Total Cerebral Small-Vessel Disease Score is Associated with Mortality during Follow-Up after Acute Ischemic Stroke
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초록
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.
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.
참고문헌 (33)
- Pantoni L, "Cerebral small vessel disease: from pathogenesis and clinical characteristics to therapeutic challenges", Lancet Neurol, 9, pp.689~701 (2010)
- Greenberg SM, "Cerebral microbleeds: a guide to detection and interpretation", Lancet Neurol, 8, pp.165~174 (2009)
- Doubal FN, "Enlarged perivascular spaces on MRI are a feature of cerebral small vessel disease", Stroke, 41, pp.450~454 (2010)
- Beom Joon Kim, "Cerebral Microbleeds: Their Associated Factors, Radiologic Findings, and Clinical Implications", 대한뇌졸중학회지, 15(3), pp.153~163 (2013), 대한뇌졸중학회[DOI]
- Kalaria RN, "Small vessel disease and subcortical vascular dementia", J Clin Neurol, 2, pp.1~11 (2006)
- Staals J, "Stroke subtype, vascular risk factors, and total MRI brain small-vessel disease burden", Neurology, 83, pp.1228~1234 (2014)
- Huijts M, "Accumulation of MRI markers of cerebral small vessel disease is associated with decreased cognitive function. A study in firstever lacunar stroke and hypertensive patients", Front Aging Neurosci, 5, pp.72~ (2013)
- Lee BI, "Yonsei Stroke Registry. Analysis of 1,000 patients with acute cerebral infarctions", Cerebrovasc Dis, 12, pp.145~151 (2001)
- 최혜윤, "Beneficial Effects of Stroke-Unit Care in Stroke Patients with Atrial Fibrillation", Yonsei Medical Journal, 54(2), pp.301~305 (2013), 연세대학교의과대학[DOI]
- Song TJ, "Differential impact of unrecognised brain infarction on stroke outcome in non-valvular atrial fibrillation", Thromb Haemost, 112, pp.1312~1318 (2014)
- Song TJ, "Association of cerebral microbleeds with mortality in stroke patients having atrial fibrillation", Neurology, 83, pp.1308~1315 (2014)
- Song TJ, "The distribution of cerebral microbleeds determines their association with arterial stiffness in non-cardioembolic acute stroke patients", Eur J Neurol, 21, pp.463~469 (2014)
- Wardlaw JM, "Neuroimaging standards for research into small vessel disease and its contribution to ageing and neurodegeneration", Lancet Neurol, 12, pp.822~838 (2013)
- 김영대, "Traditional Risk Factors for Stroke in East Asia", 대한뇌졸중학회지, 18(3), pp.273~285 (2016), 대한뇌졸중학회
- 오미선, "Validity and Reliability of a Korean Version of the National Institutes of Health Stroke Scale", Journal of Clinical Neurology, 8(3), pp.177~183 (2012), 대한신경과학회[DOI]
- Adams HP Jr, "Classification of subtype of acute ischemic stroke. Definitions for use in a multicenter clinical trial. TOAST. Trial of Org 10172in Acute Stroke Treatment", Stroke, 24, pp.35~41 (1993)
- Kim HC, "Six-year survival and causes of death among stroke patients in Korea", Neuroepidemiology, 32, pp.94~100 (2009)
- Adachi T, "Frequency and pathogenesis of silent subcortical brain infarction in acute first-ever ischemic stroke", Intern Med, 41, pp.103~108 (2002)
- Vermeer SE, "Silent brain infarcts: a systematic review", Lancet Neurol, 6, pp.611~619 (2007)
- Klarenbeek P, "Ambulatory blood pressure in patients with lacunar stroke: association with total MRI burden of cerebral small vessel disease", Stroke, 44, pp.2995~2999 (2013)
- Arsava EM, "Severity of leukoaraiosis correlates with clinical outcome after ischemic stroke", Neurology, 72, pp.1403~1410 (2009)
- Lim JS, "Cerebral microbleeds and early recurrent stroke after transient ischemic attack: results from the Korean Transient Ischemic Attack Expression Registry", JAMA Neurol, 72, pp.301~308 (2015)
- Soo YO, "Risk vs benefit of anti-thrombotic therapy in ischaemic stroke patients with cerebral microbleeds", J Neurol, 255, pp.1679~1686 (2008)
- Altmann-Schneider I, "Cerebral microbleeds are predictive of mortality in the elderly", Stroke, 42, pp.638~644 (2011)
- Bokura H, "Silent brain infarction and subcortical white matter lesions increase the risk of stroke and mortality: a prospective cohort study", J Stroke Cerebrovasc Dis, 15, pp.57~63 (2006)
- Montagne A, "Vascular plasticity and cognition during normal aging and dementia", JAMA Neurol, 72, pp.495~496 (2015)
- 김영대, "Long-Term Mortality According to the Characteristics of Early Neurological Deterioration in Ischemic Stroke Patients", Yonsei Medical Journal, 55(3), pp.669~675 (2014), 연세대학교의과대학[DOI]
- Kim J, "Prognostic value of urine dipstick proteinuria on mortality after acute ischemic stroke", Atherosclerosis, 253, pp.118~123 (2016)
- 김영대, "Increased Risk of Cardiovascular Events in Stroke Patients Who had Not Undergone Evaluation for Coronary Artery Disease", Yonsei Medical Journal, 58(1), pp.114~122 (2017), 연세대학교의과대학[DOI]
- Oh MS, "Gender differences in the mortality and outcome of stroke patients in Korea", Cerebrovasc Dis, 28, pp.427~434 (2009)
- Wong KS, "Long-term mortality and recurrent stroke risk among Chinese stroke patients with predominant intracranial atherosclerosis", Stroke, 34, pp.2361~2366 (2003)
- Putaala J, "Silent brain infarcts, leukoaraiosis, and long-term prognosis in young ischemic stroke patients", Neurology, 76, pp.1742~1749 (2011)
- Charidimou A, "Cerebral microbleeds and recurrent stroke risk: systematic review and meta-analysis of prospective ischemic stroke and transient ischemic attack cohorts", Stroke, 44, pp.995~1001 (2013)