2.14–3.23) for eGFR 2 with proteinuria. The all-cause mortality risk of eGFR and/or proteinuria was much higher in females than in males (P for interaction

Asymptomatic extracranial artery stenosis (ECAS) is a well-known risk factor for stroke and H-type hypertension, which is defined as hypertension with hyperhomocysteinemia, is associated with cardio-cerebrovascular diseases. However, the impact of H-type hypertension on ECAS is mostly unknown. We designed this study to investigate the association between H-type hypertension and prevalence of ECAS. We included 2330 participants in this study and classified them into four groups: the control group without hypertension or hyperhomocysteinemia, isolated hypertension group, isolated hyperhomocysteinemia group and H-type hypertension group. We measured the baseline plasma total homocysteine levels and assessed ECAS by carotid duplex sonography twice at baseline and during follow up. We used a Cox regression model to analyse the association between H-type hypertension and ECAS. At baseline, 608 subjects suffered from H-type hypertension. Within two years of follow-up, asymptomatic ECAS occurred in 250 (10.73%) participants. After adjusting for relevant risk factors, we found H-type hypertension to be an independent risk factor for asymptomatic ECAS (relative risk (RR) 3.16, 95% confidence interval (95% CI) 2.00–5.00). Our findings provide direct evidence for the importance of H-type hypertension in the occurrence of ECAS and as a potential therapeutic target for carotid atherosclerosis.

Given the recognized links between atherosclerosis and cognitive impairment, the aim of this study was to examine the association between the ankle-brachial index (ABI) and cognitive impairment in a cross-sectional setting of a Chinese population.Participants (n = 3,048, aged ≥40 years, 1727 men and 1321 women) were recruited from the ongoing community-based Asymptomatic Polyvascular Abnormalities Community Study. ABI was measured and a low ABI was defined as0.9. Cognition status was evaluated via the Mini-Mental Status Exam. Multivariate logistic regression models and linear regression models were used to assess the association between ABI and cognitive impairment.A low ABI was associated with cognitive impairment (odds ratio, OR = 1.983; 95% confidence interval, CI: 1.150-3.419), independent of the potential confounders. In addition, a decreasing ABI (per standard deviation) was significantly associated with cognitive impairment in fully adjusted models (OR = 1.156; CI: 1.013-1.319) and with a significant trend of decreasing MMSE scores (β = 0.703, 95% CI 0.189-1.218, p = 0.0074). Furthermore, the odds of a low ABI associated with cognitive impairment in participants without hypertension and participants with diabetes were 4.924 (CI: 1.860-13.035) and 6.393 (CI: 2.431-16.810), respectively.A low ABI is associated with cognitive impairment, especially in non-hypertensive and diabetic patients.

Diabetes may be one of the risk factors of cognitive impairment. In this study, we aimed to investigate the relationship between diabetes status and cognitive impairment among the middle-aged and elderly population (≥40 years) in Chinese rural communities.A sample of 3392 participants aged 40 years or older from the China National Stroke Prevention Project (CSPP) between 2015 and 2017 were enrolled in this study. Cognitive function was assessed by the Beijing edition of the Montreal cognitive assessment (MoCA) scale. Cognitive impairment was diagnosed as a MoCA score 26. Diabetes status was divided into three groups------Normal: fasting plasma glucose (FPG) ≤ 5.5 mmol/L, Prediabetes: 5.6 ≤ FPG ≤ 6.9 mmol/L, Diabetes: FPG ≥ 7.0 mmol/L or with a history of diabetes. Multivariate logistic regression was used to analyze the association between diabetes status and cognitive impairment.Out of the 3392 enrolled participants, 2023(59.6%) had cognitive impairment, 1586(46.8%) had abnormal fasting plasma glucose including 867(25.6%) prediabetes and 719(21.2%) diabetes. After adjusting for potential risk factors, we found prediabetes (OR: 1.22, 95%CI: 1.03-1.45) and diabetes (OR: 1.28, 95%CI: 1.06-1.55) are all associated with cognitive impairment, especially in the domains of language (prediabetes: OR: 1.14, 95%CI: 1.05-1.25; diabetes: OR:1.13, 95%CI: 1.03-1.24), visuospatial/executive functions (diabetes: OR: 1.50, 95%CI: 1.22-1.84) and attention (diabetes: OR: 1.15, 95%CI: 1.02-1.31).In this large community-based study, we found diabetes status may be an independent risk factor for cognitive impairment, particularly in domains of language, visuospatial/executive functions, and attention.

