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White Matter Hyperintensities Improve Ischemic Stroke Recurrence Prediction.

Søren Due Andersen1, Torben Bjerregaard Larsen, Anders Gorst-Rasmussen

  • 1Department of Neurology, Aalborg University, Aalborg, Denmark.

Cerebrovascular Diseases (Basel, Switzerland)
|October 18, 2016
PubMed
Summary

White matter hyperintensities increase recurrent ischemic stroke risk in patients without atrial fibrillation. Augmenting clinical scores with WMH data improves stroke recurrence prediction, offering better risk stratification.

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Area of Science:

  • Neurology
  • Radiology
  • Cardiology

Background:

  • Recurrent ischemic stroke poses a significant risk, with current clinical stratification performing modestly in non-atrial fibrillation (AF) patients.
  • Cerebral white matter hyperintensities (WMH) are linked to incident stroke, but their role in stroke recurrence is less clear.
  • Improving risk prediction models is crucial for enhancing clinical utility in stroke management.

Purpose of the Study:

  • To investigate the association between cerebral white matter hyperintensities (WMH) and recurrent ischemic stroke risk in a non-AF cohort.
  • To evaluate the predictive performance of established clinical scores (CHA2DS2VASc, Essen Stroke Risk Score) augmented with WMH information.
  • To assess the accuracy of WMH burden alone in predicting recurrent ischemic stroke.

Main Methods:

  • Observational cohort study of 832 non-AF ischemic stroke patients.
  • Assessment of white matter hyperintensities (WMH) severity using MRI.
  • Cox proportional hazards analysis and C-statistic evaluation for predictive performance of clinical scores and WMH scores.

Main Results:

  • Increasing WMH burden was independently associated with higher recurrent ischemic stroke risk (HR 5.28 for most severe).
  • Recalibrating CHA2DS2VASc and Essen Stroke Risk Scores by adding WMH information improved their predictive discriminatory performance (C-statistics increased).
  • WMH-based risk scores demonstrated accuracy comparable to established clinical scores for predicting stroke recurrence.

Conclusions:

  • Elevated white matter hyperintensities burden is an independent predictor of recurrent ischemic stroke in non-AF patients.
  • Incorporating WMH into clinical scores enhances their ability to predict ischemic stroke recurrence.
  • WMH assessment offers a valuable tool for refining stroke risk stratification.