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Cranial Magnetic Resonance Imaging as a Screening Tool for Evaluation of Silent Brain Ischemia in Severe Coronary Artery Disease: A Clinical Based Study

Yıl 2020, Cilt: 22 Sayı: 3, 201 - 206, 30.12.2020
https://doi.org/10.18678/dtfd.763145

Öz

Aim: Silent brain ischemia (SBI), defined as ischemic changes and infarcts without neurologic signs, is an established marker of poor survival. Magnetic resonance imaging (MRI) is useful to define SBI and white matter hyperintensities that correspond to microangipathic ischemic disease. This study aimed to investigate the relationship among SBI, white matter lesions and the extent of coronary artery disease (CAD), and to determine possible predictors of SBI.
Material and Methods: A total 10640 patients who underwent coronary angiography were retrospectively screened to reveal 312 patients who had been evaluated with a subsequent cranial MRI within 6 months. CAD severity was established with Gensini score and MRIs were evaluated to determine presence of SBI and white matter hyperintensities scored by Fazekas. Finally, 58 patients with SBI and 254 without SBI consisted SBI and non-SBI groups.
Results: Patients with SBI were significantly older with higher prevalence of male gender than the non-SBI patients. Both Gensini and Fazekas scores were higher in SBI-group (p<0.001). Fazekas score was positively correlated with Gensini score (r=0.219, p<0.001) and age (r=0.465, p<0.001). In the logistic regression analysis; age, male gender and Gensini score were identified as the independent predictors of SBI.
Conclusion: Although SBIs don’t present neurological symptoms they are associated with poor survival and future stroke. Our data suggest that cranial MRI may be a screening tool in risk stratification, particularly in elderly male patients with multivessel CAD. Our study also depicted that age, male gender and high Gensini scores are the independent predictors of SBI.

