Increased VEGF and Decreased SDF-1 alpha in Patients with Silent Brain Infarction Are Associated with Better Prognosis after First-Ever Acute Lacunar Stroke

Abstract

Background: Pre-existing silent brain infarctions (SBIs) have been reported to be associated with better outcomes after first-ever symptomatic ischemic stroke, although the mechanism of this remains unclear. We investigated the association between SBIs, outcomes of acute lacunar infarction, and biomarkers including vascular endothelial growth factor (VEGF), stromal cell-derived factor-1 alpha (SDF-1 alpha), macrophage migration inhibitory factor (MIF), and high-mobility group box-1 (HMGB1). Methods: A total of 68 consecutive patients diagnosed with first-ever lacunar infarction (<20 mm) within 24 hours of symptom onset were included in this study. Clinical, laboratory, and imaging data were obtained. Plasma levels of VEGF, SDF-1 alpha, MIF, and HMGB1 were assessed using Enzyme-Linked Immunosorbent Assay kits. Results: SBIs were noted in 31 of the 68 patients. Although the initial National Institutes of Health Stroke Scale scores were not related with the presence of SBIs (P = .313), patients with SBIs had better outcomes at 3 months (P = .029). Additionally, plasma VEGF levels were higher (P = .035) and SDF-1 alpha levels were lower (P < .001) in patients with SBIs. Logistic regression analysis indicated that VEGF and SDF-1 alpha were independently associated with the presence of SBIs. Conclusions: SBIs are associated with favorable outcomes in patients with first-ever acute lacunar infarction and higher levels of VEGF, and lower levels of SDF-1 alpha in these patients may contribute to their more favorable prognosis.