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Hooman Kamel - One of the best experts on this subject based on the ideXlab platform.

  • abstract p603 atrial Cardiopathy and brain infarction in multiple vascular territories in the arcadia trial
    Stroke, 2021
    Co-Authors: Hooman Kamel
    Abstract:

    Introduction: Some embolic strokes of undetermined source (ESUS) are likely caused by occult cardiac embolism. One potential cardioembolic source is atrial Cardiopathy without atrial fibrillation (...

  • racial differences in atrial Cardiopathy phenotypes in ischemic stroke patients
    Neurology, 2021
    Co-Authors: Hooman Kamel, Kathleen Alwell, Brett M Kissela, Heidi Sucharew, Daniel Woo, Matthew L Flaherty, Simona Ferioli, Stacie L Demel, Charles J Moomaw
    Abstract:

    Objective To test the hypothesis that thrombogenic atrial Cardiopathy may be relevant to stroke-related racial disparities, we compared atrial Cardiopathy phenotypes between Black vs White patients with ischemic stroke. Methods We assessed markers of atrial Cardiopathy in the Greater Cincinnati/Northern Kentucky Stroke Study, a study of stroke incidence in a population of 1.3 million. We obtained ECGs and reports of echocardiograms performed during evaluation of stroke during the 2010/2015 study periods. Patients with atrial fibrillation (AF) or flutter (AFL) were excluded. Investigators blinded to patients9 characteristics measured P-wave terminal force in ECG lead V1 (PTFV1), a marker of left atrial fibrosis and impaired interatrial conduction, and abstracted left atrial diameter from echocardiogram reports. Linear regression was used to examine the association between race and atrial Cardiopathy markers after adjustment for demographics, body mass index, and vascular comorbidities. Results Among 3,426 ischemic stroke cases in Black or White patients without AF/AFL, 2,391 had a left atrial diameter measurement (mean, 3.65 ± 0.70 cm). Black race was associated with smaller left atrial diameter in unadjusted (β coefficient, −0.11; 95% confidence interval [CI], −0.17 to −0.05) and adjusted (β, −0.15; 95% CI, −0.21 to −0.09) models. PTFV1 measurements were available in 3,209 patients (mean, 3,434 ± 2,525 μV*ms). Black race was associated with greater PTFV1 in unadjusted (β, 1.59; 95% CI, 1.21–1.97) and adjusted (β, 1.45; 95% CI, 1.00–1.80) models. Conclusions We found systematic Black–White racial differences in left atrial structure and pathophysiology in a population-based sample of patients with ischemic stroke. Classification of Evidence This study provides Class II evidence that atrial Cardiopathy phenotypes differ in Black people with acute stroke compared to White people.

  • atrial Cardiopathy and stroke mortality in the general population
    International Journal of Stroke, 2020
    Co-Authors: Muhammad Imtiaz Ahmad, Hooman Kamel, Matthew J Singleton, Prashant D Bhave, Elsayed Z Soliman
    Abstract:

    BackgroundPrior studies examining the link between atrial Cardiopathy and stroke risk have focused mainly on non-fatal stroke.AimsTo examine the association between atrial Cardiopathy and stroke mo...

  • abstract 26 predictors of atrial Cardiopathy among patients in the arcadia trial an analysis of the first 924 patients
    Stroke, 2020
    Co-Authors: Mitchell S.v. Elkind, David L Tirschwell, Richard A Kronmal, Joseph P Broderick, Caitlyn Meinzer, Will Longstreth, Seemant Chaturvedi, Claudia S Moy, Hooman Kamel
    Abstract:

    Background: Atrial Cardiopathy (AC) in absence of atrial fibrillation is a suspected cause of embolic stroke of undetermined source (ESUS). Predictors of AC remain incompletely characterized. We hy...

  • atrial Cardiopathy and nonstenosing large artery plaque in patients with embolic stroke of undetermined source
    Stroke, 2020
    Co-Authors: Hooman Kamel, Lesly A Pearce, George Ntaios, David J Gladstone, Kanjana S Perera, Risto O Roine, Elena Meseguer, Ashkan Shoamanesh, Scott D Berkowitz, Hardi Mundl
    Abstract:

    Background and Purpose— Atrial Cardiopathy and atherosclerotic plaque are two potential mechanisms underlying embolic strokes of undetermined source (ESUS). The relationship between these two mecha...

Mitchell S.v. Elkind - One of the best experts on this subject based on the ideXlab platform.

