Ye Chen, Liu Junfeng, Wei Chenchen, Wang Yanan, Song Quhong, Pan Ruosu, Tao Wendan, Wu Bo, Liu Ming
Department of Neurology, West China Hospital, Sichuan University, Chengdu 610041, China.
Department of Neurology, The Affiliated Hospital of Qingdao University, Qingdao 266003, China.
Brain Sci. 2022 Jul 25;12(8):978. doi: 10.3390/brainsci12080978.
Objective: To explore whether deep medullary veins (DMVs) in the unaffected hemisphere were associated with functional outcome in acute cardioembolic stroke patients. Methods: Acute cardioembolic stroke patients at a single center were retrospectively included. DMVs visibility in the unaffected hemisphere was assessed using a well-established four-grade scoring method based on susceptibility-weighted imaging (SWI): grades 0−3 (grade 0 for no visible DMVs; grade 1 for the numbers of conspicuous DMVs < 5; grade 2 for numbers raging from 5 to 10; grade 3 for more than 10). Patients were further divided into mild-to-moderate (grade 0−2) and severe DMVs (grade 3) groups. Functional outcomes were evaluated using the modified Rankin scale (mRS) score at three months. Poor outcome was defined as mRS ≥ 3. Binary logistic regression analysis was used to explore the association between DMVs grade and functional outcome. Results: A total of 170 patients were finally included. Compared with the mild-to-moderate DMVs group (149 patients), the severe DMVs group (21 patients) had higher baseline National Institutes of Health Stroke Scale (NIHSS) scores (p = 0.002), lower levels of admission systolic blood pressure (BP) (p = 0.031), and elevated rates of large infarction (p = 0.003). At three months, the severe DMVs group had higher mRS (p = 0.002). Patients in the poor outcome group (82/170, 48.2%) had older age, higher baseline NIHSS score, lower admission diastolic BP, higher rates of hemorrhagic transformation and large infarction, and an increased proportion of severe DMVs (all p < 0.05). After adjusting for confounders, multivariable regression analysis showed that the severe DMVs grade (adjusted odds ratio [OR] = 5.830, 95% confidence interval [CI] = 1.266−26.856, p = 0.024) was significantly associated with three-month functional outcomes without interaction with other potential risk factors (p for interaction > 0.05). Conclusions: DMVs grade in the unaffected hemisphere was independently associated with three-month functional outcome in acute cardioembolic stroke patients. Patients with severe DMVs were more likely to have a poor functional outcome at three months.
探讨急性心源性栓塞性卒中患者未受累半球的深髓静脉（DMV）是否与功能结局相关。方法：回顾性纳入单中心的急性心源性栓塞性卒中患者。基于磁敏感加权成像（SWI），采用一种成熟的四级评分方法评估未受累半球的DMV显影情况：0 - 3级（0级为未见到DMV；1级为可见的DMV数量<5条；2级为数量在5至10条之间；3级为超过10条）。患者进一步分为轻度至中度（0 - 2级）和重度DMV（3级）组。在3个月时使用改良Rankin量表（mRS）评分评估功能结局。结局不良定义为mRS≥3。采用二元逻辑回归分析探讨DMV分级与功能结局之间的关联。结果：最终纳入170例患者。与轻度至中度DMV组（149例患者）相比，重度DMV组（21例患者）的基线美国国立卫生研究院卒中量表（NIHSS）评分更高（p = 0.002），入院收缩压（BP）水平更低（p = 0.031），大面积梗死发生率更高（p = 0.003）。在3个月时，重度DMV组的mRS更高（p = 0.002）。结局不良组（82/170，48.2%）的患者年龄更大，基线NIHSS评分更高，入院舒张压更低，出血性转化和大面积梗死发生率更高，重度DMV的比例增加（所有p<0.05）。在对混杂因素进行校正后，多变量回归分析显示，重度DMV分级（校正比值比[OR]=5.830，95%置信区间[CI]=1.266 - 26.856，p = 0.024）与3个月时的功能结局显著相关，且与其他潜在危险因素无交互作用（交互作用p>0.05）。结论：未受累半球的DMV分级与急性心源性栓塞性卒中患者3个月时的功能结局独立相关。重度DMV患者在3个月时功能结局不良的可能性更大。
