Correlation Analysis For Perivascular Spaces And The Recurrence And Mortality Of Cerebral Amyloid Angiopathy-related Intracerebral Hemorrhage

Background: Perivascular spaces(PVS)are one of the important imaging markers of cerebral small vessel disease(CSVD)and are closely related to cerebral amyloid angiopathy(CAA).However,the relationship between PVS and prognostic outcomes such as recurrent intracerebral hemorrhage(ICH)and mortality in CAA-related cases remains unclear.Methods:This study retrospectively included spontaneous intracerebral hemorrhage patients who were treated at Qingdao University Affiliated Hospital from January 2016 to December 2020.Based on the 2.0 version of the Boston diagnostic criteria,a total of 94 cases were diagnosed as possible or probable CAA-ICH patients,with 9 cases lost to follow-up.Eventually,85 patients who met the criteria were included in the study.Clinical baseline data such as age,gender,history of hypertension,coronary heart disease and stroke were collected,as well as laboratory parameters including fasting blood glucose,uric acid,homocysteine,high-density lipoprotein,low-density lipoprotein,total cholesterol,triglycerides,and coagulation within48 hours of admission.Imaging markers of CSVD,including PVS in the centrum semiovale,basal ganglia,and hippocampus,cerebral microbleeds(CMBs),white matter hyperintensity(WMH),cortical superficial siderosis(c SS),and lacunas(LA),were identified according to the diagnostic criteria for vascular neuroimaging lesions.The individual imaging markers of CSVD and the overall burden of CSVD were assessed and graded.Follow-up was conducted through telephone interviews to determine the recurrence and survival of cerebral hemorrhage.Spearman correlation analysis was performed to determine the correlation between PVS and other CSVD imaging markers.Based on the occurrence of recurrent brain hemorrhage,the CAA-ICH population was divided into the recurrence group and non-recurrence group,and a comparison of baseline data was conducted.Kaplan-Meier survival analysis was used to determine the relationship between PVS and recurrent CAA-ICH brain hemorrhage,and the between-group comparison was performed using the log-rank(Mantel-Cox)test.Cox regression analysis was performed to explore the influencing factors of recurrent CAA-ICH brain hemorrhage and draw conclusions.Results: A total of 85 patients with CAA-ICH were included in the study,with 70 patients classified as probable CAA and 15 patients as possible CAA-ICH.The average age of the patients was 72.34 years,and 55.8% were male.50.6% of the patients had PVS burden in the centrum semiovale.The median follow-up time was 66 months,during which 34 patients experienced recurrent cerebral hemorrhage,accounting for 40% of the total number of patients.Spearman correlation analysis revealed interrelationships among PVS in the centrum semiovale,hippocampus,and basal ganglia.Total PVS burden was correlated with LA,but no significant correlations were found between PVS and other markers such as c SS,CMBs,WMH,and LA.Kaplan-Meier analysis demonstrated a correlation between the total burden of CSVD and recurrence and mortality in patients with CAA-ICH,as well as between c SS as a single imaging marker,while no correlations were found between PVS in the centrum semiovale,basal ganglia,hippocampus,and total PVS burden with recurrent CAA-ICH(p>0.05).Univariate Cox regression analysis showed that c SS(HR=2.94,95% CI:1.27-6.76),WMH(HR=1.12,95% CI: 1.01-1.25),periventricular WMH(HR=1.73,95% CI:1.11-2.69),and the total burden of CSVD(HR=2.50,95% CI: 1.27-4.93)were associated with recurrent CAA-ICH and mortality.Multivariate Cox regression analysis revealed that c SS was an independent risk factor for poor outcome in patients with CAA-ICH(HR=2.86,95% CI: 1.22-6.68,p=0.008).Conclusions:1.PVS are commonly present in the population with CAA-ICH,with the centrum semiovale being the most common location.There is a close relationship between PVS in different regions,but no significant correlations have been found between PVS and other markers of CSVD.2.There is no significant association between PVS and recurrent ICH or mortality in CAA-ICH patients.and the presence of c SS is associated with poor outcomes in terms of recurrent ICH and mortality in CAA-ICH patients.This conclusion needs further confirmation in large-scale prospective studies.