August 06, 2019; 93 (6) Article
White matter hyperintensity load on stroke recurrence and mortality at 1 year after ischemic stroke
Wi-Sun Ryu, Dawid Schellingerhout, Keun-Sik Hong, Sang-Wuk Jeong, Min Uk Jang, Man-Seok Park, Kang-Ho Choi, Joon-Tae Kim, View ORCID ProfileBeom Joon Kim, Jun Lee, Jae-Kwan Cha, Dae-Hyun Kim, Hyun-Wook Nah, Soo Joo Lee, Jae Guk Kim, Yong-Jin Cho, Byung-Chul Lee, Kyung-Ho Yu, Mi Sun Oh, Jong-Moo Park, Kyusik Kang, Kyung Bok Lee, Tai Hwan Park, Sang-Soon Park, Juneyoung Lee, Hee-Joon Bae, Dong-Eog Kim
First published July 15, 2019, DOI: https://doi.org/10.1212/WNL.0000000000007896
Wi-Sun Ryu
From the Stroke Center and Korean Brain MRI Data Center (W.-S.R., S.-W.J., D.-E.K.), Dongguk University Ilsan Hospital, Goyang; Departments of Radiology and Cancer Systems Imaging (D.S.), University of Texas M.D. Anderson Cancer Center, Houston; Department of Neurology (K.-S.H., Y.-J.C.), Ilsan Paik Hospital, Inje University, Goyang; Department of Neurology (M.U.J.), Hallym University Dongtan Sacred Heart Hospital, Hwaseong; Department of Neurology (M.-S.P., K.-H.C., J.-T.K.), Chonnam National University Medical School, Chonnam National University Hospital, Gwangju; Department of Neurology (B.J.K., H.-J.B.), Seoul National University Bundang Hospital, Seongnam; Department of Neurology (Jun Lee), Yeungnam University Hospital, Daegu; Department of Neurology (J.-K.C., D.-H.K., H.-W.N.), Dong-A University Hospital, Busan; Department of Neurology (S.J.L., J.G.K.), Eulji University Hospital, Daejeon; Department of Neurology (B.-C.L., K.-H.Y., M.S.O.), Hallym University Sacred Heart Hospital, Anyang; Department of Neurology (J.M.-P., K.K.), Nowon Eulji Medical Center, Seoul; Department of Neurology (K.B.L.), Soonchunhyang University Hospital, Seoul; Department of Neurology (T.H.P., S.-S.P.), Seoul Medical Center; and Department of Biostatistics (Juneyoung Lee), Korea University College of Medicine, Seoul.
Dawid Schellingerhout
From the Stroke Center and Korean Brain MRI Data Center (W.-S.R., S.-W.J., D.-E.K.), Dongguk University Ilsan Hospital, Goyang; Departments of Radiology and Cancer Systems Imaging (D.S.), University of Texas M.D. Anderson Cancer Center, Houston; Department of Neurology (K.-S.H., Y.-J.C.), Ilsan Paik Hospital, Inje University, Goyang; Department of Neurology (M.U.J.), Hallym University Dongtan Sacred Heart Hospital, Hwaseong; Department of Neurology (M.-S.P., K.-H.C., J.-T.K.), Chonnam National University Medical School, Chonnam National University Hospital, Gwangju; Department of Neurology (B.J.K., H.-J.B.), Seoul National University Bundang Hospital, Seongnam; Department of Neurology (Jun Lee), Yeungnam University Hospital, Daegu; Department of Neurology (J.-K.C., D.-H.K., H.-W.N.), Dong-A University Hospital, Busan; Department of Neurology (S.J.L., J.G.K.), Eulji University Hospital, Daejeon; Department of Neurology (B.-C.L., K.-H.Y., M.S.O.), Hallym University Sacred Heart Hospital, Anyang; Department of Neurology (J.M.-P., K.K.), Nowon Eulji Medical Center, Seoul; Department of Neurology (K.B.L.), Soonchunhyang University Hospital, Seoul; Department of Neurology (T.H.P., S.-S.P.), Seoul Medical Center; and Department of Biostatistics (Juneyoung Lee), Korea University College of Medicine, Seoul.
Keun-Sik Hong
From the Stroke Center and Korean Brain MRI Data Center (W.-S.R., S.-W.J., D.-E.K.), Dongguk University Ilsan Hospital, Goyang; Departments of Radiology and Cancer Systems Imaging (D.S.), University of Texas M.D. Anderson Cancer Center, Houston; Department of Neurology (K.-S.H., Y.-J.C.), Ilsan Paik Hospital, Inje University, Goyang; Department of Neurology (M.U.J.), Hallym University Dongtan Sacred Heart Hospital, Hwaseong; Department of Neurology (M.-S.P., K.-H.C., J.-T.K.), Chonnam National University Medical School, Chonnam National University Hospital, Gwangju; Department of Neurology (B.J.K., H.-J.B.), Seoul National University Bundang Hospital, Seongnam; Department of Neurology (Jun Lee), Yeungnam University Hospital, Daegu; Department of Neurology (J.-K.C., D.-H.K., H.-W.N.), Dong-A University Hospital, Busan; Department of Neurology (S.J.L., J.G.K.), Eulji University Hospital, Daejeon; Department of Neurology (B.-C.L., K.-H.Y., M.S.O.), Hallym University Sacred Heart Hospital, Anyang; Department of Neurology (J.M.-P., K.K.), Nowon Eulji Medical Center, Seoul; Department of Neurology (K.B.L.), Soonchunhyang University Hospital, Seoul; Department of Neurology (T.H.P., S.-S.P.), Seoul Medical Center; and Department of Biostatistics (Juneyoung Lee), Korea University College of Medicine, Seoul.
