Clinical significance of cerebral microbleeds on MRI: A comprehensive meta-analysis of risk of intracerebral hemorrhage, ischemic stroke, mortality, and dementia in cohort studies (v1)

被引：85

作者：

Charidimou, Andreas ^{[1
,2
]}

Shams, Sara ^{[3
,4
]}

Romero, Jose R. ^{[5
,6
]}

Ding, Jie ^{[7
]}

Veltkamp, Roland ^{[8
,9
]}

Horstmann, Solveig ^{[8
]}

Eiriksdottir, Gudny ^{[10
]}

van Buchem, Mark A. ^{[11
]}

Gudnason, Vilmundur ^{[10
]}

Himali, Jayandra J. ^{[5
,6
,12
]}

Gurol, M. Edip ^{[1
]}

Viswanathan, Anand ^{[1
]}

Imaizumi, Toshio ^{[13
]}

Vernooij, Meike W. ^{[14
,15
]}

Seshadri, Sudha ^{[5
,6
]}

Greenberg, Steven M. ^{[1
]}

Benavente, Oscar R. ^{[16
]}

Launer, Lenore J. ^{[7
]}

Shoamanesh, Ashkan ^{[17
,18
]}

机构：

[1] Harvard Med Sch, Massachusetts Gen Hosp, Dept Neurol, J Philip Kistler Stroke Res Ctr, Boston, MA USA

[2] Individual Patient Data Meta Anal Grp, Cochrane Methods, Boston, MA USA

[3] Karolinska Inst, Div Med Imaging & Technol, Dept Clin Sci Intervent & Technol, Stockholm, Sweden

[4] Karolinska Univ Hosp, Dept Radiol, Stockholm, Sweden

[5] Boston Univ, Sch Med, Dept Neurol, Framingham, MA USA

[6] NHLBIs Framingham Heart Study, Framingham, MA USA

[7] NIA, Lab Epidemiol & Populat Sci, NIH, Bethesda, MD USA

[8] Heidelberg Univ, Dept Neurol, Heidelberg, Germany

[9] Imperial Coll London, Div Brain Sci, Dept Stroke Med, London, England

[10] Iceland Heart Assoc, Kopavogur, Iceland

[11] Leiden Univ, Dept Radiol, Med Ctr, Leiden, Netherlands

[12] Boston Univ, Sch Publ Hlth, Dept Biostat, Boston, MA USA

[13] Kushiro City Gen Hosp, Dept Neurosurg, Kushiro, Hokkaido, Japan

[14] Erasmus MC Univ Med Ctr, Dept Epidemiol, Rotterdam, Netherlands

[15] Erasmus MC Univ Med Ctr, Dept Radiol & Nucl Med, Rotterdam, Netherlands

[16] Univ British Columbia, UBC Hosp, Stroke & Cerebrovasc Hlth Program, Div Neurol,Dept Med, Vancouver, BC, Canada

[17] McMaster Univ, Dept Med Neurol, Hamilton, ON, Canada

[18] Populat Hlth Res Inst, Hamilton, ON, Canada

来源：

INTERNATIONAL JOURNAL OF STROKE | 2018年 / 13卷 / 05期

关键词：

Antithrombotic; brain microbleeds; cerebral microbleeds; cerebral small vessel disease; intracerebral hemorrahage; magnetic resonance imaging; SMALL VESSEL DISEASE; WHITE-MATTER HYPERINTENSITIES; RECURRENT STROKE; CEREBROVASCULAR-DISEASE; ATRIAL-FIBRILLATION; COGNITIVE DECLINE; ASSOCIATION; PROGRESSION; PREDICTORS; RATIONALE;

D O I：

10.1177/1747493017751931

中图分类号：

R74 [神经病学与精神病学];

学科分类号：

摘要：

Background Cerebral microbleeds can confer a high risk of intracerebral hemorrhage, ischemic stroke, death and dementia, but estimated risks remain imprecise and often conflicting. We investigated the association between cerebral microbleeds presence and these outcomes in a large meta-analysis of all published cohorts including: ischemic stroke/TIA, memory clinic, high risk elderly populations, and healthy individuals in population-based studies. Methods Cohorts (with>100 participants) that assessed cerebral microbleeds presence on MRI, with subsequent follow-up (3 months) were identified. The association between cerebral microbleeds and each of the outcomes (ischemic stroke, intracerebral hemorrhage, death, and dementia) was quantified using random effects models of (a) unadjusted crude odds ratios and (b) covariate-adjusted hazard rations. Results We identified 31 cohorts (n=20,368): 19 ischemic stroke/TIA (n=7672), 4 memory clinic (n=1957), 3 high risk elderly (n=1458) and 5 population-based cohorts (n=11,722). Cerebral microbleeds were associated with an increased risk of ischemic stroke (OR: 2.14; 95% CI: 1.58-2.89 and adj-HR: 2.09; 95% CI: 1.71-2.57), but the relative increase in future intracerebral hemorrhage risk was greater (OR: 4.65; 95% CI: 2.68-8.08 and adj-HR: 3.93; 95% CI: 2.71-5.69). Cerebral microbleeds were an independent predictor of all-cause mortality (adj-HR: 1.36; 95% CI: 1.24-1.48). In three population-based studies, cerebral microbleeds were independently associated with incident dementia (adj-HR: 1.35; 95% CI: 1.00-1.82). Results were overall consistent in analyses stratified by different populations, but with different degrees of heterogeneity. Conclusions Our meta-analysis shows that cerebral microbleeds predict an increased risk of stroke, death, and dementia and provides up-to-date effect sizes across different clinical settings. These pooled estimates can inform clinical decisions and trials, further supporting cerebral microbleeds role as biomarkers of underlying subclinical brain pathology in research and clinical settings.

引用

页码：454 / 468

页数：15

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