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  • Ovid Technologies (Wolters Kluwer Health)  (12)
  • Cloonan, Lisa  (12)
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  • Ovid Technologies (Wolters Kluwer Health)  (12)
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  • 1
    Online Resource
    Online Resource
    Role of Acute Lesion Topography in Initial Ischemic Stroke Severity and Long-Term Functional Outcomes
    Ovid Technologies (Wolters Kluwer Health) ; 2015
    In:  Stroke Vol. 46, No. 9 ( 2015-09), p. 2438-2444
    Details
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 46, No. 9 ( 2015-09), p. 2438-2444
    Abstract: Acute infarct volume, often proposed as a biomarker for evaluating novel interventions for acute ischemic stroke, correlates only moderately with traditional clinical end points, such as the modified Rankin Scale. We hypothesized that the topography of acute stroke lesions on diffusion-weighted magnetic resonance imaging may provide further information with regard to presenting stroke severity and long-term functional outcomes. Methods— Data from a prospective stroke repository were limited to acute ischemic stroke subjects with magnetic resonance imaging completed within 48 hours from last known well, admission NIH Stroke Scale (NIHSS), and 3-to-6 months modified Rankin Scale scores. Using voxel-based lesion symptom mapping techniques, including age, sex, and diffusion-weighted magnetic resonance imaging lesion volume as covariates, statistical maps were calculated to determine the significance of lesion location for clinical outcome and admission stroke severity. Results— Four hundred ninety subjects were analyzed. Acute stroke lesions in the left hemisphere were associated with more severe NIHSS at admission and poor modified Rankin Scale at 3 to 6 months. Specifically, injury to white matter (corona radiata, internal and external capsules, superior longitudinal fasciculus, and uncinate fasciculus), postcentral gyrus, putamen, and operculum were implicated in poor modified Rankin Scale. More severe NIHSS involved these regions, as well as the amygdala, caudate, pallidum, inferior frontal gyrus, insula, and precentral gyrus. Conclusions— Acute lesion topography provides important insights into anatomic correlates of admission stroke severity and poststroke outcomes. Future models that account for infarct location in addition to diffusion-weighted magnetic resonance imaging volume may improve stroke outcome prediction and identify patients likely to benefit from aggressive acute intervention and personalized rehabilitation strategies.
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/STROKEAHA.115.009643
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2015
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  • 2
    Online Resource
    Online Resource
    Design and rationale for examining neuroimaging genetics in ischemic stroke : The MRI-GENIE study
    Ovid Technologies (Wolters Kluwer Health) ; 2017
    In:  Neurology Genetics Vol. 3, No. 5 ( 2017-10), p. e180-
    Details
    In: Neurology Genetics, Ovid Technologies (Wolters Kluwer Health), Vol. 3, No. 5 ( 2017-10), p. e180-
    Abstract: To describe the design and rationale for the genetic analysis of acute and chronic cerebrovascular neuroimaging phenotypes detected on clinical MRI in patients with acute ischemic stroke (AIS) within the scope of the MRI–GENetics Interface Exploration (MRI-GENIE) study. Methods: MRI-GENIE capitalizes on the existing infrastructure of the Stroke Genetics Network (SiGN). In total, 12 international SiGN sites contributed MRIs of 3,301 patients with AIS. Detailed clinical phenotyping with the web-based Causative Classification of Stroke (CCS) system and genome-wide genotyping data were available for all participants. Neuroimaging analyses include the manual and automated assessments of established MRI markers. A high-throughput MRI analysis pipeline for the automated assessment of cerebrovascular lesions on clinical scans will be developed in a subset of scans for both acute and chronic lesions, validated against gold standard, and applied to all available scans. The extracted neuroimaging phenotypes will improve characterization of acute and chronic cerebrovascular lesions in ischemic stroke, including CCS subtypes, and their effect on functional outcomes after stroke. Moreover, genetic testing will uncover variants associated with acute and chronic MRI manifestations of cerebrovascular disease. Conclusions: The MRI-GENIE study aims to develop, validate, and distribute the MRI analysis platform for scans acquired as part of clinical care for patients with AIS, which will lead to (1) novel genetic discoveries in ischemic stroke, (2) strategies for personalized stroke risk assessment, and (3) personalized stroke outcome assessment.
