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J Neurol Neurosurg Psychiatry doi:10.1136/jnnp.2008.154104

Age-related white matter changes predict stroke death in long-term follow up

  1. Niku Oksala (niku.oksala{at}tuubi1.net)
  1. Division of Vascular Surgery, Finland
    1. Anni Oksala (anni.oksala{at}uta.fi)
    1. Tampere University, Finland
      1. Tarja Pohjasvaara (tarja.pohjasvaara{at}pp.inet.fi)
      1. Helsinki University Hospital, Finland
        1. Risto Vataja (risto.vataja{at}hus.fi)
        1. Helsinki University Hospital, Finland
          1. Markku Kaste (markku.kaste{at}hus.fi)
          1. Helsinki University Hospital, Finland
            1. Pekka Karhunen (pekka.karhunen{at}uta.fi)
            1. Tampere University, Finland
              1. Timo J Erkinjuntti (timo.erkinjuntti{at}hus.fi)
              1. Helsinki University Hospital, Finland
                • Published Online First 22 February 2009

                Abstract

                Objective: Recurrent strokes and functional decline are predicted by age related white matter changes (ARWMC). Whether they are associated with long term survival among hospital patients referred for acute stroke is not known.

                Methods: A total of 396 consecutive acute stroke patients subjected to magnetic resonance imaging were included in the study and followed-up up to 12 years.

                Results: Of the patients 28% had mild, 18% had moderate and 54% had severe ARWMCs. In Kaplan-Meier analysis, poor survival was predicted by severe ARWMCs (p<0.0001), cardiac failure (CF, p<0.0001), atrial fibrillation (AF, p<0.0001), other arrhythmias (p=0.003), peripheral arterial disease (PAD, p=0.004) and poor modified Rankin score (mRS) (p<0.0001). ARWMC was related to death by all brain related causes, especially ischemic stroke (p<0.0001). In stepwise Cox regression analysis adjusted with significant risk factors, severe ARWMCs (HR 1.34, 95%CI 1.03-1.73, p=0.029), age (HR 1.07, 95%CI 1.05-1.09, p<0.0001), CF (HR 1.59, 95%CI 1.17-2.15, p=0.003), AF (HR 1.68, 95%CI 1.24-2.27, p=0.001), PAD (HR 1.59, 95%CI 1.11-2.26, p=0.011), diabetes (HR 1.44, 95%CI 1.08-1.92), p=0.013), smoking (HR 1.60, 95%CI 1.23-2.08, p<0.0001), and mRS (HR 1.65, 95%CI 1.26-2.14, p<0.0001) were independently associated with death from all causes. Severe ARWMCs (HR 1.80, 95%CI 1.10-2.96, p=0.019), age (HR 1.05, 95%CI 1.01-1.09, p=0.009), AF (HR 1.82, 95%CI 1.08-3.07, p=0.026), PAD (HR 2.17, 95%CI 1.19-3.95, p=0.012) and mRS (HR 2.75, 95%CI 1.67-4.54, p<0.0001) were specifically associated with death from brain-related causes.

                Conclusions: In patients with acute stroke, ARWMC seems to be a significant predictor of poor long term survival and death by ischemic stroke.

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