Association of Neuroimaging Markers of Cerebral Small Vessel Disease With Short-Term Outcomes in Patients With Minor Cerebrovascular Events

Abstract Objective: As one of the Magnetic resonance imaging (MRI) makers of cerebral small vessel disease (SVD), increasing evidences have showed that white matter hyperintensity (WMH) can predict the short-term outcome of acute ischemic stroke (AIS). It is unclear that whether neuroimaging markers of SVD are also associated with short-term outcomes of minor cerebrovascular events. In the present study, We investigate neuroimaging markers of SVD in order to explore their roles in prediction of short-term outcome in patients with minor cerebrovascular events. Methods: Consecutive first-ever stroke patients(n=546)from the Affiliated Jiangning Hospital of Nanjing Medical University were enrolled. A total of 388 patients were enrolled according to minor cerebrovascular events definition and exclusion criteria. MRI scans were performed within seven days of stroke onset, and then neuroimaging markers of SVD including WMH, lacunes, cerebral microbleeds (CMB), and perivascular spaces (PVS) , SVD burden scores were assessed. We completed baseline characteristics and evaluated the relationships of short-term outcomes to SVD neuroimaging markers and SVD scores. The 90-day modified Rankin Scale (mRS) was thought as primary outcome and was dichotomized as good functional outcome (mRS 0-1) and poor outcome (mRS 2-6). Secondary outcomes were stroke progression and stroke recurrence. Results: Higher age, National Institutes of Health Stroke Scale (NIHSS) upon admission, lipoprotein-associated phospholipase A2 (LP-PLA2) and lacunes, Fazekas score were correlated with poor functional outcome (P<0.05), But after adjusting for confounding variables, among the neuroimaging markers of cerebral small vessel disease, only Fazekas score (OR, 1.343; 95% confidence interval, 1.020-1.770; P=0.036) was found to be associated with poor outcome at 90 days. Higher Fazekas and SVD scores were not associated with stroke progression or stroke recurrence. Conclusion: WMH can predict the poor functional outcome of minor cerebrovascular events. Adding other neuroimaging markers of SVD and total SVD burden score, however, does not improve the prediction,which indicated WMH can as neuroimaging markers for guiding the treatment of minor cerebrovascular events.

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Association of neuroimaging markers of cerebral small vessel disease with short-term outcomes in patients with minor cerebrovascular events

BMC Neurology ◽

10.1186/s12883-021-02043-9 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Xuemei Chen ◽

Lin Wang ◽

Junying Jiang ◽

Yuanyuan Gao ◽

Rui Zhang ◽

...

Keyword(s):

Functional Outcome ◽

Small Vessel Disease ◽

National Institutes Of Health ◽

Stroke Recurrence ◽

Short Term ◽

Poor Functional Outcome ◽

Term Outcome ◽

Vessel Disease ◽

Short Term Outcome ◽

Cerebrovascular Events

Abstract Background Increasing evidences have showed that neuroimaging markers of SVD can predict the short-term outcome of acute ischemic stroke (AIS). It is unclear that whether neuroimaging markers of SVD are also associated with short-term outcomes of minor cerebrovascular events. In the present study, we investigate neuroimaging markers of SVD in order to explore their roles in prediction of short-term outcome in patients with minor cerebrovascular events. Methods Consecutive first-ever stroke patients (n = 546) from the Affiliated Jiangning Hospital of Nanjing Medical University were enrolled. A total of 388 patients were enrolled according to minor cerebrovascular events definition (National Institutes of Health Stroke Scale Score ≤ 3) and exclusion criteria. MRI scans were performed within 7 days of stroke onset, and then neuroimaging markers of SVD including WMH, lacunes, cerebral microbleeds (CMB), and perivascular spaces (PVS), SVD burden scores were assessed. We completed baseline characteristics and evaluated the relationships of short-term outcomes to SVD neuroimaging markers and SVD scores. The 90-day modified Rankin Scale (mRS) was thought as primary outcome and was dichotomized as good functional outcome (mRS 0–1) and poor outcome (mRS 2–6). Secondary outcomes were stroke progression and stroke recurrence. Results Higher age, National Institutes of Health Stroke Scale (NIHSS) upon admission, lipoprotein-associated phospholipase A2 (LP-PLA2) and lacunes, Fazekas score were correlated with poor functional outcome (P < 0.05), But after adjusting for confounding variables, among the neuroimaging markers of cerebral small vessel disease, only Fazekas score (OR, 1.343; 95% confidence interval, 1.020–1.770; P = 0.036) was found to be associated with poor outcome at 90 days. Higher Fazekas and SVD scores were not associated with stroke progression or stroke recurrence. Conclusion WMH can predict the poor functional outcome of minor cerebrovascular events. Adding other neuroimaging markers of SVD and total SVD burden score, however, does not improve the prediction, which indicated WMH can as neuroimaging markers for guiding the treatment of minor cerebrovascular events.