    Type of Medium: Online Resource
    ISSN: 2376-7839
    URL: Article
    DOI: 10.1212/NXG.0000000000000180
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2017
    detail.hit.zdb_id: 2818607-2
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  • 3
    Online Resource
    Online Resource
    Abstract TMP121: Gender Differences in Functional Outcomes After Acute Ischemic Stroke: The Role of White Matter Structural Integrity
    Ovid Technologies (Wolters Kluwer Health) ; 2017
    In:  Stroke Vol. 48, No. suppl_1 ( 2017-02)
    Details
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 48, No. suppl_1 ( 2017-02)
    Abstract: Background: Women are known to have worse post-stroke outcomes; however, the underlying mechanisms remain unclear. We evaluated sex-specific clinical and neuroimaging characteristics linked to cerebrovascular brain health in association with functional recovery after acute ischemic stroke (AIS). Methods: We reviewed 316 AIS patients with acute MRI ( 〈 48 hours from symptom onset) and modified Rankin scale score (mRS) assessed at 3-6 months post-stroke. Acute infarct volume on diffusion-weighted imaging (DWIv) and white matter hyperintensity volume (WMHv) on FLAIR sequences were determined using a validated semi-automated method. Mean diffusivity (MD) and fractional anisotropy (FA) of normal appearing white matter (NAWM) were derived from the contralesional hemisphere. Wilcoxon rank sum, Spearman correlation, and Fisher’s exact tests were used at p-value 〈 0.05, as appropriate. Results: Women comprised 41.1% of this AIS cohort, and as compared to men, they were older (68 vs. 62.8 years, p = 0.002), had higher prevalence of atrial fibrillation (21.5% vs. 12.4%, p = 0.04), and less tobacco use (21.1% vs. 36.3%, p = 0.03). There was no statistically significant difference between men and women in admission stroke severity, TOAST stroke subtype distribution, DWIv or WMHv. However, women were significantly less likely to have a favorable outcome (mRS 〈 2), as compared to men (53.7% vs. 68.5%, p = 0.01). Both FA (ρ -0.18, p=0.04) and MD (ρ 0.28, p=0.002) values in NAWM correlated with follow-up mRS in women, but only MD (ρ 0.26, p=0.0004) in men. Conclusion: Despite no differences in admission NIHSS, acute infarct size, WMH burden or stroke subtype, women with AIS had significantly worse post-stroke outcomes in our cohort. Our findings suggest that microstructural integrity, as assessed by NAWM diffusivity anisotropy measurements, may represent a neuroimaging correlate of worse outcomes in women. The correlation between markers of white matter microstructural integrity and long-term mRS provides insight into the underlying mechanisms of disease that may influence functional recovery after stroke.
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/str.48.suppl_1.tmp121
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2017
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  • 4
    Online Resource
    Online Resource
    Abstract WMP14: Increased Diffusion Heterogeneity After Acute Ischemic Stroke is Associated With Salvageable Tissue
    Ovid Technologies (Wolters Kluwer Health) ; 2016
    In:  Stroke Vol. 47, No. suppl_1 ( 2016-02)
    Details
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 47, No. suppl_1 ( 2016-02)
    Abstract: Background: Diffusion kurtosis MRI (DKI) may be more sensitive to microstructural changes in acute ischemic stroke (AIS), compared to diffusion weighted MRI (DWI). We investigated differences in diffusion kurtosis metrics related to time and tissue outcome. Methods: DKI from AIS patients enrolled in a prospective serial MRI study were analyzed (N=18). Mean kurtosis (MK), axial kurtosis (AK), radial kurtosis (RK), mean diffusivity (MD), axial diffusivity (AD), radial diffusivity (RD) and fractional anisotropy (FA) maps were calculated. Follow-up (FU) FLAIR infarct volumes were defined as “final.” Abnormal perfusion was defined as tissue with Tmax values greater than 6 seconds. All maps were co-registered to one another. DWI and DKI were compared (nonparametric Spearman’s correlation analysis) in the following regions: Core (abnormal acute DWI and FU), Growth (normal acute DWI, abnormal FU), and Salvaged (normal acute DWI, abnormal acute perfusion, normal FU). Results: Patient characteristics were: mean±SD age 66±10 years, median [IQR] admission NIHSS score 6 [3-11] , time-to-acute MRI 6.2±2.1 h, time-to-FU MRI 3.0±1.3 days, acute DWI lesion 4.9 [0.8-21.1] cm3 and FU lesion 12.9 [1.8-54.7] cm3. Significant correlations were found between time-to-MRI and diffusivity and kurtosis metrics, but differed depending on tissue outcome (Table). Discussion: The significant inverse correlation between FA and RK and time-to-MRI in salvaged tissue suggests renormalization of transient ischemia-induced increases in FA and RK tissue with otherwise preserved cytoarchitecture. One possible mechanism underlying this could be that hyperacute ischemia-induced cellular swelling increases tortuosity of water diffusion paths, imposing direction-dependent restrictions upon diffusion. Coupled with changes in DWI, DKI may provide further insight into tissue evolution after AIS and therefore improve identification of potentially salvageable tissue.
