Introduction: Increased blood pressure variability (BPV) is detrimental after acute ischaemic stroke, but the interaction between BPV and neuroimaging factors that directly influence stroke outcome has not been explor...Introduction: Increased blood pressure variability (BPV) is detrimental after acute ischaemic stroke, but the interaction between BPV and neuroimaging factors that directly influence stroke outcome has not been explored. Methods: We retrospectively reviewed inpatients from 2007 to 2014 with acute anterior circulation ischaemic stroke, CT perfusion and angiography at hospital admission, and a modified Rankin Scale (MRS) 30- 365 days after stroke onset. BPV indices included SD, coefficient of variation and successive variation of the systolic blood pressure between 0 and 120 hours after admission. Ordinal logistic regression models were fitted to MRS with predictor variables of BPV indices. Models were further stratified by CT perfusion volumetric measurements, proximal vessel occlusion and collateral score. Results: 110 patients met the inclusion criteria. The likelihood of a 1-point rise in the MRS increased with every 10 mm Hg increase in BPV (OR for the 3 BPV indices ranged from 2.27 to 5.54), which was more pronounced in patients with larger ischaemic core volumes (OR 8.37 to 18.0) and larger hypoperfused volumes (OR 6.02 to 15.4). This association also held true for patients with larger mismatch volume, proximal vessel occlusion and good collateral vessels. Conclusions: These results indicate that increased BPV is associated with worse neurological outcome after stroke, particularly in patients with a large lesion core volume, concurrent viable ischaemic penumbra, proximal vessel occlusion and good collaterals. This subset of patients, who are often not candidates for or fail acute stroke therapies such as intravenous tissue plasminogen activator or endovascular thrombectomy, may benefit from interventions aimed at reducing BPV.展开更多
Background White matter hyperintensity(WMH)on brain MRI is associated with developing dementia or mild cognitive impairment(MCI),but WMH progression over time has not been fully investigated as an independent risk fac...Background White matter hyperintensity(WMH)on brain MRI is associated with developing dementia or mild cognitive impairment(MCI),but WMH progression over time has not been fully investigated as an independent risk factor.Methods We performed a post hoc analysis of the Systolic Blood Pressure Intervention Trial-Memory and Cognition in Decreased Hypertension(SPRINT MIND)trial.The primary outcome was incident probable dementia or MCI(dementia/MCI)before the follow-up MRI at 48 months from enrolment.The primary predictor was WMH progression,defined as the Z score difference between the follow-up and baseline WMH volumes.The secondary predictor was a binary WMH progression threshold(≥1.4 mL vs<1.4 mL).Results Among the 433 included patients,33(7.6%)developed dementia/MCI.There were 156(36.0%)patients who met the WMH progression threshold of≥1.4 mL,in whom the rate of dementia/MCI was 12.8%(20/156)vs 4.7%(13/277)of patients with<1.4 mL WMH progression(p=0.002).In multivariable logistic regression,the Z score of WMH progression was associated with dementia/MCI(OR 1.51,95%CI 1.12 to 2.04,p=0.007)as was the WMH progression threshold of≥1.4 mL(OR 2.89,95%CI 1.23 to 6.81,p=0.015).Conclusions In this post hoc analysis of SPRINT MIND,WMH progression over 48 months was associated with the development of probable dementia or MCI.展开更多
基金the National Center for Advancing Translational Sciences of the National Institutes of Health under Award Number KL2TR001065.
文摘Introduction: Increased blood pressure variability (BPV) is detrimental after acute ischaemic stroke, but the interaction between BPV and neuroimaging factors that directly influence stroke outcome has not been explored. Methods: We retrospectively reviewed inpatients from 2007 to 2014 with acute anterior circulation ischaemic stroke, CT perfusion and angiography at hospital admission, and a modified Rankin Scale (MRS) 30- 365 days after stroke onset. BPV indices included SD, coefficient of variation and successive variation of the systolic blood pressure between 0 and 120 hours after admission. Ordinal logistic regression models were fitted to MRS with predictor variables of BPV indices. Models were further stratified by CT perfusion volumetric measurements, proximal vessel occlusion and collateral score. Results: 110 patients met the inclusion criteria. The likelihood of a 1-point rise in the MRS increased with every 10 mm Hg increase in BPV (OR for the 3 BPV indices ranged from 2.27 to 5.54), which was more pronounced in patients with larger ischaemic core volumes (OR 8.37 to 18.0) and larger hypoperfused volumes (OR 6.02 to 15.4). This association also held true for patients with larger mismatch volume, proximal vessel occlusion and good collateral vessels. Conclusions: These results indicate that increased BPV is associated with worse neurological outcome after stroke, particularly in patients with a large lesion core volume, concurrent viable ischaemic penumbra, proximal vessel occlusion and good collaterals. This subset of patients, who are often not candidates for or fail acute stroke therapies such as intravenous tissue plasminogen activator or endovascular thrombectomy, may benefit from interventions aimed at reducing BPV.
文摘Background White matter hyperintensity(WMH)on brain MRI is associated with developing dementia or mild cognitive impairment(MCI),but WMH progression over time has not been fully investigated as an independent risk factor.Methods We performed a post hoc analysis of the Systolic Blood Pressure Intervention Trial-Memory and Cognition in Decreased Hypertension(SPRINT MIND)trial.The primary outcome was incident probable dementia or MCI(dementia/MCI)before the follow-up MRI at 48 months from enrolment.The primary predictor was WMH progression,defined as the Z score difference between the follow-up and baseline WMH volumes.The secondary predictor was a binary WMH progression threshold(≥1.4 mL vs<1.4 mL).Results Among the 433 included patients,33(7.6%)developed dementia/MCI.There were 156(36.0%)patients who met the WMH progression threshold of≥1.4 mL,in whom the rate of dementia/MCI was 12.8%(20/156)vs 4.7%(13/277)of patients with<1.4 mL WMH progression(p=0.002).In multivariable logistic regression,the Z score of WMH progression was associated with dementia/MCI(OR 1.51,95%CI 1.12 to 2.04,p=0.007)as was the WMH progression threshold of≥1.4 mL(OR 2.89,95%CI 1.23 to 6.81,p=0.015).Conclusions In this post hoc analysis of SPRINT MIND,WMH progression over 48 months was associated with the development of probable dementia or MCI.
