Publications by authors named "Kappelle L"
Article Synopsis
- Cerebral small vessel disease (SVD) can lead to various cerebrovascular issues, but research on sex differences in SVD is limited.
- This study analyzed data from over 20,000 patients with acute ischemic stroke to examine whether the presence and severity of cerebral microbleeds (CMB) and other SVD markers differ between males and females.
- Results showed that males had more frequent CMB while females had fewer lacunes but higher severe white matter hyperintensities, indicating distinct SVD characteristics based on sex.
Article Synopsis
- Cognitive impairment is prevalent in heart failure (HF) patients, and the study investigates sex differences in cognitive functioning linked to HF characteristics and brain injury.
- The research involved 162 HF patients who underwent neuropsychological assessments and brain MRI, revealing that women tend to perform better in global cognition and memory compared to men, despite differences in HF characteristics between sexes.
- Results showed that while some cognitive differences were associated with ischemic causes of HF, others, particularly in global cognition, persisted even after accounting for vascular brain injury factors.
Article Synopsis
- The study evaluated the PACAS risk model's ability to identify patients at high risk for severe asymptomatic carotid artery stenosis (ACAS) and predict future strokes and cardiovascular disease (CVD) risk.
- It involved 26,384 patients aged 45-80, finding that 6.3% had severe ACAS at baseline and that higher PACAS scores correlated with increased incidences of stroke and CVD over roughly 70,000 patient-years of follow-up.
- The PACAS model was confirmed to effectively discriminate and calibrate risk levels, indicating that patients with higher scores had a significantly higher prevalence of severe ACAS and related events during the follow-up period.
Article Synopsis
- Research investigates sex disparities in stroke treatment, highlighting that women experience worse functional outcomes than men after acute ischemic stroke (AIS).
- The study analyzed data from 58,632 AIS patients in the Netherlands, focusing on treatments used, time metrics, and functional outcomes at three months post-treatment.
- Results showed women were older, had longer onset-to-door times, and faced higher odds of poor outcomes compared to men, even when adjusting for age and initial stroke severity.
Higher blood pressure variability (BPV) predisposes to cognitive decline. To investigate underlying mechanisms, we measured 24-h ambulatory BPV, nocturnal dipping and orthostatic hypotension in 518 participants with vascular cognitive impairment, carotid occlusive disease, heart failure, or reference participants. We determined cross-sectional associations between BPV indices and plasma biomarkers of neuronal injury (neurofilament light chain) and Alzheimer's disease (phosphorylated-tau-181 and Aβ42/Aβ40).
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- The study compares two strategies for managing high blood pressure in patients with ischaemic strokes who are eligible for intravenous thrombolysis: an active blood-pressure-lowering strategy and a conservative, non-lowering approach.
- Conducted across 37 Dutch stroke centers, it involved eligible adults with elevated blood pressure and aimed to assess functional outcomes at 90 days, alongside secondary measures like complications and treatment timing.
- The trial started in January 2015 but was prematurely halted due to low patient enrollment and lack of funding.
Background: Orthostatic hypotension (OH) is associated with an increased risk of dementia, potentially attributable to cerebral hypoperfusion. We investigated which patterns and characteristics of OH are related to cognition or to potentially underlying structural brain injury in hemodynamically impaired patients and healthy reference participants.
Methods: Participants with carotid occlusive disease or heart failure, and reference participants from the Heart-Brain Connection Study underwent OH measurements, neuropsychological assessment and brain MRI.
Background: We hypothesize that Alzheimer's disease (AD)-related pathology may accelerate cognitive decline in patients with cardiovascular diseases.
Objective: To investigate the association between blood-based biomarkers of AD, astrocyte activation, and neurodegeneration and cognitive decline.
Methods: From the multi-center Heart-Brain study, we included 412 patients with heart failure, carotid occlusive disease or vascular cognitive impairment (age:68.
Introduction: Cerebral perforating arteries provide blood supply to the deep regions of the brain. Recently, it became possible to measure blood flow velocity and pulsatility in these small arteries. It is unknown if vascular risk factors are related to these measures.
View Article and Find Full Text PDFBiological processes underlying decreased cerebral blood flow (CBF) in patients with cardiovascular disease (CVD) are largely unknown. We hypothesized that identification of protein clusters associated with lower CBF in patients with CVD may explain underlying processes. In 428 participants (74% cardiovascular diseases; 26% reference participants) from the Heart-Brain Connection Study, we assessed the relationship between 92 plasma proteins from the Olink® cardiovascular III panel and normal-appearing grey matter CBF, using affinity propagation and hierarchical clustering algorithms, and generated a Biomarker Compound Score (BCS).
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- PSCI affects about half of stroke survivors, with the study showing no difference in overall occurrence between men and women but notable differences in specific cognitive impairments.
- Male stroke survivors tend to have less impairment in attention, executive functioning, and language, but a higher risk for verbal memory impairment compared to females.
- The Mini-Mental State Examination is more sensitive but less specific for detecting PSCI in women, while the Montreal Cognitive Assessment shows similar sensitivity and specificity for both sexes.
