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Excessive White Matter Hyperintensity Increases Susceptibility to Poor Functional Outcomes After Acute Ischemic Stroke

Hong, Sungmin ; Giese, Anne Katrin ; Schirmer, Markus D. ; Bonkhoff, Anna K. ; Bretzner, Martin ; Rist, Pamela ; Dalca, Adrian V. ; Regenhardt, Robert W. ; Etherton, Mark R. and Donahue, Kathleen L. , et al. (2021) In Frontiers in Neurology 12.
Abstract

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... (More)

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.

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organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
acute ischemic stroke, brain health, brain vulnerability, functional independence, functional outcome after acute stroke, post-stroke outcomes, stroke, white matter hyper intensity
in
Frontiers in Neurology
volume
12
article number
700616
publisher
Frontiers Media S. A.
external identifiers
  • pmid:34566844
  • scopus:85115694007
ISSN
1664-2295
DOI
10.3389/fneur.2021.700616
language
English
LU publication?
yes
additional info
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.
id
06f0654c-fb05-44c2-87e9-18d24e5d4238
date added to LUP
2021-12-15 11:50:54
date last changed
2022-05-05 06:44:51
@article{06f0654c-fb05-44c2-87e9-18d24e5d4238,
  abstract     = {{<p>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 &lt; 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 &lt; 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 &lt; 0.01 and OR = 0.61, 95% CI: (0.42, 0.87), p &lt; 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.</p>}},
  author       = {{Hong, Sungmin and Giese, Anne Katrin and Schirmer, Markus D. and Bonkhoff, Anna K. and Bretzner, Martin and Rist, Pamela and Dalca, Adrian V. and Regenhardt, Robert W. and Etherton, Mark R. and Donahue, Kathleen L. and Nardin, Marco and Mocking, Steven J.T. and McIntosh, Elissa C. and Attia, John and Benavente, Oscar R. and Cole, John W. and Donatti, Amanda and Griessenauer, Christoph J. and Heitsch, Laura and Holmegaard, Lukas and Jood, Katarina and Jimenez-Conde, Jordi and Roquer, Jaume and Kittner, Steven J. and Lemmens, Robin and Levi, Christopher R. and McDonough, Caitrin W. and Meschia, James F. and Phuah, Chia Ling and Rolfs, Arndt and Ropele, Stefan and Rosand, Jonathan and Rundek, Tatjana and Sacco, Ralph L. and Schmidt, Reinhold and Enzinger, Christian and Sharma, Pankaj and Slowik, Agnieszka and Sousa, Alessandro and Stanne, Tara M. and Strbian, Daniel and Tatlisumak, Turgut and Thijs, Vincent and Vagal, Achala and Wasselius, Johan and Woo, Daniel and Zand, Ramin and McArdle, Patrick F. and Worrall, Bradford B. and Wu, Ona and Jern, Christina and Lindgren, Arne G. and Maguire, Jane and Tomppo, Liisa and Golland, Polina and Rost, Natalia S.}},
  issn         = {{1664-2295}},
  keywords     = {{acute ischemic stroke; brain health; brain vulnerability; functional independence; functional outcome after acute stroke; post-stroke outcomes; stroke; white matter hyper intensity}},
  language     = {{eng}},
  month        = {{09}},
  publisher    = {{Frontiers Media S. A.}},
  series       = {{Frontiers in Neurology}},
  title        = {{Excessive White Matter Hyperintensity Increases Susceptibility to Poor Functional Outcomes After Acute Ischemic Stroke}},
  url          = {{http://dx.doi.org/10.3389/fneur.2021.700616}},
  doi          = {{10.3389/fneur.2021.700616}},
  volume       = {{12}},
  year         = {{2021}},
}