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Impact of white matter hyperintensities on the prognosis of cryptogenic stroke patients

 Seong Ho Jeong  ;  Sung Soo Ahn  ;  Minyoul Baik  ;  Ki Hoon Kim  ;  JoonSang Yoo  ;  Kyoungsub Kim  ;  Hye Sun Lee  ;  Jimin Ha  ;  Young Dae Kim  ;  Ji Hoe Heo  ;  Hyo Suk Nam 
 PLOS ONE, Vol.13(4) : e0196014, 2018 
Journal Title
Issue Date
Adult ; Aged ; Female ; Humans ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Neuroimaging/*methods ; Prognosis ; Prospective Studies ; Regression Analysis ; Retrospective Studies ; Stroke/*physiopathology ; Survival Analysis ; X-Ray Computed Tomography ; White Matter/*physiopathology
BACKGROUND: To our knowledge, little is known regarding whether white matter hyperintensities (WMH) affect the prognosis of cryptogenic stroke (CS) patients. Understanding this association may be helpful with expecting the prognosis of CS patients. METHODS: This retrospective observational study enrolled consecutive CS patients who underwent brain MRI and comprehensive cardiac evaluation. Severe WMH was defined as Fazekas' score >/=3. We defined poor functional outcome as modified Rankin Scale score >/=3 at 3 months. Long-term mortality and causes of death were identified using national death certificates and assessed by Kaplan-Meier method and regression analysis model. RESULTS: Among 2732 patients with first-ever ischemic stroke, 599 (21.9%) patients were classified as having CS. After exclusions, 235 patients were enrolled and followed up for a median of 7.7 years (IQR, 6.7-9.0). Severe WMH were found in 81 (34.5%) patients. After adjustments, severe WMH were an independent predictor for poor functional outcomes at 3 months (OR 5.25, 95% CI, 2.07-13.31). Subgroup analysis showed that severe WMH were an independent predictor for long-term mortality only in younger patients (age < 65) (HR 3.11, 95% CI, 1.29-7.50), but not in older patients (HR 1.19, 95% CI, 0.63-2.23). CONCLUSIONS: Severe WMH were independently associated with short-term functional outcomes in CS patients and independently associated with long-term mortality in younger CS patients. Grading WMH is of value in predicting prognosis of CS patients with young age.
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1. College of Medicine (의과대학) > Dept. of Neurology (신경과학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Radiology (영상의학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Yonsei Biomedical Research Center (연세의생명연구원) > 1. Journal Papers
Yonsei Authors
Kim, Kyoung Sub(김경섭)
Kim, Young Dae(김영대) ORCID logo https://orcid.org/0000-0001-5750-2616
Nam, Hyo Suk(남효석) ORCID logo https://orcid.org/0000-0002-4415-3995
Ahn, Sung Soo(안성수) ORCID logo https://orcid.org/0000-0002-0503-5558
Yoo, Joon Sang(유준상)
Lee, Hye Sun(이혜선) ORCID logo https://orcid.org/0000-0001-6328-6948
Heo, Ji Hoe(허지회) ORCID logo https://orcid.org/0000-0001-9898-3321
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