Kaynakça

  • Fisher CM. Lacunes: small, deep cerebral infarcts. Neurology. 1965;15:774-84.
  • Vermeer SE, Longstreth WT Jr, Koudstaal PJ. Silent brain infarcts: a systematic review. Lancet Neurol. 2007;6(7):611-9.
  • Kwon HM, Kim BJ, Lee SH, Choi SH, Oh BH, Yoon BW. Metabolic syndrome as an independent risk factor of silent brain infarction in healthy people. Stroke. 2006;37(2):466-70.
  • Fanning JP, Wong AA, Fraser JF. The epidemiology of silent brain infarction: a systematic review of population-based cohorts. BMC Med. 2014;12:119.
  • Bokura H, Kobayashi S, Yamaguchi S, Iijima K, Nagai A, Toyoda G, et al. Silent brain infarction and subcortical white matter lesions increase the risk of stroke and mortality: a prospective cohort study. J Stroke Cerebrovasc Dis. 2006;15(2):57-63.
  • Fanning JP, Wesley AJ, Wong AA, Fraser JF. Emerging spectra of silent brain infarction. Stroke. 2014;45(11):3461-71.
  • Longstreth WT Jr, Dulberg C, Manolio TA, Lewis MR, Beauchamp NJ Jr, O’Leary D, et al. Incidence, manifestations, and predictors of brain infarcts defined by serial cranial magnetic resonance imaging in the elderly: the cardiovascular health study. Stroke. 2002;33(10):2376-82.
  • Zhu YC, Dufouil C, TzourioC, Chabriat H. Silent brain infarcts: a review of MRI diagnostic criteria. Stroke. 2011;42(4):1140-5.
  • Pardo PJM, Labrador Fuster T, Torres Nuez J. Silent brain infarctions in patients with coronary heart disease. A Spanish population survey. J Neurol. 1998;245(2):93-7.
  • Sullivan DR, Marwick TH, Freedman SB. A new method of scoring coronary angiograms to reflect extent of coronary atherosclerosis and improve correlation with major risk factors. Am Heart J. 1990;119(6):1262-7.
  • Gupta A, Giambrone AE, Gialdini G, Finn C, Delgado D, Gutierrez J, et al. Silent brain infarction and risk of future stroke: a systematic review and meta-analysis. Stroke. 2016;47(3):719-25.
  • Fazekas F, Chawluk JB, Alavi A, Hurtig HI, Zimmerman RA. MR signal abnormalities at 1.5 T in Alzheimer's dementia and normal aging. AJR Am J Roentgenol.1987;149(2):351-6.
  • Tanaka H, Sueyoshi K, Nishino M, Ishida M, Fukunaga R, Abe H. Silent brain infarction and coronary artery disease in Japanese patients. Arch Neurol. 1993;50(7):706-9.
  • Uehara T, Tabuchi M, Mori E. Risk factors for silent cerebral infarcts in subcortical white matter and basal ganglia. Stroke. 1999;30(2):378-82.
  • Hermann DM, Gronewold J, Lehmann N, Moebus S, Jöckel KH, Bauer M, et al. Coronary artery calcification is an independent stroke predictor in the general population. Stroke.2013;44(4):1008-13.
  • Durakoğlu Z, Öner İ, Kılıç B, Seber SK, Yurtsever H. lmpaired glucose tolerance and aherosclerosis. Sisli Etfal Hastan Tip Bul. 1996;30(3):28-32.
  • Vermeer SE, Den Heijer T, Koudstaal PJ, Oudkerk M, Hofman A, Breteller MM, et al. Incidence and risk factors of silent brain infarcts in the population-based Rotterdam Scan Study. Stroke. 2003;34(2):392-6.
  • Feng C, Bai X, Xu Y, Hua T, Liu XY. The 'silence' of silent brain infarctions may be related to chronic ischemic preconditioning and nonstrategic locations rather than to a small infarction size. Clinics (Sao Paulo). 2013;68(3):365-9.
  • Badrin S, Mohamad N, Yunus NA, Zulkifli MM. A brief psychotic episode with depressive symptoms in silent right frontal lobe infarct. Korean J Fam Med. 2017;38(6):380-2.
  • Pantoni L. Pathophysiology of age-related cerebral white matter changes. Cerebrovasc Dis. 2002;13(Suppl 2):7-10.
  • Xiong YY, Mok V. Age-related white matter changes. J Aging Res. 2011;2011:617927.
  • Zhang C, Wang Y, Zhao X, Wang C, Liu L, Pu Y, et al. Factors associated with severity of leukoaraiosis in first-ever lacunar stroke and atherosclerotic ischemic stroke patients. J Stroke Cerebrovasc Dis. 2014;23(10):2862-8.
  • Chen X, Wen W, Anstey KJ, Sachdev PS. Prevalence, incidence, and risk factors of lacunar infarcts in a community sample. Neurology. 2009;73(4):266-72.
  • Lee SC, Park SJ, Ki HK, Gwon HC, Chung CS, Byun HS, et al. Prevalence and risk factors of silent cerebral infarction in apparently normal adults. Hypertension. 2000;36(1):73-7.
  • Hoshide S, Kario K, Mitsuhashi T, Sato Y, Umeda Y, Katsuki T, et al. Different patterns of silent cerebral infarct in patients with coronary artery disease or hypertension. Am J Hypertens. 2001;14(6 Pt 1):509-15.
  • Kwee RM, Kwee TC. Virchow-Robin spaces at MR imaging. Radiographics. 2007;27(4):1071-86.
  • Cho AH, Kim HR, Kim W, Yang DW. White matter hyperintensity in ischemic stroke patients: it may regress over time. J Stroke. 2015;17(1):60-6.

Ciddi Koroner Arter Hastalığında Sessiz Beyin İskemisini Değerlendirmede Tarama Aracı Olarak Kranial Manyetik Rezonans Görüntüleme: Klinik Tabanlı Bir Çalışma

Yıl 2020, Cilt: 22 Sayı: 3, 201 - 206, 30.12.2020
https://doi.org/10.18678/dtfd.763145

