Homocysteine Level Is Associated with White Matter Hyperintensity Locations in Patients with Acute Ischemic Stroke.

Yuan Gao,Yuming Xu,Shilei Sun,Sen Wei,Jie Qin,Rui Zhang,Bo Song,Hui Fang,Yan Ji,Yan Li

doi:10.1371/journal.pone.0144431

Yuan Gao, Yuming Xu + Show 8 more

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https://doi.org/10.1371/journal.pone.0144431

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Journal: PloS one	Publication Date: Dec 7, 2015
Citations: 17	License type: CC BY 4.0

Affiliation: First Affiliated Hospital of Zhengzhou University

Abstract

Background and PurposeThe relationship between plasma level of total homocysteine (tHcy) and white matter hyperintensities (WMHs), especially in patients with acute ischemic stroke (AIS), is controversial. The present study investigated the association between these two as well as WMH locations in a large cohort of patients with AIS.MethodsConsecutive patients were reviewed from a prospective ischemic stroke database. Clinical data, including tHcy level and WMHs, were assessed. WMHs were assessed using the Fazekas scale and Age-Related White Matter Changes (ARWMC) visual grading scale. The association between tHcy and WMH locations was investigated by using multivariate logistic regression analyses.ResultsA total of 923 out of 1,205 patients were examined. The average age was 58.9 ± 11.9 years; 31.6% were female. Elevated tHcy level was significantly associated with WMHs. For the highest tHcy quartile, the odds ratio (OR) (95% confidence interval; CI) was 1.891 (1.257; 2.843) according to the Fazekas scale and 1.781 (1.185; 2.767) according to the ARWMC scale when compared to the lowest quartile. However, in a subgroup analysis, only WMHs in the periventricular area and left or right frontal areas were found to be independently associated with tHcy level. For the highest tHcy quartile, the OR (95% CI) was 1.761 (1.172; 2.648) for the periventricular WMHs, 1.768 (1.134; 2.756)for the left frontal WMHs, and 1.890 (1.206; 2.960)for the right frontal WMHs.ConclusionsIn patients with AIS, plasma tHcy level is related to WMHs, especially WMHs distributed within the periventricular and frontal areas.

Highlights

Cerebral white matter hyperintensities (WMHs) are areas of hypointense signals on T1-weighted images and hyperintense signals on T2-weighted and fluid-attenuated inversion recovery (FLAIR) images obtained from magnetic resonance imaging (MRI) of the brain [1]
For the highest total homocysteine (tHcy) quartile, the odds ratio (OR) (95% confidence interval; CI) was 1.891 (1.257; 2.843) according to the Fazekas scale and 1.781 (1.185; 2.767) according to the Age-Related White Matter Changes (ARWMC) scale when compared to the lowest quartile
In patients with acute ischemic stroke (AIS), plasma tHcy level is related to WMHs, especially WMHs distributed within the periventricular and frontal areas

Summary

Introduction

Cerebral white matter hyperintensities (WMHs) are areas of hypointense signals on T1-weighted images and hyperintense signals on T2-weighted and fluid-attenuated inversion recovery (FLAIR) images obtained from magnetic resonance imaging (MRI) of the brain [1]. Expanding studies suggest that plasma total homocysteine (tHcy) level is associated with WMHs in general populations [4] and even in stroke patient [5]; other studies have failed to replicate this association [6]. Even fewer studies have examined the association between tHcy level and WMHs in different lobes [10], and no study has examined it in patients with acute ischemic stroke (AIS). The present study included a large sample of patients with AIS with the goal of determining the association between plasma tHcy levels and WMHs as well as WMH locations. The relationship between plasma level of total homocysteine (tHcy) and white matter hyperintensities (WMHs), especially in patients with acute ischemic stroke (AIS), is controversial. The present study investigated the association between these two as well as WMH locations in a large cohort of patients with AIS.

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