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Article ; Online: Simulation and Machine Learning Provide New Approaches to Examine Quality of Acute Stroke Management.

Kamal, Noreen / Lakshminarayan, Kamakshi

2022 Volume 53, Issue 9, Page(s) 2768–2769

MeSH term(s)	Computer Simulation ; Humans ; Machine Learning ; Stroke/diagnosis ; Stroke/therapy
Language	English
Publishing date	2022-07-15
Publishing country	United States
Document type	Editorial ; Comment
ZDB-ID	80381-9
ISSN	1524-4628 ; 0039-2499 ; 0749-7954
ISSN (online)	1524-4628
ISSN	0039-2499 ; 0749-7954
DOI	10.1161/STROKEAHA.122.039954
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Zs.A 448: Show issues

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Article ; Online: Sex-specific racial and ethnic variations in short-term outcomes among patients with first or recurrent ischemic stroke: Paul Coverdell National Acute Stroke Program, 2016-2020.

Asaithambi, Ganesh / George, Mary G / Tong, Xin / Lakshminarayan, Kamakshi

Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association

2024 Volume 33, Issue 4, Page(s) 107560

Abstract: Background and purpose: To understand the association of sex-specific race and ethnicity on the short-term outcomes of initial and recurrent ischemic stroke events.: Methods: Using the Paul Coverdell National Acute Stroke Program from 2016-2020, we ... ...

Abstract	Background and purpose: To understand the association of sex-specific race and ethnicity on the short-term outcomes of initial and recurrent ischemic stroke events. Methods: Using the Paul Coverdell National Acute Stroke Program from 2016-2020, we examined 426,062 ischemic stroke admissions from 629 hospitals limited to non-Hispanic White (NHW), non-Hispanic Black (NHB), and Hispanic patients. We performed multivariate logistic regression analyses to assess the combined effects of sex-specific race and ethnicity on short-term outcomes for acute ischemic stroke patients presenting with initial or recurrent stroke events. Outcomes assessed include rates of in-hospital death, discharge to home, and symptomatic intracranial hemorrhage (sICH) after reperfusion treatment. Results: Among studied patients, the likelihood of developing sICH after reperfusion treatment for initial ischemic stroke was not significantly different. The likelihood of experiencing in-hospital death among patients presenting with initial stroke was notably higher among NHW males (AOR 1.59 [95 % CI 1.46, 1.73]), NHW females (AOR 1.34 [95 % CI 1.23, 1.45]), and Hispanic males (AOR 1.57 [95 % CI 1.36, 1.81]) when compared to NHB females. Hispanic females were more likely to be discharged home when compared to NHB females after initial stroke event (AOR 1.32 [95 % CI 1.23, 1.41]). NHB males (AOR 0.90 [95 % CI 0.87, 0.94]) and NHW females (AOR 0.89 [95 % CI 0.86, 0.92]) were less likely to be discharged to home. All groups with recurrent ischemic strokes experienced higher likelihood of in-hospital death when compared to NHB females with the highest likelihood among NHW males (AOR 2.13 [95 % CI 1.87, 2.43]). Hispanic females had a higher likelihood of discharging home when compared to NHB females hospitalized for recurrent ischemic stroke, while NHB males and NHW females with recurrent ischemic stroke hospitalizations were less likely to discharge home. Conclusions: Sex-specific race and ethnic disparities remain for short-term outcomes in both initial and recurrent ischemic stroke hospitalizations. Further studies are needed to address disparities among recurrent ischemic stroke hospitalizations.
MeSH term(s)	Female ; Humans ; Male ; Black or African American ; Hospital Mortality ; Ischemic Stroke/diagnosis ; Ischemic Stroke/therapy ; Stroke/diagnosis ; Stroke/therapy ; White People ; White ; Hispanic or Latino
Language	English
Publishing date	2024-01-07
Publishing country	United States
Document type	Journal Article
ZDB-ID	1131675-5
ISSN	1532-8511 ; 1052-3057
ISSN (online)	1532-8511
ISSN	1052-3057
DOI	10.1016/j.jstrokecerebrovasdis.2024.107560
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Zs.A 3519: Show issues

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Article ; Online: Trends in intravenous thrombolysis utilization for acute ischemic stroke based on hospital size: Paul Coverdell National Acute Stroke Program, 2010-2019.

