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Biological Mechanism of Sex Difference in Stroke Manifestation and Outcomes

BACKGROUND AND OBJECTIVES: Female patients tend to have greater disability and worse long-term outcomes after stroke than male patients. To date, the biological basis of sex difference in ischemic stroke remains unclear. We aimed to (1) assess sex differences in clinical manifestation and outcomes o...

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Autores principales: Ryu, Wi-Sun, Chung, Jinyong, Schellingerhout, Dawid, Jeong, Sang-Wuk, Kim, Hang-Rai, Park, Jung E., Kim, Beom Joon, Kim, Joon-Tae, Hong, Keun-Sik, Lee, Kyungbok, Park, Tai Hwan, Park, Sang-Soon, Park, Jong-Moo, Kang, Kyusik, Cho, Yong-Jin, Park, Hong-Kyun, Lee, Byung-Chul, Yu, Kyung-Ho, Oh, Mi Sun, Lee, Soo Joo, Kim, Jae Guk, Cha, Jae-Kwan, Kim, Dae-Hyun, Lee, Jun, Han, Moon-Ku, Park, Man Seok, Choi, Kang-Ho, Lee, Juneyoung, Bae, Hee-Joon, Kim, Dong-Eog
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Lippincott Williams & Wilkins 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10264052/
https://www.ncbi.nlm.nih.gov/pubmed/37094993
http://dx.doi.org/10.1212/WNL.0000000000207346
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author Ryu, Wi-Sun
Chung, Jinyong
Schellingerhout, Dawid
Jeong, Sang-Wuk
Kim, Hang-Rai
Park, Jung E.
Kim, Beom Joon
Kim, Joon-Tae
Hong, Keun-Sik
Lee, Kyungbok
Park, Tai Hwan
Park, Sang-Soon
Park, Jong-Moo
Kang, Kyusik
Cho, Yong-Jin
Park, Hong-Kyun
Lee, Byung-Chul
Yu, Kyung-Ho
Oh, Mi Sun
Lee, Soo Joo
Kim, Jae Guk
Cha, Jae-Kwan
Kim, Dae-Hyun
Lee, Jun
Han, Moon-Ku
Park, Man Seok
Choi, Kang-Ho
Lee, Juneyoung
Bae, Hee-Joon
Kim, Dong-Eog
author_facet Ryu, Wi-Sun
Chung, Jinyong
Schellingerhout, Dawid
Jeong, Sang-Wuk
Kim, Hang-Rai
Park, Jung E.
Kim, Beom Joon
Kim, Joon-Tae
Hong, Keun-Sik
Lee, Kyungbok
Park, Tai Hwan
Park, Sang-Soon
Park, Jong-Moo
Kang, Kyusik
Cho, Yong-Jin
Park, Hong-Kyun
Lee, Byung-Chul
Yu, Kyung-Ho
Oh, Mi Sun
Lee, Soo Joo
Kim, Jae Guk
Cha, Jae-Kwan
Kim, Dae-Hyun
Lee, Jun
Han, Moon-Ku
Park, Man Seok
Choi, Kang-Ho
Lee, Juneyoung
Bae, Hee-Joon
Kim, Dong-Eog
author_sort Ryu, Wi-Sun
collection PubMed
description BACKGROUND AND OBJECTIVES: Female patients tend to have greater disability and worse long-term outcomes after stroke than male patients. To date, the biological basis of sex difference in ischemic stroke remains unclear. We aimed to (1) assess sex differences in clinical manifestation and outcomes of acute ischemic stroke and (2) investigate whether the sex disparity is due to different infarct locations or different impacts of infarct in the same location. METHODS: This MRI-based multicenter study included 6,464 consecutive patients with acute ischemic stroke (<7 days) from 11 centers in South Korea (May 2011–January 2013). Multivariable statistical and brain mapping methods were used to analyze clinical and imaging data collected prospectively: admission NIH Stroke Scale (NIHSS) score, early neurologic deterioration (END) within 3 weeks, modified Rankin Scale (mRS) score at 3 months, and culprit cerebrovascular lesion (symptomatic large artery steno-occlusion and cerebral infarction) locations. RESULTS: The mean (SD) age was 67.5 (12.6) years, and 2,641 (40.9%) were female patients. Percentage infarct volumes on diffusion-weighted MRI did not differ between female patients and male patients (median 0.14% vs 0.14%, p = 0.35). However, female