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Effects of white matter hyperintensity burden on functional outcome after mild versus moderate-to-severe ischemic
Dong-Seok Gwak1,2, Wi-Sun Ryu3, Dawid Schellingerhout4
1Department of Neurology, Dongguk University Ilsan Hospital, 52-6 Dongguk-Ro, Ilsandong-Gu, Goyang-si, Gyeonggi-do, 10326, Republic of Korea.
Abstract:
It is uncertain whether the prognostic power of white matter hyperintensity (WMH) on post-stroke outcomes is modulated as a function of initial neurological severity, a critical determinant of outcome after stroke. This multi-center MRI study tested if higher WMH quintiles were associated with 3-month poor functional outcome (modified Rankin Scale ≥ 3) for mild versus moderate-to-severe ischemic stroke. Mild and moderate-to-severe stroke were defined as admission National Institute of Health Stroke Scale scores of 1-4 and ≥ 5, respectively. Mean age of the enrolled patients (n = 8918) was 67.2 ± 12.6 years and 60.1% male. The association between WMH quintiles and poor functional outcome was modified by stroke severity (p-for-interaction = 0.008). In mild stroke (n = 4994), WMH quintiles associated with the 3-month outcome in a dose-dependent manner for the 2nd to 5th quintile versus the 1st quintile, with adjusted-odds-ratios (aOR [95% confidence interval]) being 1.29 [0.96-1.73], 1.37 [1.02-1.82], 1.60 [1.19-2.13], and 1.89 [1.41-2.53], respectively. In moderate-to-severe stroke (n = 3924), however, there seemed to be a threshold effect: only the highest versus the lowest WMH quintile was significantly associated with poor functional outcome (aOR 1.69 [1.29-2.21]). WMH burden aggravates 3-month functional outcome after mild stroke, but has a lesser modulatory effect for moderate-to-severe stroke, likely due to saturation effects.
Insights
White matter hyperintensity (WMH) significantly impacts stroke recovery. Higher WMH burden worsens outcomes in mild strokes, but has a lesser effect in moderate-to-severe strokes, suggesting a saturation effect.
Area of Science:
- Neurology
- Radiology
- Clinical Medicine
Background:
- White matter hyperintensity (WMH) is a common finding on MRI scans.
- The prognostic significance of WMH in post-stroke outcomes is not fully understood, especially concerning initial stroke severity.
- Neurological severity is a key factor influencing stroke recovery.
Purpose of the Study:
- To investigate if the prognostic value of WMH on 3-month post-stroke outcomes differs between mild and moderate-to-severe ischemic strokes.
- To determine the association between WMH burden and poor functional outcomes based on initial stroke severity.
Main Methods:
- A multi-center MRI study involving 8918 patients with ischemic stroke.
- Patients were categorized into mild (NIHSS 1-4) and moderate-to-severe (NIHSS ≥5) stroke groups.
- The association between WMH quintiles and 3-month functional outcome (modified Rankin Scale ≥3) was analyzed, considering stroke severity.
Main Results:
- Stroke severity significantly modified the association between WMH burden and functional outcome (p=0.008).
- In mild strokes, increasing WMH burden (2nd to 5th quintile) showed a dose-dependent association with poor 3-month outcomes.
- In moderate-to-severe strokes, only the highest WMH quintile was significantly associated with poor outcomes, indicating a potential threshold effect.
Conclusions:
- WMH burden exacerbates 3-month functional outcomes in patients with mild ischemic stroke.
- The impact of WMH on functional outcomes appears less pronounced in moderate-to-severe strokes, possibly due to saturation effects.
- Initial stroke severity is a crucial factor in modulating the prognostic power of WMH.
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