Artificial intelligence in stroke

Ictus; Reloj inteligente; ChatbotIctus; Rellotge intel·ligent; ChatbotStroke; Smartwatch; ChatbotLa inteligencia artificial (IA) tiene un gran campo de aplicación en el ictus y en sus diferentes fases de atención. En la fase aguda del ictus es útil para la detección de signos de afectación, permitiendo el reconocimiento facial automático y la medición del grado de paresia empleando sensores cinéticos. La neuroimagen cerebral puede interpretarse de manera automática para detectar zonas isquémicas empleando contraste, y también se puede detectar la presencia de oclusión vascular sin uso de contraste. Los relojes inteligentes pueden detectar fibrilación auricular, una de las principales causas de ictus, realizando electrocardiogramas digitales, pero también analizando el patrón del ritmo irregular sin intervención del usuario. La ecografía puede realizarse en diferentes entornos, en manos de no expertos, con dispositivos de bolsillo que analizan la imagen de manera automática. Para mejorar la prevención secundaria, el paciente puede interaccionar con un chatbot que le permitirá obtener una respuesta rápida a sus inquietudes. Finalmente, los robots son capaces de complementar la rehabilitación en pacientes que lo requieran tras un ictus.Artificial intelligence (AI) has a wide field of application in several stroke stages. In acute phase of stroke, AI is useful for detection of stroke signs such as facial palsy by automatic facial recognition and limb weakness using kinetic sensors. Brain scan can be automatically interpreted to detect cerebral ischemic using contrast, but even AI may detect vascular occlusion without any contrast. Smart watches can detect atrial fibrillation, one of the main causes of stroke, by digital electrocardiograms assessment but also by analyzing the irregular rhythm pattern without user intervention. Ultrasound can be performed in different settings, by non-experts, using pocket devices that integrates AI to automatically analyze the image. In order to improve secondary prevention, patient can interact with a chatbot that allows a quick response to their concerns. Finally, AI robots are capable of complementing rehabilitation for disabled patients after a stroke

Implantación de catgut en el tratamiento de la radiculopatía cervical crónica

Introduction: chronic cervical radiculopathy is a disease that affects the life quality of patient. Objective: to evaluate the therapeutic response of catgut implantation in the treatment of chronic cervical radiculopathy. Method: a quasi-experimental, longitudinal and prospective study was realized in 86 patients affected by chronic cervical radiculopathy at “Comandante Manuel Fajardo Rivero” Hospital between October 2010 and December 2013. Patients were divided into two groups, one of study and other of control; the first received as treatment the catgut implantation and the second with drugs. Theoretical methods were used: analysis-synthesis, deduction-induction, hypothetical-deductive and historical-logical; empirical methods: observation, measurement, experimentation and interview and descriptive statistical methods for the interpretation of the results. Results: it was found that the usefulness of catgut treatment prevailed in the study group and behaved the same in each of the variants that marked Bi syndrome. Conclusions: The therapeutic response to catgut implantation is satisfactory in the treatment of chronic cervical radiculopathy.Introducción: la radiculopatía cervical crónica es una enfermedad que afecta la calidad de vida del paciente. Objetivo: valorar la respuesta terapéutica de la implantación de catgut en el tratamiento de la radiculopatía cervical crónica. Método: se realizó un estudio cuasi experimental, longitudinal y prospectivo en 86 pacientes afectados por radiculopatía cervical crónica en el Hospital “Comandante Manuel Fajardo Rivero” entre octubre de 2010 y diciembre de 2013. Los pacientes fueron divididos en dos grupos, uno de estudio y otro de control; el primero recibió como tratamiento la implantación de catgut y el segundo fármacos. Se utilizaron métodos teóricos: análisis-síntesis, deducción-inducción, hipotético-deductivo e histórico-lógico; métodos empíricos: observación, medición, experimentación y entrevista y métodos estadísticos descriptivos para la interpretación de los resultados. Resultados: se constató que la utilidad del tratamiento con catgut prevaleció en el grupo estudio y que se comportó igual en cada una de las variantes que marcó el síndrome Bi. Conclusiones: la respuesta terapéutica a la implantación de catgut es satisfactoria en el tratamiento de la radiculopatía cervical crónica

Accuracy of a Smartwatch to Assess Heart Rate Monitoring and Atrial Fibrillation in Stroke Patients