Background: Patients with carotid artery occlusion (CAO) are vulnerable to cognitive impairment (CI). Anaemia is associated with CI in the general population. We hypothesized that lower haemoglobin is associated with cognitive impairment (CI) in patients with CAO and that this association is accentuated by cerebral blood flow (CBF).
View Article and Find Full Text PDFBackground: Effectiveness of carotid procedures (surgery and stenting) in patients with asymptomatic carotid artery stenosis (ACAS) depends on the absolute risk reduction that patients might receive from these procedures. We aimed to quantify the risk of ipsilateral ischemic stroke and examined temporal trends and determinants of these risks in patients with ACAS treated conservatively.
Methods: We conducted a systematic review from inception to March 9, 2023, of peer-reviewed trials and cohort studies describing ipsilateral ischemic stroke risk in medically treated patients with ACAS of ≥50%.
Background: Diagnosis of cerebrovascular disease is based on both clinical and radiological findings, however, they do not always correlate.
Aims: To investigate ischemic stroke recurrence and mortality in patients with different imaging phenotypes of ischemic cerebrovascular disease.
Methods: Within the SMART-MR study, a prospective patient cohort with arterial disease, cerebrovascular diseases of participants at baseline were classified as no cerebrovascular disease (reference group, = 828), symptomatic cerebrovascular disease ( = 204), covert vascular lesions ( = 156), or imaging negative ischemia ( = 90) based upon clinical and MRI findings.
Background: Prion-like transmission of amyloid-ß through cadaveric dura, decades after neurosurgical procedures, has been hypothesized as an iatrogenic cause of cerebral amyloid angiopathy (CAA). We investigated new and previously described patients to assess the clinical profile, radiological features, and outcome of this presumed iatrogenic CAA-subtype (iCAA).
Methods: Patients were collected from our prospective lobar hemorrhage and CAA database (n=251) with patients presenting to our hospital between 2008 and 2022.
Article Synopsis
- Cerebral microbleeds increase the risk of both ischemic stroke and intracranial hemorrhage, complicating treatment choices for patients with atrial fibrillation on various antithrombotic therapies.
- A study analyzed 7,839 patients, finding that microbleeds significantly raised the relative risk of intracranial hemorrhage (2.74 times) and ischemic stroke (1.29 times), particularly with combination therapies of anticoagulants and antiplatelets.
- For patients on combination therapy, those with multiple microbleeds faced a higher absolute risk of intracranial hemorrhage compared to ischemic stroke, indicating a need for more research to develop effective preventive strategies.
Purpose: The Utrecht Cardiovascular Cohort-Second Manifestations of Arterial Disease (UCC-SMART) Study is an ongoing prospective single-centre cohort study with the aim to assess important determinants and the prognosis of cardiovascular disease progression. This article provides an update of the rationale, design, included patients, measurements and findings from the start in 1996 to date.
Participants: The UCC-SMART Study includes patients aged 18-90 years referred to the University Medical Center Utrecht, the Netherlands, for management of cardiovascular disease (CVD) or severe cardiovascular risk factors.
Article Synopsis
- Identifying cardiac sources in acute ischemic stroke patients is crucial for selecting effective secondary prevention strategies, and this study assessed the utility of cardiac CTA in detecting these sources.
- Out of 370 patients, 12% had cardiac thrombus on admission CTA, with a significant number found in the left atrial appendage, indicating a correlation with more severe strokes and greater treatment needs.
- The study revealed that spectral CT techniques improved diagnostic certainty for detecting left atrial appendage thrombus compared to traditional CTA methods.
Background: Cardiovascular disease is an important contributor to cognitive impairment. This likely involves prototypical vascular disease mechanisms like ischemia, but cardiovascular disease might also impact the brain by accelerating cerebral amyloid-β accumulation. We aimed to determine whether there is an association between heart disease or carotid occlusive disease (COD) and cerebral amyloid-β burden.
View Article and Find Full Text PDFBlood pressure variability (BPV) is related to cerebral white matter hyperintensities (WMH), but longitudinal studies assessing WMH progression are scarce. Patients with cardiovascular disease and control participants of the Heart-Brain Connection Study underwent 24-hour ambulatory blood pressure monitoring and repeated brain MRI at baseline and after 2 years. Using linear regression, we determined whether different measures of BPV (standard deviation, coefficient of variation, average real variability (ARV), variability independent of the mean) and nocturnal dipping were associated with WMH and whether this association was mediated or moderated by baseline cerebral perfusion.
View Article and Find Full Text PDFObjectives: To evaluate how costs of healthcare can be reduced, there is an increasing need to gain insight into the main drivers of such costs. We evaluated drivers of costs of predefined subgroups of patients who had a stroke by linking cost registration with clinical data.
Methods: We retrospectively selected 555 consecutive patients with ischaemic stroke participating between June 2011 and December 2016 in the Dutch Parelsnoer Initiative.
This study examined associations of neighbourhood walkability with cognitive functioning (i.e., global cognition, memory, language, attention-psychomotor speed, and executive functioning) in participants without or with either heart failure, carotid occlusive disease, or vascular cognitive impairment.
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