Sang-Wuk Jeong
From the Stroke Center and Korean Brain MRI Data Center (W.-S.R., S.-W.J., D.-E.K.), Dongguk University Ilsan Hospital, Goyang; Departments of Radiology and Cancer Systems Imaging (D.S.), University of Texas M.D. Anderson Cancer Center, Houston; Department of Neurology (K.-S.H., Y.-J.C.), Ilsan Paik Hospital, Inje University, Goyang; Department of Neurology (M.U.J.), Hallym University Dongtan Sacred Heart Hospital, Hwaseong; Department of Neurology (M.-S.P., K.-H.C., J.-T.K.), Chonnam National University Medical School, Chonnam National University Hospital, Gwangju; Department of Neurology (B.J.K., H.-J.B.), Seoul National University Bundang Hospital, Seongnam; Department of Neurology (Jun Lee), Yeungnam University Hospital, Daegu; Department of Neurology (J.-K.C., D.-H.K., H.-W.N.), Dong-A University Hospital, Busan; Department of Neurology (S.J.L., J.G.K.), Eulji University Hospital, Daejeon; Department of Neurology (B.-C.L., K.-H.Y., M.S.O.), Hallym University Sacred Heart Hospital, Anyang; Department of Neurology (J.M.-P., K.K.), Nowon Eulji Medical Center, Seoul; Department of Neurology (K.B.L.), Soonchunhyang University Hospital, Seoul; Department of Neurology (T.H.P., S.-S.P.), Seoul Medical Center; and Department of Biostatistics (Juneyoung Lee), Korea University College of Medicine, Seoul.
Min Uk Jang
From the Stroke Center and Korean Brain MRI Data Center (W.-S.R., S.-W.J., D.-E.K.), Dongguk University Ilsan Hospital, Goyang; Departments of Radiology and Cancer Systems Imaging (D.S.), University of Texas M.D. Anderson Cancer Center, Houston; Department of Neurology (K.-S.H., Y.-J.C.), Ilsan Paik Hospital, Inje University, Goyang; Department of Neurology (M.U.J.), Hallym University Dongtan Sacred Heart Hospital, Hwaseong; Department of Neurology (M.-S.P., K.-H.C., J.-T.K.), Chonnam National University Medical School, Chonnam National University Hospital, Gwangju; Department of Neurology (B.J.K., H.-J.B.), Seoul National University Bundang Hospital, Seongnam; Department of Neurology (Jun Lee), Yeungnam University Hospital, Daegu; Department of Neurology (J.-K.C., D.-H.K., H.-W.N.), Dong-A University Hospital, Busan; Department of Neurology (S.J.L., J.G.K.), Eulji University Hospital, Daejeon; Department of Neurology (B.-C.L., K.-H.Y., M.S.O.), Hallym University Sacred Heart Hospital, Anyang; Department of Neurology (J.M.-P., K.K.), Nowon Eulji Medical Center, Seoul; Department of Neurology (K.B.L.), Soonchunhyang University Hospital, Seoul; Department of Neurology (T.H.P., S.-S.P.), Seoul Medical Center; and Department of Biostatistics (Juneyoung Lee), Korea University College of Medicine, Seoul.
Man-Seok Park
From the Stroke Center and Korean Brain MRI Data Center (W.-S.R., S.-W.J., D.-E.K.), Dongguk University Ilsan Hospital, Goyang; Departments of Radiology and Cancer Systems Imaging (D.S.), University of Texas M.D. Anderson Cancer Center, Houston; Department of Neurology (K.-S.H., Y.-J.C.), Ilsan Paik Hospital, Inje University, Goyang; Department of Neurology (M.U.J.), Hallym University Dongtan Sacred Heart Hospital, Hwaseong; Department of Neurology (M.-S.P., K.-H.C., J.-T.K.), Chonnam National University Medical School, Chonnam National University Hospital, Gwangju; Department of Neurology (B.J.K., H.-J.B.), Seoul National University Bundang Hospital, Seongnam; Department of Neurology (Jun Lee), Yeungnam University Hospital, Daegu; Department of Neurology (J.-K.C., D.-H.K., H.-W.N.), Dong-A University Hospital, Busan; Department of Neurology (S.J.L., J.G.K.), Eulji University Hospital, Daejeon; Department of Neurology (B.-C.L., K.-H.Y., M.S.O.), Hallym University Sacred Heart Hospital, Anyang; Department of Neurology (J.M.-P., K.K.), Nowon Eulji Medical Center, Seoul; Department of Neurology (K.B.L.), Soonchunhyang University Hospital, Seoul; Department of Neurology (T.H.P., S.-S.P.), Seoul Medical Center; and Department of Biostatistics (Juneyoung Lee), Korea University College of Medicine, Seoul.
Kang-Ho Choi
From the Stroke Center and Korean Brain MRI Data Center (W.-S.R., S.-W.J., D.-E.K.), Dongguk University Ilsan Hospital, Goyang; Departments of Radiology and Cancer Systems Imaging (D.S.), University of Texas M.D. Anderson Cancer Center, Houston; Department of Neurology (K.-S.H., Y.-J.C.), Ilsan Paik Hospital, Inje University, Goyang; Department of Neurology (M.U.J.), Hallym University Dongtan Sacred Heart Hospital, Hwaseong; Department of Neurology (M.-S.P., K.-H.C., J.-T.K.), Chonnam National University Medical School, Chonnam National University Hospital, Gwangju; Department of Neurology (B.J.K., H.-J.B.), Seoul National University Bundang Hospital, Seongnam; Department of Neurology (Jun Lee), Yeungnam University Hospital, Daegu; Department of Neurology (J.-K.C., D.-H.K., H.-W.N.), Dong-A University Hospital, Busan; Department of Neurology (S.J.L., J.G.K.), Eulji University Hospital, Daejeon; Department of Neurology (B.-C.L., K.-H.Y., M.S.O.), Hallym University Sacred Heart Hospital, Anyang; Department of Neurology (J.M.-P., K.K.), Nowon Eulji Medical Center, Seoul; Department of Neurology (K.B.L.), Soonchunhyang University Hospital, Seoul; Department of Neurology (T.H.P., S.-S.P.), Seoul Medical Center; and Department of Biostatistics (Juneyoung Lee), Korea University College of Medicine, Seoul.
