Differential impact of white matter hyperintensities on long-term outcomes in ischemic stroke patients with large artery atherosclerosis

Minyoul Baik, Kyoungsub Kim, Joonsang Yoo, Hyeon Chang Kim, Seong Ho Jeong, Ki Hoon Kim, Hyung Jong Park, Young Dae Kim, Ji Hoe Heo, Hyo Suk Nam

Research output: Contribution to journalArticle

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Abstract

Background: The presence of white matter hyperintensity (WMH) is related to poor long-term outcomes in stroke patients. However, the long-term outcome is unknown in patients with both large artery atherosclerosis (LAA) and WMH. Methods: We investigated the impact of WMH on long-term outcome in patients with LAA. Consecutive patients in a prospective stroke registry were included. Patients were followed for a median of 7.7 years (interquartile range, 5.6-9.7). The degree of WMH was assessed by Fazekas grade on fluid-attenuated inversion recovery images. Total WMH burden was calculated by summation of Fazekas scores in periventricular and deep white matter. Severe WMH was defined as total burden score > 3. Results: Among 2529 patients, 639 patients (25.3%) were classified with the LAA subtype. After applying exclusion criteria, the data from 538 patients were analyzed. The mean patient age was 65.7 ± 10.3 years. Severe WMHs were found in 243 patients (45.2%). During follow-up, 200 patients (37.2%) died. Cox regression analysis showed that LAA patients with severe WMH had a 1.50-fold (95% CI, 1.12-2.00, p = 0.007) higher death rate compared to those without. In the older age group (>65 years), Cox regression revealed that patients with severe WMH had a 1.75-fold (95% CI, 1.15-2.65, p = 0.008) higher 5-year death rate, whereas the younger age group did not have this association. Conclusion: The degree of WMH might be a surrogate marker for long-term outcome in patients with LAA. Atherosclerotic burdens in both small and large arteries might impact long-term prognosis in ischemic stroke patients.

Original languageEnglish
Article numbere0189611
JournalPloS one
Volume12
Issue number12
DOIs
Publication statusPublished - 2017 Dec

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atherosclerosis
stroke
Regression analysis
arteries
Atherosclerosis
Arteries
Stroke
Recovery
Fluids
White Matter
Age Groups
Mortality
prognosis
Registries
regression analysis
Biomarkers

All Science Journal Classification (ASJC) codes

  • Biochemistry, Genetics and Molecular Biology(all)
  • Agricultural and Biological Sciences(all)

Cite this

Baik, Minyoul ; Kim, Kyoungsub ; Yoo, Joonsang ; Kim, Hyeon Chang ; Jeong, Seong Ho ; Kim, Ki Hoon ; Park, Hyung Jong ; Kim, Young Dae ; Heo, Ji Hoe ; Nam, Hyo Suk. / Differential impact of white matter hyperintensities on long-term outcomes in ischemic stroke patients with large artery atherosclerosis. In: PloS one. 2017 ; Vol. 12, No. 12.
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title = "Differential impact of white matter hyperintensities on long-term outcomes in ischemic stroke patients with large artery atherosclerosis",
abstract = "Background: The presence of white matter hyperintensity (WMH) is related to poor long-term outcomes in stroke patients. However, the long-term outcome is unknown in patients with both large artery atherosclerosis (LAA) and WMH. Methods: We investigated the impact of WMH on long-term outcome in patients with LAA. Consecutive patients in a prospective stroke registry were included. Patients were followed for a median of 7.7 years (interquartile range, 5.6-9.7). The degree of WMH was assessed by Fazekas grade on fluid-attenuated inversion recovery images. Total WMH burden was calculated by summation of Fazekas scores in periventricular and deep white matter. Severe WMH was defined as total burden score > 3. Results: Among 2529 patients, 639 patients (25.3{\%}) were classified with the LAA subtype. After applying exclusion criteria, the data from 538 patients were analyzed. The mean patient age was 65.7 ± 10.3 years. Severe WMHs were found in 243 patients (45.2{\%}). During follow-up, 200 patients (37.2{\%}) died. Cox regression analysis showed that LAA patients with severe WMH had a 1.50-fold (95{\%} CI, 1.12-2.00, p = 0.007) higher death rate compared to those without. In the older age group (>65 years), Cox regression revealed that patients with severe WMH had a 1.75-fold (95{\%} CI, 1.15-2.65, p = 0.008) higher 5-year death rate, whereas the younger age group did not have this association. Conclusion: The degree of WMH might be a surrogate marker for long-term outcome in patients with LAA. Atherosclerotic burdens in both small and large arteries might impact long-term prognosis in ischemic stroke patients.",
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Differential impact of white matter hyperintensities on long-term outcomes in ischemic stroke patients with large artery atherosclerosis. / Baik, Minyoul; Kim, Kyoungsub; Yoo, Joonsang; Kim, Hyeon Chang; Jeong, Seong Ho; Kim, Ki Hoon; Park, Hyung Jong; Kim, Young Dae; Heo, Ji Hoe; Nam, Hyo Suk.

