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

Giese, Anne Katrin (author)
Broad Institute,Harvard Medical School
Schirmer, Markus D. (author)
Massachusetts Institute of Technology,Harvard Medical School,German Center for Neurodegenerative Diseases (DZNE), Bonn
Dalca, Adrian V. (author)
Massachusetts General Hospital,Massachusetts Institute of Technology
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Sridharan, Ramesh (author)
Massachusetts Institute of Technology
Donahue, Kathleen L. (author)
Harvard Medical School
Nardin, Marco (author)
Harvard Medical School
Irie, Robert (author)
Massachusetts General Hospital
McIntosh, Elissa C. (author)
Massachusetts General Hospital
Mocking, Steven J.T. (author)
Massachusetts General Hospital
Xu, Huichun (author)
Slotervaart Hospital
Cole, John W. (author)
Slotervaart Hospital
Giralt-Steinhauer, Eva (author)
Autonomous University of Barcelona
Jimenez-Conde, Jordi (author)
Autonomous University of Barcelona
Jern, Christina (author)
University of Gothenburg
Kleindorfer, Dawn O. (author)
University of Cincinnati College of Medicine
Lemmens, Robin (author)
Catholic University of Leuven,University Hospitals Leuven
Wasselius, Johan (author)
Lund University,Lunds universitet,Diagnostisk radiologi, Lund,Sektion V,Institutionen för kliniska vetenskaper, Lund,Medicinska fakulteten,Neuroradiologi,Forskargrupper vid Lunds universitet,Stroke Imaging Research group,Diagnostic Radiology, (Lund),Section V,Department of Clinical Sciences, Lund,Faculty of Medicine,Neuroradiology,Lund University Research Groups
Lindgren, Arne (author)
Lund University,Lunds universitet,Neurologi, Lund,Sektion IV,Institutionen för kliniska vetenskaper, Lund,Medicinska fakulteten,Klinisk strokeforskning,Forskargrupper vid Lunds universitet,Neurology, Lund,Section IV,Department of Clinical Sciences, Lund,Faculty of Medicine,Clinical Stroke Research Group,Lund University Research Groups
Rundek, Tatjana (author)
University of Miami
Sacco, Ralph L. (author)
University of Miami
Schmidt, Reinhold (author)
Medical University of Graz
Sharma, Pankaj (author)
Ashford And St Peter's Hospital,Royal Holloway University of London
Slowik, Agnieszka (author)
Jagiellonian University
Thijs, Vincent (author)
University of Melbourne,Austin Health
Worrall, Bradford B. (author)
University of Virginia,Massachusetts General Hospital
Woo, Daniel (author)
University of Cincinnati College of Medicine
Kittner, Steven J. (author)
Slotervaart Hospital
McArdle, Patrick F. (author)
Slotervaart Hospital
Mitchell, Braxton D. (author)
Slotervaart Hospital
Rosand, Jonathan (author)
Harvard Medical School,Broad Institute,Massachusetts General Hospital
Meschia, James F. (author)
Mayo Clinic Florida
Wu, Ona (author)
Massachusetts General Hospital,Harvard Medical School
Golland, Polina (author)
Massachusetts Institute of Technology
Rost, Natalia S. (author)
Harvard Medical School
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 (creator_code:org_t)
2020
2020
English 10 s.
In: Neurology. - 0028-3878. ; 95:1, s. 79-88
Related links:
http://dx.doi.org/10...
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https://lup.lub.lu.s...
https://doi.org/10.1...
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  • Journal article (peer-reviewed)
Abstract Subject headings
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  • 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.

Subject headings

MEDICIN OCH HÄLSOVETENSKAP  -- Klinisk medicin -- Neurologi (hsv//swe)
MEDICAL AND HEALTH SCIENCES  -- Clinical Medicine -- Neurology (hsv//eng)

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