In:
Cerebrovascular Diseases, S. Karger AG, Vol. 49, No. 4 ( 2020), p. 427-436
Kurzfassung:
〈 b 〉 〈 i 〉 Background and Purpose: 〈 /i 〉 〈 /b 〉 The influence of specific brain lesions on health-related quality of life (HRQoL) after acute ischemic stroke (AIS) is uncertain. We aimed to identify imaging predictors of poor HRQoL in alteplase-treated participants of the alteplase dose arm of the Enhanced Control of Hypertension and Thrombolysis Stroke Study (ENCHANTED). 〈 b 〉 〈 i 〉 Methods: 〈 /i 〉 〈 /b 〉 ENCHANTED was an international trial of low- versus standard-dose intravenous alteplase in AIS patients, with functional outcome (modified Rankin scale [mRS]) and HRQoL on the 5-dimension European Quality of Life Scale (EQ-5D) assessed at 90 days post-randomization. Brain images were analyzed centrally by trained assessors. Multivariable logistic regression was undertaken in the study population randomly divided (2:1) into training (development) and validation (performance) groups, with age (per 10-year increase), ethnicity, baseline National Institutes of Health Stroke Scale (NIHSS) score, diabetes mellitus, premorbid function (mRS score 0 or 1), and proxy respondent, forced into all models. Data are presented with odds ratios (ORs) and 95% confidence intervals (CIs). 〈 b 〉 〈 i 〉 Results: 〈 /i 〉 〈 /b 〉 Eight prediction models were developed and validated in 2,526 AIS patients (median age 67.5 years; 38.4% female; 61.7% Asian) with complete brain imaging and 90-day EQ-5D utility score data. The best performance model included acute ischemic changes in the right (OR 1.69, 95% CI: 1.24–2.29) and deep (OR 1.50, 95% CI: 1.03–2.19) middle cerebral artery (MCA) regions. Several background features of brain frailty – atrophy, white matter change, and old infarcts – were significantly associated with adverse physical but not emotional HRQoL domains. 〈 b 〉 〈 i 〉 Conclusions: 〈 /i 〉 〈 /b 〉 In thrombolysed AIS patients, right-sided and deep ischemia within the MCA territory predict poor overall HRQoL, whilst features of old cerebral ischemia are associated with reduced physical HRQoL.
Materialart:
Online-Ressource
ISSN:
1015-9770
,
1421-9786
Sprache:
Englisch
Verlag:
S. Karger AG
Publikationsdatum:
2020
ZDB Id:
1482069-9