In: PloS one, Vol. 12, No. 12, e0189611, 12.2017.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Differential impact of white matter hyperintensities on long-term outcomes in ischemic stroke patients with large artery atherosclerosis

AU - Baik, Minyoul

AU - Kim, Kyoungsub

AU - Yoo, Joonsang

AU - Kim, Hyeon Chang

AU - Jeong, Seong Ho

AU - Kim, Ki Hoon

AU - Park, Hyung Jong

AU - Kim, Young Dae

AU - Heo, Ji Hoe

AU - Nam, Hyo Suk

PY - 2017/12

Y1 - 2017/12

N2 - Background: The presence of white matter hyperintensity (WMH) is related to poor long-term outcomes in stroke patients. However, the long-term outcome is unknown in patients with both large artery atherosclerosis (LAA) and WMH. Methods: We investigated the impact of WMH on long-term outcome in patients with LAA. Consecutive patients in a prospective stroke registry were included. Patients were followed for a median of 7.7 years (interquartile range, 5.6-9.7). The degree of WMH was assessed by Fazekas grade on fluid-attenuated inversion recovery images. Total WMH burden was calculated by summation of Fazekas scores in periventricular and deep white matter. Severe WMH was defined as total burden score > 3. Results: Among 2529 patients, 639 patients (25.3%) were classified with the LAA subtype. After applying exclusion criteria, the data from 538 patients were analyzed. The mean patient age was 65.7 ± 10.3 years. Severe WMHs were found in 243 patients (45.2%). During follow-up, 200 patients (37.2%) died. Cox regression analysis showed that LAA patients with severe WMH had a 1.50-fold (95% CI, 1.12-2.00, p = 0.007) higher death rate compared to those without. In the older age group (>65 years), Cox regression revealed that patients with severe WMH had a 1.75-fold (95% CI, 1.15-2.65, p = 0.008) higher 5-year death rate, whereas the younger age group did not have this association. Conclusion: The degree of WMH might be a surrogate marker for long-term outcome in patients with LAA. Atherosclerotic burdens in both small and large arteries might impact long-term prognosis in ischemic stroke patients.

AB - Background: The presence of white matter hyperintensity (WMH) is related to poor long-term outcomes in stroke patients. However, the long-term outcome is unknown in patients with both large artery atherosclerosis (LAA) and WMH. Methods: We investigated the impact of WMH on long-term outcome in patients with LAA. Consecutive patients in a prospective stroke registry were included. Patients were followed for a median of 7.7 years (interquartile range, 5.6-9.7). The degree of WMH was assessed by Fazekas grade on fluid-attenuated inversion recovery images. Total WMH burden was calculated by summation of Fazekas scores in periventricular and deep white matter. Severe WMH was defined as total burden score > 3. Results: Among 2529 patients, 639 patients (25.3%) were classified with the LAA subtype. After applying exclusion criteria, the data from 538 patients were analyzed. The mean patient age was 65.7 ± 10.3 years. Severe WMHs were found in 243 patients (45.2%). During follow-up, 200 patients (37.2%) died. Cox regression analysis showed that LAA patients with severe WMH had a 1.50-fold (95% CI, 1.12-2.00, p = 0.007) higher death rate compared to those without. In the older age group (>65 years), Cox regression revealed that patients with severe WMH had a 1.75-fold (95% CI, 1.15-2.65, p = 0.008) higher 5-year death rate, whereas the younger age group did not have this association. Conclusion: The degree of WMH might be a surrogate marker for long-term outcome in patients with LAA. Atherosclerotic burdens in both small and large arteries might impact long-term prognosis in ischemic stroke patients.

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