The analysis of association between single features of small vessel disease and stroke outcome shows the independent impact of the number of microbleeds and presence of lacunes.
Journal
Scientific reports
ISSN: 2045-2322
Titre abrégé: Sci Rep
Pays: England
ID NLM: 101563288
Informations de publication
Date de publication:
10 Feb 2024
10 Feb 2024
Historique:
received:
30
08
2023
accepted:
01
02
2024
medline:
10
2
2024
pubmed:
10
2
2024
entrez:
9
2
2024
Statut:
epublish
Résumé
The impact of small vessel disease (SVD) on stroke outcome was investigated either separately for its single features in isolation or for SVD sum score measuring a qualitative (binary) assessment of SVD-lesions. We aimed to investigate which SVD feature independently impacts the most on stroke outcome and to compare the continuous versus binary SVD assessment that reflects pronouncement and presence correspondingly. Patients with a first-ever anterior circulation ischemic stroke were retrospectively investigated. We performed an ordered logistic regression analysis to predict stroke outcome (mRS 3 months, 0-6) using age, stroke severity, and pre-stroke disability as baseline input variables and adding SVD-features (lacunes, microbleeds, enlarged perivascular spaces, white matter hyperintensities) assessed either continuously (model 1) or binary (model 2). The data of 873 patients (age 67.9 ± 15.4, NIHSS 24 h 4.1 ± 4.8) was analyzed. In model 1 with continuous SVD-features, the number of microbleeds was the only independent predictor of stroke outcome in addition to clinical parameters (OR 1.21; 95% CI 1.07-1.37). In model 2 with the binary SVD assessment, only the presence of lacunes independently improved the prediction of stroke outcome (OR 1.48, 1.1-1.99). In a post hoc analysis, both the continuous number of microbleeds and the presence of lacunes were independent significant predictors. Thus, the number of microbleeds evaluated continuously and the presence of lacunes are associated with stroke outcome independent from age, stroke severity, pre-stroke disability and other SVD-features. Whereas the presence of lacunes is adequately represented in SVD sum score, the microbleeds assessment might require another cutoff and/or gradual scoring, when prediction of stroke outcome is needed.
Identifiants
pubmed: 38336856
doi: 10.1038/s41598-024-53500-7
pii: 10.1038/s41598-024-53500-7
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
3402Subventions
Organisme : Dementia Research Switzerland - Synapsis Foundation
ID : 2019-PI05
Organisme : Dementia Research Switzerland - Synapsis Foundation
ID : 2019-PI05
Organisme : Dementia Research Switzerland - Synapsis Foundation
ID : 2019-PI05
Informations de copyright
© 2024. The Author(s).
Références
Wardlaw, J. M., Smith, C. & Dichgans, M. Small vessel disease: Mechanisms and clinical implications. Lancet Neurol. 18, 684–696 (2019).
doi: 10.1016/S1474-4422(19)30079-1
pubmed: 31097385
ter Telgte, A. et al. Cerebral small vessel disease: From a focal to a global perspective. Nat. Rev. Neurol. 14, 387–398 (2018).
doi: 10.1038/s41582-018-0014-y
pubmed: 29802354
Jokinen, H. et al. Global burden of small vessel disease-related brain changes on MRI predicts cognitive and functional decline. Stroke 51, 170–178 (2020).
doi: 10.1161/STROKEAHA.119.026170
pubmed: 31699021
Debette, S. et al. Clinical Significance of magnetic resonance imaging markers of vascular brain injury: A systematic review and meta-analysis. JAMA Neurol. 76, 81–94 (2019).
doi: 10.1001/jamaneurol.2018.3122
pubmed: 30422209
Del Brutto, V. J. et al. Total cerebral small vessel disease score and all-cause mortality in older adults of Amerindian ancestry: The Atahualpa Project. Eur. Stroke J. 6, 412–419 (2021).
doi: 10.1177/23969873211060803
pubmed: 35342801
pmcid: 8948511
De Giuli, V. et al. Subclinical vascular brain lesions in young adults with acute ischemic stroke. Stroke 53, 1190–1198 (2022).
