Poor Brain Health at time of Stroke Linked to Worse Outcomes in Women Compared to Men
Poster No:
226
Submission Type:
Abstract Submission
Authors:
Kenda Alhadid1,2, Erik Lindgren1, Robert Regenhardt1,2, Natalia Rost1,2, Markus Schirmer1,2
Institutions:
1J. Philip Kistler Stroke Research Center, Massachusetts General Hospital, Boston, MA, 2Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
First Author:
Kenda Alhadid
J. Philip Kistler Stroke Research Center, Massachusetts General Hospital|Department of Neurology, Massachusetts General Hospital, Harvard Medical School
Boston, MA|Boston, MA
J. Philip Kistler Stroke Research Center, Massachusetts General Hospital|Department of Neurology, Massachusetts General Hospital, Harvard Medical School
Boston, MA|Boston, MA
Co-Author(s):
Robert Regenhardt
J. Philip Kistler Stroke Research Center, Massachusetts General Hospital|Department of Neurology, Massachusetts General Hospital, Harvard Medical School
Boston, MA|Boston, MA
J. Philip Kistler Stroke Research Center, Massachusetts General Hospital|Department of Neurology, Massachusetts General Hospital, Harvard Medical School
Boston, MA|Boston, MA
Natalia Rost
J. Philip Kistler Stroke Research Center, Massachusetts General Hospital|Department of Neurology, Massachusetts General Hospital, Harvard Medical School
Boston, MA|Boston, MA
J. Philip Kistler Stroke Research Center, Massachusetts General Hospital|Department of Neurology, Massachusetts General Hospital, Harvard Medical School
Boston, MA|Boston, MA
Markus Schirmer
J. Philip Kistler Stroke Research Center, Massachusetts General Hospital|Department of Neurology, Massachusetts General Hospital, Harvard Medical School
Boston, MA|Boston, MA
J. Philip Kistler Stroke Research Center, Massachusetts General Hospital|Department of Neurology, Massachusetts General Hospital, Harvard Medical School
Boston, MA|Boston, MA
Introduction:
Stroke is the leading cause of severe long-term disability worldwide, and it has been established that female stroke survivors experience worse outcomes (Bushnell et al., 2018)(Martin et al., 2024). Sex-specific differences have been described in various aspects of stroke from disease mechanism and genetic susceptibility to differences in diagnosis, management, and functional outcomes (Di Carlo et al., 2003). Recent neuroimaging studies have shown that various patterns of lesional ischemic stroke injury are associated with worse outcomes in females, and that injury to highly connected hubs in brain networks produce more severe deficits in women compared to men (Bonkhoff et al., 2023, Bonkhoff et al., 2021). In this study we evaluated if brain health at the time of stroke – quantified by a surrogate imaging biomarker called effective reserve (eR) (Schirmer et al., 2019) (Schirmer et al., 2024) – has a differential impact on functional recovery in men and women.
Methods:
Study participants were selected from 2 cohorts of arterial ischemic stroke patients described in prior works (GASROS (Zhang et al., 2015) and MRI-GENIE (Giese et al., 2017)). Patients included were > 18 years with confirmed diagnosis of acute arterial ischemic stroke, with modified Rankin Scale (mRS) scores at 90 days post-stroke. Brain volume, white matter hyperintensity (WMH) volume, and lesional injury volume were calculated from two MRI sequences. eR was defined as a latent variable, given as: eR ~ Age + WMH load + Brain volume and parameters were estimated using only one of the cohorts. eR was then calculated for each patient and categorized into poor (1st quartile), moderate (2nd and 3rd quartiles), and high (4th quartile) brain health. mRS scores were compared between men and women across the three categories using the Kolmogorov-Smirnov test. All analyses were performed in R with significance set at p<0.05.
Results:
A total of N = 1039 patients were included in the analysis: 62% male, with no significant differences in the number of patients with diabetes between men and women. Men had a significantly higher rate of hypertension (p<0.05), and higher rates of smoking (p<0.001). Stroke etiology based on the TOAST classification was not significantly different between the sexes. Within the poor brain health group, women had significantly worse outcomes compared to men in both cohorts (Fig. 1) with a significant proportion with an mRS score of 3 or higher, while there were no observed differences between men and women in this category with respect to lesion load, WMH load, or in participant age for each mRS outcome.
Conclusions:
We demonstrate that poor brain health, defined in this context as low effective reserve (eR), has significant implications for outcome prediction in female stroke survivors. We found that poor brain health at the time of incident stroke is linked with a high likelihood of functional impairment and requiring assistance with ambulation in women. This is in spite of increased prevalence of traditional cardiovascular risk factors in men in our cohorts (smoking and hypertension). Importantly, eR is a neuroimaging biomarker that can be easily computed from standard-of-care clinical scans facilitating its translation. Along with other clinical and imaging characteristics, this data strongly supports its value for sex-specific brain health and stroke outcome modeling.
Disorders of the Nervous System:
Neurodegenerative/ Late Life (eg. Parkinson’s, Alzheimer’s) 1
Modeling and Analysis Methods:
Classification and Predictive Modeling 2
Keywords:
Cerebrovascular Disease
MRI
Other - effective reserve
1|2Indicates the priority used for review
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