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Association of Neuroimaging Markers of Cerebral Small Vessel Disease With Short-Term Outcomes in Patients With Minor Cerebrovascular Events

10.21203/rs.3.rs-57506/v3 ◽

2020 ◽

Author(s):

Xuemei Chen ◽

Lin Wang ◽

Junying Jiang ◽

Yuanyuan Gao ◽

Rui Zhang ◽

...

Keyword(s):

Functional Outcome ◽

Small Vessel Disease ◽

National Institutes Of Health ◽

Stroke Recurrence ◽

Short Term ◽

Poor Functional Outcome ◽

Term Outcome ◽

Vessel Disease ◽

Short Term Outcome ◽

Cerebrovascular Events

Abstract Background: Increasing evidences have showed that neuroimaging markers of SVD can predict the short-term outcome of acute ischemic stroke (AIS).It is unclear that whether neuroimaging markers of SVD are also associated with short-term outcomes of minor cerebrovascular events. In the present study, we investigate neuroimaging markers of SVD in order to explore their roles in prediction of short-term outcome in patients with minor cerebrovascular events. Methods: Consecutive first-ever stroke patients (n=546) from the Affiliated Jiangning Hospital of Nanjing Medical University were enrolled. A total of 388 patients were enrolled according to minor cerebrovascular events definition（National Institutes of Health Stroke Scale Score≤3）and exclusion criteria. MRI scans were performed within seven days of stroke onset, and then neuroimaging markers of SVD including WMH, lacunes, cerebral microbleeds (CMB), and perivascular spaces (PVS) , SVD burden scores were assessed. We completed baseline characteristics and evaluated the relationships of short-term outcomes to SVD neuroimaging markers and SVD scores. The 90-day modified Rankin Scale (mRS) was thought as primary outcome and was dichotomized as good functional outcome (mRS 0-1) and poor outcome (mRS 2-6). Secondary outcomes were stroke progression and stroke recurrence. Results: Higher age, National Institutes of Health Stroke Scale (NIHSS) upon admission, lipoprotein-associated phospholipase A2 (LP-PLA2) and lacunes, Fazekas score were correlated with poor functional outcome (P<0.05), But after adjusting for confounding variables, among the neuroimaging markers of cerebral small vessel disease, only Fazekas score (OR, 1.343; 95% confidence interval, 1.020-1.770; P=0.036) was found to be associated with poor outcome at 90 days. Higher Fazekas and SVD scores were not associated with stroke progression or stroke recurrence. Conclusion: WMH can predict the poor functional outcome of minor cerebrovascular events. Adding other neuroimaging markers of SVD and total SVD burden score, however, does not improve the prediction, which indicated WMH can as neuroimaging markers for guiding the treatment of minor cerebrovascular events.

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Association of Neuroimaging Markers of Cerebral Small Vessel Disease With Short-Term Outcomes in Patients With Minor Cerebrovascular Events

10.21203/rs.3.rs-57506/v4 ◽

2021 ◽

Author(s):

Xuemei Chen ◽

Lin Wang ◽

Junying Jiang ◽

Yuanyuan Gao ◽

Rui Zhang ◽

...