Asaithambi, Ganesh / Tong, Xin / Lakshminarayan, Kamakshi

The American journal of emergency medicine

2023 Volume 67, Page(s) 51–55

Abstract: Introduction: The rate of intravenous thrombolysis (IVT) utilization in acute ischemic stroke (AIS) has been increasing, and this has coincided with improved door-to-needle times (DNTs). Smaller hospitals have been observed to utilize IVT less ... ...

Abstract	Introduction: The rate of intravenous thrombolysis (IVT) utilization in acute ischemic stroke (AIS) has been increasing, and this has coincided with improved door-to-needle times (DNTs). Smaller hospitals have been observed to utilize IVT less frequently or even not at all. Using a multistate stroke registry, we sought to determine the impact of hospital size on trends in IVT utilization for AIS. Methods: Utilizing data from the Paul Coverdell National Acute Stroke Program (PCNASP), we studied trends in IVT for AIS patients between 2010 and 2019 based on hospital size. Hospitals were grouped into quartiles based on size. We studied the impact of hospital size on DNTs and overall IVT utilization. Results: During the study period, there were 530,828 AIS patients (mean age 70.3 ± 0.02 years, 50.4% men) from 540 participating hospitals. We did not identify a significant trend in IVT utilization among hospitals within the first quartile (p = 0.1005), but there were significantly increased trends within the hospitals belonging to the second, third, and fourth quartiles (p < 0.001 for all). All quartiles were observed to have significantly increased trends in DNTs ≤60 min (p < 0.0001), but only hospitals within the second, third, and fourth quartiles experienced significantly increased trends in DNTs ≤45 min (p < 0.0001). Conclusion: In our registry-based analysis, we observed an increased trend in IVT utilization for AIS among larger hospitals. There was an overall improvement in rates of DNTs ≤60 min, but only larger hospitals were observed to have improved DNTs ≤45 min.
MeSH term(s)	Male ; Humans ; Aged ; Female ; Fibrinolytic Agents/therapeutic use ; Ischemic Stroke/drug therapy ; Brain Ischemia/drug therapy ; Thrombolytic Therapy ; Health Facility Size ; Stroke/drug therapy ; Treatment Outcome
Chemical Substances	Fibrinolytic Agents
Language	English
Publishing date	2023-02-11
Publishing country	United States
Document type	Journal Article
ZDB-ID	605890-5
ISSN	1532-8171 ; 0735-6757
ISSN (online)	1532-8171
ISSN	0735-6757
DOI	10.1016/j.ajem.2023.02.009
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Zs.A 2005: Show issues

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Article ; Online: Obstructive sleep apnea, nocturnal hypoxemia, and retinal microvasculature: The Atherosclerosis Risk in Communities Study.

Hoeft, Nathan / Full, Kelsie M / Misialek, Jeffrey R / Lakshminarayan, Kamakshi / Shrestha, Srishti / Deal, Jennifer A / Lutsey, Pamela L

Sleep advances : a journal of the Sleep Research Society

2024 Volume 5, Issue 1, Page(s) zpae004

Abstract: Study objectives: Retinal microvascular pathology (RMP) and obstructive sleep apnea (OSA) are both cardiovascular disease risk factors. Limited data exists on their interrelationship. We tested the hypotheses that OSA and nocturnal hypoxemia would be ... ...

