The association between hypertensive angiopathy and cerebral amyloid angiopathy in primary intracerebral hemorrhage

Yuyi Zhu; Lu Liu; Luyao Zhong; Yajun Cheng; Shihong Zhang; Bo Wu; Deren Wang; Mangmang Xu

doi:10.3389/fneur.2023.1257896

The association between hypertensive angiopathy and cerebral amyloid angiopathy in primary intracerebral hemorrhage

Front Neurol. 2023 Oct 19:14:1257896. doi: 10.3389/fneur.2023.1257896. eCollection 2023.

Authors

Yuyi Zhu^{1

2}, Lu Liu³, Luyao Zhong^{1

2}, Yajun Cheng^{1

2}, Shihong Zhang^{1

2}, Bo Wu^{1

2}, Deren Wang^{1

2}, Mangmang Xu^{1

2}

Affiliations

¹ Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China.
² Center of Cerebrovascular Diseases, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China.
³ Health Management Center, General Practice Medical Center, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China.

Abstract

Objective: To determine the association between the burden of cerebral small vessel disease (CSVD) due to hypertensive angiopathy (HA) and cerebral amyloid angiopathy (CAA) on MRI in patients with primary intracerebral hemorrhage (ICH).

Methods: Patients with primary ICH admitted to our center from March 2012 to November 2021 were consecutively enrolled. We used multivariate binary and ordinal regression analyses to assess the association between HA-CSVD burden and CAA-CSVD burden. Lobar cerebral microbleeds (CMBs) were categorized into three level of severity: 0-1, 2-4, and ≥ 5 lobar CMBs. A high CAA-CSVD score was defined as a CAA-CSVD score of ≥3.

Results: Overall, 222 participants (mean age 59.88 ± 13.56) were included into analysis. Age and ICH etiology differed among different lobar CMB severity and between the presence and absence of high CAA-CSVD score (all p < 0.05). Positive associations between HA-related markers and both lobar CMB severity and high CAA-CSVD score (p < 0.05 for the presence of lacune, deep CMBs ≥5, the presence of WMH, and HA-CSVD score) were observed in univariate analysis. These associations remained significant after adjusting for age, sex, ICH etiology, and potential vascular risk factors. The distribution of CAA-CSVD score was significantly different between patients with and without CMBs ≥5 (adjusted OR 2.351, 95% CI 1.242-4.455, p = 0.009) after correcting for age, sex, ICH etiology, and vascular risk factors.

Conclusion: Our study provides evidence of an association between HA-CSVD and CAA-CSVD in patients with primary ICH, which needs to be verified in future studies.

Keywords: MRI; cerebral amyloid angiopathy; cerebral small vessel disease; hypertensive angiopathy; primary intracerebral hemorrhage.

Grants and funding

The author(s) declare financial support was received for the research, authorship, and/or publication of this article. This study was supported by the National Natural Science Foundation of China (82001250), the Natural Science Foundation of Science and Technology Department of Sichuan Province (2023NSFSC1561), the 1·3·5 Project for Disciplines of Excellence–Clinical Research Incubation Project of West China Hospital (2018HXFH041), and the China Postdoctoral Science Foundation (2020M683322 and 2021T140488).