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White Matter Hyperintensities Improve Ischemic Stroke Recurrence Prediction
- Source :
- Andersen, S D, Larsen, T B, Gorst-Rasmussen, A, Yavarian, Y, Lip, G Y H & Bach, F W 2017, ' White Matter Hyperintensities Improve Ischemic Stroke Recurrence Prediction ', Cerebrovascular Diseases, vol. 43, no. 1-2, pp. 17-24 . https://doi.org/10.1159/000450962
- Publication Year :
- 2017
-
Abstract
- Background: Nearly one in 5 patients with ischemic stroke will invariably experience a second stroke within 5 years. Stroke risk stratification schemes based solely on clinical variables perform only modestly in non-atrial fibrillation (AF) patients and improvement of these schemes will enhance their clinical utility. Cerebral white matter hyperintensities are associated with an increased risk of incident ischemic stroke in the general population, whereas their association with the risk of ischemic stroke recurrence is more ambiguous. In a non-AF stroke cohort, we investigated the association between cerebral white matter hyperintensities and the risk of recurrent ischemic stroke, and we evaluated the predictive performance of the CHA2DS2VASc score and the Essen Stroke Risk Score (clinical scores) when augmented with information on white matter hyperintensities. Methods: In a registry-based, observational cohort study, we included 832 patients (mean age 59.6 (SD 13.9); 42.0% females) with incident ischemic stroke and no AF. We assessed the severity of white matter hyperintensities using MRI. Hazard ratios stratified by the white matter hyperintensities score and adjusted for the components of the CHA2DS2VASc score were calculated based on the Cox proportional hazards analysis. Recalibrated clinical scores were calculated by adding one point to the score for the presence of moderate to severe white matter hyperintensities. The discriminatory performance of the scores was assessed with the C-statistic. Results: White matter hyperintensities were significantly associated with the risk of recurrent ischemic stroke after adjusting for clinical risk factors. The hazard ratios ranged from 1.65 (95% CI 0.70-3.86) for mild changes to 5.28 (95% CI 1.98-14.07) for the most severe changes. C-statistics for the prediction of recurrent ischemic stroke were 0.59 (95% CI 0.51-0.65) for the CHA2DS2VASc score and 0.60 (95% CI 0.53-0.68) for the Essen Stroke Risk Score. The recalibrated clinical scores showed improved C-statistics: the recalibrated CHA2DS2VASc score 0.62 (95% CI 0.54-0.70; p = 0.024) and the recalibrated Essen Stroke Risk Score 0.63 (95% CI 0.56-0.71; p = 0.031). C-statistics of the white matter hyperintensities score were 0.62 (95% CI 0.52-0.68) to 0.65 (95% CI 0.58-0.73). Conclusions: An increasing burden of white matter hyperintensities was independently associated with recurrent ischemic stroke in a cohort of non-AF ischemic stroke patients. Recalibration of the CHA2DS2VASc score and the Essen Stroke Risk Score with one point for the presence of moderate to severe white matter hyperintensities led to improved discriminatory performance in ischemic stroke recurrence prediction. Risk scores based on white matter hyperintensities alone were at least as accurate as the established clinical risk scores in the prediction of ischemic stroke recurrence.
- Subjects :
- Male
medicine.medical_specialty
Time Factors
Denmark
Severity of Illness Index
Brain Ischemia
Decision Support Techniques
Stroke risk
03 medical and health sciences
0302 clinical medicine
Leukoencephalopathies
Predictive Value of Tests
Recurrence
Risk Factors
Internal medicine
Severity of illness
medicine
Humans
Recurrence prediction
Registries
030212 general & internal medicine
Aged
Proportional Hazards Models
Aged, 80 and over
medicine.diagnostic_test
Proportional hazards model
business.industry
Magnetic resonance imaging
Middle Aged
Prognosis
Magnetic Resonance Imaging
White Matter
Hyperintensity
Stroke
Neurology
Predictive value of tests
Ischemic stroke
Cardiology
Female
Neurology (clinical)
Cardiology and Cardiovascular Medicine
business
030217 neurology & neurosurgery
Subjects
Details
- Language :
- English
- Database :
- OpenAIRE
- Journal :
- Andersen, S D, Larsen, T B, Gorst-Rasmussen, A, Yavarian, Y, Lip, G Y H & Bach, F W 2017, ' White Matter Hyperintensities Improve Ischemic Stroke Recurrence Prediction ', Cerebrovascular Diseases, vol. 43, no. 1-2, pp. 17-24 . https://doi.org/10.1159/000450962
- Accession number :
- edsair.doi.dedup.....d4ad37b807bb6d2fa373713cee4e86a4
- Full Text :
- https://doi.org/10.1159/000450962