Joon-Tae Kim
From the Stroke Center and Korean Brain MRI Data Center (W.-S.R., S.-W.J., D.-E.K.), Dongguk University Ilsan Hospital, Goyang; Departments of Radiology and Cancer Systems Imaging (D.S.), University of Texas M.D. Anderson Cancer Center, Houston; Department of Neurology (K.-S.H., Y.-J.C.), Ilsan Paik Hospital, Inje University, Goyang; Department of Neurology (M.U.J.), Hallym University Dongtan Sacred Heart Hospital, Hwaseong; Department of Neurology (M.-S.P., K.-H.C., J.-T.K.), Chonnam National University Medical School, Chonnam National University Hospital, Gwangju; Department of Neurology (B.J.K., H.-J.B.), Seoul National University Bundang Hospital, Seongnam; Department of Neurology (Jun Lee), Yeungnam University Hospital, Daegu; Department of Neurology (J.-K.C., D.-H.K., H.-W.N.), Dong-A University Hospital, Busan; Department of Neurology (S.J.L., J.G.K.), Eulji University Hospital, Daejeon; Department of Neurology (B.-C.L., K.-H.Y., M.S.O.), Hallym University Sacred Heart Hospital, Anyang; Department of Neurology (J.M.-P., K.K.), Nowon Eulji Medical Center, Seoul; Department of Neurology (K.B.L.), Soonchunhyang University Hospital, Seoul; Department of Neurology (T.H.P., S.-S.P.), Seoul Medical Center; and Department of Biostatistics (Juneyoung Lee), Korea University College of Medicine, Seoul.
Beom Joon Kim
From the Stroke Center and Korean Brain MRI Data Center (W.-S.R., S.-W.J., D.-E.K.), Dongguk University Ilsan Hospital, Goyang; Departments of Radiology and Cancer Systems Imaging (D.S.), University of Texas M.D. Anderson Cancer Center, Houston; Department of Neurology (K.-S.H., Y.-J.C.), Ilsan Paik Hospital, Inje University, Goyang; Department of Neurology (M.U.J.), Hallym University Dongtan Sacred Heart Hospital, Hwaseong; Department of Neurology (M.-S.P., K.-H.C., J.-T.K.), Chonnam National University Medical School, Chonnam National University Hospital, Gwangju; Department of Neurology (B.J.K., H.-J.B.), Seoul National University Bundang Hospital, Seongnam; Department of Neurology (Jun Lee), Yeungnam University Hospital, Daegu; Department of Neurology (J.-K.C., D.-H.K., H.-W.N.), Dong-A University Hospital, Busan; Department of Neurology (S.J.L., J.G.K.), Eulji University Hospital, Daejeon; Department of Neurology (B.-C.L., K.-H.Y., M.S.O.), Hallym University Sacred Heart Hospital, Anyang; Department of Neurology (J.M.-P., K.K.), Nowon Eulji Medical Center, Seoul; Department of Neurology (K.B.L.), Soonchunhyang University Hospital, Seoul; Department of Neurology (T.H.P., S.-S.P.), Seoul Medical Center; and Department of Biostatistics (Juneyoung Lee), Korea University College of Medicine, Seoul.
Jun Lee
From the Stroke Center and Korean Brain MRI Data Center (W.-S.R., S.-W.J., D.-E.K.), Dongguk University Ilsan Hospital, Goyang; Departments of Radiology and Cancer Systems Imaging (D.S.), University of Texas M.D. Anderson Cancer Center, Houston; Department of Neurology (K.-S.H., Y.-J.C.), Ilsan Paik Hospital, Inje University, Goyang; Department of Neurology (M.U.J.), Hallym University Dongtan Sacred Heart Hospital, Hwaseong; Department of Neurology (M.-S.P., K.-H.C., J.-T.K.), Chonnam National University Medical School, Chonnam National University Hospital, Gwangju; Department of Neurology (B.J.K., H.-J.B.), Seoul National University Bundang Hospital, Seongnam; Department of Neurology (Jun Lee), Yeungnam University Hospital, Daegu; Department of Neurology (J.-K.C., D.-H.K., H.-W.N.), Dong-A University Hospital, Busan; Department of Neurology (S.J.L., J.G.K.), Eulji University Hospital, Daejeon; Department of Neurology (B.-C.L., K.-H.Y., M.S.O.), Hallym University Sacred Heart Hospital, Anyang; Department of Neurology (J.M.-P., K.K.), Nowon Eulji Medical Center, Seoul; Department of Neurology (K.B.L.), Soonchunhyang University Hospital, Seoul; Department of Neurology (T.H.P., S.-S.P.), Seoul Medical Center; and Department of Biostatistics (Juneyoung Lee), Korea University College of Medicine, Seoul.