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/str.47.suppl_1.wmp14
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2016
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  • 5
    Online Resource
    Online Resource
    Structural Integrity of Normal Appearing White Matter and Sex-Specific Outcomes After Acute Ischemic Stroke
    Ovid Technologies (Wolters Kluwer Health) ; 2017
    In:  Stroke Vol. 48, No. 12 ( 2017-12), p. 3387-3389
    Details
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 48, No. 12 ( 2017-12), p. 3387-3389
    Abstract: Women have worse poststroke outcomes than men. We evaluated sex-specific clinical and neuroimaging characteristics of white matter in association with functional recovery after acute ischemic stroke. Methods— We performed a retrospective analysis of acute ischemic stroke patients with admission brain MRI and 3- to 6-month modified Rankin Scale score. White matter hyperintensity and acute infarct volume were quantified on fluid-attenuated inversion recovery and diffusion tensor imaging MRI, respectively. Diffusivity anisotropy metrics were calculated in normal appearing white matter contralateral to the acute ischemia. Results— Among 319 patients with acute ischemic stroke, women were older (68.0 versus 62.7 years; P =0.004), had increased incidence of atrial fibrillation (21.4% versus 12.2%; P =0.04), and lower rate of tobacco use (21.1% versus 35.9%; P =0.03). There was no sex-specific difference in white matter hyperintensity volume, acute infarct volume, National Institutes of Health Stroke Scale, prestroke modified Rankin Scale score, or normal appearing white matter diffusivity anisotropy metrics. However, women were less likely to have an excellent outcome (modified Rankin Scale score 〈 2: 49.6% versus 67.0%; P =0.005). In logistic regression analysis, female sex and the interaction of sex with fractional anisotropy, radial diffusivity, and axial diffusivity were independent predictors of functional outcome. Conclusions— Female sex is associated with decreased likelihood of excellent outcome after acute ischemic stroke. The correlation between markers of white matter integrity and functional outcomes in women, but not men, suggests a potential sex-specific mechanism.
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/STROKEAHA.117.019258
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2017
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  • 6
    Online Resource
    Online Resource
    Integrity of normal-appearing white matter and functional outcomes after acute ischemic stroke
    Ovid Technologies (Wolters Kluwer Health) ; 2017
    In:  Neurology Vol. 88, No. 18 ( 2017-05-02), p. 1701-1708
    Details
    In: Neurology, Ovid Technologies (Wolters Kluwer Health), Vol. 88, No. 18 ( 2017-05-02), p. 1701-1708
    Abstract: To characterize the effect of white matter microstructural integrity on cerebral tissue and long-term functional outcomes after acute ischemic stroke (AIS). Methods: Consecutive AIS patients with brain MRI acquired within 48 hours of symptom onset and 90-day modified Rankin Scale (mRS) score were included. Acute infarct volume on diffusion-weighted imaging (DWIv) and white matter hyperintensity volume (WMHv) on T2 fluid-attenuated inversion recovery MRI were measured. Median fractional anisotropy (FA), mean diffusivity, radial diffusivity, and axial diffusivity values were calculated within normal-appearing white matter (NAWM) in the hemisphere contralateral to the acute lesion. Regression models were used to assess the association between diffusivity metrics and acute cerebral tissue and long-term functional outcomes in AIS. Level of significance was set at p 〈 0.05 for all analyses. Results: Among 305 AIS patients with DWIv and mRS score, mean age was 64.4 ± 15.9 years, and 183 participants (60%) were male. Median NIH Stroke Scale (NIHSS) score was 3 (interquartile range [IQR] 1–8), and median normalized WMHv was 6.19 cm 3 (IQR 3.0–12.6 cm 3 ). Admission stroke severity (β = 0.16, p 〈 0.0001) and small vessel stroke subtype (β = −1.53, p 〈 0.0001), but not diffusivity metrics, were independently associated with DWIv. However, median FA in contralesional NAWM was independently associated with mRS score (β = −9.74, p = 0.02), along with age, female sex, NIHSS score, and DWIv. Conclusions: FA decrease in NAWM contralateral to the acute infarct is associated with worse mRS category at 90 days after stroke. These data suggest that white matter integrity may contribute to functional recovery after stroke.
