Highlights
- •Patients who survive an ischemic stroke are at a high risk of recurrence within 1 years.
- •The risk factors of recurrent stroke play important roles in secondary prevention.
- •retinal image contains large amount of information for stroke risk estimation.
- •Determine significant clinical features and retinal characteristics for patients after the first episode of ischemic stroke.
- •Comparison of prediction models based on risk factors and retinal characteristics associated with recurrence one year after ischemic stroke.
Abstract
Objectives: To develop risk estimation models for 1-year ischemic stroke recurrence using clinical
risk factors and retinal characteristics. Methods: From June 2017 to January 2019, 332 patients with first-ever ischemic stroke were
enrolled and followed up in the Shenzhen Traditional Chinese Medicine hospital in
China. The primary endpoint was defined as fatal or recurrent stroke after 1 year
of the index stroke. Clinical risk factors and retinal characteristics were identified
by multivariate logistic models. Results: The multivariate logistic model with only clinical risk factors showed that Cerebral
Atherosclerosis (OR 1.68, 95%CI: 1.000-2.81), white matter lesions (OR 3.61, 95%CI:
2.18-5.98), and Cardiac disease (OR 1.88, 95%CI: 1.02-3.46) were statistically significantly
associated with higher stroke recurrence risk. The sensitivity and specificity of
this model were 69.1% and 68.4% respectively. The multivariate logistic model with
only retinal characteristics showed that central retinal venule equivalent (OR .34,
95%CI: .14-.83), hemorrhage (OR .6, 95%CI: .41-.88), exudate (OR 1.64, 95%CI: 1.16-2.32),
central retinal artery equivalent (OR 2.95, 95%CI: 1.23-7.08), and Aangle (OR 0.8,
95%CI: .61-1.004) were statistically significantly associated with stroke recurrence.
The sensitivity and specificity of the model were 62.0% and 64.4% respectively. The
multivariate logistic model with both clinical risk factors and retinal characteristics
showed that cerebral atherosclerosis (OR 1.74, 95%CI: 1.020-2.981), white matter lesions
(OR 3.65, 95%CI: 2.17-6.13), cardiac disease (OR 1.99, 95%CI: 1.06-3.74), hemorrhage
(OR .68, 95%CI: .49-.96), exudate (OR 1.65, 95%CI: 1.16-2.36) were independent risk
factors of stroke recurrence. The sensitivity and specificity of the model were 72.5%
and 70.7% respectively. Conclusions: Combining the traditional risk factors of stroke with the retinal vessels characteristics
to establish the recurrent cerebral infarction prediction model may improve the accuracy
of the prediction.
Key Words
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Article info
Publication history
Published online: January 13, 2020
Accepted:
November 26,
2019
Received in revised form:
October 30,
2019
Received:
September 24,
2019
Footnotes
Work was performed at Shenzhen Traditional Medicine hospital (clinical case collecting) and Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong (data analysis).
Grant Support: Supported by the National Natural Science Fund of China (81803952), the Shenzhen Municipal Science and Technology Bureau (JCYJ20170412174025934), Scientific Research Projects of Guangdong Traditional Chinese Medicine Bureau (20173013), Sanming Project of Medicine in Shenzhen (SZSM201612001) and the Technology and Business Development Fund of the Chinese University of Hong Kong (TBF17MED004).
Identification
DOI: https://doi.org/10.1016/j.jstrokecerebrovasdis.2019.104581
Copyright
Crown Copyright © 2019 Published by Elsevier Inc. All rights reserved.