Keyword(s):

Functional Outcome ◽

Small Vessel Disease ◽

National Institutes Of Health ◽

Stroke Recurrence ◽

Short Term ◽

Poor Functional Outcome ◽

Term Outcome ◽

Vessel Disease ◽

Short Term Outcome ◽

Cerebrovascular Events

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Association of Neuroimaging Markers of Cerebral Small Vessel Disease With Short-Term Outcomes in Patients With Minor Cerebrovascular Events

10.21203/rs.3.rs-57506/v2 ◽

2020 ◽

Author(s):

Xuemei Chen ◽

Lin Wang ◽

Junying Jiang ◽

Yuanyuan Gao ◽

Rui Zhang ◽

...

Keyword(s):

Functional Outcome ◽

Small Vessel Disease ◽

National Institutes Of Health ◽

Stroke Recurrence ◽

Short Term ◽

Poor Functional Outcome ◽

Term Outcome ◽

Vessel Disease ◽

Short Term Outcome ◽

Cerebrovascular Events

Abstract Objective: Increasing evidences have showed that neuroimaging markers of SVD can predict the short-term outcome of acute ischemic stroke (AIS).It is unclear that whether neuroimaging markers of SVD are also associated with short-term outcomes of minor cerebrovascular events. In the present study, we investigate neuroimaging markers of SVD in order to explore their roles in prediction of short-term outcome in patients with minor cerebrovascular events. Methods: Consecutive first-ever stroke patients (n=546) from the Affiliated Jiangning Hospital of Nanjing Medical University were enrolled. A total of 388 patients were enrolled according to minor cerebrovascular events definition（National Institutes of Health Stroke Scale Score≤3）and exclusion criteria. MRI scans were performed within seven days of stroke onset, and then neuroimaging markers of SVD including WMH, lacunes, cerebral microbleeds (CMB), and perivascular spaces (PVS) , SVD burden scores were assessed. We completed baseline characteristics and evaluated the relationships of short-term outcomes to SVD neuroimaging markers and SVD scores. The 90-day modified Rankin Scale (mRS) was thought as primary outcome and was dichotomized as good functional outcome (mRS 0-1) and poor outcome (mRS 2-6). Secondary outcomes were stroke progression and stroke recurrence. Results: Higher age, National Institutes of Health Stroke Scale (NIHSS) upon admission, lipoprotein-associated phospholipase A2 (LP-PLA2) and lacunes, Fazekas score were correlated with poor functional outcome (P<0.05), But after adjusting for confounding variables, among the neuroimaging markers of cerebral small vessel disease, only Fazekas score (OR, 1.343; 95% confidence interval, 1.020-1.770; P=0.036) was found to be associated with poor outcome at 90 days. Higher Fazekas and SVD scores were not associated with stroke progression or stroke recurrence. Conclusion: WMH can predict the poor functional outcome of minor cerebrovascular events. Adding other neuroimaging markers of SVD and total SVD burden score, however, does not improve the prediction, which indicated WMH can as neuroimaging markers for guiding the treatment of minor cerebrovascular events.

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Cerebral Small Vessel Disease Load Predicts Functional Outcome and Stroke Recurrence After Intracerebral Hemorrhage: A Median Follow-Up of 5 Years

Frontiers in Aging Neuroscience ◽

10.3389/fnagi.2021.628271 ◽

2021 ◽

Vol 13 ◽

Author(s):

Mangmang Xu ◽

Baojin Li ◽

Di Zhong ◽

Yajun Cheng ◽

Qian Wu ◽

...

