Department of Neurology, Tokyo Women's Medical University Hospital, Tokyo, Japan.
Suita Municipal Hospital, Suita, Japan.
Hypertens Res. 2024 Nov;47(11):3001-3009. doi: 10.1038/s41440-024-01797-2. Epub 2024 Jul 31.
Total small vessel disease (SVD) score is used to measure the burden of SVD by incorporating four established neuroimaging markers; white matter hyperintensity, lacune, cerebral microbleed, and enlarged perivascular space, ranging from 0 to 4. Whether total SVD scores predict all vascular outcomes remains unclear. This study aimed to clarify the predictive value of the total SVD score for incident stroke, mortality, and acute coronary syndrome in independent outpatients with vascular risk factors. We derived data from The Tokyo Women's Medical University Cerebrovascular Disease registry, a prospective observational registry in which 1011 patients with evidence of cerebral vessel disease on magnetic resonance imaging were enrolled. They were followed up until March 2023. The primary outcomes were stroke, all-cause death, and acute coronary syndrome (ACS). After excluding those with a modified Rankin scale score >1, Mini-mental State Examination score <24, and missing T2* images, 692 patients were included. During a median follow-up period of 4.6 years, stroke, ACS, and all-cause death occurred in 52, 24, and 45 patients, respectively. In multivariate analysis, the total SVD score was independently associated with stroke, and all-cause death but not with acute coronary syndrome. Both cutoff values of the total SVD score for stroke, and all-cause death were 1. In conclusion, the total SVD score could predict stroke and mortality but not acute coronary syndrome. Our results suggest intensive management of patients with a total SVD score ≥1 to prevent stroke and all-cause death. Patients with higher total SVD scores were significantly more likely to have a stroke (A; P = 0.012) than those with lower total SVD scores. However, no association was observed between total SVD scores and acute coronary syndrome (B, P = 0.604). For incident stroke, total SVD scores of 1 and 2 were the cutoff levels.
总小血管疾病（SVD）评分用于通过纳入四个已建立的神经影像学标志物来衡量 SVD 的负担；脑白质高信号、腔隙、脑微出血和扩大的血管周围间隙，范围从 0 到 4。总 SVD 评分是否预测所有血管结局仍不清楚。本研究旨在阐明总 SVD 评分对有血管危险因素的独立门诊患者的卒中、死亡率和急性冠状动脉综合征的预测价值。我们从东京女子医科大学脑血管病登记处获取数据，这是一个前瞻性观察性登记处，共纳入了 1011 名磁共振成像显示有脑血管疾病证据的患者。他们随访至 2023 年 3 月。主要结局是卒中、全因死亡和急性冠状动脉综合征（ACS）。排除改良 Rankin 量表评分>1、简易精神状态检查评分<24 和 T2*图像缺失的患者后，共纳入 692 名患者。在中位随访 4.6 年期间，分别有 52、24 和 45 例患者发生卒中、ACS 和全因死亡。多变量分析显示，总 SVD 评分与卒中、全因死亡独立相关，但与 ACS 无关。卒中、全因死亡的总 SVD 评分截断值均为 1。总之，总 SVD 评分可预测卒中及死亡率，但不能预测 ACS。我们的研究结果表明，对于总 SVD 评分≥1 的患者，应进行强化管理以预防卒中及全因死亡。总 SVD 评分较高的患者发生卒中的可能性显著高于评分较低的患者（A；P = 0.012）。然而，总 SVD 评分与 ACS 之间无相关性（B，P = 0.604）。对于卒中事件，总 SVD 评分 1 和 2 为截断值。
