9 research outputs found
Stroke patients with cancer are at increased risk of recurrent stroke and cardiovascular mortality
Background: Cancer patients are at increased risk of cardiovascular and cerebrovascular events. It is unclear
whether cancer confers any additional risk for recurrent stroke or cardiovascular mortality after stroke.
Methods: This was a single-centre, observational study of 1105 consecutive Chinese ischaemic stroke patients
recruited from a large stroke rehabilitation unit based in Hong Kong. We sought to determine whether patients
with cancer are at higher risk of recurrent stroke and cardiovascular mortality.
Results: Among 1105 patients, 58 patients (5.2%) had cancer, of whom 74% were in remission. After a mean
follow-up of 76 ± 18 months, 241 patients developed a recurrent stroke: 22 in patients with cancer (38%, annual
incidence, 13.94%/year), substantially more than those without cancer (21%, 4.65%/year) [P < 0.01]. In a Cox
regression model, cancer, age, and atrial fibrillation were the three independent predictors of recurrent stroke
with a hazard ratio (HR) of 2.42 (95% confidence interval [CI], 1.54-3.80), 1.01 (1.00-1.03), and 1.35 (1.01-1.82),
respectively. Likewise, patients with cancer had a higher cardiovascular mortality compared with those without
cancer (4.30%/year vs 2.35%/year; P = 0.08). In Cox regression analysis, cancer (HR = 2.08; 95% CI, 1.08-4.02), age
(HR = 1.04; 95% CI, 1.02-1.06), heart failure (HR = 3.07; 95% CI, 1.72-5.47), and significant carotid atherosclerosis
(HR = 1.55; 95% CI, 1.02-2.36) were independent predictors for cardiovascular mortality.
Conclusions: Cancer patients who develop ischaemic stroke are at increased risk of recurrent stroke and
cardiovascular mortality.published_or_final_versio
Variants, clinical characteristics and prognostic factors of Guillain-Barre syndrome in Chinese
INTRODUCTION: The variants, clinical characteristics, and prognostic factors of Guillain-Barre syndrome (GBS) in Hong Kong Chinese has not been widely studied previously. METHODS: We performed a retrospective review of adults with GBS admitted to Queen Mary Hospital, Hong Kong during the peri…published_or_final_versio
Long-term prognostic implications of visit-to-visit blood pressure variability in patients with ischaemic stroke
Background: Both blood pressure (BP) and its variability (BPV) are established risk factors for the development
of atherosclerotic diseases and are associated with an increased risk of cardiovascular and all-cause mortality.
The long-term prognostic implications of out-patient clinic visit-to-visit BPV among patients with ischaemic
stroke are nevertheless unknown.
Methods: We prospectively followed up the clinical outcome of 632 consecutive ischaemic stroke patients
without atrial fibrillation. The mean BP and BPV, as determined by the coefficient of variation of the systolic and
diastolic BP, were recorded during a mean of 12 ± 6 outpatient clinic visits.
Results: The mean age of the patients was 71 ± 11 years. After a mean of 76 ± 18 month’s follow-up, 161 (26%)
patients died, 35% (56/161) were due to cardiovascular causes. 16% and 5% developed recurrent stroke and
acute coronary syndrome (ACS), respectively. After adjusting for mean systolic BP and confounding variables,
patients with a high systolic BPV were at significantly greater risk of cardiovascular mortality (hazard ratio [HR]
= 2.36; 95% confidence interval [CI], 1.02-5.49; P < 0.05). A high systolic BPV also predicted all-cause mortality
after adjusting for mean systolic BP (HR = 1.79; 95% CI, 1.16-2.75; P < 0.05). There was no association between
systolic BPV with non-fatal recurrent stroke nor non-fatal ACS. A raised diastolic BPV did not predict recurrent
non-fatal stroke, non-fatal ACS nor mortality.
Conclusions: Visit-to-visit systolic BPV predicts long-term all-cause and cardiovascular mortality in patients with
ischaemic stroke without atrial fibrillation, independent of other conventional risk factors including average BP
control.published_or_final_versio
Visit-to-visit systolic blood pressure variability predicts all-cause and cardiovascular mortality after lacunar infarct
Background: Both blood pressure (BP) and its variability (BPV) are established risk factors for development of
atherosclerotic disease and are associated with an increased risk for cardiovascular and all-cause mortality.