Accuracy; Atrial fibrillation; SmartwatchPrecisión; Fibrilación auricular; Reloj inteligentePrecisió; Fibril·lació auricular; Rellotge intel·ligentBackground: Consumer smartwatches may be a helpful tool to screen for atrial fibrillation (AF). However, validation studies on older stroke patients remain scarce. The aim of this pilot study from RCT NCT05565781 was to validate the resting heart rate (HR) measurement and the irregular rhythm notification (IRN) feature in stroke patients in sinus rhythm (SR) and AF. (2) Methods: Resting clinical HR measurements (every 5 min) were assessed using continuous bedside ECG monitoring (CEM) and the Fitbit Charge 5 (FC5). IRNs were gathered after at least 4 h of CEM. Lin’s concordance correlation coefficient (CCC), Bland-Altman analysis, and mean absolute percentage error (MAPE) were used for agreement and accuracy assessment. (3) Results: In all, 526 individual pairs of measurements were obtained from 70 stroke patients—age 79.4 years (SD ± 10.2), 63% females, BMI 26.3 (IQ 22.2–30.5), and NIHSS score 8 (IQR 1.5–20). The agreement between the FC5 and CEM was good (CCC 0.791) when evaluating paired HR measurements in SR. Meanwhile, the FC5 provided weak agreement (CCC 0.211) and low accuracy (MAPE 16.48%) when compared to CEM recordings in AF. Regarding the accuracy of the IRN feature, analysis found a low sensitivity (34%) and high specificity (100%) for detecting AF. (4) Conclusion: The FC5 was accurate at assessing the HR during SR, but the accuracy during AF was poor. In contrast, the IRN feature was acceptable for guiding decisions regarding AF screening in stroke patients.This study was funded by the Instituto de Salud Carlos III and the European Union (ERDF/ESF)—A way to build Europe (PI20/01210). Funding was also received in the framework of the “Digital Health Research Promotion Program: from the idea to the project” from the eHealth Center of the Universitat Oberta de Catalunya (UOC)

External Validation of SAFE Score to Predict Atrial Fibrillation Diagnosis after Ischemic Stroke: A Retrospective Multicenter Study

Diagnóstico; Fibrilación auricular; Ictus isquémicoDiagnòstic; Fibril·lació auricular; Ictus isquèmicDiagnosis; Atrial fibrillation; Ischemic strokeIntroduction: The screening for atrial fibrillation (AF) scale (SAFE score) was recently developed to provide a prediction of the diagnosis of AF after an ischemic stroke. It includes 7 items: age ≥ 65 years, bronchopathy, thyroid disease, cortical location of stroke, intracranial large vessel occlusion, NT-ProBNP ≥250 pg/mL, and left atrial enlargement. In the internal validation, a good performance was obtained, with an AUC = 0.88 (95% CI 0.84-0.91) and sensitivity and specificity of 83% and 80%, respectively, for scores ≥ 5. The aim of this study is the external validation of the SAFE score in a multicenter cohort. Methods: A retrospective multicenter study, including consecutive patients with ischemic stroke or transient ischemic attack between 2020 and 2022 with at least 24 hours of cardiac monitoring. Patients with previous AF or AF diagnosed on admission ECG were excluded. Results: Overall, 395 patients were recruited for analysis. The SAFE score obtained an AUC = 0.822 (95% CI 0.778-0.866) with a sensitivity of 87.2%, a specificity of 65.4%, a positive predictive value of 44.1%, and a negative predictive value of 94.3% for a SAFE score ≥ 5, with no significant gender differences. Calibration analysis in the external cohort showed an absence of significant differences between the observed values and those predicted by the model (Hosmer-Lemeshow's test 0.089). Conclusions: The SAFE score showed adequate discriminative ability and calibration, so its external validation is justified. Further validations in other external cohorts or specific subpopulations of stroke patients might be required.We acknowledge FIBAO (Biomedical Research Foundation) and Adrián Aparicio Mota for their assistance with statistical analysis. Adrián Aparicio (a FIBAO statistician) analyzed the collected data. The project was the winner of the IV research grant “STROKE PROJECT 2020” from the Spanish Society of Neurology

Multiphase CT Angiography Improves Prediction of Intracerebral Hemorrhage Expansion