    Type of Medium: Online Resource
    ISSN: 0028-3878 , 1526-632X
    URL: Article
    DOI: 10.1212/WNL.0000000000003890
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2017
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  • 7
    Online Resource
    Online Resource
    Abstract TP52: Neurite Density and Orientation Dispersion are Decreased in White Matter in Patients With Advanced Leukoariaosis
    Ovid Technologies (Wolters Kluwer Health) ; 2018
    In:  Stroke Vol. 49, No. Suppl_1 ( 2018-01-22)
    Details
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 49, No. Suppl_1 ( 2018-01-22)
    Abstract: Background: Alterations to microstructural integrity in white matter hyperintensities (WMH) in patients with severe leukoaraiosis are poorly understood. Neurite density and orientation dispersion imaging (NODDI) produce better estimates of myelin density than diffusion tensor MRI (DTI) and therefore may provide additional in vivo insight into WMH pathophysiology. Methods: NODDI was acquired in a prospective study of acute ischemic stroke patients with advanced white matter disease (N=36). Neurite density (ND), and orientation dispersion (OD) were calculated along with model-free diffusion parameters: mean kurtosis (MK), axial kurtosis (AK), radial kurtosis (RK), mean diffusivity (MD), axial diffusivity (AD), radial diffusivity (RD) and fractional anisotropy (FA). Median values were measured in in the hemisphere contralateral to the incident stroke in regions of WMH and in normal appearing white matter (NAWM) and compared (paired Wilcoxon-exact test). Linear regression was performed to evaluate univariate predictors of log-transformed WMH volumes (log WMHv). Results: Patient characteristics were: mean±SD age 69±10 y, time-to-MRI 2.8±1.2 days, median [IQ] normalized WMHv 4.7 [2.3-9.3] and 61% men. MD, AD and RD were greater, while FA, MK, AK, RK, OD and ND were lower in WMH compared to NAWM (P 〈 0.001, see Figure). Increased MD (P=0.004), AD (P 〈 0.0001) and AK (P=0.01) in NAWM and decreased OD in NAWM (P=0.01) were significant predictors of increased log WMHv. Discussion: Diffusivity, kurtosis and ND and OD in acute stroke patients with moderate to severe leuokoaraiosis differed significantly between NAWM and WMH in the contralateral hemisphere. Reduced neurite density is suggestive of microstructural injury. Reduced OD is typically associated with greater organization, but might also reflect restricted extracellular space diffusivity. The association of MD, AD, AK and OD in NAWM with WMH burden suggests there is ongoing risk for developing future WMH.
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/str.49.suppl_1.TP52
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2018
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  • 8
    Online Resource
    Online Resource
    Abstract WP43: Advanced White Matter Disease is Associated With Increased Blood-Brain Barrier Permeability and Early Diffuse Microstructural Changes in Patients With Acute Ischemic Stroke
    Ovid Technologies (Wolters Kluwer Health) ; 2016
    In:  Stroke Vol. 47, No. suppl_1 ( 2016-02)
    Details
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 47, No. suppl_1 ( 2016-02)
    Abstract: Background: In acute ischemic stroke (AIS), cerebral tissue damage and clinical outcomes are linked to pre-existing microvascular dysfunction, manifesting as white matter hyperintensity (WMH). Elevated blood-brain barrier permeability (BBB-P) has been implicated in advanced WMH. We tested the microstructural integrity of BBB as measured by dynamic susceptibility contrast (DSC) MRI K 2 coefficient values in AIS patients with advanced WMH. Methods: Twenty patients enrolled in a prospective acute MRI study underwent diffusion tensor (DTI) and DSC MRI on admission for AIS. BBB-P estimates were derived from DSC MRI using the K 2 coefficients. Fractional anisotropy (FA), mean diffusivity (MD), axial diffusivity (AD) and radial diffusivity (RD) maps were calculated. Mean K 2 , MD, AD, RD and FA values were measured in regions of WMH and normally appearing white matter (NAWM) in the hemisphere contralateral to AIS and compared (two-tailed Student t-Test). WMH volume (WMHv) was assessed on acute FLAIR using a validated semi-automated volumetric protocol. Linear regression was performed to evaluate significant predictors of K 2 , MD, AD, RD, and