Öz

Amaç: Nörolojik bulgu göstermeyen iskemik değişiklikler ve enfarktlar olarak tanımlanan sessiz beyin iskemisi (SBI), kötü sağ kalımın bilinen bir göstergesidir. Manyetik rezonans görüntüleme (MRG), SBI ve mikroanjiopatik iskemik hastalığa karşılık gelen beyaz madde hiperintensitelerini göstermede yararlı bir yöntemdir. Bu çalışmada SBI, beyaz madde lezyonları ile koroner arter hastalığı (KAH) arasındaki ilişkiyi araştırmak ve SBI'nın olası belirleyicilerini belirlemek amaçlanmıştır.
Gereç ve Yöntemler: Koroner anjiyografi yapılan toplam 10640 hasta retrospektif olarak taranarak 6 ay içerisinde müteakip olarak kranial MRG ile değerlendirilmiş 312 hasta belirlendi. KAH ciddiyeti Gensini skoru ile tespit edildi ve MRG’ler SBI varlığı ile Fazekas skoru ile ölçülen beyaz madde hiperintensiteleri açısından değerlendirildi. Bunun sonucunda SBI olan 58 ve SBI olmayan 254 hasta, SBI ve SBI olmayan hasta gruplarını oluşturdu.
Bulgular: SBI olan hastalar, SBI olmayan hastalardan anlamlı şekilde daha yaşlı ve daha yüksek prevalansta erkek cinsiyette idi. SBI grubunda hem Gensini hem de Fazekas skorları daha yüksekti (p<0.001). Fazekas skoru, Gensini skoru (r=0,219; p<0,001) ve yaş (r=0,465; p<0,001) ile pozitif korelasyonlu idi. Lojistik regresyon analizinde; yaş, erkek cinsiyet ve Gensini skoru, SBI’nın bağımsız belirteçleri olarak belirlendi.
Sonuç: SBI nörolojik semptom göstermese de, kötü sağ kalım ve ileride yaşanacak inme ile ilişkilidir. Bulgularımız, kranial MRG’nin özellikle çoklu damar KAH olan yaşlı erkeklerde risk değerlendirmesi için bir tarama aracı olabileceğini göstermektedir. Çalışmamız ayrıca yaş, erkek cinsiyet ve yüksek Gensini skorunun SBI’nın bağımsız belirteçleri olduğunu göstermiştir.