Keyword(s):

Regression Analysis ◽

Intracerebral Hemorrhage ◽

Functional Outcome ◽

Small Vessel Disease ◽

Cerebral Small Vessel Disease ◽

Stroke Recurrence ◽

Poor Functional Outcome ◽

Vessel Disease

Background: Uncertainty exists over the long-term prognostic significance of cerebral small vessel disease (CSVD) in primary intracerebral hemorrhage (ICH).Methods: We performed a longitudinal analysis of CSVD and clinical outcomes in consecutive patients with primary ICH who had MRI. Baseline CSVD load (including white matter hyperintensities [WMH], cerebral microbleeds [CMBs], lacunes, and enlarged perivascular spaces [EPVS]) was evaluated. The cumulative CSVD score was calculated by combining the presence of each CSVD marker (range 0–4). We followed participants for poor functional outcome [modified Rankin scale [mRS] ≥ 4], stroke recurrence, and time-varying survival during a median follow-up of 4.9 [interquartile range [IQR] 3.1–6.0] years. Parsimonious and fuller multivariable logistic regression analysis and Cox-regression analysis were performed to estimate the association of CSVD markers, individually and collectively, with each outcome.Results: A total of 153 patients were included in the analyses. CMBs ≥ 10 [adjusted OR [adOR] 3.252, 95% CI 1.181–8.956, p = 0.023] and periventricular WMH (PWMH) (adOR 2.053, 95% CI 1.220–3.456, p = 0.007) were significantly associated with poor functional outcome. PWMH (adOR 2.908, 95% CI 1.230–6.878, p = 0.015) and lobar CMB severity (adOR 1.811, 95% CI 1.039–3.157, p = 0.036) were associated with stroke recurrence. The cumulative CSVD score was associated with poor functional outcome (adOR 1.460, 95% CI 1.017–2.096) and stroke recurrence (adOR 2.258, 95% CI 1.080–4.723). Death occurred in 36.1% (13/36) of patients with CMBs ≥ 10 compared with 18.8% (22/117) in those with CMB < 10 (adjusted HR 2.669, 95% CI 1.248–5.707, p = 0.011). In addition, the cumulative CSVD score ≥ 2 was associated with a decreased survival rate (adjusted HR 3.140, 95% CI 1.066–9.250, p = 0.038).Conclusions: Severe PWMH, CMB, or cumulative CSVD burden exert important influences on the long-term outcome of ICH.

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Cognitive reserve moderates long-term cognitive and functional outcome in cerebral small vessel disease

Journal of Neurology Neurosurgery & Psychiatry ◽

10.1136/jnnp-2016-313914 ◽

2016 ◽

Vol 87 (12) ◽

pp. 1296-1302 ◽

Cited By ~ 19

Author(s):

Hanna Jokinen ◽

Susanna Melkas ◽

Sofia Madureira ◽

Ana Verdelho ◽

José M Ferro ◽

...

Keyword(s):

Functional Outcome ◽

Cognitive Reserve ◽

Small Vessel Disease ◽

Cerebral Small Vessel Disease ◽

Small Vessel ◽

Vessel Disease

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Cerebral Small Vessel Disease and Functional Outcome Prediction After Intracerebral Hemorrhage

Neurology ◽

10.1212/wnl.0000000000011746 ◽

2021 ◽

Vol 96 (15) ◽

pp. e1954-e1965

Author(s):

Isabel C. Hostettler ◽

Ghil Schwarz ◽

Gareth Ambler ◽

Duncan Wilson ◽

Gargi Banerjee ◽

...

Keyword(s):

