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Dunn EC, Soare TW, Raffeld MR, Busso DS, Crawford KM, Davis KA, Fisher VA, Slopen N, Smith ADAC, Tiemeier H, Susser ES. What life course theoretical models best explain the relationship between exposure to childhood adversity and psychopathology symptoms: recency, accumulation, or sensitive periods? Psychol Med 2018; 48:2562-2572. [PMID: 29478418 PMCID: PMC6109629 DOI: 10.1017/s0033291718000181] [Citation(s) in RCA: 90] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Although childhood adversity is a potent determinant of psychopathology, relatively little is known about how the characteristics of adversity exposure, including its developmental timing or duration, influence subsequent mental health outcomes. This study compared three models from life course theory (recency, accumulation, sensitive period) to determine which one(s) best explained this relationship. METHODS Prospective data came from the Avon Longitudinal Study of Parents and Children (n = 7476). Four adversities commonly linked to psychopathology (caregiver physical/emotional abuse; sexual/physical abuse; financial stress; parent legal problems) were measured repeatedly from birth to age 8. Using a statistical modeling approach grounded in least angle regression, we determined the theoretical model(s) explaining the most variability (r2) in psychopathology symptoms measured at age 8 using the Strengths and Difficulties Questionnaire and evaluated the magnitude of each association. RESULTS Recency was the best fitting theoretical model for the effect of physical/sexual abuse (girls r2 = 2.35%; boys r2 = 1.68%). Both recency (girls r2 = 1.55%) and accumulation (boys r2 = 1.71%) were the best fitting models for caregiver physical/emotional abuse. Sensitive period models were chosen alone (parent legal problems in boys r2 = 0.29%) and with accumulation (financial stress in girls r2 = 3.08%) more rarely. Substantial effect sizes were observed (standardized mean differences = 0.22-1.18). CONCLUSIONS Child psychopathology symptoms are primarily explained by recency and accumulation models. Evidence for sensitive periods did not emerge strongly in these data. These findings underscore the need to measure the characteristics of adversity, which can aid in understanding disease mechanisms and determining how best to reduce the consequences of exposure to adversity.
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Affiliation(s)
- Erin C Dunn
- Center for Genomic Medicine, Massachusetts General Hospital,Boston, MA,USA
| | - Thomas W Soare
- Center for Genomic Medicine, Massachusetts General Hospital,Boston, MA,USA
| | - Miriam R Raffeld
- Center for Genomic Medicine, Massachusetts General Hospital,Boston, MA,USA
| | - Daniel S Busso
- Center for Genomic Medicine, Massachusetts General Hospital,Boston, MA,USA
| | | | - Kathryn A Davis
- Center for Genomic Medicine, Massachusetts General Hospital,Boston, MA,USA
| | - Virginia A Fisher
- Center for Genomic Medicine, Massachusetts General Hospital,Boston, MA,USA
| | - Natalie Slopen
- Department of Epidemiology and Biostatistics,School of Public Health, University of Maryland,College Park, MD,USA
| | | | | | - Ezra S Susser
- Department of Epidemiology,Mailman School of Public Health, Columbia University,New York, NY,USA
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Dunn EC, Crawford KM, Soare TW, Button KS, Raffeld MR, Smith AD, Penton-Voak IS, Munafò MR. Exposure to childhood adversity and deficits in emotion recognition: results from a large, population-based sample. J Child Psychol Psychiatry 2018; 59:845-854. [PMID: 29512866 PMCID: PMC6041167 DOI: 10.1111/jcpp.12881] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/04/2018] [Indexed: 01/12/2023]
Abstract
BACKGROUND Emotion recognition skills are essential for social communication. Deficits in these skills have been implicated in mental disorders. Prior studies of clinical and high-risk samples have consistently shown that children exposed to adversity are more likely than their unexposed peers to have emotion recognition skills deficits. However, only one population-based study has examined this association. METHODS We analyzed data from children participating in the Avon Longitudinal Study of Parents and Children, a prospective birth cohort (n = 6,506). We examined the association between eight adversities, assessed repeatedly from birth to age 8 (caregiver physical or emotional abuse; sexual or physical abuse; maternal psychopathology; one adult in the household; family instability; financial stress; parent legal problems; neighborhood disadvantage) and the ability to recognize facial displays of emotion measured using the faces subtest of the Diagnostic Assessment of Non-Verbal Accuracy (DANVA) at age 8.5 years. In addition to examining the role of exposure (vs. nonexposure) to each type of adversity, we also evaluated the role of the timing, duration, and recency of each adversity using a Least Angle Regression variable selection procedure. RESULTS Over three-quarters of the sample experienced at least one adversity. We found no evidence to support an association between emotion recognition deficits and previous exposure to adversity, either in terms of total lifetime exposure, timing, duration, or recency, or when stratifying by sex. CONCLUSIONS Results from the largest population-based sample suggest that even extreme forms of adversity are unrelated to emotion recognition deficits as measured by the DANVA, suggesting the possible immutability of emotion recognition in the general population. These findings emphasize the importance of population-based studies to generate generalizable results.
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Affiliation(s)
- Erin C. Dunn
- Psychiatric and Neurodevelopmental Genetics Unit, Massachusetts General Hospital, Boston, MA, United States of America
- Department of Psychiatry, Harvard Medical School, Boston, MA, United States of America
- Stanley Center for Psychiatric Research, The Broad Institute of Harvard and MIT, Cambridge, MA, United States of America
- Center on the Developing Child at Harvard University, Cambridge, MA, United States of America
| | - Katherine M. Crawford
- Psychiatric and Neurodevelopmental Genetics Unit, Massachusetts General Hospital, Boston, MA, United States of America
| | - Thomas W. Soare
- Psychiatric and Neurodevelopmental Genetics Unit, Massachusetts General Hospital, Boston, MA, United States of America
- Department of Psychiatry, Harvard Medical School, Boston, MA, United States of America
- Stanley Center for Psychiatric Research, The Broad Institute of Harvard and MIT, Cambridge, MA, United States of America
| | | | - Miriam R. Raffeld
- Psychiatric and Neurodevelopmental Genetics Unit, Massachusetts General Hospital, Boston, MA, United States of America
| | - Andrew D.A.C. Smith
- Applied Statistics Group, University of the West of England, Bristol, United Kingdom
| | - Ian S. Penton-Voak
- School of Experimental Psychology, University of Bristol, Bristol, United Kingdom
| | - Marcus R. Munafò
- School of Experimental Psychology, University of Bristol, Bristol, United Kingdom
- Medical Research Council Integrative Epidemiology Unit (MRC IEU) at the University of Bristol, Bristol, United Kingdom
- UK Centre for Tobacco and Alcohol Studies, University of Bristol, Bristol, United Kingdom
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Phuah CL, Dave T, Malik R, Raffeld MR, Ayres AM, Goldstein JN, Viswanathan A, Greenberg SM, Jagiella JM, Hansen BM, Norrving B, Jimenez-Conde J, Roquer J, Pichler A, Enzinger C, Montaner J, Fernandez-Cadenas I, Lindgren A, Slowik A, Schmidt R, Biffi A, Rost N, Langefeld CD, Markus HS, Mitchell BD, Worrall BB, Kittner SJ, Woo D, Dichgans M, Rosand J, Anderson CD. Genetic variants influencing elevated myeloperoxidase levels increase risk of stroke. Brain 2017; 140:2663-2672. [PMID: 28969386 DOI: 10.1093/brain/awx220] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2017] [Accepted: 07/08/2017] [Indexed: 12/13/2022] Open
Abstract
Primary intracerebral haemorrhage and lacunar ischaemic stroke are acute manifestations of progressive cerebral microvascular disease. Current paradigms suggest atherosclerosis is a chronic, dynamic, inflammatory condition precipitated in response to endothelial injury from various environmental challenges. Myeloperoxidase plays a central role in initiation and progression of vascular inflammation, but prior studies linking myeloperoxidase with stroke risk have been inconclusive. We hypothesized that genetic determinants of myeloperoxidase levels influence the development of vascular instability, leading to increased primary intracerebral haemorrhage and lacunar stroke risk. We used a discovery cohort of 1409 primary intracerebral haemorrhage cases and 1624 controls from three studies, an extension cohort of 12 577 ischaemic stroke cases and 25 643 controls from NINDS-SiGN, and a validation cohort of 10 307 ischaemic stroke cases and 29 326 controls from METASTROKE Consortium with genome-wide genotyping to test this hypothesis. A genetic risk score reflecting elevated myeloperoxidase levels was constructed from 15 common single nucleotide polymorphisms identified from prior genome-wide studies of circulating myeloperoxidase levels (P < 5 × 10-6). This genetic risk score was used as the independent variable in multivariable regression models for association with primary intracerebral haemorrhage and ischaemic stroke subtypes. We used fixed effects meta-analyses to pool estimates across studies. We also used Cox regression models in a prospective cohort of 174 primary intracerebral haemorrhage survivors for association with intracerebral haemorrhage recurrence. We present effects of myeloperoxidase elevating single nucleotide polymorphisms on stroke risk per risk allele, corresponding to a one allele increase in the myeloperoxidase increasing genetic risk score. Genetic determinants of elevated circulating myeloperoxidase levels were associated with both primary intracerebral haemorrhage risk (odds ratio, 1.07, P = 0.04) and recurrent intracerebral haemorrhage risk (hazards ratio, 1.45, P = 0.006). In analysis of ischaemic stroke subtypes, the myeloperoxidase increasing genetic risk score was strongly associated with lacunar subtype only (odds ratio, 1.05, P = 0.0012). These results, demonstrating that common genetic variants that increase myeloperoxidase levels increase risk of primary intracerebral haemorrhage and lacunar stroke, directly implicate the myeloperoxidase pathway in the pathogenesis of cerebral small vessel disease. Because genetic variants are not influenced by environmental exposures, these results provide new support for a causal rather than bystander role for myeloperoxidase in the progression of cerebrovascular disease. Furthermore, these results support a rationale for chronic inflammation as a potential modifiable stroke risk mechanism, and suggest that immune-targeted therapies could be useful for treatment and prevention of cerebrovascular disease.
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Affiliation(s)
- Chia-Ling Phuah
- Center for Human Genetic Research, Massachusetts General Hospital (MGH), Boston, MA, USA.,Division of Neurocritical Care and Emergency Neurology, Department of Neurology, MGH, Boston, MA, USA
| | - Tushar Dave
- Division of Endocrinology, Diabetes and Nutrition, Department of Medicine, University of Maryland School of Medicine, Baltimore, USA
| | - Rainer Malik
- Institute for Stroke and Dementia Research, Klinikum der Universität München, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Miriam R Raffeld
- Center for Human Genetic Research, Massachusetts General Hospital (MGH), Boston, MA, USA
| | - Alison M Ayres
- Center for Human Genetic Research, Massachusetts General Hospital (MGH), Boston, MA, USA.,J. Philip Kistler Stroke Research Center, Department of Neurology, MGH, Boston, MA, USA
| | | | - Anand Viswanathan
- Program in Medical and Population Genetics, Broad Institute, Cambridge, MA, USA
| | - Steven M Greenberg
- J. Philip Kistler Stroke Research Center, Department of Neurology, MGH, Boston, MA, USA
| | - Jeremiasz M Jagiella
- Department of Neurology, Jagiellonian University Medical College, Krakow, Poland
| | - Björn M Hansen
- Department of Clinical Sciences Lund, Neurology, Lund University, Lund, Sweden.,Department of Neurology and Rehabilitation Medicine, Neurology, Skåne University Hospital, Lund, Sweden
| | - Bo Norrving
- Department of Clinical Sciences Lund, Neurology, Lund University, Lund, Sweden.,Department of Neurology and Rehabilitation Medicine, Neurology, Skåne University Hospital, Lund, Sweden
| | - Jordi Jimenez-Conde
- Neurovascular Research Unit, Department of Neurology, Institut Municipal d'Investigacio´ Medica-Hospital del Mar, Universitat Autonoma de Barcelona, Barcelona, Spain.,Program in Inflammation and Cardiovascular Disorders, Institut Municipal d'Investigacio´ Medica-Hospital del Mar, Universitat Autonoma de Barcelona, Barcelona, Spain
| | - Jaume Roquer
- Neurovascular Research Unit, Department of Neurology, Institut Municipal d'Investigacio´ Medica-Hospital del Mar, Universitat Autonoma de Barcelona, Barcelona, Spain.,Program in Inflammation and Cardiovascular Disorders, Institut Municipal d'Investigacio´ Medica-Hospital del Mar, Universitat Autonoma de Barcelona, Barcelona, Spain
| | | | - Christian Enzinger
- Department of Neurology, Medical University of Graz, Austria.,Division of Neuroradiology, Department of Radiology, Medical University of Graz, Austria
| | - Joan Montaner
- Neurovascular Research Laboratory and Neurovascular Unit, Institut de Recerca, Hospital Vall d'Hebron, Universitat Autonoma de Barcelona, Barcelona, Spain
| | - Israel Fernandez-Cadenas
- Neurovascular Research Laboratory and Neurovascular Unit, Institut de Recerca, Hospital Vall d'Hebron, Universitat Autonoma de Barcelona, Barcelona, Spain.,Stroke Pharmacogenomics and Genetics, Fundació Docència i Recerca Mutua Terrassa, Mutua de Terrassa Hospital, Terrassa, Spain
| | - Arne Lindgren
- Department of Clinical Sciences Lund, Neurology, Lund University, Lund, Sweden.,Department of Neurology and Rehabilitation Medicine, Neurology, Skåne University Hospital, Lund, Sweden
| | - Agnieszka Slowik
- Department of Neurology, Jagiellonian University Medical College, Krakow, Poland
| | | | - Alessandro Biffi
- Center for Human Genetic Research, Massachusetts General Hospital (MGH), Boston, MA, USA.,J. Philip Kistler Stroke Research Center, Department of Neurology, MGH, Boston, MA, USA.,Division of Behavioral Neurology, Department of Neurology, MGH, Boston, MA, USA.,Division of Neuropsychiatry, Department of Psychiatry, MGH, Boston, MA, USA
| | - Natalia Rost
- J. Philip Kistler Stroke Research Center, Department of Neurology, MGH, Boston, MA, USA
| | - Carl D Langefeld
- Center for Public Health Genomics, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Hugh S Markus
- Department of Clinical Neurosciences, University of Cambridge, UK
| | - Braxton D Mitchell
- Geriatrics Research and Education Clinical Center, Baltimore Veterans Administration Medical Center, Baltimore, MD, USA
| | - Brad B Worrall
- Department of Neurology, University of Virginia, Charlottesville, VA, USA.,Department of Public Health Science, University of Virginia, Charlottesville, VA, USA
| | - Steven J Kittner
- Department of Neurology, University of Maryland School of Medicine, Baltimore, MD, USA.,Department of Neurology, Veterans Affairs Medical Center, Baltimore, MD, USA
| | - Daniel Woo
- University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Martin Dichgans
- Institute for Stroke and Dementia Research, Klinikum der Universität München, Ludwig-Maximilians-Universität München, Munich, Germany.,German Center for Neurodegenerative Diseases (DZNE) and Munich Cluster for Systems Neurology (SyNergy), Germany
| | - Jonathan Rosand
- Center for Human Genetic Research, Massachusetts General Hospital (MGH), Boston, MA, USA.,Division of Neurocritical Care and Emergency Neurology, Department of Neurology, MGH, Boston, MA, USA.,J. Philip Kistler Stroke Research Center, Department of Neurology, MGH, Boston, MA, USA
| | - Christopher D Anderson
- Center for Human Genetic Research, Massachusetts General Hospital (MGH), Boston, MA, USA.,Division of Neurocritical Care and Emergency Neurology, Department of Neurology, MGH, Boston, MA, USA.,Program in Medical and Population Genetics, Broad Institute, Cambridge, MA, USA.,J. Philip Kistler Stroke Research Center, Department of Neurology, MGH, Boston, MA, USA
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Phuah CL, Raffeld MR, Ayres AM, Gurol ME, Viswanathan A, Greenberg SM, Biffi A, Rosand J, Anderson CD. APOE polymorphisms influence longitudinal lipid trends preceding intracerebral hemorrhage. Neurol Genet 2016; 2:e81. [PMID: 27433544 PMCID: PMC4936477 DOI: 10.1212/nxg.0000000000000081] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/15/2016] [Accepted: 05/03/2016] [Indexed: 11/15/2022]
Abstract
Objective: We sought to determine whether APOE genotype influences a previously observed decline in serum total cholesterol (TC) and low-density lipoprotein (LDL) levels preceding primary intracerebral hemorrhage (ICH), as a potential demonstration of nonamyloid mechanisms of APOE in ICH risk. Methods: We performed a single-center retrospective longitudinal analysis using patients with known APOE genotype drawn from an ongoing cohort study of ICH. Serum lipid measurements for TC, triglycerides (TGs), LDL, and high-density lipoprotein (HDL) collected within 2 years before and after index ICH were extracted from electronic medical records. Piecewise linear mixed-effects models were used to compare APOE allele–specific effects on temporal serum lipid trends in ICH. Demographics, medical history, medications, and health maintenance data were included as fixed effects. Inter- and intraindividual variations in lipid levels were modeled as random effects. Results: A total of 124 ICH cases were analyzed. APOE ε4 carriers had greater rates of decline in serum TC and LDL within 6 months preceding ICH (TC: −7.30 mg/dL/mo, p = 0.0035; LDL: −8.44 mg/dL/mo, p = 0.0001). Conversely, serum TC and LDL levels in APOE ε2 carriers were unchanged within the same time period. APOE genotype had no associations with serum HDL or TG trends. Conclusions: APOE allele status predicts serum TC and LDL changes preceding acute ICH. Our results have implications for ongoing efforts in dissecting the role of dyslipidemia in cerebrovascular disease risk. APOE genotype–specific influence on lipid trends provides a clue for one mechanism by which APOE may influence risk of ICH. Further characterization of the metabolic roles of APOE is needed to improve the understanding of APOE biology in cerebrovascular disease risk.
