Association between neurovascular coupling, functional connectivity, and stroke prognosis: A functional near-infrared spectroscopy prognostic study

Abstract: BACKGROUND: The predictive value of acute-phase functional connectivity (FC) and neurovascular coupling (NVC) for functional prognosis in stroke patients remains unclear. METHODS: In a prospective cohort of 60 stroke patients, functional near-infrared spectroscopy assessed FC, brain activation pattern, and NVC (indexed by general linear model–derived β values) within 7 days post-stroke. Functional outcome (modified Rankin Scale mRS score at 90 days) was dichotomized as favorable (mRS 0–1) or unfavorable. Least Absolute Shrinkage and Selection Operator regression selected variables for a Firth’s logistic regression model predicting unfavorable outcome risk. RESULTS: Patients with a favorable outcome showed stronger global FC and bilateral cortical activation, whereas unfavorable patients exhibited predominantly contralesional compensatory pattern. Task-evoked responses were greater in favorable group in the ipsilesional primary motor cortex (iM1, t = 2.09, q = 0.04) and bilateral somatosensory association cortex (SAC, ipsilesional: t = 3.49, q < 0.001; contralesional: t = 2.34, q = 0.03). A Firth’s logistic regression model incorporating four predictors—admission National Institutes of Health Stroke Scale score, the contralesional frontoparietal cortex-ipsilesional supramarginal gyrus FC value, iM1-β value, and ipsilesional somatosensory association cortex-β (iSAC-β) value—achieved an area under the receiver-operating characteristic curve of 0.86, with the iSAC-β value emerging as the leading neuroimaging contributor. CONCLUSION: Acute-phase FC strength and NVC are predictive of 90-day functional outcome after stroke. Ipsilesional SAC may represent a potential target for acute-phase prognostic stratification and mechanistically informed interventions. TRIAL REGISTRATION: http://www.clinicaltrials.gov (identifier: NCT06925178).