Intracerebral Hemorrhage ◽

Functional Outcome ◽

Small Vessel Disease ◽

Characteristic Curve ◽

Cerebral Small Vessel Disease ◽

Small Vessel ◽

Cortical Atrophy ◽

Vessel Disease ◽

Lemeshow Test ◽

Ich Score

ObjectiveTo determine whether CT-based cerebral small vessel disease (SVD) biomarkers are associated with 6-month functional outcome after intracerebral hemorrhage (ICH) and whether these biomarkers improve the performance of the preexisting ICH prediction score.MethodsWe included 864 patients with acute ICH from a multicenter, hospital-based prospective cohort study. We evaluated CT-based SVD biomarkers (white matter hypodensities [WMH], lacunes, brain atrophy, and a composite SVD burden score) and their associations with poor 6-month functional outcome (modified Rankin Scale score >2). The area under the receiver operating characteristic curve (AUROC) and Hosmer-Lemeshow test were used to assess discrimination and calibration of the ICH score with and without SVD biomarkers.ResultsIn multivariable models (adjusted for ICH score components), WMH presence (odds ratio [OR] 1.52, 95% confidence interval [CI] 1.12–2.06), cortical atrophy presence (OR 1.80, 95% CI 1.19–2.73), deep atrophy presence (OR 1.66, 95% CI 1.17–2.34), and severe atrophy (either deep or cortical) (OR 1.94, 95% CI 1.36–2.74) were independently associated with poor functional outcome. For the revised ICH score, the AUROC was 0.71 (95% CI 0.68–0.74). Adding SVD markers did not significantly improve ICH score discrimination; for the best model (adding severe atrophy), the AUROC was 0.73 (95% CI 0.69–0.76). These results were confirmed when lobar and nonlobar ICH were considered separately.ConclusionsThe ICH score has acceptable discrimination for predicting 6-month functional outcome after ICH. CT biomarkers of SVD are associated with functional outcome, but adding them does not significantly improve ICH score discrimination.Trial Registration InformationClinicalTrials.gov Identifier: NCT02513316.

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Synergistic associations of cognitive and motor impairments with functional outcome in covert cerebral small vessel disease

European Journal of Neurology ◽

10.1111/ene.15108 ◽

2021 ◽

Author(s):

Hanna Jokinen ◽

Hanna M. Laakso ◽

Matti Ahlström ◽

Anne Arola ◽

Juha Lempiäinen ◽

...

Keyword(s):

Functional Outcome ◽

Small Vessel Disease ◽

Cerebral Small Vessel Disease ◽

Small Vessel ◽

Motor Impairments ◽

Vessel Disease

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Risk of vascular events or death in different manifestations of cerebral small vessel disease: a 2-year follow-up study with a control group

10.1101/151498 ◽

2017 ◽

Author(s):

Jacek Staszewski ◽

Renata Piusińska-Macoch ◽

Bogdan Brodacki ◽

Ewa Skrobowska ◽

Katarzyna Macek ◽

...

Keyword(s):

Small Vessel Disease ◽

White Matter Lesions ◽

Cerebral Small Vessel Disease ◽

Small Vessel ◽

Control Group ◽

Vascular Events ◽

Vessel Disease ◽

Mri Features ◽

Cerebrovascular Events ◽

Single Center Study

Background and PurposeNatural course of cerebral small vessel disease (CSVD) has not yet been thoroughly studied. The aim of the single center study was to establish risk of vascular events or death in different manifestations of CSVD.Methods150 consecutive, functionally independent patients with marked MRI features of CSVD and with recent lacunar stroke (n=52, LS), 20 with deep hemorrhagic stroke (HS), 28 with vascular parkinsonism (VaP), 50 with vascular dementia (VaD) and 55 controls (CG) with high atherothrombotic risk free of cerebrovascular events were prospectively recruited and followed for 24 months.ResultsMean age and sex distribution were similar in CSVD and CG but patients with CSVD were less likely to have CAD (19% vs 40%, p=0,02) and tended to have higher prevalence of diabetes (54% vs 37%, p=0,11). The risk of vascular events or death was increased in any patients with moderate to severe white matter lesions at baseline MRI (HR 2,0; 95%CI 0,85-7,2), in CSVD (4,56; 95%CI 1,3-14,9) vs CG, regardless of its clinical manifestation: LS or HS (HR 4,70; 95%CI 1,3-16,2) and VaD or VaP (HR 4,59; 95%CI 1,3-15,7).ConclusionsPatients with symptomatic CSVD regardless of the clinical (acute or chronic) manifestation had more than fourfold the risk of vascular events or death in 24 months of observation compared with controls with high atherothrombotic risk free of cerebrovascular events.

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