Study On The Prognostic Factors In Patients With Acute Cardioembolic Stroke

Part 1 Analysis of Prognostic Factors in Patients with Acute Cardioembolic StrokeBackground and purpose:Post-stroke blood pressure(BP)regulation is an important aspect of stroke management in the acute phase.A large number of studies have analyzed the impact of post-stroke BP on the prognosis of patients with acute ischemic stroke,but few studies have explored its effect on the functional recovery of acute cardioembolic stroke(CE)specifically.We explored the role of BP in predicting functional outcomes and further identified the risk factors for the 3-month prognosis of CE patients.Participants and Methods:A single-center database of first-ever acute CE according to the TOAST classification,from May 2014 to September 2019,was retrospectively analyzed.All patients were with the firstever stroke and were hospitalized within 48 hours.The first systolic blood pressure(SBP)values measured on admission were categorized by 15 mm Hg increments,namely < 125,125-139,140-154,155-169 and ? 170 mm Hg.The first diastolic blood pressure(DBP)values were categorized by 10 mm Hg increments,namely < 75,75-84,85-94,95-104 and ? 105 mm Hg.Then the differences of demographic data and risk factors among each quintile were compared.We assessed the baseline functional deficit with The National Institutes of Health Stroke Scale(NIHSS),evaluated the severity of leukoaraiosis with Fazekas scale,and then defined moderate to severe leukoaraiosis as Fazekas score ? 3 points.The incidence of stroke associated pneumonia(SAP),cerebral hemorrhage and other important complications were recorded.The patients were followed up and were defined as poor functional outcome(PFO)group if the modified Rankin Scale(m RS)? 3 at 3 months,after excluding patients with serious medical diseases.Logistic regression analysis was performed to discern the independent predictors for PFO.Results:Totally,251 patients were included in this study.At admission,SBP weakly correlated with NIHSS score(r = 0.246,P < 0.001).Of the five SBP subgroups,patients with SBP ? 170 mm Hg had the highest baseline NIHSS score(P = 0.002).Among the five DBP quintiles,there was no significant difference in the baseline NIHSS score.At 3months,100(39.8%)patients belong to the PFO group,which had significantly higher baseline NIHSS score(P < 0.001),higher incidence of SAP and higher proportion of moderate to severe leukoaraiosis.The proportion of PFO in patients with SBP ? 170 mmhg was significantly higher than that in other quintiles(P = 0.033).Binary logistic regression analysis showed that the independent predictors of PFO were baseline NIHSS score(P < 0.001),SAP(P = 0.001),moderate to severe leukoaraiosis(P = 0.005)and asymptomatic intracranial hemorrhage(ns ICH)(P =0.017).There was no independent correlation between BP parameters and functional outcome.Conclusion:For acute CE patients in anterior circulation,baseline NIHSS score,SAP,moderate to severe leukoaraiosis and complication of cerebral hemorrhage,not blood pressure parameters,are the independent predictors for PFO at 3 months.Thus,therapies to reduce the severity of infarction and measures to manage important complications may be critical in CE treatment.Part 2 Effect of Total Cerebral Small Vessel Disease Burden on Short-term Prognosis of Acute Cardioembolic PatientsBackgroud and purpose:The total cerebral small vessel disease(cSVD)burden is a pattern to evaluate cSVD systematically,and it is an important factor to predict the adverse prognosis of patients with ischemic stroke.Imaging markers of c SVD are also found in patients with cardioembolic stroke(CE),though their effect on the prognosis of these patients is not clear.This study aimed to explore the effect of the total c SVD burden on the functional outcomes of CE patients.Participants and Methods:First-ever acute CE patients,who had a baseline NIHSS score of 0~14 and were admitted within 48 hours in the Department of Neurology were enrolled from May2014 to September 2019.According to the MRI images,the total c SVD burden(0-3points)was calculated by evaluating the grade or quantity of white matter hyperintensities,lacunae and enlarged perivascular spaces.The modified Rankin Scale(m RS),adjusted by the baseline NIHSS score was used to evaluate the functional outcomes 3 months after CE onset.According to the m RS,patients were divided into good and poor functional outcome groups.Baseline and clinical factors of the two outcome groups were compared.Bivariate Logistic regression analysis was performed to identify the effect of the total c SVD burden on the functional outcome.Results:Among the 189 patients,52.9,27.1,14.8 and 4.8% had a total c SVD burden score of 0,1,2 and 3.At 3 months,124 patients had a good prognosis.Univariate regression analysis showed that three c SVD features had strongest negative associations with functional outcomes(OR = 0.042,95% CI 0.005-0.364).After adjustment for potential confounders,a high c SVD burden(3 features,OR = 0.076,95% CI0.008-0.750)and the score of total c SVD burden(OR = 0.563,95%CI 0.360~0.879)remained negatively associated with good outcome.Conclusions:cSVD markers can be widely found as “background” in CE patients.High total cSVD burden score is an independent risk factor for short-term prognosis in CE patients.This study can provide clues for further exploring the effect of baseline functional state on the outcome of other stroke subtypes.