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Total Cerebral Small-Vessel Disease Score is Associated with Mortality during Follow-Up after Acute Ischemic Stroke
Tae Jin Song1,2, Jinkwon Kim3, Dongbeom Song1
1Department of Neurology, Yonsei University College of Medicine, Seoul, Korea.
Insights
The total cerebral small-vessel disease (CSVD) score effectively predicts long-term mortality in acute ischemic stroke patients. Higher CSVD scores correlate with increased risk of death from all causes, ischemic stroke, and hemorrhagic stroke.
Area of Science:
- Neurology
- Radiology
- Public Health
Background:
- Cerebral small-vessel disease (CSVD) is a significant factor in stroke.
- The total CSVD score quantifies the cumulative burden of CSVD markers.
- Assessing the prognostic value of the total CSVD score in acute ischemic stroke is crucial.
Purpose of the Study:
- To evaluate the association between the total CSVD score and long-term mortality in patients with acute ischemic stroke.
- To determine if the total CSVD score can serve as an imaging biomarker for predicting outcomes.
Main Methods:
- 1,096 acute ischemic stroke patients undergoing brain MRI were analyzed.
- The total CSVD score was calculated based on cerebral microbleeds, white-matter hyperintensities, perivascular spaces, and lacunar infarctions.
- Long-term mortality data were collected and analyzed using Cox proportional-hazards models.
Main Results:
- The total CSVD score was independently associated with increased all-cause mortality (HR=1.18)
- Higher CSVD scores predicted higher risks of death from ischemic stroke (HR=1.20) and hemorrhagic stroke (HR=2.05).
- No significant association was found between the total CSVD score and fatal cardiovascular events.
Conclusions:
- The total CSVD score is a valuable imaging biomarker for predicting long-term mortality in acute ischemic stroke patients.
- This score can aid in risk stratification and patient management following ischemic stroke.
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.