Browsing by Author "Adeoye A. M."

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Development and Reliability of a User-Friendly Multicenter Phenotyping Application for Hemorrhagic and Ischemic Stroke
(Elsevier Inc., 2017) Owolabi M.; Ogbole G.; Akinyemi R.; Salaam K.; Akpa O.; Mongkolwat P.; Omisore A.; Agunloye A.; Efidi R.; Odo J.; Makanjuola A.; Akpalu A.; Sarfo F.; Owolabi L.; Obiako R.; Wahab K.; Sanya E.; Adebayo P.; Komolafe M.; Adeoye A. M.; Fawale M. B.
"Background: Annotation and Image Markup on ClearCanvas Enriched Stroke– phenotyping Software (ACCESS) is a novel stand-alone computer software application that allows the creation of simple standardized annotations for reporting brain images of all stroke types. We developed the ACCESS application and determined its inter-rater and intra-rater reliability in the Stroke Investigative Research and Educational Network (SIREN) study to assess its suitability for multicenter studies. Methods: One hundred randomly selected stroke imaging reports from 5 SIREN sites were re-evaluated by 4 trained independent raters to determine the inter-rater reliability of the ACCESS (version 12.0) software for stroke phenotyping. To determine intra-rater reliability, 6 raters reviewed the same cases previously reported by them after a month of interval. Ischemic stroke was classified using the Oxfordshire Community Stroke Project (OCSP), Trial of Org 10172 in Acute Stroke Treatment (TOAST), and Atherosclerosis, Small-vessel disease, Cardiac source, Other cause (ASCO) protocols, while hemorrhagic stroke was classified using the Structural lesion, Medication, Amyloid angiopathy, Systemic disease, Hypertensive angiopathy and Undetermined (SMASH-U) protocol in ACCESS. Agreement among raters was measured with Cohen’s kappa statistics. Results: For primary stroke type, inter-rater agreement was .98 (95% confidence interval [CI], .94-1.00), while intra-rater agreement was 1.00 (95% CI, 1.00). For OCSP subtypes, inter-rater agreement was .97 (95% CI, .92-1.00) for the partial anterior circulation infarcts, .92 (95% CI, .76-1.00) for the total anterior circulation infarcts, and excellent for both lacunar infarcts and posterior circulation infarcts. Intra-rater agreement was .97 (.90-1.00), while inter-rater agreement was .93 (95% CI, .84-1.00) for TOAST subtypes. Inter-rater agreement ranged between .78 (cardioembolic) and .91 (large artery atherosclerotic) for ASCO subtypes and was .80 (95% CI, .56-1.00) for SMASH-U subtypes. Conclusion: The ACCESS application facilitates a con cordant and reproducible classification of stroke subtypes by multiple investigators, making it suitable for clinical use and multicenter research.
Echocardiographic abnormalities and determinants of 1-month outcome of stroke among West Africans in the SIREN Study
(American Heart Association, 2019) Adeoye A. M.; Ovbiagele B.; Akinyemi J. O.; Ogah O. S.; Akinyemi R.; Gebregziabher M.; Wahab K.; Fakunle A. G.; Akintunde A.; Adebayo O.; Aje A.; Tiwari H. K; Arnett D.; Agyekum F.; Appiah L. T.; Amusa G.; Olunuga T. O.; Akpa O.; Sarfo F. S.; Akpalu A.; Jenkins C.; Lackland D.
