Influence of stroke infarct location on quality of life assessed in a multivariate lesion-symptom mapping study

Abstract

Conflict of interest statementAK reports grants from European Union 7th Framework Program during the conduct of the study. ADM has nothing to disclose. CM has nothing to disclose. AW has nothing to disclose. ES has nothing to disclose. ME reports grants from European Union 7th Framework Program during the conduct of the study. THC has nothing to disclose. MEn reports grants from European Union 7th Framework Program during the conduct of the study, grants from Bayer and fees paid to the Charité from Bayer, Boehringer Ingelheim, BMS/Pfizer, Daiichi Sankyo, Amgen, GlaxoSmithKlineGSK, Sanofi, Covidien, Novartis, all outside the submitted work. JBF reports grants from European Union 7th Framework Program during the conduct of the study and personal fees from Bioclinica, BMS, Biogen, Artemida, Cerevast, Guerbet, EISAI and Nicolab outside the submitted work. JF has nothing to disclose. IG reports grants from European Union 7th Framework Program during the conduct of the study. JP has nothing to disclose. VT reports grants from European Union 7th Framework Program and personal fees and non-financial support from Boehringer Ingelheim, Pfizer/BMS, Bayer, Sygnis, Amgen and Allergan outside the submitted work. RL reports no personal fees, but institutional support for consultancy and speaker fees from Bayer, Boehringer-Ingelheim, Genentech, Ischemaview, Medtronic and Occlutech outside the submitted work. KWM reports grants from European Union 7th Framework Program during the conduct of the study, personal fees and non-financial support from Boehringer Ingelheim outside the submitted work, personal fees from Boehringer Ingelheim, Bayer, Daiichi Sankyo and ReNeuron outside the submitted work. NN has nothing to disclose. SP reports grants from European Union 7th Framework Program during the conduct of the study. CZS reports grants from Novo Nordisk Foundation and personal fees from Bayer outside the submitted work. CG reports grants from European Union 7th Framework Program during the conduct of the study, personal fees from AMGEN, Bayer Vital, BMS, Boehringer Ingelheim, Sanofi Aventis, Abbott, and Prediction Biosciences outside the submitted work. GT reports grants from European Union 7th Framework Program during the conduct of the study, personal fees from Acandis, Boehringer Ingelheim, BMS/Pfizer, Stryker, Daiichi Sankyo, grants and personal fees from Bayer, grants from Corona Foundation, German Innovation Fonds and Else Kroener Fresenius Foundation outside the submitted work. BC reports grants from European Union 7th Framework Program during the conduct of the study and personal fees from Bayer Vital and Abbott, all outside the submitted work. ; International audience ; Stroke has a deleterious impact on quality of life. However, it is less well known if stroke lesions in different brain regions are associated with reduced quality of life (QoL). We therefore investigated this association by multivariate lesion-symptom mapping. We analyzed magnetic resonance imaging and clinical data from the WAKE-UP trial. European Quality of Life 5 Dimensions (EQ-5D) 3 level questionnaires were completed 90 days after stroke. Lesion symptom mapping was performed using a multivariate machine learning algorithm (support vector regression) based on stroke lesions 22-36 h after stroke. Brain regions with significant associations were explored in reference to white matter tracts. Of 503 randomized patients, 329 were included in the analysis (mean age 65.4 years, SD 11.5; median NIHSS = 6, IQR 4-9; median EQ-5D score 90 days after stroke 1, IQR 0-4, median lesion volume 3.3 ml, IQR 1.1-16.9 ml). After controlling for lesion volume, significant associations between lesions and EQ-5D score were detected for the right putamen, and internal capsules of both hemispheres. Multivariate lesion inference analysis revealed an association between injuries of the cortico-spinal tracts with worse self-reported quality of life 90 days after stroke in comparably small stroke lesions, extending previous reports of the association of striato-capsular lesions with worse functional outcome. Our findings are of value to identify patients at risk of impaired QoL after stroke.