FA. Correlation analysis was performed (Pearson product-moment). Results: Mean age of subjects was 66 (±10) years, 30% were women, median WMHv 3.5cm 3 [IQR 1.6-7.4]. K 2 values differed significantly between WMH and NAWM (0.32 x10 -3 vs. 1.1 x10 -3 , p 〈 0.03), as did the diffusivity metrics for WMH and NAWM (FA: 0.25 vs 0.38; MD: 1.3 x10 -3 vs 0.84 x10 -3 ; AD: 1.6 x10 -3 vs 1.2 x10 -3 ; RD: 1.14 x10 -3 vs 0.66 x10 -3 ; all p 〈 0.0001). K 2 and RD values were correlated within WMH (R=-0.45, P=0.046) but not in NAWM (R=0.06, P=0.81). Multivariate analysis found systolic BP (SBP) and lnWMHv to be significant predictors of MD (P=0.0009), AD (P=0.002), and RD (P=0.002) in NAWM. Discussion: BBB-P and diffusivity values in patients with AIS and advanced leukoaraiosis differed significantly between WMH and NAWM in the hemisphere contralateral to acute infarct. Association between the RD and K 2 coefficients in WMH suggests the role of BBB-P in pathophysiology of WMH and the loss of microstructural white matter integrity associated with it. Further, the influence of SBP and lnWMHv on NAWM diffusivity values suggests ongoing risk for developing future WMH.
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/str.47.suppl_1.wp43
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2016
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  • 9
    Online Resource
    Online Resource
    Abstract TMP58: Determinants of White Matter Hyperintensity in Acute Ischemic Stroke Patients: The MRI-GENIE Study
    Ovid Technologies (Wolters Kluwer Health) ; 2017
    In:  Stroke Vol. 48, No. suppl_1 ( 2017-02)
    Details
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 48, No. suppl_1 ( 2017-02)
    Abstract: 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.
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/str.48.suppl_1.tmp58
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2017
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  • 10
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    Abstract WP218: Brain Reserve: A Protective Mechanism for Stroke Outcome
    Ovid Technologies (Wolters Kluwer Health) ; 2017
    In:  Stroke Vol. 48, No. suppl_1 ( 2017-02)
    Details
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 48, No. suppl_1 ( 2017-02)
    Abstract: Introduction: Stroke is a leading cause of disability worldwide. Mechanisms of post-stroke recovery are complex, and conventional outcome prediction models are limited. “Brain reserve” (BR) has been proposed as a construct to model the brain’s capacity to withstand insults. BR has been shown to co-vary with white matter hyperintensity volume (WMHv) using structural equation modeling (SEM), a technique to test models with latent variables. Hypothesis: We hypothesize that BR is a protective mechanism that improves functional outcome after acute ischemic stroke (AIS). Methods: We define an effective brain reserve (eBR), the remaining brain reserve after other influences have been accounted for. Using SEM, we characterize eBR through intra-cranial volume (ICV), age and systolic blood pressure (SBP). Our model incorporates known relationships between age, SBP, WMHv, acute infarct volume on diffusion-weighted imaging (DWIv) and 90-day functional post-stroke outcome (modified Rankin Scale; mRS), as shown in Figure 1. Path analysis was performed (R; package lavaan) to estimate the relations within the model in a dataset of 451 AIS patients. No priors were used for the path coefficients. Results: The estimated model coefficients (Figure 1) show that eBR is negatively associated with age and SBP, but positively with ICV, while association between age, SBP and WMHv are positive. Outcome is positively associated with WMHv and DWIv and negatively with eBR, suggesting that eBR acts as a protective mechanism. All path coefficients are statistically significant, except for WMHv and mRS. Conclusion: Our analysis shows that eBR is negatively associated with post-stroke outcome (the higher eBR, the lower mRS), suggesting that eBR acts as a protective mechanism. Additionally we reproduced known relationships between WMHv, SBP, age, DWIv and mRS.
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/str.48.suppl_1.wp218
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2017
    detail.hit.zdb_id: 1467823-8
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