RESUMO
Acute ischemic stroke affects men and women differently. In particular, women are often reported to experience higher acute stroke severity than men. We derived a low-dimensional representation of anatomical stroke lesions and designed a Bayesian hierarchical modeling framework tailored to estimate possible sex differences in lesion patterns linked to acute stroke severity (National Institute of Health Stroke Scale). This framework was developed in 555 patients (38% female). Findings were validated in an independent cohort (n = 503, 41% female). Here, we show brain lesions in regions subserving motor and language functions help explain stroke severity in both men and women, however more widespread lesion patterns are relevant in female patients. Higher stroke severity in women, but not men, is associated with left hemisphere lesions in the vicinity of the posterior circulation. Our results suggest there are sex-specific functional cerebral asymmetries that may be important for future investigations of sex-stratified approaches to management of acute ischemic stroke.
Assuntos
Tronco Encefálico/patologia , AVC Isquêmico/patologia , Córtex Sensório-Motor/patologia , Tálamo/patologia , Idoso , Idoso de 80 Anos ou mais , Teorema de Bayes , Mapeamento Encefálico , Tronco Encefálico/irrigação sanguínea , Tronco Encefálico/diagnóstico por imagem , Revascularização Cerebral/métodos , Estudos de Coortes , Feminino , Humanos , Processamento de Imagem Assistida por Computador , AVC Isquêmico/diagnóstico por imagem , AVC Isquêmico/terapia , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Córtex Sensório-Motor/irrigação sanguínea , Córtex Sensório-Motor/diagnóstico por imagem , Índice de Gravidade de Doença , Fatores Sexuais , Tálamo/irrigação sanguínea , Tálamo/diagnóstico por imagem , Resultado do TratamentoRESUMO
Advances in genomics are enhancing our understanding of the genetic basis of cardiovascular diseases, both congenital and acquired, and stroke. These advances include finding genes that cause or increase the risk for childhood and adult-onset diseases, finding genes that influence how patients respond to medications, and the development of genetics-guided therapies for diseases. However, the ability of cardiovascular and stroke clinicians to fully understand and apply this knowledge to the care of their patients has lagged. This statement addresses what the specialist caring for patients with cardiovascular diseases and stroke should know about genetics; how they can gain this knowledge; how they can keep up-to-date with advances in genetics, genomics, and pharmacogenetics; and how they can apply this knowledge to improve the care of patients and families with cardiovascular diseases and stroke.