Jae-Kwan Cha
From the Stroke Center and Korean Brain MRI Data Center (W.-S.R., S.-W.J., D.-E.K.), Dongguk University Ilsan Hospital, Goyang; Departments of Radiology and Cancer Systems Imaging (D.S.), University of Texas M.D. Anderson Cancer Center, Houston; Department of Neurology (K.-S.H., Y.-J.C.), Ilsan Paik Hospital, Inje University, Goyang; Department of Neurology (M.U.J.), Hallym University Dongtan Sacred Heart Hospital, Hwaseong; Department of Neurology (M.-S.P., K.-H.C., J.-T.K.), Chonnam National University Medical School, Chonnam National University Hospital, Gwangju; Department of Neurology (B.J.K., H.-J.B.), Seoul National University Bundang Hospital, Seongnam; Department of Neurology (Jun Lee), Yeungnam University Hospital, Daegu; Department of Neurology (J.-K.C., D.-H.K., H.-W.N.), Dong-A University Hospital, Busan; Department of Neurology (S.J.L., J.G.K.), Eulji University Hospital, Daejeon; Department of Neurology (B.-C.L., K.-H.Y., M.S.O.), Hallym University Sacred Heart Hospital, Anyang; Department of Neurology (J.M.-P., K.K.), Nowon Eulji Medical Center, Seoul; Department of Neurology (K.B.L.), Soonchunhyang University Hospital, Seoul; Department of Neurology (T.H.P., S.-S.P.), Seoul Medical Center; and Department of Biostatistics (Juneyoung Lee), Korea University College of Medicine, Seoul.
Dae-Hyun Kim
From the Stroke Center and Korean Brain MRI Data Center (W.-S.R., S.-W.J., D.-E.K.), Dongguk University Ilsan Hospital, Goyang; Departments of Radiology and Cancer Systems Imaging (D.S.), University of Texas M.D. Anderson Cancer Center, Houston; Department of Neurology (K.-S.H., Y.-J.C.), Ilsan Paik Hospital, Inje University, Goyang; Department of Neurology (M.U.J.), Hallym University Dongtan Sacred Heart Hospital, Hwaseong; Department of Neurology (M.-S.P., K.-H.C., J.-T.K.), Chonnam National University Medical School, Chonnam National University Hospital, Gwangju; Department of Neurology (B.J.K., H.-J.B.), Seoul National University Bundang Hospital, Seongnam; Department of Neurology (Jun Lee), Yeungnam University Hospital, Daegu; Department of Neurology (J.-K.C., D.-H.K., H.-W.N.), Dong-A University Hospital, Busan; Department of Neurology (S.J.L., J.G.K.), Eulji University Hospital, Daejeon; Department of Neurology (B.-C.L., K.-H.Y., M.S.O.), Hallym University Sacred Heart Hospital, Anyang; Department of Neurology (J.M.-P., K.K.), Nowon Eulji Medical Center, Seoul; Department of Neurology (K.B.L.), Soonchunhyang University Hospital, Seoul; Department of Neurology (T.H.P., S.-S.P.), Seoul Medical Center; and Department of Biostatistics (Juneyoung Lee), Korea University College of Medicine, Seoul.
Hyun-Wook Nah
From the Stroke Center and Korean Brain MRI Data Center (W.-S.R., S.-W.J., D.-E.K.), Dongguk University Ilsan Hospital, Goyang; Departments of Radiology and Cancer Systems Imaging (D.S.), University of Texas M.D. Anderson Cancer Center, Houston; Department of Neurology (K.-S.H., Y.-J.C.), Ilsan Paik Hospital, Inje University, Goyang; Department of Neurology (M.U.J.), Hallym University Dongtan Sacred Heart Hospital, Hwaseong; Department of Neurology (M.-S.P., K.-H.C., J.-T.K.), Chonnam National University Medical School, Chonnam National University Hospital, Gwangju; Department of Neurology (B.J.K., H.-J.B.), Seoul National University Bundang Hospital, Seongnam; Department of Neurology (Jun Lee), Yeungnam University Hospital, Daegu; Department of Neurology (J.-K.C., D.-H.K., H.-W.N.), Dong-A University Hospital, Busan; Department of Neurology (S.J.L., J.G.K.), Eulji University Hospital, Daejeon; Department of Neurology (B.-C.L., K.-H.Y., M.S.O.), Hallym University Sacred Heart Hospital, Anyang; Department of Neurology (J.M.-P., K.K.), Nowon Eulji Medical Center, Seoul; Department of Neurology (K.B.L.), Soonchunhyang University Hospital, Seoul; Department of Neurology (T.H.P., S.-S.P.), Seoul Medical Center; and Department of Biostatistics (Juneyoung Lee), Korea University College of Medicine, Seoul.
Soo Joo Lee
From the Stroke Center and Korean Brain MRI Data Center (W.-S.R., S.-W.J., D.-E.K.), Dongguk University Ilsan Hospital, Goyang; Departments of Radiology and Cancer Systems Imaging (D.S.), University of Texas M.D. Anderson Cancer Center, Houston; Department of Neurology (K.-S.H., Y.-J.C.), Ilsan Paik Hospital, Inje University, Goyang; Department of Neurology (M.U.J.), Hallym University Dongtan Sacred Heart Hospital, Hwaseong; Department of Neurology (M.-S.P., K.-H.C., J.-T.K.), Chonnam National University Medical School, Chonnam National University Hospital, Gwangju; Department of Neurology (B.J.K., H.-J.B.), Seoul National University Bundang Hospital, Seongnam; Department of Neurology (Jun Lee), Yeungnam University Hospital, Daegu; Department of Neurology (J.-K.C., D.-H.K., H.-W.N.), Dong-A University Hospital, Busan; Department of Neurology (S.J.L., J.G.K.), Eulji University Hospital, Daejeon; Department of Neurology (B.-C.L., K.-H.Y., M.S.O.), Hallym University Sacred Heart Hospital, Anyang; Department of Neurology (J.M.-P., K.K.), Nowon Eulji Medical Center, Seoul; Department of Neurology (K.B.L.), Soonchunhyang University Hospital, Seoul; Department of Neurology (T.H.P., S.-S.P.), Seoul Medical Center; and Department of Biostatistics (Juneyoung Lee), Korea University College of Medicine, Seoul.
