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)

for The International META-MICROBLEEDS Initiative

Research output: Contribution to journalArticle

15 Citations (Scopus)

Abstract

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.

Original languageEnglish (US)
Pages (from-to)454-468
Number of pages15
JournalInternational Journal of Stroke
Volume13
Issue number5
DOIs
StatePublished - Jul 1 2018
Externally publishedYes

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Cerebral Hemorrhage
Dementia
Meta-Analysis
Cohort Studies
Stroke
Mortality
Population
Biomarkers
Odds Ratio
Clinical Trials
Pathology
Brain
Research

Keywords

  • Antithrombotic
  • brain microbleeds
  • cerebral microbleeds
  • cerebral small vessel disease
  • intracerebral hemorrahage
  • magnetic resonance imaging

ASJC Scopus subject areas

  • Neurology

Cite this

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). / for The International META-MICROBLEEDS Initiative.

In: International Journal of Stroke, Vol. 13, No. 5, 01.07.2018, p. 454-468.

Research output: Contribution to journalArticle

@article{c0601cabd7924c8db032acf84863545b,
title = "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)",
abstract = "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.",
keywords = "Antithrombotic, brain microbleeds, cerebral microbleeds, cerebral small vessel disease, intracerebral hemorrahage, magnetic resonance imaging",
author = "{for The International META-MICROBLEEDS Initiative} and Andreas Charidimou and Sara Shams and Romero, {Jose R.} and Jie Ding and Roland Veltkamp and Solveig Horstmann and Gudny Eiriksdottir and {van Buchem}, {Mark A.} and Vilmundur Gudnason and Himali, {Jayandra J.} and Gurol, {M. Edip} and Anand Viswanathan and Toshio Imaizumi and Vernooij, {Meike W.} and Sudha Seshadri and Greenberg, {Steven M.} and Benavente, {Oscar R.} and Launer, {Lenore J.} and Ashkan Shoamanesh",
year = "2018",
month = "7",
day = "1",
doi = "10.1177/1747493017751931",
language = "English (US)",
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pages = "454--468",
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TY - JOUR

T1 - Clinical significance of cerebral microbleeds on MRI

T2 - A comprehensive meta-analysis of risk of intracerebral hemorrhage, ischemic stroke, mortality, and dementia in cohort studies (v1)

AU - for The International META-MICROBLEEDS Initiative

AU - Charidimou, Andreas

AU - Shams, Sara

AU - Romero, Jose R.

AU - Ding, Jie

AU - Veltkamp, Roland

AU - Horstmann, Solveig

AU - Eiriksdottir, Gudny

AU - van Buchem, Mark A.

AU - Gudnason, Vilmundur

AU - Himali, Jayandra J.

AU - Gurol, M. Edip

AU - Viswanathan, Anand

AU - Imaizumi, Toshio

AU - Vernooij, Meike W.

AU - Seshadri, Sudha

AU - Greenberg, Steven M.

AU - Benavente, Oscar R.

AU - Launer, Lenore J.

AU - Shoamanesh, Ashkan

PY - 2018/7/1

Y1 - 2018/7/1

N2 - 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.

AB - 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.

KW - Antithrombotic

KW - brain microbleeds

KW - cerebral microbleeds

KW - cerebral small vessel disease

KW - intracerebral hemorrahage

KW - magnetic resonance imaging

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U2 - 10.1177/1747493017751931

DO - 10.1177/1747493017751931

M3 - Article

VL - 13

SP - 454

EP - 468

JO - International Journal of Stroke

JF - International Journal of Stroke

SN - 1747-4930

IS - 5

ER -