  • abstract 26 predictors of atrial Cardiopathy among patients in the arcadia trial an analysis of the first 924 patients
    Stroke, 2020
    Co-Authors: Mitchell S.v. Elkind, David L Tirschwell, Richard A Kronmal, Joseph P Broderick, Caitlyn Meinzer, Will Longstreth, Seemant Chaturvedi, Claudia S Moy, Hooman Kamel
    Abstract:

    Background: Atrial Cardiopathy (AC) in absence of atrial fibrillation is a suspected cause of embolic stroke of undetermined source (ESUS). Predictors of AC remain incompletely characterized. We hy...

  • atrial Cardiopathy and stroke prevention
    Current Cardiology Reports, 2018
    Co-Authors: Mitchell S.v. Elkind
    Abstract:

    Many patients with ischemic stroke have a stroke syndrome and neuroimaging findings consistent with embolism, but no evidence of atrial fibrillation. Recent data suggest that the pathological atrial substrate, or atrial Cardiopathy, that underlies atrial fibrillation, rather than atrial fibrillation itself, may be an important cause of unexplained strokes. This paper will review the literature on the rationale and data behind the concept of atrial Cardiopathy, its pathophysiology, suggested biomarkers of atrial Cardiopathy, and therapeutic implications. Several lines of evidence suggest that patients can have strokes associated with disorders of the atrium, even without frank atrial fibrillation. Even in patients with paroxysmal atrial fibrillation, cardiac emboli may occur temporally disassociated from episodes of atrial fibrillation, and the left atrial appendage flow patterns associated with increased thromboembolic risk may occur even when the surface electrocardiogram demonstrates normal sinus rhythm. Biomarkers of left atrial structural and electrophysiological abnormalities have been associated with stroke risk, even in the absence of atrial fibrillation. Atrial Cardiopathy, as determined by the presence of biomarkers of left atrial dysfunction, may provide a therapeutic target to reduce the risk of cardioembolic stroke in the absence of atrial fibrillation. Clinical trials are currently ongoing to test this hypothesis.

  • abstract 173 atrial Cardiopathy and the risk of ischemic stroke in the cardiovascular health study
    Stroke, 2018
    Co-Authors: Hooman Kamel, Kristen K. Patton, Evan L. Thacker, Traci M. Bartz, Rebecca F. Gottesman, Mitchell S.v. Elkind, Phyllis K. Stein, Peter M. Okin, Christopher Defilippi, Susan R. Heckbert
    Abstract:

    Introduction: Several lines of evidence indicate that some cases of cryptogenic stroke may be due to an atrial Cardiopathy that forms a nidus for thrombus formation and embolization even in the abs...

  • Atrial Cardiopathy and the risk of ischemic stroke in the chs (cardiovascular health study)
    Stroke, 2018
    Co-Authors: Hooman Kamel, Christopher R. De Filippi, Kristen K. Patton, Evan L. Thacker, Traci M. Bartz, Rebecca F. Gottesman, Mitchell S.v. Elkind, Phyllis K. Stein, Peter M. Okin, Susan R. Heckbert
    Abstract:

    BACKGROUND AND PURPOSE Emerging evidence suggests that an underlying atrial Cardiopathy may result in thromboembolism before atrial fibrillation (AF) develops. We examined the association between various markers of atrial Cardiopathy and the risk of ischemic stroke. METHODS The CHS (Cardiovascular Health Study) prospectively enrolled community-dwelling adults ≥65 years of age. For this study, we excluded participants diagnosed with stroke or AF before baseline. Exposures were several markers of atrial Cardiopathy: baseline P-wave terminal force in ECG lead V1, left atrial dimension on echocardiogram, and N terminal pro B type natriuretic peptide (NT-proBNP), as well as incident AF. Incident AF was ascertained from 12-lead electrocardiograms at annual study visits for the first decade after study enrollment and from inpatient and outpatient Medicare data throughout follow-up. The primary outcome was incident ischemic stroke. We used Cox proportional hazards models that included all 4 atrial Cardiopathy markers along with adjustment for demographic characteristics and established vascular risk factors. RESULTS Among 3723 participants who were free of stroke and AF at baseline and who had data on all atrial Cardiopathy markers, 585 participants (15.7%) experienced an incident ischemic stroke during a median 12.9 years of follow-up. When all atrial Cardiopathy markers were combined in 1 Cox model, we found significant associations with stroke for P-wave terminal force in ECG lead V1 (hazard ratio per 1000 μV*ms 1.04; 95% confidence interval, 1.001-1.08), log-transformed NT-proBNP (hazard ratio per doubling of NT-proBNP, 1.09; 95% confidence interval, 1.03-1.16), and incident AF (hazard ratio, 2.04; 95% confidence interval, 1.67-2.48) but not left atrial dimension (hazard ratio per cm, 0.96; 95% confidence interval, 0.84-1.10). CONCLUSIONS In addition to clinically apparent AF, other evidence of abnormal atrial substrate is associated with subsequent ischemic stroke. This finding is consistent with the hypothesis that thromboembolism from the left atrium may occur in the setting of several different manifestations of atrial disease.

