title: Leukoaraiosis and stroke recurrence risk in patients with and without atrial fibrillation.
abstract: OBJECTIVE
  We aimed to investigate the association between leukoaraiosis and long-term risk of stroke recurrence adjusting for clinical scores developed and validated for the prediction of stroke risk, such as CHADS2 (congestive heart failure, hypertension, age ≥75 years, diabetes mellitus, and stroke or TIA) and CHA2DS2-VASc (congestive heart failure, hypertension, age ≥75 years, diabetes mellitus, stroke or TIA, vascular disease, age 65-74 years, sex category).
  
  
  METHODS
  Study population was derived from the Athens Stroke Registry and was categorized in 2 subgroups according to the presence of atrial fibrillation (AF). Cox proportional hazards analysis was performed to assess the independent predictors of stroke recurrence. To investigate whether leukoaraiosis adds to the prognostic accuracy of CHADS2 and CHA2DS2-VASc scores, we used the likelihood ratio test. Overall model assessment was performed with Nagelkerke R(2) and Harrell C statistic. Kaplan-Meier analyses were also performed.
  
  
  RESULTS
  Among 1,892 patients, there were 320 (16.9%) with leukoaraiosis and 670 (35.4%) with AF. In the Kaplan-Meier analysis, there was significant difference in cumulative probability of stroke recurrence between patients with and without leukoaraiosis in the non-AF group (p < 0.01), but not in the AF group (p = 0.46). On Cox multivariate analysis, leukoaraiosis was found to be a significant independent predictor of stroke recurrence only in the non-AF group, in the models adjusting for CHADS2 (hazard ratio: 1.86, 95% confidence interval: 1.35-2.56) and CHA2DS2-VASc (hazard ratio: 1.82, 95% confidence interval: 1.32-2.51) scores. Leukoaraiosis was not a predictor of stroke recurrence in the AF group. Leukoaraiosis did not improve the predictive accuracy of the 2 scores, whether in the non-AF group (Harrell C statistic: 0.56 vs 0.59 [p = 0.31] for the model including CHADS2; 0.56 vs 0.59 [p = 0.44] for the model including CHA2DS2-VASc) or the AF group (Harrell C statistic: 0.63 vs 0.62 for the model including CHADS2; 0.64 vs 0.64 for the model including CHA2DS2-VASc).
  