Kaynakça

  • Fisher CM. Lacunes: small, deep cerebral infarcts. Neurology. 1965;15:774-84.
  • Vermeer SE, Longstreth WT Jr, Koudstaal PJ. Silent brain infarcts: a systematic review. Lancet Neurol. 2007;6(7):611-9.
  • Kwon HM, Kim BJ, Lee SH, Choi SH, Oh BH, Yoon BW. Metabolic syndrome as an independent risk factor of silent brain infarction in healthy people. Stroke. 2006;37(2):466-70.
  • Fanning JP, Wong AA, Fraser JF. The epidemiology of silent brain infarction: a systematic review of population-based cohorts. BMC Med. 2014;12:119.
  • Bokura H, Kobayashi S, Yamaguchi S, Iijima K, Nagai A, Toyoda G, et al. Silent brain infarction and subcortical white matter lesions increase the risk of stroke and mortality: a prospective cohort study. J Stroke Cerebrovasc Dis. 2006;15(2):57-63.
  • Fanning JP, Wesley AJ, Wong AA, Fraser JF. Emerging spectra of silent brain infarction. Stroke. 2014;45(11):3461-71.
  • Longstreth WT Jr, Dulberg C, Manolio TA, Lewis MR, Beauchamp NJ Jr, O’Leary D, et al. Incidence, manifestations, and predictors of brain infarcts defined by serial cranial magnetic resonance imaging in the elderly: the cardiovascular health study. Stroke. 2002;33(10):2376-82.
  • Zhu YC, Dufouil C, TzourioC, Chabriat H. Silent brain infarcts: a review of MRI diagnostic criteria. Stroke. 2011;42(4):1140-5.
  • Pardo PJM, Labrador Fuster T, Torres Nuez J. Silent brain infarctions in patients with coronary heart disease. A Spanish population survey. J Neurol. 1998;245(2):93-7.
  • Sullivan DR, Marwick TH, Freedman SB. A new method of scoring coronary angiograms to reflect extent of coronary atherosclerosis and improve correlation with major risk factors. Am Heart J. 1990;119(6):1262-7.
  • Gupta A, Giambrone AE, Gialdini G, Finn C, Delgado D, Gutierrez J, et al. Silent brain infarction and risk of future stroke: a systematic review and meta-analysis. Stroke. 2016;47(3):719-25.
  • Fazekas F, Chawluk JB, Alavi A, Hurtig HI, Zimmerman RA. MR signal abnormalities at 1.5 T in Alzheimer's dementia and normal aging. AJR Am J Roentgenol.1987;149(2):351-6.
  • Tanaka H, Sueyoshi K, Nishino M, Ishida M, Fukunaga R, Abe H. Silent brain infarction and coronary artery disease in Japanese patients. Arch Neurol. 1993;50(7):706-9.
  • Uehara T, Tabuchi M, Mori E. Risk factors for silent cerebral infarcts in subcortical white matter and basal ganglia. Stroke. 1999;30(2):378-82.
  • Hermann DM, Gronewold J, Lehmann N, Moebus S, Jöckel KH, Bauer M, et al. Coronary artery calcification is an independent stroke predictor in the general population. Stroke.2013;44(4):1008-13.
  • Durakoğlu Z, Öner İ, Kılıç B, Seber SK, Yurtsever H. lmpaired glucose tolerance and aherosclerosis. Sisli Etfal Hastan Tip Bul. 1996;30(3):28-32.
  • Vermeer SE, Den Heijer T, Koudstaal PJ, Oudkerk M, Hofman A, Breteller MM, et al. Incidence and risk factors of silent brain infarcts in the population-based Rotterdam Scan Study. Stroke. 2003;34(2):392-6.
  • Feng C, Bai X, Xu Y, Hua T, Liu XY. The 'silence' of silent brain infarctions may be related to chronic ischemic preconditioning and nonstrategic locations rather than to a small infarction size. Clinics (Sao Paulo). 2013;68(3):365-9.
  • Badrin S, Mohamad N, Yunus NA, Zulkifli MM. A brief psychotic episode with depressive symptoms in silent right frontal lobe infarct. Korean J Fam Med. 2017;38(6):380-2.
  • Pantoni L. Pathophysiology of age-related cerebral white matter changes. Cerebrovasc Dis. 2002;13(Suppl 2):7-10.
  • Xiong YY, Mok V. Age-related white matter changes. J Aging Res. 2011;2011:617927.
  • Zhang C, Wang Y, Zhao X, Wang C, Liu L, Pu Y, et al. Factors associated with severity of leukoaraiosis in first-ever lacunar stroke and atherosclerotic ischemic stroke patients. J Stroke Cerebrovasc Dis. 2014;23(10):2862-8.
  • Chen X, Wen W, Anstey KJ, Sachdev PS. Prevalence, incidence, and risk factors of lacunar infarcts in a community sample. Neurology. 2009;73(4):266-72.
  • Lee SC, Park SJ, Ki HK, Gwon HC, Chung CS, Byun HS, et al. Prevalence and risk factors of silent cerebral infarction in apparently normal adults. Hypertension. 2000;36(1):73-7.
  • Hoshide S, Kario K, Mitsuhashi T, Sato Y, Umeda Y, Katsuki T, et al. Different patterns of silent cerebral infarct in patients with coronary artery disease or hypertension. Am J Hypertens. 2001;14(6 Pt 1):509-15.
  • Kwee RM, Kwee TC. Virchow-Robin spaces at MR imaging. Radiographics. 2007;27(4):1071-86.
  • Cho AH, Kim HR, Kim W, Yang DW. White matter hyperintensity in ischemic stroke patients: it may regress over time. J Stroke. 2015;17(1):60-6.
Toplam 27 adet kaynakça vardır.

