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

Authors
 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 
Citation
 PLoS One, Vol.13(4) : e0196014, 2018 
Journal Title
 PLoS One 
Issue Date
2018
MeSH
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
Abstract
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.
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/162392
Files in This Item:
T201801501.pdf Download
DOI
10.1371/journal.pone.0196014
Appears in Collections:
1. Journal Papers (연구논문) > 1. College of Medicine (의과대학) > Dept. of Neurology (신경과학교실)
1. Journal Papers (연구논문) > 1. College of Medicine (의과대학) > Dept. of Radiology (영상의학교실)
1. Journal Papers (연구논문) > 1. College of Medicine (의과대학) > Yonsei Biomedical Research Center (연세의생명연구원)
Yonsei Authors
김경섭(Kim, Kyoung Sub)
김영대(Kim, Young Dae)
남효석(Nam, Hyo Suk) ORCID logo https://orcid.org/0000-0002-4415-3995
안성수(Ahn, Sung Soo) ORCID logo https://orcid.org/0000-0002-0503-5558
유준상(Yoo, Joon Sang)
이혜선(Lee, Hye Sun) ORCID logo https://orcid.org/0000-0001-6328-6948
허지회(Heo, Ji Hoe) ORCID logo https://orcid.org/0000-0001-9898-3321
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