Stroke outcomes are worse with larger leukoaraiosis volumes

Wi Sun Ryu, Sung Ho Woo, Dawid Schellingerhout, Min Uk Jang, Kyoung Jong Park, Keun Sik Hong, Sang Wuk Jeong, Jeong Yong Na, Ki Hyun Cho, Joon Tae Kim, Beom Joon Kim, Moon Ku Han, Jun Lee, Jae Kwan Cha, Dae Hyun Kim, Soo Joo Lee, Youngchai Ko, Yong Jin Cho, Byung Chul Lee, Kyung Ho YuMi Sun Oh, Jong Moo Park, Kyusik Kang, Kyung Bok Lee, Tai Hwan Park, Juneyoung Lee, Heung Kook Choi, Kiwon Lee, Hee Joon Bae, Dong Eog Kim

Research output: Contribution to journalArticle

24 Citations (Scopus)

Abstract

Leukoaraiosis or white matter hyperintensities are frequently observed on magnetic resonance imaging of stroke patients. We investigated how white matter hyperintensity volumes affect stroke outcomes, generally and by subtype. In total, 5035 acute ischaemic stroke patients were enrolled. Strokes were classified as large artery atherosclerosis, small vessel occlusion, or cardioembolism. White matter hyperintensity volumes were stratified into quintiles. Mean age (± standard deviation) was 66.3 ± 12.8, 59.6% male. Median (interquartile range) modified Rankin Scale score was 2 (1-3) at discharge and 1 (0-3) at 3 months; 16.5% experienced early neurological deterioration, and 3.3% recurrent stroke. The Cochran-Mantel-Haenszel test with adjustment for age, stroke severity, sex, and thrombolysis status showed that the distributions of 3-month modified Rankin Scale scores differed across white matter hyperintensity quintiles (P < 0.001). Multiple ordinal logistic regression analysis showed that higher white matter hyperintensity quintiles were independently associated with worse 3-month modified Rankin Scale scores; adjusted odds ratios (95% confidence interval) for the second to fifth quintiles versus the first quintile were 1.29 (1.10-1.52), 1.40 (1.18-1.66), 1.69 (1.42-2.02) and 2.03 (1.69-2.43), respectively. For large artery atherosclerosis (39.0%), outcomes varied by white matter hyperintensity volume (P = 0.01, Cochran-Mantel-Haenszel test), and the upper three white matter hyperintensity quintiles (versus the first quintile) had worse 3-month modified Rankin Scale scores; adjusted odds ratios were 1.45 (1.10-1.90), 1.86 (1.41-2.47), and 1.89 (1.41-2.54), respectively. Patients with large artery atherosclerosis were vulnerable to early neurological deterioration (19.4%), and the top two white matter hyperintensity quintiles were more vulnerable still: 23.5% and 22.3%. Moreover, higher white matter hyperintensities were associated with poor modified Rankin Scale improvement: adjusted odds ratios for the upper two quintiles versus the first quintile were 0.66 (0.47-0.94) and 0.62 (0.43-0.89), respectively. For small vessel occlusion (17.8%), outcomes tended to vary by white matter hyperintensitiy volume (P = 0.10, Cochran-Mantel-Haenszel test), and the highest quintile was associated with worse 3-month modified Rankin Scale scores: adjusted odds ratio for the fifth quintile versus first quintile, 1.98 (1.23-3.18). In this subtype, worse white matter hyperintensities were associated with worse National Institute of Health Stroke Scale scores at presentation. For cardioembolism (20.6%), outcomes did not vary significantly by white matter hyperintensity volume (P = 0.19, Cochran-Mantel-Haenszel test); however, the adjusted odds ratio for the highest versus lowest quintiles was 1.62 (1.09-2.40). Regardless of stroke subtype, white matter hyperintensities were not associated with stroke recurrence within 3 months of follow-up. In conclusion, white matter hyperintensity volume independently correlates with stroke outcomes in acute ischaemic stroke. There are some suggestions that stroke outcomes may be affected by leukoaraiosis differentially depending on stroke subtypes, to be confirmed in future investigations.

