Table 1 : Demographic characteristics at baseline of patients with and without follow-up brain MRI
Variable
|
No FU brain MRI n = 57
|
At least 1 FU brain MRI n = 47
|
p
|
Age (years)
|
47.9 (12.4)
|
48.2 (10.8)
|
0.88*
|
Sex (female/male)
|
21/35
|
13/34
|
0.36 £
|
Diabetes mellitus
|
3 (5.3 %)
|
5 (10.6 %)
|
0.46 ¤
|
Hypercholesterolemia
|
7 (12.3 %)
|
10 (21.3 %)
|
0.22£
|
Active smoker
|
24 (42.1 %)
|
17 (36.2 %)
|
0.54£
|
HypertensionandTargetOrgan damage
|
SBP at admission (mmHg)
|
215.7 (33.2)
|
211.3 (24.5)
|
0.46*
|
DBP at admission (mmHg)
|
119.2 (19.7)
|
118.4 (18.6)
|
0.83*
|
Severe Hypertensive retinopathy
|
44 (78.5 %)
|
31 (66 %)
|
0.20 £
|
Creatinin level (µmol/l)
|
124 (95 - 180)
|
106 (84 - 172)
|
0.12µ
|
Cardiac damage
|
50 (89.3 %)
|
40 (85.1 %)
|
0.53£
|
TMA stigmata
|
8 (14.0 %)
|
12 (25.5 %)
|
0.14£
|
Neurologicalmanifestationsuponadmission
|
Neurologic symptoms at admission
|
22 (38.6 %)
|
22 (46.8 %)
|
0.39 £
|
Acute brain injury
|
22 (38.6 %)
|
27 (57.4 %)
|
0.055 £
|
Ischemic stroke
|
9 (15.8 %)
|
10 (21.3 %)
|
0.44 £
|
Cerebral Hemorrhage
|
7 (12.3 %)
|
9 (19.1 %)
|
0.31 £
|
PRES
|
7 (12.3 %)
|
12 (25.5 %)
|
0.082 £
|
Mean SVD score
|
1.6 (1.1)
|
1.9 (1.2)
|
0.17*
|
Results are expressed as average (SD), median (IQR) or number (%).
FU : Follow-Up, SBP : systolic blood pressure, DBP: diastolic blood pressure, MRI: Magnetic resonance imaging, TMA : thrombotic microangiopathy, standing for elevated LDH measurement associated with low haptoglobin level. Cardiac damage stands for disproportionate left ventricular hypertrophy on echocardiography or electrocardiogram and / or cardiac biomarkers elevation (troponin and BNP).
* : T-Test, £:Chi-2 test, µ:Mann-Whitney test, ¤: Fisher’s exact test
Table 2 : Follow-up brain MRI findings compared to baseline brain MRI findings
Variables
|
Baseline (n=47)
|
Latest brain MRI follow-up
(n=47)
|
p
|
Clinical data
|
SBP (mmHg)
|
211.3(24.5)
|
136.0 (18)
|
< 0.01 §
|
DBP (mmHg)
|
118.4 (18.6)
|
86.0 (12.4)
|
< 0.01 §
|
Blood pressure control
|
0 (0%)
|
22 (46.8%)
|
< 0.01 ¤
|
Parenchymal injuries
|
Acute brain injury
|
27 (54.7%)
|
7 (14.9%)
|
0.02 £
|
Ischemic stroke
|
10 (21.3 %)
|
5 (10.6 %)
|
0.25 ¤
|
Cerebral Hemorrhage
|
9 (19.1 %)
|
2 (4.3 %)
|
0.05 ¤
|
PRES
|
12 (25.5 %)
|
0 (0 %)
|
< 0.01 ¤
|
Chronic microvascular injuries
|
At least one chronic lacunar infarct
|
29 (62%)
|
33 (70.2%)
|
0.019 £
|
Among them. mean number of lacunar infarct
|
2.45 (1.72)
|
2.93 (2.42)
|
0.07§
|
At least one microbleed
|
26(55%)
|
28 (56%)
|
0.16 £
|
Among them. mean number of microbleeds
|
3.4 (2.1)
|
4.9 (3.9)
|
0.057 §
|
Extensive WMH (Fazekas score 2 or 3)
Deep
Periventricular
|
30 (64%)
33 (70%)
|
24 (51%)
33 (70%)
|
0.034 £
1 £
|
Mean SVD score
SVD score
0
1
2
3
4
|
1.9 (1.2)
6 (13%)
13 (28%)
7 (15%)
14 (30%)
7 (15%)
|
2.0 (1.3)
8 (17%)
9 (19%)
9 (19%)
16 (34%)
5 (11%)
|
0.64 §
|
Results are expressed as average (SD), median (IQR) or number (%).
SBP : systolic blood pressure, DBP: diastolic blood pressure, MRI: Magnetic resonance imaging, PRES : posterior reversible encephalopathy syndrome, WMH : white matter hyperintensities, SVD : small vessel disease. Blood pressure control stands for systolic blood pressure < 140 mmHg and diastolic blood pressure < 90 mmHg. Acute brain injury encompasses acute stroke, hemorrhage and/or PRES.
