Evidence mapPaperPMID 40847482Full record

SynthesisJournal of the American Heart Association2025

Cerebral Small-Vessel Disease Markers on Magnetic Resonance Imaging as Predictors of Recurrent Vascular Events and Death in Ischemic Stroke: A Systematic Review and Meta-Analysis.

Muhammad Nurhakim Hairus S, Adithya Srinivasan, Shemin Ayesha Shaik Mohideen, Neil Chen Yi Lun MacAlevey, Mark Y Chan, Aloysius S T Leow, Xin Zhou, Gregory Y H Lip, Benjamin Y Q Tan, Leonard L L Yeo and 3 more

Abstract readSystematic ReviewMeta-Analysis
In one paragraph

Synthesis in Journal of the American Heart Association, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

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field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

0 citing papers in PubMed.

No citing paper in PubMed yet.

4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

13 authors.

Muhammad Nurhakim Hairus SYong Loo Lin School of Medicine National University of Singapore Singapore.ORCID 0009-0001-9894-6421
Adithya SrinivasanYong Loo Lin School of Medicine National University of Singapore Singapore.
Shemin Ayesha Shaik MohideenYong Loo Lin School of Medicine National University of Singapore Singapore.ORCID 0009-0002-6074-4848
Neil Chen Yi Lun MacAleveyYong Loo Lin School of Medicine National University of Singapore Singapore.ORCID 0009-0000-1074-4300
Mark Y ChanYong Loo Lin School of Medicine National University of Singapore Singapore.ORCID 0000-0003-0389-7450
Aloysius S T LeowDepartment of Cardiology National University Heart Centre Singapore Singapore.ORCID 0000-0003-3659-1650
Xin ZhouDepartment of Cardiology Tianjin Medical University General Hospital Tianjin China.ORCID 0000-0003-1395-7103
Gregory Y H LipLiverpool Centre for Cardiovascular Science University of Liverpool, Liverpool John Moores University and Liverpool Heart and Chest Hospital Liverpool United Kingdom.ORCID 0000-0002-7566-1626
Benjamin Y Q TanYong Loo Lin School of Medicine National University of Singapore Singapore.ORCID 0000-0003-1824-9077
Leonard L L YeoYong Loo Lin School of Medicine National University of Singapore Singapore.ORCID 0000-0002-4249-0402
Yao Neng TeoDepartment of Cardiology National University Heart Centre Singapore Singapore.ORCID 0000-0002-1150-9174
Yao Hao TeoDepartment of Cardiology National University Heart Centre Singapore Singapore.ORCID 0000-0003-0439-4097
Ching-Hui SiaYong Loo Lin School of Medicine National University of Singapore Singapore.ORCID 0000-0002-2764-2869

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundCerebral small-vessel disease encompasses a spectrum of magnetic resonance imaging features reflecting microvascular pathology in ischemic stroke. Among these, white matter hyperintensities (WMHs) and cerebral microbleeds (CMBs) are the most widely studied. While both are well established as risk factors for cognitive decline in patients with acute ischemic stroke (AIS), their prognostic value for vascular events and death after AIS remains unclear. This study aims to evaluate WMH and CMB as predictors of recurrent stroke, cardiovascular death, and all-cause death in patients with AIS.

methodsWe systematically searched PubMed and Embase for longitudinal studies from July 1977 to March 2024 reporting adjusted hazard ratios (HRs) or odds ratios for these outcomes after AIS. Pooled estimates were generated using random-effects models, and heterogeneity was explored using meta-regression and prediction intervals.

resultsFifty studies (n=44 140) were included. WMHs were a significant predictor of stroke recurrence (HR,1.72 [95% CI, 1.39-2.13]) and all-cause death (HR, 1.58 [95% CI, 1.11-2.23]). Similarly, CMBs were associated with stroke recurrence (HR, 1.88 [95% CI, 1.52-2.33]), with lobar and mixed types conferring higher risk than deep CMBs, and predicted cardiovascular death (HR, 1.45 [95% CI, 1.2-1.75]). For stroke recurrence, risk estimates increased in parallel with WMH and CMB burden.

conclusionsThis meta-analysis supports WMHs and CMBs as independent predictors of stroke recurrence and death in AIS. Burden and distribution further refine prognostic accuracy and inform poststroke risk assessment.

Indexed as

Cerebral HemorrhageCerebral Small Vessel DiseasesIschemic StrokeMagnetic Resonance ImagingHumansPredictive Value of TestsPrognosisRecurrenceRisk AssessmentRisk FactorsWhite Matterall‐cause deathcardiovascular deathcerebral microbleedscerebral small‐vessel diseaseischemic strokerecurrent strokewhite matter hyperintensities

Identifiers

PMID40847482
PMCPMC12553415

What Socratic holds

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.