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Association between leukoaraiosis and hemorrhagic transformation after cardioembolic stroke due to atrial fibrillation and/or rheumatic heart disease

  • Author Footnotes
    1 These authors contributed equally to this work.
    Chen-Chen Wei
    Footnotes
    1 These authors contributed equally to this work.
    Affiliations
    Department of Neurology, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu 610041, Sichuan Province, PR China
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  • Author Footnotes
    1 These authors contributed equally to this work.
    Shu-Ting Zhang
    Footnotes
    1 These authors contributed equally to this work.
    Affiliations
    Department of Neurology, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu 610041, Sichuan Province, PR China
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  • Yun-Han Wang
    Affiliations
    Department of Ultrasound, Chengdu First People's Hospital, 18 Wanxiang North Road, Chengdu 610041, Sichuan Province, PR China
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  • Jun-Feng Liu
    Affiliations
    Department of Neurology, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu 610041, Sichuan Province, PR China
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  • Jie Li
    Affiliations
    Department of Neurology, People's Hospital of Deyang City, No. 174 North Section 1, Taishan Road, Deyang 618000, Sichuan Province, PR China
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  • Ruo-Zhen Yuan
    Affiliations
    Department of Neurology, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu 610041, Sichuan Province, PR China
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  • Ge Tan
    Affiliations
    Department of Neurology, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu 610041, Sichuan Province, PR China
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  • Shi-Hong Zhang
    Correspondence
    Corresponding authors at: Stroke Clinical Research Unit, Department of Neurology, West China Hospital, Sichuan University, No. 37, Guo Xue Xiang, Chengdu 610041, Sichuan Province, PR China.
    Affiliations
    Department of Neurology, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu 610041, Sichuan Province, PR China
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  • Ming Liu
    Correspondence
    Corresponding authors at: Stroke Clinical Research Unit, Department of Neurology, West China Hospital, Sichuan University, No. 37, Guo Xue Xiang, Chengdu 610041, Sichuan Province, PR China.
    Affiliations
    Department of Neurology, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu 610041, Sichuan Province, PR China
    Search for articles by this author
  • Author Footnotes
    1 These authors contributed equally to this work.

      Highlights

      • Cardioembolic stroke due to AF/RHD is characterized with high frequency of HT.
      • We studied the association between LA and HT in cardioembolic stroke due to AF/RHD.
      • Moderate to severe LA is associated with HT in cardioembolic stroke due to AF/RHD.
      • The presence of periventricular or anterior LA on MRI increases the risk of HT.

      Abstract

      Cardioembolic stroke due to atrial fibrillation (AF) and/or rheumatic heart disease (RHD) often involves hemorrhagic transformation (HT), and we examined whether leukoaraiosis (LA) was associated with HT in these cases. We prospectively enrolled 251 patients who were admitted to two hospitals within one month of experiencing cardioembolic stroke due to AF/RHD. LA severity was assessed using three visual rating scales. HT was identified in 99 patients (39.4%) based on baseline computed tomography (CT) and post-admission magnetic resonance imaging or second CT. Univariate analysis identified risk of HT as higher in the presence of frontal LA based on the age-related white matter changes scale and in the presence of anterior LA based on the VSS scale. Multivariate analysis confirmed that moderate to severe LA was independently associated with higher HT risk. Of the various sites affected in LA, frontal LA correlated with highest risk of HT (OR 3.199, 95%CI 1.555–6.580). These results suggest that moderate to severe LA, especially at periventricular and anterior sites, is associated with HT after cardioembolic stroke due to AF/RHD. These findings suggest the need to take LA into account as a HT risk factor when considering the use of anticoagulation and thrombolysis in these patients.

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