White matter hyperintensity burden in acute stroke patients differs by ischemic stroke subtype
| Autor: | Tatjana Rundek, Ona Wu, Ramesh Sridharan, Vincent Thijs, Marco Nardin, Daniel Woo, Bradford B. Worrall, Christina Jern, Ralph L. Sacco, Steven J. T. Mocking, Pankaj Sharma, Agnieszka Slowik, Steven J. Kittner, Anne-Katrin Giese, Braxton D. Mitchell, Elissa C. McIntosh, Jordi Jimenez-Conde, Markus D. Schirmer, Polina Golland, John W. Cole, Arne Lindgren, Robin Lemmens, Adrian V. Dalca, Eva Giralt-Steinhauer, Dawn Kleindorfer, Reinhold Schmidt, Natalia S. Rost, Jonathan Rosand, Patrick F. McArdle, Johan Wassélius, Huichun Xu, James F. Meschia, Robert E. Irie, Kathleen L. Donahue |
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| Rok vydání: | 2020 |
| Předmět: |
Male
0301 basic medicine medicine.medical_specialty complications [Arterial Occlusive Diseases] Neurology Arterial Occlusive Diseases pathology [Brain Ischemia] Article diagnostic imaging [White Matter] Brain Ischemia Lesion 03 medical and health sciences Deep Learning 0302 clinical medicine Neuroimaging Risk Factors pathology [White Matter] Internal medicine diagnostic imaging [Stroke] medicine Humans ddc:610 Stroke Aged Retrospective Studies etiology [Stroke] Acute stroke Aged 80 and over business.industry Middle Aged medicine.disease White Matter etiology [Brain Ischemia] Magnetic Resonance Imaging 030104 developmental biology White matter hyperintensity diagnostic imaging [Brain Ischemia] Ischemic stroke Cohort pathology [Stroke] Cardiology Female Neurology (clinical) medicine.symptom business 030217 neurology & neurosurgery |
| Zdroj: | Neurology 95(1), e79-e88 (2020). doi:10.1212/WNL.0000000000009728 Neurology |
| ISSN: | 1526-632X 0028-3878 |
| DOI: | 10.1212/wnl.0000000000009728 |
| Popis: | ObjectiveTo examine etiologic stroke subtypes and vascular risk factor profiles and their association with white matter hyperintensity (WMH) burden in patients hospitalized for acute ischemic stroke (AIS).MethodsFor the MRI Genetics Interface Exploration (MRI-GENIE) study, we systematically assembled brain imaging and phenotypic data for 3,301 patients with AIS. All cases underwent standardized web tool–based stroke subtyping with the Causative Classification of Ischemic Stroke (CCS). WMH volume (WMHv) was measured on T2 brain MRI scans of 2,529 patients with a fully automated deep-learning trained algorithm. Univariable and multivariable linear mixed-effects modeling was carried out to investigate the relationship of vascular risk factors with WMHv and CCS subtypes.ResultsPatients with AIS with large artery atherosclerosis, major cardioembolic stroke, small artery occlusion (SAO), other, and undetermined causes of AIS differed significantly in their vascular risk factor profile (all p < 0.001). Median WMHv in all patients with AIS was 5.86 cm3 (interquartile range 2.18–14.61 cm3) and differed significantly across CCS subtypes (p < 0.0001). In multivariable analysis, age, hypertension, prior stroke, smoking (all p < 0.001), and diabetes mellitus (p = 0.041) were independent predictors of WMHv. When adjusted for confounders, patients with SAO had significantly higher WMHv compared to those with all other stroke subtypes (p < 0.001).ConclusionIn this international multicenter, hospital-based cohort of patients with AIS, we demonstrate that vascular risk factor profiles and extent of WMH burden differ by CCS subtype, with the highest lesion burden detected in patients with SAO. These findings further support the small vessel hypothesis of WMH lesions detected on brain MRI of patients with ischemic stroke. |
| Databáze: | OpenAIRE |
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