Abstract
Background: Uncertainty exists over the long-term prognostic significance of cerebral small vessel disease (CSVD) in primary intracerebral hemorrhage (ICH).Methods: We performed a longitudinal analysis of CSVD and clinical outcomes in consecutive patients with primary ICH who had MRI. Baseline CSVD load (including white matter hyperintensities [WMH], cerebral microbleeds [CMBs], lacunes, and enlarged perivascular spaces [EPVS]) was evaluated. The cumulative CSVD score was calculated by combining the presence of each CSVD marker (range 0–4). We followed participants for poor functional outcome [modified Rankin scale [mRS] ≥ 4], stroke recurrence, and time-varying survival during a median follow-up of 4.9 [interquartile range [IQR] 3.1–6.0] years. Parsimonious and fuller multivariable logistic regression analysis and Cox-regression analysis were performed to estimate the association of CSVD markers, individually and collectively, with each outcome.Results: A total of 153 patients were included in the analyses. CMBs ≥ 10 [adjusted OR [adOR] 3.252, 95% CI 1.181–8.956, p = 0.023] and periventricular WMH (PWMH) (adOR 2.053, 95% CI 1.220–3.456, p = 0.007) were significantly associated with poor functional outcome. PWMH (adOR 2.908, 95% CI 1.230–6.878, p = 0.015) and lobar CMB severity (adOR 1.811, 95% CI 1.039–3.157, p = 0.036) were associated with stroke recurrence. The cumulative CSVD score was associated with poor functional outcome (adOR 1.460, 95% CI 1.017–2.096) and stroke recurrence (adOR 2.258, 95% CI 1.080–4.723). Death occurred in 36.1% (13/36) of patients with CMBs ≥ 10 compared with 18.8% (22/117) in those with CMB < 10 (adjusted HR 2.669, 95% CI 1.248–5.707, p = 0.011). In addition, the cumulative CSVD score ≥ 2 was associated with a decreased survival rate (adjusted HR 3.140, 95% CI 1.066–9.250, p = 0.038).Conclusions: Severe PWMH, CMB, or cumulative CSVD burden exert important influences on the long-term outcome of ICH.
Highlights
Spontaneous primary intracerebral hemorrhage (ICH) is mainly caused by cerebral small vessel disease (CSVD), including hypertensive arteriopathy (HA) and cerebral amyloid angiopathy (CAA) (Charidimou et al, 2016; Hankey, 2017), and has both short- and long-term consequences of high case fatality, disability, and risk of recurrent serious vascular events (Poon et al, 2014)
cerebral microbleed (CMB) ≥ 10 [adjusted OR [adOR] 3.252, 95% CI 1.181–8.956, p = 0.023] and periventricular white matter hyperintensities (WMH) (PWMH) were significantly associated with poor functional outcome
PWMH and lobar CMB severity were associated with stroke recurrence
Summary
Spontaneous primary intracerebral hemorrhage (ICH) is mainly caused by cerebral small vessel disease (CSVD), including hypertensive arteriopathy (HA) and cerebral amyloid angiopathy (CAA) (Charidimou et al, 2016; Hankey, 2017), and has both short- and long-term consequences of high case fatality, disability, and risk of recurrent serious vascular events (Poon et al, 2014) Both HA and CAA are associated with magnetic resonance imaging (MRI) markers of CSVD, including lacunes, white matter hyperintensities (WMH), cerebral microbleeds (CMBs), and enlarged perivascular spaces (EPVS) (Charidimou et al, 2016). Uncertainty exists over the long-term prognostic significance of cerebral small vessel disease (CSVD) in primary intracerebral hemorrhage (ICH)
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