Jae Guk Kim
From the Stroke Center and Korean Brain MRI Data Center (W.-S.R., S.-W.J., D.-E.K.), Dongguk University Ilsan Hospital, Goyang; Departments of Radiology and Cancer Systems Imaging (D.S.), University of Texas M.D. Anderson Cancer Center, Houston; Department of Neurology (K.-S.H., Y.-J.C.), Ilsan Paik Hospital, Inje University, Goyang; Department of Neurology (M.U.J.), Hallym University Dongtan Sacred Heart Hospital, Hwaseong; Department of Neurology (M.-S.P., K.-H.C., J.-T.K.), Chonnam National University Medical School, Chonnam National University Hospital, Gwangju; Department of Neurology (B.J.K., H.-J.B.), Seoul National University Bundang Hospital, Seongnam; Department of Neurology (Jun Lee), Yeungnam University Hospital, Daegu; Department of Neurology (J.-K.C., D.-H.K., H.-W.N.), Dong-A University Hospital, Busan; Department of Neurology (S.J.L., J.G.K.), Eulji University Hospital, Daejeon; Department of Neurology (B.-C.L., K.-H.Y., M.S.O.), Hallym University Sacred Heart Hospital, Anyang; Department of Neurology (J.M.-P., K.K.), Nowon Eulji Medical Center, Seoul; Department of Neurology (K.B.L.), Soonchunhyang University Hospital, Seoul; Department of Neurology (T.H.P., S.-S.P.), Seoul Medical Center; and Department of Biostatistics (Juneyoung Lee), Korea University College of Medicine, Seoul.
Yong-Jin Cho
From the Stroke Center and Korean Brain MRI Data Center (W.-S.R., S.-W.J., D.-E.K.), Dongguk University Ilsan Hospital, Goyang; Departments of Radiology and Cancer Systems Imaging (D.S.), University of Texas M.D. Anderson Cancer Center, Houston; Department of Neurology (K.-S.H., Y.-J.C.), Ilsan Paik Hospital, Inje University, Goyang; Department of Neurology (M.U.J.), Hallym University Dongtan Sacred Heart Hospital, Hwaseong; Department of Neurology (M.-S.P., K.-H.C., J.-T.K.), Chonnam National University Medical School, Chonnam National University Hospital, Gwangju; Department of Neurology (B.J.K., H.-J.B.), Seoul National University Bundang Hospital, Seongnam; Department of Neurology (Jun Lee), Yeungnam University Hospital, Daegu; Department of Neurology (J.-K.C., D.-H.K., H.-W.N.), Dong-A University Hospital, Busan; Department of Neurology (S.J.L., J.G.K.), Eulji University Hospital, Daejeon; Department of Neurology (B.-C.L., K.-H.Y., M.S.O.), Hallym University Sacred Heart Hospital, Anyang; Department of Neurology (J.M.-P., K.K.), Nowon Eulji Medical Center, Seoul; Department of Neurology (K.B.L.), Soonchunhyang University Hospital, Seoul; Department of Neurology (T.H.P., S.-S.P.), Seoul Medical Center; and Department of Biostatistics (Juneyoung Lee), Korea University College of Medicine, Seoul.
Byung-Chul Lee
From the Stroke Center and Korean Brain MRI Data Center (W.-S.R., S.-W.J., D.-E.K.), Dongguk University Ilsan Hospital, Goyang; Departments of Radiology and Cancer Systems Imaging (D.S.), University of Texas M.D. Anderson Cancer Center, Houston; Department of Neurology (K.-S.H., Y.-J.C.), Ilsan Paik Hospital, Inje University, Goyang; Department of Neurology (M.U.J.), Hallym University Dongtan Sacred Heart Hospital, Hwaseong; Department of Neurology (M.-S.P., K.-H.C., J.-T.K.), Chonnam National University Medical School, Chonnam National University Hospital, Gwangju; Department of Neurology (B.J.K., H.-J.B.), Seoul National University Bundang Hospital, Seongnam; Department of Neurology (Jun Lee), Yeungnam University Hospital, Daegu; Department of Neurology (J.-K.C., D.-H.K., H.-W.N.), Dong-A University Hospital, Busan; Department of Neurology (S.J.L., J.G.K.), Eulji University Hospital, Daejeon; Department of Neurology (B.-C.L., K.-H.Y., M.S.O.), Hallym University Sacred Heart Hospital, Anyang; Department of Neurology (J.M.-P., K.K.), Nowon Eulji Medical Center, Seoul; Department of Neurology (K.B.L.), Soonchunhyang University Hospital, Seoul; Department of Neurology (T.H.P., S.-S.P.), Seoul Medical Center; and Department of Biostatistics (Juneyoung Lee), Korea University College of Medicine, Seoul.
Kyung-Ho Yu
From the Stroke Center and Korean Brain MRI Data Center (W.-S.R., S.-W.J., D.-E.K.), Dongguk University Ilsan Hospital, Goyang; Departments of Radiology and Cancer Systems Imaging (D.S.), University of Texas M.D. Anderson Cancer Center, Houston; Department of Neurology (K.-S.H., Y.-J.C.), Ilsan Paik Hospital, Inje University, Goyang; Department of Neurology (M.U.J.), Hallym University Dongtan Sacred Heart Hospital, Hwaseong; Department of Neurology (M.-S.P., K.-H.C., J.-T.K.), Chonnam National University Medical School, Chonnam National University Hospital, Gwangju; Department of Neurology (B.J.K., H.-J.B.), Seoul National University Bundang Hospital, Seongnam; Department of Neurology (Jun Lee), Yeungnam University Hospital, Daegu; Department of Neurology (J.-K.C., D.-H.K., H.-W.N.), Dong-A University Hospital, Busan; Department of Neurology (S.J.L., J.G.K.), Eulji University Hospital, Daejeon; Department of Neurology (B.-C.L., K.-H.Y., M.S.O.), Hallym University Sacred Heart Hospital, Anyang; Department of Neurology (J.M.-P., K.K.), Nowon Eulji Medical Center, Seoul; Department of Neurology (K.B.L.), Soonchunhyang University Hospital, Seoul; Department of Neurology (T.H.P., S.-S.P.), Seoul Medical Center; and Department of Biostatistics (Juneyoung Lee), Korea University College of Medicine, Seoul.
