Abstract TMP58: Determinants of White Matter Hyperintensity in Acute Ischemic Stroke Patients: The MRI-GENIE Study
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 5.7cm3 (interquartile range (IQR): 2.2-12.8cm3). 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 (8.0cm3, IQR: 4.2-15.4cm3), large-artery stroke (6.9cm3, IQR: 3.1-14.7cm3), small-vessel stroke (5.8cm3, IQR: 2.5-13.5cm3), stroke of undetermined (4.7cm3, IQR: 1.6-11.0cm3) or other (2.55cm3, IQR: 0.9-8.8cm3) 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.
Author Disclosures: A. Giese: None. M.D. Schirmer: None. A.V. Dalca: None. R. Sridharan: None. L. Cloonan: None. H. Xu: None. J.W. Cole: None. P.F. McArdle: None. J.P. Broderick: Other Research Support; Modest; Genentech - monies to department for my role on Executive Committee of PRISMS Trial. Other Research Support; Significant; Modest. J. Jimenez-Conde: None. C. Jern: None. B.M. Kissela: None. D.O. Kleindorfer: None. R. Lemmens: None. A. Lindgren: None. J.F. Meschia: Research Grant; Significant; NIH-NINDS research grant: U01 NS069208. T. Rundek: Research Grant; Significant; NIH-NINDS research grant: U01 NS069208. R.L. Sacco: Research Grant; Modest; Boehringer Ingelheim for RESPECT ESUS trial. R. Schmidt: None. P. Sharma: None. A. Slowik: None. V. Thijs: None. D. Woo: Research Grant; Significant; NIH-NINDS research grant: U01 NS069208. B.B. Worrall: Research Grant; Significant; NIH-NINDS research grant: U01 NS069208. Other; Modest; Deputy Editor of Neurology. O. Wu: Research Grant; Significant; NIH-NINDS research grants: R01NS059775, R01NS063925, R01NS082285, P50NS051343, R01NS086905, U01 NS069208. Consultant/Advisory Board; Modest; Penumbra. S.J. Kittner: Research Grant; Significant; NIH-NINDS research grant: U01 NS069208. B.D. Mitchell: None. J. Rosand: Research Grant; Significant; NIH-NINDS research grant: U01 NS069208. P. Golland: Research Grant; Significant; NIH-NIBIB research grant: P41EB015902. N.S. Rost: Research Grant; Significant; NIH-NINDS research grants: R01NS086905, K23NS064052, R01NS082285.
- © 2017 by American Heart Association, Inc.