Impact of vascular aging on stroke prognosis: the novel severity and arterial stiffness (SASt) score.

IF 2.4 4区医学 Q2 CLINICAL NEUROLOGY

Neurological Sciences Pub Date : 2025-10-07 DOI:10.1007/s10072-025-08527-7

Nikolaos Kakaletsis, Athanase D Protogerou, Naohisa Hosomi, Tomohisa Nezu, Patrik Michel, Thevoz Guillaume, Davide Strambo, Young Seo Kim, Wonjae Sung, Konstantinos Vemmos, Eleni Korompoki, Maurizio Acampa, Jukka Putaala, Lauri Tulkki, Matthias Hermann, Protazy Rejmer, Philip M Bath, Lisa J Woodhouse, Elpida Athanasopoulou, Haralampos Milionis, George Ntaios, Vasilios Kotsis, Christos Savopoulos

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引用次数: 0

Abstract

Introduction: Assessing vascular aging to identify and categorize the residual risk of adverse outcomes in acute ischemic stroke (AIS) is important for improving AIS prognoses. This study aimed to investigate the prognostic value and correlation among three indirect measures of vascular aging derived from 24-hour blood pressure monitoring (24 h-BPM) following AIS. Furthermore, it aimed to develop a new score that includes vascular aging metrics to enhance the prognostic accuracy for stroke outcomes.

Methods: A total of 2,730 AIS patients with a mean age of 72.0 ± 14.4 years who underwent 24 h-BPM were included. Three vascular aging indexes derived from 24 h-BPM: estimated pulse wave velocity (ePWV), early vascular aging ambulatory score (EVAAs), and 24-hour pulse pressure (24 h-PP) were evaluated. Primary outcome was the modified Rankin Scale (mRS) score > 2 at 3 months post-stroke.

Result: ePWV showed superior predictive value for poor functional outcome (AUC: 0.77, 95% CI: 0.74-0.79) at 3 months post-stroke. Optimal cutoff points for predicting poor functional outcome at 3 months were 12.2 m/s for ePWV (sensitivity: 79.4%, specificity: 61.7%), 65% for EVAAs (sensitivity: 66.4%, specificity: 51.5%), and 51.1mmHg for 24 h-PP (sensitivity: 66.7%, specificity: 46.6%). A new "Severity and Arterial Stiffness" (SASt) score was formulated: SASt = NIHSS + 2*ePWV, which demonstrated excellent discriminatory power for predicting poor functional outcome (AUC: 0.87, 95% CI: 0.85-0.88) at 3 months post-stroke.

Conclusions: The ePWV and the new SASt score show promising potential as tools for identifying patients at higher risk for poor outcomes at 3 months post-stroke. While these findings are encouraging, further prospective studies are needed to validate their utility before they can be adopted in clinical practice.

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血管老化对脑卒中预后的影响：新的严重程度和动脉硬度（SASt）评分。

简介：评估血管老化以识别和分类急性缺血性卒中（AIS）不良结局的剩余风险对于改善AIS预后非常重要。本研究旨在探讨AIS后24小时血压监测（24 h-BPM）中血管衰老的三种间接指标的预后价值和相关性。此外，该研究旨在开发一种新的评分方法，包括血管老化指标，以提高卒中预后的准确性。方法：选取2730例平均年龄（72.0±14.4）岁，bpm为24 h的AIS患者。评估24 h bpm的三个血管老化指标：估计脉搏波速度（ePWV）、早期血管老化动态评分（EVAAs）和24小时脉压（24 h-PP）。主要终点是卒中后3个月的改良Rankin量表（mRS）评分bb0.2。结果：ePWV对脑卒中后3个月的功能不良预后有较好的预测价值（AUC: 0.77, 95% CI: 0.74-0.79）。预测3个月功能不良预后的最佳截止点为ePWV为12.2 m/s（敏感性：79.4%，特异性：61.7%），EVAAs为65%（敏感性：66.4%，特异性：51.5%），24 h-PP为51.1mmHg（敏感性：66.7%，特异性：46.6%）。制定了新的“严重程度和动脉硬度”（SASt）评分：SASt = NIHSS + 2*ePWV，该评分在预测脑卒中后3个月的不良功能结局（AUC: 0.87, 95% CI: 0.85-0.88）方面具有出色的区分能力。结论：ePWV和新的SASt评分作为识别卒中后3个月不良预后高风险患者的工具具有很大的潜力。虽然这些发现令人鼓舞，但在临床实践中采用之前，还需要进一步的前瞻性研究来验证其效用。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Neurological Sciences 医学-临床神经学

CiteScore

6.10

自引率

3.00%

发文量

743

审稿时长

4 months

期刊介绍： Neurological Sciences is intended to provide a medium for the communication of results and ideas in the field of neuroscience. The journal welcomes contributions in both the basic and clinical aspects of the neurosciences. The official language of the journal is English. Reports are published in the form of original articles, short communications, editorials, reviews and letters to the editor. Original articles present the results of experimental or clinical studies in the neurosciences, while short communications are succinct reports permitting the rapid publication of novel results. Original contributions may be submitted for the special sections History of Neurology, Health Care and Neurological Digressions - a forum for cultural topics related to the neurosciences. The journal also publishes correspondence book reviews, meeting reports and announcements.