Dataset Information

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

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 (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.

SUBMITTER: Hong S

PROVIDER: S-EPMC8461233 | biostudies-literature | 2021

REPOSITORIES: biostudies-literature

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

Hong Sungmin S Giese Anne-Katrin AK Schirmer Markus D MD Bonkhoff Anna K AK Bretzner Martin M Rist Pamela P Dalca Adrian V AV Regenhardt Robert W RW Etherton Mark R MR Donahue Kathleen L KL Nardin Marco M Mocking Steven J T SJT McIntosh Elissa C EC Attia John J Benavente Oscar R OR Cole John W JW Donatti Amanda A Griessenauer Christoph J CJ Heitsch Laura L Holmegaard Lukas L Jood Katarina K Jimenez-Conde Jordi J Roquer Jaume J Kittner Steven J SJ Lemmens Robin R Levi Christopher R CR McDonough Caitrin W CW Meschia James F JF Phuah Chia-Ling CL Rolfs Arndt A Ropele Stefan S Rosand Jonathan J Rundek Tatjana T Sacco Ralph L RL Schmidt Reinhold R Enzinger Christian C Sharma Pankaj P Slowik Agnieszka A Sousa Alessandro A Stanne Tara M TM Strbian Daniel D Tatlisumak Turgut T Thijs Vincent V Vagal Achala A Wasselius Johan J Woo Daniel D Zand Ramin R McArdle Patrick F PF Worrall Bradford B BB Wu Ona O Jern Christina C Lindgren Arne G AG Maguire Jane J Tomppo Liisa L Golland Polina P Rost Natalia S NS

Frontiers in neurology 20210910

<b>Objective:</b> 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. <b>Methods:</b> We included 890 patients who survived after an acute ischemic stroke from the MRI-Genetics Interface Exploration (MRI-GENIE) ...[more]

PMID: 34566844

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Project description:ImportanceAlthough increasing evidence suggests that trimethylamine N-oxide (TMAO) is associated with atherosclerosis, little is known about whether TMAO and its related metabolites (ie, choline, betaine, and carnitine) are associated with small vessel disease.ObjectiveTo evaluate the association between TMAO and its related metabolites with features of cerebral small vessel disease, including white matter hyperintensity volume (WMHV) and acute lacunar infarction.Design, setting, and participantsThis cross-sectional study included patients enrolled in the Specialized Programs of Translational Research in Acute Stroke biorepository. The registry included 522 patients with acute ischemic stroke who were 18 years or older who presented at the Massachusetts General Hospital or Brigham and Women's Hospital within 9 hours after onset between January 2007 and April 2010. The analyses in this study were conducted between November 2022 and April 2023.ExposuresPlasma TMAO, choline, betaine, and carnitine were measured by liquid chromatography-tandem mass spectrometry.Main outcomes and measuresWMHV was quantified by a semiautomated approach using signal intensity threshold with subsequent manual editing. Ischemic stroke subtype was classified using the Causative Classification System.ResultsAmong 351 patients included in this study, the mean (SD) age was 69 (15) years; 209 patients (59.5%) were male and had a median (IQR) admission National Institute of Health Stroke Scale of 6 (3-13). The magnetic resonance imaging subgroup consisted of 291 patients with a mean (SD) age of 67 (15) years. Among these, the median (IQR) WMHV was 3.2 (1.31-8.4) cm3. TMAO was associated with WMHV after adjustment for age and sex (β, 0.15; 95% CI, 0.01-0.29; P < .001). TMAO remained significant in a multivariate analysis adjusted for age, sex, hypertension, diabetes, and smoking (β, 0.14; 95% CI, 0-0.29; P = .05). TMAO was associated with lacunar stroke but not other ischemic stroke subtypes in a model adjusted for age, sex, hypertension, diabetes, and smoking (OR, 1.67; 95% CI, 1.05-2.66; P = .03).Conclusions and relevanceIn this observational study, TMAO was associated with cerebral small vessel disease determined by WMHV and acute lacunar infarction. The association was independent of traditional vascular risk factors.