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Affiliation(s)
- Chia-Ling Phuah
- Division of Neurocritical Care and Emergency Neurology (C.-L.P., J.R., C.D.A.), Center for Human Genetic Research (C.-L.P., M.R.R., A.B., J.R., C.D.A.), The J. Philip Kistler Stroke Research Center (A.M.A., M.E.G., A.V., S.M.G., J.R., C.D.A.), Hemorrhagic Stroke Research Group (A.M.A., M.E.G., A.V., S.M.G., J.R., C.D.A.), Division of Behavioral Neurology (A.B.), Division of Psychiatry (A.B.), Department of Psychiatry, Massachusetts General Hospital, Boston; and Program in Medical and Population Genetics (C.-L.P., A.B., J.R., C.D.A.), Broad Institute, Cambridge, MA
| | - Miriam R Raffeld
- Division of Neurocritical Care and Emergency Neurology (C.-L.P., J.R., C.D.A.), Center for Human Genetic Research (C.-L.P., M.R.R., A.B., J.R., C.D.A.), The J. Philip Kistler Stroke Research Center (A.M.A., M.E.G., A.V., S.M.G., J.R., C.D.A.), Hemorrhagic Stroke Research Group (A.M.A., M.E.G., A.V., S.M.G., J.R., C.D.A.), Division of Behavioral Neurology (A.B.), Division of Psychiatry (A.B.), Department of Psychiatry, Massachusetts General Hospital, Boston; and Program in Medical and Population Genetics (C.-L.P., A.B., J.R., C.D.A.), Broad Institute, Cambridge, MA
| | - Alison M Ayres
- Division of Neurocritical Care and Emergency Neurology (C.-L.P., J.R., C.D.A.), Center for Human Genetic Research (C.-L.P., M.R.R., A.B., J.R., C.D.A.), The J. Philip Kistler Stroke Research Center (A.M.A., M.E.G., A.V., S.M.G., J.R., C.D.A.), Hemorrhagic Stroke Research Group (A.M.A., M.E.G., A.V., S.M.G., J.R., C.D.A.), Division of Behavioral Neurology (A.B.), Division of Psychiatry (A.B.), Department of Psychiatry, Massachusetts General Hospital, Boston; and Program in Medical and Population Genetics (C.-L.P., A.B., J.R., C.D.A.), Broad Institute, Cambridge, MA
| | - M Edip Gurol
- Division of Neurocritical Care and Emergency Neurology (C.-L.P., J.R., C.D.A.), Center for Human Genetic Research (C.-L.P., M.R.R., A.B., J.R., C.D.A.), The J. Philip Kistler Stroke Research Center (A.M.A., M.E.G., A.V., S.M.G., J.R., C.D.A.), Hemorrhagic Stroke Research Group (A.M.A., M.E.G., A.V., S.M.G., J.R., C.D.A.), Division of Behavioral Neurology (A.B.), Division of Psychiatry (A.B.), Department of Psychiatry, Massachusetts General Hospital, Boston; and Program in Medical and Population Genetics (C.-L.P., A.B., J.R., C.D.A.), Broad Institute, Cambridge, MA
| | - Anand Viswanathan
- Division of Neurocritical Care and Emergency Neurology (C.-L.P., J.R., C.D.A.), Center for Human Genetic Research (C.-L.P., M.R.R., A.B., J.R., C.D.A.), The J. Philip Kistler Stroke Research Center (A.M.A., M.E.G., A.V., S.M.G., J.R., C.D.A.), Hemorrhagic Stroke Research Group (A.M.A., M.E.G., A.V., S.M.G., J.R., C.D.A.), Division of Behavioral Neurology (A.B.), Division of Psychiatry (A.B.), Department of Psychiatry, Massachusetts General Hospital, Boston; and Program in Medical and Population Genetics (C.-L.P., A.B., J.R., C.D.A.), Broad Institute, Cambridge, MA
| | - Steven M Greenberg
- Division of Neurocritical Care and Emergency Neurology (C.-L.P., J.R., C.D.A.), Center for Human Genetic Research (C.-L.P., M.R.R., A.B., J.R., C.D.A.), The J. Philip Kistler Stroke Research Center (A.M.A., M.E.G., A.V., S.M.G., J.R., C.D.A.), Hemorrhagic Stroke Research Group (A.M.A., M.E.G., A.V., S.M.G., J.R., C.D.A.), Division of Behavioral Neurology (A.B.), Division of Psychiatry (A.B.), Department of Psychiatry, Massachusetts General Hospital, Boston; and Program in Medical and Population Genetics (C.-L.P., A.B., J.R., C.D.A.), Broad Institute, Cambridge, MA
| | - Alessandro Biffi
- Division of Neurocritical Care and Emergency Neurology (C.-L.P., J.R., C.D.A.), Center for Human Genetic Research (C.-L.P., M.R.R., A.B., J.R., C.D.A.), The J. Philip Kistler Stroke Research Center (A.M.A., M.E.G., A.V., S.M.G., J.R., C.D.A.), Hemorrhagic Stroke Research Group (A.M.A., M.E.G., A.V., S.M.G., J.R., C.D.A.), Division of Behavioral Neurology (A.B.), Division of Psychiatry (A.B.), Department of Psychiatry, Massachusetts General Hospital, Boston; and Program in Medical and Population Genetics (C.-L.P., A.B., J.R., C.D.A.), Broad Institute, Cambridge, MA
| | - Jonathan Rosand
- Division of Neurocritical Care and Emergency Neurology (C.-L.P., J.R., C.D.A.), Center for Human Genetic Research (C.-L.P., M.R.R., A.B., J.R., C.D.A.), The J. Philip Kistler Stroke Research Center (A.M.A., M.E.G., A.V., S.M.G., J.R., C.D.A.), Hemorrhagic Stroke Research Group (A.M.A., M.E.G., A.V., S.M.G., J.R., C.D.A.), Division of Behavioral Neurology (A.B.), Division of Psychiatry (A.B.), Department of Psychiatry, Massachusetts General Hospital, Boston; and Program in Medical and Population Genetics (C.-L.P., A.B., J.R., C.D.A.), Broad Institute, Cambridge, MA
| | - Christopher D Anderson
- Division of Neurocritical Care and Emergency Neurology (C.-L.P., J.R., C.D.A.), Center for Human Genetic Research (C.-L.P., M.R.R., A.B., J.R., C.D.A.), The J. Philip Kistler Stroke Research Center (A.M.A., M.E.G., A.V., S.M.G., J.R., C.D.A.), Hemorrhagic Stroke Research Group (A.M.A., M.E.G., A.V., S.M.G., J.R., C.D.A.), Division of Behavioral Neurology (A.B.), Division of Psychiatry (A.B.), Department of Psychiatry, Massachusetts General Hospital, Boston; and Program in Medical and Population Genetics (C.-L.P., A.B., J.R., C.D.A.), Broad Institute, Cambridge, MA
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5
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Phuah CL, Raffeld MR, Ayres AM, Viswanathan A, Greenberg SM, Biffi A, Rosand J, Anderson CD. Subacute decline in serum lipids precedes the occurrence of primary intracerebral hemorrhage. Neurology 2016; 86:2034-41. [PMID: 27164693 DOI: 10.1212/wnl.0000000000002716] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2015] [Accepted: 01/05/2016] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE We aimed to describe the temporal variation in circulating lipid levels among patients with intracerebral hemorrhage (ICH) and investigate their association with ICH risk. METHODS This was a single-center, retrospective, longitudinal, case-control analysis using cases drawn from an ongoing cohort study of primary ICH and controls drawn from a hospital-based clinical data registry. Piecewise linear mixed-effect random coefficient models were used to determine the significance of changes in serum lipid trends on ICH risk. RESULTS Two hundred twelve ICH cases and 301 control individuals were analyzed. Overall trends in serum total cholesterol (TC) and low-density lipoprotein (LDL) levels differed between ICH cases and non-ICH controls (p = 0.00001 and p = 0.0092, respectively). Patients with ICH experience accelerated decline in serum TC and LDL levels during 6 months immediately preceding ICH, compared with levels between 6 and 24 months pre-ICH (TC: -29.25 mg/dL, p = 0.001; LDL: -21.48 mg/dL, p = 0.0038), which was not observed in non-ICH controls. Subgroup analysis confirmed that this phenomenon cannot be attributed to statin or alcohol exposure. Serum triglycerides and high-density lipoprotein trends did not differ between groups. CONCLUSIONS Longitudinal lipid levels differ between ICH cases and non-ICH controls, most notably for a decline in serum TC and LDL levels within 6 months preceding primary ICH, independent of statin or alcohol use. These changes in serum TC and LDL trends suggest a biological pathway that precipitates ICH occurrence. Further studies are needed to replicate these results and characterize rate of change in serum lipids as a potential biomarker of impending acute cerebral injury.
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Affiliation(s)
- Chia-Ling Phuah
- From the Division of Neurocritical Care and Emergency Neurology (C.-L.P., J.R., C.D.A.), Center for Human Genetic Research (C.-L.P., M.R.R., A.B., J.R., C.D.A.), The J. Philip Kistler Stroke Research Center (A.M.A., A.V., S.M.G., J.R., C.D.A.), and Hemorrhagic Stroke Research Group (A.M.A., A.V., S.M.G., A.B., J.R., C.D.A.), Massachusetts General Hospital, Boston; and Program in Medical and Population Genetics (C.-L.P., A.B., J.R., C.D.A.), Broad Institute, Cambridge, MA
| | - Miriam R Raffeld
- From the Division of Neurocritical Care and Emergency Neurology (C.-L.P., J.R., C.D.A.), Center for Human Genetic Research (C.-L.P., M.R.R., A.B., J.R., C.D.A.), The J. Philip Kistler Stroke Research Center (A.M.A., A.V., S.M.G., J.R., C.D.A.), and Hemorrhagic Stroke Research Group (A.M.A., A.V., S.M.G., A.B., J.R., C.D.A.), Massachusetts General Hospital, Boston; and Program in Medical and Population Genetics (C.-L.P., A.B., J.R., C.D.A.), Broad Institute, Cambridge, MA
| | - Alison M Ayres
- From the Division of Neurocritical Care and Emergency Neurology (C.-L.P., J.R., C.D.A.), Center for Human Genetic Research (C.-L.P., M.R.R., A.B., J.R., C.D.A.), The J. Philip Kistler Stroke Research Center (A.M.A., A.V., S.M.G., J.R., C.D.A.), and Hemorrhagic Stroke Research Group (A.M.A., A.V., S.M.G., A.B., J.R., C.D.A.), Massachusetts General Hospital, Boston; and Program in Medical and Population Genetics (C.-L.P., A.B., J.R., C.D.A.), Broad Institute, Cambridge, MA
| | - Anand Viswanathan
- From the Division of Neurocritical Care and Emergency Neurology (C.-L.P., J.R., C.D.A.), Center for Human Genetic Research (C.-L.P., M.R.R., A.B., J.R., C.D.A.), The J. Philip Kistler Stroke Research Center (A.M.A., A.V., S.M.G., J.R., C.D.A.), and Hemorrhagic Stroke Research Group (A.M.A., A.V., S.M.G., A.B., J.R., C.D.A.), Massachusetts General Hospital, Boston; and Program in Medical and Population Genetics (C.-L.P., A.B., J.R., C.D.A.), Broad Institute, Cambridge, MA
| | - Steven M Greenberg
- From the Division of Neurocritical Care and Emergency Neurology (C.-L.P., J.R., C.D.A.), Center for Human Genetic Research (C.-L.P., M.R.R., A.B., J.R., C.D.A.), The J. Philip Kistler Stroke Research Center (A.M.A., A.V., S.M.G., J.R., C.D.A.), and Hemorrhagic Stroke Research Group (A.M.A., A.V., S.M.G., A.B., J.R., C.D.A.), Massachusetts General Hospital, Boston; and Program in Medical and Population Genetics (C.-L.P., A.B., J.R., C.D.A.), Broad Institute, Cambridge, MA
| | - Alessandro Biffi
- From the Division of Neurocritical Care and Emergency Neurology (C.-L.P., J.R., C.D.A.), Center for Human Genetic Research (C.-L.P., M.R.R., A.B., J.R., C.D.A.), The J. Philip Kistler Stroke Research Center (A.M.A., A.V., S.M.G., J.R., C.D.A.), and Hemorrhagic Stroke Research Group (A.M.A., A.V., S.M.G., A.B., J.R., C.D.A.), Massachusetts General Hospital, Boston; and Program in Medical and Population Genetics (C.-L.P., A.B., J.R., C.D.A.), Broad Institute, Cambridge, MA
| | - Jonathan Rosand
- From the Division of Neurocritical Care and Emergency Neurology (C.-L.P., J.R., C.D.A.), Center for Human Genetic Research (C.-L.P., M.R.R., A.B., J.R., C.D.A.), The J. Philip Kistler Stroke Research Center (A.M.A., A.V., S.M.G., J.R., C.D.A.), and Hemorrhagic Stroke Research Group (A.M.A., A.V., S.M.G., A.B., J.R., C.D.A.), Massachusetts General Hospital, Boston; and Program in Medical and Population Genetics (C.-L.P., A.B., J.R., C.D.A.), Broad Institute, Cambridge, MA
| | - Christopher D Anderson
- From the Division of Neurocritical Care and Emergency Neurology (C.-L.P., J.R., C.D.A.), Center for Human Genetic Research (C.-L.P., M.R.R., A.B., J.R., C.D.A.), The J. Philip Kistler Stroke Research Center (A.M.A., A.V., S.M.G., J.R., C.D.A.), and Hemorrhagic Stroke Research Group (A.M.A., A.V., S.M.G., A.B., J.R., C.D.A.), Massachusetts General Hospital, Boston; and Program in Medical and Population Genetics (C.-L.P., A.B., J.R., C.D.A.), Broad Institute, Cambridge, MA.
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Affiliation(s)
- Miriam R Raffeld
- From the Department of Neurology, Center for Human Genetic Research, Massachusetts General Hospital, Boston (M.R.R.); Department of Neurology, Lariboisière Hospital, Paris 7 University, DHU Neurovasc Sorbonne Paris Cité, Paris, France (S.D.); Inserm U897, Bordeaux University, Talence, France (S.D.); and Department of Neurology, University of Cincinnati Medical Center, OH (D.W.)
| | - Stephanie Debette
- From the Department of Neurology, Center for Human Genetic Research, Massachusetts General Hospital, Boston (M.R.R.); Department of Neurology, Lariboisière Hospital, Paris 7 University, DHU Neurovasc Sorbonne Paris Cité, Paris, France (S.D.); Inserm U897, Bordeaux University, Talence, France (S.D.); and Department of Neurology, University of Cincinnati Medical Center, OH (D.W.)
| | - Daniel Woo
- From the Department of Neurology, Center for Human Genetic Research, Massachusetts General Hospital, Boston (M.R.R.); Department of Neurology, Lariboisière Hospital, Paris 7 University, DHU Neurovasc Sorbonne Paris Cité, Paris, France (S.D.); Inserm U897, Bordeaux University, Talence, France (S.D.); and Department of Neurology, University of Cincinnati Medical Center, OH (D.W.).
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Phuah CL, Raffeld MR, Ayres AM, Biffi A, Gurol ME, Viswanathan A, Greenberg SM, Rosand J, Anderson CD. Abstract 125: Subacute Decline in Serum Cholesterol Precedes the Occurrence of Primary Intracerebral Hemorrhage: Results From a Longitudinal Study. Stroke 2016. [DOI: 10.1161/str.47.suppl_1.125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction:
Dyslipidemia plays a paradoxical role in some forms of cerebrovascular disease. Unlike its relationship with ischemic stroke, hypercholesterolemia has been associated with reduced risk of intracerebral hemorrhage (ICH). However, serum lipid levels have wide variation coefficients, and point estimates are likely not representative of long-term exposures. Understanding the temporal trends in serum lipid levels and their association with ICH may improve understanding of the biology of dyslipidemia in ICH. We sought to determine the course of temporal variations in total cholesterol (TC), low-density lipoprotein (LDL), triglycerides (TG) and high-density lipoprotein (HDL) over 48 months before and after primary ICH.
Methods:
We performed a single-center retrospective longitudinal case-control analysis using cases drawn from an ongoing cohort study of primary ICH and controls drawn from a clinical data registry of patients hospitalized for acute non-cerebral events. Piecewise linear mixed-effects models were used to compare the impact of ICH or hospitalization on lipid trends.
Results:
212 ICH cases and 301 control subjects were analyzed. Overall trends in serum TC and LDL levels differed between ICH subjects and non-ICH controls (p<0.0001). ICH subjects experienced significant decline in serum TC and LDL levels during 6 months immediately preceding ICH, compared with levels between 6 to 24 months pre-ICH (TC: -29.25mg/dL, p=0.001; LDL: -21.48mg/dL, p=0.0038), which were not observed in non-ICH controls (TC: -4.32mg/dL, p=0.41; LDL: -1.56mg/dL, p=0.85). Subgroup analysis confirmed that this phenomenon could not be attributed to statin or alcohol exposure. Trends for serum TG and HDL did not differ between groups.
Conclusions:
Longitudinal serum TC and LDL levels demonstrate decline within 6 months preceding primary ICH, independent of statin or alcohol use. Subjects hospitalized for non-cerebral events did not exhibit this phenomenon. These temporal trends suggest changes in serum TC and LDL levels herald a generalized process that may precipitate ICH occurrence. Further studies are needed to replicate these results and characterize rate of change in serum lipids as a potential biomarker of impending acute cerebral injury.
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Phuah CL, Raffeld MR, Ayres AM, Biffi A, Gurol ME, Viswanathan A, Greenberg SM, Rosand J, Anderson CD. Abstract WP358: APOE Polymorphisms Influence Longitudinal Lipid Trends Preceding Primary Intracerebral Hemorrhage. Stroke 2016. [DOI: 10.1161/str.47.suppl_1.wp358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction:
Primary intracerebral hemorrhage (ICH) remains one of the most severe forms of acute cerebrovascular disease. APOE ε2 and ε4 are risk factors for primary ICH, and also involved in regulation of circulating lipid levels. Hypercholesterolemia has been associated with reduced ICH risk. However, the biological mechanisms mediating the roles of APOE and serum lipids on ICH risk remain unclear. Given the pleiotropic relationship between APOE, ICH, and serum lipid levels, we sought to determine the influence of APOE genotype on temporal serum lipid trends before and after ICH.
Methods:
We performed a single-center retrospective longitudinal cohort analysis using subjects with known APOE genotype drawn from an ongoing cohort study of primary ICH. Serum lipid measurements for total cholesterol (TC), triglycerides (TG), low-density lipoprotein (LDL), and high-density lipoprotein (HDL) collected within 2 years preceding and following index ICH were extracted from electronic medical records (EMR). Piecewise linear mixed-effects random-coefficent models were used to compare APOE allele-specific effects on changes in serum lipid trends in ICH.
Results:
124 ICH cases were analyzed. APOE ε4 carriers had significantly greater rates of decline in serum TC and LDL levels within 6 months prior to ICH (TC: -7.30 mg/dL/month, p=0.0035; LDL: -8.44 mg/dL/month, p=0.0001) compared to non-carriers (TC: -3.79 mg/dL/month, p=0.17; LDL: -2.39 mg/dL/month, p=0.55). In contrast, TC and LDL trends for APOE ε2 carriers were not significantly altered within the same time period. APOE genotype had no associations with serum HDL or TG trends.
Conclusions:
APOE allele status is a strong predictor of subacute serum TC and LDL changes preceding ICH. Our results have implications for ongoing efforts in dissecting the role of dyslipidemia in cerebrovascular disease risk. While further studies are needed, our observation that APOE ε4 influences serum lipid trends preceding ICH provides additional insight towards lipid-dependent and lipid-independent APOE-genotype specific effects on stroke risk and suggests that characterization of the metabolic role of APOE is needed to improve understanding of APOE biology in cerebrovascular disease.
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Dunn EC, Busso DS, Raffeld MR, Smoller JW, Nelson CA, Doyle AE, Luk G. Does developmental timing of exposure to child maltreatment predict memory performance in adulthood? Results from a large, population-based sample. Child Abuse Negl 2016; 51:181-91. [PMID: 26585216 PMCID: PMC4713298 DOI: 10.1016/j.chiabu.2015.10.014] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/17/2015] [Revised: 10/13/2015] [Accepted: 10/15/2015] [Indexed: 05/23/2023]
Abstract
Although maltreatment is a known risk factor for multiple adverse outcomes across the lifespan, its effects on cognitive development, especially memory, are poorly understood. Using data from a large, nationally representative sample of young adults (Add Health), we examined the effects of physical and sexual abuse on working and short-term memory in adulthood. We examined the association between exposure to maltreatment as well as its timing of first onset after adjusting for covariates. Of our sample, 16.50% of respondents were exposed to physical abuse and 4.36% to sexual abuse by age 17. An analysis comparing unexposed respondents to those exposed to physical or sexual abuse did not yield any significant differences in adult memory performance. However, two developmental time periods emerged as important for shaping memory following exposure to sexual abuse, but in opposite ways. Relative to non-exposed respondents, those exposed to sexual abuse during early childhood (ages 3-5), had better number recall and those first exposed during adolescence (ages 14-17) had worse number recall. However, other variables, including socioeconomic status, played a larger role (than maltreatment) on working and short-term memory. We conclude that a simple examination of "exposed" versus "unexposed" respondents may obscure potentially important within-group differences that are revealed by examining the effects of age at onset to maltreatment.
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Affiliation(s)
- Erin C. Dunn
- Center for Human Genetic Research, Massachusetts General Hospital
- Department of Psychiatry, Harvard Medical School
- Stanley Center for Psychiatric Research, The Broad Institute of Harvard and MIT
| | | | | | - Jordan W. Smoller
- Center for Human Genetic Research, Massachusetts General Hospital
- Department of Psychiatry, Harvard Medical School
- Stanley Center for Psychiatric Research, The Broad Institute of Harvard and MIT
- Boston Children's Hospital, Boston, MA
| | - Charles A. Nelson
- Harvard Graduate School of Education, Cambridge, MA
- Boston Children's Hospital, Boston, MA
- Center on the Developing Child, Harvard University
| | - Alysa E. Doyle
- Center for Human Genetic Research, Massachusetts General Hospital
- Department of Psychiatry, Harvard Medical School
- Stanley Center for Psychiatric Research, The Broad Institute of Harvard and MIT
| | - Gigi Luk
- Harvard Graduate School of Education, Cambridge, MA
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Raffeld MR, Biffi A, Battey TWK, Ayres AM, Viswanathan A, Greenberg SM, Rosand J, Anderson CD. APOE ε4 and lipid levels affect risk of recurrent nonlobar intracerebral hemorrhage. Neurology 2015; 85:349-56. [PMID: 26115730 DOI: 10.1212/wnl.0000000000001790] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2015] [Accepted: 03/27/2015] [Indexed: 01/01/2023] Open
Abstract
OBJECTIVE Genetic variants ε2/ε4 within the APOE gene are established risk factors for lobar intracerebral hemorrhage (ICH). Published preliminary data suggest a potential role for APOE ε4 in risk of nonlobar ICH. We therefore investigated the role of APOE in recurrent nonlobar ICH, and sought to clarify whether effects of APOE on circulating lipids mediate this association. METHODS Three hundred sixty-three survivors of nonlobar ICH were followed prospectively for ICH recurrence, with APOE genotype determined at enrollment. All participants had clinical, demographic, and laboratory data captured at time of index ICH and during follow-up. Using a multivariate model, we performed association and interaction analyses of the relationships among APOE genotype, lipid levels, and recurrent nonlobar ICH. RESULTS We observed 29 nonlobar ICH recurrences among 363 survivors. APOE ε4 was associated with recurrent nonlobar ICH (hazard ratio = 1.31; 95% confidence interval = 1.02-2.69; p = 0.038) after adjustment for age/sex/ethnicity and cardiovascular risk factors. Increasing low-density lipoprotein (LDL) levels were associated with decreased risk of recurrent nonlobar ICH (p = 0.027), as were decreasing HDL levels (p = 0.046). LDL levels modified the association of APOE ε4 with recurrent nonlobar ICH (mediation p < 0.05). No associations were identified between APOE ε2 and recurrent nonlobar ICH. CONCLUSION APOE ε4 is associated with recurrent ICH in nonlobar brain regions, providing further evidence for its causal role in ICH unrelated to cerebral amyloid angiopathy. LDL levels modulated this effect, suggesting that circulating lipid levels may mediate a portion of the role of APOE ε4 in nonlobar ICH.
