Prediction of functional outcome using the novel asymmetric middle cerebral artery index in cryptogenic stroke patients

Minho Han; Young Dae Kim; Hyung Jong Park; In Gun Hwang; Junghye Choi; Jimin Ha; Ji Hoe Heo; Hyo Suk Nam

doi:10.1371/journal.pone.0208918

Prediction of functional outcome using the novel asymmetric middle cerebral artery index in cryptogenic stroke patients

Minho Han, Young Dae Kim, Hyung Jong Park, In Gun Hwang, Junghye Choi, Jimin Ha, Ji Hoe Heo, Hyo Suk Nam

Department of Neurology

Research output: Contribution to journal › Article › peer-review

4 Citations (Scopus)

Abstract

Background Etiology is unknown in approximately one-quarter of stroke patients after evaluation, which is termed cryptogenic stroke (CS). The prognosis of CS patients is largely undetermined. We created a novel index from transcranial Doppler parameters including mean flow velocity (MV) and pulsatility index (PI) and investigated whether the calculation of asymmetry in the novel parameter can predict functional outcomes in CS patients. Methods We made the middle cerebral artery (MCA) index (%) as a novel parameter, which was calculated as 100 X (MCA MV + MCA PI X 10) / (MCA MV–MCA PI X 10). The MCA asymmetry index (%) was also calculated as 100 X (|Rt MCA index–Lt MCA index|) / (Rt MCA index + Lt MCA index) / 2. Poor functional outcomes were defined as modified Rankin Scale score (mRS) 3 at 3 months after stroke onset. Results A total of 377 CS patients were included. Among them, 52 (13.8%) patients had a poor outcome. The overall MCA asymmetry index was two-fold higher in CS patients with a poor outcome (10.26%) compared to those with a good outcome (5.41%, p = 0.002). In multivariable analysis, the overall MCA asymmetry index (OR, 1.054, 95% CI, 1.013–1.096, p = 0.009) and the cutoff value of the overall MCA asymmetry index >9 were associated with poor outcomes at 3 months (OR, 3.737, 95% CI, 1.530–9.128, p = 0.004). Conclusion We demonstrated that the novel asymmetric MCA index can predict short-term functional outcomes in CS patients.

Original language	English
Article number	e0208918
Journal	PloS one
Volume	14
Issue number	1
DOIs	https://doi.org/10.1371/journal.pone.0208918
Publication status	Published - 2019 Jan

Bibliographical note

Funding Information:
This work was supported by the National Research Foundation of Korea (NRF) grant, funded by the Korean government (MSIP) (2016R1C1B2016028). The funder had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Publisher Copyright:
© 2019 Han et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

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10.1371/journal.pone.0208918

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@article{731e898277154f5a8a66cadbf3020843,

title = "Prediction of functional outcome using the novel asymmetric middle cerebral artery index in cryptogenic stroke patients",

abstract = "Background Etiology is unknown in approximately one-quarter of stroke patients after evaluation, which is termed cryptogenic stroke (CS). The prognosis of CS patients is largely undetermined. We created a novel index from transcranial Doppler parameters including mean flow velocity (MV) and pulsatility index (PI) and investigated whether the calculation of asymmetry in the novel parameter can predict functional outcomes in CS patients. Methods We made the middle cerebral artery (MCA) index (%) as a novel parameter, which was calculated as 100 X (MCA MV + MCA PI X 10) / (MCA MV–MCA PI X 10). The MCA asymmetry index (%) was also calculated as 100 X (|Rt MCA index–Lt MCA index|) / (Rt MCA index + Lt MCA index) / 2. Poor functional outcomes were defined as modified Rankin Scale score (mRS) 3 at 3 months after stroke onset. Results A total of 377 CS patients were included. Among them, 52 (13.8%) patients had a poor outcome. The overall MCA asymmetry index was two-fold higher in CS patients with a poor outcome (10.26%) compared to those with a good outcome (5.41%, p = 0.002). In multivariable analysis, the overall MCA asymmetry index (OR, 1.054, 95% CI, 1.013–1.096, p = 0.009) and the cutoff value of the overall MCA asymmetry index >9 were associated with poor outcomes at 3 months (OR, 3.737, 95% CI, 1.530–9.128, p = 0.004). Conclusion We demonstrated that the novel asymmetric MCA index can predict short-term functional outcomes in CS patients.",

