Department of Neurology, Asan Medical Center University of Ulsan College of Medicine Seoul Republic of Korea.
Department of Neurology Korea University Guro Hospital, Korea University College of Medicine Seoul Republic of Korea.
J Am Heart Assoc. 2023 Dec 5;12(23):e030515. doi: 10.1161/JAHA.123.030515. Epub 2023 Nov 28.
This study explored the risk factors, neuroimaging features, and prognostic implications of nonhypertensive white matter hyperintensity (WMH) in patients with acute ischemic stroke and transient ischemic attack.
We included 2283 patients with hypertension and 1003 without from a pool of 10 602. Associations of moderate-to-severe WMH with known risk factors, functional outcome, and a composite of recurrent stroke, myocardial infarction, and all-cause mortality were evaluated. A subset of 351 patients without hypertension and age- and sex-matched pairs with hypertension and moderate-to-severe WMH was created for a detailed topographic examination of WMH, lacunes, and microbleeds. Approximately 35% of patients without hypertension and 65% of patients with hypertensive stroke exhibited moderate-to-severe WMH. WMH was associated with age, female sex, and previous stroke, irrespective of hypertension. In patients without hypertension, WMH was associated with initial systolic blood pressure and was more common in the anterior temporal region. In patients with hypertension, WMH was associated with small vessel occlusion as a stroke mechanism and was more frequent in the periventricular region near the posterior horn of the lateral ventricle. The higher prevalence of occipital microbleeds in patients without hypertension and deep subcortical lacunes in patients with hypertension were also observed. Associations of moderate-to-severe WMH with 3-month functional outcome and 1-year cumulative incidence of the composite outcome were significant (both <0.01), although the latter lost significance after adjustments. The associations between WMH and outcomes were consistent across hypertensive status.
One-third of patients without hypertension with stroke have moderate-to-severe WMH. The pathogenesis of WMH may differ between patients without and with hypertension, but its impact on outcome appears similar.
本研究探讨了伴有急性缺血性卒中和短暂性脑缺血发作的非高血压性脑白质高信号（WMH）的危险因素、神经影像学特征和预后意义。
我们纳入了高血压患者 2283 例和非高血压患者 1003 例，这两组均来源于 10602 例患者。评估了中重度 WMH 与已知危险因素、功能结局以及卒中复发、心肌梗死和全因死亡率组成的复合终点的相关性。对无高血压的 351 例患者和年龄及性别匹配的伴有高血压且中重度 WMH 的患者进行亚组研究，以详细检查 WMH、腔隙性梗死和微出血。大约 35%无高血压的患者和 65%伴有高血压的卒中患者表现为中重度 WMH。无论是否伴有高血压，WMH 均与年龄、女性和既往卒中相关。在无高血压的患者中，WMH 与初始收缩压相关，且更常见于前颞叶区域。在伴有高血压的患者中，WMH 与小血管闭塞这一卒中机制相关，且更常见于侧脑室后角附近的脑室周围区域。还观察到无高血压患者枕部微出血更为常见和伴有高血压患者深部皮质下腔隙性梗死更为常见的情况。中重度 WMH 与 3 个月时的功能结局和 1 年时复合结局的累积发生率显著相关（均<0.01），但后者在调整后失去了统计学意义。WMH 与结局之间的相关性在高血压状态下是一致的。
三分之一无高血压的卒中患者存在中重度 WMH。WMH 的发病机制可能在无高血压和伴有高血压的患者中存在差异，但对结局的影响似乎相似。
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