TY - JOUR
T1 - White matter hyperintensity burden in acute stroke patients differs by ischemic stroke subtype
AU - Giese, Anne Katrin
AU - Schirmer, Markus D.
AU - Dalca, Adrian V.
AU - Sridharan, Ramesh
AU - Donahue, Kathleen L.
AU - Nardin, Marco
AU - Irie, Robert
AU - McIntosh, Elissa C.
AU - Mocking, Steven J.T.
AU - Xu, Huichun
AU - Cole, John W.
AU - Giralt-Steinhauer, Eva
AU - Jimenez-Conde, Jordi
AU - Jern, Christina
AU - Kleindorfer, Dawn O.
AU - Lemmens, Robin
AU - Wasselius, Johan
AU - Lindgren, Arne
AU - Rundek, Tatjana
AU - Sacco, Ralph L.
AU - Schmidt, Reinhold
AU - Sharma, Pankaj
AU - Slowik, Agnieszka
AU - Thijs, Vincent
AU - Worrall, Bradford B.
AU - Woo, Daniel
AU - Kittner, Steven J.
AU - McArdle, Patrick F.
AU - Mitchell, Braxton D.
AU - Rosand, Jonathan
AU - Meschia, James F.
AU - Wu, Ona
AU - Golland, Polina
AU - Rost, Natalia S.
N1 - Publisher Copyright:
© 2020 American Academy of Neurology.
PY - 2020/7/7
Y1 - 2020/7/7
N2 - 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.
AB - 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.
UR - https://www.scopus.com/pages/publications/85088211081
U2 - 10.1212/WNL.0000000000009728
DO - 10.1212/WNL.0000000000009728
M3 - Article
C2 - 32493718
AN - SCOPUS:85088211081
SN - 0028-3878
VL - 95
SP - 79
EP - 88
JO - Neurology
JF - Neurology
IS - 1
ER -