Association of Left Ventricular Hypertrophy and Atrial Fibrillation with Hemorrhagic Evolution of Small Vessel Disease |
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| Authors: | Antonio Muscari Giovanni Masetti Luca Faccioli Marco Ghinelli Marco Pastore Trossello Giovanni M Puddu Luca Spinardi Marco Zoli |
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| Institution: | 1. Stroke Unit–Medical Department of Continuity of Care and Disability, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Italy;2. Department of Medical and Surgical Sciences, University of Bologna, Italy;3. Diagnostic and Interventional Neuroradiology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Italy;4. Department of Cardiothoracic and Vascular Medicine, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Italy;1. Center of Medical Research, Shijiazhuang People''s Hospital, Fangbei Road, Shijiazhuang, Hebei Province 050011, China;2. Department of Neurosurgery, Shijiazhuang People''s Hospital, Hebei, China;3. Department of oncology, Hebei General Hospital, Hebei, China;4. AECC Sichuan Gas Turbine Establishment, Sichuan, China;5. Department of Catheterization Room, Shijiazhuang People''s Hospital, Hebei, China;2. Division of Gerontology and Geriatric Medicine, Department of Medicine, University of Maryland School of Medicine, Baltimore, MD, United States;3. Department of Neurology, University of Maryland School of Medicine, Baltimore 21201, MD, United States;1. Department of Neurology, Neurological Institute, Cleveland Clinic, Cleveland, OH, United States;2. Department of Neurology, Cerebrovascular Center, Neurological Institute, Cleveland, OH, United States;3. Department of Pharmacy, Neurological Institute, Cleveland Clinic, Cleveland, OH, United States;1. Department of Neurology, Tsuchiura Kyodo General Hospital, Ibaraki, Japan;2. Department of Diagnostic Radiology and Nuclear Medicine, Tokyo Medical and Dental University, Tokyo, Japan;1. State Key Laboratory of Natural Medicines, Department of Physiology, School of Basic Medicine and Clinical Pharmacy, China Pharmaceutical University, Nanjing 210009, China;2. Mongolian University of Pharmaceutical Sciences, Ulaanbaatar 18130, Mongolia |
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| Abstract: | ObjectivesCerebral small vessel disease (SVD) is often associated with hypertension and may evolve towards intracerebral hemorrhage (ICH) or lacunar ischemic stroke. However, the factors favoring the evolution towards ICH or lacunar stroke are not well understood.Materials and MethodsThis retrospective study included 326 consecutive patients (71.1±13.2 years, 38% women): 143 with deep ICH and 183 with lacunar lesions (LL) <2 cm, which were visible in a deep location on brain CT scan. Among LL patients, 143 had a small-artery occlusion (SAO) stroke according to the TOAST classification. Clinical characteristics plus laboratory and neuroradiological variables of these patients had been prospectively collected and a subgroup underwent echocardiography.ResultsIn multivariate analysis, ICH patients (97% hypertensive), compared to SAO patients (89% hypertensive), had greater left ventricular wall thickness (LVWT; OR 4.15, 95%CI 1.64-10.53, for those with LVWT ≥ 1.4 cm, 70% of whom were hemorrhagic) and lower prevalence of white matter lesions (OR 0.30, 95%CI 0.13-0.70), ever smokers (OR 0.39, 95%CI 0.18–0.82) and diabetics (OR 0.29, 95% CI 0.10-0.84). Moreover, ICH patients had a greater prevalence of atrial fibrillation than LL patients (OR 3.14, 95%CI 1.11-8.93), and so they were more often anticoagulated.ConclusionsMost SVD patients were hypertensive, but those evolving towards ICH were characterized by organ damage at the cardiac level (increase in LVWT and atrial fibrillation), while those evolving towards lacunar stroke were characterized by a higher prevalence of smokers and diabetics, and by organ damage at the cerebral level (white matter lesions). |
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