Angiography; Intracerebral hemorrhage; PredictionAngiografía; Hemorragia intracerebral; PredicciónAngiografia; Hemorràgia intracerebral; PrediccióPurpose To determine the prevalence of the spot sign and the accuracy of using the spot sign to predict intracerebral hemorrhage (ICH) expansion with standardized multiphase computed tomographic (CT) angiography. Materials and Methods This prospective observational cohort study included 123 consecutive patients with acute ICH (onset 33% or >6 mL) at 24 hours. Associations between the presence of the spot sign and substantial hematoma expansion were assessed by using the Pearson χ2 test. Results The later the phase of CT angiography, the higher the frequency of the spot sign. The spot sign was seen in 29.3% of patients in phase 1, 43.1% of patients in phase 2, and 46.3% of patients in phase 3 (P B > C > D > no spot sign (P = .002). Conclusion Multiphase CT angiography can help differentiate among different forms of spot sign presentation and can help stratify patients at risk for hematoma expansion. The more arterial the spot sign pattern, the greater the frequency and extent of expansion

Proteins and pathways in atrial fibrillation and atrial cardiomyopathy underlying cryptogenic stroke

Atrial fibrillation (AF) is one of the most prevalent causes of cryptogenic stroke. Also, apart from AF itself, structural and remodelling changes in the atria might be an underlying cause of cryptogenic stroke. We aimed to discover circulating proteins and reveal pathways altered in AF and atrial cardiomyopathy, measured by left atrial volume index (LAVI) and peak atrial longitudinal strain (PALS), in patients with cryptogenic stroke. An aptamer array (including 1310 proteins) was measured in the blood of 20 cryptogenic stroke patients monitored during 28 days with a Holter device as a case-control study of the Crypto-AF cohort. Protein levels were compared between patients with (n = 10) and without AF (n = 10) after stroke, and the best candidates were tested in 111 patients from the same cohort (44 patients with AF and 67 without AF). In addition, in the first 20 patients, proteins were explored according to PALS and LAVI values. Forty-six proteins were differentially expressed in AF cases. Of those, four proteins were tested in a larger sample size. Only DPP7, presenting lower levels in AF patients, was further validated. Fifty-seven proteins correlated with LAVI, and 270 correlated with PALS. NT-proBNP was common in all the discovery analyses performed. Interestingly, many proteins and pathways were altered in patients with low PALS. Multiple proteins and pathways related to AF and atrial cardiomyopathy have been revealed. The role of DPP7 as a biomarker for stroke aetiology should be further explored. Moreover, the present study may be considered hypothesis-generatin

Granulocytes-Rich Thrombi in Cerebral Large Vessel Occlusion Are Associated with Increased Stiffness and Poorer Revascularization Outcomes

Acute stroke; Flow cytometry; Mechanical thrombectomyIctus agut; Citometria de flux; Trombectomia mecànicaIctus agudo; Citometría de flujo; Trombectomía mecánicaWe aim to identify a profile of intracranial thrombus resistant to recanalization by mechanical thrombectomy (MT) in acute stroke treatment. The first extracted clot of each MT was analyzed by flow cytometry obtaining the composition of the main leukocyte populations: granulocytes, monocytes, and lymphocytes. Demographics, reperfusion treatment, and grade of recanalization were registered. MT failure (MTF) was defined as final thrombolysis in cerebral infarction score IIa or lower and/or need of permanent intracranial stenting as a rescue therapy. To explore the relationship between stiffness of intracranial clots and cellular composition, unconfined compression tests were performed in other cohorts of cases. Thrombi obtained in 225 patients were analyzed. MTF were observed in 30 cases (13%). MTF was associated with atherosclerosis etiology (33.3% vs. 15.9%; p = 0.021) and higher number of passes (3 vs. 2; p < 0.001). Clot analysis of MTF showed higher percentage of granulocytes [82.46 vs. 68.90% p < 0.001] and lower percentage of monocytes [9.18% vs.17.34%, p < 0.001] in comparison to successful MT cases. The proportion of clot granulocytes (aOR 1.07; 95% CI 1.01–1.14) remained an independent marker of MTF. Among thirty-eight clots mechanically tested, there was a positive correlation between granulocyte proportion and thrombi stiffness (Pearson’s r = 0.35, p = 0.032), with a median clot stiffness of 30.2 (IQR, 18.9–42.7) kPa. Granulocytes-rich thrombi are harder to capture by mechanical thrombectomy due to increased stiffness, so a proportion of intracranial granulocytes might be useful to guide personalized endovascular procedures in acute stroke treatment.Open Access Funding provided by Universitat Autonoma de Barcelona. This work was supported by “Project 355/C/2017, Fundació La Marató de TV3 in Strokes and Traumatic Spinal Cord and Brain Injury, 2017 Call of Projects.

