Study On The Relationship Between High Signal White Matter And Prognosis In Patients With Acute Ischemic Stroke

Part â… :The association between white matter hyperintensity and prognosis for acute ischemic stroke patientsBackground:Growing evidence has improved that white matter hyperintensity (WMH) is associated with functional outcomes and stroke recurrence after acute ischemic stroke. This study investigated the association between WMH and functional outcomes and stroke recurrence at different time points, and evaluated the different impact of periventricular hyperintensity (PVH) and deep white matter hyperintensity (DWMH) on functional outcomes and stroke recurrence.Methods:Brain MRI was performed on1733 acute infarction patients in SMART study recruited from 47 hospitals and PVH and DWMH were scored by Fazekas scale. Vascular disease risk factors were obtained from the study and outcome measures were modified Rankin Scale (mRS) at 4 weeks,6 weeks and 6 months and stroke recurrence at 6 weeks, 6 months and 12 months poststroke.Results:Multivariate analysis showed that PVH was not associated with mRS at 4 weeks and 6 weeks poststroke, but PVH was associated with mRS at 6 months (OR=2.520, 95%CI=1.393-4.559) and stroke recurrence at 6 weeks (OR=6.837,95%CI=1.669-28.012), stroke recurrence at6 months (OR=3.796,95%CI=1.503-9.585) and stroke recurrence at12 months (OR=3.851,95%CI=1.843-8.047). DWMH had no association with any outcome measures above.Conclusion:WMH could predict functional outcomes and stroke recurrence after acute ischemic stroke and in term of location, PVH could predict the functional outcomes at 6 months and stroke recurrence at 6 weeks,6 months and 12 months. DWMH could not predict any prognosis above. In conclusion, PVH had a much better ability to predict outcomes poststroke than DWMH.Partâ…¡:The association between white matter hyperintensity and prognosis for acute solitary perforating artery infarction patientsBackground:There are more and more studies investigating the association between white matter hyperintensity (WMH) and the prognosis of acute ischemic stroke, but only few studies explored the distinction between different types of infarction. This study preferred to investigate the association between WMH and functional outcomes and stroke recurrence in small vessel infarction and tried to find a population which could represent small vessel infarction better by evaluating the recent infarction lesions.Methods:262 patients of solitary perforating artery infarction and 403 patients of other types of infarction of anterior circulation were classified according to the location, size and quantity of recent infarction lesions of 1733 patients which included all types of infarction. Vascular disease risk factors were obtained from the study and outcome measures were modified Rankin Scale (mRS) at 4 weeks,6 weeks and 6 months and stroke recurrence at 6 weeks,6 months and 12 months poststroke.Results:Compared to population of all types of infarction, in solitary perforating artery infarctionpopulation, there were fewer patients with stroke or TIA (24.4% vs 32.8%), fewer patients with coronary heart disease (6.9% vs 13.4%), and fewer patients with atrial flutter or atrial fibrillation (1.9% vs 7.4%). It concluded that solitary perforating artery infarctionpopulation could represent small vessel infarction better. Insolitary perforating artery infarctionpopulation, PVH was associated with mRS at 6 months (OR=4.145,95%CI=1.101-15.604) and stroke recurrence at 6 months (OR=23.492, 95%CI=1.801-306.480), and stroke recurrence at 12 months (OR=13.478, 95%CI=1.690-107.473). Inother types of infarctionpopulation, PVH was associated with mRS at 6weeks (OR=5.037,95%CI=1.642-15.446) and mRS at 6 months (OR=5.136, 95%CI=1.472-17.917). There was no association between PVH and stroke recurrence in other types of infarctionpopulation. DWMH had no association with any outcome measures above.Conclusion:ln functional outcomes, the association between WMH and outcomes had littledifference between solitary perforating artery infarction and other types of infarction population. In stroke recurrence, the association between WMH and stroke recurrence in solitary perforating artery infarction was much stronger than the one in other types of infarction population.As for location, PVH had a much better ability to predict outcomes poststroke than DWMH.