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Mo-P4:286 Seasonal variation in the occurrence of stroke in Northern Greece
P4
IMo-P4:285
Mon&ty, June 19, 2006: Poster Session Clbtical aspects of cardiovascular disectse
I
Ii R I S K F O R T R A N S I E N T I S C H E M I C A T T A C K S IS M A I N L Y D E T E R M I N E D BY I N T I M A - M E D I A THICKNESS AND CAROTID PLAQUE ECHOGENICITY
A. Kalogeropoulos, G. Hahalis, G. Terzis, A. Chrysanthopoulou, D. Siablis, D. Alexopoulos. Universi~ Hospital of Patras, Patras, Greece Objective: Stenosis severity, plaque morphology, and intima-media thickness (IMT), all have prognostic impact in patients with asymptomatic carotid artery disease. However, their independent contribution to risk for cerebrovascular events is uncleax. M e t h o d s : We compared the ultrasonographic characteristics of 88 consecutive patients with first transient ischemic attack (TIA) without known cardioembolic source with those of 176 asymptomatic control subjects. The control group was matched by propensity score for age, gender, body mass index, smoking status, hypertension, diabetes, and dyslipidemia. Results: IMT was higher in TIA patients compared to control subjects (0.744-0.14mm vs 0.684-0.13mm, p=0.001). Plaques were found in 71% of patients and 65% of controls (p=ns). Compared with controls, TIA patients demonstrated more frequently predominantly echolucent lesions (77% vs 56%, p=0.005) and high-grade carotid stenoses (21% vs 10%, p=0.042). TIA patients with low-to-moderate grade ( < 7 0 % ) lesions exhibited higher IMT (0.784-0.10mm vs. 0.714-0.12ram, p<0.001) and more prevalent echolucent morphology (78% vs 54%, p=0.007) in comparison with their control counterparts. No significant differences were observed regarding high-grade lesions. In multiwxiate models only IMT and plaque echogenicity emerged as independent determinants of risk. Conclusions: Risk for TIA is primarily associated with IMT and plaque echogenicity, especially in the absence of high-grade lesions. Stenosis severity appears to be of limited prognostic value, since the majority of patients at risk have low-to-moderate grade or no lesions. Funding: None
IMo-P4:286
I
Ii S E A S O N A L V A R I A T I O N IN T H E O C C U R R E N C E O F S T R O K E IN N O R T H E R N G R E E C E
A. Kaxagiannis, E Semertzidis, K. Tziomalos, A. Kakafika, M. Sileli, E. Kountana, V. Athyros, C. Zamboulis. Second Propedeutic Department of
Intental Medicine, Aristotle UnA,ersi~ of Thessaloniki, Hippokration Hospital, Thessaloniki, Greece Objective: Results of studies into the impact of seasonal variation on the incidence of stroke have been inconsistent. The main goal of this study was to investigate the seasonal variation of stroke occurrence in Northern Greece. M e t h o d s : During a period of seven years (1997-2004), 6425 patients (3302 men, 3123 women) with stroke have been enrolled. The four seasons were defined on the basis of meteorological reports: winter (December through February), spring (March through May), summer (June through August), and fall (September through November). Results: Strokes were divided into ischaemic strokes (IS, 77.8%), intracerebral haemorrhages (ICH, 11.4%), subaxachnoid haemorrhages (SAH, 3.6%) and transient ischaemic attacks (7.2%). A m o n g all patients, 26.8% developed stroke in winter, 26.3% in spring, 22.5% in summer and 24.2% in fall. Overall fatality during hospitalization was 14.3%; case fatality for IS was 11.6%, for ICH, 32.7% and for SAH 43.2%. There were no statistically significantly differences between stroke attack rates, stroke subtypes, fatality and four seasons. Conclusions: There is no seasonal influence on the incidence and fatality of stroke in Northern Greece.