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Affiliation(s)
- Miriam R Raffeld
- From the Hemorrhagic Stroke Research Group (M.R.R., A.B., T.W.K.B., A.M.A., A.V., S.M.G., J.R., C.D.A.), Division of Neurocritical Care and Emergency Neurology, Department of Neurology (M.R.R., A.B., T.W.K.B., J.R., C.D.A.), and Center for Human Genetic Research (M.R.R., A.B., T.W.K.B., J.R., C.D.A.), Massachusetts General Hospital, Boston
| | - Alessandro Biffi
- From the Hemorrhagic Stroke Research Group (M.R.R., A.B., T.W.K.B., A.M.A., A.V., S.M.G., J.R., C.D.A.), Division of Neurocritical Care and Emergency Neurology, Department of Neurology (M.R.R., A.B., T.W.K.B., J.R., C.D.A.), and Center for Human Genetic Research (M.R.R., A.B., T.W.K.B., J.R., C.D.A.), Massachusetts General Hospital, Boston
| | - Thomas W K Battey
- From the Hemorrhagic Stroke Research Group (M.R.R., A.B., T.W.K.B., A.M.A., A.V., S.M.G., J.R., C.D.A.), Division of Neurocritical Care and Emergency Neurology, Department of Neurology (M.R.R., A.B., T.W.K.B., J.R., C.D.A.), and Center for Human Genetic Research (M.R.R., A.B., T.W.K.B., J.R., C.D.A.), Massachusetts General Hospital, Boston
| | - Alison M Ayres
- From the Hemorrhagic Stroke Research Group (M.R.R., A.B., T.W.K.B., A.M.A., A.V., S.M.G., J.R., C.D.A.), Division of Neurocritical Care and Emergency Neurology, Department of Neurology (M.R.R., A.B., T.W.K.B., J.R., C.D.A.), and Center for Human Genetic Research (M.R.R., A.B., T.W.K.B., J.R., C.D.A.), Massachusetts General Hospital, Boston
| | - Anand Viswanathan
- From the Hemorrhagic Stroke Research Group (M.R.R., A.B., T.W.K.B., A.M.A., A.V., S.M.G., J.R., C.D.A.), Division of Neurocritical Care and Emergency Neurology, Department of Neurology (M.R.R., A.B., T.W.K.B., J.R., C.D.A.), and Center for Human Genetic Research (M.R.R., A.B., T.W.K.B., J.R., C.D.A.), Massachusetts General Hospital, Boston
| | - Steven M Greenberg
- From the Hemorrhagic Stroke Research Group (M.R.R., A.B., T.W.K.B., A.M.A., A.V., S.M.G., J.R., C.D.A.), Division of Neurocritical Care and Emergency Neurology, Department of Neurology (M.R.R., A.B., T.W.K.B., J.R., C.D.A.), and Center for Human Genetic Research (M.R.R., A.B., T.W.K.B., J.R., C.D.A.), Massachusetts General Hospital, Boston
| | - Jonathan Rosand
- From the Hemorrhagic Stroke Research Group (M.R.R., A.B., T.W.K.B., A.M.A., A.V., S.M.G., J.R., C.D.A.), Division of Neurocritical Care and Emergency Neurology, Department of Neurology (M.R.R., A.B., T.W.K.B., J.R., C.D.A.), and Center for Human Genetic Research (M.R.R., A.B., T.W.K.B., J.R., C.D.A.), Massachusetts General Hospital, Boston
| | - Christopher D Anderson
- From the Hemorrhagic Stroke Research Group (M.R.R., A.B., T.W.K.B., A.M.A., A.V., S.M.G., J.R., C.D.A.), Division of Neurocritical Care and Emergency Neurology, Department of Neurology (M.R.R., A.B., T.W.K.B., J.R., C.D.A.), and Center for Human Genetic Research (M.R.R., A.B., T.W.K.B., J.R., C.D.A.), Massachusetts General Hospital, Boston.
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Radmanesh F, Falcone GJ, Anderson CD, McWilliams D, Devan WJ, Brown WM, Battey TWK, Ayres AM, Raffeld MR, Schwab K, Sun G, Deka R, Viswanathan A, Goldstein JN, Greenberg SM, Tirschwell DL, Silliman SL, Selim M, Meschia JF, Brown DL, Worrall BB, Langefeld CD, Woo D, Rosand J. Rare Coding Variation and Risk of Intracerebral Hemorrhage. Stroke 2015; 46:2299-301. [PMID: 26111891 DOI: 10.1161/strokeaha.115.009838] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2015] [Accepted: 05/15/2015] [Indexed: 01/22/2023]
Abstract
BACKGROUND AND PURPOSE Intracerebral hemorrhage has a substantial genetic component. We performed a preliminary search for rare coding variants associated with intracerebral hemorrhage. METHODS A total of 757 cases and 795 controls were genotyped using the Illumina HumanExome Beadchip (Illumina, Inc, San Diego, CA). Meta-analyses of single-variant and gene-based association were computed. RESULTS No rare coding variants were associated with intracerebral hemorrhage. Three common variants on chromosome 19q13 at an established susceptibility locus, encompassing TOMM40, APOE, and APOC1, met genome-wide significance (P<5e-08). After adjusting for the APOE epsilon alleles, this locus was no longer convincingly associated with intracerebral hemorrhage. No gene reached genome-wide significance level in gene-based association testing. CONCLUSIONS Although no coding variants of large effect were detected, this study further underscores a major challenge for the study of genetic susceptibility loci; large sample sizes are required for sufficient power except for loci with large effects.
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Affiliation(s)
- Farid Radmanesh
- From the Center for Human Genetic Research (F.R., G.J.F., C.D.A., W.J.D., T.W.K.B., M.R.R., J.R.), Division of Neurocritical Care and Emergency Neurology, Department of Neurology (F.R., G.J.F., C.D.A., W.J.D., T.W.K.B., M.R.R., J.R.), J. Philip Kistler Stroke Research Center (F.R., G.J.F., C.D.A., W.J.D., T.W.K.B., A.M.A., M.R.R., K.S., A.V., S.M.G., J.R.), and Department of Emergency Medicine (J.N.G.), Massachusetts General Hospital, Boston; Program in Medical and Population Genetics, Broad Institute, Cambridge, MA (F.R., G.J.F., C.D.A., W.J.D., T.W.K.B., M.R.R., J.R.); Department of Biostatistical Sciences, Center for Public Health Genomics, Wake Forest School of Medicine, Winston-Salem, NC (D.M., W.M.B., C.D.L.); Quinnipiac University, Frank H. Netter MD School of Medicine, Hamden, CT (W.J.D.); Department of Environmental Health (G.S., R.D.) and Department of Neurology and Rehabilitation (D.W.), University of Cincinnati College of Medicine, OH; Department of Neurology, Harborview Medical Center, University of Washington, Seattle (D.L.T.); Department of Neurology, University of Florida College of Medicine, Jacksonville (S.L.S.); Department of Neurology, Beth Israel Deaconess Medical Center, Boston, MA (M.S.); Department of Neurology, Mayo Clinic, Jacksonville, FL (J.F.M.); Department of Neurology, University of Michigan Health System, Ann Arbor (D.L.B.); and Departments of Neurology and Public Health Sciences, University of Virginia Health System, Charlottesville (B.B.W.)
| | - Guido J Falcone
- From the Center for Human Genetic Research (F.R., G.J.F., C.D.A., W.J.D., T.W.K.B., M.R.R., J.R.), Division of Neurocritical Care and Emergency Neurology, Department of Neurology (F.R., G.J.F., C.D.A., W.J.D., T.W.K.B., M.R.R., J.R.), J. Philip Kistler Stroke Research Center (F.R., G.J.F., C.D.A., W.J.D., T.W.K.B., A.M.A., M.R.R., K.S., A.V., S.M.G., J.R.), and Department of Emergency Medicine (J.N.G.), Massachusetts General Hospital, Boston; Program in Medical and Population Genetics, Broad Institute, Cambridge, MA (F.R., G.J.F., C.D.A., W.J.D., T.W.K.B., M.R.R., J.R.); Department of Biostatistical Sciences, Center for Public Health Genomics, Wake Forest School of Medicine, Winston-Salem, NC (D.M., W.M.B., C.D.L.); Quinnipiac University, Frank H. Netter MD School of Medicine, Hamden, CT (W.J.D.); Department of Environmental Health (G.S., R.D.) and Department of Neurology and Rehabilitation (D.W.), University of Cincinnati College of Medicine, OH; Department of Neurology, Harborview Medical Center, University of Washington, Seattle (D.L.T.); Department of Neurology, University of Florida College of Medicine, Jacksonville (S.L.S.); Department of Neurology, Beth Israel Deaconess Medical Center, Boston, MA (M.S.); Department of Neurology, Mayo Clinic, Jacksonville, FL (J.F.M.); Department of Neurology, University of Michigan Health System, Ann Arbor (D.L.B.); and Departments of Neurology and Public Health Sciences, University of Virginia Health System, Charlottesville (B.B.W.)
| | - Christopher D Anderson
- From the Center for Human Genetic Research (F.R., G.J.F., C.D.A., W.J.D., T.W.K.B., M.R.R., J.R.), Division of Neurocritical Care and Emergency Neurology, Department of Neurology (F.R., G.J.F., C.D.A., W.J.D., T.W.K.B., M.R.R., J.R.), J. Philip Kistler Stroke Research Center (F.R., G.J.F., C.D.A., W.J.D., T.W.K.B., A.M.A., M.R.R., K.S., A.V., S.M.G., J.R.), and Department of Emergency Medicine (J.N.G.), Massachusetts General Hospital, Boston; Program in Medical and Population Genetics, Broad Institute, Cambridge, MA (F.R., G.J.F., C.D.A., W.J.D., T.W.K.B., M.R.R., J.R.); Department of Biostatistical Sciences, Center for Public Health Genomics, Wake Forest School of Medicine, Winston-Salem, NC (D.M., W.M.B., C.D.L.); Quinnipiac University, Frank H. Netter MD School of Medicine, Hamden, CT (W.J.D.); Department of Environmental Health (G.S., R.D.) and Department of Neurology and Rehabilitation (D.W.), University of Cincinnati College of Medicine, OH; Department of Neurology, Harborview Medical Center, University of Washington, Seattle (D.L.T.); Department of Neurology, University of Florida College of Medicine, Jacksonville (S.L.S.); Department of Neurology, Beth Israel Deaconess Medical Center, Boston, MA (M.S.); Department of Neurology, Mayo Clinic, Jacksonville, FL (J.F.M.); Department of Neurology, University of Michigan Health System, Ann Arbor (D.L.B.); and Departments of Neurology and Public Health Sciences, University of Virginia Health System, Charlottesville (B.B.W.)
| | - David McWilliams
- From the Center for Human Genetic Research (F.R., G.J.F., C.D.A., W.J.D., T.W.K.B., M.R.R., J.R.), Division of Neurocritical Care and Emergency Neurology, Department of Neurology (F.R., G.J.F., C.D.A., W.J.D., T.W.K.B., M.R.R., J.R.), J. Philip Kistler Stroke Research Center (F.R., G.J.F., C.D.A., W.J.D., T.W.K.B., A.M.A., M.R.R., K.S., A.V., S.M.G., J.R.), and Department of Emergency Medicine (J.N.G.), Massachusetts General Hospital, Boston; Program in Medical and Population Genetics, Broad Institute, Cambridge, MA (F.R., G.J.F., C.D.A., W.J.D., T.W.K.B., M.R.R., J.R.); Department of Biostatistical Sciences, Center for Public Health Genomics, Wake Forest School of Medicine, Winston-Salem, NC (D.M., W.M.B., C.D.L.); Quinnipiac University, Frank H. Netter MD School of Medicine, Hamden, CT (W.J.D.); Department of Environmental Health (G.S., R.D.) and Department of Neurology and Rehabilitation (D.W.), University of Cincinnati College of Medicine, OH; Department of Neurology, Harborview Medical Center, University of Washington, Seattle (D.L.T.); Department of Neurology, University of Florida College of Medicine, Jacksonville (S.L.S.); Department of Neurology, Beth Israel Deaconess Medical Center, Boston, MA (M.S.); Department of Neurology, Mayo Clinic, Jacksonville, FL (J.F.M.); Department of Neurology, University of Michigan Health System, Ann Arbor (D.L.B.); and Departments of Neurology and Public Health Sciences, University of Virginia Health System, Charlottesville (B.B.W.)
| | - William J Devan
- From the Center for Human Genetic Research (F.R., G.J.F., C.D.A., W.J.D., T.W.K.B., M.R.R., J.R.), Division of Neurocritical Care and Emergency Neurology, Department of Neurology (F.R., G.J.F., C.D.A., W.J.D., T.W.K.B., M.R.R., J.R.), J. Philip Kistler Stroke Research Center (F.R., G.J.F., C.D.A., W.J.D., T.W.K.B., A.M.A., M.R.R., K.S., A.V., S.M.G., J.R.), and Department of Emergency Medicine (J.N.G.), Massachusetts General Hospital, Boston; Program in Medical and Population Genetics, Broad Institute, Cambridge, MA (F.R., G.J.F., C.D.A., W.J.D., T.W.K.B., M.R.R., J.R.); Department of Biostatistical Sciences, Center for Public Health Genomics, Wake Forest School of Medicine, Winston-Salem, NC (D.M., W.M.B., C.D.L.); Quinnipiac University, Frank H. Netter MD School of Medicine, Hamden, CT (W.J.D.); Department of Environmental Health (G.S., R.D.) and Department of Neurology and Rehabilitation (D.W.), University of Cincinnati College of Medicine, OH; Department of Neurology, Harborview Medical Center, University of Washington, Seattle (D.L.T.); Department of Neurology, University of Florida College of Medicine, Jacksonville (S.L.S.); Department of Neurology, Beth Israel Deaconess Medical Center, Boston, MA (M.S.); Department of Neurology, Mayo Clinic, Jacksonville, FL (J.F.M.); Department of Neurology, University of Michigan Health System, Ann Arbor (D.L.B.); and Departments of Neurology and Public Health Sciences, University of Virginia Health System, Charlottesville (B.B.W.)
| | - W Mark Brown
- From the Center for Human Genetic Research (F.R., G.J.F., C.D.A., W.J.D., T.W.K.B., M.R.R., J.R.), Division of Neurocritical Care and Emergency Neurology, Department of Neurology (F.R., G.J.F., C.D.A., W.J.D., T.W.K.B., M.R.R., J.R.), J. Philip Kistler Stroke Research Center (F.R., G.J.F., C.D.A., W.J.D., T.W.K.B., A.M.A., M.R.R., K.S., A.V., S.M.G., J.R.), and Department of Emergency Medicine (J.N.G.), Massachusetts General Hospital, Boston; Program in Medical and Population Genetics, Broad Institute, Cambridge, MA (F.R., G.J.F., C.D.A., W.J.D., T.W.K.B., M.R.R., J.R.); Department of Biostatistical Sciences, Center for Public Health Genomics, Wake Forest School of Medicine, Winston-Salem, NC (D.M., W.M.B., C.D.L.); Quinnipiac University, Frank H. Netter MD School of Medicine, Hamden, CT (W.J.D.); Department of Environmental Health (G.S., R.D.) and Department of Neurology and Rehabilitation (D.W.), University of Cincinnati College of Medicine, OH; Department of Neurology, Harborview Medical Center, University of Washington, Seattle (D.L.T.); Department of Neurology, University of Florida College of Medicine, Jacksonville (S.L.S.); Department of Neurology, Beth Israel Deaconess Medical Center, Boston, MA (M.S.); Department of Neurology, Mayo Clinic, Jacksonville, FL (J.F.M.); Department of Neurology, University of Michigan Health System, Ann Arbor (D.L.B.); and Departments of Neurology and Public Health Sciences, University of Virginia Health System, Charlottesville (B.B.W.)
| | - Thomas W K Battey
- From the Center for Human Genetic Research (F.R., G.J.F., C.D.A., W.J.D., T.W.K.B., M.R.R., J.R.), Division of Neurocritical Care and Emergency Neurology, Department of Neurology (F.R., G.J.F., C.D.A., W.J.D., T.W.K.B., M.R.R., J.R.), J. Philip Kistler Stroke Research Center (F.R., G.J.F., C.D.A., W.J.D., T.W.K.B., A.M.A., M.R.R., K.S., A.V., S.M.G., J.R.), and Department of Emergency Medicine (J.N.G.), Massachusetts General Hospital, Boston; Program in Medical and Population Genetics, Broad Institute, Cambridge, MA (F.R., G.J.F., C.D.A., W.J.D., T.W.K.B., M.R.R., J.R.); Department of Biostatistical Sciences, Center for Public Health Genomics, Wake Forest School of Medicine, Winston-Salem, NC (D.M., W.M.B., C.D.L.); Quinnipiac University, Frank H. Netter MD School of Medicine, Hamden, CT (W.J.D.); Department of Environmental Health (G.S., R.D.) and Department of Neurology and Rehabilitation (D.W.), University of Cincinnati College of Medicine, OH; Department of Neurology, Harborview Medical Center, University of Washington, Seattle (D.L.T.); Department of Neurology, University of Florida College of Medicine, Jacksonville (S.L.S.); Department of Neurology, Beth Israel Deaconess Medical Center, Boston, MA (M.S.); Department of Neurology, Mayo Clinic, Jacksonville, FL (J.F.M.); Department of Neurology, University of Michigan Health System, Ann Arbor (D.L.B.); and Departments of Neurology and Public Health Sciences, University of Virginia Health System, Charlottesville (B.B.W.)
| | - Alison M Ayres
- From the Center for Human Genetic Research (F.R., G.J.F., C.D.A., W.J.D., T.W.K.B., M.R.R., J.R.), Division of Neurocritical Care and Emergency Neurology, Department of Neurology (F.R., G.J.F., C.D.A., W.J.D., T.W.K.B., M.R.R., J.R.), J. Philip Kistler Stroke Research Center (F.R., G.J.F., C.D.A., W.J.D., T.W.K.B., A.M.A., M.R.R., K.S., A.V., S.M.G., J.R.), and Department of Emergency Medicine (J.N.G.), Massachusetts General Hospital, Boston; Program in Medical and Population Genetics, Broad Institute, Cambridge, MA (F.R., G.J.F., C.D.A., W.J.D., T.W.K.B., M.R.R., J.R.); Department of Biostatistical Sciences, Center for Public Health Genomics, Wake Forest School of Medicine, Winston-Salem, NC (D.M., W.M.B., C.D.L.); Quinnipiac University, Frank H. Netter MD School of Medicine, Hamden, CT (W.J.D.); Department of Environmental Health (G.S., R.D.) and Department of Neurology and Rehabilitation (D.W.), University of Cincinnati College of Medicine, OH; Department of Neurology, Harborview Medical Center, University of Washington, Seattle (D.L.T.); Department of Neurology, University of Florida College of Medicine, Jacksonville (S.L.S.); Department of Neurology, Beth Israel Deaconess Medical Center, Boston, MA (M.S.); Department of Neurology, Mayo Clinic, Jacksonville, FL (J.F.M.); Department of Neurology, University of Michigan Health System, Ann Arbor (D.L.B.); and Departments of Neurology and Public Health Sciences, University of Virginia Health System, Charlottesville (B.B.W.)
| | - Miriam R Raffeld
- From the Center for Human Genetic Research (F.R., G.J.F., C.D.A., W.J.D., T.W.K.B., M.R.R., J.R.), Division of Neurocritical Care and Emergency Neurology, Department of Neurology (F.R., G.J.F., C.D.A., W.J.D., T.W.K.B., M.R.R., J.R.), J. Philip Kistler Stroke Research Center (F.R., G.J.F., C.D.A., W.J.D., T.W.K.B., A.M.A., M.R.R., K.S., A.V., S.M.G., J.R.), and Department of Emergency Medicine (J.N.G.), Massachusetts General Hospital, Boston; Program in Medical and Population Genetics, Broad Institute, Cambridge, MA (F.R., G.J.F., C.D.A., W.J.D., T.W.K.B., M.R.R., J.R.); Department of Biostatistical Sciences, Center for Public Health Genomics, Wake Forest School of Medicine, Winston-Salem, NC (D.M., W.M.B., C.D.L.); Quinnipiac University, Frank H. Netter MD School of Medicine, Hamden, CT (W.J.D.); Department of Environmental Health (G.S., R.D.) and Department of Neurology and Rehabilitation (D.W.), University of Cincinnati College of Medicine, OH; Department of Neurology, Harborview Medical Center, University of Washington, Seattle (D.L.T.); Department of Neurology, University of Florida College of Medicine, Jacksonville (S.L.S.); Department of Neurology, Beth Israel Deaconess Medical Center, Boston, MA (M.S.); Department of Neurology, Mayo Clinic, Jacksonville, FL (J.F.M.); Department of Neurology, University of Michigan Health System, Ann Arbor (D.L.B.); and Departments of Neurology and Public Health Sciences, University of Virginia Health System, Charlottesville (B.B.W.)
| | - Kristin Schwab
- From the Center for Human Genetic Research (F.R., G.J.F., C.D.A., W.J.D., T.W.K.B., M.R.R., J.R.), Division of Neurocritical Care and Emergency Neurology, Department of Neurology (F.R., G.J.F., C.D.A., W.J.D., T.W.K.B., M.R.R., J.R.), J. Philip Kistler Stroke Research Center (F.R., G.J.F., C.D.A., W.J.D., T.W.K.B., A.M.A., M.R.R., K.S., A.V., S.M.G., J.R.), and Department of Emergency Medicine (J.N.G.), Massachusetts General Hospital, Boston; Program in Medical and Population Genetics, Broad Institute, Cambridge, MA (F.R., G.J.F., C.D.A., W.J.D., T.W.K.B., M.R.R., J.R.); Department of Biostatistical Sciences, Center for Public Health Genomics, Wake Forest School of Medicine, Winston-Salem, NC (D.M., W.M.B., C.D.L.); Quinnipiac University, Frank H. Netter MD School of Medicine, Hamden, CT (W.J.D.); Department of Environmental Health (G.S., R.D.) and Department of Neurology and Rehabilitation (D.W.), University of Cincinnati College of Medicine, OH; Department of Neurology, Harborview Medical Center, University of Washington, Seattle (D.L.T.); Department of Neurology, University of Florida College of Medicine, Jacksonville (S.L.S.); Department of Neurology, Beth Israel Deaconess Medical Center, Boston, MA (M.S.); Department of Neurology, Mayo Clinic, Jacksonville, FL (J.F.M.); Department of Neurology, University of Michigan Health System, Ann Arbor (D.L.B.); and Departments of Neurology and Public Health Sciences, University of Virginia Health System, Charlottesville (B.B.W.)
