Influence of white matter lesions on the prognosis of acute cardioembolic stroke without reperfusion therapy

Guo, Yue-Liang Leon; Chen, Zhuoyou; Wang, Qian; Zhang, Min; Dong, Guanzhong; Zou, Wenying; Yao, Tian; Xu, Yun

doi:10.1186/s12883-021-02372-9

Cited by 5 publications

(3 citation statements)

References 23 publications

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“… 18 , 19 Our previous study enrolled CES patients identified by cranial CT or MRI scan and found that WMLs are an independent risk factor for the outcome. 20 In this study, patients were evaluated by MRI and it was found that WMH was an independent risk factor for poor prognosis, which was consistent with the results of studies focusing on ischemic stroke with other causes. 21 …”

Section: Discussionsupporting

confidence: 88%

Influence of Pre-Existing Cerebral Small Vessel Disease on the Outcome of Acute Cardioembolic Stroke: A Retrospective Study

Su¹,

Guo²,

Chen³

et al. 2022

NDT

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Purpose This study was to explore the role of pre-existing small vessel disease (SVD) on the 3-month outcomes of acute cardioembolic stroke (CES) patients. Patients and Methods Data of 189 consecutive acute CES patients at a single center were retrospectively enrolled. SVD imaging markers of lacunes, white matter hyperintensities (WMH) and enlarged perivascular spaces (EPVS) were evaluated and their total burden score (0–3 points) was calculated. Patients were divided into the good functional outcome group (modified Rankin scale, mRS ≤ 2) and the poor functional outcome group (mRS ≥ 3) at 3 months after stroke onset. The effect of each single SVD marker and its total burden score on the outcome was identified using binary logistic regression. Results Overall, 100 (52.9%), 52 (27.1%), 28 (14.8%) and 9 (4.8%) patients had 0, 1, 2 and 3 SVD imaging markers. Patients with a total SVD burden score of 2 and 3 were significantly older and had higher baseline National Institutes of Health Stroke Scale (NIHSS) score than those with a score of 0 and 1 (P<0.01). Forty-seven (24.9%) patients had a poor outcome. Patients in the poor outcome group had significantly higher baseline NIHSS score, increased incidence of stroke associated pneumonia, and heavier burden of lacunes, WMH and EPVS, and thus had elevated total SVD burden score than those in good outcome group (P<0.05). After adjusting for potential confounders, the WMH (odds ratio [OR] = 2.6777, 95% confidence interval [CI] = 1.052–6.812, P = 0.039) and the total SVD burden score (OR = 1.717, 95% CI = 1.072–2.749, P = 0.024) were, respectively, independent risk factors for a poor outcome. Conclusion The pre-existing SVD may be associated with the 3-month prognosis of CES.

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Section: Discussionsupporting

confidence: 88%

Influence of Pre-Existing Cerebral Small Vessel Disease on the Outcome of Acute Cardioembolic Stroke: A Retrospective Study

Su¹,

Guo²,

Chen³

et al. 2022

NDT

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“…A total Fazekas score, ranging from 0 to 6, was estimated by summing the Fazekas scores for PWMH and DWMH. We defined severe WMH as a total Fazekas score of ≥3, as previously described (Guo et al, 2021). In accordance with the STRIVE criteria (Staals et al, 2014;Duering et al, 2023), the SVD score was determined by a double-blinded review of FLAIR images by two expert vascular neurologists (M Lee and S-H Lee; ICC = 0.92, p < 0.001).…”

Section: Data Collection and Definition Of Parametersmentioning

confidence: 99%

Impact of white matter hyperintensity volumes estimated by automated methods using deep learning on stroke outcomes in small vessel occlusion stroke

Lee,

Suh,

Sohn

et al. 2024

Front. Aging Neurosci.

