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The cardiovascular outcome of patients with motor impairment and extensive leukoaraiosis
D Inzitari1, A Di Carlo, M Mascalchi
1Department of Neurological and Psychiatric Sciences, University of Florence, Italy.
Insights
Patients with motor impairment and extensive leukoaraiosis face a significantly higher risk of stroke and cardiovascular events. Lacunar infarction appears to be a key factor influencing their poor long-term outcome.
Area of Science:
- Neurology
- Cardiovascular Medicine
- Radiology
Background:
- The long-term prognosis for patients exhibiting motor impairment and extensive leukoaraiosis on computed tomographic scans remains largely unknown.
- Leukoaraiosis, a white matter change, is often associated with cerebrovascular disease.
Purpose of the Study:
- To investigate the incidence of stroke, myocardial infarction, and death in patients with motor impairment and extensive leukoaraiosis.
- To compare the cardiovascular outcomes of these patients against a control group without leukoaraiosis.
Main Methods:
- A cohort study involving 31 patients with motor impairment and extensive leukoaraiosis (cases) and 68 neurologic patients without leukoaraiosis (controls).
- Both groups underwent routine neurologic and cardiovascular assessments.
- Follow-up duration averaged approximately 50 months for both cases and controls.
Main Results:
- The 6-year cumulative risk of stroke was significantly higher in cases (49%) compared to controls (16%), with a hazard ratio of 3.0.
- The combined risk of stroke or myocardial infarction was also substantially greater in cases (69%) versus controls (36%), hazard ratio 2.9.
- Adjusting for conventional vascular risk factors did not eliminate the increased stroke risk in cases, but adjustment for lacunar stroke history and imaging reduced the observed risk.
Conclusions:
- Patients presenting with motor impairment and extensive leukoaraiosis experience a markedly poor cardiovascular outcome.
- The presence of lacunar infarction may be a primary determinant of the adverse long-term prognosis in this patient population.
Background And Methods:
The long-term outcome of patients with motor impairment and extensive leukoaraiosis on computed tomographic scan is unknown. We studied the incidence of stroke, myocardial infarction, and death in 31 such patients (cases) and in 68 neurologic patients without leukoaraiosis (controls). The patients in both groups had a routine neurologic and cardiovascular assessment and were followed up for 51.9 +/- 20.1 (mean +/- SD) months (cases) and 49.5 +/- 18.6 months (controls).
Results:
The 6-year risk of cumulative stroke, as determined by life table analysis, was 49% among cases and 16% among controls (hazard ratio, 3.0; 95% confidence interval, 1.2 to 7.5). The risk of stroke or myocardial infarction was 69% vs 36% (hazard ratio, 2.9; 95% confidence interval, 1.4 to 6.2). The stroke risk remained significantly increased among cases after adjustment for age, sex, and any conventional vascular risk factor, while it was reduced (hazard ratio, 2.5; 95% confidence interval, 0.8 to 7.4) after adjustment for history of lacunar stroke was corrected for and was almost halved (hazard ratio, 1.6; 95% confidence interval, 0.5 to 4.6) after adjustment for the presence of lacunar infarction images on computed tomographic scan.
Conclusions:
Patients with motor impairment and extensive leukoaraiosis have a very poor cardiovascular outcome. Lacunar infarction might be the major determinant of the outcome in these patients.