The Predictive Value of Neuroimaging-based Risk Evaluation Model on the Prognosis of Cerebral Infarction Patients with Transient Symptoms

doi:10.3969/j.issn.1673-5765.2022.03.010

Abstract

Abstract: Objective To assess the predictive value of the comprehensive stroke recurrence (CSR) model, an imaging-based risk score, for short-term and long-term stroke risk in cerebral infarction patients with transient symptoms, and the predictive ability between this model and clinical scores was compared. Methods This study enrolled the cerebral infarction patients with transient symptoms from the TIA database of the First Affiliated Hospital of Zhengzhou University. The baseline information were collected and ABCD2 score, Essen Stroke Risk Score (ESRS) and CSR score(based on head MRI) were calculated in the patients. The outcome was ischemic stroke at 7 days and 1 year. The ROC curve was performed to compare the predictive value of the three scores. Results A total of 441 eligible patients were enrolled in this study, with an average age of 57.5±11.9 years and 153 females (34.7%). The CSR score (AUC 0.688, 95%CI 0.642-0.731) was superior in predicting 1-year stroke risk than ABCD2 score (AUC 0.579, 95%CI 0.531-0.625, P =0.014) and ESRS (AUC 0.580, 95%CI 0.532-0.626, P =0.011). Conclusions CSR score had a higher predictive value for predicting the long-term risk of ischemic stroke, compared with the clinical risk factor-based scores such as ESRS and ABCD2 score.

Key words: Transient ischemic stroke; Transient symptoms with infarction; Ischemic stroke;ABCD2 score; Comprehensive stroke recurrence model; Essen stroke risk score; Prediction

摘要：

目的评估基于神经影像特征的综合卒中复发模型（comprehensive stroke recurrence model，CSR）在短暂症状伴梗死（transient symptoms with infarction，TSI）人群中预测短期和长期卒中风险的能力，并与基于临床危险因素的卒中风险预测评分进行比较。

方法本研究数据来源于郑州大学第一附属医院的TIA数据库。收集数据库中TS（I MRI DWI序列显示弥散受限）患者的基线特征，评定ABCD2评分和Essen卒中风险评分（Essen stroke risk score，ESRS），根据患者入院后头颅MRI结果进行CSR评分。于TSI后7 d、1年进行随访，终点事件为缺血性卒中。绘制ABCD2、ESRS和CSR评分预测缺血性卒中的ROC曲线，计算不同评分的AUC并进行比较。

结果研究共纳入符合入组和排除标准的TSI患者441例，平均57.5±11.9岁，女性153例（34.7%）。 CSR评分（AUC 0.688，95%CI 0.642～0.731）对TSI后1年卒中风险的预测价值高于ABCD2评分（AUC 0.579，95%CI 0.531～0.625，P =0.014）和ESRS（AUC 0.580，95%CI 0.532～0.626，P =0.011）。

结论与基于临床危险因素的评分如ABCD2、ESRS相比，CSR评分对TSI患者的长期缺血性卒中风险具有更好的预测价值。

关键词: 短暂性脑缺血发作; 短暂症状伴梗死; 缺血性卒中; ABCD2评分; 综合卒中复发模型; Essen卒中风险评分; 预测

CAO Shuang, ZHAO Lu, PEI Lulu, YANG Shuxiang, GAO Yuan, FANG Hui, SUN Shilei, WU Jun, SONG Bo, XU Yuming. The Predictive Value of Neuroimaging-based Risk Evaluation Model on the Prognosis of Cerebral Infarction Patients with Transient Symptoms[J]. Chinese Journal of Stroke, 2022, 17(03): 278-284.

曹爽, 赵璐, 裴璐璐, 杨书祥, 高远, 方慧, 孙石磊, 吴军, 宋波, 许予明. 神经影像模型对短暂症状伴梗死患者预后的预测作用研究[J]. 中国卒中杂志, 2022, 17(03): 278-284.