Background-—Little is known about the relationship between echocardiographic abnormalities and outcome among patients with acute stroke. We investigated the pattern and association of baseline echocardiographic variables with 1-month disability and mortality among patients with stroke in the SIREN (Stroke Investigative Research and Education Network) study. Methods and Results-—We enrolled and followed up consecutive 1020 adult patients with acute stroke with baseline transthoracic echocardiography from west Africa. To explore the relationship between echocardiographic variables and 1-month disability (using modified Rankin scale >3) and fatality, regression models were fitted. Relative risks were computed with 95% CIs. The participants comprised 60% men with a mean age of 59.2_14.6 years. Ischemic stroke was associated with smaller aortic root diameter (30.2 versus 32.5, P=0.018) and septal (16.8 versus 19.1, P<0.001) and posterior wall thickness at systole (18.9 versus 21.5, P=0.004). Over 90% of patients with stroke had abnormal left ventricular (LV) geometry with eccentric hypertrophy predominating (56.1%). Of 13 candidate variables investigated, only baseline abnormal LV geometry (concentric hypertrophy) was weakly associated with 1-month disability (unadjusted relative risk, 1.80; 95% CI, 0.97–5.73). Severe LV systolic dysfunction was significantly associated with increased 1-month mortality (unadjusted relative risk, 3.05; 95% CI, 1.36–6.83). Conclusions-—Nine of 10 patients with acute stroke had abnormal LV geometry and a third had systolic dysfunction. Severe LV systolic dysfunction was significantly associated with 1 month mortality. Larger studies are required to establish the independent effect and unravel predictive accuracy of this association
Exploring overlaps between the genomic and environmental determinants of LVH and stroke
(Elsevier Ltd, 2017) Adeoye A. M.; Ovbiagele B.; Kolo P.; Appiah L.; Ajek A.; Adebayo O.; Sarfo F.; Akinyemi J.; Adekunle G.; Agyekum F.; Shidali V.; Ogah O.; Lackland D.; Gebregziabher M.; Arnett D.; Tiwari H. K.; Akinyemi R.; Olagoke O. O.; Oguntade A. S.; Olunuga T.; Uwanruochi K.; Jenkins C.; Adadey P.; Iheonye H.; Owolabi L.; Obiako R.; Akinjopo S.; Armstrong K.; Akpalu A.; Fakunle A.; Saulson R.; Aridegbe M.; Olowoyo P.; Osaigbovo G.; Akpa O.
Background: Whether left ventricular hypertrophy (LVH) is determined by similar genomic and environmental risk factors with stroke, or is simply an intermediate stroke marker, is unknown. Objectives: We present a research plan and preliminary findings to explore the overlap in the genomic and environmental determinants of LVH and stroke among Africans participating in the SIREN (Stroke Investigative Research and Education Network) study. Methods: SIREN is a transnational, multicenter study involving acute stroke patients and age-, ethnicity-, and sex-matched control subjects recruited from 9 sites in Ghana and Nigeria. Genomic and environmental risk factors and other relevant phenotypes for stroke and LVH are being collected and compared using standard techniques. Results: This preliminary analysis included only 725 stroke patients (mean age 59.1 13.2 years; 54.3% male). Fifty-five percent of the stroke subjects had LVH with greater proportion among women (51.6% vs. 48.4%; p < 0.001). Those with LVH were younger (57.9 12.8 vs. 60.6 13.4; p ¼ 0.006) and had higher mean systolic and diastolic blood pressure (167.1/99.5 mm Hg vs 151.7/90.6 mm Hg; p < 0.001). Uncontrolled blood pressure at presentation was prevalent in subjects with LVH (76.2% vs. 57.7%; p < 0.001). Significant independent predictors of LVH were age 90 mm Hg (AOR: 2.10; 95% CI: 1.39 to 3.19; p < 0.001). Conclusions: The prevalence of LVH was high among stroke patients especially the younger ones, suggesting a genetic component to LVH. Hypertension was a major modifiable risk factor for stroke as well as LVH. It is envisaged that the SIREN project will elucidate polygenic overlap (if present) between LVH and stroke among Africans, thereby defining the role of LVH as a putative intermediate cardiovascular phenotype and therapeutic target to inform interventions to reduce stroke risk in populations of African ancestry
Knowledge, attitudes and practices of West Africans on genetic studies of stroke: Evidence from the SIREN Study
(World Stroke Organization Reprints and permissions, 2018) Akinyemi R. O.; Sarfo F. S.; Akinyemi J.; Singh A.; Akpa M. O.; Akpalu A.; Owolabi L.; Adeoye A. M.; Obiako R.; Wahab K.; Sanya E.; Komolafe M.; Ogbole G.; Fawale M.; Adebayo P.; Osaigbovo G.; Sunmonu T.; Olowoyo P.; Chukwuonye I.; Obiabo Y.; Adeniji O.; Fakunle G.; Melikam E.; Saulson R.; Yaria J.; Uwanruochi K.