Patients with intracerebral hemorrhage are susceptible to venous thromboembolism, but the relationship between venous thromboembolism and outcome is largely unknown. We aim to investigate the association of in-hospital venous thromboembolism with functional outcome in patients with intracerebral hemorrhage.From September 2014 through August 2016, we conducted a hospital-based, prospective study by consecutively recruiting eligible patients with first-ever acute spontaneous intracerebral hemorrhage. In-hospital venous thromboembolism was defined as observation of pulmonary embolism or deep vein thrombosis during initial hospitalization. The primary end point was death or disability (modified Rankin Scale 3 to 6) at discharge, 3-month and 1-year follow-up. Logistic analysis was conducted to evaluate the association of venous thromboembolism and poor functional outcome.Among 637 participants included in the analysis, the prevalence of venous thromboembolism was 22.6%. After adjusting for confounding factors, venous thromboembolism was independently associated with death or disability at discharge (odds ratio 2.09, 95% confidence interval 1.12-3.85), 3-month follow-up (2.00 [1.12-3.54]) and 1-year follow-up (2.00 [1.14-3.49]). Venous thromboembolism was also an independent indicator of disability (modified Rankin Scale 3-5) among ICH survivors, with odds ratios ranging from 1.93 to 2.08 (all P0.05). The relationship was stronger in patients with hematoma volume10 ml (3.24 [1.11-9.46]) and ≥30 ml (2.57 [1.03-6.44]) (P for interaction=0.002) at 1-year follow-up. The results were confirmed by sensitivity analysis.In-hospital venous thromboembolism was independently associated with poor outcome at discharge, 3-month and 1-year in patients with intracerebral hemorrhage.

Purpose: This study aimed to investigate the effects of aCAS on cognitive functioning in a Chinese community population who were over 40 year-old and to find the domains of cognitive impairment which were mainly affected. Methods: Information was collected on the presence of CAS, which was assessed by Color Doppler Ultrasound, from the Asymptomatic Polyvascular Abnormalities Community study, and cognitive functioning was assessed by the score of the Montreal Cognitive Assessment (MoCA). Multivariate logistic regression was used to assess the relationships between aCAS and cognitive impairment. Results: A total of 812 (61.2% men, 55% of 40-60y) patients were included in this study. After adjusting for potential confounding factors, the associations between the aCAS and cognitive impairment remained significant [odds ratio(OR)(95% confidence interval, 95%CI)=1.812(1.049-3.127)]. Also, there were significant relationships between the aCAS and the domains of cognitive function like attention, language, abstraction and recall [OR(95%CI) 2.740(1.494-5.023), 2.005(1.184-3.396), 2.841(1.594-5.065), 4.674(2.478-8.818) respectively, P < 0.05). In addition, there were no interaction effects of age and other possible risk factors on the association. Conclusion: In the over 40 year-old Chinese community population, aCAS was an independent indicator of cognitive impairment, especially affecting the function of attention, language, abstraction and recall. Table 1 Baseline demographic characteristics and cardiovascular risk factors between groups with/without cognitive impairment Values are median (interquartile range) or number (percent). Table 2 Unadjusted and Multivariate-adjusted OR (95% CI) for total and subtests of MoCA, according to groups with vs. without CAS. *P OR: odd ratio; CI: confidence interval Model 1: adjusted for age and gender. Model 2: adjusted for age, gender, BMI, education, current smoking and alcohol consumption. Model 3:adjusted for age, gender, BMI, education, current smoking, alcohol consumption hypertension, diabetes, hyperlipidemia, hs-CRP and Hcy.

Little is known about the association between homocysteine (Hcy) and asymptomatic CAS in the healthy population. The purpose of this study was to investigate the relationship between Hcy levels and asymptomatic CAS in a Chinese community population. The current study included 5393 participants who were age of 40 years or older, and free of stroke, transient ischemic attack, and coronary artery disease. Demographic and clinical variables were investigated, and the presence of CAS was assessed by Color Doppler Ultrasound. A multivariate logistic regression was used to examine the association between Hcy levels and asymptomatic CAS. 361 (6.69%) participants were diagnosed with asymptomatic CAS, who had higher Hcy levels compared with those without (p-value for trend = 0.0001). After adjusting other possible risk factors, Hcy > 19.3μmol/L was considered as an independent indicator of asymptomatic CAS (OR 1.53, 95%CI 1.05–2.23; p-value for trend = 0.0265), but with a difference between participants with diabetes and without [OR (95%CI): 2.89(1.02–8.22) vs. 1.42(0.95–2.12); P interaction