  • atrial Cardiopathy a mechanism of cryptogenic stroke
    Expert Review of Cardiovascular Therapy, 2017
    Co-Authors: Shadi Yaghi, Hooman Kamel, Mitchell S.v. Elkind
    Abstract:

    ABSTRACTIntroduction: Cryptogenic stroke accounts for approximately 30% of all ischemic strokes. Recently, atrial Cardiopathy diagnosed by the presence of one of its serum, imaging, or electrocardiogram biomarkers has been shown to be associated with ischemic stroke, particularly of embolic subtypes.Areas covered: This paper aims to summarize data on occult atrial fibrillation and stroke, provide an overview on mechanisms, such as inflammation and fibrosis, of stroke in atrial Cardiopathy, critically review data on biomarkers of atrial Cardiopathy and their association with stroke, and suggest therapeutic implications, including directions for future research.Expert commentary: Atrial Cardiopathy may constitute one of the mechanisms in cryptogenic stroke, and patients with evidence of atrial Cardiopathy constitute a group of patients in whom clinical trials are warranted to test anticoagulation versus antiplatelet therapy to reduce stroke recurrence risk. In addition, more studies are needed to determine ...

David J Gladstone - One of the best experts on this subject based on the ideXlab platform.

Rebecca F. Gottesman - One of the best experts on this subject based on the ideXlab platform.

  • associations between atrial Cardiopathy and cerebral amyloid the aric pet study
    Journal of the American Heart Association, 2020
    Co-Authors: Michelle C Johansen, Thomas H Mosley, David S Knopman, Dean F Wong, Chiadi E Ndumele, Amil M Shah, Scott D Solomon, Rebecca F. Gottesman
    Abstract:

    Background Atrial fibrillation (AF) is a risk factor for cognitive decline, possibly from silent brain infarction. Left atrial changes in structure or function (atrial Cardiopathy) can lead to AF b...

  • understanding atrial Cardiopathy an under recognized contributor to cardioembolic stroke
    Current Treatment Options in Neurology, 2019
    Co-Authors: Michelle C Johansen, Henrique Doria De Vasconcellos, Rebecca F. Gottesman
    Abstract:

    Ischemic stroke is the fifth leading cause of death in the world with cardioembolic stroke (CES) causing a disproportional amount of the morbidity and mortality associated with stroke. Atrial fibrillation (AF) is the leading cause of CES, and as the population ages, the incidence of CES is anticipated to rise. The importance of proper diagnosis and treatment of patients with embolic-appearing stroke is significant due to the burden of disease and the severity of the illness. The past decade has seen an explosion of treatment options for patients with CES related to AF as well as better mechanisms by which to monitor and diagnose patients with AF. While optimal secondary prevention of stroke with anticoagulation in the setting of AF is known, what remains to be defined is the appropriate treatment of other types of strokes that appear embolic, but no source of the embolism is discovered. In this article, we will review what is known about the diagnosis and treatment of CES, discuss the emergence of novel therapeutics and emphasize what must be investigated in the future to move the field forward, such as the emerging concept of atrial Cardiopathy.

  • abstract 173 atrial Cardiopathy and the risk of ischemic stroke in the cardiovascular health study
    Stroke, 2018
    Co-Authors: Hooman Kamel, Kristen K. Patton, Evan L. Thacker, Traci M. Bartz, Rebecca F. Gottesman, Mitchell S.v. Elkind, Phyllis K. Stein, Peter M. Okin, Christopher Defilippi, Susan R. Heckbert
    Abstract:

    Introduction: Several lines of evidence indicate that some cases of cryptogenic stroke may be due to an atrial Cardiopathy that forms a nidus for thrombus formation and embolization even in the abs...

  • Atrial Cardiopathy and the risk of ischemic stroke in the chs (cardiovascular health study)
    Stroke, 2018
    Co-Authors: Hooman Kamel, Christopher R. De Filippi, Kristen K. Patton, Evan L. Thacker, Traci M. Bartz, Rebecca F. Gottesman, Mitchell S.v. Elkind, Phyllis K. Stein, Peter M. Okin, Susan R. Heckbert
    Abstract:

