From the Department of Neurology (J.P.C., J.R.A., A.R.-T., S.M., P.K., A.C., C.K., Z.D., K.S., M.E.G., A.V., C.D.A., S.M.G., J.R., A.B.), Hemorrhagic Stroke Research Program (J.P.C., J.R.A., A.R.-T., S.M., P.K., A.C., C.K, Z.D., K.S., M.E.G., A.V., C.D.A., S.M.G., J.R., A.B.), Henry and Allison McCance Center for Brain Health (J.P.C., J.R.A., P.K., C.K., C.D.A., J.R., A.B.), and Center for Genomic Medicine (J.R.A., S.M., P.K., C.K., C.D.A., J.R., A.B.), Massachusetts General Hospital, Boston; University of Lille (M.P.), Inserm, CHU Lille, U1172-LilNCog-Lille Neuroscience & Cognition, France; School of Medicine (A.R.-T.), University of California, Irvine; Department of Neurology and Rehabilitation Medicine (S.D., L.G., M.L.F., D.W.), University of Cincinnati, OH; Department of Biostatistics and Data Sciences (C.D.L.), Wake Forest University, Winston-Salem, NC; Department of Neurology (A.T.), Keck School of Medicine, University of Southern California; and Los Angeles County Department of Health Services (A.T.), CA.
Neurology. 2021 May 18;96(20):e2469-e2480. doi: 10.1212/WNL.0000000000011932. Epub 2021 Apr 21.
Black and Hispanic survivors of intracerebral hemorrhage (ICH) are at higher risk of recurrent intracranial bleeding. MRI-based markers of chronic cerebral small vessel disease (CSVD) are consistently associated with recurrent ICH. We therefore sought to investigate whether racial/ethnic differences in MRI-defined CSVD subtype and severity contribute to disparities in ICH recurrence risk.
We analyzed data from the Massachusetts General Hospital ICH study (n = 593) and the Ethnic/Racial Variations of Intracerebral Hemorrhage (ERICH) study (n = 329). Using CSVD markers derived from MRIs obtained within 90 days of index ICH, we classified ICH cases as cerebral amyloid angiopathy (CAA)-related, hypertensive arteriopathy (HTNA)-related, and mixed etiology. We quantified CSVD burden using validated global, CAA-specific, and HTNA-specific scores. We compared CSVD subtype and severity among White, Black, and Hispanic ICH survivors and investigated its association with ICH recurrence risk.
We analyzed data for 922 ICH survivors (655 White, 130 Black, 137 Hispanic). Minority ICH survivors had greater global CSVD ( = 0.011) and HTNA burden ( = 0.021) on MRI. Furthermore, minority survivors of HTNA-related and mixed-etiology ICH demonstrated higher HTNA burden, resulting in increased ICH recurrence risk (all < 0.05).
We uncovered significant differences in CSVD subtypes and severity among White and minority survivors of primary ICH, with direct implication for known disparities in ICH recurrence risk. Future studies of racial/ethnic disparities in ICH outcomes will benefit from including detailed MRI-based assessment of CSVD subtypes and severity and investigating social determinants of health.
脑出血（ICH）幸存者中，黑人和西班牙裔人群再次发生颅内出血的风险更高。基于 MRI 的慢性脑小血管疾病（CSVD）标志物与再次发生 ICH 始终相关。因此，我们试图探究 MRI 定义的 CSVD 亚型和严重程度的种族/民族差异是否导致 ICH 复发风险的差异。
我们分析了马萨诸塞州综合医院 ICH 研究（n=593）和种族/民族颅内出血差异（ERICH）研究（n=329）的数据。使用在 ICH 指数 90 天内获得的 MRI 获得的 CSVD 标志物，我们将 ICH 病例分为与脑淀粉样血管病（CAA）相关、与高血压性小血管病（HTNA）相关以及混合病因。我们使用经验证的全球、CAA 特异性和 HTNA 特异性评分来量化 CSVD 负担。我们比较了白种人、黑人和西班牙裔 ICH 幸存者之间的 CSVD 亚型和严重程度，并研究了其与 ICH 复发风险的关系。
我们分析了 922 名 ICH 幸存者的数据（655 名白种人，130 名黑种人，137 名西班牙裔人）。少数族裔 ICH 幸存者的 MRI 显示出更大的全球 CSVD（=0.011）和 HTNA 负担（=0.021）。此外，HTNA 相关和混合病因 ICH 的少数族裔幸存者表现出更高的 HTNA 负担，从而导致 ICH 复发风险增加（均<0.05）。
我们发现白种人和少数族裔原发性 ICH 幸存者的 CSVD 亚型和严重程度存在显著差异，这直接影响了 ICH 复发风险的已知差异。未来对 ICH 结果的种族/民族差异的研究将受益于包括 CSVD 亚型和严重程度的详细 MRI 评估以及健康的社会决定因素的研究。