Abstract	Study objectives: Retinal microvascular pathology (RMP) and obstructive sleep apnea (OSA) are both cardiovascular disease risk factors. Limited data exists on their interrelationship. We tested the hypotheses that OSA and nocturnal hypoxemia would be associated with RMP and vessel calibers. Methods: We conducted a quasi-cross-sectional analysis of 1625 participants in the Atherosclerosis Risk in Communities Sleep Heart Health Study. Participants completed in-home polysomnography monitoring (1996-1998) and were categorized by OSA severity (apnea-hypopnea index: <5, 5-14.9, and ≥15) and proportion of total sleep time with oxygen saturation < 90% (T90). Retinal photography (1993-1995) was used to assess RMP and measure vascular diameters (central retinal arteriolar equivalent [CRAE] and central retinal venular equivalent [CRVE]). Logistic and linear models were adjusted for demographics, behaviors, and BMI. Results: Of the participants, 19% had OSA (AHI > 15) and 4% had RMP. Severe OSA was not associated with RMP [OR (95% CI): 1.08 (0.49 to 2.38)] or CRAE in adjusted models. OSA severity showed a positive linear relationship with CRVE; adjusted mean CRVE for those with OSA was 195.8 μm compared to 193.2 μm for those without OSA ( Conclusions: OSA and T90 were not associated with RMP or CRAE. However, both OSA and T90 ≥ 5% were associated with wider venules, which may be early and indicative changes of increased inflammation and future risk of stroke and CHD.
Language	English
Publishing date	2024-01-20
Publishing country	United States
Document type	Journal Article
ISSN	2632-5012
ISSN (online)	2632-5012
DOI	10.1093/sleepadvances/zpae004
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Article ; Online: The role of population-level preventive care for brain health in ageing.

Sabayan, Behnam / Doyle, Sara / Rost, Natalia S / Sorond, Farzaneh A / Lakshminarayan, Kamakshi / Launer, Lenore J

The lancet. Healthy longevity

2023 Volume 4, Issue 6, Page(s) e274–e283

Abstract: Over the past several decades, a worldwide demographic transition has led to an increasing number of older adults with chronic neurological conditions. These conditions, which have a profound effect on the cognitive function and physical ability of older ...

Abstract	Over the past several decades, a worldwide demographic transition has led to an increasing number of older adults with chronic neurological conditions. These conditions, which have a profound effect on the cognitive function and physical ability of older adults, also have a long preclinical phase. This feature provides a unique opportunity to implement preventive measures for high-risk groups and the population as a whole, and therefore to reduce the burden of neurological diseases. The concept of brain health has emerged as the overarching theme to define overall brain function independently of underlying pathophysiological processes. We review the concept of brain health from the ageing and preventive care perspectives, discuss the mechanisms underpinning ageing and brain ageing, highlight the interplay of various forces resulting in deviation from brain health towards brain disease, and provide an overview of strategies to promote brain health with a life-course approach.
MeSH term(s)	Brain ; Cognition/physiology
Language	English
Publishing date	2023-05-15
Publishing country	England
Document type	Journal Article ; Review ; Research Support, N.I.H., Extramural
ISSN	2666-7568
ISSN (online)	2666-7568
DOI	10.1016/S2666-7568(23)00051-X
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Article ; Online: Percutaneous left atrial appendage occlusion and risk of stroke, hospitalized bleeding and death in Medicare beneficiaries.

Wang, Wendy / Chen, Lin Yee / Walker, Rob F / Alonso, Alvaro / Norby, Faye L / Lakshminarayan, Kamakshi / Lutsey, Pamela L

Pharmacoepidemiology and drug safety

2024 Volume 33, Issue 4, Page(s) e5786

Abstract: Purpose: Among patients with atrial fibrillation (AF), a nonpharmacologic option (e.g., percutaneous left atrial appendage occlusion [LAAO]) is needed for patients with oral anticoagulant (OAC) contraindications. Among beneficiaries in the Medicare fee- ... ...

