Ischemic stroke recurrence and mortality in different imaging phenotypes of ischemic cerebrovascular disease: The SMART-MR Study
Lucci, Carlo; Rissanen, Ina; de Jong, Pim A; Kappelle, L Jaap; Hendrikse, Jeroen; Geerlings, Mirjam I
(2023) European Stroke Journal, volume 8, issue 2, pp. 522 - 531
(Article)
Abstract
BACKGROUND: Diagnosis of cerebrovascular disease is based on both clinical and radiological findings, however, they do not always correlate. AIMS: To investigate ischemic stroke recurrence and mortality in patients with different imaging phenotypes of ischemic cerebrovascular disease. METHODS: Within the SMART-MR study, a prospective patient cohort with arterial disease, cerebrovascular
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diseases of participants at baseline were classified as no cerebrovascular disease (reference group, n = 828), symptomatic cerebrovascular disease ( n = 204), covert vascular lesions ( n = 156), or imaging negative ischemia ( n = 90) based upon clinical and MRI findings. Ischemic strokes and deaths were collected at 6 month-intervals up to 17 years of follow-up. With Cox regression, relationships between phenotype and ischemic stroke recurrence, cardiovascular mortality, and non-vascular mortality were studied adjusted for age, sex, and cardiovascular risk factors. RESULTS: Compared to reference group risk for recurrent ischemic stroke was increased not only in the symptomatic cerebrovascular disease (HR 3.9, 95% CI 2.3-6.6), but also in the covert vascular lesion (HR 2.5, 95% CI 1.3-4.8) and the imaging negative ischemia groups (HR 2.4, 95% CI 1.1-5.5). Risk for cardiovascular mortality was increased in the symptomatic cerebrovascular disease (HR 2.2, 95% CI 1.5-3.2) and covert vascular lesions groups (HR 2.3, 95% CI 1.5-3.4), while the risk was less strong but also increased in the imaging negative ischemia group (HR 1.7, 95% CI 0.9-3.0). CONCLUSIONS: People with all imaging phenotypes of cerebrovascular disease have increased risk of recurrent ischemic stroke and mortality compared to other arterial diseases. Strict preventive measures should be performed even when imaging findings or clinical symptoms are absent. DATA ACCESS STATEMENT: For use of anonymized data, a reasonable request has to be made in writing to the UCC-SMART study group and the third party has to sign a confidentiality agreement.
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Keywords: Cerebrovascular Disorders/diagnostic imaging, Humans, Ischemic Stroke/diagnostic imaging, Magnetic Resonance Imaging, Phenotype, Prospective Studies, Risk Factors, Stroke/diagnostic imaging, cardiovascular disease, Stroke, MRI, mortality, imaging negative ischemia, Clinical Neurology, Cardiology and Cardiovascular Medicine, Research Support, Non-U.S. Gov't, Journal Article
ISSN: 2396-9873
Publisher: SAGE Publications Inc.
Note: Funding Information: We gratefully acknowledge the contribution of the SMART research nurses; R van Petersen (data-manager); BGF Dinther (vascular manager), and the members of the Utrecht Cardiovascular Cohort-Second Manifestations of ARTerial disease-Studygroup (UCC-SMART-Studygroup): FW Asselbergs and HM Nathoe, Department of Cardiology; GJ de Borst, Department of Vascular Surgery; ML Bots and MI Geerlings, Julius Center for Health Sciences and Primary Care; MH Emmelot, Department of Geriatrics; PA de Jong and T Leiner, Department of Radiology; AT Lely, Department of Obstetrics & Gynecology; NP van der Kaaij, Department of Cardiothoracic Surgery; LJ Kappelle and YM Ruigrok, Department of Neurology; MC Verhaar, Department of Nephrology; and FLJ Visseren (chair) and J Westerink, Department of Vascular Medicine, University Medical Center Utrecht and Utrecht University. The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: The research of Ina Rissanen is supported by Orion Research Foundation. The research of Jeroen Hendrikse has received funding from the European Research Council under the European Union’s Horizon 2020 Programme (H2020)/ERC grant agreement n°637024 (HEARTOFSTROKE) and H2020 grant agreement No 666881, SVDs@target. Jeroen Hendrikse is supported by the Netherlands Organization for Scientific Research (NWO) under grant n°91712322. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. Funding Information: The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: The research of Ina Rissanen is supported by Orion Research Foundation. The research of Jeroen Hendrikse has received funding from the European Research Council under the European Union’s Horizon 2020 Programme (H2020)/ERC grant agreement n°637024 (HEARTOFSTROKE) and H2020 grant agreement No 666881, SVDs@target. Jeroen Hendrikse is supported by the Netherlands Organization for Scientific Research (NWO) under grant n°91712322. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. Publisher Copyright: © European Stroke Organisation 2023.
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