Mi Sun Oh
From the Stroke Center and Korean Brain MRI Data Center (W.-S.R., S.-W.J., D.-E.K.), Dongguk University Ilsan Hospital, Goyang; Departments of Radiology and Cancer Systems Imaging (D.S.), University of Texas M.D. Anderson Cancer Center, Houston; Department of Neurology (K.-S.H., Y.-J.C.), Ilsan Paik Hospital, Inje University, Goyang; Department of Neurology (M.U.J.), Hallym University Dongtan Sacred Heart Hospital, Hwaseong; Department of Neurology (M.-S.P., K.-H.C., J.-T.K.), Chonnam National University Medical School, Chonnam National University Hospital, Gwangju; Department of Neurology (B.J.K., H.-J.B.), Seoul National University Bundang Hospital, Seongnam; Department of Neurology (Jun Lee), Yeungnam University Hospital, Daegu; Department of Neurology (J.-K.C., D.-H.K., H.-W.N.), Dong-A University Hospital, Busan; Department of Neurology (S.J.L., J.G.K.), Eulji University Hospital, Daejeon; Department of Neurology (B.-C.L., K.-H.Y., M.S.O.), Hallym University Sacred Heart Hospital, Anyang; Department of Neurology (J.M.-P., K.K.), Nowon Eulji Medical Center, Seoul; Department of Neurology (K.B.L.), Soonchunhyang University Hospital, Seoul; Department of Neurology (T.H.P., S.-S.P.), Seoul Medical Center; and Department of Biostatistics (Juneyoung Lee), Korea University College of Medicine, Seoul.
Jong-Moo Park
From the Stroke Center and Korean Brain MRI Data Center (W.-S.R., S.-W.J., D.-E.K.), Dongguk University Ilsan Hospital, Goyang; Departments of Radiology and Cancer Systems Imaging (D.S.), University of Texas M.D. Anderson Cancer Center, Houston; Department of Neurology (K.-S.H., Y.-J.C.), Ilsan Paik Hospital, Inje University, Goyang; Department of Neurology (M.U.J.), Hallym University Dongtan Sacred Heart Hospital, Hwaseong; Department of Neurology (M.-S.P., K.-H.C., J.-T.K.), Chonnam National University Medical School, Chonnam National University Hospital, Gwangju; Department of Neurology (B.J.K., H.-J.B.), Seoul National University Bundang Hospital, Seongnam; Department of Neurology (Jun Lee), Yeungnam University Hospital, Daegu; Department of Neurology (J.-K.C., D.-H.K., H.-W.N.), Dong-A University Hospital, Busan; Department of Neurology (S.J.L., J.G.K.), Eulji University Hospital, Daejeon; Department of Neurology (B.-C.L., K.-H.Y., M.S.O.), Hallym University Sacred Heart Hospital, Anyang; Department of Neurology (J.M.-P., K.K.), Nowon Eulji Medical Center, Seoul; Department of Neurology (K.B.L.), Soonchunhyang University Hospital, Seoul; Department of Neurology (T.H.P., S.-S.P.), Seoul Medical Center; and Department of Biostatistics (Juneyoung Lee), Korea University College of Medicine, Seoul.
Kyusik Kang
From the Stroke Center and Korean Brain MRI Data Center (W.-S.R., S.-W.J., D.-E.K.), Dongguk University Ilsan Hospital, Goyang; Departments of Radiology and Cancer Systems Imaging (D.S.), University of Texas M.D. Anderson Cancer Center, Houston; Department of Neurology (K.-S.H., Y.-J.C.), Ilsan Paik Hospital, Inje University, Goyang; Department of Neurology (M.U.J.), Hallym University Dongtan Sacred Heart Hospital, Hwaseong; Department of Neurology (M.-S.P., K.-H.C., J.-T.K.), Chonnam National University Medical School, Chonnam National University Hospital, Gwangju; Department of Neurology (B.J.K., H.-J.B.), Seoul National University Bundang Hospital, Seongnam; Department of Neurology (Jun Lee), Yeungnam University Hospital, Daegu; Department of Neurology (J.-K.C., D.-H.K., H.-W.N.), Dong-A University Hospital, Busan; Department of Neurology (S.J.L., J.G.K.), Eulji University Hospital, Daejeon; Department of Neurology (B.-C.L., K.-H.Y., M.S.O.), Hallym University Sacred Heart Hospital, Anyang; Department of Neurology (J.M.-P., K.K.), Nowon Eulji Medical Center, Seoul; Department of Neurology (K.B.L.), Soonchunhyang University Hospital, Seoul; Department of Neurology (T.H.P., S.-S.P.), Seoul Medical Center; and Department of Biostatistics (Juneyoung Lee), Korea University College of Medicine, Seoul.
Kyung Bok Lee
From the Stroke Center and Korean Brain MRI Data Center (W.-S.R., S.-W.J., D.-E.K.), Dongguk University Ilsan Hospital, Goyang; Departments of Radiology and Cancer Systems Imaging (D.S.), University of Texas M.D. Anderson Cancer Center, Houston; Department of Neurology (K.-S.H., Y.-J.C.), Ilsan Paik Hospital, Inje University, Goyang; Department of Neurology (M.U.J.), Hallym University Dongtan Sacred Heart Hospital, Hwaseong; Department of Neurology (M.-S.P., K.-H.C., J.-T.K.), Chonnam National University Medical School, Chonnam National University Hospital, Gwangju; Department of Neurology (B.J.K., H.-J.B.), Seoul National University Bundang Hospital, Seongnam; Department of Neurology (Jun Lee), Yeungnam University Hospital, Daegu; Department of Neurology (J.-K.C., D.-H.K., H.-W.N.), Dong-A University Hospital, Busan; Department of Neurology (S.J.L., J.G.K.), Eulji University Hospital, Daejeon; Department of Neurology (B.-C.L., K.-H.Y., M.S.O.), Hallym University Sacred Heart Hospital, Anyang; Department of Neurology (J.M.-P., K.K.), Nowon Eulji Medical Center, Seoul; Department of Neurology (K.B.L.), Soonchunhyang University Hospital, Seoul; Department of Neurology (T.H.P., S.-S.P.), Seoul Medical Center; and Department of Biostatistics (Juneyoung Lee), Korea University College of Medicine, Seoul.