Original languageEnglish
Pages (from-to)158-170
Number of pages13
JournalBrain : a journal of neurology
Volume140
Issue number1
DOIs
Publication statusPublished - 2017 Jan 1

Fingerprint

Leukoaraiosis
Stroke
Odds Ratio
Atherosclerosis
Arteries
White Matter
National Institutes of Health (U.S.)

Keywords

  • ischaemic stroke
  • magnetic resonance image
  • outcome
  • white matter hyperintensities

ASJC Scopus subject areas

  • Clinical Neurology

Cite this

Ryu, W. S., Woo, S. H., Schellingerhout, D., Jang, M. U., Park, K. J., Hong, K. S., ... Kim, D. E. (2017). Stroke outcomes are worse with larger leukoaraiosis volumes. Brain : a journal of neurology, 140(1), 158-170. https://doi.org/10.1093/brain/aww259

Stroke outcomes are worse with larger leukoaraiosis volumes. / Ryu, Wi Sun; Woo, Sung Ho; Schellingerhout, Dawid; Jang, Min Uk; Park, Kyoung Jong; Hong, Keun Sik; Jeong, Sang Wuk; Na, Jeong Yong; Cho, Ki Hyun; Kim, Joon Tae; Kim, Beom Joon; Han, Moon Ku; Lee, Jun; Cha, Jae Kwan; Kim, Dae Hyun; Lee, Soo Joo; Ko, Youngchai; Cho, Yong Jin; Lee, Byung Chul; Yu, Kyung Ho; Oh, Mi Sun; Park, Jong Moo; Kang, Kyusik; Lee, Kyung Bok; Park, Tai Hwan; Lee, Juneyoung; Choi, Heung Kook; Lee, Kiwon; Bae, Hee Joon; Kim, Dong Eog.

In: Brain : a journal of neurology, Vol. 140, No. 1, 01.01.2017, p. 158-170.