| | - Guangyun Sun
- From the Center for Human Genetic Research (F.R., G.J.F., C.D.A., W.J.D., T.W.K.B., M.R.R., J.R.), Division of Neurocritical Care and Emergency Neurology, Department of Neurology (F.R., G.J.F., C.D.A., W.J.D., T.W.K.B., M.R.R., J.R.), J. Philip Kistler Stroke Research Center (F.R., G.J.F., C.D.A., W.J.D., T.W.K.B., A.M.A., M.R.R., K.S., A.V., S.M.G., J.R.), and Department of Emergency Medicine (J.N.G.), Massachusetts General Hospital, Boston; Program in Medical and Population Genetics, Broad Institute, Cambridge, MA (F.R., G.J.F., C.D.A., W.J.D., T.W.K.B., M.R.R., J.R.); Department of Biostatistical Sciences, Center for Public Health Genomics, Wake Forest School of Medicine, Winston-Salem, NC (D.M., W.M.B., C.D.L.); Quinnipiac University, Frank H. Netter MD School of Medicine, Hamden, CT (W.J.D.); Department of Environmental Health (G.S., R.D.) and Department of Neurology and Rehabilitation (D.W.), University of Cincinnati College of Medicine, OH; Department of Neurology, Harborview Medical Center, University of Washington, Seattle (D.L.T.); Department of Neurology, University of Florida College of Medicine, Jacksonville (S.L.S.); Department of Neurology, Beth Israel Deaconess Medical Center, Boston, MA (M.S.); Department of Neurology, Mayo Clinic, Jacksonville, FL (J.F.M.); Department of Neurology, University of Michigan Health System, Ann Arbor (D.L.B.); and Departments of Neurology and Public Health Sciences, University of Virginia Health System, Charlottesville (B.B.W.)
| | - Ranjan Deka
- From the Center for Human Genetic Research (F.R., G.J.F., C.D.A., W.J.D., T.W.K.B., M.R.R., J.R.), Division of Neurocritical Care and Emergency Neurology, Department of Neurology (F.R., G.J.F., C.D.A., W.J.D., T.W.K.B., M.R.R., J.R.), J. Philip Kistler Stroke Research Center (F.R., G.J.F., C.D.A., W.J.D., T.W.K.B., A.M.A., M.R.R., K.S., A.V., S.M.G., J.R.), and Department of Emergency Medicine (J.N.G.), Massachusetts General Hospital, Boston; Program in Medical and Population Genetics, Broad Institute, Cambridge, MA (F.R., G.J.F., C.D.A., W.J.D., T.W.K.B., M.R.R., J.R.); Department of Biostatistical Sciences, Center for Public Health Genomics, Wake Forest School of Medicine, Winston-Salem, NC (D.M., W.M.B., C.D.L.); Quinnipiac University, Frank H. Netter MD School of Medicine, Hamden, CT (W.J.D.); Department of Environmental Health (G.S., R.D.) and Department of Neurology and Rehabilitation (D.W.), University of Cincinnati College of Medicine, OH; Department of Neurology, Harborview Medical Center, University of Washington, Seattle (D.L.T.); Department of Neurology, University of Florida College of Medicine, Jacksonville (S.L.S.); Department of Neurology, Beth Israel Deaconess Medical Center, Boston, MA (M.S.); Department of Neurology, Mayo Clinic, Jacksonville, FL (J.F.M.); Department of Neurology, University of Michigan Health System, Ann Arbor (D.L.B.); and Departments of Neurology and Public Health Sciences, University of Virginia Health System, Charlottesville (B.B.W.)
| | - Anand Viswanathan
- From the Center for Human Genetic Research (F.R., G.J.F., C.D.A., W.J.D., T.W.K.B., M.R.R., J.R.), Division of Neurocritical Care and Emergency Neurology, Department of Neurology (F.R., G.J.F., C.D.A., W.J.D., T.W.K.B., M.R.R., J.R.), J. Philip Kistler Stroke Research Center (F.R., G.J.F., C.D.A., W.J.D., T.W.K.B., A.M.A., M.R.R., K.S., A.V., S.M.G., J.R.), and Department of Emergency Medicine (J.N.G.), Massachusetts General Hospital, Boston; Program in Medical and Population Genetics, Broad Institute, Cambridge, MA (F.R., G.J.F., C.D.A., W.J.D., T.W.K.B., M.R.R., J.R.); Department of Biostatistical Sciences, Center for Public Health Genomics, Wake Forest School of Medicine, Winston-Salem, NC (D.M., W.M.B., C.D.L.); Quinnipiac University, Frank H. Netter MD School of Medicine, Hamden, CT (W.J.D.); Department of Environmental Health (G.S., R.D.) and Department of Neurology and Rehabilitation (D.W.), University of Cincinnati College of Medicine, OH; Department of Neurology, Harborview Medical Center, University of Washington, Seattle (D.L.T.); Department of Neurology, University of Florida College of Medicine, Jacksonville (S.L.S.); Department of Neurology, Beth Israel Deaconess Medical Center, Boston, MA (M.S.); Department of Neurology, Mayo Clinic, Jacksonville, FL (J.F.M.); Department of Neurology, University of Michigan Health System, Ann Arbor (D.L.B.); and Departments of Neurology and Public Health Sciences, University of Virginia Health System, Charlottesville (B.B.W.)
| | - Joshua N Goldstein
- From the Center for Human Genetic Research (F.R., G.J.F., C.D.A., W.J.D., T.W.K.B., M.R.R., J.R.), Division of Neurocritical Care and Emergency Neurology, Department of Neurology (F.R., G.J.F., C.D.A., W.J.D., T.W.K.B., M.R.R., J.R.), J. Philip Kistler Stroke Research Center (F.R., G.J.F., C.D.A., W.J.D., T.W.K.B., A.M.A., M.R.R., K.S., A.V., S.M.G., J.R.), and Department of Emergency Medicine (J.N.G.), Massachusetts General Hospital, Boston; Program in Medical and Population Genetics, Broad Institute, Cambridge, MA (F.R., G.J.F., C.D.A., W.J.D., T.W.K.B., M.R.R., J.R.); Department of Biostatistical Sciences, Center for Public Health Genomics, Wake Forest School of Medicine, Winston-Salem, NC (D.M., W.M.B., C.D.L.); Quinnipiac University, Frank H. Netter MD School of Medicine, Hamden, CT (W.J.D.); Department of Environmental Health (G.S., R.D.) and Department of Neurology and Rehabilitation (D.W.), University of Cincinnati College of Medicine, OH; Department of Neurology, Harborview Medical Center, University of Washington, Seattle (D.L.T.); Department of Neurology, University of Florida College of Medicine, Jacksonville (S.L.S.); Department of Neurology, Beth Israel Deaconess Medical Center, Boston, MA (M.S.); Department of Neurology, Mayo Clinic, Jacksonville, FL (J.F.M.); Department of Neurology, University of Michigan Health System, Ann Arbor (D.L.B.); and Departments of Neurology and Public Health Sciences, University of Virginia Health System, Charlottesville (B.B.W.)
| | - Steven M Greenberg
- From the Center for Human Genetic Research (F.R., G.J.F., C.D.A., W.J.D., T.W.K.B., M.R.R., J.R.), Division of Neurocritical Care and Emergency Neurology, Department of Neurology (F.R., G.J.F., C.D.A., W.J.D., T.W.K.B., M.R.R., J.R.), J. Philip Kistler Stroke Research Center (F.R., G.J.F., C.D.A., W.J.D., T.W.K.B., A.M.A., M.R.R., K.S., A.V., S.M.G., J.R.), and Department of Emergency Medicine (J.N.G.), Massachusetts General Hospital, Boston; Program in Medical and Population Genetics, Broad Institute, Cambridge, MA (F.R., G.J.F., C.D.A., W.J.D., T.W.K.B., M.R.R., J.R.); Department of Biostatistical Sciences, Center for Public Health Genomics, Wake Forest School of Medicine, Winston-Salem, NC (D.M., W.M.B., C.D.L.); Quinnipiac University, Frank H. Netter MD School of Medicine, Hamden, CT (W.J.D.); Department of Environmental Health (G.S., R.D.) and Department of Neurology and Rehabilitation (D.W.), University of Cincinnati College of Medicine, OH; Department of Neurology, Harborview Medical Center, University of Washington, Seattle (D.L.T.); Department of Neurology, University of Florida College of Medicine, Jacksonville (S.L.S.); Department of Neurology, Beth Israel Deaconess Medical Center, Boston, MA (M.S.); Department of Neurology, Mayo Clinic, Jacksonville, FL (J.F.M.); Department of Neurology, University of Michigan Health System, Ann Arbor (D.L.B.); and Departments of Neurology and Public Health Sciences, University of Virginia Health System, Charlottesville (B.B.W.)
| | - David L Tirschwell
- From the Center for Human Genetic Research (F.R., G.J.F., C.D.A., W.J.D., T.W.K.B., M.R.R., J.R.), Division of Neurocritical Care and Emergency Neurology, Department of Neurology (F.R., G.J.F., C.D.A., W.J.D., T.W.K.B., M.R.R., J.R.), J. Philip Kistler Stroke Research Center (F.R., G.J.F., C.D.A., W.J.D., T.W.K.B., A.M.A., M.R.R., K.S., A.V., S.M.G., J.R.), and Department of Emergency Medicine (J.N.G.), Massachusetts General Hospital, Boston; Program in Medical and Population Genetics, Broad Institute, Cambridge, MA (F.R., G.J.F., C.D.A., W.J.D., T.W.K.B., M.R.R., J.R.); Department of Biostatistical Sciences, Center for Public Health Genomics, Wake Forest School of Medicine, Winston-Salem, NC (D.M., W.M.B., C.D.L.); Quinnipiac University, Frank H. Netter MD School of Medicine, Hamden, CT (W.J.D.); Department of Environmental Health (G.S., R.D.) and Department of Neurology and Rehabilitation (D.W.), University of Cincinnati College of Medicine, OH; Department of Neurology, Harborview Medical Center, University of Washington, Seattle (D.L.T.); Department of Neurology, University of Florida College of Medicine, Jacksonville (S.L.S.); Department of Neurology, Beth Israel Deaconess Medical Center, Boston, MA (M.S.); Department of Neurology, Mayo Clinic, Jacksonville, FL (J.F.M.); Department of Neurology, University of Michigan Health System, Ann Arbor (D.L.B.); and Departments of Neurology and Public Health Sciences, University of Virginia Health System, Charlottesville (B.B.W.)
| | - Scott L Silliman
- From the Center for Human Genetic Research (F.R., G.J.F., C.D.A., W.J.D., T.W.K.B., M.R.R., J.R.), Division of Neurocritical Care and Emergency Neurology, Department of Neurology (F.R., G.J.F., C.D.A., W.J.D., T.W.K.B., M.R.R., J.R.), J. Philip Kistler Stroke Research Center (F.R., G.J.F., C.D.A., W.J.D., T.W.K.B., A.M.A., M.R.R., K.S., A.V., S.M.G., J.R.), and Department of Emergency Medicine (J.N.G.), Massachusetts General Hospital, Boston; Program in Medical and Population Genetics, Broad Institute, Cambridge, MA (F.R., G.J.F., C.D.A., W.J.D., T.W.K.B., M.R.R., J.R.); Department of Biostatistical Sciences, Center for Public Health Genomics, Wake Forest School of Medicine, Winston-Salem, NC (D.M., W.M.B., C.D.L.); Quinnipiac University, Frank H. Netter MD School of Medicine, Hamden, CT (W.J.D.); Department of Environmental Health (G.S., R.D.) and Department of Neurology and Rehabilitation (D.W.), University of Cincinnati College of Medicine, OH; Department of Neurology, Harborview Medical Center, University of Washington, Seattle (D.L.T.); Department of Neurology, University of Florida College of Medicine, Jacksonville (S.L.S.); Department of Neurology, Beth Israel Deaconess Medical Center, Boston, MA (M.S.); Department of Neurology, Mayo Clinic, Jacksonville, FL (J.F.M.); Department of Neurology, University of Michigan Health System, Ann Arbor (D.L.B.); and Departments of Neurology and Public Health Sciences, University of Virginia Health System, Charlottesville (B.B.W.)
| | - Magdy Selim
- From the Center for Human Genetic Research (F.R., G.J.F., C.D.A., W.J.D., T.W.K.B., M.R.R., J.R.), Division of Neurocritical Care and Emergency Neurology, Department of Neurology (F.R., G.J.F., C.D.A., W.J.D., T.W.K.B., M.R.R., J.R.), J. Philip Kistler Stroke Research Center (F.R., G.J.F., C.D.A., W.J.D., T.W.K.B., A.M.A., M.R.R., K.S., A.V., S.M.G., J.R.), and Department of Emergency Medicine (J.N.G.), Massachusetts General Hospital, Boston; Program in Medical and Population Genetics, Broad Institute, Cambridge, MA (F.R., G.J.F., C.D.A., W.J.D., T.W.K.B., M.R.R., J.R.); Department of Biostatistical Sciences, Center for Public Health Genomics, Wake Forest School of Medicine, Winston-Salem, NC (D.M., W.M.B., C.D.L.); Quinnipiac University, Frank H. Netter MD School of Medicine, Hamden, CT (W.J.D.); Department of Environmental Health (G.S., R.D.) and Department of Neurology and Rehabilitation (D.W.), University of Cincinnati College of Medicine, OH; Department of Neurology, Harborview Medical Center, University of Washington, Seattle (D.L.T.); Department of Neurology, University of Florida College of Medicine, Jacksonville (S.L.S.); Department of Neurology, Beth Israel Deaconess Medical Center, Boston, MA (M.S.); Department of Neurology, Mayo Clinic, Jacksonville, FL (J.F.M.); Department of Neurology, University of Michigan Health System, Ann Arbor (D.L.B.); and Departments of Neurology and Public Health Sciences, University of Virginia Health System, Charlottesville (B.B.W.)
| | - James F Meschia
- From the Center for Human Genetic Research (F.R., G.J.F., C.D.A., W.J.D., T.W.K.B., M.R.R., J.R.), Division of Neurocritical Care and Emergency Neurology, Department of Neurology (F.R., G.J.F., C.D.A., W.J.D., T.W.K.B., M.R.R., J.R.), J. Philip Kistler Stroke Research Center (F.R., G.J.F., C.D.A., W.J.D., T.W.K.B., A.M.A., M.R.R., K.S., A.V., S.M.G., J.R.), and Department of Emergency Medicine (J.N.G.), Massachusetts General Hospital, Boston; Program in Medical and Population Genetics, Broad Institute, Cambridge, MA (F.R., G.J.F., C.D.A., W.J.D., T.W.K.B., M.R.R., J.R.); Department of Biostatistical Sciences, Center for Public Health Genomics, Wake Forest School of Medicine, Winston-Salem, NC (D.M., W.M.B., C.D.L.); Quinnipiac University, Frank H. Netter MD School of Medicine, Hamden, CT (W.J.D.); Department of Environmental Health (G.S., R.D.) and Department of Neurology and Rehabilitation (D.W.), University of Cincinnati College of Medicine, OH; Department of Neurology, Harborview Medical Center, University of Washington, Seattle (D.L.T.); Department of Neurology, University of Florida College of Medicine, Jacksonville (S.L.S.); Department of Neurology, Beth Israel Deaconess Medical Center, Boston, MA (M.S.); Department of Neurology, Mayo Clinic, Jacksonville, FL (J.F.M.); Department of Neurology, University of Michigan Health System, Ann Arbor (D.L.B.); and Departments of Neurology and Public Health Sciences, University of Virginia Health System, Charlottesville (B.B.W.)
| | - Devin L Brown
- From the Center for Human Genetic Research (F.R., G.J.F., C.D.A., W.J.D., T.W.K.B., M.R.R., J.R.), Division of Neurocritical Care and Emergency Neurology, Department of Neurology (F.R., G.J.F., C.D.A., W.J.D., T.W.K.B., M.R.R., J.R.), J. Philip Kistler Stroke Research Center (F.R., G.J.F., C.D.A., W.J.D., T.W.K.B., A.M.A., M.R.R., K.S., A.V., S.M.G., J.R.), and Department of Emergency Medicine (J.N.G.), Massachusetts General Hospital, Boston; Program in Medical and Population Genetics, Broad Institute, Cambridge, MA (F.R., G.J.F., C.D.A., W.J.D., T.W.K.B., M.R.R., J.R.); Department of Biostatistical Sciences, Center for Public Health Genomics, Wake Forest School of Medicine, Winston-Salem, NC (D.M., W.M.B., C.D.L.); Quinnipiac University, Frank H. Netter MD School of Medicine, Hamden, CT (W.J.D.); Department of Environmental Health (G.S., R.D.) and Department of Neurology and Rehabilitation (D.W.), University of Cincinnati College of Medicine, OH; Department of Neurology, Harborview Medical Center, University of Washington, Seattle (D.L.T.); Department of Neurology, University of Florida College of Medicine, Jacksonville (S.L.S.); Department of Neurology, Beth Israel Deaconess Medical Center, Boston, MA (M.S.); Department of Neurology, Mayo Clinic, Jacksonville, FL (J.F.M.); Department of Neurology, University of Michigan Health System, Ann Arbor (D.L.B.); and Departments of Neurology and Public Health Sciences, University of Virginia Health System, Charlottesville (B.B.W.)
| | - Bradford B Worrall
- From the Center for Human Genetic Research (F.R., G.J.F., C.D.A., W.J.D., T.W.K.B., M.R.R., J.R.), Division of Neurocritical Care and Emergency Neurology, Department of Neurology (F.R., G.J.F., C.D.A., W.J.D., T.W.K.B., M.R.R., J.R.), J. Philip Kistler Stroke Research Center (F.R., G.J.F., C.D.A., W.J.D., T.W.K.B., A.M.A., M.R.R., K.S., A.V., S.M.G., J.R.), and Department of Emergency Medicine (J.N.G.), Massachusetts General Hospital, Boston; Program in Medical and Population Genetics, Broad Institute, Cambridge, MA (F.R., G.J.F., C.D.A., W.J.D., T.W.K.B., M.R.R., J.R.); Department of Biostatistical Sciences, Center for Public Health Genomics, Wake Forest School of Medicine, Winston-Salem, NC (D.M., W.M.B., C.D.L.); Quinnipiac University, Frank H. Netter MD School of Medicine, Hamden, CT (W.J.D.); Department of Environmental Health (G.S., R.D.) and Department of Neurology and Rehabilitation (D.W.), University of Cincinnati College of Medicine, OH; Department of Neurology, Harborview Medical Center, University of Washington, Seattle (D.L.T.); Department of Neurology, University of Florida College of Medicine, Jacksonville (S.L.S.); Department of Neurology, Beth Israel Deaconess Medical Center, Boston, MA (M.S.); Department of Neurology, Mayo Clinic, Jacksonville, FL (J.F.M.); Department of Neurology, University of Michigan Health System, Ann Arbor (D.L.B.); and Departments of Neurology and Public Health Sciences, University of Virginia Health System, Charlottesville (B.B.W.)
| | - Carl D Langefeld
- From the Center for Human Genetic Research (F.R., G.J.F., C.D.A., W.J.D., T.W.K.B., M.R.R., J.R.), Division of Neurocritical Care and Emergency Neurology, Department of Neurology (F.R., G.J.F., C.D.A., W.J.D., T.W.K.B., M.R.R., J.R.), J. Philip Kistler Stroke Research Center (F.R., G.J.F., C.D.A., W.J.D., T.W.K.B., A.M.A., M.R.R., K.S., A.V., S.M.G., J.R.), and Department of Emergency Medicine (J.N.G.), Massachusetts General Hospital, Boston; Program in Medical and Population Genetics, Broad Institute, Cambridge, MA (F.R., G.J.F., C.D.A., W.J.D., T.W.K.B., M.R.R., J.R.); Department of Biostatistical Sciences, Center for Public Health Genomics, Wake Forest School of Medicine, Winston-Salem, NC (D.M., W.M.B., C.D.L.); Quinnipiac University, Frank H. Netter MD School of Medicine, Hamden, CT (W.J.D.); Department of Environmental Health (G.S., R.D.) and Department of Neurology and Rehabilitation (D.W.), University of Cincinnati College of Medicine, OH; Department of Neurology, Harborview Medical Center, University of Washington, Seattle (D.L.T.); Department of Neurology, University of Florida College of Medicine, Jacksonville (S.L.S.); Department of Neurology, Beth Israel Deaconess Medical Center, Boston, MA (M.S.); Department of Neurology, Mayo Clinic, Jacksonville, FL (J.F.M.); Department of Neurology, University of Michigan Health System, Ann Arbor (D.L.B.); and Departments of Neurology and Public Health Sciences, University of Virginia Health System, Charlottesville (B.B.W.)
| | - Daniel Woo
- From the Center for Human Genetic Research (F.R., G.J.F., C.D.A., W.J.D., T.W.K.B., M.R.R., J.R.), Division of Neurocritical Care and Emergency Neurology, Department of Neurology (F.R., G.J.F., C.D.A., W.J.D., T.W.K.B., M.R.R., J.R.), J. Philip Kistler Stroke Research Center (F.R., G.J.F., C.D.A., W.J.D., T.W.K.B., A.M.A., M.R.R., K.S., A.V., S.M.G., J.R.), and Department of Emergency Medicine (J.N.G.), Massachusetts General Hospital, Boston; Program in Medical and Population Genetics, Broad Institute, Cambridge, MA (F.R., G.J.F., C.D.A., W.J.D., T.W.K.B., M.R.R., J.R.); Department of Biostatistical Sciences, Center for Public Health Genomics, Wake Forest School of Medicine, Winston-Salem, NC (D.M., W.M.B., C.D.L.); Quinnipiac University, Frank H. Netter MD School of Medicine, Hamden, CT (W.J.D.); Department of Environmental Health (G.S., R.D.) and Department of Neurology and Rehabilitation (D.W.), University of Cincinnati College of Medicine, OH; Department of Neurology, Harborview Medical Center, University of Washington, Seattle (D.L.T.); Department of Neurology, University of Florida College of Medicine, Jacksonville (S.L.S.); Department of Neurology, Beth Israel Deaconess Medical Center, Boston, MA (M.S.); Department of Neurology, Mayo Clinic, Jacksonville, FL (J.F.M.); Department of Neurology, University of Michigan Health System, Ann Arbor (D.L.B.); and Departments of Neurology and Public Health Sciences, University of Virginia Health System, Charlottesville (B.B.W.)
| | - Jonathan Rosand
- From the Center for Human Genetic Research (F.R., G.J.F., C.D.A., W.J.D., T.W.K.B., M.R.R., J.R.), Division of Neurocritical Care and Emergency Neurology, Department of Neurology (F.R., G.J.F., C.D.A., W.J.D., T.W.K.B., M.R.R., J.R.), J. Philip Kistler Stroke Research Center (F.R., G.J.F., C.D.A., W.J.D., T.W.K.B., A.M.A., M.R.R., K.S., A.V., S.M.G., J.R.), and Department of Emergency Medicine (J.N.G.), Massachusetts General Hospital, Boston; Program in Medical and Population Genetics, Broad Institute, Cambridge, MA (F.R., G.J.F., C.D.A., W.J.D., T.W.K.B., M.R.R., J.R.); Department of Biostatistical Sciences, Center for Public Health Genomics, Wake Forest School of Medicine, Winston-Salem, NC (D.M., W.M.B., C.D.L.); Quinnipiac University, Frank H. Netter MD School of Medicine, Hamden, CT (W.J.D.); Department of Environmental Health (G.S., R.D.) and Department of Neurology and Rehabilitation (D.W.), University of Cincinnati College of Medicine, OH; Department of Neurology, Harborview Medical Center, University of Washington, Seattle (D.L.T.); Department of Neurology, University of Florida College of Medicine, Jacksonville (S.L.S.); Department of Neurology, Beth Israel Deaconess Medical Center, Boston, MA (M.S.); Department of Neurology, Mayo Clinic, Jacksonville, FL (J.F.M.); Department of Neurology, University of Michigan Health System, Ann Arbor (D.L.B.); and Departments of Neurology and Public Health Sciences, University of Virginia Health System, Charlottesville (B.B.W.).