Tai Hwan Park
From the Stroke Center and Korean Brain MRI Data Center (W.-S.R., S.-W.J., D.-E.K.), Dongguk University Ilsan Hospital, Goyang; Departments of Radiology and Cancer Systems Imaging (D.S.), University of Texas M.D. Anderson Cancer Center, Houston; Department of Neurology (K.-S.H., Y.-J.C.), Ilsan Paik Hospital, Inje University, Goyang; Department of Neurology (M.U.J.), Hallym University Dongtan Sacred Heart Hospital, Hwaseong; Department of Neurology (M.-S.P., K.-H.C., J.-T.K.), Chonnam National University Medical School, Chonnam National University Hospital, Gwangju; Department of Neurology (B.J.K., H.-J.B.), Seoul National University Bundang Hospital, Seongnam; Department of Neurology (Jun Lee), Yeungnam University Hospital, Daegu; Department of Neurology (J.-K.C., D.-H.K., H.-W.N.), Dong-A University Hospital, Busan; Department of Neurology (S.J.L., J.G.K.), Eulji University Hospital, Daejeon; Department of Neurology (B.-C.L., K.-H.Y., M.S.O.), Hallym University Sacred Heart Hospital, Anyang; Department of Neurology (J.M.-P., K.K.), Nowon Eulji Medical Center, Seoul; Department of Neurology (K.B.L.), Soonchunhyang University Hospital, Seoul; Department of Neurology (T.H.P., S.-S.P.), Seoul Medical Center; and Department of Biostatistics (Juneyoung Lee), Korea University College of Medicine, Seoul.
Sang-Soon Park
From the Stroke Center and Korean Brain MRI Data Center (W.-S.R., S.-W.J., D.-E.K.), Dongguk University Ilsan Hospital, Goyang; Departments of Radiology and Cancer Systems Imaging (D.S.), University of Texas M.D. Anderson Cancer Center, Houston; Department of Neurology (K.-S.H., Y.-J.C.), Ilsan Paik Hospital, Inje University, Goyang; Department of Neurology (M.U.J.), Hallym University Dongtan Sacred Heart Hospital, Hwaseong; Department of Neurology (M.-S.P., K.-H.C., J.-T.K.), Chonnam National University Medical School, Chonnam National University Hospital, Gwangju; Department of Neurology (B.J.K., H.-J.B.), Seoul National University Bundang Hospital, Seongnam; Department of Neurology (Jun Lee), Yeungnam University Hospital, Daegu; Department of Neurology (J.-K.C., D.-H.K., H.-W.N.), Dong-A University Hospital, Busan; Department of Neurology (S.J.L., J.G.K.), Eulji University Hospital, Daejeon; Department of Neurology (B.-C.L., K.-H.Y., M.S.O.), Hallym University Sacred Heart Hospital, Anyang; Department of Neurology (J.M.-P., K.K.), Nowon Eulji Medical Center, Seoul; Department of Neurology (K.B.L.), Soonchunhyang University Hospital, Seoul; Department of Neurology (T.H.P., S.-S.P.), Seoul Medical Center; and Department of Biostatistics (Juneyoung Lee), Korea University College of Medicine, Seoul.
Juneyoung Lee
From the Stroke Center and Korean Brain MRI Data Center (W.-S.R., S.-W.J., D.-E.K.), Dongguk University Ilsan Hospital, Goyang; Departments of Radiology and Cancer Systems Imaging (D.S.), University of Texas M.D. Anderson Cancer Center, Houston; Department of Neurology (K.-S.H., Y.-J.C.), Ilsan Paik Hospital, Inje University, Goyang; Department of Neurology (M.U.J.), Hallym University Dongtan Sacred Heart Hospital, Hwaseong; Department of Neurology (M.-S.P., K.-H.C., J.-T.K.), Chonnam National University Medical School, Chonnam National University Hospital, Gwangju; Department of Neurology (B.J.K., H.-J.B.), Seoul National University Bundang Hospital, Seongnam; Department of Neurology (Jun Lee), Yeungnam University Hospital, Daegu; Department of Neurology (J.-K.C., D.-H.K., H.-W.N.), Dong-A University Hospital, Busan; Department of Neurology (S.J.L., J.G.K.), Eulji University Hospital, Daejeon; Department of Neurology (B.-C.L., K.-H.Y., M.S.O.), Hallym University Sacred Heart Hospital, Anyang; Department of Neurology (J.M.-P., K.K.), Nowon Eulji Medical Center, Seoul; Department of Neurology (K.B.L.), Soonchunhyang University Hospital, Seoul; Department of Neurology (T.H.P., S.-S.P.), Seoul Medical Center; and Department of Biostatistics (Juneyoung Lee), Korea University College of Medicine, Seoul.