Abstract	Purpose: Among patients with atrial fibrillation (AF), a nonpharmacologic option (e.g., percutaneous left atrial appendage occlusion [LAAO]) is needed for patients with oral anticoagulant (OAC) contraindications. Among beneficiaries in the Medicare fee-for-service coverage 20% sample databases (2015-18) who had AF and an elevated CHA Methods: Patients undergoing percutaneous LAAO were matched to up to five OAC users by sex, age, date of enrollment, index date, CHA Results: Median follow-up was 10.3 months. After multivariable adjustments, no significant difference for risk of stroke or death was noted when patients with percutaneous LAAO were compared with OAC users (HRs [95% CIs]: 1.14 [0.86-1.52], 0.98 [0.86-1.10]). There was a 2.94-fold (95% CI: 2.50-3.45) increased risk for hospitalized bleeding for percutaneous LAAO compared with OAC use. Among patients 65 to <78 years old, those undergoing percutaneous LAAO had higher risk of stroke compared with OAC users. No association was present in those ≥78 years. Conclusion: In this analysis of real-world AF patients, percutaneous LAAO versus OAC use was associated with similar risk of death, nonsignificantly elevated risk of stroke, and an elevated risk of bleeding in the post-procedural period. Overall, these results support results of randomized trials that percutaneous LAAO may be an alternative to OAC use for patients with contraindications.
MeSH term(s)	Humans ; Female ; Aged ; United States/epidemiology ; Male ; Atrial Appendage/surgery ; Treatment Outcome ; Medicare ; Stroke/epidemiology ; Stroke/etiology ; Stroke/prevention & control ; Hemorrhage/chemically induced ; Hemorrhage/epidemiology ; Atrial Fibrillation/complications ; Atrial Fibrillation/epidemiology ; Atrial Fibrillation/chemically induced ; Anticoagulants/adverse effects
Chemical Substances	Anticoagulants
Language	English
Publishing date	2024-03-31
Publishing country	England
Document type	Journal Article
ZDB-ID	1099748-9
ISSN	1099-1557 ; 1053-8569
ISSN (online)	1099-1557
ISSN	1053-8569
DOI	10.1002/pds.5786
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Zs.A 3395: Show issues

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Article ; Online: Deep terminal negative of the P wave in V1 and incidence of ischemic stroke: The atherosclerosis risk in communities (ARIC) study.

Li, Mingfang / Ji, Yuekai / Shen, Youmei / Wang, Wendy / Lakshminarayan, Kamakshi / Soliman, Elsayed Z / Chen, Minglong / Chen, Lin Yee

Journal of electrocardiology

2024 Volume 84, Page(s) 123–128

Abstract: Background: Deep terminal negative of the P wave in V1 (DTNPV1) is a marker of left atrial remodeling. We aimed to evaluate the association of DTNPV1 with incident ischemic stroke.: Methods: The Atherosclerosis Risk in Communities study is a ... ...

Abstract	Background: Deep terminal negative of the P wave in V1 (DTNPV1) is a marker of left atrial remodeling. We aimed to evaluate the association of DTNPV1 with incident ischemic stroke. Methods: The Atherosclerosis Risk in Communities study is a prospective community-based cohort study. All participants at visit 4 (1996-1998) except those with prevalent stroke, missing covariates, and missing or uninterpretable ECG were included. DTNPV1 was defined as the absolute value of the depth of the terminal negative phase >100 μV in the presence of biphasic P wave in V1. Association between DTNPV1 as a time-dependent exposure variable and incident ischemic stroke was evaluated. The accuracy of the prediction model consisting of DTNPV1 and CHA Results: Among 10,605 participants (63 ± 6 years, 56% women, 20% Black), 803 cases of ischemic stroke occurred over a median follow-up of 20.19 years. After adjusting for demographics, DTNPV1 was associated with an increased risk of stroke (HR 1.96, [95% CI 1.39-2.77]). After further adjusting for stroke risk factors, use of aspirin and anticoagulants, and time-dependent atrial fibrillation, DTNPV1 was associated with a 1.50-fold (95% CI 1.06-2.13) increased risk of stroke. When added to the CHA Conclusion: DTNPV1 is significantly associated with higher risk of ischemic stroke. Since DTNPV1 is a simplified electrocardiographic parameter, it may help stroke prediction, a subject for further research.
Language	English
Publishing date	2024-04-16
Publishing country	United States
Document type	Journal Article
ZDB-ID	410286-1
ISSN	1532-8430 ; 0022-0736
ISSN (online)	1532-8430
ISSN	0022-0736
DOI	10.1016/j.jelectrocard.2024.03.016
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Article ; Online: High Incidence and Unique Features of Cerebral Venous Sinus Thrombosis in Hospitalized Patients With COVID-19 Infection.