Research output: Contribution to journalArticle

Ryu, WS, Woo, SH, Schellingerhout, D, Jang, MU, Park, KJ, Hong, KS, Jeong, SW, Na, JY, Cho, KH, Kim, JT, Kim, BJ, Han, MK, Lee, J, Cha, JK, Kim, DH, Lee, SJ, Ko, Y, Cho, YJ, Lee, BC, Yu, KH, Oh, MS, Park, JM, Kang, K, Lee, KB, Park, TH, Lee, J, Choi, HK, Lee, K, Bae, HJ & Kim, DE 2017, 'Stroke outcomes are worse with larger leukoaraiosis volumes', Brain : a journal of neurology, vol. 140, no. 1, pp. 158-170. https://doi.org/10.1093/brain/aww259
Ryu WS, Woo SH, Schellingerhout D, Jang MU, Park KJ, Hong KS et al. Stroke outcomes are worse with larger leukoaraiosis volumes. Brain : a journal of neurology. 2017 Jan 1;140(1):158-170. https://doi.org/10.1093/brain/aww259
Ryu, Wi Sun ; Woo, Sung Ho ; Schellingerhout, Dawid ; Jang, Min Uk ; Park, Kyoung Jong ; Hong, Keun Sik ; Jeong, Sang Wuk ; Na, Jeong Yong ; Cho, Ki Hyun ; Kim, Joon Tae ; Kim, Beom Joon ; Han, Moon Ku ; Lee, Jun ; Cha, Jae Kwan ; Kim, Dae Hyun ; Lee, Soo Joo ; Ko, Youngchai ; Cho, Yong Jin ; Lee, Byung Chul ; Yu, Kyung Ho ; Oh, Mi Sun ; Park, Jong Moo ; Kang, Kyusik ; Lee, Kyung Bok ; Park, Tai Hwan ; Lee, Juneyoung ; Choi, Heung Kook ; Lee, Kiwon ; Bae, Hee Joon ; Kim, Dong Eog. / Stroke outcomes are worse with larger leukoaraiosis volumes. In: Brain : a journal of neurology. 2017 ; Vol. 140, No. 1. pp. 158-170.
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abstract = "Leukoaraiosis or white matter hyperintensities are frequently observed on magnetic resonance imaging of stroke patients. We investigated how white matter hyperintensity volumes affect stroke outcomes, generally and by subtype. In total, 5035 acute ischaemic stroke patients were enrolled. Strokes were classified as large artery atherosclerosis, small vessel occlusion, or cardioembolism. White matter hyperintensity volumes were stratified into quintiles. Mean age (± standard deviation) was 66.3 ± 12.8, 59.6{\%} male. Median (interquartile range) modified Rankin Scale score was 2 (1-3) at discharge and 1 (0-3) at 3 months; 16.5{\%} experienced early neurological deterioration, and 3.3{\%} recurrent stroke. The Cochran-Mantel-Haenszel test with adjustment for age, stroke severity, sex, and thrombolysis status showed that the distributions of 3-month modified Rankin Scale scores differed across white matter hyperintensity quintiles (P < 0.001). Multiple ordinal logistic regression analysis showed that higher white matter hyperintensity quintiles were independently associated with worse 3-month modified Rankin Scale scores; adjusted odds ratios (95{\%} confidence interval) for the second to fifth quintiles versus the first quintile were 1.29 (1.10-1.52), 1.40 (1.18-1.66), 1.69 (1.42-2.02) and 2.03 (1.69-2.43), respectively. For large artery atherosclerosis (39.0{\%}), outcomes varied by white matter hyperintensity volume (P = 0.01, Cochran-Mantel-Haenszel test), and the upper three white matter hyperintensity quintiles (versus the first quintile) had worse 3-month modified Rankin Scale scores; adjusted odds ratios were 1.45 (1.10-1.90), 1.86 (1.41-2.47), and 1.89 (1.41-2.54), respectively. Patients with large artery atherosclerosis were vulnerable to early neurological deterioration (19.4{\%}), and the top two white matter hyperintensity quintiles were more vulnerable still: 23.5{\%} and 22.3{\%}. Moreover, higher white matter hyperintensities were associated with poor modified Rankin Scale improvement: adjusted odds ratios for the upper two quintiles versus the first quintile were 0.66 (0.47-0.94) and 0.62 (0.43-0.89), respectively. For small vessel occlusion (17.8{\%}), outcomes tended to vary by white matter hyperintensitiy volume (P = 0.10, Cochran-Mantel-Haenszel test), and the highest quintile was associated with worse 3-month modified Rankin Scale scores: adjusted odds ratio for the fifth quintile versus first quintile, 1.98 (1.23-3.18). In this subtype, worse white matter hyperintensities were associated with worse National Institute of Health Stroke Scale scores at presentation. For cardioembolism (20.6{\%}), outcomes did not vary significantly by white matter hyperintensity volume (P = 0.19, Cochran-Mantel-Haenszel test); however, the adjusted odds ratio for the highest versus lowest quintiles was 1.62 (1.09-2.40). Regardless of stroke subtype, white matter hyperintensities were not associated with stroke recurrence within 3 months of follow-up. In conclusion, white matter hyperintensity volume independently correlates with stroke outcomes in acute ischaemic stroke. There are some suggestions that stroke outcomes may be affected by leukoaraiosis differentially depending on stroke subtypes, to be confirmed in future investigations.",
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author = "Ryu, {Wi Sun} and Woo, {Sung Ho} and Dawid Schellingerhout and Jang, {Min Uk} and Park, {Kyoung Jong} and Hong, {Keun Sik} and Jeong, {Sang Wuk} and Na, {Jeong Yong} and Cho, {Ki Hyun} and Kim, {Joon Tae} and Kim, {Beom Joon} and Han, {Moon Ku} and Jun Lee and Cha, {Jae Kwan} and Kim, {Dae Hyun} and Lee, {Soo Joo} and Youngchai Ko and Cho, {Yong Jin} and Lee, {Byung Chul} and Yu, {Kyung Ho} and Oh, {Mi Sun} and Park, {Jong Moo} and Kyusik Kang and Lee, {Kyung Bok} and Park, {Tai Hwan} and Juneyoung Lee and Choi, {Heung Kook} and Kiwon Lee and Bae, {Hee Joon} and Kim, {Dong Eog}",
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TY - JOUR