author = "Minho Han and Kim, {Young Dae} and Park, {Hyung Jong} and Hwang, {In Gun} and Junghye Choi and Jimin Ha and Heo, {Ji Hoe} and Nam, {Hyo Suk}",

note = "Funding Information: This work was supported by the National Research Foundation of Korea (NRF) grant, funded by the Korean government (MSIP) (2016R1C1B2016028). The funder had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. Publisher Copyright: {\textcopyright} 2019 Han et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.",

year = "2019",

month = jan,

doi = "10.1371/journal.pone.0208918",

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volume = "14",

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T1 - Prediction of functional outcome using the novel asymmetric middle cerebral artery index in cryptogenic stroke patients

AU - Han, Minho

AU - Kim, Young Dae

AU - Park, Hyung Jong

AU - Hwang, In Gun

AU - Choi, Junghye

AU - Ha, Jimin

AU - Heo, Ji Hoe

AU - Nam, Hyo Suk

N1 - Funding Information: This work was supported by the National Research Foundation of Korea (NRF) grant, funded by the Korean government (MSIP) (2016R1C1B2016028). The funder had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. Publisher Copyright: © 2019 Han et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

PY - 2019/1

Y1 - 2019/1

N2 - Background Etiology is unknown in approximately one-quarter of stroke patients after evaluation, which is termed cryptogenic stroke (CS). The prognosis of CS patients is largely undetermined. We created a novel index from transcranial Doppler parameters including mean flow velocity (MV) and pulsatility index (PI) and investigated whether the calculation of asymmetry in the novel parameter can predict functional outcomes in CS patients. Methods We made the middle cerebral artery (MCA) index (%) as a novel parameter, which was calculated as 100 X (MCA MV + MCA PI X 10) / (MCA MV–MCA PI X 10). The MCA asymmetry index (%) was also calculated as 100 X (|Rt MCA index–Lt MCA index|) / (Rt MCA index + Lt MCA index) / 2. Poor functional outcomes were defined as modified Rankin Scale score (mRS) 3 at 3 months after stroke onset. Results A total of 377 CS patients were included. Among them, 52 (13.8%) patients had a poor outcome. The overall MCA asymmetry index was two-fold higher in CS patients with a poor outcome (10.26%) compared to those with a good outcome (5.41%, p = 0.002). In multivariable analysis, the overall MCA asymmetry index (OR, 1.054, 95% CI, 1.013–1.096, p = 0.009) and the cutoff value of the overall MCA asymmetry index >9 were associated with poor outcomes at 3 months (OR, 3.737, 95% CI, 1.530–9.128, p = 0.004). Conclusion We demonstrated that the novel asymmetric MCA index can predict short-term functional outcomes in CS patients.

AB - Background Etiology is unknown in approximately one-quarter of stroke patients after evaluation, which is termed cryptogenic stroke (CS). The prognosis of CS patients is largely undetermined. We created a novel index from transcranial Doppler parameters including mean flow velocity (MV) and pulsatility index (PI) and investigated whether the calculation of asymmetry in the novel parameter can predict functional outcomes in CS patients. Methods We made the middle cerebral artery (MCA) index (%) as a novel parameter, which was calculated as 100 X (MCA MV + MCA PI X 10) / (MCA MV–MCA PI X 10). The MCA asymmetry index (%) was also calculated as 100 X (|Rt MCA index–Lt MCA index|) / (Rt MCA index + Lt MCA index) / 2. Poor functional outcomes were defined as modified Rankin Scale score (mRS) 3 at 3 months after stroke onset. Results A total of 377 CS patients were included. Among them, 52 (13.8%) patients had a poor outcome. The overall MCA asymmetry index was two-fold higher in CS patients with a poor outcome (10.26%) compared to those with a good outcome (5.41%, p = 0.002). In multivariable analysis, the overall MCA asymmetry index (OR, 1.054, 95% CI, 1.013–1.096, p = 0.009) and the cutoff value of the overall MCA asymmetry index >9 were associated with poor outcomes at 3 months (OR, 3.737, 95% CI, 1.530–9.128, p = 0.004). Conclusion We demonstrated that the novel asymmetric MCA index can predict short-term functional outcomes in CS patients.

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Prediction of functional outcome using the novel asymmetric middle cerebral artery index in cryptogenic stroke patients

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