  
  CONCLUSIONS
  Leukoaraiosis is an independent predictor of stroke recurrence in non-AF stroke patients. However, leukoaraiosis did not increase the accuracy of the CHADS2 and CHA2DS2-VASc scores to predict stroke recurrence in AF or non-AF stroke patients.
authors.affiliation: From the Department of Medicine (G.N., D.L., V.P., K.M.), Larissa University Hospital, School of Medicine, University of Thessaly, Larissa, Greece; University of Birmingham Centre for Cardiovascular Sciences (G.Y.H.L.), City Hospital, Birmingham, UK; Department of Clinical Therapeutics (E.M., K.V.), Medical School of Athens, Alexandra Hospital, Athens; Department of Medicine (H.M.), Ioannina University Hospital, School of Medicine, University of Ioannina; and Department of Neurology (K.S.), Eginition Hospital, University of Athens Medical School, Greece. gntaios@med.uth.gr.
authors.forename: George
authors.initials: G
authors.lastname: Ntaios
authors.affiliation: From the Department of Medicine (G.N., D.L., V.P., K.M.), Larissa University Hospital, School of Medicine, University of Thessaly, Larissa, Greece; University of Birmingham Centre for Cardiovascular Sciences (G.Y.H.L.), City Hospital, Birmingham, UK; Department of Clinical Therapeutics (E.M., K.V.), Medical School of Athens, Alexandra Hospital, Athens; Department of Medicine (H.M.), Ioannina University Hospital, School of Medicine, University of Ioannina; and Department of Neurology (K.S.), Eginition Hospital, University of Athens Medical School, Greece.
authors.forename: Gregory Y H
authors.initials: GY
authors.lastname: Lip
authors.affiliation: From the Department of Medicine (G.N., D.L., V.P., K.M.), Larissa University Hospital, School of Medicine, University of Thessaly, Larissa, Greece; University of Birmingham Centre for Cardiovascular Sciences (G.Y.H.L.), City Hospital, Birmingham, UK; Department of Clinical Therapeutics (E.M., K.V.), Medical School of Athens, Alexandra Hospital, Athens; Department of Medicine (H.M.), Ioannina University Hospital, School of Medicine, University of Ioannina; and Department of Neurology (K.S.), Eginition Hospital, University of Athens Medical School, Greece.
authors.forename: Dimitris
authors.initials: D
authors.lastname: Lambrou
authors.affiliation: From the Department of Medicine (G.N., D.L., V.P., K.M.), Larissa University Hospital, School of Medicine, University of Thessaly, Larissa, Greece; University of Birmingham Centre for Cardiovascular Sciences (G.Y.H.L.), City Hospital, Birmingham, UK; Department of Clinical Therapeutics (E.M., K.V.), Medical School of Athens, Alexandra Hospital, Athens; Department of Medicine (H.M.), Ioannina University Hospital, School of Medicine, University of Ioannina; and Department of Neurology (K.S.), Eginition Hospital, University of Athens Medical School, Greece.
authors.forename: Vasileios
authors.initials: V
authors.lastname: Papavasileiou
authors.affiliation: From the Department of Medicine (G.N., D.L., V.P., K.M.), Larissa University Hospital, School of Medicine, University of Thessaly, Larissa, Greece; University of Birmingham Centre for Cardiovascular Sciences (G.Y.H.L.), City Hospital, Birmingham, UK; Department of Clinical Therapeutics (E.M., K.V.), Medical School of Athens, Alexandra Hospital, Athens; Department of Medicine (H.M.), Ioannina University Hospital, School of Medicine, University of Ioannina; and Department of Neurology (K.S.), Eginition Hospital, University of Athens Medical School, Greece.
authors.forename: Efstathios
authors.initials: E
authors.lastname: Manios
authors.affiliation: From the Department of Medicine (G.N., D.L., V.P., K.M.), Larissa University Hospital, School of Medicine, University of Thessaly, Larissa, Greece; University of Birmingham Centre for Cardiovascular Sciences (G.Y.H.L.), City Hospital, Birmingham, UK; Department of Clinical Therapeutics (E.M., K.V.), Medical School of Athens, Alexandra Hospital, Athens; Department of Medicine (H.M.), Ioannina University Hospital, School of Medicine, University of Ioannina; and Department of Neurology (K.S.), Eginition Hospital, University of Athens Medical School, Greece.
authors.forename: Haralampos
authors.initials: H
authors.lastname: Milionis
authors.affiliation: From the Department of Medicine (G.N., D.L., V.P., K.M.), Larissa University Hospital, School of Medicine, University of Thessaly, Larissa, Greece; University of Birmingham Centre for Cardiovascular Sciences (G.Y.H.L.), City Hospital, Birmingham, UK; Department of Clinical Therapeutics (E.M., K.V.), Medical School of Athens, Alexandra Hospital, Athens; Department of Medicine (H.M.), Ioannina University Hospital, School of Medicine, University of Ioannina; and Department of Neurology (K.S.), Eginition Hospital, University of Athens Medical School, Greece.
authors.forename: Konstantinos
authors.initials: K
authors.lastname: Spengos
authors.affiliation: From the Department of Medicine (G.N., D.L., V.P., K.M.), Larissa University Hospital, School of Medicine, University of Thessaly, Larissa, Greece; University of Birmingham Centre for Cardiovascular Sciences (G.Y.H.L.), City Hospital, Birmingham, UK; Department of Clinical Therapeutics (E.M., K.V.), Medical School of Athens, Alexandra Hospital, Athens; Department of Medicine (H.M.), Ioannina University Hospital, School of Medicine, University of Ioannina; and Department of Neurology (K.S.), Eginition Hospital, University of Athens Medical School, Greece.
authors.forename: Konstantinos
authors.initials: K
authors.lastname: Makaritsis
authors.affiliation: From the Department of Medicine (G.N., D.L., V.P., K.M.), Larissa University Hospital, School of Medicine, University of Thessaly, Larissa, Greece; University of Birmingham Centre for Cardiovascular Sciences (G.Y.H.L.), City Hospital, Birmingham, UK; Department of Clinical Therapeutics (E.M., K.V.), Medical School of Athens, Alexandra Hospital, Athens; Department of Medicine (H.M.), Ioannina University Hospital, School of Medicine, University of Ioannina; and Department of Neurology (K.S.), Eginition Hospital, University of Athens Medical School, Greece.
authors.forename: Konstantinos
authors.initials: K
authors.lastname: Vemmos
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001281:Atrial Fibrillation / Q000175:diagnosis / Q000453:epidemiology*; D015897:Comorbidity; D005260:Female; D005500:Follow-Up Studies; D006115:Greece / Q000453:epidemiology; D006801:Humans; D053208:Kaplan-Meier Estimate; D049292:Leukoaraiosis / Q000175:diagnosis / Q000453:epidemiology*; D008297:Male; D016016:Proportional Hazards Models; D012008:Recurrence; D012042:Registries / Q000706:statistics & numerical data*; D018570:Risk Assessment; D012720:Severity of Illness Index; D020521:Stroke / Q000175:diagnosis / Q000453:epidemiology*