T1 - Stroke outcomes are worse with larger leukoaraiosis volumes

AU - Ryu, Wi Sun

AU - Woo, Sung Ho

AU - Schellingerhout, Dawid

AU - Jang, Min Uk

AU - Park, Kyoung Jong

AU - Hong, Keun Sik

AU - Jeong, Sang Wuk

AU - Na, Jeong Yong

AU - Cho, Ki Hyun

AU - Kim, Joon Tae

AU - Kim, Beom Joon

AU - Han, Moon Ku

AU - Lee, Jun

AU - Cha, Jae Kwan

AU - Kim, Dae Hyun

AU - Lee, Soo Joo

AU - Ko, Youngchai

AU - Cho, Yong Jin

AU - Lee, Byung Chul

AU - Yu, Kyung Ho

AU - Oh, Mi Sun

AU - Park, Jong Moo

AU - Kang, Kyusik

AU - Lee, Kyung Bok

AU - Park, Tai Hwan

AU - Lee, Juneyoung

AU - Choi, Heung Kook

AU - Lee, Kiwon

AU - Bae, Hee Joon

AU - Kim, Dong Eog

PY - 2017/1/1

Y1 - 2017/1/1

N2 - Leukoaraiosis or white matter hyperintensities are frequently observed on magnetic resonance imaging of stroke patients. We investigated how white matter hyperintensity volumes affect stroke outcomes, generally and by subtype. In total, 5035 acute ischaemic stroke patients were enrolled. Strokes were classified as large artery atherosclerosis, small vessel occlusion, or cardioembolism. White matter hyperintensity volumes were stratified into quintiles. Mean age (± standard deviation) was 66.3 ± 12.8, 59.6% male. Median (interquartile range) modified Rankin Scale score was 2 (1-3) at discharge and 1 (0-3) at 3 months; 16.5% experienced early neurological deterioration, and 3.3% recurrent stroke. The Cochran-Mantel-Haenszel test with adjustment for age, stroke severity, sex, and thrombolysis status showed that the distributions of 3-month modified Rankin Scale scores differed across white matter hyperintensity quintiles (P < 0.001). Multiple ordinal logistic regression analysis showed that higher white matter hyperintensity quintiles were independently associated with worse 3-month modified Rankin Scale scores; adjusted odds ratios (95% confidence interval) for the second to fifth quintiles versus the first quintile were 1.29 (1.10-1.52), 1.40 (1.18-1.66), 1.69 (1.42-2.02) and 2.03 (1.69-2.43), respectively. For large artery atherosclerosis (39.0%), outcomes varied by white matter hyperintensity volume (P = 0.01, Cochran-Mantel-Haenszel test), and the upper three white matter hyperintensity quintiles (versus the first quintile) had worse 3-month modified Rankin Scale scores; adjusted odds ratios were 1.45 (1.10-1.90), 1.86 (1.41-2.47), and 1.89 (1.41-2.54), respectively. Patients with large artery atherosclerosis were vulnerable to early neurological deterioration (19.4%), and the top two white matter hyperintensity quintiles were more vulnerable still: 23.5% and 22.3%. Moreover, higher white matter hyperintensities were associated with poor modified Rankin Scale improvement: adjusted odds ratios for the upper two quintiles versus the first quintile were 0.66 (0.47-0.94) and 0.62 (0.43-0.89), respectively. For small vessel occlusion (17.8%), outcomes tended to vary by white matter hyperintensitiy volume (P = 0.10, Cochran-Mantel-Haenszel test), and the highest quintile was associated with worse 3-month modified Rankin Scale scores: adjusted odds ratio for the fifth quintile versus first quintile, 1.98 (1.23-3.18). In this subtype, worse white matter hyperintensities were associated with worse National Institute of Health Stroke Scale scores at presentation. For cardioembolism (20.6%), outcomes did not vary significantly by white matter hyperintensity volume (P = 0.19, Cochran-Mantel-Haenszel test); however, the adjusted odds ratio for the highest versus lowest quintiles was 1.62 (1.09-2.40). Regardless of stroke subtype, white matter hyperintensities were not associated with stroke recurrence within 3 months of follow-up. In conclusion, white matter hyperintensity volume independently correlates with stroke outcomes in acute ischaemic stroke. There are some suggestions that stroke outcomes may be affected by leukoaraiosis differentially depending on stroke subtypes, to be confirmed in future investigations.

