Investigation of Association between PFO Complicated by Cryptogenic Stroke and a Common Variant of the Cardiac Transcription Factor GATA4

Patent foramen ovale (PFO) is associated with clinical conditions including cryptogenic stroke, migraine and varicose veins. Data from studies in humans and mouse suggest that PFO and the secundum form of atrial septal defect (ASDII) exist in an anatomical continuum of septal dysmorphogenesis with a common genetic basis. Mutations in multiple members of the evolutionarily conserved cardiac transcription factor network, including GATA4, cause or predispose to ASDII and PFO. Here, we assessed whether the most prevalent variant of the GATA4 gene, S377G, was significantly associated with PFO or ASD. Our analysis of world indigenous populations showed that GATA4 S377G was largely Caucasian-specific, and so subjects were restricted to those of Caucasian descent. To select for patients with larger PFO, we limited our analysis to those with cryptogenic stroke in which PFO was a subsequent finding. In an initial study of Australian subjects, we observed a weak association between GATA4 S377G and PFO/Stroke relative to Caucasian controls in whom ASD and PFO had been excluded (OR = 2.16; p = 0.02). However, in a follow up study of German Caucasians no association was found with either PFO or ASD. Analysis of combined Australian and German data confirmed the lack of a significant association. Thus, the common GATA4 variant S377G is likely to be relatively benign in terms of its participation in CHD and PFO/Stroke

The effects of the COVID-19 lockdown and socio-economic factors on stroke hospitalizations in France

Abstract Background Worldwide, the COVID-19 pandemic has been associated with a drop in overall stroke hospitalizations. Additionally, there is a well-known association between stroke and socioeconomic status. This study aims to assess the COVID-19 effect on stroke admissions in France during the first national lockdown and investigate the factors associated with its spatial heterogeneity. Methods In this retrospective nationwide study, we used data from the French hospital discharge database (PMSI) to estimate rates of admission for stroke to all public and private hospitals in 2019 and 2020. We used negative binomial regression to test for a nationwide change in stroke admissions during the first lockdown, compared to the same period in 2019 (from week 12 to week 19). We conducted a multivariate analysis to explore the factors associated with the stroke admission incidence rate ratio variation (2020 incidence rate/2019 incidence rate) at the county level. Results We found a significant nationwide reduction in stroke admissions during the first wave of COVID-19 (incidence rate ratio 0,91 [0,86 - 0.97]), with notable geographic variations. After adjustment on hospital bed capacity, cumulative in-hospital COVID-19 incidence, standardized death rate at age 65 and unemployment rate, a higher share of labourers at the county level was associated with a higher incidence rate ratio (p &amp;lt; 0.01). Conclusions During the first national lockdown, there has been an overall decrease in stroke admission rates. Socio-economic determinants such as low-skilled jobs were independently associated with an increase in the stroke admission incidence rate ratio, while we did not find any independent effect from the local COVID 19 burden and hospital capacities. Key messages The first national lockdown led to an overall decrease in stroke admissions in France. This decrease varied between counties according to socio-economic determinants. </jats:sec

Socioeconomic determinants of traditional diet in Eastern Europe: result from the HAPIEE study

International audienceBackgroundWorldwide, the COVID-19 pandemic has been associated with a drop in overall stroke hospitalizations. Additionally, there is a well-known association between stroke and socioeconomic status. This study aims to assess the COVID-19 effect on stroke admissions in France during the first national lockdown and investigate the factors associated with its spatial heterogeneity.MethodsIn this retrospective nationwide study, we used data from the French hospital discharge database (PMSI) to estimate rates of admission for stroke to all public and private hospitals in 2019 and 2020. We used negative binomial regression to test for a nationwide change in stroke admissions during the first lockdown, compared to the same period in 2019 (from week 12 to week 19). We conducted a multivariate analysis to explore the factors associated with the stroke admission incidence rate ratio variation (2020 incidence rate/2019 incidence rate) at the county level.ResultsWe found a significant nationwide reduction in stroke admissions during the first wave of COVID-19 (incidence rate ratio 0,91 [0,86 - 0.97]), with notable geographic variations. After adjustment on hospital bed capacity, cumulative in-hospital COVID-19 incidence, standardized death rate at age 65 and unemployment rate, a higher share of labourers at the county level was associated with a higher incidence rate ratio (p < 0.01).ConclusionsDuring the first national lockdown, there has been an overall decrease in stroke admission rates. Socio-economic determinants such as low-skilled jobs were independently associated with an increase in the stroke admission incidence rate ratio, while we did not find any independent effect from the local COVID 19 burden and hospital capacities.Key messages The first national lockdown led to an overall decrease in stroke admissions in France. This decrease varied between counties according to socio-economic determinants

Early and late seizures after cryptogenic ischemic stroke in young adults

Objectives: To assess the incidence and predictive factors of early and late seizures after ischemic stroke in young adults.Methods: A total of 581 patients (aged 18 to 55 years) with recent cryptogenic ischemic stroke were prospectively enrolled at 30 neurology departments and followed for 37.8 ± 9.7 months. Early seizures (occurring within 7 days of stroke) were assessed by chart review and late seizures were prospectively recorded at each follow-up visit. Clinical and brain imaging findings were reviewed by two neurologists and two neuroradiologists who were blinded to the occurrence of seizures.Results: Fourteen of the 581 patients (2.4%) developed early seizures, 71% of which occurred within the first 24 hours. Rankin scale ≥3 (odds ratio [OR] 3.9, 95% CI 1.2 to 12.7) and cortical involvement (OR 7.7, 95% CI 1.0 to 61.1) were independently associated with early seizures. Late seizures occurred only in patients with hemispheric stroke (n = 20). The risk of first late seizure was 3.1% (95% CI 1.4 to 4.8) within 1 year and 5.5% (95% CI 3.1 to 7.9) within 3 years. The mean delay between stroke and first late seizure was 12.9 months (0.3 to 33.9). Late seizures were associated with early seizure (hazard ratio [HR] 5.1, 95% CI 1.8 to 14.8), cortical signs (HR 4.5, 95% CI 1.6 to 13.1), and size of infarct superior to one-half hemisphere (HR 9.7, 95% CI 3.1 to 30.8). Eleven of the 20 patients with late seizure experienced recurrences (multiple in eight) on antiepileptic drug treatment. Most of them were seizure free at the end of the follow-up.Conclusion: Epilepsy is rarely a major problem in young cryptogenic ischemic stroke survivors. Early seizures are associated with stroke disability and cortical involvement. Early seizures, cortical signs, and large infarct are independent risk factors for late seizures.</jats:p