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White matter hyperintensity burden in acute stroke patients differs by ischemic stroke subtype

Giese, Anne Katrin ; Schirmer, Markus D. ; Dalca, Adrian V. ; Sridharan, Ramesh ; Donahue, Kathleen L. ; Nardin, Marco ; Irie, Robert ; McIntosh, Elissa C. ; Mocking, Steven J.T. and Xu, Huichun , et al. (2020) In Neurology 95(1). p.79-88
Abstract

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... (More)

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.

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organization
publishing date
type
Contribution to journal
publication status
published
subject
in
Neurology
volume
95
issue
1
pages
10 pages
publisher
Lippincott Williams & Wilkins
external identifiers
  • pmid:32493718
  • scopus:85088211081
ISSN
0028-3878
DOI
10.1212/WNL.0000000000009728
language
English
LU publication?
yes
id
e17fbadd-f23b-4524-9542-e8555caf4215
date added to LUP
2021-01-12 11:06:19
date last changed
2022-05-12 17:21:44
@article{e17fbadd-f23b-4524-9542-e8555caf4215,
  abstract     = {{<p>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 &lt; 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 &lt; 0.0001). In multivariable analysis, age, hypertension, prior stroke, smoking (all p &lt; 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 &lt; 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. </p>}},
  author       = {{Giese, Anne Katrin and Schirmer, Markus D. and Dalca, Adrian V. and Sridharan, Ramesh and Donahue, Kathleen L. and Nardin, Marco and Irie, Robert and McIntosh, Elissa C. and Mocking, Steven J.T. and Xu, Huichun and Cole, John W. and Giralt-Steinhauer, Eva and Jimenez-Conde, Jordi and Jern, Christina and Kleindorfer, Dawn O. and Lemmens, Robin and Wasselius, Johan and Lindgren, Arne and Rundek, Tatjana and Sacco, Ralph L. and Schmidt, Reinhold and Sharma, Pankaj and Slowik, Agnieszka and Thijs, Vincent and Worrall, Bradford B. and Woo, Daniel and Kittner, Steven J. and McArdle, Patrick F. and Mitchell, Braxton D. and Rosand, Jonathan and Meschia, James F. and Wu, Ona and Golland, Polina and Rost, Natalia S.}},
  issn         = {{0028-3878}},
  language     = {{eng}},
  month        = {{07}},
  number       = {{1}},
  pages        = {{79--88}},
  publisher    = {{Lippincott Williams & Wilkins}},
  series       = {{Neurology}},
  title        = {{White matter hyperintensity burden in acute stroke patients differs by ischemic stroke subtype}},
  url          = {{http://dx.doi.org/10.1212/WNL.0000000000009728}},
  doi          = {{10.1212/WNL.0000000000009728}},
  volume       = {{95}},
  year         = {{2020}},
}