patients showed higher stroke severity (NIHSS score, median 4 vs 3, p < 0.001) and had more frequent END (adjusted difference 3.5%; p = 0.002) than male patients. Female patients had more frequent striatocapsular lesions (43.6% vs 39.8%, p = 0.001) and less frequent cerebrocortical (48.2% vs. 50.7% in patients older than 52 years, p = 0.06) and cerebellar (9.1% vs. 11.1%, p = 0.009) lesions than male patients, which aligned with angiographic findings: female patients had more prevalent symptomatic steno-occlusion of the middle cerebral artery (MCA) (31.1% vs 25.3%; p < 0.001) compared with male patients, who had more frequent symptomatic steno-occlusion of the extracranial internal carotid artery (14.2% vs 9.3%; p < 0.001) and vertebral artery (6.5% vs 4.7%; p = 0.001). Cortical infarcts in female patients, specifically left-sided parieto-occipital regions, were associated with higher NIHSS scores than expected for similar infarct volumes in male patients. Consequently, female patients had a higher likelihood of unfavorable functional outcome (mRS score >2) than male patients (adjusted absolute difference 4.5%; 95% CI 2.0–7.0; p < 0.001). DISCUSSION: Female patients have more frequent MCA disease and striatocapsular motor pathway involvement with acute ischemic stroke, along with left parieto-occipital cortical infarcts showing greater severity for equivalent infarct volumes than in male patients. This leads to more severe initial neurologic symptoms, higher susceptibility to neurologic worsening, and less 3-month functional independence, when compared with male patients.
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spelling pubmed-102640522023-06-15 Biological Mechanism of Sex Difference in Stroke Manifestation and Outcomes Ryu, Wi-Sun Chung, Jinyong Schellingerhout, Dawid Jeong, Sang-Wuk Kim, Hang-Rai Park, Jung E. Kim, Beom Joon Kim, Joon-Tae Hong, Keun-Sik Lee, Kyungbok Park, Tai Hwan Park, Sang-Soon Park, Jong-Moo Kang, Kyusik Cho, Yong-Jin Park, Hong-Kyun Lee, Byung-Chul Yu, Kyung-Ho Oh, Mi Sun Lee, Soo Joo Kim, Jae Guk Cha, Jae-Kwan Kim, Dae-Hyun Lee, Jun Han, Moon-Ku Park, Man Seok Choi, Kang-Ho Lee, Juneyoung Bae, Hee-Joon Kim, Dong-Eog Neurology Research Article BACKGROUND AND OBJECTIVES: Female patients tend to have greater disability and worse long-term outcomes after stroke than male patients. To date, the biological basis of sex difference in ischemic stroke remains unclear. We aimed to (1) assess sex differences in clinical manifestation and outcomes of acute ischemic stroke and (2) investigate whether the sex disparity is due to different infarct locations or different impacts of infarct in the same location. METHODS: This MRI-based multicenter study included 6,464 consecutive patients with acute ischemic stroke (<7 days) from 11 centers in South Korea (May 2011–January 2013). Multivariable statistical and brain mapping methods were used to analyze clinical and imaging data collected prospectively: admission NIH Stroke Scale (NIHSS) score, early neurologic deterioration (END) within 3 weeks, modified Rankin Scale (mRS) score at 3 months, and culprit cerebrovascular lesion (symptomatic large artery steno-occlusion and cerebral infarction) locations. RESULTS: The mean (SD) age was 67.5 (12.6) years, and 2,641 (40.9%) were female patients. Percentage infarct volumes on diffusion-weighted MRI did not differ between female patients and male patients (median 0.14% vs 