London, United Kingdom 2013 1 Small vessel stroke and white matter disease 14:30 - 14:40 Homocysteine, kidney function and progression of cerebral small vessel disease. The SMART- MR study R.P. Kloppenborg1, M.I. Geerlings2, F.L. Visseren3, M. Vermeulen4, Y. van der Graaf5, P.J. Nederkoorn6 Academic Medical Center, Amsterdam, THE NETHERLANDS1,Julius Center for Health Sciences and Primary Care, Utrecht, THE NETHERLANDS2, University Medical Cen-ter Utrecht, Utrecht, THE NETHERLANDS3, Academic Medical Center, Amsterdam, THE NETHERLANDS4, Julius Center for Health Sciences and Primary Care, Utrecht, THE NETH-ERLANDS5, Academic Medical Center, Amsterdam, THE NETHERLANDS6 Background Increased homocysteine level and decreased kidney function have both been implicated as con-tributing factors for cerebral small vessel disease, but longitudinal studies are scarce. Homocys-teine level and kidney function also confound each other. We investigated the associations of homocysteine level and kidney function with progression of cerebral small vessel disease. Fur-thermore, we investigated the prospective relationship between homocysteine level and change in kidney function at follow-up and vice versa. Methods Within the SMART-MR study, a prospective cohort study on brain changes on MRI in patients with symptomatic atherosclerotic disease, 663 patients (57±9 yrs) had vascular screening and 1.5 Tesla MRI at baseline and after a mean follow-up of 3.9 years. Regression analysis was used to estimate the longitudinal association between hyperhomocysteinemia, and estimated Glomerular Filtration Rate (eGFR) with presence and progression of total WML volume and LIs and the relationship between homocysteine levels at baseline and kidney function at fol-low- Cerebrovasc Dis 2013; 35 (suppl 3)1-854 37 up and vice versa. Results After adjusting for age, sex, follow-up time, baseline WML volume, eGFR, and vascular risk factors, hyperhomocysteinemia was associated with total WML volume at baseline and pro-gression of total WML volume (OR 2.6, 95% CI 1.4-5.0, p=0.003), but not with progression of lacunar infarcts (OR 1.9, 0.9-4.1). Worse kidney function was associated with total WML volume at baseline but not at follow-up. Interestingly, increased homocysteine levels predicted worse kidney function at follow-up but not vice versa. Conclusion Hyperhomocysteinemia level predicts both WML progression and kidney dysfunction in pa-tients with atherosclerotic disease. This suggests a role for homocysteine in the development of CSVD and suggests that kidney dysfunction represents end-organ damage in small vessel dis-ease rather than being a causal agent. 14:30-16:00 Room 7,8,11,12 Joint Symposium 1 ESC/ESNCH Hot Debates in Neurosonology Chairs: L. Csiba, Hungary and M.G. Hennerici, Germany Controversy Pro: Sonothrombolysis will become standard treatment A. Alexandrov, USA Contra: Ultrasound therapy of acute stroke is doomed to failure S. Meairs, Germany Microemboli detection – is it worth the trouble ? H. Markus, UK Does ultrasound make a difference in the setting of acute stroke ? C. Molina, Spain 14:30-16:00 Oral Session Room 14,15,16 Small vessel stroke and white matter disease Chairs: H. Bäzner, Germany and D. Tanne, Israel
Karger_ESC London_2013
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