The prognostic implications of out-patient clinic visit-to-visit BPV among patients with lacunar infarction are
nevertheless unknown.
Methods: We prospectively followed up the clinical outcome of 281 patients with lacunar infarction. The mean
BP and BPV, as determined by the standard deviation of the systolic and diastolic BP, were recorded during a
mean of 13 ± 6 out-patient clinic visits.
Results: The mean age of the population was 70 ± 10 years. After a mean of 78 ± 18 month’s follow-up, 65 (23%)
patients died, 31% (20/65) were due to cardiovascular causes. 14% and 7% developed recurrent stroke and acute
coronary syndrome, respectively. After adjusting for age, sex, mean systolic and diastolic BP, cardiovascular
risk factors and co-morbidities, patients with a systolic BPV of the third tertile had significantly higher risk of
all-cause (hazard ratio [HR] = 1.97; 95% confidence interval [CI], 1.02-3.80; P = 0.04) and cardiovascular mortality
(HR = 7.64; 95% CI, 1.65-35.41; P < 0.01) compared to those with systolic BPV of the first tertile. Nevertheless,
systolic BPV did not predict recurrent stroke or acute coronary syndrome. Diastolic BPV did not predict various
adverse clinical outcomes.
Conclusions: Visit-to-visit systolic BPV predicts long-term all-cause and cardiovascular mortality after lacunar
infarct, independent of conventional risk factors including average BP control.published_or_final_versio
Myasthenic crisis in patients with generalised myasthenia gravis
INTRODUCTION: Myasthenia gravis (MG) is an important autoimmune disease causing generalised weakness and
even mortality, which is amenable to immunotherapies. Myasthenic crisis (MC) is the most serious presentation
of MG typically requiring ventilator support under the care of intensive care unit. We studied factors which
predict development of MC in generalised MG (gMG) patients and patients’ serum cytokine levels as potential
biomarkers for MG exacerbation and crisis ...published_or_final_versio
Long-Term Prognostic Implications of Visit-to-Visit Blood Pressure Variability in Patients With Ischemic Stroke
BACKGROUND: Blood pressure (BP) variability (BPV) is a novel risk factor for the development of atherosclerotic diseases. High BPV has recently been shown to predict all-cause and cardiovascular mortality in patients with lacunar infarct. Whether BPV has prognostic implications in patients with ischemic stroke subtypes, other than those due to small-vessel occlusion, remains uncertain.
METHODS: We prospectively followed up the clinical outcome of 632 consecutive ischemic stroke patients without atrial fibrillation. The average BP and BPV, as determined by the coefficient of variation of the systolic and diastolic BP, were recorded during a mean 12 ± 6 outpatient clinic visits.
RESULTS: The average age of the population was 71 ± 11 years. After a mean of 76 ± 18 months of follow-up, 161 patients died (26%); 35% (n = 56 of 161) of these deaths were due to cardiovascular causes. Sixteen percent and 5% developed recurrent stroke and acute coronary syndrome (ACS), respectively. After adjusting for mean systolic BP and confounding variables, patients with high systolic BPV were at significantly greater risk of cardiovascular mortality (hazards ratio (HR) = 2.36; 95% confidence interval (CI) = 1.02-5.49; P < 0.05). High systolic BPV also predicted all-cause mortality after adjusting for mean systolic BP (HR = 1.79; 95% CI = 1.16-2.75; P < 0.05). There was no association between systolic BPV and nonfatal recurrent stroke or nonfatal ACS. Raised diastolic BPV did not predict recurrent nonfatal stroke, nonfatal ACS, or mortality.
CONCLUSIONS: Visit-to-visit systolic BPV predicts long-term all-cause and cardiovascular mortality in patients with ischemic stroke without atrial fibrillation, independent of other conventional risk factors, including average BP control
Myasthenic crisis in patients with generalised myasthenia gravis. Hong Kong Academy of Medicine, 2014.
Establishing an eLearning Platform in Clinical Neurosciences
HKU Li Ka Shing Faculty of Medicine Frontiers Series: ‘MOOCs in Postmodern Asia’ (27 Oct 2014) ‘Big Data and Precision Medicine’ (28 Oct 2014