J Clin Neurol.  2017 Apr;13(2):187-195. 10.3988/jcn.2017.13.2.187.

Total Cerebral Small-Vessel Disease Score is Associated with Mortality during Follow-Up after Acute Ischemic Stroke

• Song TJ
• Kim J
• Song D
• Yoo J
• Lee HS
• Kim YJ
• Nam HS
• Heo JH
• Kim YD

• KMID: 2376021
• DOI: http://doi.org/10.3988/jcn.2017.13.2.187

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.

Keyword

cerebral small-vessel diseases; cerebral microbleeds; white-matter hyperintensities; perivascular spaces; asymptomatic lacunar infarctions

MeSH Terms

Brain
Cause of Death
Follow-Up Studies*
Humans
Magnetic Resonance Imaging
Mortality*
Stroke*
Stroke, Lacunar

Figure

• 

  Fig. 1 Selection of patients. GRE: gradient recalled echo, TIA: transient ischemic attack.

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  Fig. 2 Kaplan-Meier survival plots for patients with acute ischemic stroke according to total CSVD score. The Kaplan-Meier curve shows that deaths related to all causes (p=0.001) (A), ischemic stroke (p=0.001) (B), and hemorrhagic stroke (p=0.001) (C) were associated with the total CSVD score, whereas fatal cardiovascular events were not (p=0.100) (D). CSVD: cerebral small-vessel disease, SVD: small-vessel disease.

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