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Raffeld MR, Anderson CD, Battey TW, Ayers AM, Schwab K, Viswanathan A, Greenberg SM, Rosand J, Biffi A. Abstract T P153: APOE e4 Increases Risk of Recurrent Non-lobar Hemorrhage. Stroke 2015. [DOI: 10.1161/str.46.suppl_1.tp153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction:
Genetic variants ε2 / ε4 within the APOE gene are established risk factors for lobar intracerebral Hemorrhage (ICH) and its recurrence. Data from a large case-control meta-analysis suggest a potential but not yet replicated role for APOE ε4 in risk of non-lobar ICH.
Hypothesis:
APOE ε4 increases risk of recurrent non-lobar ICH and, replicating prior results, increases risk of initial non-lobar ICH.
Methods:
Among consecutive non-lobar ICH cases from our single center series (n=468), 363 survivors were followed for recurrence. All subjects had clinical and demographic data, and APOE genotype determined at the time of index ICH. In a separate case-control analysis, 156 non-lobar ICH cases and 152 ICH-free controls, ascertained subsequent to all prior publications, were analyzed as replication of previously published case-control findings. These case-control results were then meta-analyzed with previously published data.
Results:
We observed 29 non-lobar-ICH recurrences among 363 survivors. APOE ε4 was associated with non-lobar-ICH recurrence (HR = 1.31, 95% CI =1.02 - 2.69, p = 0.038) after adjustment for age / gender / ethnicity and cardiovascular risk factors.
Case-control analyses of newly ascertained subjects replicated the APOE ε4 association with risk of non-lobar ICH (OR = 1.31, 95% CI = 1.02-1.68, p = 0.035). Meta-analysis of these with published case-control data returned an association between ε4 and non-lobar ICH (OR = 1.21, 95% CI = 1.11-1.32, p = 1.5 x 10
-5
).
No associations were identified between APOE ε2 and non-lobar ICH risk or recurrence.
Conclusions:
APOE ε4, but not ε2 is associated with risk and recurrence of non-lobar ICH. Whether APOE’s role in non-lobar ICH involves beta-amyloid pathology, its presumed mechanism in lobar ICH, requires further study.
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Affiliation(s)
| | | | | | - Alison M Ayers
- Neurology, J. Philip Kistler Stroke Rsch Cntr, Boston, MA
| | - Kristin Schwab
- Neurology, J. Philip Kistler Stroke Rsch Cntr, Boston, MA
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13
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Falcone GJ, Radmanesh F, Brouwers HB, Battey TWK, Devan WJ, Valant V, Raffeld MR, Chitsike LP, Ayres AM, Schwab K, Goldstein JN, Viswanathan A, Greenberg SM, Selim M, Meschia JF, Brown DL, Worrall BB, Silliman SL, Tirschwell DL, Flaherty ML, Martini SR, Deka R, Biffi A, Kraft P, Woo D, Rosand J, Anderson CD. APOE ε variants increase risk of warfarin-related intracerebral hemorrhage. Neurology 2014; 83:1139-46. [PMID: 25150286 DOI: 10.1212/wnl.0000000000000816] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
OBJECTIVE We aimed to assess the effect of APOE ε variants on warfarin-related intracerebral hemorrhage (wICH), evaluated their predictive power, and tested for interaction with warfarin in causing wICH. METHODS This was a prospective, 2-stage (discovery and replication), case-control study. wICH was classified as lobar or nonlobar based on the location of the hematoma. Controls were sampled from ambulatory clinics (discovery) and random digit dialing (replication). APOE ε variants were directly genotyped. A case-control design and logistic regression analysis were utilized to test for association between APOE ε and wICH. A case-only design and logistic regression analysis were utilized to test for interaction between APOE ε and warfarin. Receiver operating characteristic curves were implemented to evaluate predictive power. RESULTS The discovery stage included 319 wICHs (44% lobar) and 355 controls. APOE ε2 was associated with lobar (odds ratio [OR] 2.46; p < 0.001) and nonlobar wICH (OR 1.67; p = 0.04), whereas ε4 was associated with lobar (OR 2.09; p < 0.001) but not nonlobar wICH (p = 0.35). The replication stage (63 wICHs and 1,030 controls) confirmed the association with ε2 (p = 0.03) and ε4 (p = 0.003) for lobar but not for nonlobar wICH (p > 0.20). Genotyping information on APOE ε variants significantly improved case/control discrimination of lobar wICH (C statistic 0.80). No statistical interaction between warfarin and APOE was found (p > 0.20). CONCLUSIONS APOE ε variants constitute strong risk factors for lobar wICH. APOE exerts its effect independently of warfarin, although power limitations render this absence of interaction preliminary. Evaluation of the predictive ability of APOE in cohort studies is warranted.
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Affiliation(s)
- Guido J Falcone
- From the Center for Human Genetic Research (G.J.F., F.R., H.B.B., T.W.K.B., W.J.D., V.V., M.R.R., L.P.C., A.M.A., K.S., A.V., S.M.G., A.B., J.R., C.D.A.), J. Philip Kistler Stroke Research Center (G.J.F., F.R., H.B.B., T.W.K.B., W.J.D., V.V., M.R.R., A.B., J.R., C.D.A.), Division of Neurocritical Care and Emergency Neurology, Department of Neurology (G.J.F., F.R., H.B.B., T.W.K.B., W.J.D., M.R.R., A.B., J.R., C.D.A.), and Department of Emergency Medicine (J.N.G.), Massachusetts General Hospital, Boston; Program in Medical and Population Genetics (G.J.F., F.R., H.B.B., T.W.K.B., W.J.D., M.R.R., A.B., J.R., C.D.A.), Broad Institute, Cambridge, MA; Department of Epidemiology (G.J.F., P.K.), Harvard School of Public Health, Boston; Department of Neurology (M.S.), Beth Israel Deaconess Medical Center, Boston, MA; Department of Neurology (J.F.M.), Mayo Clinic, Jacksonville, FL; Stroke Program (D.L.B.), Department of Neurology, University of Michigan Health System, Ann Arbor; Departments of Neurology and Public Health Sciences (B.B.W.), University of Virginia Health System, Charlottesville; Department of Neurology (S.L.S.), University of Florida College of Medicine, Jacksonville; Stroke Center (D.L.T.), Harborview Medical Center, University of Washington, Seattle; and University of Cincinnati College of Medicine (M.L.F., S.R.M., R.D., D.W.), OH
| | - Farid Radmanesh
- From the Center for Human Genetic Research (G.J.F., F.R., H.B.B., T.W.K.B., W.J.D., V.V., M.R.R., L.P.C., A.M.A., K.S., A.V., S.M.G., A.B., J.R., C.D.A.), J. Philip Kistler Stroke Research Center (G.J.F., F.R., H.B.B., T.W.K.B., W.J.D., V.V., M.R.R., A.B., J.R., C.D.A.), Division of Neurocritical Care and Emergency Neurology, Department of Neurology (G.J.F., F.R., H.B.B., T.W.K.B., W.J.D., M.R.R., A.B., J.R., C.D.A.), and Department of Emergency Medicine (J.N.G.), Massachusetts General Hospital, Boston; Program in Medical and Population Genetics (G.J.F., F.R., H.B.B., T.W.K.B., W.J.D., M.R.R., A.B., J.R., C.D.A.), Broad Institute, Cambridge, MA; Department of Epidemiology (G.J.F., P.K.), Harvard School of Public Health, Boston; Department of Neurology (M.S.), Beth Israel Deaconess Medical Center, Boston, MA; Department of Neurology (J.F.M.), Mayo Clinic, Jacksonville, FL; Stroke Program (D.L.B.), Department of Neurology, University of Michigan Health System, Ann Arbor; Departments of Neurology and Public Health Sciences (B.B.W.), University of Virginia Health System, Charlottesville; Department of Neurology (S.L.S.), University of Florida College of Medicine, Jacksonville; Stroke Center (D.L.T.), Harborview Medical Center, University of Washington, Seattle; and University of Cincinnati College of Medicine (M.L.F., S.R.M., R.D., D.W.), OH
| | - H Bart Brouwers
- From the Center for Human Genetic Research (G.J.F., F.R., H.B.B., T.W.K.B., W.J.D., V.V., M.R.R., L.P.C., A.M.A., K.S., A.V., S.M.G., A.B., J.R., C.D.A.), J. Philip Kistler Stroke Research Center (G.J.F., F.R., H.B.B., T.W.K.B., W.J.D., V.V., M.R.R., A.B., J.R., C.D.A.), Division of Neurocritical Care and Emergency Neurology, Department of Neurology (G.J.F., F.R., H.B.B., T.W.K.B., W.J.D., M.R.R., A.B., J.R., C.D.A.), and Department of Emergency Medicine (J.N.G.), Massachusetts General Hospital, Boston; Program in Medical and Population Genetics (G.J.F., F.R., H.B.B., T.W.K.B., W.J.D., M.R.R., A.B., J.R., C.D.A.), Broad Institute, Cambridge, MA; Department of Epidemiology (G.J.F., P.K.), Harvard School of Public Health, Boston; Department of Neurology (M.S.), Beth Israel Deaconess Medical Center, Boston, MA; Department of Neurology (J.F.M.), Mayo Clinic, Jacksonville, FL; Stroke Program (D.L.B.), Department of Neurology, University of Michigan Health System, Ann Arbor; Departments of Neurology and Public Health Sciences (B.B.W.), University of Virginia Health System, Charlottesville; Department of Neurology (S.L.S.), University of Florida College of Medicine, Jacksonville; Stroke Center (D.L.T.), Harborview Medical Center, University of Washington, Seattle; and University of Cincinnati College of Medicine (M.L.F., S.R.M., R.D., D.W.), OH
| | - Thomas W K Battey
- From the Center for Human Genetic Research (G.J.F., F.R., H.B.B., T.W.K.B., W.J.D., V.V., M.R.R., L.P.C., A.M.A., K.S., A.V., S.M.G., A.B., J.R., C.D.A.), J. Philip Kistler Stroke Research Center (G.J.F., F.R., H.B.B., T.W.K.B., W.J.D., V.V., M.R.R., A.B., J.R., C.D.A.), Division of Neurocritical Care and Emergency Neurology, Department of Neurology (G.J.F., F.R., H.B.B., T.W.K.B., W.J.D., M.R.R., A.B., J.R., C.D.A.), and Department of Emergency Medicine (J.N.G.), Massachusetts General Hospital, Boston; Program in Medical and Population Genetics (G.J.F., F.R., H.B.B., T.W.K.B., W.J.D., M.R.R., A.B., J.R., C.D.A.), Broad Institute, Cambridge, MA; Department of Epidemiology (G.J.F., P.K.), Harvard School of Public Health, Boston; Department of Neurology (M.S.), Beth Israel Deaconess Medical Center, Boston, MA; Department of Neurology (J.F.M.), Mayo Clinic, Jacksonville, FL; Stroke Program (D.L.B.), Department of Neurology, University of Michigan Health System, Ann Arbor; Departments of Neurology and Public Health Sciences (B.B.W.), University of Virginia Health System, Charlottesville; Department of Neurology (S.L.S.), University of Florida College of Medicine, Jacksonville; Stroke Center (D.L.T.), Harborview Medical Center, University of Washington, Seattle; and University of Cincinnati College of Medicine (M.L.F., S.R.M., R.D., D.W.), OH
| | - William J Devan
- From the Center for Human Genetic Research (G.J.F., F.R., H.B.B., T.W.K.B., W.J.D., V.V., M.R.R., L.P.C., A.M.A., K.S., A.V., S.M.G., A.B., J.R., C.D.A.), J. Philip Kistler Stroke Research Center (G.J.F., F.R., H.B.B., T.W.K.B., W.J.D., V.V., M.R.R., A.B., J.R., C.D.A.), Division of Neurocritical Care and Emergency Neurology, Department of Neurology (G.J.F., F.R., H.B.B., T.W.K.B., W.J.D., M.R.R., A.B., J.R., C.D.A.), and Department of Emergency Medicine (J.N.G.), Massachusetts General Hospital, Boston; Program in Medical and Population Genetics (G.J.F., F.R., H.B.B., T.W.K.B., W.J.D., M.R.R., A.B., J.R., C.D.A.), Broad Institute, Cambridge, MA; Department of Epidemiology (G.J.F., P.K.), Harvard School of Public Health, Boston; Department of Neurology (M.S.), Beth Israel Deaconess Medical Center, Boston, MA; Department of Neurology (J.F.M.), Mayo Clinic, Jacksonville, FL; Stroke Program (D.L.B.), Department of Neurology, University of Michigan Health System, Ann Arbor; Departments of Neurology and Public Health Sciences (B.B.W.), University of Virginia Health System, Charlottesville; Department of Neurology (S.L.S.), University of Florida College of Medicine, Jacksonville; Stroke Center (D.L.T.), Harborview Medical Center, University of Washington, Seattle; and University of Cincinnati College of Medicine (M.L.F., S.R.M., R.D., D.W.), OH
| | - Valerie Valant
- From the Center for Human Genetic Research (G.J.F., F.R., H.B.B., T.W.K.B., W.J.D., V.V., M.R.R., L.P.C., A.M.A., K.S., A.V., S.M.G., A.B., J.R., C.D.A.), J. Philip Kistler Stroke Research Center (G.J.F., F.R., H.B.B., T.W.K.B., W.J.D., V.V., M.R.R., A.B., J.R., C.D.A.), Division of Neurocritical Care and Emergency Neurology, Department of Neurology (G.J.F., F.R., H.B.B., T.W.K.B., W.J.D., M.R.R., A.B., J.R., C.D.A.), and Department of Emergency Medicine (J.N.G.), Massachusetts General Hospital, Boston; Program in Medical and Population Genetics (G.J.F., F.R., H.B.B., T.W.K.B., W.J.D., M.R.R., A.B., J.R., C.D.A.), Broad Institute, Cambridge, MA; Department of Epidemiology (G.J.F., P.K.), Harvard School of Public Health, Boston; Department of Neurology (M.S.), Beth Israel Deaconess Medical Center, Boston, MA; Department of Neurology (J.F.M.), Mayo Clinic, Jacksonville, FL; Stroke Program (D.L.B.), Department of Neurology, University of Michigan Health System, Ann Arbor; Departments of Neurology and Public Health Sciences (B.B.W.), University of Virginia Health System, Charlottesville; Department of Neurology (S.L.S.), University of Florida College of Medicine, Jacksonville; Stroke Center (D.L.T.), Harborview Medical Center, University of Washington, Seattle; and University of Cincinnati College of Medicine (M.L.F., S.R.M., R.D., D.W.), OH
| | - Miriam R Raffeld
- From the Center for Human Genetic Research (G.J.F., F.R., H.B.B., T.W.K.B., W.J.D., V.V., M.R.R., L.P.C., A.M.A., K.S., A.V., S.M.G., A.B., J.R., C.D.A.), J. Philip Kistler Stroke Research Center (G.J.F., F.R., H.B.B., T.W.K.B., W.J.D., V.V., M.R.R., A.B., J.R., C.D.A.), Division of Neurocritical Care and Emergency Neurology, Department of Neurology (G.J.F., F.R., H.B.B., T.W.K.B., W.J.D., M.R.R., A.B., J.R., C.D.A.), and Department of Emergency Medicine (J.N.G.), Massachusetts General Hospital, Boston; Program in Medical and Population Genetics (G.J.F., F.R., H.B.B., T.W.K.B., W.J.D., M.R.R., A.B., J.R., C.D.A.), Broad Institute, Cambridge, MA; Department of Epidemiology (G.J.F., P.K.), Harvard School of Public Health, Boston; Department of Neurology (M.S.), Beth Israel Deaconess Medical Center, Boston, MA; Department of Neurology (J.F.M.), Mayo Clinic, Jacksonville, FL; Stroke Program (D.L.B.), Department of Neurology, University of Michigan Health System, Ann Arbor; Departments of Neurology and Public Health Sciences (B.B.W.), University of Virginia Health System, Charlottesville; Department of Neurology (S.L.S.), University of Florida College of Medicine, Jacksonville; Stroke Center (D.L.T.), Harborview Medical Center, University of Washington, Seattle; and University of Cincinnati College of Medicine (M.L.F., S.R.M., R.D., D.W.), OH
| | - Lennox P Chitsike
- From the Center for Human Genetic Research (G.J.F., F.R., H.B.B., T.W.K.B., W.J.D., V.V., M.R.R., L.P.C., A.M.A., K.S., A.V., S.M.G., A.B., J.R., C.D.A.), J. Philip Kistler Stroke Research Center (G.J.F., F.R., H.B.B., T.W.K.B., W.J.D., V.V., M.R.R., A.B., J.R., C.D.A.), Division of Neurocritical Care and Emergency Neurology, Department of Neurology (G.J.F., F.R., H.B.B., T.W.K.B., W.J.D., M.R.R., A.B., J.R., C.D.A.), and Department of Emergency Medicine (J.N.G.), Massachusetts General Hospital, Boston; Program in Medical and Population Genetics (G.J.F., F.R., H.B.B., T.W.K.B., W.J.D., M.R.R., A.B., J.R., C.D.A.), Broad Institute, Cambridge, MA; Department of Epidemiology (G.J.F., P.K.), Harvard School of Public Health, Boston; Department of Neurology (M.S.), Beth Israel Deaconess Medical Center, Boston, MA; Department of Neurology (J.F.M.), Mayo Clinic, Jacksonville, FL; Stroke Program (D.L.B.), Department of Neurology, University of Michigan Health System, Ann Arbor; Departments of Neurology and Public Health Sciences (B.B.W.), University of Virginia Health System, Charlottesville; Department of Neurology (S.L.S.), University of Florida College of Medicine, Jacksonville; Stroke Center (D.L.T.), Harborview Medical Center, University of Washington, Seattle; and University of Cincinnati College of Medicine (M.L.F., S.R.M., R.D., D.W.), OH
| | - Alison M Ayres
- From the Center for Human Genetic Research (G.J.F., F.R., H.B.B., T.W.K.B., W.J.D., V.V., M.R.R., L.P.C., A.M.A., K.S., A.V., S.M.G., A.B., J.R., C.D.A.), J. Philip Kistler Stroke Research Center (G.J.F., F.R., H.B.B., T.W.K.B., W.J.D., V.V., M.R.R., A.B., J.R., C.D.A.), Division of Neurocritical Care and Emergency Neurology, Department of Neurology (G.J.F., F.R., H.B.B., T.W.K.B., W.J.D., M.R.R., A.B., J.R., C.D.A.), and Department of Emergency Medicine (J.N.G.), Massachusetts General Hospital, Boston; Program in Medical and Population Genetics (G.J.F., F.R., H.B.B., T.W.K.B., W.J.D., M.R.R., A.B., J.R., C.D.A.), Broad Institute, Cambridge, MA; Department of Epidemiology (G.J.F., P.K.), Harvard School of Public Health, Boston; Department of Neurology (M.S.), Beth Israel Deaconess Medical Center, Boston, MA; Department of Neurology (J.F.M.), Mayo Clinic, Jacksonville, FL; Stroke Program (D.L.B.), Department of Neurology, University of Michigan Health System, Ann Arbor; Departments of Neurology and Public Health Sciences (B.B.W.), University of Virginia Health System, Charlottesville; Department of Neurology (S.L.S.), University of Florida College of Medicine, Jacksonville; Stroke Center (D.L.T.), Harborview Medical Center, University of Washington, Seattle; and University of Cincinnati College of Medicine (M.L.F., S.R.M., R.D., D.W.), OH
| | - Kristin Schwab
- From the Center for Human Genetic Research (G.J.F., F.R., H.B.B., T.W.K.B., W.J.D., V.V., M.R.R., L.P.C., A.M.A., K.S., A.V., S.M.G., A.B., J.R., C.D.A.), J. Philip Kistler Stroke Research Center (G.J.F., F.R., H.B.B., T.W.K.B., W.J.D., V.V., M.R.R., A.B., J.R., C.D.A.), Division of Neurocritical Care and Emergency Neurology, Department of Neurology (G.J.F., F.R., H.B.B., T.W.K.B., W.J.D., M.R.R., A.B., J.R., C.D.A.), and Department of Emergency Medicine (J.N.G.), Massachusetts General Hospital, Boston; Program in Medical and Population Genetics (G.J.F., F.R., H.B.B., T.W.K.B., W.J.D., M.R.R., A.B., J.R., C.D.A.), Broad Institute, Cambridge, MA; Department of Epidemiology (G.J.F., P.K.), Harvard School of Public Health, Boston; Department of Neurology (M.S.), Beth Israel Deaconess Medical Center, Boston, MA; Department of Neurology (J.F.M.), Mayo Clinic, Jacksonville, FL; Stroke Program (D.L.B.), Department of Neurology, University of Michigan Health System, Ann Arbor; Departments of Neurology and Public Health Sciences (B.B.W.), University of Virginia Health System, Charlottesville; Department of Neurology (S.L.S.), University of Florida College of Medicine, Jacksonville; Stroke Center (D.L.T.), Harborview Medical Center, University of Washington, Seattle; and University of Cincinnati College of Medicine (M.L.F., S.R.M., R.D., D.W.), OH
| | - Joshua N Goldstein
