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Clinical Trial
. 2012 Jun;43(6):1490-5.
doi: 10.1161/STROKEAHA.111.643262. Epub 2012 Apr 24.

Apolipoprotein E genotype predicts hematoma expansion in lobar intracerebral hemorrhage

H Bart Brouwers  1 , Alessandro Biffi, Alison M Ayres, Kristin Schwab, Lynelle Cortellini, Javier M Romero, Natalia S Rost, Anand Viswanathan, Steven M Greenberg, Jonathan Rosand, Joshua N Goldstein
Affiliations
Clinical Trial

Apolipoprotein E genotype predicts hematoma expansion in lobar intracerebral hemorrhage

H Bart Brouwers et al. Stroke. 2012 Jun.

Abstract

Background and purpose: Hematoma volume is the most potent predictor of outcome in spontaneous intracerebral hemorrhage (ICH), and hematoma expansion after hospital presentation occurs in up to 40% of individuals. Among patients with lobar ICH, the apolipoprotein E (APOE) ε2 allele predicts larger hematoma volumes at presentation. We investigated whether the ε2 allele also identifies individuals at increased risk of hematoma expansion.

Methods: We analyzed 510 patients with primary ICH and genetic data available from an ongoing prospective cohort study. Baseline and follow-up CT scans were assessed for ICH location and volume using computer-assisted volumetric methods.

Results: Individuals with lobar ICH who possessed APOE ε2 were at increased risk for hematoma expansion (OR, 2.72; 95% CI, 1.19-6.23; P=0.009). The highest odds of expansion were in patients who qualified for the diagnosis of cerebral amyloid angiopathy-related ICH and carried the APOE ε2 allele (OR, 6.02; 95% CI, 1.60-22.58; P=0.008). There was no effect of ε2 on hematoma expansion in deep ICH and APOE ε4 had no effect on hematoma expansion in lobar or deep ICH.

Conclusions: Possession of APOE ε2 predisposes individuals with lobar ICH to hematoma expansion. This effect is even more pronounced in patients with amyloid angiopathy-related ICH, consistent with the ε2 allele's role in vascular amyloid deposition and vessel fragility.

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Figures

Figure 1
Figure 1
Cohort flowchart
Figure 2
Figure 2
Hematoma expansion in lobar ICH
Figure 3
Figure 3
Hematoma expansion in probable / definite CAA-related ICH (in subjects with MRI or pathology)
See this image and copyright information in PMC

Comment in

References

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