References

[1] AMARENCO P. Transient ischemic attack[J]. N Engl J Med，2020，382（20）：1933-1941.
[2] LIOUTAS V，IVAN C S，HIMALI J J，et al. Incidence of transient ischemic attack and association with long-term risk of stroke[J]. JAMA，2021，325（4）：373-381.
[3] SHAHJOUEI S，SADIGHI A，CHAUDHARY D，et al. A 5-decade analysis of incidence trends of ischemic stroke after transient ischemic attack：a systematic review and meta-analysis[J]. JAMA Neurol，2021，78（1）：77-87.
[4] KELLY P J，ALBERS G W，CHATZIKONSTANTINOU A，et al. Validation and comparison of imaging-based scores for prediction of early stroke risk after transient ischaemic attack：a pooled analysis of individual-patient data from cohort studies[J]. Lancet Neurol，2016，15（12）：1238-1247.
[5] 中华医学会神经病学分会，中华医学会神经病学分会脑血管病学组. 中国缺血性脑卒中和短暂性脑缺血发作二级预防指南2014[J]. 中华神经科杂志，2015，48（4）：258-273.
[6] AMARENCO P，LAVALLéE P C，LABREUCHE J， et al. One-year risk of stroke after transient ischemic attack or minor stroke[J]. N Engl J Med，2016，374（16）：1533-1542.
[7] J ING J，MENG X，ZHAO X Q，et al. Dual antiplatelet therapy in transient ischemic attack and minor stroke with different infarction patterns：subgroup analysis of the chance randomized clinical trial[J]. JAMA Neurol，2018，75（6）：711-719.
[8] YUAN J L，JIA Z J，SONG YG，et al. Incidence and predictors of acute ischemic lesions on brain magnetic resonance imaging in patients with a clinical diagnosis of transient ischemic attack in China[J/OL]. Front Neurol，2019，10：764[2021-10-29]. https://doi.org/10.3389/fneur.2019.00764.
[9] MAYER L，FERRARI J，KREBS S，et al. ABCD3-I score and the risk of early or 3-month stroke recurrence in tissue- and time-based definitions of TIA and minor stroke[J]. J Neurol，2018，265（3）：530-534.
[10] DAI Q L，SUN W，XIONG Y，Y et al. From clinical to tissue-based dual TIA：validation and refinement of ABCD3-I score[J]. Neurology，2015，84（14）：1426-1432.
[11] AY H，KOROSHETZ W J，BENNER T，et al. Transient ischemic attack with infarction：a unique syndrome?[J]. Ann Neurol，2005，57（5）：679-686.
[12] NAM K W，KWON H M，LIM J S，et al. Clinical relevance of abnormal neuroimaging findings and long-term risk of stroke recurrence[J]. Eur J Neurol，2017，24（11）：1348-1354.
[13] SONG B，FANG H，ZHAO L，et al. Validation of the ABCD3-I score to predict stroke risk after transient ischemic attack[J]. Stroke，2013，44（5）：1244-1248.

[14] SONG B，CAO Y，PEI L L，et al. Efficacy of high intensity statin use for transient ischemic attack patients with positive diffusion-weighted imaging[J/OL]. Sci Rep，2019，9（1）：1173[2021-10-29]. https://doi.org/10.1038/s41598-018-36986-w.

