Factors influencing haemorrhagic transformation in ischaemic stroke

Álvarez-Sabín, José; Maisterra, Olga; Santamarina, Estevo; Kase, Carlos S.

doi:10.1016/s1474-4422(13)70055-3

Cited by 239 publications

(217 citation statements)

References 165 publications

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“…Our finding that THRIVE score may predict hemorrhagic transformation after ischemic stroke is consistent with previous studies identifying older age, 4 atrial fibrillation, hypertension, 17 and hyperglycemia 18 as risk factors for hemorrhagic transformation after ischemic stroke. All these parameters are taken into account when calculating the THRIVE score.…”

Section: Discussionsupporting

confidence: 93%

Totaled Health Risks in Vascular Events Score Predicts Clinical Outcomes in Patients With Cardioembolic and Other Subtypes of Ischemic Stroke

Lei

Liu

et al. 2014

Stroke

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Background and Purpose— Whether totaled health risks in vascular events (THRIVE) score can be used to predict clinical outcomes and risk of hemorrhagic transformation in patients with special subtypes of ischemic stroke remains an open question. Methods— We analyzed the possible relationships between THRIVE score and clinical outcomes in patients with cardioembolic stroke or noncardioembolic stroke who did not receive thrombolytic therapy. Clinical outcomes and hemorrhagic transformation within 3 months of admission were compared among 3 patient subgroups with initial THRIVE scores of 0 to 2, 3 to 5, or 6 to 9. Results— A total of 505 patients with cardioembolic stroke and 3374 patients with noncardioembolic stroke were included in our analysis. As THRIVE score increased, the rate of patients showing good clinical outcome decreased, whereas the rate of mortality and hemorrhagic transformation increased after ischemic stroke. Increasing THRIVE score was independently associated with decreasing likelihood of good outcome, defined as a modified Rankin Scale score of 0 to 2 (cardioembolic stroke: odds ratio, 0.59; 95% confidence interval, 0.51–0.67; noncardioembolic stroke: odds ratio, 0.53; 95% confidence interval, 0.49–0.57), and with increasing likelihood of death (cardioembolic: odds ratio, 1.48; 95% confidence interval, 1.28–1.70; noncardioembolic: odds ratio, 1.95; 95% confidence interval, 1.76–2.16). THRIVE score showed good receiver operating characteristics for predicting good outcome and mortality in patients with cardioembolic stroke and noncardioembolic stroke. Conclusions— The THRIVE score is a simple tool that helps clinicians estimate good outcome and death after ischemic stroke.

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Section: Discussionsupporting

confidence: 93%

Totaled Health Risks in Vascular Events Score Predicts Clinical Outcomes in Patients With Cardioembolic and Other Subtypes of Ischemic Stroke

Lei

Liu

et al. 2014

Stroke

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“…According to a previous study, based on both imaging and autopsy results, the pathogenesis of haemorrhagic infarctions and parenchymal haematomas are different; while haemorrhagic infarctions are the consequences of multifocal extravasation of red blood cells, usually in the grey matter, parenchymal haematomas probably represent haemorrhages from single damaged vessels, injured by ischaemia and following reperfusion [31]. Since the transformation occurs in the already necrotic tissue, often no clinical worsening, reflecting the development of HT, could be detected [32]. The general clinical condition of acute stroke patients with fatal outcome is very poor, there are several additional extracerebral factors (i.e.…”

Section: Discussionmentioning

confidence: 87%

Haemorrhagic transformation in ischaemic stroke is more frequent than clinically suspected – A neuropathological study

Szepesi

Csokonay

Murnyák

et al. 2016

Journal of the Neurological Sciences

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ObjectivesThe vast majority of literature on the frequency of the haemorrhagic transformation of ischaemic stroke is based on imaging studies. The purpose of the present study was to assess the added value of autopsy and neuropathological analysis in a neurology centre with emphasis on acute stroke care. MethodsWe retrospectively analysed the findings of 100 consecutive brain autopsies followed by detailed clinical correlation. ResultsThe clinical diagnosis was confirmed by neuropathology in every patient with intracerebral haemorrhage and with non-cerebrovascular neurological disorders (e.g. primary tumours, metastases, infections). At admission 64 patients (age 62 years, SD 6.5) were diagnosed with acute ischaemic stroke. In 10 of these patients (16%) haemorrhagic transformation was diagnosed clinically by a second CT. In 24 cases (38%) haemorrhagic transformation was detected only at autopsy. The distribution of haemorrhagic transformation in our material was the following: small petechiae in 26.5%, more confluent petechiae in 29.4%, ≤ 30% of the infarcted area with some mild space-occupying effect in 29.4% and > 30% of the infarcted area with significant space-occupying effect or clot remote from infarcted area in 14.7%. Most of the PH1-2 transformations developed in thrombolysed patients and all of the PH2 type transformations were diagnosed already clinically. ConclusionsWe demonstrated that haemorrhagic transformation is frequent and often undiscovered in vivo. Our findings underline the importance of post-mortem neuropathological examination also in the era of advanced imaging techniques and prove that autopsy is the ultimate yardstick of our diagnostic and therapeutic efforts. The high number of haemorrhagic transformations diagnosed only after death is an important novel finding with clinical implications.

