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Total Cerebral Small-Vessel Disease Score is Associated with Mortality during Follow-Up after Acute Ischemic Stroke

View Article: PubMed Central - PubMed

ABSTRACT

Background and purpose: The recently developed total cerebral small-vessel disease (CSVD) score might appropriately reflect the total burden or severity of CSVD. We investigated whether the total CSVD score is associated with long-term outcomes during follow-up in patients with acute ischemic stroke.

Methods: In total, 1,096 consecutive patients with acute ischemic stroke who underwent brain magnetic resonance imaging were enrolled. We calculated the total CSVD score for each patient after determining the burden of cerebral microbleeds (CMBs), high-grade white-matter hyperintensities (HWHs), high-grade perivascular spaces (HPVSs), and asymptomatic lacunar infarctions (ALIs). We recorded the date and cause of death for all of the patients using data from the Korean National Statistical Office. We compared the long-term mortality rate with the total CSVD score using Cox proportional-hazards models.

Results: CMBs were found in 26.8% of the subjects (294/1,096), HWHs in 16.4% (180/1,096), HPVSs in 19.3% (211/1,096), and ALIs in 38.0% (416/1,096). After adjusting for age, sex, and variables that were significant at p<0.1 in the univariate analysis, the total CSVD score was independently associated with long-term death from all causes [hazard ratio (HR)=1.18 per point, 95% confidence interval (CI)=1.07–1.30], ischemic stroke (HR=1.20 per point, 95% CI=1.01–1.42), and hemorrhagic stroke (HR=2.05 per point, 95% CI=1.30–3.22), but not with fatal cardiovascular events (HR=1.17 per point, 95% CI=0.82–1.67).

Conclusions: The total CSVD score is a potential imaging biomarker for predicting mortality during follow-up in patients with acute ischemic stroke.

No MeSH data available.


Related in: MedlinePlus

Kaplan-Meier survival plots for patients with acute ischemic stroke according to total CSVD score. The Kaplan-Meier curve shows that deaths related to all causes (p=0.001) (A), ischemic stroke (p=0.001) (B), and hemorrhagic stroke (p=0.001) (C) were associated with the total CSVD score, whereas fatal cardiovascular events were not (p=0.100) (D). CSVD: cerebral small-vessel disease, SVD: small-vessel disease.
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Figure 2: Kaplan-Meier survival plots for patients with acute ischemic stroke according to total CSVD score. The Kaplan-Meier curve shows that deaths related to all causes (p=0.001) (A), ischemic stroke (p=0.001) (B), and hemorrhagic stroke (p=0.001) (C) were associated with the total CSVD score, whereas fatal cardiovascular events were not (p=0.100) (D). CSVD: cerebral small-vessel disease, SVD: small-vessel disease.

Mentions: Among the total of 1,096 patients, 240 (21.9%) died at a median follow-up of 3.8 years (interquartile range=3.2–4.3 years); 77 (32.1%) patients died of fatal ischemic stroke, 17 (7.1%) of fatal cardiovascular events, and 9 (3.8%) of fatal hemorrhagic stroke. Among the other causes of death, malignancy was the most common, followed by renal failure and diabetes mellitus (Supplementary Table 1 in the online-only Data Supplement). The Kaplan-Meier curve showed that all prespecified outcomes (all-cause mortality, fatal ischemic stroke, and fatal hemorrhagic stroke) other than fatal cardiovascular events were associated with the CSVD score (Fig. 2).


Total Cerebral Small-Vessel Disease Score is Associated with Mortality during Follow-Up after Acute Ischemic Stroke
Kaplan-Meier survival plots for patients with acute ischemic stroke according to total CSVD score. The Kaplan-Meier curve shows that deaths related to all causes (p=0.001) (A), ischemic stroke (p=0.001) (B), and hemorrhagic stroke (p=0.001) (C) were associated with the total CSVD score, whereas fatal cardiovascular events were not (p=0.100) (D). CSVD: cerebral small-vessel disease, SVD: small-vessel disease.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC5392462&req=5

Figure 2: Kaplan-Meier survival plots for patients with acute ischemic stroke according to total CSVD score. The Kaplan-Meier curve shows that deaths related to all causes (p=0.001) (A), ischemic stroke (p=0.001) (B), and hemorrhagic stroke (p=0.001) (C) were associated with the total CSVD score, whereas fatal cardiovascular events were not (p=0.100) (D). CSVD: cerebral small-vessel disease, SVD: small-vessel disease.
Mentions: Among the total of 1,096 patients, 240 (21.9%) died at a median follow-up of 3.8 years (interquartile range=3.2–4.3 years); 77 (32.1%) patients died of fatal ischemic stroke, 17 (7.1%) of fatal cardiovascular events, and 9 (3.8%) of fatal hemorrhagic stroke. Among the other causes of death, malignancy was the most common, followed by renal failure and diabetes mellitus (Supplementary Table 1 in the online-only Data Supplement). The Kaplan-Meier curve showed that all prespecified outcomes (all-cause mortality, fatal ischemic stroke, and fatal hemorrhagic stroke) other than fatal cardiovascular events were associated with the CSVD score (Fig. 2).

View Article: PubMed Central - PubMed

ABSTRACT

Background and purpose: The recently developed total cerebral small-vessel disease (CSVD) score might appropriately reflect the total burden or severity of CSVD. We investigated whether the total CSVD score is associated with long-term outcomes during follow-up in patients with acute ischemic stroke.

Methods: In total, 1,096 consecutive patients with acute ischemic stroke who underwent brain magnetic resonance imaging were enrolled. We calculated the total CSVD score for each patient after determining the burden of cerebral microbleeds (CMBs), high-grade white-matter hyperintensities (HWHs), high-grade perivascular spaces (HPVSs), and asymptomatic lacunar infarctions (ALIs). We recorded the date and cause of death for all of the patients using data from the Korean National Statistical Office. We compared the long-term mortality rate with the total CSVD score using Cox proportional-hazards models.

Results: CMBs were found in 26.8% of the subjects (294/1,096), HWHs in 16.4% (180/1,096), HPVSs in 19.3% (211/1,096), and ALIs in 38.0% (416/1,096). After adjusting for age, sex, and variables that were significant at p<0.1 in the univariate analysis, the total CSVD score was independently associated with long-term death from all causes [hazard ratio (HR)=1.18 per point, 95% confidence interval (CI)=1.07–1.30], ischemic stroke (HR=1.20 per point, 95% CI=1.01–1.42), and hemorrhagic stroke (HR=2.05 per point, 95% CI=1.30–3.22), but not with fatal cardiovascular events (HR=1.17 per point, 95% CI=0.82–1.67).

Conclusions: The total CSVD score is a potential imaging biomarker for predicting mortality during follow-up in patients with acute ischemic stroke.

No MeSH data available.


Related in: MedlinePlus