- Title
- Excessive White Matter Hyperintensity Increases Susceptibility to Poor Functional Outcomes After Acute Ischemic Stroke
- Creator
- 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, J; Roquer, J; Kittner, SJ; Lemmens, R; Levi, CR; McDonough, CW; Meschia, JF; Phuah, CL; Rolfs, A; Ropele, S; Rosand, J; Rundek, T; Sacco, RL; Schmidt, R; Enzinger, C; Sharma, P; Slowik, A; Sousa, A; Stanne, TM; Strbian, D; Tatlisumak, T; Thijs, V; Vagal, A; Wasselius, J; Woo, D; Zand, R; McArdle, PF; Worrall, BB; Wu, O; Jern, C; Lindgren, AG; Maguire, J; Tomppo, L; Golland, P; Rost, NS
- Relation
- Frontiers in Neurology Vol. 12, Issue 10 September 2021, no. 700616
- Publisher Link
- http://dx.doi.org/10.3389/fneur.2021.700616
- Publisher
- Frontiers Research Foundation
- Resource Type
- journal article
- Date
- 2021
- Description
- 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.
- Subject
- acute ischemic stroke; brain health; brain vulnerability; functional independence; functional outocome after acute stroke; post-stroke outcomes; SDG 3; Sustainable Development Goals
- Identifier
- http://hdl.handle.net/1959.13/1435252
- Identifier
- uon:39658
- Identifier
- ISSN:1664-2295
- Rights
- © 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. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
- Language
- eng
- Full Text
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