Association of white matter hyperintensity markers on MRI and long-term risk of mortality and ischemic stroke: The SMART-MR study

Objective

To determine whether white matter hyperintensity (WMH) markers on MRI are associated with long-term risk of mortality and ischemic stroke.

Methods

We included consecutive patients with manifest arterial disease enrolled in the SMART-MR study. We obtained WMH markers (volume, type and shape) from brain MRI scans performed at baseline using an automated algorithm. During follow-up, occurrence of death and ischemic stroke was recorded. Using Cox regression, we investigated associations of WMH markers with risk of mortality and ischemic stroke, adjusting for demographics, cardiovascular risk factors and cerebrovascular disease.

Results

We included 999 patients (59±10 years; 79% male) with a median follow-up of 12.5 years (range 0.2-16.0 years). A greater periventricular or confluent WMH volume was independently associated with a greater risk of vascular death (hazard ratio (HR) 1.29, 95% CI 1.13-1.47 for a 1 unit increase in natural log-transformed WMH volume) and ...

研究目标：明确磁共振成像（MRI）上的脑白质高信号（white matter hyperintensity, WMH）标记物是否与死亡及缺血性卒中的长期发病风险存在关联。

研究方法：本研究连续纳入SMART-MR研究中登记的显性动脉疾病患者。采用自动化算法对基线颅脑MRI扫描结果进行分析，提取WMH标记物（包括体积、类型及形态）。随访期间记录患者的死亡及缺血性卒中发生情况。采用Cox回归模型分析WMH标记物与死亡及缺血性卒中发病风险的关联，并对人口统计学特征、心血管危险因素及脑血管疾病进行校正。

研究结果：本研究共纳入999例患者（年龄59±10岁；男性占比79%），中位随访时间为12.5年（范围0.2~16.0年）。脑室周围或融合性WMH体积更大与血管性死亡风险升高独立相关（自然对数转换后的WMH体积每增加1个单位，风险比（hazard ratio, HR）为1.29，95%置信区间（confidence interval, CI）为1.13~1.47），且……