AB - Leukoaraiosis or white matter hyperintensities are frequently observed on magnetic resonance imaging of stroke patients. We investigated how white matter hyperintensity volumes affect stroke outcomes, generally and by subtype. In total, 5035 acute ischaemic stroke patients were enrolled. Strokes were classified as large artery atherosclerosis, small vessel occlusion, or cardioembolism. White matter hyperintensity volumes were stratified into quintiles. Mean age (± standard deviation) was 66.3 ± 12.8, 59.6% male. Median (interquartile range) modified Rankin Scale score was 2 (1-3) at discharge and 1 (0-3) at 3 months; 16.5% experienced early neurological deterioration, and 3.3% recurrent stroke. The Cochran-Mantel-Haenszel test with adjustment for age, stroke severity, sex, and thrombolysis status showed that the distributions of 3-month modified Rankin Scale scores differed across white matter hyperintensity quintiles (P < 0.001). Multiple ordinal logistic regression analysis showed that higher white matter hyperintensity quintiles were independently associated with worse 3-month modified Rankin Scale scores; adjusted odds ratios (95% confidence interval) for the second to fifth quintiles versus the first quintile were 1.29 (1.10-1.52), 1.40 (1.18-1.66), 1.69 (1.42-2.02) and 2.03 (1.69-2.43), respectively. For large artery atherosclerosis (39.0%), outcomes varied by white matter hyperintensity volume (P = 0.01, Cochran-Mantel-Haenszel test), and the upper three white matter hyperintensity quintiles (versus the first quintile) had worse 3-month modified Rankin Scale scores; adjusted odds ratios were 1.45 (1.10-1.90), 1.86 (1.41-2.47), and 1.89 (1.41-2.54), respectively. Patients with large artery atherosclerosis were vulnerable to early neurological deterioration (19.4%), and the top two white matter hyperintensity quintiles were more vulnerable still: 23.5% and 22.3%. Moreover, higher white matter hyperintensities were associated with poor modified Rankin Scale improvement: adjusted odds ratios for the upper two quintiles versus the first quintile were 0.66 (0.47-0.94) and 0.62 (0.43-0.89), respectively. For small vessel occlusion (17.8%), outcomes tended to vary by white matter hyperintensitiy volume (P = 0.10, Cochran-Mantel-Haenszel test), and the highest quintile was associated with worse 3-month modified Rankin Scale scores: adjusted odds ratio for the fifth quintile versus first quintile, 1.98 (1.23-3.18). In this subtype, worse white matter hyperintensities were associated with worse National Institute of Health Stroke Scale scores at presentation. For cardioembolism (20.6%), outcomes did not vary significantly by white matter hyperintensity volume (P = 0.19, Cochran-Mantel-Haenszel test); however, the adjusted odds ratio for the highest versus lowest quintiles was 1.62 (1.09-2.40). Regardless of stroke subtype, white matter hyperintensities were not associated with stroke recurrence within 3 months of follow-up. In conclusion, white matter hyperintensity volume independently correlates with stroke outcomes in acute ischaemic stroke. There are some suggestions that stroke outcomes may be affected by leukoaraiosis differentially depending on stroke subtypes, to be confirmed in future investigations.

KW - ischaemic stroke

KW - magnetic resonance image

KW - outcome

KW - white matter hyperintensities

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