0.14%, p = 0.35). However, female patients showed higher stroke severity (NIHSS score, median 4 vs 3, p < 0.001) and had more frequent END (adjusted difference 3.5%; p = 0.002) than male patients. Female patients had more frequent striatocapsular lesions (43.6% vs 39.8%, p = 0.001) and less frequent cerebrocortical (48.2% vs. 50.7% in patients older than 52 years, p = 0.06) and cerebellar (9.1% vs. 11.1%, p = 0.009) lesions than male patients, which aligned with angiographic findings: female patients had more prevalent symptomatic steno-occlusion of the middle cerebral artery (MCA) (31.1% vs 25.3%; p < 0.001) compared with male patients, who had more frequent symptomatic steno-occlusion of the extracranial internal carotid artery (14.2% vs 9.3%; p < 0.001) and vertebral artery (6.5% vs 4.7%; p = 0.001). Cortical infarcts in female patients, specifically left-sided parieto-occipital regions, were associated with higher NIHSS scores than expected for similar infarct volumes in male patients. Consequently, female patients had a higher likelihood of unfavorable functional outcome (mRS score >2) than male patients (adjusted absolute difference 4.5%; 95% CI 2.0–7.0; p < 0.001). DISCUSSION: Female patients have more frequent MCA disease and striatocapsular motor pathway involvement with acute ischemic stroke, along with left parieto-occipital cortical infarcts showing greater severity for equivalent infarct volumes than in male patients. This leads to more severe initial neurologic symptoms, higher susceptibility to neurologic worsening, and less 3-month functional independence, when compared with male patients. Lippincott Williams & Wilkins 2023-06-13 /pmc/articles/PMC10264052/ /pubmed/37094993 http://dx.doi.org/10.1212/WNL.0000000000207346 Text en Copyright © 2023 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the American Academy of Neurology. https://creativecommons.org/licenses/by-nc-nd/4.0/This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives License 4.0 (CC BY-NC-ND) (https://creativecommons.org/licenses/by-nc-nd/4.0/) , which permits downloading and sharing the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.
spellingShingle Research Article
Ryu, Wi-Sun
Chung, Jinyong
Schellingerhout, Dawid
Jeong, Sang-Wuk
Kim, Hang-Rai
Park, Jung E.
Kim, Beom Joon
Kim, Joon-Tae
Hong, Keun-Sik
Lee, Kyungbok
Park, Tai Hwan
Park, Sang-Soon
Park, Jong-Moo
Kang, Kyusik
Cho, Yong-Jin
Park, Hong-Kyun
Lee, Byung-Chul
Yu, Kyung-Ho
Oh, Mi Sun
Lee, Soo Joo
Kim, Jae Guk
Cha, Jae-Kwan
Kim, Dae-Hyun
Lee, Jun
Han, Moon-Ku
Park, Man Seok
Choi, Kang-Ho
Lee, Juneyoung
Bae, Hee-Joon
Kim, Dong-Eog
Biological Mechanism of Sex Difference in Stroke Manifestation and Outcomes
title Biological Mechanism of Sex Difference in Stroke Manifestation and Outcomes
title_full Biological Mechanism of Sex Difference in Stroke Manifestation and Outcomes
title_fullStr Biological Mechanism of Sex Difference in Stroke Manifestation and Outcomes
title_full_unstemmed Biological Mechanism of Sex Difference in Stroke Manifestation and Outcomes
title_short Biological Mechanism of Sex Difference in Stroke Manifestation and Outcomes
title_sort biological mechanism of sex difference in stroke manifestation and outcomes
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10264052/
https://www.ncbi.nlm.nih.gov/pubmed/37094993
http://dx.doi.org/10.1212/WNL.0000000000207346
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