- From the Center for Human Genetic Research (G.J.F., F.R., H.B.B., T.W.K.B., W.J.D., V.V., M.R.R., L.P.C., A.M.A., K.S., A.V., S.M.G., A.B., J.R., C.D.A.), J. Philip Kistler Stroke Research Center (G.J.F., F.R., H.B.B., T.W.K.B., W.J.D., V.V., M.R.R., A.B., J.R., C.D.A.), Division of Neurocritical Care and Emergency Neurology, Department of Neurology (G.J.F., F.R., H.B.B., T.W.K.B., W.J.D., M.R.R., A.B., J.R., C.D.A.), and Department of Emergency Medicine (J.N.G.), Massachusetts General Hospital, Boston; Program in Medical and Population Genetics (G.J.F., F.R., H.B.B., T.W.K.B., W.J.D., M.R.R., A.B., J.R., C.D.A.), Broad Institute, Cambridge, MA; Department of Epidemiology (G.J.F., P.K.), Harvard School of Public Health, Boston; Department of Neurology (M.S.), Beth Israel Deaconess Medical Center, Boston, MA; Department of Neurology (J.F.M.), Mayo Clinic, Jacksonville, FL; Stroke Program (D.L.B.), Department of Neurology, University of Michigan Health System, Ann Arbor; Departments of Neurology and Public Health Sciences (B.B.W.), University of Virginia Health System, Charlottesville; Department of Neurology (S.L.S.), University of Florida College of Medicine, Jacksonville; Stroke Center (D.L.T.), Harborview Medical Center, University of Washington, Seattle; and University of Cincinnati College of Medicine (M.L.F., S.R.M., R.D., D.W.), OH
| | - Anand Viswanathan
- From the Center for Human Genetic Research (G.J.F., F.R., H.B.B., T.W.K.B., W.J.D., V.V., M.R.R., L.P.C., A.M.A., K.S., A.V., S.M.G., A.B., J.R., C.D.A.), J. Philip Kistler Stroke Research Center (G.J.F., F.R., H.B.B., T.W.K.B., W.J.D., V.V., M.R.R., A.B., J.R., C.D.A.), Division of Neurocritical Care and Emergency Neurology, Department of Neurology (G.J.F., F.R., H.B.B., T.W.K.B., W.J.D., M.R.R., A.B., J.R., C.D.A.), and Department of Emergency Medicine (J.N.G.), Massachusetts General Hospital, Boston; Program in Medical and Population Genetics (G.J.F., F.R., H.B.B., T.W.K.B., W.J.D., M.R.R., A.B., J.R., C.D.A.), Broad Institute, Cambridge, MA; Department of Epidemiology (G.J.F., P.K.), Harvard School of Public Health, Boston; Department of Neurology (M.S.), Beth Israel Deaconess Medical Center, Boston, MA; Department of Neurology (J.F.M.), Mayo Clinic, Jacksonville, FL; Stroke Program (D.L.B.), Department of Neurology, University of Michigan Health System, Ann Arbor; Departments of Neurology and Public Health Sciences (B.B.W.), University of Virginia Health System, Charlottesville; Department of Neurology (S.L.S.), University of Florida College of Medicine, Jacksonville; Stroke Center (D.L.T.), Harborview Medical Center, University of Washington, Seattle; and University of Cincinnati College of Medicine (M.L.F., S.R.M., R.D., D.W.), OH
| | - Steven M Greenberg
- From the Center for Human Genetic Research (G.J.F., F.R., H.B.B., T.W.K.B., W.J.D., V.V., M.R.R., L.P.C., A.M.A., K.S., A.V., S.M.G., A.B., J.R., C.D.A.), J. Philip Kistler Stroke Research Center (G.J.F., F.R., H.B.B., T.W.K.B., W.J.D., V.V., M.R.R., A.B., J.R., C.D.A.), Division of Neurocritical Care and Emergency Neurology, Department of Neurology (G.J.F., F.R., H.B.B., T.W.K.B., W.J.D., M.R.R., A.B., J.R., C.D.A.), and Department of Emergency Medicine (J.N.G.), Massachusetts General Hospital, Boston; Program in Medical and Population Genetics (G.J.F., F.R., H.B.B., T.W.K.B., W.J.D., M.R.R., A.B., J.R., C.D.A.), Broad Institute, Cambridge, MA; Department of Epidemiology (G.J.F., P.K.), Harvard School of Public Health, Boston; Department of Neurology (M.S.), Beth Israel Deaconess Medical Center, Boston, MA; Department of Neurology (J.F.M.), Mayo Clinic, Jacksonville, FL; Stroke Program (D.L.B.), Department of Neurology, University of Michigan Health System, Ann Arbor; Departments of Neurology and Public Health Sciences (B.B.W.), University of Virginia Health System, Charlottesville; Department of Neurology (S.L.S.), University of Florida College of Medicine, Jacksonville; Stroke Center (D.L.T.), Harborview Medical Center, University of Washington, Seattle; and University of Cincinnati College of Medicine (M.L.F., S.R.M., R.D., D.W.), OH
| | - Magdy Selim
- From the Center for Human Genetic Research (G.J.F., F.R., H.B.B., T.W.K.B., W.J.D., V.V., M.R.R., L.P.C., A.M.A., K.S., A.V., S.M.G., A.B., J.R., C.D.A.), J. Philip Kistler Stroke Research Center (G.J.F., F.R., H.B.B., T.W.K.B., W.J.D., V.V., M.R.R., A.B., J.R., C.D.A.), Division of Neurocritical Care and Emergency Neurology, Department of Neurology (G.J.F., F.R., H.B.B., T.W.K.B., W.J.D., M.R.R., A.B., J.R., C.D.A.), and Department of Emergency Medicine (J.N.G.), Massachusetts General Hospital, Boston; Program in Medical and Population Genetics (G.J.F., F.R., H.B.B., T.W.K.B., W.J.D., M.R.R., A.B., J.R., C.D.A.), Broad Institute, Cambridge, MA; Department of Epidemiology (G.J.F., P.K.), Harvard School of Public Health, Boston; Department of Neurology (M.S.), Beth Israel Deaconess Medical Center, Boston, MA; Department of Neurology (J.F.M.), Mayo Clinic, Jacksonville, FL; Stroke Program (D.L.B.), Department of Neurology, University of Michigan Health System, Ann Arbor; Departments of Neurology and Public Health Sciences (B.B.W.), University of Virginia Health System, Charlottesville; Department of Neurology (S.L.S.), University of Florida College of Medicine, Jacksonville; Stroke Center (D.L.T.), Harborview Medical Center, University of Washington, Seattle; and University of Cincinnati College of Medicine (M.L.F., S.R.M., R.D., D.W.), OH
| | - James F Meschia
- From the Center for Human Genetic Research (G.J.F., F.R., H.B.B., T.W.K.B., W.J.D., V.V., M.R.R., L.P.C., A.M.A., K.S., A.V., S.M.G., A.B., J.R., C.D.A.), J. Philip Kistler Stroke Research Center (G.J.F., F.R., H.B.B., T.W.K.B., W.J.D., V.V., M.R.R., A.B., J.R., C.D.A.), Division of Neurocritical Care and Emergency Neurology, Department of Neurology (G.J.F., F.R., H.B.B., T.W.K.B., W.J.D., M.R.R., A.B., J.R., C.D.A.), and Department of Emergency Medicine (J.N.G.), Massachusetts General Hospital, Boston; Program in Medical and Population Genetics (G.J.F., F.R., H.B.B., T.W.K.B., W.J.D., M.R.R., A.B., J.R., C.D.A.), Broad Institute, Cambridge, MA; Department of Epidemiology (G.J.F., P.K.), Harvard School of Public Health, Boston; Department of Neurology (M.S.), Beth Israel Deaconess Medical Center, Boston, MA; Department of Neurology (J.F.M.), Mayo Clinic, Jacksonville, FL; Stroke Program (D.L.B.), Department of Neurology, University of Michigan Health System, Ann Arbor; Departments of Neurology and Public Health Sciences (B.B.W.), University of Virginia Health System, Charlottesville; Department of Neurology (S.L.S.), University of Florida College of Medicine, Jacksonville; Stroke Center (D.L.T.), Harborview Medical Center, University of Washington, Seattle; and University of Cincinnati College of Medicine (M.L.F., S.R.M., R.D., D.W.), OH
| | - Devin L Brown
- From the Center for Human Genetic Research (G.J.F., F.R., H.B.B., T.W.K.B., W.J.D., V.V., M.R.R., L.P.C., A.M.A., K.S., A.V., S.M.G., A.B., J.R., C.D.A.), J. Philip Kistler Stroke Research Center (G.J.F., F.R., H.B.B., T.W.K.B., W.J.D., V.V., M.R.R., A.B., J.R., C.D.A.), Division of Neurocritical Care and Emergency Neurology, Department of Neurology (G.J.F., F.R., H.B.B., T.W.K.B., W.J.D., M.R.R., A.B., J.R., C.D.A.), and Department of Emergency Medicine (J.N.G.), Massachusetts General Hospital, Boston; Program in Medical and Population Genetics (G.J.F., F.R., H.B.B., T.W.K.B., W.J.D., M.R.R., A.B., J.R., C.D.A.), Broad Institute, Cambridge, MA; Department of Epidemiology (G.J.F., P.K.), Harvard School of Public Health, Boston; Department of Neurology (M.S.), Beth Israel Deaconess Medical Center, Boston, MA; Department of Neurology (J.F.M.), Mayo Clinic, Jacksonville, FL; Stroke Program (D.L.B.), Department of Neurology, University of Michigan Health System, Ann Arbor; Departments of Neurology and Public Health Sciences (B.B.W.), University of Virginia Health System, Charlottesville; Department of Neurology (S.L.S.), University of Florida College of Medicine, Jacksonville; Stroke Center (D.L.T.), Harborview Medical Center, University of Washington, Seattle; and University of Cincinnati College of Medicine (M.L.F., S.R.M., R.D., D.W.), OH
| | - Bradford B Worrall
- From the Center for Human Genetic Research (G.J.F., F.R., H.B.B., T.W.K.B., W.J.D., V.V., M.R.R., L.P.C., A.M.A., K.S., A.V., S.M.G., A.B., J.R., C.D.A.), J. Philip Kistler Stroke Research Center (G.J.F., F.R., H.B.B., T.W.K.B., W.J.D., V.V., M.R.R., A.B., J.R., C.D.A.), Division of Neurocritical Care and Emergency Neurology, Department of Neurology (G.J.F., F.R., H.B.B., T.W.K.B., W.J.D., M.R.R., A.B., J.R., C.D.A.), and Department of Emergency Medicine (J.N.G.), Massachusetts General Hospital, Boston; Program in Medical and Population Genetics (G.J.F., F.R., H.B.B., T.W.K.B., W.J.D., M.R.R., A.B., J.R., C.D.A.), Broad Institute, Cambridge, MA; Department of Epidemiology (G.J.F., P.K.), Harvard School of Public Health, Boston; Department of Neurology (M.S.), Beth Israel Deaconess Medical Center, Boston, MA; Department of Neurology (J.F.M.), Mayo Clinic, Jacksonville, FL; Stroke Program (D.L.B.), Department of Neurology, University of Michigan Health System, Ann Arbor; Departments of Neurology and Public Health Sciences (B.B.W.), University of Virginia Health System, Charlottesville; Department of Neurology (S.L.S.), University of Florida College of Medicine, Jacksonville; Stroke Center (D.L.T.), Harborview Medical Center, University of Washington, Seattle; and University of Cincinnati College of Medicine (M.L.F., S.R.M., R.D., D.W.), OH
| | - Scott L Silliman
- From the Center for Human Genetic Research (G.J.F., F.R., H.B.B., T.W.K.B., W.J.D., V.V., M.R.R., L.P.C., A.M.A., K.S., A.V., S.M.G., A.B., J.R., C.D.A.), J. Philip Kistler Stroke Research Center (G.J.F., F.R., H.B.B., T.W.K.B., W.J.D., V.V., M.R.R., A.B., J.R., C.D.A.), Division of Neurocritical Care and Emergency Neurology, Department of Neurology (G.J.F., F.R., H.B.B., T.W.K.B., W.J.D., M.R.R., A.B., J.R., C.D.A.), and Department of Emergency Medicine (J.N.G.), Massachusetts General Hospital, Boston; Program in Medical and Population Genetics (G.J.F., F.R., H.B.B., T.W.K.B., W.J.D., M.R.R., A.B., J.R., C.D.A.), Broad Institute, Cambridge, MA; Department of Epidemiology (G.J.F., P.K.), Harvard School of Public Health, Boston; Department of Neurology (M.S.), Beth Israel Deaconess Medical Center, Boston, MA; Department of Neurology (J.F.M.), Mayo Clinic, Jacksonville, FL; Stroke Program (D.L.B.), Department of Neurology, University of Michigan Health System, Ann Arbor; Departments of Neurology and Public Health Sciences (B.B.W.), University of Virginia Health System, Charlottesville; Department of Neurology (S.L.S.), University of Florida College of Medicine, Jacksonville; Stroke Center (D.L.T.), Harborview Medical Center, University of Washington, Seattle; and University of Cincinnati College of Medicine (M.L.F., S.R.M., R.D., D.W.), OH
| | - David L Tirschwell
- From the Center for Human Genetic Research (G.J.F., F.R., H.B.B., T.W.K.B., W.J.D., V.V., M.R.R., L.P.C., A.M.A., K.S., A.V., S.M.G., A.B., J.R., C.D.A.), J. Philip Kistler Stroke Research Center (G.J.F., F.R., H.B.B., T.W.K.B., W.J.D., V.V., M.R.R., A.B., J.R., C.D.A.), Division of Neurocritical Care and Emergency Neurology, Department of Neurology (G.J.F., F.R., H.B.B., T.W.K.B., W.J.D., M.R.R., A.B., J.R., C.D.A.), and Department of Emergency Medicine (J.N.G.), Massachusetts General Hospital, Boston; Program in Medical and Population Genetics (G.J.F., F.R., H.B.B., T.W.K.B., W.J.D., M.R.R., A.B., J.R., C.D.A.), Broad Institute, Cambridge, MA; Department of Epidemiology (G.J.F., P.K.), Harvard School of Public Health, Boston; Department of Neurology (M.S.), Beth Israel Deaconess Medical Center, Boston, MA; Department of Neurology (J.F.M.), Mayo Clinic, Jacksonville, FL; Stroke Program (D.L.B.), Department of Neurology, University of Michigan Health System, Ann Arbor; Departments of Neurology and Public Health Sciences (B.B.W.), University of Virginia Health System, Charlottesville; Department of Neurology (S.L.S.), University of Florida College of Medicine, Jacksonville; Stroke Center (D.L.T.), Harborview Medical Center, University of Washington, Seattle; and University of Cincinnati College of Medicine (M.L.F., S.R.M., R.D., D.W.), OH
| | - Matthew L Flaherty
- From the Center for Human Genetic Research (G.J.F., F.R., H.B.B., T.W.K.B., W.J.D., V.V., M.R.R., L.P.C., A.M.A., K.S., A.V., S.M.G., A.B., J.R., C.D.A.), J. Philip Kistler Stroke Research Center (G.J.F., F.R., H.B.B., T.W.K.B., W.J.D., V.V., M.R.R., A.B., J.R., C.D.A.), Division of Neurocritical Care and Emergency Neurology, Department of Neurology (G.J.F., F.R., H.B.B., T.W.K.B., W.J.D., M.R.R., A.B., J.R., C.D.A.), and Department of Emergency Medicine (J.N.G.), Massachusetts General Hospital, Boston; Program in Medical and Population Genetics (G.J.F., F.R., H.B.B., T.W.K.B., W.J.D., M.R.R., A.B., J.R., C.D.A.), Broad Institute, Cambridge, MA; Department of Epidemiology (G.J.F., P.K.), Harvard School of Public Health, Boston; Department of Neurology (M.S.), Beth Israel Deaconess Medical Center, Boston, MA; Department of Neurology (J.F.M.), Mayo Clinic, Jacksonville, FL; Stroke Program (D.L.B.), Department of Neurology, University of Michigan Health System, Ann Arbor; Departments of Neurology and Public Health Sciences (B.B.W.), University of Virginia Health System, Charlottesville; Department of Neurology (S.L.S.), University of Florida College of Medicine, Jacksonville; Stroke Center (D.L.T.), Harborview Medical Center, University of Washington, Seattle; and University of Cincinnati College of Medicine (M.L.F., S.R.M., R.D., D.W.), OH
| | - Sharyl R Martini
- From the Center for Human Genetic Research (G.J.F., F.R., H.B.B., T.W.K.B., W.J.D., V.V., M.R.R., L.P.C., A.M.A., K.S., A.V., S.M.G., A.B., J.R., C.D.A.), J. Philip Kistler Stroke Research Center (G.J.F., F.R., H.B.B., T.W.K.B., W.J.D., V.V., M.R.R., A.B., J.R., C.D.A.), Division of Neurocritical Care and Emergency Neurology, Department of Neurology (G.J.F., F.R., H.B.B., T.W.K.B., W.J.D., M.R.R., A.B., J.R., C.D.A.), and Department of Emergency Medicine (J.N.G.), Massachusetts General Hospital, Boston; Program in Medical and Population Genetics (G.J.F., F.R., H.B.B., T.W.K.B., W.J.D., M.R.R., A.B., J.R., C.D.A.), Broad Institute, Cambridge, MA; Department of Epidemiology (G.J.F., P.K.), Harvard School of Public Health, Boston; Department of Neurology (M.S.), Beth Israel Deaconess Medical Center, Boston, MA; Department of Neurology (J.F.M.), Mayo Clinic, Jacksonville, FL; Stroke Program (D.L.B.), Department of Neurology, University of Michigan Health System, Ann Arbor; Departments of Neurology and Public Health Sciences (B.B.W.), University of Virginia Health System, Charlottesville; Department of Neurology (S.L.S.), University of Florida College of Medicine, Jacksonville; Stroke Center (D.L.T.), Harborview Medical Center, University of Washington, Seattle; and University of Cincinnati College of Medicine (M.L.F., S.R.M., R.D., D.W.), OH
| | - Ranjan Deka
- From the Center for Human Genetic Research (G.J.F., F.R., H.B.B., T.W.K.B., W.J.D., V.V., M.R.R., L.P.C., A.M.A., K.S., A.V., S.M.G., A.B., J.R., C.D.A.), J. Philip Kistler Stroke Research Center (G.J.F., F.R., H.B.B., T.W.K.B., W.J.D., V.V., M.R.R., A.B., J.R., C.D.A.), Division of Neurocritical Care and Emergency Neurology, Department of Neurology (G.J.F., F.R., H.B.B., T.W.K.B., W.J.D., M.R.R., A.B., J.R., C.D.A.), and Department of Emergency Medicine (J.N.G.), Massachusetts General Hospital, Boston; Program in Medical and Population Genetics (G.J.F., F.R., H.B.B., T.W.K.B., W.J.D., M.R.R., A.B., J.R., C.D.A.), Broad Institute, Cambridge, MA; Department of Epidemiology (G.J.F., P.K.), Harvard School of Public Health, Boston; Department of Neurology (M.S.), Beth Israel Deaconess Medical Center, Boston, MA; Department of Neurology (J.F.M.), Mayo Clinic, Jacksonville, FL; Stroke Program (D.L.B.), Department of Neurology, University of Michigan Health System, Ann Arbor; Departments of Neurology and Public Health Sciences (B.B.W.), University of Virginia Health System, Charlottesville; Department of Neurology (S.L.S.), University of Florida College of Medicine, Jacksonville; Stroke Center (D.L.T.), Harborview Medical Center, University of Washington, Seattle; and University of Cincinnati College of Medicine (M.L.F., S.R.M., R.D., D.W.), OH
| | - Alessandro Biffi
- From the Center for Human Genetic Research (G.J.F., F.R., H.B.B., T.W.K.B., W.J.D., V.V., M.R.R., L.P.C., A.M.A., K.S., A.V., S.M.G., A.B., J.R., C.D.A.), J. Philip Kistler Stroke Research Center (G.J.F., F.R., H.B.B., T.W.K.B., W.J.D., V.V., M.R.R., A.B., J.R., C.D.A.), Division of Neurocritical Care and Emergency Neurology, Department of Neurology (G.J.F., F.R., H.B.B., T.W.K.B., W.J.D., M.R.R., A.B., J.R., C.D.A.), and Department of Emergency Medicine (J.N.G.), Massachusetts General Hospital, Boston; Program in Medical and Population Genetics (G.J.F., F.R., H.B.B., T.W.K.B., W.J.D., M.R.R., A.B., J.R., C.D.A.), Broad Institute, Cambridge, MA; Department of Epidemiology (G.J.F., P.K.), Harvard School of Public Health, Boston; Department of Neurology (M.S.), Beth Israel Deaconess Medical Center, Boston, MA; Department of Neurology (J.F.M.), Mayo Clinic, Jacksonville, FL; Stroke Program (D.L.B.), Department of Neurology, University of Michigan Health System, Ann Arbor; Departments of Neurology and Public Health Sciences (B.B.W.), University of Virginia Health System, Charlottesville; Department of Neurology (S.L.S.), University of Florida College of Medicine, Jacksonville; Stroke Center (D.L.T.), Harborview Medical Center, University of Washington, Seattle; and University of Cincinnati College of Medicine (M.L.F., S.R.M., R.D., D.W.), OH
| | - Peter Kraft
- From the Center for Human Genetic Research (G.J.F., F.R., H.B.B., T.W.K.B., W.J.D., V.V., M.R.R., L.P.C., A.M.A., K.S., A.V., S.M.G., A.B., J.R., C.D.A.), J. Philip Kistler Stroke Research Center (G.J.F., F.R., H.B.B., T.W.K.B., W.J.D., V.V., M.R.R., A.B., J.R., C.D.A.), Division of Neurocritical Care and Emergency Neurology, Department of Neurology (G.J.F., F.R., H.B.B., T.W.K.B., W.J.D., M.R.R., A.B., J.R., C.D.A.), and Department of Emergency Medicine (J.N.G.), Massachusetts General Hospital, Boston; Program in Medical and Population Genetics (G.J.F., F.R., H.B.B., T.W.K.B., W.J.D., M.R.R., A.B., J.R., C.D.A.), Broad Institute, Cambridge, MA; Department of Epidemiology (G.J.F., P.K.), Harvard School of Public Health, Boston; Department of Neurology (M.S.), Beth Israel Deaconess Medical Center, Boston, MA; Department of Neurology (J.F.M.), Mayo Clinic, Jacksonville, FL; Stroke Program (D.L.B.), Department of Neurology, University of Michigan Health System, Ann Arbor; Departments of Neurology and Public Health Sciences (B.B.W.), University of Virginia Health System, Charlottesville; Department of Neurology (S.L.S.), University of Florida College of Medicine, Jacksonville; Stroke Center (D.L.T.), Harborview Medical Center, University of Washington, Seattle; and University of Cincinnati College of Medicine (M.L.F., S.R.M., R.D., D.W.), OH
| | - Daniel Woo
