Abstract TMP58: Determinants of White Matter Hyperintensity in Acute Ischemic Stroke Patients: The MRI-GENIE Study

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Anne-Katrin Giese ◽  
Markus D Schirmer ◽  
Adrian V Dalca ◽  
Ramesh Sridharan ◽  
Lisa Cloonan ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Risk Factors ◽  
Ischemic Stroke ◽  
White Matter ◽  
Stroke Risk ◽  
Smoking Status ◽  
Vascular Risk Factors ◽  
White Matter Hyperintensity ◽  
Vascular Risk ◽  
Prior Stroke

Introduction: White matter hyperintensity (WMH) is a highly heritable trait and a significant contributor to stroke risk and severity. Vascular risk factors contribute to WMH severity; however, knowledge of the determinants of WMH in acute ischemic stroke (AIS) is still limited. Hypothesis: WMH volume (WMHv) varies across AIS subtypes and is modified by vascular risk factors. Methods: We extracted WMHv from the clinical MRI scans of 2683 AIS subjects from the MRI-Genetics Interface Exploration (MRI-GENIE) study using a novel fully-automated, volumetric analysis pipeline. Demographic data, stroke risk factors and stroke subtyping for the Causative Classification of Stroke (CCS) were performed at each of the 12 international study sites. WMHv was natural log-transformed for linear regression analyses. Results: Median WMHv was 5.7cm 3 (interquartile range (IQR): 2.2-12.8cm 3 ). In univariable analysis, age (63.1 ± 14.7 years, β=0.04, SE=0.002), prior stroke (10.2%, β=0.66, SE=0.08), hypertension (65.4%, β=0.75, SE=0.05), diabetes mellitus (23.1%, β=0.35, SE=0.06), coronary artery disease (17.6%, β=0.04, SE=0.002), and atrial fibrillation (14.6%, β=0.48, SE=0.07) were significant predictors of WMHv (all p<0.0001), as well as smoking status (52.2%, β=0.15, SE=0.05, p=0.005), race (16.5% Non-Caucasian, β=0.25, SE=0.07) and ethnicity (8.2% Hispanic, β=0.30, SE=0.11) (all p<0.01). In multivariable analysis, age (β=0.04, SE=0.002), prior stroke (β=0.56, SE=0.08), hypertension (β=0.33, SE=0.05), smoking status (β=0.16, SE=0.05), race (β=0.42, SE=0.06), and ethnicity (β=0.34, SE=0.09) were independent predictors of WMHv (all p<0.0001), as well as diabetes mellitus (β=0.13, SE=0.06, p=0.02). WMHv differed significantly (p<0.0001, unadjusted) across CCS stroke subtypes: cardioembolic stroke (8.0cm 3 , IQR: 4.2-15.4cm 3 ), large-artery stroke (6.9cm 3 , IQR: 3.1-14.7cm 3 ), small-vessel stroke (5.8cm 3 , IQR: 2.5-13.5cm 3 ), stroke of undetermined (4.7cm 3 , IQR: 1.6-11.0cm 3 ) or other (2.55cm 3 , IQR: 0.9-8.8cm 3 ) causes. Conclusion: In this largest-to-date, multicenter hospital-based cohort of AIS patients with automated WMHv analysis, common vascular risk factors contribute significantly to WMH burden and WMHv varies by CCS subtype.

Abstract W MP58: The Relationship Between Carotid Stiffness, Diastolic Diameter, and White Matter Hyperintensity Volume: The Northern Manhattan Study

Stroke ◽  
2014 ◽  
Vol 45 (suppl_1) ◽  
Author(s):  
Matthew S Markert ◽  
Chuanhui Dong ◽  
David Della-Morte ◽  
Eugene Roberts ◽  
Susanne Bartels ◽  
...  
Keyword(s):  
Risk Factors ◽  
White Matter ◽  
Small Vessel Disease ◽  
Vascular Risk Factors ◽  
Small Vessel ◽  
White Matter Hyperintensity ◽  
Large Artery ◽  
Vascular Risk ◽  
Vessel Disease ◽  
Carotid Stiffness

Background: Changes in the extracranial vasculature may be associated with small vessel disease in the brain. We sought to examine the association of carotid stiffness and carotid diastolic diameter with white matter hyperintensity volume (WMHV), a magnetic resonance imaging (MRI) measure for cerebral small vessel disease, in a multi-ethnic community-based cohort. Methods: We evaluated 1140 stroke-free participants in the Northern Manhattan study who underwent brain MRIs and high-resolution carotid ultrasounds. We used linear regression to examine carotid stiffness and diastolic diameter with WMHV after adjusting for sociodemographics, lifestyle behaviors, and traditional vascular risk factors. Results: Among 1140 participants (mean age: 70.6±9.0 years; 61% women; 15% White, 16% Black, 59% Hispanics), the mean carotid stiffness was 8.19 ± 5.39, mean carotid diastolic diameter was 6.16 ± 0.93 mm, and mean WMHV 0.68 ± 0.84. In a fully adjusted model, diastolic diameter was associated with log-WMHV (β=0.10, p=0.001). In a stratified multivariable linear model, greater carotid arterial stiffness and diastolic diameter were associated with log-WMHV among Hispanics (β=0.15, p=0.005 and β=0.13, p<0.001, respectively), but not among blacks or whites. Conclusion: Greater carotid stiffness and diastolic diameter were associated with greater WMHV independent of demographics and traditional vascular risk factors, especially among Hispanics. Further studies are needed to understand how these large artery characteristics relate to WMH formation and lesion load. Carotid ultrasound may be a useful tool to assess the risk of increased brain white matter disease in a pre-clinical stage.