doi: 10.1161/STROKEAHA.121.036038
pubmed: 34727743
Pasi, M. & Cordonnier, C. Clinical relevance of cerebral small vessel diseases. Stroke 51, 47–53 (2020).
doi: 10.1161/STROKEAHA.119.024148
pubmed: 31752613
Klarenbeek, P. et al. Ambulatory blood pressure in patients with lacunar stroke: Association with total MRI burden of cerebral small vessel disease. Stroke 44, 2995–2999 (2013).
doi: 10.1161/STROKEAHA.113.002545
pubmed: 23982717
Staals, J. et al. Stroke subtype, vascular risk factors, and total MRI brain small-vessel disease burden. Neurology 83, 1228–1234 (2014).
doi: 10.1212/WNL.0000000000000837
pubmed: 25165388
pmcid: 4180484
Georgakis, M. K. et al. Cerebral small vessel disease burden and cognitive and functional outcomes after stroke: A multicenter prospective cohort study. Alzheimers Dement J. Alzheimers Assoc. https://doi.org/10.1002/alz.12744 (2022).
doi: 10.1002/alz.12744
Coutureau, J. et al. Cerebral small vessel disease MRI features do not improve the prediction of stroke outcome. Neurology 96, e527–e537 (2021).
doi: 10.1212/WNL.0000000000011208
pubmed: 33184231
Wardlaw, J. M. et al. Neuroimaging standards for research into small vessel disease and its contribution to ageing and neurodegeneration. Lancet Neurol. 12, 822–838 (2013).
doi: 10.1016/S1474-4422(13)70124-8
pubmed: 23867200
pmcid: 3714437
Georgakis, M. K. et al. WMH and long-term outcomes in ischemic stroke: A systematic review and meta-analysis. Neurology 92, e1298–e1308 (2019).
doi: 10.1212/WNL.0000000000007142
pubmed: 30770431
Arauz, A. et al. Prospective study of single and multiple lacunar infarcts using magnetic resonance imaging. Stroke 34, 2453–2458 (2003).
doi: 10.1161/01.STR.0000090351.41662.91
pubmed: 14500936
Sakuta, K. et al. Cerebral microbleeds load and long-term outcomes in minor ischemic stroke. J. Stroke Cerebrovasc. Dis. 30, 105973 (2021).
doi: 10.1016/j.jstrokecerebrovasdis.2021.105973
pubmed: 34271277
Kim, B. J. & Lee, S.-H. Prognostic impact of cerebral small vessel disease on stroke outcome. J. Stroke 17, 101–110 (2015).
doi: 10.5853/jos.2015.17.2.101
pubmed: 26060797
pmcid: 4460329
Greenberg, S. M. et al. Cerebral microbleeds: A field guide to their detection and interpretation. Lancet Neurol. 8, 165–174 (2009).
doi: 10.1016/S1474-4422(09)70013-4
pubmed: 19161908
pmcid: 3414436
Fazekas, F. et al. MR signal abnormalities at 1.5 T in Alzheimer’s dementia and normal aging. AJR Am. J. Roentgenol. 149, 351–356 (1987).
doi: 10.2214/ajr.149.2.351
pubmed: 3496763
Doubal, F. N. et al. Enlarged perivascular spaces on MRI are a feature of cerebral small vessel disease. Stroke 41, 450–454 (2010).
doi: 10.1161/STROKEAHA.109.564914
pubmed: 20056930
Venables, W. N. & Ripley, B. D. Modern Applied Statistics with S (Springer, Berlin, 2002).
doi: 10.1007/978-0-387-21706-2
Vernooij, M. W. et al. Prevalence and risk factors of cerebral microbleeds: The Rotterdam Scan Study. Neurology 70, 1208–1214 (2008).
doi: 10.1212/01.wnl.0000307750.41970.d9
pubmed: 18378884
Sperber, C. et al. A typology of cerebral small vessel disease based on imaging markers. J. Neurol. https://doi.org/10.1007/s00415-023-11831-x (2023).
doi: 10.1007/s00415-023-11831-x
pubmed: 37848651
pmcid: 10828033
Wilson, D. et al. Cerebral microbleeds and stroke risk after ischaemic stroke or transient ischaemic attack: A pooled analysis of individual patient data from cohort studies. Lancet Neurol. 18, 653–665 (2019).
