TY - JOUR
T1 - Excessive White Matter Hyperintensity Increases Susceptibility to Poor Functional Outcomes After Acute Ischemic Stroke
AU - The MRI-GENIE and GISCOME Investigators and the International Stroke Genetics Consortium
AU - Hong, Sungmin
AU - Giese, Anne Katrin
AU - Schirmer, Markus D.
AU - Bonkhoff, Anna K.
AU - Bretzner, Martin
AU - Rist, Pamela
AU - Dalca, Adrian V.
AU - Regenhardt, Robert W.
AU - Etherton, Mark R.
AU - Donahue, Kathleen L.
AU - Nardin, Marco
AU - Mocking, Steven J.T.
AU - McIntosh, Elissa C.
AU - Attia, John
AU - Benavente, Oscar R.
AU - Cole, John W.
AU - Donatti, Amanda
AU - Griessenauer, Christoph J.
AU - Heitsch, Laura
AU - Holmegaard, Lukas
AU - Jood, Katarina
AU - Jimenez-Conde, Jordi
AU - Roquer, Jaume
AU - Kittner, Steven J.
AU - Lemmens, Robin
AU - Levi, Christopher R.
AU - McDonough, Caitrin W.
AU - Meschia, James F.
AU - Phuah, Chia Ling
AU - Rolfs, Arndt
AU - Ropele, Stefan
AU - Rosand, Jonathan
AU - Rundek, Tatjana
AU - Sacco, Ralph L.
AU - Schmidt, Reinhold
AU - Enzinger, Christian
AU - Sharma, Pankaj
AU - Slowik, Agnieszka
AU - Sousa, Alessandro
AU - Stanne, Tara M.
AU - Strbian, Daniel
AU - Tatlisumak, Turgut
AU - Thijs, Vincent
AU - Vagal, Achala
AU - Wasselius, Johan
AU - Woo, Daniel
AU - Zand, Ramin
AU - McArdle, Patrick F.
AU - Worrall, Bradford B.
AU - Wu, Ona
N1 - Publisher Copyright:
© Copyright © 2021 Hong, Giese, Schirmer, Bonkhoff, Bretzner, Rist, Dalca, Regenhardt, Etherton, Donahue, Nardin, Mocking, McIntosh, Attia, Benavente, Cole, Donatti, Griessenauer, Heitsch, Holmegaard, Jood, Jimenez-Conde, Roquer, Kittner, Lemmens, Levi, McDonough, Meschia, Phuah, Rolfs, Ropele, Rosand, Rundek, Sacco, Schmidt, Enzinger, Sharma, Slowik, Sousa, Stanne, Strbian, Tatlisumak, Thijs, Vagal, Wasselius, Woo, Zand, McArdle, Worrall, Wu, Jern, Lindgren, Maguire, Tomppo, Golland, Rost and the MRI-GENIE and GISCOME Investigators and the International Stroke Genetics Consortium.
PY - 2021/9/10
Y1 - 2021/9/10
N2 - Objective: To personalize the prognostication of post-stroke outcome using MRI-detected cerebrovascular pathology, we sought to investigate the association between the excessive white matter hyperintensity (WMH) burden unaccounted for by the traditional stroke risk profile of individual patients and their long-term functional outcomes after a stroke. Methods: We included 890 patients who survived after an acute ischemic stroke from the MRI-Genetics Interface Exploration (MRI-GENIE) study, for whom data on vascular risk factors (VRFs), including age, sex, atrial fibrillation, diabetes mellitus, hypertension, coronary artery disease, smoking, prior stroke history, as well as acute stroke severity, 3- to−6-month modified Rankin Scale score (mRS), WMH, and brain volumes, were available. We defined the unaccounted WMH (uWMH) burden via modeling of expected WMH burden based on the VRF profile of each individual patient. The association of uWMH and mRS score was analyzed by linear regression analysis. The odds ratios of patients who achieved full functional independence (mRS < 2) in between trichotomized uWMH burden groups were calculated by pair-wise comparisons. Results: The expected WMH volume was estimated with respect to known VRFs. The uWMH burden was associated with a long-term functional outcome (β = 0.104, p < 0.01). Excessive uWMH burden significantly reduced the odds of achieving full functional independence after a stroke compared to the low and average uWMH burden [OR = 0.4, 95% CI: (0.25, 0.63), p < 0.01 and OR = 0.61, 95% CI: (0.42, 0.87), p < 0.01, respectively]. Conclusion: The excessive amount of uWMH burden unaccounted for by the traditional VRF profile was associated with worse post-stroke functional outcomes. Further studies are needed to evaluate a lifetime brain injury reflected in WMH unrelated to the VRF profile of a patient as an important factor for stroke recovery and a plausible indicator of brain health.
AB - Objective: To personalize the prognostication of post-stroke outcome using MRI-detected cerebrovascular pathology, we sought to investigate the association between the excessive white matter hyperintensity (WMH) burden unaccounted for by the traditional stroke risk profile of individual patients and their long-term functional outcomes after a stroke. Methods: We included 890 patients who survived after an acute ischemic stroke from the MRI-Genetics Interface Exploration (MRI-GENIE) study, for whom data on vascular risk factors (VRFs), including age, sex, atrial fibrillation, diabetes mellitus, hypertension, coronary artery disease, smoking, prior stroke history, as well as acute stroke severity, 3- to−6-month modified Rankin Scale score (mRS), WMH, and brain volumes, were available. We defined the unaccounted WMH (uWMH) burden via modeling of expected WMH burden based on the VRF profile of each individual patient. The association of uWMH and mRS score was analyzed by linear regression analysis. The odds ratios of patients who achieved full functional independence (mRS < 2) in between trichotomized uWMH burden groups were calculated by pair-wise comparisons. Results: The expected WMH volume was estimated with respect to known VRFs. The uWMH burden was associated with a long-term functional outcome (β = 0.104, p < 0.01). Excessive uWMH burden significantly reduced the odds of achieving full functional independence after a stroke compared to the low and average uWMH burden [OR = 0.4, 95% CI: (0.25, 0.63), p < 0.01 and OR = 0.61, 95% CI: (0.42, 0.87), p < 0.01, respectively]. Conclusion: The excessive amount of uWMH burden unaccounted for by the traditional VRF profile was associated with worse post-stroke functional outcomes. Further studies are needed to evaluate a lifetime brain injury reflected in WMH unrelated to the VRF profile of a patient as an important factor for stroke recovery and a plausible indicator of brain health.
KW - acute ischemic stroke
KW - brain health
KW - brain vulnerability
KW - functional independence
KW - functional outcome after acute stroke
KW - post-stroke outcomes
KW - stroke
KW - white matter hyper intensity
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U2 - 10.3389/fneur.2021.700616
DO - 10.3389/fneur.2021.700616
M3 - Article
AN - SCOPUS:85115694007
SN - 1664-2295
VL - 12
JO - Frontiers in Neurology
JF - Frontiers in Neurology
M1 - 700616
ER -