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Brain Imaging Signs and Health-Related Quality of Life after Acute Ischemic Stroke: Analysis of ENCHANTED Alteplase Dose Arm.

journal contribution
posted on 28.09.2020, 11:24 by Xiaoying Chen, Candice Delcourt, Lingli Sun, Zien Zhou, Sohei Yoshimura, Shoujiang You, Alejandra Malavera, Takako Torii-Yoshimura, Cheryl Carcel, Hisatomi Arima, Maree L Hackett, Thompson Robinson, Lili Song, Xia Wang, Richard I Lindley, John Chalmers, Craig S Anderson, ENCHANTED Investigators
BACKGROUND AND PURPOSE: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). METHODS: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). RESULTS: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. CONCLUSIONS: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.

History

Citation

Cerebrovasc Dis 2020;49:427–436

Author affiliation

Department of Cardiovascular Sciences

Version

AM (Accepted Manuscript)

Published in

Cerebrovascular Diseases

Volume

49

Issue

4

Pagination

427–436

Publisher

Karger Publishers

issn

1015-9770

eissn

1421-9786

Acceptance date

07/06/2020

Copyright date

2020

Available date

22/07/2021

Spatial coverage

Switzerland

Language

eng