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Title: White matter hyperintensity burden in acute stroke patients differs by ischemic stroke subtype.
Austin Authors: 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;Xu, Huichun;Cole, John W;Giralt-Steinhauer, Eva;Jimenez-Conde, Jordi;Jern, Christina;Kleindorfer, Dawn O;Lemmens, Robin;Wasselius, Johan;Lindgren, Arne;Rundek, Tatjana;Sacco, Ralph L;Schmidt, Reinhold;Sharma, Pankaj;Slowik, Agnieszka;Thijs, Vincent N ;Worrall, Bradford B;Woo, Daniel;Kittner, Steven J;McArdle, Patrick F;Mitchell, Braxton D;Rosand, Jonathan;Meschia, James F;Wu, Ona;Golland, Polina;Rost, Natalia S
Affiliation: KU Leuven-University of Leuven, Department of Neurosciences, Experimental Neurology
Stroke Division, The Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Heidelberg, Victoria, Australia
Department of Neurology, Austin Health, Heidelberg, Victoria, Australia
Departments of Neurology and Public Health Sciences, University of Virginia, Charlottesville
Center for Genomic Medicine, Massachusetts General Hospital
Institute of Cardiovascular Research, Royal Holloway University of London, Egham, UK
Henry and Allison McCance Center for Brain Health, Boston, MA
Department of Neurology, Mayo Clinic, Jacksonville, FL
Department of Neurology, Jagiellonian University Medical College, Krakow, Poland
Department of Neurology, Clinical Division of Neurogeriatrics, Medical University Graz, Austria
Department of Neurology, Miller School of Medicine, University of Miami, The Evelyn F. McKnight Brain Institute, FL
Department of Neurology and Rehabilitation Medicine, Neurology, Skåne University Hospital, Lund, Sweden
Department of Clinical Sciences Lund, Neurology, Lund University
VIB, Vesalius Research Center, Laboratory of Neurobiology, University Hospitals Leuven, Department of Neurology, Belgium
Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston
Ashford and St Peter's Hospital, UK
Program in Medical and Population Genetics, Broad Institute of MIT and Harvard, Computer Science and Artificial Intelligence Lab, Massachusetts Institute of Technology, Cambridge
Department of Population Health Sciences, German Centre for Neurodegenerative Diseases, Bonn, Germany
Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Charlestown
Division of Endocrinology, Diabetes and Nutrition, Department of Medicine, University of Maryland School of Medicine
Department of Neurology, University of Maryland School of Medicine and Veterans Affairs Maryland Health Care System, Baltimore
Department of Neurology, Neurovascular Research Group, IMIM-Hospital del Mar (Institut Hospital del Mar d'Investigacions Mèdiques), Universitat Autonoma de Barcelona, Spain
Institute of Biomedicine, Sahlgrenska Academy at University of Gothenburg, Sweden
Department of Neurology and Rehabilitation Medicine\, University of Cincinnati College of Medicine, OH
Issue Date: Jul-2020 2020-06-03
Publication information: Neurology 2020; 95(1): e79-e88
Abstract: To 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). For 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. Patients 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). In 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.
DOI: 10.1212/WNL.0000000000009728
ORCID: 0000-0002-8500-2376
PubMed URL: 32493718
Type: Journal Article
Appears in Collections:Journal articles

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