IMo-P4:2871 CC OE RRERBERLAALT I OHNE MBOEDTYWNEAEMNI CMS E TINA BEOLLDOELRILSYM
AND
P A T I E N T S A F T E R I S C H E M I C S T R O K E C A U S E D BY ATHROSCLEROTIC VESSEL LESIONS S. Kuznetsova i Z. Rozhkova ~ , V. Kuznetsov 1 . 1b~stitute of Gerontology,
Kiev, Ukraine: 2Scientific Diagnostic Center; Kiev, Ukraine Objective: NAA, Cr and Cho determination in intact and damaged brain hemispheres of post-stroke patients; metabolism/volume blood flow rate (VBFR) relationships in extra- and intracranial vessels. M e t h o d s : 119 post-stroke patients aged 59-71 years and 100 healthy subjects 59-69 years (control). Ultrasound duplex scanning and 1H M R spectroscopy. Results: With right-sided hemisphere ischemia localisation, NAA, Cr and
109
Cho contents of occipital gray matter area of a damaged hemisphere were reduced: NAA (2.94-2.0), Cr (11.34-1.3) and Cho (8.74-1.0). Control values: 23.64-1.6, 12.94-1.5 and 9.64-1.4. With the left-sided, separate metabolites were measured only in frontal white matter area: NAA fall in damaged (1.94-2.1) and Cr and Cho rise in intact hemisphere: 13.84-1.0 and 11.74-1.2. Control values: 23.84-2.6, 10.64-1.6 and 9.34-2.11. Due to rehabilitation, the structure of correlation between metabolite contents and V B F R along carotid and vertebro-basilar vessels altered. With right-sided ischemia, the gray and white matter NAA, Cr and Cho contents of both hemispheres correlated with VBFR along respective median brain arteries. With left-sided ischemia, NAA contents of both hemispheres correlated with VBFR along left lumbar artery. Conclusion: After stroke there was the hemisphere-dependent reduction of major metabolite contents of occipital and frontal areas in both intact and damaged hemispheres. Finding: Due to treatment there took place a transformation of correlations between major metabolite contents and volume blood flow rate, being more marked in right-sided ischemia localisation.
I
I M o - P 4 : 2 8 8 Ii T H E D I A B E T E S M E L I T U S A S M A I N R I S K F A C T O R F O R S T R O K E IN I S L A N D L E M N O S G R E C C E POPULATION S. Paximadas 1, S. Pagoni 2 , E Nikitopoulou ] , G. Kalokerinos 2 , G. Katsigianni I , B. Kalompokis 1.1Second Department ofb~temal Medicine
attd Lipid Unit, General Hospital of Athens Elpis, Athens, Greece." 2Third Departnwnt of lntetTtal Medicine, General Hospital of Athens G.Gennin~ttas, Athens, Greece Introduction: In an attempt to evaluate the levels of several cardiovascular risk factors in island Lemnos Greece we conducted an epidemiological population-based health study. Purpose: In this population-based cohort study we recorded the basic cardiovascular risk factors as diabetes mellitus (D.M.) and old stroke in a radon sample from island Lemnos Greece. M a t e r i a l a n d M e t h o d s : We examined 655 radon adults, aged 61,9-4-13,3 (18-91) years, 198 (30,2%) males (M) and 457 (69,8%) females (F). The program of investigation included clinical data, laboratory analyses and recorded the D.M. and old stroke. Statistical analysis was performed using a SPSS 11,0. Results: 3,1% from sample had old stroke, 1,8% F and 1,2% M (95%C.I.=0,934, p=0,334), age 62-t-13 years NO - 71-t-6 years YES (p=0,001), 12,1% had D.M., 7,3% F and 4,7% M (95%C.I.=3,459, p=0,063), age 61-t-14 NO - 70-4-9 YES, (p=0,000), 0,9% had old stroke and D.M. (95%C.I.=6,259, p=0,012). C o n d u s i o n s : The study shows that the prevalence of old stroke there was in about 3% in our population, D.M. had about "'fi of population, the age of those who had old stroke or D.M. was more as compared to population without D.M. or old stroke, statistically significant end 1% had old stroke and D.M., statistically significant.
