Retinal vessel multifractals predict pial collateral status in patients with acute ischemic stroke.
Retinal vessel multifractals predict pial collateral status in patients with acute ischemic stroke.
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DOI：
10.1371/journal.pone.0267837
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发表时间：
2022
期刊：
影响因子：
3.7
通讯作者：
中科院分区：
文献类型：
--
作者：
软脑膜侧支血流是急性缺血性卒中预后的主要决定因素。本研究旨在确定视网膜血管指标是否可以预测患者的软脑膜侧支循环状态和卒中结局。35例继发于大脑中动脉（MCA）闭塞的急性卒中患者接受了计算机断层扫描血管造影和视网膜眼底图像视网膜血管分析的软脑膜侧支状态分级。软脑膜侧支循环不良的患者入院时NIHSS（14.7 ± 5.5 vs 10.1 ± 5.8，p = 0.026）和mRS（2.9 ± 1.6 vs 1.9 ± 1.3，p = 0.048）评分高于软脑膜侧支循环良好的患者。视网膜血管多重分形：软脑膜侧支不良患者的D0（1.673± 0.028 vs1.652 ±0.025，p = 0.028）、D1（1.609± 0.027 vs1.590 ±0.025，p = 0.044）和f（α）max（1.674± 0.027 vs1.652 ±0.024，p = 0.019）高于软脑膜侧支良好患者。此外，支持向量机学习实现了公平的敏感性（0.743）和特异性（0.707）区分患者从良好的软脑膜侧支循环差。年龄（p = 0.702），BMI（p = 0.422），总胆固醇（p = 0.842），甘油三酯（p = 0.673），LDL（p = 0.952），HDL（p = 0.366），收缩压（p = 0.727），HbA1c（p = 0.261）和标准视网膜指标，包括CRAE（p = 0.084），CRVE（p = 0.946），AVR（p = 0.148），迂曲指数（p = 0.790），单分形Df（p = 0.576），腔隙性（p = 0.531）、曲线不对称（p = 0.679）和奇点长度（p = 0.937）在软脑膜侧支不良患者与软脑膜侧支良好患者之间没有差异。这是第一个翻译研究，以显示增加视网膜血管多重分形维数的急性缺血性中风和穷人软脑膜侧支。开发了视网膜血管分类器，以区分软脑膜侧支不良和良好的患者，并且可以快速非侵入性地识别软脑膜侧支不良的患者。
Pial collateral blood flow is a major determinant of the outcomes of acute ischemic stroke. This study was undertaken to determine whether retinal vessel metrics can predict the pial collateral status and stroke outcomes in patients. Thirty-five patients with acute stroke secondary to middle cerebral artery (MCA) occlusion underwent grading of their pial collateral status from computed tomography angiography and retinal vessel analysis from retinal fundus images. The NIHSS (14.7 ± 5.5 vs 10.1 ± 5.8, p = 0.026) and mRS (2.9 ± 1.6 vs 1.9 ± 1.3, p = 0.048) scores were higher at admission in patients with poor compared to good pial collaterals. Retinal vessel multifractals: D0 (1.673±0.028vs1.652±0.025, p = 0.028), D1 (1.609±0.027vs1.590±0.025, p = 0.044) and f(α)max (1.674±0.027vs1.652±0.024, p = 0.019) were higher in patients with poor compared to good pial collaterals. Furthermore, support vector machine learning achieved a fair sensitivity (0.743) and specificity (0.707) for differentiating patients with poor from good pial collaterals. Age (p = 0.702), BMI (p = 0.422), total cholesterol (p = 0.842), triglycerides (p = 0.673), LDL (p = 0.952), HDL (p = 0.366), systolic blood pressure (p = 0.727), HbA1c (p = 0.261) and standard retinal metrics including CRAE (p = 0.084), CRVE (p = 0.946), AVR (p = 0.148), tortuosity index (p = 0.790), monofractal Df (p = 0.576), lacunarity (p = 0.531), curve asymmetry (p = 0.679) and singularity length (p = 0.937) did not differ between patients with poor compared to good pial collaterals. This is the first translational study to show increased retinal vessel multifractal dimensions in patients with acute ischemic stroke and poor pial collaterals. A retinal vessel classifier was developed to differentiate between patients with poor and good pial collaterals and may allow rapid non-invasive identification of patients with poor pial collaterals.
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