Ning Bu1, Mohamed Salah Khlif2, Robin Lemmens3,4,5, Anke Wouters3,4,5, Jochen B Fiebach6, Angel Chamorro7, E Bernd Ringelstein8, Bo Norrving9, Rico Laage10, Martin Grond11, Guido Wilms12, Amy Brodtmann2, Vincent Thijs13. 1. Department of Neurology, the Second Affiliated Hospital of Xi'an Jiaotong University (N.B.). 2. Dementia Theme (M.S.K., A.B.), The Florey Institute of Neuroscience and Mental Health. 3. Department of Neurosciences, Experimental Neurology, KU Leuven-University of Leuven, Belgium (R. Lemmens, A.W.). 4. Laboratory of Neurobiology, VIB, Center for Brain & Disease Research, Leuven, Belgium (R. Lemmens, A.W.). 5. Department of Neurology (R. Lemmens, A.W.), University Hospitals Leuven, Belgium. 6. Center for Stroke Research, Charité, Berlin, Germany (J.B.F.). 7. Department of Neurology, University of Barcelona, Spain (A.C.). 8. Wilhelms University of Muenster, Germany (E.B.R.). 9. Department of Clinical Sciences, Section of Neurology, Lund University, Sweden (B.N.). 10. Clinical Research Department, GUIDED Development GmbH, Heidelberg, Germany (R. Laage). 11. Department of Neurology, Kreisklinikum Siegen, and University of Marburg Germany (M.G.). 12. Department of Radiology (G.W.), University Hospitals Leuven, Belgium. 13. Stroke Division (V.T.), The Florey Institute of Neuroscience and Mental Health.
Abstract
BACKGROUND AND PURPOSE: Functional outcome after stroke may be related to preexisting brain health. Several imaging markers of brain frailty have been described including brain atrophy and markers of small vessel disease. We investigated the association of these imaging markers with functional outcome after acute ischemic stroke. METHODS: We retrospectively studied patients with acute ischemic stroke enrolled in the AXIS-2 trial (AX200 in Ischemic Stroke Trial), a randomized controlled clinical trial of granulocyte colony-stimulating factor versus placebo. We assessed the ratio of brain parenchymal volume to total intracerebral volumes (ie, the brain parenchymal fraction) and total brain volumes from routine baseline magnetic resonance imaging data obtained within 9 hours of symptom onset using the unified segmentation algorithm in SPM12. Enlarged perivascular spaces, white matter hyperintensities, lacunes, as well as a small vessel disease burden, were rated visually. Functional outcomes (modified Rankin Scale score) at day 90 were determined. Logistic regression was used to test associations between brain imaging features and functional outcomes. RESULTS: We enrolled 259 patients with a mean age of 69±12 years and 46 % were female. Increased brain parenchymal fraction was associated with higher odds of excellent outcome (odds ratio per percent increase, 1.078 [95% CI, 1.008-1.153]). Total brain volumes and small vessel disease burden were not associated with functional outcome. An interaction between brain parenchymal fraction and large vessel occlusion on excellent outcome was not observed. CONCLUSIONS: Global brain health, as assessed by brain parenchymal fraction on magnetic resonance imaging, is associated with excellent functional outcome after ischemic stroke. Registration: URL: https://www.clinicaltrials.gov. Unique identifier: NCT00927836.
BACKGROUND AND PURPOSE: Functional outcome after stroke may be related to preexisting brain health. Several imaging markers of brain frailty have been described including brain atrophy and markers of small vessel disease. We investigated the association of these imaging markers with functional outcome after acute ischemic stroke. METHODS: We retrospectively studied patients with acute ischemic stroke enrolled in the AXIS-2 trial (AX200 in Ischemic Stroke Trial), a randomized controlled clinical trial of granulocyte colony-stimulating factor versus placebo. We assessed the ratio of brain parenchymal volume to total intracerebral volumes (ie, the brain parenchymal fraction) and total brain volumes from routine baseline magnetic resonance imaging data obtained within 9 hours of symptom onset using the unified segmentation algorithm in SPM12. Enlarged perivascular spaces, white matter hyperintensities, lacunes, as well as a small vessel disease burden, were rated visually. Functional outcomes (modified Rankin Scale score) at day 90 were determined. Logistic regression was used to test associations between brain imaging features and functional outcomes. RESULTS: We enrolled 259 patients with a mean age of 69±12 years and 46 % were female. Increased brain parenchymal fraction was associated with higher odds of excellent outcome (odds ratio per percent increase, 1.078 [95% CI, 1.008-1.153]). Total brain volumes and small vessel disease burden were not associated with functional outcome. An interaction between brain parenchymal fraction and large vessel occlusion on excellent outcome was not observed. CONCLUSIONS: Global brain health, as assessed by brain parenchymal fraction on magnetic resonance imaging, is associated with excellent functional outcome after ischemic stroke. Registration: URL: https://www.clinicaltrials.gov. Unique identifier: NCT00927836.
Entities:
Keywords:
atrophy; frailty; granulocyte colony; magnetic resonance imaging; stimulating factor; white matter
Authors: Anna K Bonkhoff; Sungmin Hong; Martin Bretzner; Markus D Schirmer; Robert W Regenhardt; E Murat Arsava; Kathleen Donahue; Marco Nardin; Adrian Dalca; Anne-Katrin Giese; Mark R Etherton; Brandon L Hancock; Steven J T Mocking; Elissa McIntosh; John Attia; Oscar Benavente; John W Cole; Amanda Donatti; Christoph Griessenauer; Laura Heitsch; Lukas Holmegaard; Katarina Jood; Jordi Jimenez-Conde; Steven Kittner; Robin Lemmens; Christopher Levi; Caitrin W McDonough; James Meschia; Chia-Ling Phuah; Arndt Rolfs; Stefan Ropele; Jonathan Rosand; Jaume Roquer; Tatjana Rundek; Ralph L Sacco; Reinhold Schmidt; Pankaj Sharma; Agnieszka Slowik; Martin Soederholm; Alessandro Sousa; Tara M Stanne; Daniel Strbian; Turgut Tatlisumak; Vincent Thijs; Achala Vagal; Johan Wasselius; Daniel Woo; Ramin Zand; Patrick McArdle; Bradford B Worrall; Christina Jern; Arne G Lindgren; Jane Maguire; Polina Golland; Danilo Bzdok; Ona Wu; Natalia S Rost Journal: Neurology Date: 2022-07-08 Impact factor: 11.800