Effects of white matter hyperintensity burden on functional outcome after mild versus moderate-to-severe ischemic stroke

• Published in: Scientific reports Vol. 14; no. 1; pp. 22567 - 11
• Main Authors: Gwak, Dong-Seok, Ryu, Wi-Sun, Schellingerhout, Dawid, Chung, Jinyong, Kim, Hang-Rai, Jeong, Sang-Wuk, Kim, Beom Joon, Kim, Joon-Tae, Hong, Keun-Sik, Park, Jong-Moo, Park, Man-Seok, Choi, Kang-Ho, Park, Tai Hwan, Lee, Kyungbok, Park, Sang-Soon, Kang, Kyusik, Cho, Yong-Jin, Park, Hong-Kyun, Lee, Byung-Chul, Yu, Kyung-Ho, Oh, Mi-Sun, Lee, Soo Joo, Kim, Jae Guk, Cha, Jae-Kwan, Kim, Dae-Hyun, Lee, Jun, Han, Moon-Ku, Lee, Ji Sung, Bae, Hee-Joon, Kim, Dong-Eog
• Format: Journal Article
• Language: English
• Published: London Nature Publishing Group UK 29.09.2024; Nature Publishing Group; Nature Portfolio
• Subjects: 631/378; 631/378/2607; 692/617; 692/617/375; 692/699/375; Aged; Aged, 80 and over; Female; Functional magnetic resonance imaging; Humanities and Social Sciences; Humans; Ischemia; Ischemic Stroke - diagnostic imaging; Ischemic Stroke - pathology; Magnetic Resonance Imaging; Male; Middle Aged; multidisciplinary; Prognosis; Science; Science (multidisciplinary); Severity of Illness Index; Stroke; Substantia alba; Treatment Outcome; White Matter - diagnostic imaging; White Matter - pathology
• ISSN: 2045-2322; 2045-2322
• DOI: 10.1038/s41598-024-71936-9

It is uncertain whether the prognostic power of white matter hyperintensity (WMH) on post-stroke outcomes is modulated as a function of initial neurological severity, a critical determinant of outcome after stroke. This multi-center MRI study tested if higher WMH quintiles were associated with 3-month poor functional outcome (modified Rankin Scale ≥ 3) for mild versus moderate-to-severe ischemic stroke. Mild and moderate-to-severe stroke were defined as admission National Institute of Health Stroke Scale scores of 1–4 and ≥ 5, respectively. Mean age of the enrolled patients (n = 8918) was 67.2 ± 12.6 years and 60.1% male. The association between WMH quintiles and poor functional outcome was modified by stroke severity ( p- for-interaction = 0.008). In mild stroke (n = 4994), WMH quintiles associated with the 3-month outcome in a dose-dependent manner for the 2nd to 5th quintile versus the 1st quintile, with adjusted-odds-ratios (aOR [95% confidence interval]) being 1.29 [0.96–1.73], 1.37 [1.02–1.82], 1.60 [1.19–2.13], and 1.89 [1.41–2.53], respectively. In moderate-to-severe stroke (n = 3924), however, there seemed to be a threshold effect: only the highest versus the lowest WMH quintile was significantly associated with poor functional outcome (aOR 1.69 [1.29–2.21]). WMH burden aggravates 3-month functional outcome after mild stroke, but has a lesser modulatory effect for moderate-to-severe stroke, likely due to saturation effects.