[15] ARSAVA E M，FURIE K L，SCHWAMM L H，et al. Prediction of early stroke risk in transient symptoms with infarction：relevance to the new tissue-based definition[J]. Stroke，2011，42（8）：2186-2190.
[16] WHO Monica project pr incipal investigators. The World Health Organization Monica project（monitoring trends and determinants in cardiovascular disease）：a major international collaboration[J]. J Clin Epidemiol，1988，41（2）：105-114.
[17] CAPRIE steering committee. A randomised，blinded，trial of clopidogrel versus aspirin in patients at risk of ischaemic events（CAPRIE）[J]. Lancet，1996，348（9038）：1329-1339.
[18] BRAZZELLI M，CHAPPELL F M，MIRANDA H，et al. Diffusion-weighted imaging and diagnosis of transient ischemic attack[J]. Ann Neurol，2014，75（1）：67-76.
[19] KONO Y，SHIMOYAMA T，SENGOKU R，et al. Clinical characteristics associated with abnormal diffusion-weighted images in patients with transient cerebral ischemic attack[J]. J Stroke Cerebrovasc Dis，2014，23（5）：1051-1055.
[20] CHAUDHARY D，ABEDI V，LI J，et al. Clinical risk score for predicting recurrence following a cerebral ischemic event[J/OL]. Front Neurol，2019，10：1106[2021-10-29]. ht tps://doi.org/10.3389/fneur.2019.01106.
[21] KIYOHARA T，KAMOUCHI M，KUMAI Y，et al. ABCD3 and ABCD3-I scores are superior to ABCD2 score in the prediction of short- and long-term risks of stroke after transient ischemic attack[J]. Stroke，2014，45（2）：418-425.
[22] SHEEHAN O C，MERWICK A，KELLY L，et al. Diagnostic usefulness of the ABCD2 score to distinguish transient ischemic attack and minor ischemic stroke from noncerebrovascular events：the north Dublin TIA study[J]. Stroke，2009，40（11）：3449-3454.
[23] GILES M F，ALBERS G W，AMARENCO P，et al. Early stroke risk and ABCD2 score performance in tissue- vs time-defined TIA：a multicenter study[J]. Neurology，2011，77（13）：1222-1228.
[24] FITZEK S，LEISTRITZ L，WITTE O W，et al. The Essen stroke risk score in one-year follow-up acute ischemic stroke patients[J]. Cerebrovasc Dis，2011，31（4）：400-407.
[25] MENG X，WANG Y L，ZHAO X Q，et al. Validation of the Essen stroke risk score and the stroke prognosis instrument Ⅱ in Chinese patients[J]. Stroke，2011，42（12）：3619-3620.
[26] PRABHAKARAN S，CHONG J Y，SCCO R L. Impact of abnormal diffusion-weighted imaging results on short-term outcome following transient ischemic attack[J]. Arch Neurol，2007，64（8）：1105-1109.
[27] AY H，GUNGOR L，ARSAVA E M，et al. A score to predict early risk of recurrence after ischemic stroke[J]. Neurology，2010，74（2）：128-135.
[28] LEE D K，KIM J S，KWON S U，et al. Lesion patterns and stroke mechanism in atherosclerotic middle cerebral artery disease：early diffusionweighted imaging study[J]. Stroke，2005，36（12）：2583-2588.
[29] WANG G Y，JING J，PAN Y S，et al. Does all single infarction have lower risk of stroke recurrence than multiple infarctions in minor stroke?[J/OL]. BMC Neurol，2019，19（1）：7[2021-10-29]. https://doi.org/10.1186/s12883-018-1215-0.
[30] PARK J，HEO S，LEE M，et al. White matter hyperintensities and recurrent stroke risk in patients with stroke with small-vessel disease[J]. Eur J Neurol，2019，26（6）：911-918.
[31] LI J F，OGBOLE G，ARI BISALA B，et al . Association between white matter hyperintensities and stroke in a west African patient population：evidence from the stroke investigative research and educational network study[J/OL]. Neuroimage，2020，215：116789[2021-10-29]. https://doi.org/10.1016/j.neuroimage.2020.116789.
[32] XU Y Y，ZONG L X，ZHANG C Q，et al. The association of white matter hyperintensities with stroke outcomes and antiplatelet therapy in minor stroke patients[J]. Ann Transl Med，2020，8（6）：331.
[33] VALDÉS HERNÁNDEZ M D C，GRIMSLEYMOORE T，SAKKA E，et al. Lacunar stroke lesion extent and location and white matter hyperintensities evolution 1 year post-lacunar stroke[J/OL]. Front Neurol，2021，12：640498[2021-10-29]. https://doi.org/10.3389/fneur.2021.640498.
[34] SONG B，PEI L L，FANG H，et al. Validation of the RRE-90 scale to predict stroke risk after transient symptoms with infarction：a prospective cohor t study[J/OL]. PLoS One，2015，10（9）：e0137425[2021-10-29]. https://doi.org/10.1371/journal.pone.0137425.