§:paired t test, ¤:Fisher exact test, £ : Mac Nemar test
Table3 :Evolution ofbrain MRI markers between first and follow-up MRI according to blood pressure control status
Variables
|
Blood pressure control
(n=22)
|
Absence of blood pressure control
(n=25)
|
p
|
Clinical data
|
Age at baseline (years)
|
49.3(10.9)
|
47.3 (10.7)
|
0.78µ
|
Follow-up duration (days)
|
228 (93 – 390)
|
209.5(83.5 – 739.5)
|
0.94 $
|
Sex (female/male)
|
8/14
|
5/20
|
0.21 §
|
SBP (mmHg)
|
120.9 (10.5)
|
149.4 (11.4)
|
< 0.001µ
|
DBP (mmHg)
|
76.1 (7.2)
|
94.8 (9.0)
|
< 0.001µ
|
New cerebrovascular event
|
Ischemic stroke
|
1 (4.5%)
|
4 (16%)
|
0.35 ¤
|
Cerebral Hemorrhage
|
2 (9%)
|
0 (0%)
|
0.21 ¤
|
PRES
|
0 (0%)
|
0 (0%)
|
1¤
|
Evolution of microvascular data
|
At least one chronic lacunar infarct at follow up
|
13 (59.1%)
|
20 (80 %)
|
0.12 §
|
|
Among them, mean number of lacunar infarct
|
1.8 (2.1)
|
2.3 (2.6)
|
0.62 $
|
|
At least one microbleed at follow up
|
14 (63.6%)
|
15 (60%)
|
0.80 §
|
|
Among them, mean number of microbleeds
|
2.9 (3.2)
|
1.9 (2.5)
|
0.47$
|
|
Total Fazekas score change
|
0 (-1 - 0)
|
0 (-1 - 0)
|
0.60$
|
Relative changes in total Fazekas score
-3
-2
-1
0
+ 1
|
1 (4.5%)
3 (13.6%)
3 (13.6%)
4 (63.6%)
1 (4.5%)
|
2 (8%)
4 (16%)
2 (8%)
17 (68%)
0 (0 %)
|
|
SVD score change
|
0 ( 0 – 0 )
|
0 ( 0 – 0 )
|
0.55$
|
Relative changes in SVD score
- 2
- 1
0
+1
|
1 (4.5%)
2 (9.1%)
17 (77.2%)
2 (9.1%)
|
0 (0%)
5 (20%)
15 (60%)
5 (20%)
|
|
Results are expressed as number (%). SBP : systolic blood pressure. DBP: diastolic blood pressure
MRI: Magnetic resonance imaging; PRES. posterior reversible encephalopathy syndrome; WMH. white matter hyperintensities; SVD: small vessel disease. Total Fazekas score stands for the addition of deep and periventricular Fazekas score. Total Fazekas / SVD score change represent the difference between the Total Fazekas / SVD score at follow up and at baseline.
µ : T-Test, §:Chi-2 test, $:Mann-Whitney test, ¤:Fisher’s exact test.
Regarding the mean number of lacunar infarcts and microbleeds, we chose to present data as mean (SD) because it is more informative in this situation. Nevertheless, the comparison is performed with the Mann-Whitney test because of the distribution of the data.
Table 4: Evolution of brain MRI markers during follow-up according to follow-up duration
Variables
|
Below median follow up
(n=24)
|
Above median follow up
(n=23)
|
p
|
Clinical data
|
Age at baseline (years)
|
49.9 (8.7)
|
46.4 (12.4)
|
0. 10µ
|
Follow-up duration (days)
|
85.6 (65.1)
|
880.7 (625.6)
|
<0.001µ
|
Sex (female/male)
|
9/15
|
4/19
|
0.12 §
|
Blood pressure control
|
11 (45.8%)
|
11 (47.8%)
|
0.89 §
|
New cerebrovascular event
|
Ischemic stroke
|
2 ( 8.3%)
|
3 ( 13%)
|
0.67 ¤
|
Cerebral Hemorrhage
|
1 (4.2%)
|
1(4.3%)
|
1 ¤
|
PRES
|
0 (0%)
|
0 (0%)
|
1 ¤
|
Evolution of microvascular data
|
At least one chronic lacunar infarct at follow up
|
16 (66.7%)
|
17 (73.9%)
|
0.59 §
|
Among them, mean number of lacunar infarct
|
2.1 (2.1)
|
2.1 (2.7)
|
0.59 $
|
At least one microbleed at follow up
|
14 (58.3%)
|
15 (65.2%)
|
0.63§
|
Among them, mean number of microbleeds
|
3.1 (3.2)
|
1.7 (2.4)
|
0.31 $
|
Total Fazekas score change
|
0 (0 – 0)
|
0 (0 – 0)
|
0.25 $
|
Relative changes in total Fazekas score
-3
-2
-1
0
+ 1
|
2 (8.3%)
5 (20.8%)
3 (12.5%)
12 (50%)
1 (4.2%)
|
1 (4.3%)
2 (8.7%)
1 (4.3%)
18 (78.3%)
0 (0%)
|
|
SVD score change
|
0 ( 0 – -2 )
|
0 ( 0 – 0 )
|
1 $
|
Relative changes in SVD score
- 2
- 1
0
+1
|
1 (4.2%)
4 (16.7%)
14 (58.3%)
4 (16.7%)
|
0 (0%)
3 (13%)
17 (73.9%)
2 (8.7%)
|
|
Results are expressed as number (%). SBP : systolic blood pressure. DBP: diastolic blood pressure
MRI: Magnetic resonance imaging; PRES. posterior reversible encephalopathy syndrome; WMH. white matter hyperintensities; SVD: small vessel disease. Total Fazekas score stands for the addition of deep and periventricular Fazekas score. Total Fazekas / SVD score change represent the difference between the Total Fazekas / SVD score at follow up and at baseline.
µ : T-Test, §:Chi-2 test, $:Mann-Whitney test, ¤:Fisher’s exact test
Regarding the mean number of lacunar infarcts and microbleeds, we chose to present data as mean (SD) because it is more informative in this situation. Nevertheless, the comparison is performed with the Mann-Whitney test because of the distribution of the data.