好色先生

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Abstract Details

Brain Health Reduction Mediates the Effect of Acute Infarct Volume on Functional Outcome in Acute Ischemic Stroke
Cerebrovascular Disease and Interventional Neurology
S8 - Disparities and Outcomes in Cerebrovascular Disease (3:30 PM-3:42 PM)
001

Brain health facilitates resilience to withstand detrimental effects of neurological diseases. Acute infarct volume is associated with poor outcome after AIS, but the potential mediating effects of brain health have not been investigated.

To assess whether brain health measured in patients with acute ischemic stroke (AIS) mediates the relationship between acute infarct volume and long-term functional outcome.

We analyzed AIS survivors with available admission MRI from the GASROS (derivation, single center; 2003-2011) and MRI-GENIE (validation, 17 international centers; 2003-2011) cohorts. White matter hyperintensity (WMH) and brain volume were measured on T2-FLAIR, and acute infarct volume on diffusion weighted imaging. We quantified brain health using effective reserve (eR), defined as a latent variable in structural equation modeling based on age, WMH load, and brain volume, with coefficients estimated in the derivation cohort. Mediation analysis was used to evaluate if eR (indirect pathway: infarct volume-eR-functional outcome) mediates the effect of infarct volume on functional outcome (direct pathway: infarct volume-functional outcome, modified Rankin Scale [mRS] at 90 days).

We included 997 patients with similar distributions of baseline characteristics and outcomes between the derivation (n=454) and validation (n=543) cohorts (reported as median; age 65/68 years, 35/40% female, NIHSS 3/4, acute infarct volume 2.1/4.1cc, 90-day mRS 1/1 for GASROS/MRI-GENIE). In both cohorts, eR significantly mitigated 17% and 12% of the effect of infarct volume on functional outcome (direct effect [95% confidence interval]: ß=0.30 [0.11-0.20, p<0.001] / ß=0.25 [0.10-0.20, p<0.001], indirect effect mediated through eR: ß=-0.05 [-0.04 to -0.01, p=0.001] / ß=-0.04 [-0.04 to -0.004, p=0.022]), in the derivation/validation cohort.

Brain health, quantified using the biomarker eR, mitigates the detrimental effects of acute infarct volume on functional outcome after AIS. Hence, brain health metrics should be considered while modeling functional outcome after AIS.
Authors/Disclosures
Erik Lindgren, MD, PhD
PRESENTER 		The institution of Dr. Lindgren has received research support from The Swedish Research Council. Dr. Lindgren has received research support from The Swedish Heart and Lung Foundation.
Luca Angeleri, BS Mr. Angeleri has nothing to disclose.
Robert W. Regenhardt, MD, PhD Dr. Regenhardt has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Genomadix. Dr. Regenhardt has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Rapid Medical. Dr. Regenhardt has received personal compensation in the range of $500-$4,999 for serving as an Expert Witness for Johnson and Bell Trial Lawyers. Dr. Regenhardt has received personal compensation in the range of $5,000-$9,999 for serving as an Expert Witness for Buckley, Theroux, Kline, & Cooley Trial Lawyers. The institution of Dr. Regenhardt has received research support from National Institutes of Health. The institution of Dr. Regenhardt has received research support from Society of Vascular and Interventional Neurology. The institution of Dr. Regenhardt has received research support from Heitman Foundation.
Natalia S. Rost, MD, MPH, FAHA, FAAN (Massachusetts General Hospital) Dr. Rost has received personal compensation in the range of $50,000-$99,999 for serving as an officer or member of the Board of Directors for 好色先生. Dr. Rost has received personal compensation in the range of $10,000-$49,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Stroke - AHA/ASA Journal. The institution of Dr. Rost has received research support from NIH. Dr. Rost has received publishing royalties from a publication relating to health care.
Markus D. Schirmer, PhD (Massachusetts General Hospital) The institution of Dr. Schirmer has received research support from National Institute of Aging. The institution of Dr. Schirmer has received research support from Heitman Foundation. The institution of Dr. Schirmer has received research support from MIT/MGB.