Risk Stratification Tool for Ischemic Stroke: A Risk Assessment Model Based on Traditional Risk Factors Combined With White Matter Lesions and Retinal Vascular Caliber.

Lu Zhao,Hongyang Li,Hui Hong,Xiaoyue Cheng,Yanling Wang,Bin Jiang,Xiufen Yang

doi:10.3389/fneur.2021.696986

Lu Zhao, Hongyang Li + Show 5 more

Open Access

https://doi.org/10.3389/fneur.2021.696986

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Abstract

Objective: This study aims to establish a risk assessment model based on traditional risk factors combined with the Fazekas classification of white matter lesions and retinal vascular caliber for screening the patients at high risk of ischemic stroke.Methods: This study included 296 patients (128 cases of ischemic stroke and 168 cases in the normal control group). The basic data of the patients were collected. Color fundus photography was performed after pupil dilation, and the retinal vascular caliber was measured using semiautomated vascular measurement software (IVAN Software, Sydney, Australia). The severity of white matter lesions (WML) on cranial nuclear magnetic fluid-attenuated inversion recovery images were assessed using the Fazekas scale. Moreover, logistic regression analysis was used to establish different risk assessment models for ischemic stroke. The effects of models were evaluated through the receiver operating characteristic (ROC) curve and the Delong test compared area under the curve.Results: The sensitivity and specificity of models 1 (the traditional risk factor model), 2 (the retinal vascular caliber model), 3 (the WML model), and 4 (the combined the traditional risk factor, WML and central retinal artery equivalent (CRAE) model) were 71 and 55%, 48 and 71%, 49 and 67%, and 68 and 68.5% with areas under the curve of 0.658, 0.586, 0.601, and 0.708, respectively. The area under the receiver operating characteristic curve in models 1, 2, 3, and 4 showed statistically significant differences. Moreover, no statistical significance exists in the pairwise comparison of other models.Conclusion: The risk assessment model of ischemic stroke combined with Fazekas grade of WML and CRAE is superior to the traditional risk factor and the single-index model. This model is helpful for risk stratification of high-risk stroke patients.

Highlights

Stroke is a major cause of mortality and long-term disability worldwide [1]
The central retinal artery equivalent (CRAE) in the ischemic stroke group was lower compared with the normal control group, and the difference was statistically significant (p = 0.011) (Figure 4)
No significant difference was noted between the central retinal vein equivalent (CRVE) and arterio-venous ratio (AVR) groups (Table 1)

Summary

Introduction

Stroke is a major cause of mortality and long-term disability worldwide [1]. The Global Burden of Disease Study published the epidemiological data of vascular diseases in 195 countries and regions from 1990 to 2016 and found that China is one of the countries with the highest incidence of stroke worldwide [2] with 2.5 million new stroke cases annually [3]. WML can be seen in healthy middle-aged and elderly people and can coexist with ischemic stroke [6], Alzheimer’s disease [7], and other cerebrovascular diseases. WML has many common risk factors with common cerebrovascular diseases (e.g., advanced age, hypertension, diabetes, atherosclerosis, smoking, and so on) [8]. Studies found that WML is an independent risk factor for stroke and stroke prediction [9,10,11]

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