Granulocytes-Rich Thrombi in Cerebral Large Vessel Occlusion Are Associated with Increased Stiffness and Poorer Revascularization Outcomes

Altres ajuts: acords transformatius de la UABWe aim to identify a profile of intracranial thrombus resistant to recanalization by mechanical thrombectomy (MT) in acute stroke treatment. The first extracted clot of each MT was analyzed by flow cytometry obtaining the composition of the main leukocyte populations: granulocytes, monocytes, and lymphocytes. Demographics, reperfusion treatment, and grade of recanalization were registered. MT failure (MTF) was defined as final thrombolysis in cerebral infarction score IIa or lower and/or need of permanent intracranial stenting as a rescue therapy. To explore the relationship between stiffness of intracranial clots and cellular composition, unconfined compression tests were performed in other cohorts of cases. Thrombi obtained in 225 patients were analyzed. MTF were observed in 30 cases (13%). MTF was associated with atherosclerosis etiology (33.3% vs. 15.9%; p = 0.021) and higher number of passes (3 vs. 2; p < 0.001). Clot analysis of MTF showed higher percentage of granulocytes [82.46 vs. 68.90% p < 0.001] and lower percentage of monocytes [9.18% vs.17.34%, p < 0.001] in comparison to successful MT cases. The proportion of clot granulocytes (aOR 1.07; 95% CI 1.01-1.14) remained an independent marker of MTF. Among thirty-eight clots mechanically tested, there was a positive correlation between granulocyte proportion and thrombi stiffness (Pearson's r = 0.35, p = 0.032), with a median clot stiffness of 30.2 (IQR, 18.9-42.7) kPa. Granulocytes-rich thrombi are harder to capture by mechanical thrombectomy due to increased stiffness, so a proportion of intracranial granulocytes might be useful to guide personalized endovascular procedures in acute stroke treatment. Supplementary Information: The online version contains supplementary material available at 10.1007/s13311-023-01385-1

Omecamtiv mecarbil in chronic heart failure with reduced ejection fraction, GALACTIC‐HF: baseline characteristics and comparison with contemporary clinical trials

Aims: The safety and efficacy of the novel selective cardiac myosin activator, omecamtiv mecarbil, in patients with heart failure with reduced ejection fraction (HFrEF) is tested in the Global Approach to Lowering Adverse Cardiac outcomes Through Improving Contractility in Heart Failure (GALACTIC‐HF) trial. Here we describe the baseline characteristics of participants in GALACTIC‐HF and how these compare with other contemporary trials. Methods and Results: Adults with established HFrEF, New York Heart Association functional class (NYHA) ≥ II, EF ≤35%, elevated natriuretic peptides and either current hospitalization for HF or history of hospitalization/ emergency department visit for HF within a year were randomized to either placebo or omecamtiv mecarbil (pharmacokinetic‐guided dosing: 25, 37.5 or 50 mg bid). 8256 patients [male (79%), non‐white (22%), mean age 65 years] were enrolled with a mean EF 27%, ischemic etiology in 54%, NYHA II 53% and III/IV 47%, and median NT‐proBNP 1971 pg/mL. HF therapies at baseline were among the most effectively employed in contemporary HF trials. GALACTIC‐HF randomized patients representative of recent HF registries and trials with substantial numbers of patients also having characteristics understudied in previous trials including more from North America (n = 1386), enrolled as inpatients (n = 2084), systolic blood pressure &lt; 100 mmHg (n = 1127), estimated glomerular filtration rate &lt; 30 mL/min/1.73 m2 (n = 528), and treated with sacubitril‐valsartan at baseline (n = 1594). Conclusions: GALACTIC‐HF enrolled a well‐treated, high‐risk population from both inpatient and outpatient settings, which will provide a definitive evaluation of the efficacy and safety of this novel therapy, as well as informing its potential future implementation