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

TY - JOUR

T1 - Excessive White Matter Hyperintensity Increases Susceptibility to Poor Functional Outcomes After Acute Ischemic Stroke

AU - Hong, Sungmin

AU - Giese, Anne-Katrin

AU - Schirmer, Markus D

AU - Bonkhoff, Anna K

AU - Bretzner, Martin

AU - Rist, Pamela

AU - Dalca, Adrian V

AU - Regenhardt, Robert W

AU - Etherton, Mark R

AU - Donahue, Kathleen L

AU - Nardin, Marco

AU - Mocking, Steven J T

AU - McIntosh, Elissa C

AU - Attia, John

AU - Benavente, Oscar R

AU - Cole, John W

AU - Donatti, Amanda

AU - Griessenauer, Christoph J

AU - Heitsch, Laura

AU - Holmegaard, Lukas

AU - Jood, Katarina

AU - Jimenez-Conde, Jordi

AU - Roquer, Jaume

AU - Kittner, Steven J

AU - Lemmens, Robin

AU - Levi, Christopher R

AU - McDonough, Caitrin W

AU - Meschia, James F

AU - Phuah, Chia-Ling

AU - Rolfs, Arndt

AU - Ropele, Stefan

AU - Rosand, Jonathan

AU - Rundek, Tatjana

AU - Sacco, Ralph L

AU - Schmidt, Reinhold

AU - Enzinger, Christian

AU - Sharma, Pankaj

AU - Slowik, Agnieszka

AU - Sousa, Alessandro

AU - Stanne, Tara M

AU - Strbian, Daniel

AU - Tatlisumak, Turgut

AU - Thijs, Vincent

AU - Vagal, Achala

AU - Wasselius, Johan

AU - Woo, Daniel

AU - Zand, Ramin

AU - McArdle, Patrick F

AU - Worrall, Bradford B

AU - Wu, Ona

AU - Jern, Christina

AU - Lindgren, Arne G

AU - Maguire, Jane

AU - Tomppo, Liisa

AU - Golland, Polina

AU - Rost, Natalia S

AU - MRI-GENIE and GISCOME Investigators and the International Stroke Genetics Consortium

N1 - 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.

PY - 2021

Y1 - 2021

N2 - 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.

AB - 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.

U2 - 10.3389/fneur.2021.700616

DO - 10.3389/fneur.2021.700616

M3 - SCORING: Journal article

C2 - 34566844

VL - 12

JO - FRONT NEUROL

JF - FRONT NEUROL

SN - 1664-2295

M1 - 700616

ER -