Project description:BackgroundWhite matter hyperintensity (WMH) and brain atrophy, as imaging marker of cerebral small-vessel diseases (CSVD), have a high prevalence and strong prognostic value in stroke. We aimed to explore the association between lymphocyte count, a maker of inflammation, and WMH and brain atrophy in patients with acute ischemic stroke (AIS).MethodsA total of 727 AIS patients with lymphocyte count and brain magnetic resonance imaging data were enrolled. Participants were divided into four groups according to the quartiles of baseline lymphocyte counts. WMH is frequently divided into periventricular hyperintensity (PVH) and deep white matter hyperintensity (DWMH). WMH was defined as Fazekas scale score ≥ 3; PVH was defined as periventricular Fazekas scale ≥2; DWMH was defined as deep Fazekas scale ≥2. Brain atrophy was defined as global cortical atrophy score ≥ 1. Multivariable logistic regression models were used to assess the association between lymphocyte count and WMH and brain atrophy.ResultsAmong 727 AIS, 517 (71.1%), 442 (60.8%), 459 (63.1%), 583 (80.2%) had WMH, PVH, DWMH and brain atrophy, respectively. After adjustment for potential covariates, the highest quartiles of lymphocyte counts were significantly associated with lower risk of WMH (adjusted odds ratio [aOR] 0.57, 95% confidence intervals [CI] 0.32-0.99), PVH (aOR 0.52, 95% CI 0.31-0.87), DWMH (aOR 0.53 95% CI 0.32-0.90) as well as brain atrophy (aOR 0.46, 95% CI 0.23-0.92) compared with the lowest quartiles of lymphocyte counts, respectively. Furthermore, a notable inverse association was observed between continuous lymphocyte counts and WMH, PVH, DWMH, and brain atrophy. Additionally, we found that the inverse association between baseline lymphocyte count and WMH was significant only in individuals with mild stroke.ConclusionIn patients with AIS, there was an independent and inverse association between the baseline lymphocyte count and both WMH and brain atrophy.

Project description:BackgroundThe influence of white matter hyperintensity (WMH) on clinical outcomes in acute ischemic stroke (AIS) patients treated with mechanical thrombectomy (MT) remains controversial. We performed a systematic review and meta-analysis to examine whether WMH burden is associated with clinical outcomes in AIS patients after MT.MethodsPubMed, Embase, and Web of Science were searched from inception to Sep 03, 2023. The registration number for PROSPERO is CRD42022340568. Studies reporting an association between the burden of WMH in AIS patients and clinical outcomes after MT were included in the meta-analysis. A random-effects model was used for meta-analysis. The quality of the included studies was assessed using the Newcastle-Ottawa Scale. Additionally, the presence of imprecise-study effects was evaluated using Egger's test and funnel plot.ResultsFifteen studies with 3,456 patients were enrolled in this meta-analysis. Among AIS patients who underwent MT, moderate/severe WMH had higher odds of 90-day unfavorable functional outcomes (odds ratio [OR] 2.72, 95% confidence interval [CI] 2.14-3.44; I2 = 0.0%; 95% CI 0.0%-42.7%), 90-day mortality (OR 1.94, 95% CI 1.45-2.60; I2 = 19.5%; 95% CI 0.0%-65.2%) and futile recanalization (OR 2.99, 95% CI 1.42-6.28; I2 = 69.7%; 95% CI 0.0%-91.0%) compared with none/mild WMH. However, the two groups had no significant difference in successful recanalization, symptomatic hemorrhagic transformation, and hemorrhagic transformation. A subset analysis of patients from 3 articles showed that WMH volume was not significantly associated with these outcomes. A notable limitation is that this meta-analysis lacks direct adjustment for imbalances in important baseline covariates.ConclusionsPatients with moderate/severe WMH on baseline imaging are associated with substantially increased odds of 90-day unfavorable outcomes, futile recanalization, and 90-day mortality after MT. This association suggests that moderate/severe WMH may contribute to the prediction of clinical outcomes in AIS patients after MT.

Dataset Information

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

Publications

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

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