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

Jul 27, 2020

Contributor: 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,

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

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).
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).
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.
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.

© 2020 S. Karger AG, Basel.

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About The Expert

Xiaoying Chen

The George Institute for Global Health, University of New South Wales, Camperdown, New South Wales, Australia.

Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia.

Candice Delcourt

The George Institute for Global Health, University of New South Wales, Camperdown, New South Wales, Australia.

Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia.

Neurology Department, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.

Lingli Sun

The George Institute China at Peking University Health Science Centre, Beijing, China.

Zien Zhou

The George Institute for Global Health, University of New South Wales, Camperdown, New South Wales, Australia.

Department of Radiology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.

Sohei Yoshimura

The George Institute for Global Health, University of New South Wales, Camperdown, New South Wales, Australia.

Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan.

Shoujiang You

Department of Neurology, The Second Affiliated Hospital of Soochow University, Suzhou, China.

Alejandra Malavera

The George Institute for Global Health, University of New South Wales, Camperdown, New South Wales, Australia.

Takako Torii-Yoshimura

The George Institute for Global Health, University of New South Wales, Camperdown, New South Wales, Australia.

Division of Neurology, Department of Stroke and Cerebrovascular Diseases, National Cerebral and Cardiovascular Center, Osaka, Japan.

Department of Neurology and Neuroscience, Nagoya City University Graduate School of Medical Science, Nagoya, Japan.

Cheryl Carcel

The George Institute for Global Health, University of New South Wales, Camperdown, New South Wales, Australia.

Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia.

Neurology Department, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.

Hisatomi Arima

Department of Preventive Medicine and Public Health, Fukuoka University, Fukuoka, Japan.

Maree L Hackett

The George Institute for Global Health, University of New South Wales, Camperdown, New South Wales, Australia.

Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia.

Faculty of Health and Wellbeing, University of Central Lancashire, Preston, United Kingdom.

Thompson Robinson

Department of Cardiovascular Sciences, University of Leicester, Leicester, United Kingdom.

NIHR Biomedical Research Centre, Leicester, United Kingdom.

Lili Song

The George Institute for Global Health, University of New South Wales, Camperdown, New South Wales, Australia.

Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia.

The George Institute China at Peking University Health Science Centre, Beijing, China.

Xia Wang

The George Institute for Global Health, University of New South Wales, Camperdown, New South Wales, Australia.

Richard I Lindley

Westmead Applied Research Centre, University of Sydney, Sydney, New South Wales, Australia.

John Chalmers

The George Institute for Global Health, University of New South Wales, Camperdown, New South Wales, Australia.

Craig S Anderson

The George Institute for Global Health, University of New South Wales, Camperdown, New South Wales, Australia, canderson@georgeinstitute.org.au.

Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia, canderson@georgeinstitute.org.au.

Neurology Department, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia, canderson@georgeinstitute.org.au.

The George Institute China at Peking University Health Science Centre, Beijing, China, canderson@georgeinstitute.org.au.

Heart Health Research Center, Beijing, China, canderson@georgeinstitute.org.au.

References

PubMed