- From the Center for Human Genetic Research (G.J.F., F.R., H.B.B., T.W.K.B., W.J.D., V.V., M.R.R., L.P.C., A.M.A., K.S., A.V., S.M.G., A.B., J.R., C.D.A.), J. Philip Kistler Stroke Research Center (G.J.F., F.R., H.B.B., T.W.K.B., W.J.D., V.V., M.R.R., A.B., J.R., C.D.A.), Division of Neurocritical Care and Emergency Neurology, Department of Neurology (G.J.F., F.R., H.B.B., T.W.K.B., W.J.D., M.R.R., A.B., J.R., C.D.A.), and Department of Emergency Medicine (J.N.G.), Massachusetts General Hospital, Boston; Program in Medical and Population Genetics (G.J.F., F.R., H.B.B., T.W.K.B., W.J.D., M.R.R., A.B., J.R., C.D.A.), Broad Institute, Cambridge, MA; Department of Epidemiology (G.J.F., P.K.), Harvard School of Public Health, Boston; Department of Neurology (M.S.), Beth Israel Deaconess Medical Center, Boston, MA; Department of Neurology (J.F.M.), Mayo Clinic, Jacksonville, FL; Stroke Program (D.L.B.), Department of Neurology, University of Michigan Health System, Ann Arbor; Departments of Neurology and Public Health Sciences (B.B.W.), University of Virginia Health System, Charlottesville; Department of Neurology (S.L.S.), University of Florida College of Medicine, Jacksonville; Stroke Center (D.L.T.), Harborview Medical Center, University of Washington, Seattle; and University of Cincinnati College of Medicine (M.L.F., S.R.M., R.D., D.W.), OH
| | - Jonathan Rosand
- From the Center for Human Genetic Research (G.J.F., F.R., H.B.B., T.W.K.B., W.J.D., V.V., M.R.R., L.P.C., A.M.A., K.S., A.V., S.M.G., A.B., J.R., C.D.A.), J. Philip Kistler Stroke Research Center (G.J.F., F.R., H.B.B., T.W.K.B., W.J.D., V.V., M.R.R., A.B., J.R., C.D.A.), Division of Neurocritical Care and Emergency Neurology, Department of Neurology (G.J.F., F.R., H.B.B., T.W.K.B., W.J.D., M.R.R., A.B., J.R., C.D.A.), and Department of Emergency Medicine (J.N.G.), Massachusetts General Hospital, Boston; Program in Medical and Population Genetics (G.J.F., F.R., H.B.B., T.W.K.B., W.J.D., M.R.R., A.B., J.R., C.D.A.), Broad Institute, Cambridge, MA; Department of Epidemiology (G.J.F., P.K.), Harvard School of Public Health, Boston; Department of Neurology (M.S.), Beth Israel Deaconess Medical Center, Boston, MA; Department of Neurology (J.F.M.), Mayo Clinic, Jacksonville, FL; Stroke Program (D.L.B.), Department of Neurology, University of Michigan Health System, Ann Arbor; Departments of Neurology and Public Health Sciences (B.B.W.), University of Virginia Health System, Charlottesville; Department of Neurology (S.L.S.), University of Florida College of Medicine, Jacksonville; Stroke Center (D.L.T.), Harborview Medical Center, University of Washington, Seattle; and University of Cincinnati College of Medicine (M.L.F., S.R.M., R.D., D.W.), OH
| | - Christopher D Anderson
- From the Center for Human Genetic Research (G.J.F., F.R., H.B.B., T.W.K.B., W.J.D., V.V., M.R.R., L.P.C., A.M.A., K.S., A.V., S.M.G., A.B., J.R., C.D.A.), J. Philip Kistler Stroke Research Center (G.J.F., F.R., H.B.B., T.W.K.B., W.J.D., V.V., M.R.R., A.B., J.R., C.D.A.), Division of Neurocritical Care and Emergency Neurology, Department of Neurology (G.J.F., F.R., H.B.B., T.W.K.B., W.J.D., M.R.R., A.B., J.R., C.D.A.), and Department of Emergency Medicine (J.N.G.), Massachusetts General Hospital, Boston; Program in Medical and Population Genetics (G.J.F., F.R., H.B.B., T.W.K.B., W.J.D., M.R.R., A.B., J.R., C.D.A.), Broad Institute, Cambridge, MA; Department of Epidemiology (G.J.F., P.K.), Harvard School of Public Health, Boston; Department of Neurology (M.S.), Beth Israel Deaconess Medical Center, Boston, MA; Department of Neurology (J.F.M.), Mayo Clinic, Jacksonville, FL; Stroke Program (D.L.B.), Department of Neurology, University of Michigan Health System, Ann Arbor; Departments of Neurology and Public Health Sciences (B.B.W.), University of Virginia Health System, Charlottesville; Department of Neurology (S.L.S.), University of Florida College of Medicine, Jacksonville; Stroke Center (D.L.T.), Harborview Medical Center, University of Washington, Seattle; and University of Cincinnati College of Medicine (M.L.F., S.R.M., R.D., D.W.), OH.
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14
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Brouwers HB, Raffeld MR, van Nieuwenhuizen KM, Falcone GJ, Ayres AM, McNamara KA, Schwab K, Romero JM, Velthuis BK, Viswanathan A, Greenberg SM, Ogilvy CS, van der Zwan A, Rinkel GJE, Goldstein JN, Klijn CJM, Rosand J. CT angiography spot sign in intracerebral hemorrhage predicts active bleeding during surgery. Neurology 2014; 83:883-9. [PMID: 25098540 DOI: 10.1212/wnl.0000000000000747] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVE To determine whether the CT angiography (CTA) spot sign marks bleeding complications during and after surgery for spontaneous intracerebral hemorrhage (ICH). METHODS In a 2-center study of consecutive spontaneous ICH patients who underwent CTA followed by surgical hematoma evacuation, 2 experienced readers (blinded to clinical and surgical data) reviewed CTAs for spot sign presence. Blinded raters assessed active intraoperative and postoperative bleeding. The association between spot sign and active intraoperative bleeding, postoperative rebleeding, and residual ICH volumes was evaluated using univariable and multivariable logistic regression. RESULTS A total of 95 patients met inclusion criteria: 44 lobar, 17 deep, 33 cerebellar, and 1 brainstem ICH; ≥1 spot sign was identified in 32 patients (34%). The spot sign was the only independent marker of active bleeding during surgery (odds ratio [OR] 3.4; 95% confidence interval [CI] 1.3-9.0). Spot sign (OR 4.1; 95% CI 1.1-17), female sex (OR 6.9; 95% CI 1.7-37), and antiplatelet use (OR 4.6; 95% CI 1.2-21) were predictive of postoperative rebleeding. Larger residual hematomas and postoperative rebleeding were associated with higher discharge case fatality (OR 3.4; 95% CI 1.1-11) and a trend toward increased case fatality at 3 months (OR 2.9; 95% CI 0.9-8.8). CONCLUSIONS The CTA spot sign is associated with more intraoperative bleeding, more postoperative rebleeding, and larger residual ICH volumes in patients undergoing hematoma evacuation for spontaneous ICH. The spot sign may therefore be useful to select patients for future surgical trials.
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Affiliation(s)
- H Bart Brouwers
- From the Center for Human Genetic Research (H.B.B., M.R.R., G.J.F., J.R.) and the Departments of Neurology, Neurosurgery, Radiology, and Emergency Medicine (H.B.B., M.R.R., G.J.F., A.M.A., K.A.M., K.S., J.M.R., A.V., S.M.G., C.S.O., J.N.G., J.R.), Massachusetts General Hospital, Harvard Medical School, Boston; and the Department of Neurology & Neurosurgery, Brain Center Rudolf Magnus, and Department of Radiology (H.B.B., K.M.v.N., B.K.V., A.v.d.Z., G.J.E.R., C.J.M.K.), University Medical Center Utrecht, Utrecht University, the Netherlands.
| | - Miriam R Raffeld
- From the Center for Human Genetic Research (H.B.B., M.R.R., G.J.F., J.R.) and the Departments of Neurology, Neurosurgery, Radiology, and Emergency Medicine (H.B.B., M.R.R., G.J.F., A.M.A., K.A.M., K.S., J.M.R., A.V., S.M.G., C.S.O., J.N.G., J.R.), Massachusetts General Hospital, Harvard Medical School, Boston; and the Department of Neurology & Neurosurgery, Brain Center Rudolf Magnus, and Department of Radiology (H.B.B., K.M.v.N., B.K.V., A.v.d.Z., G.J.E.R., C.J.M.K.), University Medical Center Utrecht, Utrecht University, the Netherlands
| | - Koen M van Nieuwenhuizen
- From the Center for Human Genetic Research (H.B.B., M.R.R., G.J.F., J.R.) and the Departments of Neurology, Neurosurgery, Radiology, and Emergency Medicine (H.B.B., M.R.R., G.J.F., A.M.A., K.A.M., K.S., J.M.R., A.V., S.M.G., C.S.O., J.N.G., J.R.), Massachusetts General Hospital, Harvard Medical School, Boston; and the Department of Neurology & Neurosurgery, Brain Center Rudolf Magnus, and Department of Radiology (H.B.B., K.M.v.N., B.K.V., A.v.d.Z., G.J.E.R., C.J.M.K.), University Medical Center Utrecht, Utrecht University, the Netherlands
| | - Guido J Falcone
- From the Center for Human Genetic Research (H.B.B., M.R.R., G.J.F., J.R.) and the Departments of Neurology, Neurosurgery, Radiology, and Emergency Medicine (H.B.B., M.R.R., G.J.F., A.M.A., K.A.M., K.S., J.M.R., A.V., S.M.G., C.S.O., J.N.G., J.R.), Massachusetts General Hospital, Harvard Medical School, Boston; and the Department of Neurology & Neurosurgery, Brain Center Rudolf Magnus, and Department of Radiology (H.B.B., K.M.v.N., B.K.V., A.v.d.Z., G.J.E.R., C.J.M.K.), University Medical Center Utrecht, Utrecht University, the Netherlands
| | - Alison M Ayres
- From the Center for Human Genetic Research (H.B.B., M.R.R., G.J.F., J.R.) and the Departments of Neurology, Neurosurgery, Radiology, and Emergency Medicine (H.B.B., M.R.R., G.J.F., A.M.A., K.A.M., K.S., J.M.R., A.V., S.M.G., C.S.O., J.N.G., J.R.), Massachusetts General Hospital, Harvard Medical School, Boston; and the Department of Neurology & Neurosurgery, Brain Center Rudolf Magnus, and Department of Radiology (H.B.B., K.M.v.N., B.K.V., A.v.d.Z., G.J.E.R., C.J.M.K.), University Medical Center Utrecht, Utrecht University, the Netherlands
| | - Kristen A McNamara
- From the Center for Human Genetic Research (H.B.B., M.R.R., G.J.F., J.R.) and the Departments of Neurology, Neurosurgery, Radiology, and Emergency Medicine (H.B.B., M.R.R., G.J.F., A.M.A., K.A.M., K.S., J.M.R., A.V., S.M.G., C.S.O., J.N.G., J.R.), Massachusetts General Hospital, Harvard Medical School, Boston; and the Department of Neurology & Neurosurgery, Brain Center Rudolf Magnus, and Department of Radiology (H.B.B., K.M.v.N., B.K.V., A.v.d.Z., G.J.E.R., C.J.M.K.), University Medical Center Utrecht, Utrecht University, the Netherlands
| | - Kristin Schwab
- From the Center for Human Genetic Research (H.B.B., M.R.R., G.J.F., J.R.) and the Departments of Neurology, Neurosurgery, Radiology, and Emergency Medicine (H.B.B., M.R.R., G.J.F., A.M.A., K.A.M., K.S., J.M.R., A.V., S.M.G., C.S.O., J.N.G., J.R.), Massachusetts General Hospital, Harvard Medical School, Boston; and the Department of Neurology & Neurosurgery, Brain Center Rudolf Magnus, and Department of Radiology (H.B.B., K.M.v.N., B.K.V., A.v.d.Z., G.J.E.R., C.J.M.K.), University Medical Center Utrecht, Utrecht University, the Netherlands
| | - Javier M Romero
- From the Center for Human Genetic Research (H.B.B., M.R.R., G.J.F., J.R.) and the Departments of Neurology, Neurosurgery, Radiology, and Emergency Medicine (H.B.B., M.R.R., G.J.F., A.M.A., K.A.M., K.S., J.M.R., A.V., S.M.G., C.S.O., J.N.G., J.R.), Massachusetts General Hospital, Harvard Medical School, Boston; and the Department of Neurology & Neurosurgery, Brain Center Rudolf Magnus, and Department of Radiology (H.B.B., K.M.v.N., B.K.V., A.v.d.Z., G.J.E.R., C.J.M.K.), University Medical Center Utrecht, Utrecht University, the Netherlands
| | - Birgitta K Velthuis
- From the Center for Human Genetic Research (H.B.B., M.R.R., G.J.F., J.R.) and the Departments of Neurology, Neurosurgery, Radiology, and Emergency Medicine (H.B.B., M.R.R., G.J.F., A.M.A., K.A.M., K.S., J.M.R., A.V., S.M.G., C.S.O., J.N.G., J.R.), Massachusetts General Hospital, Harvard Medical School, Boston; and the Department of Neurology & Neurosurgery, Brain Center Rudolf Magnus, and Department of Radiology (H.B.B., K.M.v.N., B.K.V., A.v.d.Z., G.J.E.R., C.J.M.K.), University Medical Center Utrecht, Utrecht University, the Netherlands
| | - Anand Viswanathan
- From the Center for Human Genetic Research (H.B.B., M.R.R., G.J.F., J.R.) and the Departments of Neurology, Neurosurgery, Radiology, and Emergency Medicine (H.B.B., M.R.R., G.J.F., A.M.A., K.A.M., K.S., J.M.R., A.V., S.M.G., C.S.O., J.N.G., J.R.), Massachusetts General Hospital, Harvard Medical School, Boston; and the Department of Neurology & Neurosurgery, Brain Center Rudolf Magnus, and Department of Radiology (H.B.B., K.M.v.N., B.K.V., A.v.d.Z., G.J.E.R., C.J.M.K.), University Medical Center Utrecht, Utrecht University, the Netherlands
| | - Steven M Greenberg
- From the Center for Human Genetic Research (H.B.B., M.R.R., G.J.F., J.R.) and the Departments of Neurology, Neurosurgery, Radiology, and Emergency Medicine (H.B.B., M.R.R., G.J.F., A.M.A., K.A.M., K.S., J.M.R., A.V., S.M.G., C.S.O., J.N.G., J.R.), Massachusetts General Hospital, Harvard Medical School, Boston; and the Department of Neurology & Neurosurgery, Brain Center Rudolf Magnus, and Department of Radiology (H.B.B., K.M.v.N., B.K.V., A.v.d.Z., G.J.E.R., C.J.M.K.), University Medical Center Utrecht, Utrecht University, the Netherlands
| | - Christopher S Ogilvy
- From the Center for Human Genetic Research (H.B.B., M.R.R., G.J.F., J.R.) and the Departments of Neurology, Neurosurgery, Radiology, and Emergency Medicine (H.B.B., M.R.R., G.J.F., A.M.A., K.A.M., K.S., J.M.R., A.V., S.M.G., C.S.O., J.N.G., J.R.), Massachusetts General Hospital, Harvard Medical School, Boston; and the Department of Neurology & Neurosurgery, Brain Center Rudolf Magnus, and Department of Radiology (H.B.B., K.M.v.N., B.K.V., A.v.d.Z., G.J.E.R., C.J.M.K.), University Medical Center Utrecht, Utrecht University, the Netherlands
| | - Albert van der Zwan
- From the Center for Human Genetic Research (H.B.B., M.R.R., G.J.F., J.R.) and the Departments of Neurology, Neurosurgery, Radiology, and Emergency Medicine (H.B.B., M.R.R., G.J.F., A.M.A., K.A.M., K.S., J.M.R., A.V., S.M.G., C.S.O., J.N.G., J.R.), Massachusetts General Hospital, Harvard Medical School, Boston; and the Department of Neurology & Neurosurgery, Brain Center Rudolf Magnus, and Department of Radiology (H.B.B., K.M.v.N., B.K.V., A.v.d.Z., G.J.E.R., C.J.M.K.), University Medical Center Utrecht, Utrecht University, the Netherlands
| | - Gabriel J E Rinkel
- From the Center for Human Genetic Research (H.B.B., M.R.R., G.J.F., J.R.) and the Departments of Neurology, Neurosurgery, Radiology, and Emergency Medicine (H.B.B., M.R.R., G.J.F., A.M.A., K.A.M., K.S., J.M.R., A.V., S.M.G., C.S.O., J.N.G., J.R.), Massachusetts General Hospital, Harvard Medical School, Boston; and the Department of Neurology & Neurosurgery, Brain Center Rudolf Magnus, and Department of Radiology (H.B.B., K.M.v.N., B.K.V., A.v.d.Z., G.J.E.R., C.J.M.K.), University Medical Center Utrecht, Utrecht University, the Netherlands
| | - Joshua N Goldstein
- From the Center for Human Genetic Research (H.B.B., M.R.R., G.J.F., J.R.) and the Departments of Neurology, Neurosurgery, Radiology, and Emergency Medicine (H.B.B., M.R.R., G.J.F., A.M.A., K.A.M., K.S., J.M.R., A.V., S.M.G., C.S.O., J.N.G., J.R.), Massachusetts General Hospital, Harvard Medical School, Boston; and the Department of Neurology & Neurosurgery, Brain Center Rudolf Magnus, and Department of Radiology (H.B.B., K.M.v.N., B.K.V., A.v.d.Z., G.J.E.R., C.J.M.K.), University Medical Center Utrecht, Utrecht University, the Netherlands
| | - Catharina J M Klijn
- From the Center for Human Genetic Research (H.B.B., M.R.R., G.J.F., J.R.) and the Departments of Neurology, Neurosurgery, Radiology, and Emergency Medicine (H.B.B., M.R.R., G.J.F., A.M.A., K.A.M., K.S., J.M.R., A.V., S.M.G., C.S.O., J.N.G., J.R.), Massachusetts General Hospital, Harvard Medical School, Boston; and the Department of Neurology & Neurosurgery, Brain Center Rudolf Magnus, and Department of Radiology (H.B.B., K.M.v.N., B.K.V., A.v.d.Z., G.J.E.R., C.J.M.K.), University Medical Center Utrecht, Utrecht University, the Netherlands
| | - Jonathan Rosand
- From the Center for Human Genetic Research (H.B.B., M.R.R., G.J.F., J.R.) and the Departments of Neurology, Neurosurgery, Radiology, and Emergency Medicine (H.B.B., M.R.R., G.J.F., A.M.A., K.A.M., K.S., J.M.R., A.V., S.M.G., C.S.O., J.N.G., J.R.), Massachusetts General Hospital, Harvard Medical School, Boston; and the Department of Neurology & Neurosurgery, Brain Center Rudolf Magnus, and Department of Radiology (H.B.B., K.M.v.N., B.K.V., A.v.d.Z., G.J.E.R., C.J.M.K.), University Medical Center Utrecht, Utrecht University, the Netherlands
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15
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Woo D, Falcone GJ, Devan WJ, Brown WM, Biffi A, Howard TD, Anderson CD, Brouwers HB, Valant V, Battey TWK, Radmanesh F, Raffeld MR, Baedorf-Kassis S, Deka R, Woo JG, Martin LJ, Haverbusch M, Moomaw CJ, Sun G, Broderick JP, Flaherty ML, Martini SR, Kleindorfer DO, Kissela B, Comeau ME, Jagiella JM, Schmidt H, Freudenberger P, Pichler A, Enzinger C, Hansen BM, Norrving B, Jimenez-Conde J, Giralt-Steinhauer E, Elosua R, Cuadrado-Godia E, Soriano C, Roquer J, Kraft P, Ayres AM, Schwab K, McCauley JL, Pera J, Urbanik A, Rost NS, Goldstein JN, Viswanathan A, Stögerer EM, Tirschwell DL, Selim M, Brown DL, Silliman SL, Worrall BB, Meschia JF, Kidwell CS, Montaner J, Fernandez-Cadenas I, Delgado P, Malik R, Dichgans M, Greenberg SM, Rothwell PM, Lindgren A, Slowik A, Schmidt R, Langefeld CD, Rosand J. Meta-analysis of genome-wide association studies identifies 1q22 as a susceptibility locus for intracerebral hemorrhage. Am J Hum Genet 2014; 94:511-21. [PMID: 24656865 PMCID: PMC3980413 DOI: 10.1016/j.ajhg.2014.02.012] [Citation(s) in RCA: 200] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2013] [Accepted: 02/24/2014] [Indexed: 11/25/2022] Open
Abstract
Intracerebral hemorrhage (ICH) is the stroke subtype with the worst prognosis and has no established acute treatment. ICH is classified as lobar or nonlobar based on the location of ruptured blood vessels within the brain. These different locations also signal different underlying vascular pathologies. Heritability estimates indicate a substantial genetic contribution to risk of ICH in both locations. We report a genome-wide association study of this condition that meta-analyzed data from six studies that enrolled individuals of European ancestry. Case subjects were ascertained by neurologists blinded to genotype data and classified as lobar or nonlobar based on brain computed tomography. ICH-free control subjects were sampled from ambulatory clinics or random digit dialing. Replication of signals identified in the discovery cohort with p < 1 × 10(-6) was pursued in an independent multiethnic sample utilizing both direct and genome-wide genotyping. The discovery phase included a case cohort of 1,545 individuals (664 lobar and 881 nonlobar cases) and a control cohort of 1,481 individuals and identified two susceptibility loci: for lobar ICH, chromosomal region 12q21.1 (rs11179580, odds ratio [OR] = 1.56, p = 7.0 × 10(-8)); and for nonlobar ICH, chromosomal region 1q22 (rs2984613, OR = 1.44, p = 1.6 × 10(-8)). The replication included a case cohort of 1,681 individuals (484 lobar and 1,194 nonlobar cases) and a control cohort of 2,261 individuals and corroborated the association for 1q22 (p = 6.5 × 10(-4); meta-analysis p = 2.2 × 10(-10)) but not for 12q21.1 (p = 0.55; meta-analysis p = 2.6 × 10(-5)). These results demonstrate biological heterogeneity across ICH subtypes and highlight the importance of ascertaining ICH cases accordingly.