Background: It is crucial to assess genomic literacy related to stroke among Africans in preparation for the ethical, legal and societal implications of the genetic revolution which has begun in Africa. Objective: To assess the knowledge, attitudes and practices (KAP) of West Africans about stroke genetic studies. Methods: A comparative cross-sectional study was conducted among stroke patients and stroke-free controls recruited across 15 sites in Ghana and Nigeria. Participants’ knowledge of heritability of stroke, willingness to undergo genetic testing and perception of the potential benefits of stroke genetic research were assessed using interviewer-administered questionnaire. Descriptive, frequency distribution and multiple regression analyses were performed. Results: Only 49% of 2029 stroke patients and 57% of 2603 stroke-free individuals knew that stroke was a heritable disorder. Among those who knew, 90% were willing to undergo genetic testing. Knowledge of stroke heritability was associated with having at least post-secondary education (OR 1.51, 1.25–1.81) and a family history of stroke (OR 1.20, 1.03–1.39) while Islamic religion (OR¼0.82, CI: 0.72–0.94), being currently unmarried (OR ¼ 0.81, CI: 0.70–0.92), and alcohol use (OR ¼ 0.78, CI: 0.67–0.91) were associated with lower odds of awareness of stroke as a heritable disorder. Willingness to undergo genetic testing for stroke was associated with having a family history of stroke (OR 1.34, 1.03– 1.74) but inversely associated with a medical history of high blood pressure (OR ¼ 0.79, 0.65–0.96). Conclusion: To further improve knowledge of stroke heritability and willingness to embrace genetic testing for stroke, individuals with less formal education, history of high blood pressure and no family history of stroke require targeted interventions
Prevalence and prognostic features of ECG abnormalities in acute stroke
(Elsevier Ltd, 2017) Adeoye A. M.; Ogah O. S.; Ovbiagele B.; Akinyemi R.; Shidali V.; Agyekum F.; Aje A.; Adebayo O.; Akinyemi J. O.; Kolo P.; Appiah L. T.; Iheonye H.; Kelechukwu U.; Ganiyu A.; Olunuga T. O.; Akpa O.; Olagoke O. O.; Sarfo F. S.; Wahab K.; Olowookere S.; Fakunle A.; Akpalu A.; Adebayo P. B.; Nkromah K.; Yaria J.; Ibinaiye P.
Background: Africa has a growing burden of stroke with associated high morbidity and a 3-year fatality rate of 84%. Cardiac disease contributes to stroke occurrence and outcomes, but the precise relationship of abnormalities as noted on a cheap and widely available test, the electrocardiogram (ECG), and acute stroke out comes have not been previously characterized in Africans. Objectives: The study assessed the prevalence and prognoses of various ECG abnormalities among African acute stroke patients encountered in a multisite, cross-national epidemiologic study. Methods: We included 890 patients from Nigeria and Ghana with acute stroke who had 12-lead ECG recording within first 24 h of admission and stroke classified based on brain computed tomography scan or magnetic resonance imaging. Stroke severity at baseline was assessed using the Stroke Levity Scale (SLS), whereas 1-month outcome was assessed using the modified Rankin Scale (mRS). Results: Patients’ mean age was 58.4 13.4 years, 490 were men (55%) and 400 were women (45%), 65.5% had ischemic stroke, and 85.4% had at least 1 ECG abnormality. Women were significantly more likely to have atrial fibrillation, or left ventricular hypertrophy with or without strain pattern. Compared to ischemic stroke patients, hemorrhagic stroke patients were less likely to have atrial fibrillation (1.0% vs. 6.7%; p ¼ 0.002), but more likely to have left ventricular hypertrophy (64.4% vs. 51.4%; p ¼ 0.004). Odds of severe disability or death at 1 month were higher with severe stroke (AOR: 2.25; 95% confidence interval: 1.44 to 3.50), or atrial enlargement (AOR: 1.45; 95% confidence interval: 1.04 to 2.02). Conclusions: About 4 in 5 acute stroke patients in this African cohort had evidence of a baseline ECG abnormality, but presence of any atrial enlargement was the only independent ECG predictor of death or disability