Abstract 24: Race/Ethnic Differences in Microbleed Characteristics and Association of Microbleeds with Poor Outcomes in the ERICH Study
Background: Microbleeds have been reported in up to 60% of patients with primary intracerebral hemorrhage (ICH) and are an important marker of a progressive, small vessel cerebral vasculopathy. The Ethnic/Racial Variations of Intracerebral Hemorrhage (ERICH) study explored the characteristics of microbleeds and their impact on long-term functional outcome.
Methods: ERICH is a multi-center prospective study designed to recruit white, black, and Hispanic cases of ICH. At least every 5th ICH patient enrolled undergoes an MRI. All MRIs are interpreted by a core laboratory blinded to clinical data.
Results: Among 642 patients with a gradient echo (GRE) sequence, 49% had ≥1 microbleeds (mean 13, median 4). Blacks had the highest rate of microbleeds at 54% compared to 48% for Hispanics, and 42% for whites (overall p=0.046; blacks vs. white p=0.018). There was a significant racial/ethnic difference in the overall rate of microbleeds in lobar locations (79% in whites, 73.5% in blacks, 61% in Hispanics, p<0.0001). A multivariable logistic regression model predicting the presence of microbleeds included hypertension (OR=1.62, p=0.037), severity of white matter disease (12 point scale, 1 point OR=1.36, p<0.0001), elevated white blood cell count (103/μL OR=1.06, p=0.012), and race/ethnicity (overall p value 0.111; compared to white, black OR=1.53, p=0.056; Hispanic OR=1.49, p=0.078). The presence of microbleeds was associated with poor outcome (6 month mRS 4-6, OR=2.21, p=0.001) in a logistic regression analysis that included ICH volume (1 cc OR=1.04, p<0.001), Glasgow Coma Scale score (OR=0.82, p<0.001), intraventricular hemorrhage (OR=1.98, p=0.003), and age (5 year OR=1.21, p<0.001).
Conclusions: This study demonstrates substantial differences in microbleed rates across race/ethnicities. This is the first study to report an intermediate microbleed rate among Hispanics relative to white and black ICH cases. In addition to hypertension and leukoaraiosis, our model suggests that inflammation may be an important factor contributing to microbleeds. As a biomarker of progressive vasculopathy and poor outcome, microbleeds may provide a valuable surrogate measure in future studies of therapies targeting optimal approaches to risk factor control.
Author Disclosures: C.S. Kidwell: Research Grant; Significant; NIH/NINDS U01 NS069763. G. Norato: Research Grant; Significant; NIH/NINDS U01 NS069763. J. Osborne: Research Grant; Significant; NIH/NINDS U01 NS069763. J. Rosand: Research Grant; Significant; NIH. Consultant/Advisory Board; Significant; Boehringer Ingelheim. M.S.V. Elkind: Research Grant; Modest; NIH/NINDS U01 NS069763. M.L. James: Research Grant; Modest; NIH, AHA. Consultant/Advisory Board; Modest; Cephalogics, Hospira. M. Flaherty: Research Grant; Significant; NIH/NINDS U01 NS069763, NINDS 2P50NS044283-06. Speakers' Bureau; Modest; CSL Behring. Other; Significant; Principal Investigator, STOP-IT Study, study drug supplied by Novo Nordisk. B.B. Worrall: Research Grant; Modest; NIH/NINDS U01 NS069763. A. Vashkevich: Research Grant; Significant; NIH/NINDS U01 NS069763. C.D. Langefeld: Research Grant; Modest; NIH/NINDS U01 NS069763. C.J. Moomaw: Research Grant; Significant; NIH/NINDS U01 NS069763. D. Woo: Research Grant; Significant; NIH/NINDS U01 NS069763.
- © 2015 by American Heart Association, Inc.