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Affiliation(s)
- Daniel Woo
- Department of Neurology and Rehabilitation Medicine, University of Cincinnati College of Medicine, Cincinnati, OH 45267, USA.
| | - Guido J Falcone
- Center for Human Genetic Research, Massachusetts General Hospital, Boston, MA 02114, USA; Division of Neurocritical Care and Emergency Neurology, Department of Neurology, Massachusetts General Hospital, Boston, MA 02114, USA; The J. Philip Kistler Stroke Research Center, Massachusetts General Hospital, Boston, MA 02114, USA; Program in Medical and Population Genetics, Broad Institute, Cambridge, MA 02141, USA; Department of Epidemiology, Harvard School of Public Health, Boston, MA 02115, USA
| | - William J Devan
- Center for Human Genetic Research, Massachusetts General Hospital, Boston, MA 02114, USA; Division of Neurocritical Care and Emergency Neurology, Department of Neurology, Massachusetts General Hospital, Boston, MA 02114, USA; The J. Philip Kistler Stroke Research Center, Massachusetts General Hospital, Boston, MA 02114, USA; Program in Medical and Population Genetics, Broad Institute, Cambridge, MA 02141, USA
| | - W Mark Brown
- Center for Public Health Genomics and Department of Biostatistical Sciences, Wake Forest University, Winston-Salem, NC 27157, USA
| | - Alessandro Biffi
- Center for Human Genetic Research, Massachusetts General Hospital, Boston, MA 02114, USA; Division of Neurocritical Care and Emergency Neurology, Department of Neurology, Massachusetts General Hospital, Boston, MA 02114, USA; The J. Philip Kistler Stroke Research Center, Massachusetts General Hospital, Boston, MA 02114, USA; Program in Medical and Population Genetics, Broad Institute, Cambridge, MA 02141, USA
| | - Timothy D Howard
- Center for Public Health Genomics and Department of Biostatistical Sciences, Wake Forest University, Winston-Salem, NC 27157, USA
| | - Christopher D Anderson
- Center for Human Genetic Research, Massachusetts General Hospital, Boston, MA 02114, USA; Division of Neurocritical Care and Emergency Neurology, Department of Neurology, Massachusetts General Hospital, Boston, MA 02114, USA; The J. Philip Kistler Stroke Research Center, Massachusetts General Hospital, Boston, MA 02114, USA; Program in Medical and Population Genetics, Broad Institute, Cambridge, MA 02141, USA
| | - H Bart Brouwers
- Center for Human Genetic Research, Massachusetts General Hospital, Boston, MA 02114, USA; Division of Neurocritical Care and Emergency Neurology, Department of Neurology, Massachusetts General Hospital, Boston, MA 02114, USA; The J. Philip Kistler Stroke Research Center, Massachusetts General Hospital, Boston, MA 02114, USA; Program in Medical and Population Genetics, Broad Institute, Cambridge, MA 02141, USA
| | - Valerie Valant
- Center for Human Genetic Research, Massachusetts General Hospital, Boston, MA 02114, USA; Division of Neurocritical Care and Emergency Neurology, Department of Neurology, Massachusetts General Hospital, Boston, MA 02114, USA; The J. Philip Kistler Stroke Research Center, Massachusetts General Hospital, Boston, MA 02114, USA; Program in Medical and Population Genetics, Broad Institute, Cambridge, MA 02141, USA
| | - Thomas W K Battey
- Center for Human Genetic Research, Massachusetts General Hospital, Boston, MA 02114, USA; Division of Neurocritical Care and Emergency Neurology, Department of Neurology, Massachusetts General Hospital, Boston, MA 02114, USA; The J. Philip Kistler Stroke Research Center, Massachusetts General Hospital, Boston, MA 02114, USA; Program in Medical and Population Genetics, Broad Institute, Cambridge, MA 02141, USA
| | - Farid Radmanesh
- Center for Human Genetic Research, Massachusetts General Hospital, Boston, MA 02114, USA; Division of Neurocritical Care and Emergency Neurology, Department of Neurology, Massachusetts General Hospital, Boston, MA 02114, USA; The J. Philip Kistler Stroke Research Center, Massachusetts General Hospital, Boston, MA 02114, USA; Program in Medical and Population Genetics, Broad Institute, Cambridge, MA 02141, USA
| | - Miriam R Raffeld
- Center for Human Genetic Research, Massachusetts General Hospital, Boston, MA 02114, USA; Division of Neurocritical Care and Emergency Neurology, Department of Neurology, Massachusetts General Hospital, Boston, MA 02114, USA; The J. Philip Kistler Stroke Research Center, Massachusetts General Hospital, Boston, MA 02114, USA; Program in Medical and Population Genetics, Broad Institute, Cambridge, MA 02141, USA
| | - Sylvia Baedorf-Kassis
- Center for Human Genetic Research, Massachusetts General Hospital, Boston, MA 02114, USA; Division of Neurocritical Care and Emergency Neurology, Department of Neurology, Massachusetts General Hospital, Boston, MA 02114, USA; The J. Philip Kistler Stroke Research Center, Massachusetts General Hospital, Boston, MA 02114, USA; Program in Medical and Population Genetics, Broad Institute, Cambridge, MA 02141, USA
| | - Ranjan Deka
- Department of Environmental Health, University of Cincinnati College of Medicine, Cincinnati, OH 45267, USA
| | - Jessica G Woo
- Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229, USA
| | - Lisa J Martin
- Division of Human Genetics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229, USA
| | - Mary Haverbusch
- Department of Neurology and Rehabilitation Medicine, University of Cincinnati College of Medicine, Cincinnati, OH 45267, USA
| | - Charles J Moomaw
- Department of Neurology and Rehabilitation Medicine, University of Cincinnati College of Medicine, Cincinnati, OH 45267, USA
| | - Guangyun Sun
- Department of Environmental Health, University of Cincinnati College of Medicine, Cincinnati, OH 45267, USA
| | - Joseph P Broderick
- Department of Neurology and Rehabilitation Medicine, University of Cincinnati College of Medicine, Cincinnati, OH 45267, USA
| | - Matthew L Flaherty
- Department of Neurology and Rehabilitation Medicine, University of Cincinnati College of Medicine, Cincinnati, OH 45267, USA
| | - Sharyl R Martini
- Department of Neurology and Rehabilitation Medicine, University of Cincinnati College of Medicine, Cincinnati, OH 45267, USA
| | - Dawn O Kleindorfer
- Department of Neurology and Rehabilitation Medicine, University of Cincinnati College of Medicine, Cincinnati, OH 45267, USA
| | - Brett Kissela
- Department of Neurology and Rehabilitation Medicine, University of Cincinnati College of Medicine, Cincinnati, OH 45267, USA
| | - Mary E Comeau
- Center for Public Health Genomics and Department of Biostatistical Sciences, Wake Forest University, Winston-Salem, NC 27157, USA
| | - Jeremiasz M Jagiella
- Department of Neurology, Jagiellonian University Medical College, Krakow 31-008, Poland
| | - Helena Schmidt
- Institute of Molecular Biology and Medical Biochemistry, Medical University Graz, Graz 8010, Austria
| | - Paul Freudenberger
- Institute of Molecular Biology and Medical Biochemistry, Medical University Graz, Graz 8010, Austria
| | - Alexander Pichler
- Department of Neurology, Medical University of Graz, Graz 8036, Austria
| | - Christian Enzinger
- Department of Neurology, Medical University of Graz, Graz 8036, Austria; Division of Neuroradiology, Department of Radiology, Medical University of Graz, Graz 8036, Austria
| | - Björn M Hansen
- Department of Clinical Sciences Lund, Neurology, Lund University, Lund 221 85, Sweden; Department of Neurology, Skåne University Hospital, Lund 221 85, Sweden
| | - Bo Norrving
- Department of Clinical Sciences Lund, Neurology, Lund University, Lund 221 85, Sweden; Department of Neurology, Skåne University Hospital, Lund 221 85, Sweden
| | - Jordi Jimenez-Conde
- Department of Neurology, Neurovascular Research Unit, Institut Hospital del Mar d'Investigacions Mèdiques, Universitat Autonoma de Barcelona/DCEXS-UPF, Barcelona 08003, Spain; Cardiovascular Epidemiology and Genetics Research Group, Institut Hospital del Mar d'Investigacions Mèdiques, Barcelona 08003, Spain
| | - Eva Giralt-Steinhauer
- Department of Neurology, Neurovascular Research Unit, Institut Hospital del Mar d'Investigacions Mèdiques, Universitat Autonoma de Barcelona/DCEXS-UPF, Barcelona 08003, Spain; Cardiovascular Epidemiology and Genetics Research Group, Institut Hospital del Mar d'Investigacions Mèdiques, Barcelona 08003, Spain
| | - Roberto Elosua
- Department of Neurology, Neurovascular Research Unit, Institut Hospital del Mar d'Investigacions Mèdiques, Universitat Autonoma de Barcelona/DCEXS-UPF, Barcelona 08003, Spain; Cardiovascular Epidemiology and Genetics Research Group, Institut Hospital del Mar d'Investigacions Mèdiques, Barcelona 08003, Spain
| | - Elisa Cuadrado-Godia
- Department of Neurology, Neurovascular Research Unit, Institut Hospital del Mar d'Investigacions Mèdiques, Universitat Autonoma de Barcelona/DCEXS-UPF, Barcelona 08003, Spain; Cardiovascular Epidemiology and Genetics Research Group, Institut Hospital del Mar d'Investigacions Mèdiques, Barcelona 08003, Spain
| | - Carolina Soriano
- Department of Neurology, Neurovascular Research Unit, Institut Hospital del Mar d'Investigacions Mèdiques, Universitat Autonoma de Barcelona/DCEXS-UPF, Barcelona 08003, Spain; Cardiovascular Epidemiology and Genetics Research Group, Institut Hospital del Mar d'Investigacions Mèdiques, Barcelona 08003, Spain
| | - Jaume Roquer
- Department of Neurology, Neurovascular Research Unit, Institut Hospital del Mar d'Investigacions Mèdiques, Universitat Autonoma de Barcelona/DCEXS-UPF, Barcelona 08003, Spain; Cardiovascular Epidemiology and Genetics Research Group, Institut Hospital del Mar d'Investigacions Mèdiques, Barcelona 08003, Spain
| | - Peter Kraft
- Department of Epidemiology, Harvard School of Public Health, Boston, MA 02115, USA
| | - Alison M Ayres
- The J. Philip Kistler Stroke Research Center, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Kristin Schwab
- The J. Philip Kistler Stroke Research Center, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Jacob L McCauley
- John P. Hussman Institute for Human Genomics, University of Miami, Miller School of Medicine, Miami, FL 33136, USA
| | - Joanna Pera
- Department of Neurology, Jagiellonian University Medical College, Krakow 31-008, Poland
| | - Andrzej Urbanik
- Department of Radiology, Jagiellonian University Medical College, Krakow 31-008, Poland
| | - Natalia S Rost
- Center for Human Genetic Research, Massachusetts General Hospital, Boston, MA 02114, USA; Division of Neurocritical Care and Emergency Neurology, Department of Neurology, Massachusetts General Hospital, Boston, MA 02114, USA; The J. Philip Kistler Stroke Research Center, Massachusetts General Hospital, Boston, MA 02114, USA; Program in Medical and Population Genetics, Broad Institute, Cambridge, MA 02141, USA
| | - Joshua N Goldstein
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Anand Viswanathan
- The J. Philip Kistler Stroke Research Center, Massachusetts General Hospital, Boston, MA 02114, USA
| | | | - David L Tirschwell
- Stroke Center, Harborview Medical Center, University of Washington, Seattle, WA 98104, USA
| | - Magdy Selim
- Department of Neurology, Stroke Division, Beth Israel Deaconess Medical Center, Boston, MA 02215, USA
| | - Devin L Brown
- Stroke Program, Department of Neurology, University of Michigan Health System, Ann Arbor, MI 48109, USA
| | - Scott L Silliman
- Department of Neurology, University of Florida College of Medicine, Jacksonville, FL 32209, USA
| | - Bradford B Worrall
- Department of Neurology and Public Health Sciences, University of Virginia Health System, Charlottesville, VA 22908, USA
| | - James F Meschia
- Department of Neurology, Mayo Clinic, Jacksonville, FL 32224, USA
| | - Chelsea S Kidwell
- Department of Neurology, University of Arizona, Tucson, AZ 85724, USA
| | - Joan Montaner
- Neurovascular Research Laboratory and Neurovascular Unit, Institut de Recerca, Hospital Vall d'Hebron, Universitat Autonoma de Barcelona, Barcelona 08035, Spain
| | - Israel Fernandez-Cadenas
- Neurovascular Research Laboratory and Neurovascular Unit, Institut de Recerca, Hospital Vall d'Hebron, Universitat Autonoma de Barcelona, Barcelona 08035, Spain; Stroke Pharmacogenomics and Genetics, Fundació Docència i Recerca Mútuaterrassa, Barcelona 08010, Spain
| | - Pilar Delgado
- Neurovascular Research Laboratory and Neurovascular Unit, Institut de Recerca, Hospital Vall d'Hebron, Universitat Autonoma de Barcelona, Barcelona 08035, Spain
| | - Rainer Malik
- Institute for Stroke and Dementia Research, Klinikum der Universität München, Ludwig-Maximilians-University, Munich 80539, Germany; Munich Cluster for Systems Neurology (Synergy), Munich 80539, Germany
| | - Martin Dichgans
- Institute for Stroke and Dementia Research, Klinikum der Universität München, Ludwig-Maximilians-University, Munich 80539, Germany; Munich Cluster for Systems Neurology (Synergy), Munich 80539, Germany
| | - Steven M Greenberg
- The J. Philip Kistler Stroke Research Center, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Peter M Rothwell
- Stroke Prevention Research Unit, Nuffield Department of Clinical Neuroscience, University of Oxford, Oxford OX3 9DU, UK
| | - Arne Lindgren
- Department of Clinical Sciences Lund, Neurology, Lund University, Lund 221 85, Sweden; Department of Neurology, Skåne University Hospital, Lund 221 85, Sweden
| | - Agnieszka Slowik
- Department of Neurology, Jagiellonian University Medical College, Krakow 31-008, Poland
| | - Reinhold Schmidt
- Department of Neurology, Medical University of Graz, Graz 8036, Austria
| | - Carl D Langefeld
- Center for Public Health Genomics and Department of Biostatistical Sciences, Wake Forest University, Winston-Salem, NC 27157, USA
| | - Jonathan Rosand
- Center for Human Genetic Research, Massachusetts General Hospital, Boston, MA 02114, USA; Division of Neurocritical Care and Emergency Neurology, Department of Neurology, Massachusetts General Hospital, Boston, MA 02114, USA; The J. Philip Kistler Stroke Research Center, Massachusetts General Hospital, Boston, MA 02114, USA; Program in Medical and Population Genetics, Broad Institute, Cambridge, MA 02141, USA.
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16
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Brouwers HB, Raffeld MR, Falcone GJ, Ayres AM, Schwab K, Romero JM, Viswanathan A, Greenberg SM, Ogilvy CS, Goldstein JN, Rosand J. Abstract WP294: CT Angiography Spot Sign Predicts Perioperative Bleeding in Primary Intracerebral Hemorrhage. Stroke 2013. [DOI: 10.1161/str.44.suppl_1.awp294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Purpose:
While hematoma evacuation for intracerebral hemorrhage (ICH) showed no clinical benefit in one large randomized trial, meta-analyses have suggested an effect for certain subgroups. Knowledge of which patients will be found to show active bleeding may help guide surgical treatment. The spot sign, i.e. contrast extravasation following CT angiography (CTA), is thought to represent active bleeding. We therefore investigated whether spot sign presence predicts active bleeding during surgery for ICH.
Methods:
Consecutive primary ICH patients who underwent a CTA followed by surgical hematoma evacuation were included over a 10-year period. CTAs were reviewed for spot sign presence by an experienced reader, blinded to clinical and surgical data. Active bleeding and re-bleeding following surgery were assessed using 5-point rating scales. The association between the spot sign and active perioperative bleeding, postoperative re-bleeding, and postoperative change in hematoma volume was evaluated using univariate and multivariate logistic regression.
Results:
During the study period, 1082 ICH patients presented to our institution, of whom 75 met inclusion criteria. 34 (45%) were lobar, 13 (17%) deep, 26 (35%) cerebellar, 1 (1%) brainstem, and 1 (1%) primary intraventricular hemorrhage. At least one spot sign was identified in 29 patients (39%). In multivariate analysis, spot sign was the sole predictor of active bleeding during surgery (OR 2.86 [95%CI 1.05-8.17],
p
= 0.044). Presence of spot sign (OR 4.46 [95%CI 1.24-18.17],
p
= 0.027) and female sex (OR 6.71 [95%CI 1.79-33.28],
p
= 0.009) were predictive of re-bleeding and larger postoperative ICH volumes. A trend toward significance was found for the association of re-bleeding with both discharge mortality (
p
= 0.055) and 90-day mortality (
p
= 0.073).
Conclusion:
This is the first study to show that CTA spot sign marks ongoing bleeding in patients undergoing hematoma evacuation following acute ICH. Patients with this finding suffer more perioperative bleeding, more postoperative re-bleeding, and larger residual ICH volumes. Our results may contribute to the selection of which ICH patients may benefit from surgery.
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Affiliation(s)
- H. B Brouwers
- Massachusetts General Hosp, Harvard Med Sch, Boston, MA
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