Silent MRI infarcts and the risk of future stroke - The cardiovascular health study
Silent MRI infarcts and the risk of future stroke - The cardiovascular health study
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DOI：
10.1212/wnl.57.7.1222
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发表时间：
2001-10-09
期刊：
影响因子：
9.9
通讯作者：
Price, T
中科院分区：
文献类型：
--
作者：
Bernick, C;Kuller, L;Price, T
背景：无症状性脑梗死在老年人的头颅MRI中很常见。目的：研究卒中风险与无症状性梗死之间的相关性，单独和与其他卒中风险因素的结合。方法：心血管健康研究（CHS）的参与者（3,324例）在1992年至1994年期间没有中风史，接受了头颅MRI扫描。无症状性梗死定义为大于3 mm的局灶性病变，在T2图像上呈高信号，如果是皮质下，在T1图像上呈低信号。在平均4年的随访中，对中风事件进行了识别和分类。作者评估了无症状性梗死患者随后发生症状性卒中的风险，以及其他潜在卒中风险因素如何改变症状性卒中的风险。结果：大约28%的CHS参与者有无症状性梗死的证据（n = 923）。无症状性梗死患者（n = 67）的卒中发生率为18.7/1000人-年，而无症状性梗死患者的卒中发生率为9.5/1000人-年。多发性（不止一次）无症状性梗死患者卒中事件的校正相对风险增加（风险比1.9 [1.2 - 2.8]）。在无症状性梗死患者中，舒张压和收缩压、颈总动脉和颈内动脉壁厚度以及房颤的存在与卒中风险增加相关（n = 53例卒中）。结论：MRI上无症状性脑梗死的存在是无临床卒中史的老年人4年随访中症状性卒中风险的独立预测因素。
Background: Silent infarcts are commonly discovered on cranial MRI in the elderly. Objective: To examine the association between risk of stroke and presence of silent infarcts, alone and in combination with other stroke risk factors. Methods: Participants (3,324) in the Cardiovascular Health Study (CHS) without a history of stroke underwent cranial MRI scans between 1992 and 1994. Silent infarcts were defined as focal lesions greater than 3 mm that were hyperintense on T2 images and, if subcortical, hypointense on T1 images. Incident strokes were identified and classified over an average follow-up of 4 years. The authors evaluated the risk of subsequent symptomatic stroke and how it was modified by other potential stroke risk factors among those with silent infarcts. Results: Approximately 28% of CHS participants had evidence of silent infarcts (n = 923). The incidence of stroke was 18.7 per 1,000 person-years in those with silent infarcts (n = 67) compared with 9.5 per 1,000 person-years in the absence of silent infarcts. The adjusted relative risk of incident stroke increased with multiple (more than one) silent infarcts (hazard ratio 1.9 [1.2 to 2.8]). Higher values of diastolic and systolic blood pressure, common and internal carotid wall thickness, and the presence of atrial fibrillation were associated with an increased risk of strokes in those with silent infarcts (n = 53 strokes). Conclusion: The presence of silent cerebral infarcts on MRI is an independent predictor of the risk of symptomatic stroke over a 4-year follow-up in older individuals without a clinical history of stroke.