Tobias Saam1, Holger Hetterich2, Verena Hoffmann3, Chun Yuan4, Martin Dichgans5, Holger Poppert6, Thomas Koeppel7, Ulrich Hoffmann8, Maximilian F Reiser2, Fabian Bamberg2. 1. Institute of Clinical Radiology, Ludwig-Maximilians-University Hospital Munich, Munich, Germany. Electronic address: tobias.saam@med.lmu.de. 2. Institute of Clinical Radiology, Ludwig-Maximilians-University Hospital Munich, Munich, Germany. 3. Institute of Biomedical Epidemiology, Ludwig-Maximilians-University Hospital Munich, Munich, Germany. 4. Department of Radiology, University of Washington, Seattle, Washington. 5. Institute for Stroke and Dementia Research, Ludwig-Maximilians-University Hospital Munich, Munich, Germany. 6. Department of Neurology, Technische Universität München, Munich, Germany. 7. Division of Vascular and Endovascular Surgery, Ludwig-Maximilians-University Hospital Munich, Munich, Germany. 8. Division of Vascular Medicine, Medical Clinic and Policlinic IV, Ludwig-Maximilians-University Hospital Munich, Munich, Germany.
Abstract
OBJECTIVES: This study sought to conduct a systematic review and meta-analysis to determine precise estimates of the predictive value of carotid intraplaque hemorrhage (IPH) as determined by magnetic resonance imaging (MRI) for cerebrovascular events. BACKGROUND: There is emerging evidence that MR-based carotid atherosclerotic plaque assessment identifies high-risk features associated with cerebrovascular events. However, available data are based on smaller samples with heterogeneous source populations despite a promising value for noninvasive risk stratification. METHODS: We searched PubMed, EMBASE, and the Cochrane Library through September 2012 for studies that followed >35 individuals after baseline MRI. Independent observers abstracted information on populations, MR techniques, outcomes, and study quality. Risk estimates of the presence of IPH for cerebrovascular events were derived in random effects regression analysis, and causes of heterogeneity were determined in meta-regression analysis. RESULTS: We identified 8 eligible studies including 689 participants who underwent carotid MRI. The prevalence of IPH at baseline was high (49.0%). Over a median follow-up of 19.6 months, a total of 108 cerebrovascular events occurred (15.7% event rate). The presence of IPH was associated with an ∼6-fold higher risk for events (hazard ratio [HR]: 5.69; 95% confidence interval [CI]: 2.98 to 10.87). The annualized event rate in subjects with detectable IPH was 17.71% compared with 2.43% in patients without IPH. Meta-regression analysis showed symptomatic subjects had higher risks as compared with asymptomatic subjects (HR: 11.71, 95% CI: 5.17 to 26.48 vs. HR: 3.50, 95% CI: 2.59 to 4.73, p = 0.0065), Also, differences were observed for sex and sample size (all p < 0.01), with moderate visual publication bias due to missing smaller sample-size studies (p = 0.18). CONCLUSIONS: Presence of IPH on MRI strongly predicts cerebrovascular events. Homogenization of future studies is warranted to allow for sufficient assessment of level of evidence for intervention trials.
OBJECTIVES: This study sought to conduct a systematic review and meta-analysis to determine precise estimates of the predictive value of carotid intraplaque hemorrhage (IPH) as determined by magnetic resonance imaging (MRI) for cerebrovascular events. BACKGROUND: There is emerging evidence that MR-based carotid atherosclerotic plaque assessment identifies high-risk features associated with cerebrovascular events. However, available data are based on smaller samples with heterogeneous source populations despite a promising value for noninvasive risk stratification. METHODS: We searched PubMed, EMBASE, and the Cochrane Library through September 2012 for studies that followed >35 individuals after baseline MRI. Independent observers abstracted information on populations, MR techniques, outcomes, and study quality. Risk estimates of the presence of IPH for cerebrovascular events were derived in random effects regression analysis, and causes of heterogeneity were determined in meta-regression analysis. RESULTS: We identified 8 eligible studies including 689 participants who underwent carotid MRI. The prevalence of IPH at baseline was high (49.0%). Over a median follow-up of 19.6 months, a total of 108 cerebrovascular events occurred (15.7% event rate). The presence of IPH was associated with an ∼6-fold higher risk for events (hazard ratio [HR]: 5.69; 95% confidence interval [CI]: 2.98 to 10.87). The annualized event rate in subjects with detectable IPH was 17.71% compared with 2.43% in patients without IPH. Meta-regression analysis showed symptomatic subjects had higher risks as compared with asymptomatic subjects (HR: 11.71, 95% CI: 5.17 to 26.48 vs. HR: 3.50, 95% CI: 2.59 to 4.73, p = 0.0065), Also, differences were observed for sex and sample size (all p < 0.01), with moderate visual publication bias due to missing smaller sample-size studies (p = 0.18). CONCLUSIONS: Presence of IPH on MRI strongly predicts cerebrovascular events. Homogenization of future studies is warranted to allow for sufficient assessment of level of evidence for intervention trials.
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