Original ArticleDeterminants of White Matter Hyperintensity Volume in Patients with Acute Ischemic Stroke
Section snippets
Patient Selection and Characteristics
All consecutive patients 18 years of age or older who presented to the Massachusetts General Hospital Emergency Department (ED) with AIS were considered for this study. Potential subjects were ascertained by reviewing ED admission logs and then approached prospectively for consent. Inclusion criteria were: (1) symptoms of AIS with corresponding evidence of restricted diffusion, consistent with acute infarction, on diffusion-weighted MRI completed within 12 hours of symptom onset; (2) T2
Results
There were 523 consecutive patients who presented to our hospital ED for evaluation of acute stroke, consented to participate in the study, and had their WMHV measured on admission brain MRI (Table 1). Of these, 56% were men. Mean age was 65.2 ± 15.5 years; median WMHV was 8.2 cm3 (4.2-16.3 cm3).
In univariate analyses, age, dHCY, systolic blood pressure, HTN, AF, and coronary artery disease were associated with increased WMHV, whereas GFR was associated with decreased WMHV (Table 2). These
Discussion
The results of our study demonstrate that in patients with AIS, risk factors for WMH severity do not appear to overlap with those previously reported for population-based cohorts. Only age and HCY level above 9 μmol/L were independently associated with increasing WMHV. None of the common vascular risk factors previously shown to contribute to severity of WMH in the population-based studies (including impaired renal function, HTN, or AF) were associated independently with more severe WMH in
Summary
Despite having a large burden of WMH, patients with AIS did not demonstrate that most of the traditional vascular risk factors play an independent role in determining the severity of WMH. Instead, only age and HCY were independently associated with WMHV. These data raise the possibility that the processes underlying WMH burden accumulation in patients with stroke may differ from those in the general population. Twin and family studies of WMH in the general and HTN populations suggest that as
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2015, Journal of Stroke and Cerebrovascular DiseasesCitation Excerpt :The finding is in agreement with a recent case–control Chinese study showing an association between WMH and 2 functional COX-2 gene polymorphisms (rs20417 and rs689466).23 White matter disease is a marker of small-vessel disease and increases with aging and cumulative burden of cerebrovascular risk factors.12,18 In addition, chronic inflammatory diseases such as lupus erythematous may trigger white matter disease without these cerebrovascular risk factors.29,30
Supported by Bugher Foundation–American Stroke Association; National Institutes of Neurological Disorders and Stroke (R01 NS04217); and the Deane Institute for Integrative Study of Atrial Fibrillation and Stroke.