Rich-Club Organization: An Important Determinant of Functional Outcome After Acute Ischemic Stroke
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Abstract
Abstract Objective To determine whether the rich-club organization, essential for information transport in the human connectome, is an important biomarker of functional outcome after acute ischemic stroke (AIS). Methods Consecutive AIS patients (N=344) with acute brain magnetic resonance imaging (MRI) (<48 hours) were eligible for this study. Each patient underwent a clinical MRI protocol, which included diffusion weighted imaging (DWI). All DWIs were registered to a template on which rich-club regions have been defined. Using manual outlines of stroke lesions, we automatically counted the number of affected rich-club regions and assessed its effect on the National Institute of Health Stroke Scale (NIHSS) and modified Rankin Scale (mRS; obtained at 90 days post-stroke) scores through ordinal regression. Results Of 344 patients (median age 65, inter-quartile range 54-76 years) with a median DWI lesion volume (DWIv) of 3cc, 64% were male. We established that an increase in number of rich-club regions affected by a stroke increases the odds of poor stroke outcome, measured by NIHSS (OR: 1.77, 95%CI 1.41-2.21) and mRS (OR: 1.38, 95%CI 1.11-1.73). Additionally, we demonstrated that the OR exceeds traditional markers, such as DWIv (OR NIHSS 1.08, 95%CI 1.06-1.11; OR mRs 1.05, 95%CI 1.03-1.07) and age (OR NIHSS 1.03, 95%CI 1.01-1.05; OR mRs 1.05, 95%CI 1.03-1.07). Conclusion In this proof-of-concept study, the number of rich-club nodes affected by a stroke lesion presents a translational biomarker of stroke outcome, which can be readily assessed using standard clinical AIS imaging protocols and considered in functional outcome prediction models beyond traditional factors.
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- Authors
- Schirmer, M. D., Ktena, S. I., Nardin, M. J., Donahue, K. L., Giese, A.-K., Etherton, M. R., Wu, O., & Rost, N. S.
- Affiliations
- Harvard University (US)
- Imperial College London (GB)
- Massachusetts General Hospital (US)
- Corresponding author
- Schirmer, Markus D.
- Venue
- Frontiers in Neurology
- Publisher
- Frontiers Media SA
- Published
- 2019-09-10
- Volume
- 10
- Pages
- 956-956
- ISSN
- 1664-2295 (ISSN-L)
- PMC
- PMC6748157
- OpenAlex
- W2969705773
- Cited by
- 27
- References
- 34
- Citations by year
- 2026: 1 · 2025: 1 · 2024: 2 · 2023: 2 · 2022: 5 · 2021: 8 · 2020: 4 · 2019: 4
- FWCI
- 4.00
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- Frontiers in Neurology (publishedVersion, cc-by)
- bioRxiv (Cold Spring Harbor Laboratory) (acceptedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- DZNE Pub (submittedVersion, cc-by)
- Zenodo (CERN European Organization for Nuclear Research) (submittedVersion, cc-by)
- Funders
- National Institute of Neurological Disorders and Stroke (K23NS064052, R01NS082285, R01NS086905)
- Horizon 2020 Framework Programme (753896)
- Henrietta B. and Frederick H. Bugher Foundation
- Topics
- Health Sciences › Medicine › Epidemiology › Acute Ischemic Stroke Management
- Life Sciences › Neuroscience › Cognitive Neuroscience › Functional Brain Connectivity Studies
- Health Sciences › Medicine › Radiology, Nuclear Medicine and Imaging › Advanced Neuroimaging Techniques and Applications
- Keywords
- rich club, acute ischemic stroke, functional outcome, stroke outcome prediction, biomarkers, human connectome, diffusion-weighted imaging, NIHSS, modified Rankin Scale, white matter microstructure
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