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IntroductionAlthough white matter hyperintensity (WMH) shares similar vascular risk and pathology with small vessel occlusion (SVO) stroke, there were few studies to evaluate the impact of the burden of WMH volume on early and delayed stroke outcomes in SVO stroke.Materials and methodsUsing a multicenter registry database, we enrolled SVO stroke patients between August 2013 and November 2022. The WMH volume was estimated by automated methods using deep learning (VUNO Med-DeepBrain, Seoul, South Korea), which was a commercially available segmentation model. After propensity score matching (PSM), we evaluated the impact of WMH volume on early neurological deterioration (END) and poor functional outcomes at 3-month modified Ranking Scale (mRS), defined as mRS score >2 at 3 months, after an SVO stroke.ResultsAmong 1,718 SVO stroke cases, the prevalence of subjects with severe WMH (Fazekas score ≥ 3) was 68.9%. After PSM, END and poor functional outcomes at 3-month mRS (mRS > 2) were higher in the severe WMH group (END: 6.9 vs. 13.5%, p < 0.001; 3-month mRS > 2: 11.4 vs. 24.7%, p < 0.001). The logistic regression analysis using the PSM cohort showed that total WMH volume increased the risk of END [odd ratio [OR], 95% confidence interval [CI]; 1.01, 1.00–1.02, p = 0.048] and 3-month mRS > 2 (OR, 95% CI; 1.02, 1.01–1.03, p < 0.001). Deep WMH was associated with both END and 3-month mRS > 2, but periventricular WMH was associated with 3-month mRS > 2 only.ConclusionThis study used automated methods using a deep learning segmentation model to assess the impact of WMH burden on outcomes in SVO stroke. Our findings emphasize the significance of WMH burden in SVO stroke prognosis, encouraging tailored interventions for better patient care.

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“…A total Fazekas score, ranging from 0 to 6, was calculated by summing the periventricular and subcortical WMLs scores [24]. According to previous studies, severe WMLs were defined as a total Fazekas score ≥ 3 [25][26][27].…”

Section: Image Acquisition and Analysismentioning

confidence: 99%

Association between Citrullinated Histone H3 and White Matter Lesions Burden in Patients with Ischemic Stroke

Zhang

Huang

et al. 2023

Brain Sciences

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Introduction: Neutrophil extracellular traps play a role in the pathophysiology of stroke and are associated with severity and mortality. We aimed to investigate whether the citrullinated histone H3 (CitH3), a biomarker for neutrophil extracellular traps formation, is associated with the white matter lesion (WML) burden in ischemic stroke patients. Methods: Between September 2021 and April 2022, 322 patients were enrolled in this prospective observational cohort study. Serum CitH3 levels were measured after admission using an enzyme-linked immunosorbent assay. WMLs severity was graded according to the Fazekas scale and conceptually defined as mild (total Fazekas score 0–2) and severe (total Fazekas score 3–6). We used multivariable regression models to determine the relationship between CitH3 concentrations and the severity of WMLs burden. Results: One-hundred and forty-eight (46.0%) patients were diagnosed with severe WMLs burden after admission. Increased CitH3 levels (first quartile vs. fourth quartile of H3Cit, odds ratio, 3.311, 95% confidence interval, 1.336–8.027; p = 0.011) were independently associated with a greater WML burden in the fully adjusted multivariable model. Similar results were found when the H3Cit was analyzed as a continuous variable. Furthermore, the multiple-adjusted spline regression model showed a linear association between H3Cit levels and severe WMLs (P = 0.001 for linearity). Conclusions: In the present study, increased CitH3 levels were positively associated with extensive WMLs in ischemic stroke patients, indicating a role of neutrophil extracellular traps formation in the pathogenesis of WMLs.

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Influence of white matter lesions on the prognosis of acute cardioembolic stroke without reperfusion therapy

Cited by 5 publications

References 23 publications

Influence of Pre-Existing Cerebral Small Vessel Disease on the Outcome of Acute Cardioembolic Stroke: A Retrospective Study

Influence of Pre-Existing Cerebral Small Vessel Disease on the Outcome of Acute Cardioembolic Stroke: A Retrospective Study

Impact of white matter hyperintensity volumes estimated by automated methods using deep learning on stroke outcomes in small vessel occlusion stroke

Association between Citrullinated Histone H3 and White Matter Lesions Burden in Patients with Ischemic Stroke

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