Association of Ischemic Imaging Phenotype With Progression of Brain Atrophy and Cerebrovascular Lesions on MRI: The SMART-MR Study. (14th September 2021)

• Record Type: Journal Article
• Authors: Rissanen, Ina; Lucci, Carlo; Ghaznawi, Rashid; Hendrikse, Jeroen; Kappelle, L. Jaap; Geerlings, Mirjam I.; Visseren, Frank L.J.; Asselbergs, Folkert W.; Nathoe, Hendrik M.; Bots, Michiel L.; Emmelot- Vonk, Marielle H.; Jan de Borst, Gert; Leiner, Tim; de Jong, Pim A.; Lely, A. Titia; van der Kaaij, Niels P.; Ruigrok, Ynte M.; Verhaar, Marianne C.; Westerink, Jan
• Is Part Of: Neurology. Volume 97:Number 11(2021)
• Publication Date: 2021-09-14
• Subjects: Neurology -- Periodicals; Neurology -- Periodicals; Neurologie -- Périodiques; 616.8
• DOI: 10.1212/WNL.0000000000012539
• Languages: English
• ISSNs: 0028-3878

Abstract

Abstract : Background and Objective: To investigate the association of silent vascular lesions, imaging negative ischemia, and symptomatic cerebrovascular disease with long-term progression of brain atrophy and cerebrovascular lesions in patients with arterial disease. Methods: Within the Second Manifestations of Arterial Disease–Magnetic Resonance (SMART-MR) study, stroke status of participants at baseline was classified as no cerebrovascular disease (reference group, n = 829), symptomatic cerebrovascular disease (n = 206), silent vascular lesion (n = 157), and imaging-negative ischemia (n = 90) according to clinical and MRI findings. With the use of linear mixed models, changes in brain and white matter hyperintensity (WMH) volumes at baseline and during 12 years of follow-up were studied in stroke classifications. Relative risks were estimated for new infarcts during follow-up associated with stroke classifications. Analyses were adjusted for age, sex, cardiovascular risk factors, and medications. Results: Symptomatic cerebrovascular disease associated with 0.35 SD (95% confidence interval [CI] 0.24–0.47) smaller brain volume and 0.61 SD (95% CI 0.48–0.74) larger WMH volume at baseline and increased risk for new infarcts during follow-up (risk ratio [RR] 2.89, 95% CI 2.00–4.16). Silent vascular lesions were associated with 0.15 SD (95% CI 0.01–0.88) smaller brain volume, 0.02 SD (95% CI 0.01–0.03) steeper brain atrophy slope, and 0.48 SD (95% CI 0.32–0.64) larger WMH volume at baseline, in addition to increased risk for lacunes (RR 2.08, 95% CI 1.48–2.94). Individuals with imaging-negative ischemia had increased risk for cortical infarcts (RR 2.88, 95% CI 2.17–3.82). Discussion: Patients with symptomatic cerebrovascular disease, silent vascular lesions, or imaging-negative ischemia have a different course of brain volume loss and cerebrovascular lesion development. These findings may have implications for future stroke risk and dementia and need further investigation.