Proximal Single Subcortical Infarction, Left Ventricular Fractional Shortening, and Risk Prediction Model Development for Neurological Deterioration in Patients With Anterior Circulation Single Subcortical Infarction.

BACKGROUND

With different infarct morphological characteristics included, the relationship between single subcortical infarction type and neurological deterioration (ND) remains unclear. Similarly, the diagnostic value of the known risk factors is also uncertain.

METHODS

We conducted a prospective observational study at a tertiary teaching hospital affiliated with Fudan University, enrolling patients with anterior circulation single subcortical infarction within 24 hours of symptom onset from 2017 to 2018. Clinical data, magnetic resonance imaging infarct characteristics, and echocardiographic indices were analyzed using a multivariable logistic regression model to identify independent ND predictors. The receiver operating characteristic curve with multiple testing corrections was performed to assess the discriminatory abilities of different models and the calibration curve for the accuracy of the optimal model.

RESULTS

The study included 298 patients, with 80 (26.85%) experiencing ND. Multivariate analysis identified admission National Institutes of Health Stroke Scale score (odds ratio [OR], 1.197 [95% CI, 1.067-1.343], =0.002), proximal single subcortical infarction (OR, 3.311 [95% CI, 1.608-6.817], =0.001), maximal diameter on axial DWI (OR, 1.651 [95% CI, 1.042-2.617], =0.033), and left ventricular fractional shortening (OR, 0.001 [95% CI, 0.000-0.282], =0.021) as independent predictors of ND. The optimal model, including the independent predictors and parent artery disease, demonstrated improved discrimination (area under the curve=0.762) and good calibration (Hosmer-Lemeshow =0.51). left ventricular fractional shortening contributed positively to this model's performance (net reclassification improvement: 24.8%, =0.051; integrated discrimination index: 2.1%, =0.018).

CONCLUSIONS

When considering different infarct morphological characteristics simultaneously, SSI type remains an independent predictor of ND in patients with anterior circulation SSI. Furthermore, our research indicated left ventricular fractional shortening as a novel predictor, which can improve the discriminative ability of the prediction model.