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

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

    Date
    2021-09-10
    Journal
    Frontiers in Neurology
    Publisher
    Frontiers Media S.A.
    Type
    Article
    
    Metadata
    Show full item record
    See at
    https://doi.org/10.3389/fneur.2021.700616
    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.
    Rights/Terms
    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.
    Keyword
    acute ischemic stroke
    brain health
    brain vulnerability
    functional independence
    functional outcome after acute stroke
    post-stroke outcomes
    stroke
    white matter hyperintensity
    Identifier to cite or link to this item
    http://hdl.handle.net/10713/16739
    ae974a485f413a2113503eed53cd6c53
    10.3389/fneur.2021.700616
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