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“…They concluded that myocardial edema occurred in 2 waves, the first occurring abruptly after reperfusion and a second “deferred wave of edema” appearing progressively in relation to inflammation and healing 15. There could be alternative explanations for the “second wavefront of edema,” including (1) a reduction in infarct tissue mass and a relative increase in percentage water or (2) an increase in the wet weight of tissue due to progressive myocardial hemorrhage or hemorrhagic transformation 17, 18. Our analysis supports the latter.…”

Section: Discussionmentioning

confidence: 99%

“…Tissue hemorrhage is typically characterized by an acute primary phase16 and then potentially by secondary hemorrhagic transformation in the subacute phase hours or days later 17, 18. Deoxyhemoglobin has paramagnetic effects that enable myocardial hemorrhage to be detected using T2‐ and T2*‐weighted CMR (T2* relaxation refers to the decay of transverse magnetization seen with gradient‐echo sequences.)…”

Section: Introductionmentioning

confidence: 99%

Temporal Evolution of Myocardial Hemorrhage and Edema in Patients After Acute ST‐Segment Elevation Myocardial Infarction: Pathophysiological Insights and Clinical Implications

Carrick

Haig

Ahmed

et al. 2016

JAHA

109

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BackgroundThe time course and relationships of myocardial hemorrhage and edema in patients after acute ST‐segment elevation myocardial infarction (STEMI) are uncertain.Methods and ResultsPatients with ST‐segment elevation myocardial infarction treated by primary percutaneous coronary intervention underwent cardiac magnetic resonance imaging on 4 occasions: at 4 to 12 hours, 3 days, 10 days, and 7 months after reperfusion. Myocardial edema (native T2) and hemorrhage (T2*) were measured in regions of interest in remote and injured myocardium. Myocardial hemorrhage was taken to represent a hypointense infarct core with a T2* value <20 ms. Thirty patients with ST‐segment elevation myocardial infarction (mean age 54 years; 25 [83%] male) gave informed consent. Myocardial hemorrhage occurred in 7 (23%), 13 (43%), 11 (33%), and 4 (13%) patients at 4 to 12 hours, 3 days, 10 days, and 7 months, respectively, consistent with a unimodal pattern. The corresponding median amounts of myocardial hemorrhage (percentage of left ventricular mass) during the first 10 days after myocardial infarction were 2.7% (interquartile range [IQR] 0.0–5.6%), 7.0% (IQR 4.9–7.5%), and 4.1% (IQR 2.6–5.5%; P<0.001). Similar unimodal temporal patterns were observed for myocardial edema (percentage of left ventricular mass) in all patients (P=0.001) and for infarct zone edema (T2, in ms: 62.1 [SD 2.9], 64.4 [SD 4.9], 65.9 [SD 5.3]; P<0.001) in patients without myocardial hemorrhage. Alternatively, in patients with myocardial hemorrhage, infarct zone edema was reduced at day 3 (T2, in ms: 51.8 [SD 4.6]; P<0.001), depicting a bimodal pattern. Left ventricular end‐diastolic volume increased from baseline to 7 months in patients with myocardial hemorrhage (P=0.001) but not in patients without hemorrhage (P=0.377).ConclusionsThe temporal evolutions of myocardial hemorrhage and edema are unimodal, whereas infarct zone edema (T2 value) has a bimodal pattern. Myocardial hemorrhage is prognostically important and represents a target for therapeutic interventions that are designed to preserve vascular integrity following coronary reperfusion.Clinical Trial Registration URL: https://clinicaltrials.gov/. Unique identifier: NCT02072850.

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Factors influencing haemorrhagic transformation in ischaemic stroke

Cited by 239 publications

References 165 publications

Totaled Health Risks in Vascular Events Score Predicts Clinical Outcomes in Patients With Cardioembolic and Other Subtypes of Ischemic Stroke

Totaled Health Risks in Vascular Events Score Predicts Clinical Outcomes in Patients With Cardioembolic and Other Subtypes of Ischemic Stroke

Haemorrhagic transformation in ischaemic stroke is more frequent than clinically suspected – A neuropathological study

Temporal Evolution of Myocardial Hemorrhage and Edema in Patients After Acute ST‐Segment Elevation Myocardial Infarction: Pathophysiological Insights and Clinical Implications

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