McCullough-Hicks, Margy E / Halterman, Daniel J / Anderson, David / Cohen, Kenneth / Lakshminarayan, Kamakshi

Stroke

2022 Volume 53, Issue 9, Page(s) e407–e410

Abstract: Background: Cerebral venous sinus thrombosis (CVST) secondary to vaccine-induced thrombotic thrombocytopenia is an extremely rare side effect of adenovirus-based COVID-19 vaccines. CVST incidence associated with COVID-19 itself has not been widely ... ...

Abstract	Background: Cerebral venous sinus thrombosis (CVST) secondary to vaccine-induced thrombotic thrombocytopenia is an extremely rare side effect of adenovirus-based COVID-19 vaccines. CVST incidence associated with COVID-19 itself has not been widely reported. We report the incidence of CVST in patients hospitalized with COVID-19 during the first year of the pandemic. Methods: We analyzed de-identified electronic medical records of a retrospective cohort of patients admitted with COVID-19 to >200 hospitals between March 2020 and March 2021. We used Results: Ninety-one thousand seven hundred twenty-seven patients were evaluated; 22 had new CVST diagnoses by electronic medical record review. CVST incidence in the hospitalized COVID-19 cohort was 231 per 1 000 000 person-years (95% CI, 152.1-350.8). Females<50 had the highest incidence overall (males <50: 378.4 [142-1008.2]; females<50: 796.5 [428.6-1480.4]). In patients ≥50 years old, males had a higher estimated CVST incidence (males≥50: 130.5 [54.3-313.6]; females≥50: 88.8 [28.6-275.2]). Older patients (45.5% of patients ≥50 versus 0% of <50 years of age, Conclusions: CVST incidence in COVID-19-positive hospitalized patients is high. Advanced age and male gender were associated with likelihood of death in hospital; further studies are required to confirm these findings.
MeSH term(s)	COVID-19/complications ; COVID-19/epidemiology ; COVID-19 Vaccines ; Female ; Humans ; Incidence ; Male ; Middle Aged ; Retrospective Studies ; Sinus Thrombosis, Intracranial/epidemiology
Chemical Substances	COVID-19 Vaccines
Language	English
Publishing date	2022-08-03
Publishing country	United States
Document type	Journal Article
ZDB-ID	80381-9
ISSN	1524-4628 ; 0039-2499 ; 0749-7954
ISSN (online)	1524-4628
ISSN	0039-2499 ; 0749-7954
DOI	10.1161/STROKEAHA.122.038955
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Zs.A 448: Show issues

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Article: Post-Stroke Brain Health Monitoring and Optimization: A Narrative Review.

Stulberg, Eric L / Sachdev, Perminder S / Murray, Anne M / Cramer, Steven C / Sorond, Farzaneh A / Lakshminarayan, Kamakshi / Sabayan, Behnam

Journal of clinical medicine

2023 Volume 12, Issue 23

Abstract: Significant advancements have been made in recent years in the acute treatment and secondary prevention of stroke. However, a large proportion of stroke survivors will go on to have enduring physical, cognitive, and psychological disabilities from ... ...