Mo-P4:2891I N T R A C R A N I A L
A T H E R O S C L E R O S I S IN F I R S T EVER ISCHEMIC STROKE: A PROSPECTIVE STUDY IN T H A I L A N D
K. Phanthumchinda, Y. Likitjaxoen, N.C. Suwanwela. ChulalongkotTz
Universi~, Bangkok, Thailand Objective: The prevalence of intracranial atherosclerosis in first ever ischemic stroke (FIS) patients has not been well documented. Computed tomography (CT) is a sensitive test to detect vascular calcification which reflects late stage atherosclerosis. This study was intended to probe the prevalence of intracranial atherosclerosis in FIS using CT. M e t h o d s : FIS patients aged more than 45 years admitted at Stroke Unit during a one year period were recruited. Non-atherosclerotic stroke was excluded by appropriate investigations. Types of ischemic stroke were classified by TOAST classification. Spiral scanning technique CT was performed. 2 carotid siphons, 2 middle cerebral arteries, one basilar artery and 2 vertebral arteries were evaluated, eFilm version 1.5.3. was used to evaluate the calcification. Results: 98 patients, 46 males and 52 females were recruited. The average age was 65.55 4- 11.45 years. Prevalence of intracranial vessel calcification was 66.3%. Large artery atherosclerosis (LAA) and small-vessel disease (SVD) were observed in 50 and 48 cases respectively. 64.0% of L A A and 68.8% of SVD had vascular calcification. Calcification was found in 117 internal carotid arteries, 7 middle cerebral arteries, 6 basilar arteries and 30 vertebral arteries. Moderate to severe calcification were found in 107 vessels.
XIV bztentational Symposium on Atherosclerosis, Rome, Italy, June 18-22, 2006
IMo-P4:285
Mon&ty, June 19, 2006: Poster Session Clbtical aspects of cardiovascular disectse
I
Ii R I S K F O R T R A N S I E N T I S C H E M I C A T T A C K S IS M A I N L Y D E T E R M I N E D BY I N T I M A - M E D I A THICKNESS AND CAROTID PLAQUE ECHOGENICITY
A. Kalogeropoulos, G. Hahalis, G. Terzis, A. Chrysanthopoulou, D. Siablis, D. Alexopoulos. Universi~ Hospital of Patras, Patras, Greece Objective: Stenosis severity, plaque morphology, and intima-media thickness (IMT), all have prognostic impact in patients with asymptomatic carotid artery disease. However, their independent contribution to risk for cerebrovascular events is uncleax. M e t h o d s : We compared the ultrasonographic characteristics of 88 consecutive patients with first transient ischemic attack (TIA) without known cardioembolic source with those of 176 asymptomatic control subjects. The control group was matched by propensity score for age, gender, body mass index, smoking status, hypertension, diabetes, and dyslipidemia. Results: IMT was higher in TIA patients compared to control subjects (0.744-0.14mm vs 0.684-0.13mm, p=0.001). Plaques were found in 71% of patients and 65% of controls (p=ns). Compared with controls, TIA patients demonstrated more frequently predominantly echolucent lesions (77% vs 56%, p=0.005) and high-grade carotid stenoses (21% vs 10%, p=0.042). TIA patients with low-to-moderate grade ( < 7 0 % ) lesions exhibited higher IMT (0.784-0.10mm vs. 0.714-0.12ram, p<0.001) and more prevalent echolucent morphology (78% vs 54%, p=0.007) in comparison with their control counterparts. No significant differences were observed regarding high-grade lesions. In multiwxiate models only IMT and plaque echogenicity emerged as independent determinants of risk. Conclusions: Risk for TIA is primarily associated with IMT and plaque echogenicity, especially in the absence of high-grade lesions. Stenosis severity appears to be of limited prognostic value, since the majority of patients at risk have low-to-moderate grade or no lesions. Funding: None
