Correlation Between The Overall Burden Of Cerebral Small Vessel Disease And Stroke Recurrence In Patients With Acute Cerebral Infarction

Objective:To investigate the relationship between the overall burden of cerebral small vessel diseases(CSVD)and recurrent stroke in patients with acute cerebral infarction.Method:A total of 880 patients with acute ischemic stroke who were hospitalized in the Department of Neurology of the Affiliated Hospital of Qingdao University from December2020 to December 2021 were collected.The demographic data,vascular risk factors,and imaging characteristics of the patients were collected.All enrolled patients underwent CSVD overall burden score based on MR imaging features.According to the CSVD overall burden score(0-4 points),the patients were divided into 5 groups.The clinical and imaging data of patients in the 5 groups were compared,and the possible influencing factors of the overall burden of CSVD were analyzed by ordered Logistic regression.Followed up for 1year,the primary outcome event was stroke recurrence,and the secondary outcome events were recurrent ischemic stroke and cerebral hemorrhage,according to the stroke recurrence,they were divided into a recurrence group and a non-recurrence group,the difference between the clinical data and imaging data of the two groups was compared,and the risk factors of stroke recurrence at 1 year were analyzed by COX regression analysis.According to the secondary outcome events,the enrolled patients were divided into recurrent cerebral infarction group and non-recurrent cerebral infarction group;cerebral hemorrhage group and no cerebral hemorrhage group.Multivariate COX regression analysis was used to explore the impact of the total burden of CSVD on recurrent cerebral infarction and cerebral hemorrhage.The predictive value of the overall burden of CSVD on stroke recurrence was explored by calculating the area under the receiver operating characteristic(ROC)curve.Result:A total of 843 cases had complete medical history and completed follow-up.The result is as follows:(1)In this study,170 patients(20.2%)had a CSVD overall burden score of 0,256patients(30.4%)had a CSVD overall burden score of 1,and 275 patients had a CSVD overall burden score of 2(32.6%),115 cases(13.6%)with a CSVD overall burden score of3,and 27 cases(3.2%)with a CSVD overall burden score of 4.(2)Statistical analysis was performed on patients with different CSVD overall burden scores.The results showed that there were statistically significant differences between the five groups in age,sex,hypertension,diabetes,triglycerides,total cholesterol,low-density lipoprotein cholesterol,fasting blood sugar,homocysteine(P<0.05).Ordinal Logistic regression analysis showed that age,sex,hypertension,and diabetes was correlated with the overall burden of CSVD(P<0.05),and increasing age,hypertension,diabetes,and male were independent risk factors of overall burden of CSVD.(3)At1 year follow-up,143 cases(17%)in recurrence group,700cases(83%)in the non-stroke recurrence group,including 119 cases(14%)of recurrent ischemic stroke and24 cases(3%)of new cerebral hemorrhage.The incidence of recurrent cerebral infarction was 4.1%(7/170)and the incidence of new cerebral hemorrhage was 0.6%(1/170)in patients with a CSVD total burden score of 0;The incidence of recurrent cerebral infarction was 6.6%(17/256)and the incidence of new cerebral hemorrhage was 0.4%(1/256)in patients with a CSVD total burden score of 1;The incidence of recurrent cerebral infarction was 17.8%(49/275)and the incidence of new cerebral hemorrhage was 2.2%(6/275)in patients with CSVD total burden score of 2.The incidence of recurrent cerebral infarction was 29.6%(34/115)and the incidence of new cerebral hemorrhage was 9.6%(11/115)in patients with CSVD total burden score of 3.The incidence of recurrent cerebral infarction was 44.4%(12/27)and the incidence of new cerebral hemorrhage was 18.5%(5/27)in patients with CSVD total burden score of 4.(4)Univariate statistical analysis was performed on the two groups with or without recurrent stroke.The results showed that there were statistically significant differences between the two groups in age,hypertension,diabetes,taking antiplatelet drugs,statin drugs,fasting blood glucose,high-density lipoprotein cholesterol,cerebral artery stenosis,the overall burden of CSVD,WMH,CMB,EPVS,and lacunes(P<0.05).COX regression analysis showed that hypertension,diabetes,cerebral arterial stenosis,the overall burden of CSVD,WMH,and CMB were independent risk factors for recurrent stroke,and use of antiplatelet drugs was an independent protective factor for recurrent stroke.Multivariate COX analysis results showed that the overall burden of CSVD was a risk factor for recurrent cerebral infarction.The risk of recurrent cerebral infarction in patients with CSVD overall burden score of 2,3 and 4 was 3.289,4.447 and 9.966 times higher than that in patients with CSVD overall burden score of 0.The overall burden of CSVD was a risk factor for new cerebral hemorrhage.The risk of cerebral hemorrhage in patients with CSVD overall burden score of 3 and 4 was 16.740 and 43.960 times that of patients with CSVD overall burden score of 0,respectively.(5)At 1-year follow-up,the area under ROC curve(AUC)of CSVD overall burden score in patients with recurrent stroke was 0.770.The area under ROC curve(AUC)of CSVD overall burden score in patients with recurrent cerebral infarction was 0.719.The area under ROC curve(AUC)of CSVD overall burden score in patients with cerebral hemorrhage was 0.812.Conclusion:Aging,hypertension,diabetes,and male are the risk factors for the increase of the overall burden of CSVD,and the overall burden of CSVD is an independent risk factor for stroke recurrence in patients with acute cerebral infarction.Although the incidence of recurrent ischemic stroke in patients with acute cerebral infarction was much higher than that of new cerebral hemorrhage,the association between the overall burden of CSVD and recurrent ischemic stroke was weaker than that of cerebral hemorrhage,suggesting that attention should be paid to the effect of total burden of CSVD on new cerebral hemorrhage in patients with cerebral infarction during secondary prevention and antithrombotic therapy.The overall burden of CSVD can be used as a predictor of one-year stroke recurrence in patients with acute cerebral infarction,which is important for clinicians to early assess the risk of stroke recurrence in patients with acute cerebral infarction and improve the secondary prevention strategy of stroke.