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.
Keywords
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References
- Factors influencing haemorrhagic transformation in ischaemic stroke.The Lancet Neurology. 2013; 12: 689-705
- Epidemiology of stroke and its subtypes in Chinese vs white populations: a systematic review.Neurology. 2013; 81: 264-272
- Acute cardioembolic cerebral infarction: answers to clinical questions.Curr. Cardiol. Rev. 2012; 8: 54-67
- Large infarcts in the middle cerebral artery territory. Etiology and outcome patterns.Neurol. 1998; 50: 341-350
- Hemorrhagic transformation of ischemic brain tissue: asymptomatic or symptomatic?.Stroke. 2001; 32: 1330-1335
- Unfavorable outcome of thrombolysis in Chinese patients with cardioembolic stroke: a prospective cohort study.CNS Neuroscience & Therapeutics. 2015; 21: 657-661
- Contribution of atrial fibrillation to incidence and outcome of ischemic stroke: results from a population-based study.Stroke. 2005; 36: 1115-1119
- Characteristics, treatment and outcome of ischemic stroke with atrial fibrillation in a Chinese hospital-based stroke study.Cerebrovasc. Dis. 2011; 31: 419-426
- Features of acute ischemic stroke with rheumatic heart disease in a hospitalized Chinese population.Stroke. 2012; 43: 2853-2857
- Use of warfarin at discharge among acute ischemic stroke patients with nonvalvular atrial fibrillation in China.Stroke. 2016; 47: 464-470
- Failure of complete recanalization is associated with poor outcome after cardioembolic stroke.Eur. J. Neurol. 2011; 18: 1171-1178
- Guidelines for the early management of patients with acute ischemic stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke Association.Stroke. 2013; 44: 870-947
- Leuko-araiosis.Arch. Neurol. 1987; 44: 21-23
- Leukoaraiosis and stroke outcome.J. Stroke Cerebrovasc. Dis. 2002; 11: 336-340
- Risk factors for incident dementia after stroke and transient ischemic attack.Alzheimers Dement. 2015; 11: 16-23
- Cerebral white matter hyperintensities predict functional stroke outcome.Cerebrovasc. Dis. 2010; 29: 22-27
- Mechanisms of sporadic cerebral small vessel disease: insights from neuroimaging.The Lancet Neurology. 2013; 12: 483-497
- Cerebral small vessel disease: from pathogenesis and clinical characteristics to therapeutic challenges.The Lancet Neurology. 2010; 9: 689-701
- Risk of symptomatic intracerebral hemorrhage after intravenous thrombolysis in patients with acute ischemic stroke and high cerebral microbleed burden: a meta-analysis.JAMA Neurology. 2016; 73: 675-683
- White matter lesions double the risk of post-thrombolytic intracerebral hemorrhage.Stroke. 2015; 46: 2149-2155
- Leukoaraiosis is associated with warfarin-related hemorrhage following ischemic stroke.Neurology. 2002; 59: 193-197
- Increased risk of post-thrombolysis intracranial hemorrhage in acute ischemic stroke patients with leukoaraiosis: a meta-analysis.PLoS One. 2016; 11: e0153486
- Leukoaraiosis and intracerebral hemorrhage after thrombolysis in acute stroke.Neurology. 2007; 68: 1020-1024
- Leukoaraiosis, cerebral hemorrhage, and outcome after intravenous thrombolysis for acute ischemic stroke: a meta-analysis (v1).Stroke. 2016; 47: 2364-2372
- Classification of subtype of acute ischemic stroke. Definitions for use in a multicenter clinical trial. TOAST. Trial of Org 10172 in Acute Stroke Treatment.Stroke. 1993; 24: 35-41
- The clinical spectrum of hemorrhagic infarction.Stroke. 1986; 17: 630-637
- Thrombolysis with alteplase 3 to 4.5 hours after acute ischemic stroke.N. Engl. J. Med. 2008; 359: 1317-1329
- Randomised double-blind placebo-controlled trial of thrombolytic therapy with intravenous alteplase in acute ischaemic stroke (ECASS II).Lancet. 1998; 352: 1245-1251
- Extent of white matter lesions is related to acute subcortical infarcts and predicts further stroke risk in patients with first ever ischaemic stroke.J. Neurol. Neurosurg. Psychiatry. 2005; 76: 793-796
- Cerebral white matter lesions and cognitive function: the Rotterdam Scan Study.Ann. Neurol. 2000; 47: 145-151
- MR signal abnormalities at 1.5 T in Alzheimer's dementia and normal aging.AJR Am. J. Roentgenol. 1987; 149: 351-356
- Grading white matter lesions on CT and MRI: a simple scale.J. Neurol. Neurosurg. Psychiatry. 1990; 53: 1080-1083
- A new rating scale for age-related white matter changes applicable to MRI and CT.Stroke. 2001; 32: 1318-1322
- Risk factors for intracranial hemorrhage in acute ischemic stroke patients treated with recombinant tissue plasminogen activator: a systematic review and meta-analysis of 55 studies.Stroke. 2012; 43: 2904-2909
- Early hemorrhagic transformation of brain infarction: rate, predictive factors, and influence on clinical outcome: results of a prospective multicenter study.Stroke. 2008; 39: 2249-2256
- Risk factors for severe hemorrhagic transformation in ischemic stroke patients treated with recombinant tissue plasminogen activator: a secondary analysis of the European-Australasian Acute Stroke Study (ECASS II).Stroke. 2001; 32: 438-441
- Hyponatremia is an independent predictor of in-hospital mortality in spontaneous intracerebral hemorrhage.Stroke. 2014; 45: 1285-1291
- Matrix metalloproteinase expression is related to hemorrhagic transformation after cardioembolic stroke.Stroke. 2001; 32: 2762-2767
- Hemorrhagic transformation in cerebral embolism.Stroke. 1989; 20: 598-603
- Frequency and determinants for hemorrhagic transformation of cerebral infarction.Neuroepidemiology. 2009; 33: 261-265
- Frequency and risk factors for spontaneous hemorrhagic transformation of cerebral infarction.J. Stroke Cerebrovasc. Dis. 2004; 13: 235-246
- Plasma immunoproteasome predicts early hemorrhagic transformation in acute ischemic stroke patients.J. Stroke Cerebrovasc. Dis. 2017; 26: 49-56
- Importance of leukoaraiosis on CT for tissue plasminogen activator decision making: evaluation of the NINDS rt-PA Stroke Study.Cerebrovasc. Dis. 2008; 26: 120-125
- Tissue plasminogen activator for acute ischemic stroke.N. Engl. J. Med. 1995; 333: 1581-1587
- Symptomatic hemorrhagic transformation and its predictors in acute ischemic stroke with atrial fibrillation.Eur. Neurol. 2010; 64: 193-200
- Frequency and predictors of spontaneous hemorrhagic transformation in ischemic stroke and its association with prognosis.J. Neurol. 2014; 261: 905-912
- Cerebral microbleeds are regionally associated with intracerebral hemorrhage.Neurology. 2004; 62: 72-76
Article info
Publication history
Published online: May 02, 2017
Accepted:
May 1,
2017
Received in revised form:
April 19,
2017
Received:
December 16,
2016
Identification
Copyright
© 2017 Published by Elsevier B.V.