Ayrıntılar

Birincil Dil İngilizce
Konular Klinik Tıp Bilimleri
Bölüm Araştırma Makalesi
Yazarlar

Tuğba İlkem Kurtoğlu Özçağlayan 0000-0003-3849-1194

Demet Özkaramanlı Gür 0000-0003-2542-8196

Ömer Özçağlayan 0000-0001-5036-4919

Birol Topcu 0000-0003-0771-2505

Aysun Ünal 0000-0002-7702-8437

Yayımlanma Tarihi 30 Aralık 2020
Gönderilme Tarihi 6 Temmuz 2020
Yayımlandığı Sayı Yıl 2020 Cilt: 22 Sayı: 3

Kaynak Göster

APA Kurtoğlu Özçağlayan, T. İ., Özkaramanlı Gür, D., Özçağlayan, Ö., Topcu, B., vd. (2020). Cranial Magnetic Resonance Imaging as a Screening Tool for Evaluation of Silent Brain Ischemia in Severe Coronary Artery Disease: A Clinical Based Study. Duzce Medical Journal, 22(3), 201-206. https://doi.org/10.18678/dtfd.763145
AMA Kurtoğlu Özçağlayan Tİ, Özkaramanlı Gür D, Özçağlayan Ö, Topcu B, Ünal A. Cranial Magnetic Resonance Imaging as a Screening Tool for Evaluation of Silent Brain Ischemia in Severe Coronary Artery Disease: A Clinical Based Study. Duzce Med J. Aralık 2020;22(3):201-206. doi:10.18678/dtfd.763145
Chicago Kurtoğlu Özçağlayan, Tuğba İlkem, Demet Özkaramanlı Gür, Ömer Özçağlayan, Birol Topcu, ve Aysun Ünal. “Cranial Magnetic Resonance Imaging As a Screening Tool for Evaluation of Silent Brain Ischemia in Severe Coronary Artery Disease: A Clinical Based Study”. Duzce Medical Journal 22, sy. 3 (Aralık 2020): 201-6. https://doi.org/10.18678/dtfd.763145.
EndNote Kurtoğlu Özçağlayan Tİ, Özkaramanlı Gür D, Özçağlayan Ö, Topcu B, Ünal A (01 Aralık 2020) Cranial Magnetic Resonance Imaging as a Screening Tool for Evaluation of Silent Brain Ischemia in Severe Coronary Artery Disease: A Clinical Based Study. Duzce Medical Journal 22 3 201–206.
IEEE T. İ. Kurtoğlu Özçağlayan, D. Özkaramanlı Gür, Ö. Özçağlayan, B. Topcu, ve A. Ünal, “Cranial Magnetic Resonance Imaging as a Screening Tool for Evaluation of Silent Brain Ischemia in Severe Coronary Artery Disease: A Clinical Based Study”, Duzce Med J, c. 22, sy. 3, ss. 201–206, 2020, doi: 10.18678/dtfd.763145.
ISNAD Kurtoğlu Özçağlayan, Tuğba İlkem vd. “Cranial Magnetic Resonance Imaging As a Screening Tool for Evaluation of Silent Brain Ischemia in Severe Coronary Artery Disease: A Clinical Based Study”. Duzce Medical Journal 22/3 (Aralık 2020), 201-206. https://doi.org/10.18678/dtfd.763145.
JAMA Kurtoğlu Özçağlayan Tİ, Özkaramanlı Gür D, Özçağlayan Ö, Topcu B, Ünal A. Cranial Magnetic Resonance Imaging as a Screening Tool for Evaluation of Silent Brain Ischemia in Severe Coronary Artery Disease: A Clinical Based Study. Duzce Med J. 2020;22:201–206.
MLA Kurtoğlu Özçağlayan, Tuğba İlkem vd. “Cranial Magnetic Resonance Imaging As a Screening Tool for Evaluation of Silent Brain Ischemia in Severe Coronary Artery Disease: A Clinical Based Study”. Duzce Medical Journal, c. 22, sy. 3, 2020, ss. 201-6, doi:10.18678/dtfd.763145.
Vancouver Kurtoğlu Özçağlayan Tİ, Özkaramanlı Gür D, Özçağlayan Ö, Topcu B, Ünal A. Cranial Magnetic Resonance Imaging as a Screening Tool for Evaluation of Silent Brain Ischemia in Severe Coronary Artery Disease: A Clinical Based Study. Duzce Med J. 2020;22(3):201-6.
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