Abstract WMP65: Association Between Sinus Bradycardia and Ischemic Stroke

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Sammy D Pishanidar ◽  
Saad A Mir ◽  
Hooman Kamel ◽  
Alexander E Merkler ◽  
Gino Gialdini ◽  
...  
Keyword(s):  
Risk Factors ◽  
Atrial Fibrillation ◽  
Ischemic Stroke ◽  
Acute Stroke ◽  
Stroke Risk ◽  
Sinus Bradycardia ◽  
Cryptogenic Stroke ◽  
Vascular Risk Factors ◽  
Vascular Risk ◽  
Medicare Beneficiaries

Background and Purpose: We assessed whether sinus bradycardia is an early sign of atrial dysfunction that might predispose to atrial thrombogenesis and therefore be associated with stroke risk. Methods: We retrospectively used inpatient and outpatient claims data from a 5% sample of Medicare beneficiaries ≥ 66 years old from 2008-2014. Our predictor variable was sinus bradycardia, defined as ICD-9-CM code 427.8x. Our primary outcome was ischemic stroke, ascertained using a previously validated diagnosis code algorithm. Patients with ischemic stroke or atrial fibrillation/flutter prior to or at the time of a bradycardia diagnosis were excluded. We used Cox regression analysis adjusted for demographics and vascular risk factors to evaluate the association between sinus bradycardia and the risk of stroke. Patients were censored at the time of a diagnosis of atrial fibrillation/flutter. In a confirmatory analysis, we assessed whether sinus bradycardia was more common in patients with cryptogenic stroke compared to stroke due to large-artery atherosclerosis or small-vessel disease using data from the Cornell AcutE Stroke Academic Registry (CAESAR), which comprises all adults with acute stroke at New York-Presbyterian Hospital/Weill Cornell Medical Center from 2011 to 2014. Results: Among 1,417,069 Medicare beneficiaries (mean age 73.4 +/- 7.6 years) who were followed for a mean of 4.36 (+/- 1.8) years, 63,385 patients received a diagnosis of sinus bradycardia. Bradycardia was significantly associated with stroke in unadjusted analysis (hazard ratio [HR], 1.7; 95% confidence interval [CI], 1.6-1.8) but not after adjustment for demographics and vascular risk factors (HR, 0.9; 95% CI, 0.8-0.9). Among 608 patients with cryptogenic or non-cardioembolic stroke in CAESAR, 93 (15.3%) had sinus bradycardia. We did not find an association between sinus bradycardia and cryptogenic stroke after adjustment for demographics, stroke severity, insular infarction, and vascular comorbidities (OR 0.9, 95% CI 0.4-1.9). Conclusion: We found no association between sinus bradycardia and future stroke risk in stroke-free patients nor an over-representation of sinus bradycardia among cryptogenic strokes versus non-cardioembolic strokes.

scholarly journals Cardiovascular risk factors and small vessel disease of the brain: Blood pressure, white matter lesions, and functional decline in older persons

2015 ◽  
Vol 36 (1) ◽  
pp. 132-142 ◽  
Author(s):  
Hazel Mae A Abraham ◽  
Leslie Wolfson ◽  
Nicola Moscufo ◽  
Charles R G Guttmann ◽  
Richard F Kaplan ◽  
...  
Keyword(s):  
Risk Factors ◽  
Blood Pressure ◽  
White Matter ◽  
Older People ◽  
Older Persons ◽  
Functional Decline ◽  
Vascular Risk Factors ◽  
White Matter Hyperintensity ◽  
Systemic Hypertension ◽  
Vascular Risk

Several potential vascular risk factors exist for the development and accumulation of subcortical white matter disease in older people. We have reported that in older people followed for up to 4 years white matter hyperintensity (WMH) lesions on magnetic resonance imaging nearly doubled in volume and were associated with alterations in mobility and cognitive function. Herein we review the genetic, metabolic, and vascular risk factors that have been evaluated in association with the development and pathogenesis of WMH in older persons. Our research efforts have focused on systemic hypertension, particularly in the out-of-office setting as 24-hour ambulatory blood pressure (BP) has proven to be a stronger indicator of the progression of WMH in older people and the associated functional decline than doctor’s office BP. Based on relations between 24-hour systolic BP levels, the accrual of WMH, and functional decline, we have designed the INFINITY trial, the first interventional study to use ambulatory BP to guide antihypertensive therapy to address this problem in the geriatric population.