Hee-Joon Bae
From the Stroke Center and Korean Brain MRI Data Center (W.-S.R., S.-W.J., D.-E.K.), Dongguk University Ilsan Hospital, Goyang; Departments of Radiology and Cancer Systems Imaging (D.S.), University of Texas M.D. Anderson Cancer Center, Houston; Department of Neurology (K.-S.H., Y.-J.C.), Ilsan Paik Hospital, Inje University, Goyang; Department of Neurology (M.U.J.), Hallym University Dongtan Sacred Heart Hospital, Hwaseong; Department of Neurology (M.-S.P., K.-H.C., J.-T.K.), Chonnam National University Medical School, Chonnam National University Hospital, Gwangju; Department of Neurology (B.J.K., H.-J.B.), Seoul National University Bundang Hospital, Seongnam; Department of Neurology (Jun Lee), Yeungnam University Hospital, Daegu; Department of Neurology (J.-K.C., D.-H.K., H.-W.N.), Dong-A University Hospital, Busan; Department of Neurology (S.J.L., J.G.K.), Eulji University Hospital, Daejeon; Department of Neurology (B.-C.L., K.-H.Y., M.S.O.), Hallym University Sacred Heart Hospital, Anyang; Department of Neurology (J.M.-P., K.K.), Nowon Eulji Medical Center, Seoul; Department of Neurology (K.B.L.), Soonchunhyang University Hospital, Seoul; Department of Neurology (T.H.P., S.-S.P.), Seoul Medical Center; and Department of Biostatistics (Juneyoung Lee), Korea University College of Medicine, Seoul.
Dong-Eog Kim
From the Stroke Center and Korean Brain MRI Data Center (W.-S.R., S.-W.J., D.-E.K.), Dongguk University Ilsan Hospital, Goyang; Departments of Radiology and Cancer Systems Imaging (D.S.), University of Texas M.D. Anderson Cancer Center, Houston; Department of Neurology (K.-S.H., Y.-J.C.), Ilsan Paik Hospital, Inje University, Goyang; Department of Neurology (M.U.J.), Hallym University Dongtan Sacred Heart Hospital, Hwaseong; Department of Neurology (M.-S.P., K.-H.C., J.-T.K.), Chonnam National University Medical School, Chonnam National University Hospital, Gwangju; Department of Neurology (B.J.K., H.-J.B.), Seoul National University Bundang Hospital, Seongnam; Department of Neurology (Jun Lee), Yeungnam University Hospital, Daegu; Department of Neurology (J.-K.C., D.-H.K., H.-W.N.), Dong-A University Hospital, Busan; Department of Neurology (S.J.L., J.G.K.), Eulji University Hospital, Daejeon; Department of Neurology (B.-C.L., K.-H.Y., M.S.O.), Hallym University Sacred Heart Hospital, Anyang; Department of Neurology (J.M.-P., K.K.), Nowon Eulji Medical Center, Seoul; Department of Neurology (K.B.L.), Soonchunhyang University Hospital, Seoul; Department of Neurology (T.H.P., S.-S.P.), Seoul Medical Center; and Department of Biostatistics (Juneyoung Lee), Korea University College of Medicine, Seoul.
White matter hyperintensity load on stroke recurrence and mortality at 1 year after ischemic stroke
Wi-Sun Ryu, Dawid Schellingerhout, Keun-Sik Hong, Sang-Wuk Jeong, Min Uk Jang, Man-Seok Park, Kang-Ho Choi, Joon-Tae Kim, Beom Joon Kim, Jun Lee, Jae-Kwan Cha, Dae-Hyun Kim, Hyun-Wook Nah, Soo Joo Lee, Jae Guk Kim, Yong-Jin Cho, Byung-Chul Lee, Kyung-Ho Yu, Mi Sun Oh, Jong-Moo Park, Kyusik Kang, Kyung Bok Lee, Tai Hwan Park, Sang-Soon Park, Juneyoung Lee, Hee-Joon Bae, Dong-Eog Kim
Neurology Aug 2019, 93 (6) e578-e589; DOI: 10.1212/WNL.0000000000007896
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Abstract
Objective To define the role and risks associated with white matter hyperintensity (WMH) load in a stroke population with respect to recurrent stroke and mortality after ischemic stroke.
Methods A total of 7,101 patients at a network of university hospitals presenting with ischemic strokes were followed up for 1 year. Multivariable Cox proportional hazards model and competing risk analysis were used to examine the independent association between quartiles of WMH load and stroke recurrence and mortality at 1 year.
Results Overall recurrent stroke risk at 1 year was 6.7%/y, divided between 5.6%/y for recurrent ischemic and 0.5%/y for recurrent hemorrhagic strokes. There was a stronger association between WMH volume and recurrent hemorrhagic stroke by quartile (hazard ratio [HR] 7.32, 14.12, and 33.52, respectively) than for ischemic recurrence (HR 1.03, 1.37, and 1.61, respectively), but the absolute incidence of ischemic recurrence by quartile was higher (3.8%/y, 4.5%/y, 6.3%/y, and 8.2%/y by quartiles) vs hemorrhagic recurrence (0.1%/y, 0.4%/y, 0.6%/y, and 1.3%/y). All-cause mortality (10.5%) showed a marked association with WMH volume (HR 1.06, 1.46, and 1.60), but this was attributable to nonvascular rather than vascular causes.
Conclusions There is an association between WMH volume load and stroke recurrence, and this association is stronger for hemorrhagic than for ischemic stroke, although the absolute risk of ischemic recurrence remains higher. These data should be helpful to practitioners seeking to find the optimal preventive/treatment regimen for poststroke patients and to individualize risk-benefit ratios.
Glossary
- CI=
- confidence interval;
- CPH=
- Cox proportional hazard;
- FLAIR=
- fluid-attenuated inversion recovery;
- HR=
- hazard ratio;
- NIHSS=
- NIH Stroke Scale;
- SPS3=
- Secondary Prevention of Small Subcortical Strokes;
- WMH=
- white matter hyperintensities
Footnotes
Go to Neurology.org/N for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article.
CME Course: NPub.org/cmelist
- Received November 11, 2018.
- Accepted in final form March 18, 2019.
- © 2019 American Academy of Neurology
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