Table_1_A Non-linear Association Between Total Small Vessel Disease Score and Hemorrhagic Transformation After Ischemic Stroke With Atrial Fibrillation and/or Rheumatic Heart Disease.DOCX

Background: Previous studies have investigated the association between a single marker of cerebral small vessel disease (SVD) and hemorrhagic transformation (HT). However, the effect of the total SVD burden on HT has not been evaluated yet. We aimed to investigate the association between the total SVD score and HT in ischemic stroke patients with atrial fibrillation (AF) and/or rheumatic heart disease (RHD).Methods: Ischemic stroke patients with AF and/or RHD admitted within 7 days after onset were enrolled at two hospitals in China. The total SVD score was based on the presence of lacunes, extensive white matter hyperintensities, cerebral microbleeds, and moderate to severe enlarged perivascular spaces in the basal ganglia. One point was awarded for the presence of each marker, with the total SVD score ranging from 0 to 4 points. HT was assessed based on follow-up imaging scans during hospitalization and was classified according to the radiographic appearance and associated neurological deterioration.Results: Of 207 enrolled patients (mean age, 67.79 years; 58.9% female), 89 (43.0%) developed HT. The distribution of the total SVD score was significantly different between patients with and without HT in the univariate analysis (p = 0.04). After adjustment for confounders, a SVD score of 1 was independently associated with an increased risk of HT [odds ratio (OR), 3.23; 95% confidence interval (CI), 1.48–7.04; p = 0.003], while a SVD score ≥2 was inversely related to the occurrence of HT (OR, 0.41; 95% CI, 0.19–0.91; p = 0.03). These independent associations remained significant in the subgroups of hemorrhagic infarction and asymptomatic HT (all p < 0.05).Conclusions: In our study, the relationship between the total SVD score and HT was not linear, since the presence of only one marker of SVD was associated with an increased risk of HT, while the presence of two or more markers of SVD was a potential protective factor for HT. These results indicate the need to take the total SVD score into account, not only a single SVD marker, when assessing the risk of HT. Further studies with larger samples are required to validate these findings.

背景：先前的研究已探讨单个脑小血管病（SVD）标志物与出血性转化（HT）之间的关联。然而，总SVD负担对HT的影响尚未得到评估。本研究旨在探究总SVD评分与缺血性卒中患者（合并心房颤动（AF）及/或风湿性心脏病（RHD））中HT之间的关联。方法：在中国两所医院中，纳入了发病后7天内入住的缺血性卒中患者。总SVD评分基于腔隙、广泛的脑白质高信号、脑微出血和基底节中度至重度扩大的血管周围间隙的存在。每个标志物的存在均获得一分，总SVD评分范围为0至4分。HT的评估基于住院期间的随访影像学检查，并根据影像学表现及相关的神经功能恶化进行分类。结果：207名纳入的患者（平均年龄，67.79岁；58.9%为女性）中，有89名（43.0%）发生了HT。在单变量分析中，总SVD评分在HT患者与非HT患者之间存在显著差异（p = 0.04）。在调整混杂因素后，SVD评分为1与HT风险增加独立相关[比值比（OR），3.23；95%置信区间（CI），1.48–7.04；p = 0.003]，而SVD评分≥2与HT的发生呈负相关（OR，0.41；95% CI，0.19–0.91；p = 0.03）。这些独立关联在出血性梗死和无症状HT的亚组中仍保持显著性（所有p < 0.05）。结论：在本研究中，总SVD评分与HT之间的关系并非线性，因为仅存在一个SVD标志物与HT风险增加相关，而存在两个或更多SVD标志物则是HT的潜在保护因素。这些结果指出，在评估HT风险时，应考虑总SVD评分，而不仅仅是单个SVD标志物。需要进一步进行更大样本的研究以验证这些发现。