    BACKGROUND AND PURPOSE Emerging evidence suggests that an underlying atrial Cardiopathy may result in thromboembolism before atrial fibrillation (AF) develops. We examined the association between various markers of atrial Cardiopathy and the risk of ischemic stroke. METHODS The CHS (Cardiovascular Health Study) prospectively enrolled community-dwelling adults ≥65 years of age. For this study, we excluded participants diagnosed with stroke or AF before baseline. Exposures were several markers of atrial Cardiopathy: baseline P-wave terminal force in ECG lead V1, left atrial dimension on echocardiogram, and N terminal pro B type natriuretic peptide (NT-proBNP), as well as incident AF. Incident AF was ascertained from 12-lead electrocardiograms at annual study visits for the first decade after study enrollment and from inpatient and outpatient Medicare data throughout follow-up. The primary outcome was incident ischemic stroke. We used Cox proportional hazards models that included all 4 atrial Cardiopathy markers along with adjustment for demographic characteristics and established vascular risk factors. RESULTS Among 3723 participants who were free of stroke and AF at baseline and who had data on all atrial Cardiopathy markers, 585 participants (15.7%) experienced an incident ischemic stroke during a median 12.9 years of follow-up. When all atrial Cardiopathy markers were combined in 1 Cox model, we found significant associations with stroke for P-wave terminal force in ECG lead V1 (hazard ratio per 1000 μV*ms 1.04; 95% confidence interval, 1.001-1.08), log-transformed NT-proBNP (hazard ratio per doubling of NT-proBNP, 1.09; 95% confidence interval, 1.03-1.16), and incident AF (hazard ratio, 2.04; 95% confidence interval, 1.67-2.48) but not left atrial dimension (hazard ratio per cm, 0.96; 95% confidence interval, 0.84-1.10). CONCLUSIONS In addition to clinically apparent AF, other evidence of abnormal atrial substrate is associated with subsequent ischemic stroke. This finding is consistent with the hypothesis that thromboembolism from the left atrium may occur in the setting of several different manifestations of atrial disease.

Susan R. Heckbert - One of the best experts on this subject based on the ideXlab platform.

  • abstract 173 atrial Cardiopathy and the risk of ischemic stroke in the cardiovascular health study
    Stroke, 2018
    Co-Authors: Hooman Kamel, Kristen K. Patton, Evan L. Thacker, Traci M. Bartz, Rebecca F. Gottesman, Mitchell S.v. Elkind, Phyllis K. Stein, Peter M. Okin, Christopher Defilippi, Susan R. Heckbert
    Abstract:

    Introduction: Several lines of evidence indicate that some cases of cryptogenic stroke may be due to an atrial Cardiopathy that forms a nidus for thrombus formation and embolization even in the abs...

  • Atrial Cardiopathy and the risk of ischemic stroke in the chs (cardiovascular health study)
    Stroke, 2018
    Co-Authors: Hooman Kamel, Christopher R. De Filippi, Kristen K. Patton, Evan L. Thacker, Traci M. Bartz, Rebecca F. Gottesman, Mitchell S.v. Elkind, Phyllis K. Stein, Peter M. Okin, Susan R. Heckbert
    Abstract:

    BACKGROUND AND PURPOSE Emerging evidence suggests that an underlying atrial Cardiopathy may result in thromboembolism before atrial fibrillation (AF) develops. We examined the association between various markers of atrial Cardiopathy and the risk of ischemic stroke. METHODS The CHS (Cardiovascular Health Study) prospectively enrolled community-dwelling adults ≥65 years of age. For this study, we excluded participants diagnosed with stroke or AF before baseline. Exposures were several markers of atrial Cardiopathy: baseline P-wave terminal force in ECG lead V1, left atrial dimension on echocardiogram, and N terminal pro B type natriuretic peptide (NT-proBNP), as well as incident AF. Incident AF was ascertained from 12-lead electrocardiograms at annual study visits for the first decade after study enrollment and from inpatient and outpatient Medicare data throughout follow-up. The primary outcome was incident ischemic stroke. We used Cox proportional hazards models that included all 4 atrial Cardiopathy markers along with adjustment for demographic characteristics and established vascular risk factors. RESULTS Among 3723 participants who were free of stroke and AF at baseline and who had data on all atrial Cardiopathy markers, 585 participants (15.7%) experienced an incident ischemic stroke during a median 12.9 years of follow-up. When all atrial Cardiopathy markers were combined in 1 Cox model, we found significant associations with stroke for P-wave terminal force in ECG lead V1 (hazard ratio per 1000 μV*ms 1.04; 95% confidence interval, 1.001-1.08), log-transformed NT-proBNP (hazard ratio per doubling of NT-proBNP, 1.09; 95% confidence interval, 1.03-1.16), and incident AF (hazard ratio, 2.04; 95% confidence interval, 1.67-2.48) but not left atrial dimension (hazard ratio per cm, 0.96; 95% confidence interval, 0.84-1.10). CONCLUSIONS In addition to clinically apparent AF, other evidence of abnormal atrial substrate is associated with subsequent ischemic stroke. This finding is consistent with the hypothesis that thromboembolism from the left atrium may occur in the setting of several different manifestations of atrial disease.