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

Abstract

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.

Keywords

• Brain ischemia
• coronary angiography
• coronary artery disease
• magnetic resonance imaging
• stroke

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

Abstract

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.

Keywords

• Beyin iskemisi
• koroner anjiyografi
• koroner arter hastalığı
• manyetik rezonans görüntüleme
• inme

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