In this cross-sectional study, we tested the construct validity of a “total SVD score,” which combines individual MRI features of small-vessel disease (SVD) in one measure, by testing associations with vascular risk factors and stroke subtype.
We analyzed data from patients with lacunar or nondisabling cortical stroke from 2 prospective stroke studies. Brain MRI was rated for the presence of lacunes, white matter hyperintensities, cerebral microbleeds, and perivascular spaces independently. The presence of each SVD feature was summed in an ordinal “SVD score” (range 0–4). We tested associations with vascular risk factors, stroke subtype, and cerebral atrophy using ordinal regression analysis.
In 461 patients, multivariable analysis found that age (odds ratio [OR] 1.10, 95% confidence interval [CI] 1.08–1.12), male sex (OR 1.58, 95% CI 1.10–2.29), hypertension (OR 1.50, 95% CI 1.02–2.20), smoking (OR 2.81, 95% CI 1.59–3.63), and lacunar stroke subtype (OR 2.45, 95% CI 1.70–3.54) were significantly and independently associated with the total SVD score. The score was not associated with cerebral atrophy.
The total SVD score may provide a more complete estimate of the full impact of SVD on the brain, in a simple and pragmatic way. It could have potential for patient or risk stratification or early efficacy assessment in clinical trials of interventions to prevent SVD progression and may (after further testing) have a useful role in clinical practice.
Travel funding to speak at Royal College of Radiologists meeting in London, UK on MRI in stroke.
Wellcome Trust Clinical Research Training Fellowship 2005 � 2008 (�173,228) �Can retinal microvascular abnormalities shed light on the pathophysiology of lacunar stroke?� Medical Research Council Centenary Early Career Research Award 2012 (�19,981) �Establishment of novel techniques to measure vascular reactivity in cerebral small vessel disease�
(1) Stroke 2008-2009 - Editorial Board; (2) Cerebrovascular diseases 2009 - Editorial Board
Covidien, provided materials for an RCT of which I am a PI from 2001-present
(1) MRC (UK)Ref No: G0200531 2003-9; (2) CSO (Scotland)CZG\2\378 2008-9; (3) NIHR (UK) 08/14/03 2010-2014
(1) CHSS Res07/A108 2007-9; (2) TSA (UK) 20111 2012-2014
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