BACKGROUND AND OBJECTIVES In patients with cerebral small vessel disease (SVD), impaired cerebrovascular reactivity (CVR) is related to worse concurrent SVD burden, but less is known about cerebrovascular reactivity and long-term SVD lesion progression and clinical outcomes. We investigated associations between cerebrovascular reactivity and 1-year progression of SVD features and clinical outcomes. METHODS Between 2018 and 2021, we recruited patients from the Edinburgh/Lothian stroke services presenting with minor ischemic stroke and SVD features as part of the Mild Stroke Study 3, a prospective observational cohort study (ISRCTN 12113543). We acquired 3T brain MRI at baseline and 1 year. At baseline, we measured cerebrovascular reactivity to 6% inhaled CO2 in subcortical gray matter, normal-appearing white matter, and white matter hyperintensities (WMH). At baseline and 1 year, we quantified SVD MRI features, incident infarcts, assessed stroke severity (NIH Stroke Scale), recurrent stroke, functional outcome (modified Rankin Scale), and cognition (Montreal Cognitive Assessment). We performed linear and logistic regressions adjusted for age, sex, and vascular risk factors, reporting the regression coefficients and odds ratios with 95% CIs. RESULTS We recruited 208 patients of whom 163 (mean age and SD: 65.8 ± 11.2 years, 32% female) had adequate baseline CVR and completed the follow-up structural MRI. The median increase in WMH volume was 0.32 mL with (Q1, Q3) = (-0.48, 1.78) mL; 29% had a recurrent stroke or incident infarct on MRI. At 1 year, patients with lower baseline cerebrovascular reactivity in normal-appearing tissues had increased WMH (regression coefficient: B = -1.14 [-2.13, -0.14] log10 (%ICV) per %/mm Hg) and perivascular space volumes (B = -1.90 [-3.21, -0.60] log10 (%ROIV) per %/mm Hg), with a similar trend in WMH. CVR was not associated with clinical outcomes at 1 year. DISCUSSION Lower baseline cerebrovascular reactivity predicted an increase in WMH and perivascular space volumes after 1 year. CVR should be considered in SVD future research and intervention studies.

中文翻译：

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脑血管反应性与小血管病 1 年影像学和临床结果的关联：一项观察性队列研究。


背景和目的 在脑小血管病 （SVD） 患者中，脑血管反应性 （CVR） 受损与并发 SVD 负荷加重有关，但对脑血管反应性和长期 SVD 病变进展和临床结局知之甚少。我们调查了脑血管反应性与 SVD 特征 1 年进展和临床结果之间的关联。方法 在 2018 年至 2021 年期间，我们从爱丁堡/洛锡安卒中服务中招募了表现出轻微缺血性卒中和 SVD 特征的患者，作为前瞻性观察队列研究 （ISRCTN 12113543） 轻度卒中研究 3 的一部分。我们在基线和 1 年时获得了 3T 脑部 MRI。在基线时，我们测量了皮质下灰质、外观正常的白质和白质高信号 （WMH） 中脑血管对 6% 吸入 CO2 的反应性。在基线和 1 年时，我们量化了 SVD MRI 特征、新发梗死、评估的卒中严重程度 （NIH 卒中量表）、复发性卒中、功能结局 （改良的 Rankin 量表） 和认知 （蒙特利尔认知评估）。我们进行了针对年龄、性别和血管危险因素进行调整的线性和 logistic 回归，报告了具有 95% CI 的回归系数和比值比。结果 我们招募了 208 例患者，其中 163 例 （平均年龄和 SD： 65.8 ± 11.2 岁，32% 为女性）基线 CVR 充足，并完成了随访结构 MRI。WMH 体积的中位增加为 0.32 mL，其中 （Q1， Q3） = （-0.48， 1.78） mL;29% 的患者在 MRI 上出现复发性卒中或意外梗死。1 年时，正常组织中基线脑血管反应性较低的患者 WMH （回归系数： B = -1.14 [-2.13， -0.14] log10 （%ICV） 每 %/mm Hg） 增加）和血管周围间隙体积 （B = -1.90 [-3.21， -0.60] log10 （%ROIV） per %/mm Hg），WMH 呈类似趋势。CVR 与 1 年时的临床结局无关。讨论 较低的基线脑血管反应性预示着 1 年后 WMH 和血管周围间隙体积的增加。CVR 应在 SVD 未来的研究和干预研究中考虑。