Chinese Cervicocephalic artery dissection study (CCADS): rationale and protocol for a multicenter prospective cohort study

GWAS-based polygenic risk scoring for predicting cerebral artery dissection in the Chinese population

OBJECTIVE

Cerebral artery dissection (CeAD) is a rare but serious disease. Genetic risk assessment for CeAD is lacking in Chinese population. We performed genome-wide association study (GWAS) and computed polygenic risk score (PRS) to explore genetic susceptibility factors and prediction model of CeAD based on patients in Huashan Hospital.

METHODS

A total of 210 CeAD patients and 280 controls were enrolled from June 2017 to September 2022 in Department of Neurology, Huashan Hospital, Fudan University. We performed GWAS to identify genetic variants associated with CeAD in 140 CeAD patients and 210 control individuals according to a case and control 1:1.5 design rule in the training dataset, while the other 70 patients with CeAD and 70 controls were used as validation. Then Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway and Gene Ontology (GO) enrichment analyses were utilized to identify the significant pathways. We constructed a PRS by capturing all independent GWAS SNPs in the analysis and explored the predictivity of PRS, age, and sex for CeAD.

RESULTS

Through GWAS analysis of the 140 cases and 210 controls in the training dataset, we identified 13 leading SNPs associated with CeAD at a genome-wide significance level of P < 5 × 10- 8. Among them, 10 SNPs were annotated in or near (in the upstream and downstream regions of ± 500Kb) 10 functional genes. rs34508376 (OR2L13) played a suggestive role in CeAD pathophysiology which was in line with previous observations in aortic aneurysms. The other nine genes were first-time associations in CeAD cases. GO enrichment analyses showed that these 10 genes have known roles in 20 important GO terms clustered into two groups: (1) cellular biological processes (BP); (2) molecular function (MF). We used genome-wide association data to compute PRS including 32 independent SNPs and constructed predictive model for CeAD by using age, sex and PRS as predictors both in training and validation test. The area under curve (AUC) of PRS predictive model for CeAD reached 99% and 95% in the training test and validation test respectively, which were significantly larger than the age and sex models of 83% and 86%.

CONCLUSIONS

Our study showed that ten risk loci were associated with CeAD susceptibility, and annotated functional genes had roles in 20 important GO terms clustered into biological process and molecular function. The PRS derived from risk variants was associated with CeAD incidence after adjusting for age and sex both in training test and validation.

Clinical and radiological features of medullary infarction caused by spontaneous vertebral artery dissection

BACKGROUND AND PURPOSE

Medullary infarction (MI) caused by spontaneous vertebral artery dissection (sVAD) is an important type of stroke. It is important to distinguish sVAD from other causes of stroke since the treatment strategies and prognosis were different between them. In this study, we aimed to explore the clinical and radiological features of MI in patients with acute MI caused by sVAD.

METHODS

Patients with acute MI caused by sVAD and non-sVAD in a single tertiary hospital were enrolled from 2010 to 2020. Epidemiologic, clinical and image features were collected and analysed. MI lesions were categorised into three levels rostrocaudally and four arterial groups: anteromedial, anterolateral, lateral and posterior.

RESULTS

A total of 128 patients with MI were enrolled with 47 cases of sVAD and 81 cases of non-sVAD. Patients with sVAD were younger than those with non-sVAD (med 44 years old vs 58 years old). The sVAD group was less likely to have hypertension (44.68% vs 67.90%; p=0.010) and diabetes (19.15% vs 45.69%; p=0.003), but more likely to have non-sudden onset (27.66% vs 9.87%, p=0.009), minor neck injury (19.15% vs 1.23%; p=0.001) and headache (46.81% vs 7.41%; p=0.000). Vertically, sVAD became more common in caudal medulla than in rostral medulla. Horizontally, the sVAD group was more likely to have lateral MI (91.48% vs 2.96%, p=0.000). In multivariable logistic regression analysis, age, non-sudden onset and headache were independently associated with sVAD with ORs of 0.935 (95% CI 0.892 to 0.981, p=0.006), 3.507 (95% CI 1.060 to 11.599, p=0.040) and 5.426 (95% CI 1.673 to 17.599, p=0.005).

CONCLUSION

sVAD was not uncommon in patients with MI, especially in patients with lateral MI. Young patients with headache and non-sudden onset should remind clinician the possibility of sVAD.