Cranial Magnetic Resonance Imaging as a Screening Tool for Evaluation of Silent Brain Ischemia in Severe Coronary Artery Disease: A Clinical Based Study

Abstract

Aim: Silent brain ischemia (SBI), defined as ischemic changes and infarcts without neurologic signs, is an established marker of poor survival. Magnetic resonance imaging (MRI) is useful to define SBI and white matter hyperintensities that correspond to microangipathic ischemic disease. This study aimed to investigate the relationship among SBI, white matter lesions and the extent of coronary artery disease (CAD), and to determine possible predictors of SBI. Material and Methods: A total 10640 patients who underwent coronary angiography were retrospectively screened to reveal 312 patients who had been evaluated with a subsequent cranial MRI within 6 months. CAD severity was established with Gensini score and MRIs were evaluated to determine presence of SBI and white matter hyperintensities scored by Fazekas. Finally, 58 patients with SBI and 254 without SBI consisted SBI and non-SBI groups. Results: Patients with SBI were significantly older with higher prevalence of male gender than the non-SBI patients. Both Gensini and Fazekas scores were higher in SBI-group (p<0.001). Fazekas score was positively correlated with Gensini score (r=0.219, p<0.001) and age (r=0.465, p<0.001). In the logistic regression analysis; age, male gender and Gensini score were identified as the independent predictors of SBI. Conclusion: Although SBIs don’t present neurological symptoms they are associated with poor survival and future stroke. Our data suggest that cranial MRI may be a screening tool in risk stratification, particularly in elderly male patients with multivessel CAD. Our study also depicted that age, male gender and high Gensini scores are the independent predictors of SBI. © 2020, Duzce University Medical School. All rights reserved.