scholarly journals White Matter Hyperintensity in Different Migraine Subtypes

2021 ◽  
Author(s):  
Larisa A. Dobrynina ◽  
Anastasia D. Suslina ◽  
Mariia V. Gubanova ◽  
Anastasia V. Belopasova ◽  
Anastasia N. Sergeeva ◽  
...  
Keyword(s):  
Risk Factors ◽  
White Matter ◽  
Brain Mri ◽  
Vascular Complications ◽  
Diagnostic Value ◽  
Vascular Risk Factors ◽  
White Matter Hyperintensity ◽  
Control Group ◽  
Vascular Risk ◽  
Different Types

Abstract Background: The diagnostic value of white matter hyperintensities (WMH) in different types of migraine are unknown. Objective: To evaluate the WMH pattern of different subtypes in migraine patients with no vascular risk factors.Methods: 92 migraine patients (73 females, mean age 34.6±8.9; 61 episodic migraine, 31 chronic migraine, 36 migraine with aura, 56 migraine without aura) without vascular risk factors underwent brain MRI (3T). We also included a matched healthy control group with no migraine (n=24).Results: The prevalence of WMH in different types of migraine was similar and ranged from 38.7% to 44.4%; the control group showed no WMH at all. Lesions were located within frontal, parietal and temporal lobes (in order of decreasing incidence) in juxtacortical and/or deep white matter. WMH appeared as round or slightly elongated foci with a median size of 2.5 mm [1.5; 3]. Total number, size and prevalence of WMH by lobes and white matter regions were similar between groups, and no interaction with age or sex was found. The number of lesions within the frontal lobe juxtacortical white matter correlated with the age of patients (r= 0.331, p=0.001) and the duration since migraine onset (r=0.264, p=0.012). Conclusion: Patients with different migraine subtypes and without vascular risk factors are characterized by a similar pattern of WMH in the absence of subclinical infarctions or microbleedings. Therefore, WMH have no relevant prognostic value regarding the course of migraine and vascular complications. WMH pattern may be used to differentiate migraine as a primary disorder and other disorders with migraine-like headache and WMH.

Abstract 1122‐000237: Prior Vascular Risk Factors Affecting Presentation Time and Utilization of Acute Ischemic Stroke Therapies

2021 ◽  
Vol 1 (S1) ◽  
Author(s):  
Jude H Charles ◽  
Mario P Zamora ◽  
Dileep R Yavagal
Keyword(s):  
Risk Factors ◽  
High School ◽  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Vascular Risk Factors ◽  
Vascular Risk ◽  
Grade School ◽  
Stroke Therapy ◽  
History Of ◽  
Prior Stroke

Introduction : Multiple factors have been reported to influence the time between onset of symptoms in acute ischemic stroke and hospital presentation. Although education level is one independent factor in presentation, as we previously reported, health literacy has not been fully assessed regarding specific patient knowledge on stroke or its known risk factors. This study aims to determine whether having a history of vascular risk factors such as prior stroke, coronary artery disease (CAD), or atrial fibrillation (AF) influence presentation time and acute ischemic stroke therapy utilization. Methods : This study included 250 acute ischemic stroke patients presenting to a large academic community hospital from February to December 2018. Educational level was defined within four categories: Grade School, High School, College or Higher, and Unknown. Last seen normal, symptom onset, and arrival times were acquired. Vascular risk factors chosen for this study included prior stroke, CAD, and AF. History of vascular risk factors was verified by medical documentation showing prior diagnosis by physician. Initial NIH Stroke Scale score, stroke location, vessel involved, LDL, hemoglobin A1c, gender, and race were also obtained. Patients were categorized based on their level of education, the presence or absence of vascular risk factors, and utilization of tPA or thrombectomy (MT). The primary outcomes were onset‐to‐arrival time (OTA), in minutes, and utilization rates of acute ischemic stroke therapies (either tPA, MT, or both). Subgroup analysis was conducted to associate education level with each vascular risk factor, comparing OTA and acute ischemic stroke therapy utilization rate. Results : As previously reported, educational level was inversely associated with OTA and positively associated with utilization of at least one acute ischemic stroke therapy. Prior stroke, CAD, and AF showed a substantial OTA decrease for all education groups except for College. Prior stroke decreased OTA in Grade School by 24% (764 vs. 579); High School by 30% (222 vs. 154) and College by 20% (52 vs. 41). CAD decreased OTA in Grade School by 65% (734 vs. 253), High School by 14% (209 vs. 180), and College by 3% (50 vs 49). AF decreased OTA in Grade School by 88% (764 vs. 91) and High School by 56% (216 vs. 95), but increased in College by 35% (47 vs. 64). History of prior stroke decreased utilization of both tPA and MT by 14%; CAD increased tPA use by 8% and MT by 5%; while AF increased tPA use by 9% and MT by 12%. Conclusions : Having at least one prior vascular risk factor (prior stroke, CAD, AF), diagnosed by a physician, was associated with lower OTA in Grade School and High School educated patients. A history of prior stroke was associated with lower acute stroke therapy utilization (tpa and MT), while both CAD and AF were associated with increased acute stroke therapy utilization.

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