Abstract	Significant advancements have been made in recent years in the acute treatment and secondary prevention of stroke. However, a large proportion of stroke survivors will go on to have enduring physical, cognitive, and psychological disabilities from suboptimal post-stroke brain health. Impaired brain health following stroke thus warrants increased attention from clinicians and researchers alike. In this narrative review based on an open timeframe search of the PubMed, Scopus, and Web of Science databases, we define post-stroke brain health and appraise the body of research focused on modifiable vascular, lifestyle, and psychosocial factors for optimizing post-stroke brain health. In addition, we make clinical recommendations for the monitoring and management of post-stroke brain health at major post-stroke transition points centered on four key intertwined domains: cognition, psychosocial health, physical functioning, and global vascular health. Finally, we discuss potential future work in the field of post-stroke brain health, including the use of remote monitoring and interventions, neuromodulation, multi-morbidity interventions, enriched environments, and the need to address inequities in post-stroke brain health. As post-stroke brain health is a relatively new, rapidly evolving, and broad clinical and research field, this narrative review aims to identify and summarize the evidence base to help clinicians and researchers tailor their own approach to integrating post-stroke brain health into their practices.
Language	English
Publishing date	2023-11-29
Publishing country	Switzerland
Document type	Journal Article ; Review
ZDB-ID	2662592-1
ISSN	2077-0383
ISSN	2077-0383
DOI	10.3390/jcm12237413
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Article ; Online: Procedure-Specific Center Volume and Mortality After Infantile Congenital Heart Surgery.

Zmora, Rachel / Spector, Logan / Bass, John / Thomas, Amanda / Knight, Jessica / Lakshminarayan, Kamakshi / St Louis, James / Kochilas, Lazaros

The Annals of thoracic surgery

2023 Volume 116, Issue 3, Page(s) 525–531

Abstract: Background: Regionalization of congenital heart surgery (CHS) has been proposed to improve postsurgical outcomes by increasing experience in the care of high-risk patients. We sought to determine whether procedure-specific center volume was associated ... ...

Abstract	Background: Regionalization of congenital heart surgery (CHS) has been proposed to improve postsurgical outcomes by increasing experience in the care of high-risk patients. We sought to determine whether procedure-specific center volume was associated with mortality after infantile CHS up to 3 years post-procedure. Methods: We analyzed data from 12,263 infants in the Pediatric Cardiac Care Consortium undergoing CHS between 1982 and 2003 at 46 centers within the United States. We used logistic regression to assess the association between procedure-specific center volume and mortality from discharge to 3 years post-procedure, accounting for clustering at the center level and adjusting for patient age and weight at surgery, chromosomal abnormality, and surgical era. Results: We found decreased odds for in-hospital mortality for Norwood procedures (odds ratio [OR] 0.955, 95% CI 0.935-0.976), arterial switch operations (OR 0.924, 95% CI 0.889-0.961), tetralogy of Fallot repairs (OR 0.975, 95% CI 0.956-0.995), Glenn shunts (OR 0.971, 95% CI 0.943-1.000), and ventricular septal defect closures (OR 0.974, 95% CI 0.964-0.985). The association persisted up to 3 years post-surgery for Norwood procedures (OR 0.971, 95% CI 0.955-0.988), arterial switches (OR 0.929, 95% CI 0.890-0.970), and ventricular septal defect closures (OR 0.986, 95% CI 0.977-0.995); however, after excluding deaths that occurred within the first 90 days of following surgery, we observed no association between center volume and mortality for any of the procedures studied. Conclusions: These findings suggest that procedure-specific center volume is inversely associated with early postoperative mortality for infantile CHS across the complexity spectrum but has no measurable effect on later mortality.
MeSH term(s)	Infant ; Child ; Humans ; United States/epidemiology ; Heart Defects, Congenital ; Cardiac Surgical Procedures ; Heart Septal Defects, Ventricular/complications ; Norwood Procedures ; Hospital Mortality ; Treatment Outcome
Language	English
Publishing date	2023-04-24
Publishing country	Netherlands
Document type	Journal Article
ZDB-ID	211007-6
ISSN	1552-6259 ; 0003-4975
ISSN (online)	1552-6259
ISSN	0003-4975
DOI	10.1016/j.athoracsur.2023.04.020
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