doi: 10.1016/S1474-4422(19)30197-8
pubmed: 31130428
pmcid: 6562236
Ding, J. et al. Space and location of cerebral microbleeds, cognitive decline, and dementia in the community. Neurology 88, 2089–2097 (2017).
doi: 10.1212/WNL.0000000000003983
pubmed: 28468844
pmcid: 5447401
Arba, F. et al. Leukoaraiosis and lacunes are associated with poor clinical outcomes in ischemic stroke patients treated with intravenous thrombolysis. Int. J. Stroke 11, 62–67 (2016).
doi: 10.1177/1747493015607517
pubmed: 26763021
Xu, T. et al. Small vessel disease burden and outcomes of mechanical thrombectomy in ischemic stroke: A systematic review and meta-analysis. Front. Neurol. https://doi.org/10.3389/fneur.2021.602037 (2021).
doi: 10.3389/fneur.2021.602037
pubmed: 35185755
pmcid: 8734591
Young, I. R. et al. Nuclear magnetic resonance (NMR) imaging in white matter disease of the brain using spin-echo sequences. J. Comput. Assist. Tomogr. 7, 290–294 (1983).
doi: 10.1097/00004728-198304000-00016
pubmed: 6833562
Gouw, A. A. et al. Heterogeneity of small vessel disease: A systematic review of MRI and histopathology correlations. J. Neurol. Neurosurg. Psychiatry 82, 126–135 (2011).
doi: 10.1136/jnnp.2009.204685
pubmed: 20935330
Yamada, S. et al. Periventricular and deep white matter leukoaraiosis have a closer association with cerebral microbleeds than age. Eur. J. Neurol. 19, 98–104 (2012).
doi: 10.1111/j.1468-1331.2011.03451.x
pubmed: 21645176
Mahammedi, A. et al. Small vessel disease, a marker of brain health: What the radiologist needs to know. AJNR Am. J. Neuroradiol. 43, 650–660 (2022).
doi: 10.3174/ajnr.A7302
pubmed: 34620594
pmcid: 9089248
Wardlaw, J. M. et al. Perivascular spaces in the brain: anatomy, physiology and pathology. Nat. Rev. Neurol. 16, 137–153 (2020).
doi: 10.1038/s41582-020-0312-z
pubmed: 32094487
Appleton, J. P. et al. Imaging markers of small vessel disease and brain frailty, and outcomes in acute stroke. Neurology 94, e439–e452 (2020).
doi: 10.1212/WNL.0000000000008881
pubmed: 31882527
pmcid: 7080284
Hostettler, I. C. et al. Cerebral small vessel disease and functional outcome prediction after intracerebral hemorrhage. Neurology 96, e1954–e1965 (2021).
doi: 10.1212/WNL.0000000000011746
pubmed: 33627495
Bu, N. et al. Imaging markers of brain frailty and outcome in patients with acute ischemic stroke. Stroke 52, 1004–1011 (2021).
doi: 10.1161/STROKEAHA.120.029841
pubmed: 33504185
Xie, Y. Population heterogeneity and causal inference. Proc. Natl. Acad. Sci. 110, 6262–6268 (2013).
doi: 10.1073/pnas.1303102110
pubmed: 23530202
pmcid: 3631652
Pasi, M. et al. Distribution of lacunes in cerebral amyloid angiopathy and hypertensive small vessel disease. Neurology 88, 2162–2168 (2017).
doi: 10.1212/WNL.0000000000004007
pubmed: 28476760
pmcid: 5467956
Sperber, C. et al. Stroke lesion size—Still a useful biomarker for stroke severity and outcome in times of high-dimensional models. NeuroImage Clin. 40, 103511 (2023).
doi: 10.1016/j.nicl.2023.103511
pubmed: 37741168
pmcid: 10520672
Umarova, R. M. Adapting the concepts of brain and cognitive reserve to post-stroke cognitive deficits: Implications for understanding neglect. Cortex 97, 327–338 (2017).
doi: 10.1016/j.cortex.2016.12.006
pubmed: 28049565