IMo-P4:286
I
Ii S E A S O N A L V A R I A T I O N IN T H E O C C U R R E N C E O F S T R O K E IN N O R T H E R N G R E E C E
A. Kaxagiannis, E Semertzidis, K. Tziomalos, A. Kakafika, M. Sileli, E. Kountana, V. Athyros, C. Zamboulis. Second Propedeutic Department of
Intental Medicine, Aristotle UnA,ersi~ of Thessaloniki, Hippokration Hospital, Thessaloniki, Greece Objective: Results of studies into the impact of seasonal variation on the incidence of stroke have been inconsistent. The main goal of this study was to investigate the seasonal variation of stroke occurrence in Northern Greece. M e t h o d s : During a period of seven years (1997-2004), 6425 patients (3302 men, 3123 women) with stroke have been enrolled. The four seasons were defined on the basis of meteorological reports: winter (December through February), spring (March through May), summer (June through August), and fall (September through November). Results: Strokes were divided into ischaemic strokes (IS, 77.8%), intracerebral haemorrhages (ICH, 11.4%), subaxachnoid haemorrhages (SAH, 3.6%) and transient ischaemic attacks (7.2%). A m o n g all patients, 26.8% developed stroke in winter, 26.3% in spring, 22.5% in summer and 24.2% in fall. Overall fatality during hospitalization was 14.3%; case fatality for IS was 11.6%, for ICH, 32.7% and for SAH 43.2%. There were no statistically significantly differences between stroke attack rates, stroke subtypes, fatality and four seasons. Conclusions: There is no seasonal influence on the incidence and fatality of stroke in Northern Greece.
IMo-P4:2871 CC OE RRERBERLAALT I OHNE MBOEDTYWNEAEMNI CMS E TINA BEOLLDOELRILSYM
AND
P A T I E N T S A F T E R I S C H E M I C S T R O K E C A U S E D BY ATHROSCLEROTIC VESSEL LESIONS S. Kuznetsova i Z. Rozhkova ~ , V. Kuznetsov 1 . 1b~stitute of Gerontology,
Kiev, Ukraine: 2Scientific Diagnostic Center; Kiev, Ukraine Objective: NAA, Cr and Cho determination in intact and damaged brain hemispheres of post-stroke patients; metabolism/volume blood flow rate (VBFR) relationships in extra- and intracranial vessels. M e t h o d s : 119 post-stroke patients aged 59-71 years and 100 healthy subjects 59-69 years (control). Ultrasound duplex scanning and 1H M R spectroscopy. Results: With right-sided hemisphere ischemia localisation, NAA, Cr and
109
Cho contents of occipital gray matter area of a damaged hemisphere were reduced: NAA (2.94-2.0), Cr (11.34-1.3) and Cho (8.74-1.0). Control values: 23.64-1.6, 12.94-1.5 and 9.64-1.4. With the left-sided, separate metabolites were measured only in frontal white matter area: NAA fall in damaged (1.94-2.1) and Cr and Cho rise in intact hemisphere: 13.84-1.0 and 11.74-1.2. Control values: 23.84-2.6, 10.64-1.6 and 9.34-2.11. Due to rehabilitation, the structure of correlation between metabolite contents and V B F R along carotid and vertebro-basilar vessels altered. With right-sided ischemia, the gray and white matter NAA, Cr and Cho contents of both hemispheres correlated with VBFR along respective median brain arteries. With left-sided ischemia, NAA contents of both hemispheres correlated with VBFR along left lumbar artery. Conclusion: After stroke there was the hemisphere-dependent reduction of major metabolite contents of occipital and frontal areas in both intact and damaged hemispheres. Finding: Due to treatment there took place a transformation of correlations between major metabolite contents and volume blood flow rate, being more marked in right-sided ischemia localisation.
I
I M o - P 4 : 2 8 8 Ii T H E D I A B E T E S M E L I T U S A S M A I N R I S K F A C T O R F O R S T R O K E IN I S L A N D L E M N O S G R E C C E POPULATION S. Paximadas 1, S. Pagoni 2 , E Nikitopoulou ] , G. Kalokerinos 2 , G. Katsigianni I , B. Kalompokis 1.1Second Department ofb~temal Medicine
attd Lipid Unit, General Hospital of Athens Elpis, Athens, Greece." 2Third Departnwnt of lntetTtal Medicine, General Hospital of Athens G.Gennin~ttas, Athens, Greece Introduction: In an attempt to evaluate the levels of several cardiovascular risk factors in island Lemnos Greece we conducted an epidemiological population-based health study. Purpose: In this population-based cohort study we recorded the basic cardiovascular risk factors as diabetes mellitus (D.M.) and old stroke in a radon sample from island Lemnos Greece. M a t e r i a l a n d M e t h o d s : We examined 655 radon adults, aged 61,9-4-13,3 (18-91) years, 198 (30,2%) males (M) and 457 (69,8%) females (F). The program of investigation included clinical data, laboratory analyses and recorded the D.M. and old stroke. Statistical analysis was performed using a SPSS 11,0. Results: 3,1% from sample had old stroke, 1,8% F and 1,2% M (95%C.I.=0,934, p=0,334), age 62-t-13 years NO - 71-t-6 years YES (p=0,001), 12,1% had D.M., 7,3% F and 4,7% M (95%C.I.=3,459, p=0,063), age 61-t-14 NO - 70-4-9 YES, (p=0,000), 0,9% had old stroke and D.M. (95%C.I.=6,259, p=0,012). C o n d u s i o n s : The study shows that the prevalence of old stroke there was in about 3% in our population, D.M. had about "'fi of population, the age of those who had old stroke or D.M. was more as compared to population without D.M. or old stroke, statistically significant end 1% had old stroke and D.M., statistically significant.
Mo-P4:2891I N T R A C R A N I A L
A T H E R O S C L E R O S I S IN F I R S T EVER ISCHEMIC STROKE: A PROSPECTIVE STUDY IN T H A I L A N D
K. Phanthumchinda, Y. Likitjaxoen, N.C. Suwanwela. ChulalongkotTz
Universi~, Bangkok, Thailand Objective: The prevalence of intracranial atherosclerosis in first ever ischemic stroke (FIS) patients has not been well documented. Computed tomography (CT) is a sensitive test to detect vascular calcification which reflects late stage atherosclerosis. This study was intended to probe the prevalence of intracranial atherosclerosis in FIS using CT. M e t h o d s : FIS patients aged more than 45 years admitted at Stroke Unit during a one year period were recruited. Non-atherosclerotic stroke was excluded by appropriate investigations. Types of ischemic stroke were classified by TOAST classification. Spiral scanning technique CT was performed. 2 carotid siphons, 2 middle cerebral arteries, one basilar artery and 2 vertebral arteries were evaluated, eFilm version 1.5.3. was used to evaluate the calcification. Results: 98 patients, 46 males and 52 females were recruited. The average age was 65.55 4- 11.45 years. Prevalence of intracranial vessel calcification was 66.3%. Large artery atherosclerosis (LAA) and small-vessel disease (SVD) were observed in 50 and 48 cases respectively. 64.0% of L A A and 68.8% of SVD had vascular calcification. Calcification was found in 117 internal carotid arteries, 7 middle cerebral arteries, 6 basilar arteries and 30 vertebral arteries. Moderate to severe calcification were found in 107 vessels.
XIV bztentational Symposium on Atherosclerosis, Rome, Italy, June 18-22, 2006