Browsing by Author "Hsu S.L."

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    Disease Severity Staging System for NOTCH3-Associated Small Vessel Disease, Including CADASIL
    (2025-01-01) Gravesteijn G.; Rutten J.W.; Cerfontaine M.N.; Hack R.J.; Liao Y.C.; Jolly A.A.; Guey S.; Hsu S.L.; Park J.Y.; Yuan Y.; Kopczak A.; Rifino N.; Neilson S.J.; Poggesi A.; Shourav M.M.I.; Saito S.; Ishiyama H.; Domínguez Mayoral A.; Nogueira R.; Muiño E.; Andersen P.; De Stefano N.; Santo G.; Sukhonpanich N.; Mele F.; Park A.; Lee J.S.; Rodríguez-Girondo M.; Vonk S.J.J.; Brodtmann A.; Börjesson-Hanson A.; Pantoni L.; Fernández-Cadenas I.; Silva A.R.; Montanaro V.V.A.; Kalaria R.N.; Lopergolo D.; Ihara M.; Meschia J.F.; Muir K.W.; Bersano A.; Pescini F.; Duering M.; Choi J.C.; Ling C.; Kim H.; Markus H.S.; Chabriat H.; Lee Y.C.; Lesnik Oberstein S.A.J.; Gravesteijn G.; Mahidol University
    Importance: Typical cysteine-altering NOTCH3 (NOTCH3cys) variants are highly prevalent (approximately 1 in 300 individuals) and are associated with a broad spectrum of small vessel disease (SVD), ranging from early-onset stroke and dementia (cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy [CADASIL]) to nonpenetrance. A staging system that captures the full NOTCH3-SVD severity spectrum is needed and currently lacking. Objective: To design a simple disease severity staging system that captures the broad clinicoradiological NOTCH3-SVD severity spectrum. Design, Setting, and Participants: A cohort study was performed in which the NOTCH3-SVD severity staging system was developed using a discovery cohort (2019-2020) and validated in independent international CADASIL cohorts (1999-2023) and the UK Biobank. Clinical and imaging data were collected from participants originating from 23 international CADASIL cohorts and from the UK Biobank. Eligibility criteria were presence of a NOTCH3cys variant, availability of brain magnetic resonance imaging, and modified Rankin Scale score. The discovery cohort consisted of 195 NOTCH3cys-positive cases from families with CADASIL; the validation set included 1713 NOTCH3cys-positive cases from 15 countries. The UK Biobank cohort consisted of 101 NOTCH3cys-positive individuals. Data from 2-year (2019-2023) and 18-year (1999-2017) follow-up studies were also analyzed. Data analysis was performed from July 2023 to August 2024. Main Outcomes and Measures: Percentage of cases following the sequence of events of the NOTCH3-SVD stages, and the association between the stages and ischemic stroke, intracerebral hemorrhage, global cognition, processing speed, brain volume, brain microstructural damage, and serum neurofilament light chain (NfL) level. Results: The NOTCH3-SVD staging system encompasses 9 disease stages or substages, ranging from stage 0 (premanifest stage) to stage 4B (end stage). Of all 1908 cases, which included 195 in the discovery cohort (mean [SD] age, 52.4 [12.2] years) and 1713 in the validation cohorts (mean [SD] age, 53.1 [13.0] years), 1789 (94%) followed the sequence of events defined by the NOTCH3-SVD staging system. The NOTCH3-SVD stages were associated with neuroimaging outcomes in the NOTCH3cys-positive cases in the CADASIL cohorts and in the UK Biobank and with cognitive outcomes and serum NfL level in cases from the CADASIL cohorts. The NOTCH3-SVD staging system captured disease progression and was associated with 18-year survival. Conclusions and Relevance: The NOTCH3-SVD staging system captures the full disease spectrum, from asymptomatic individuals with a NOTCH3cys variant to patients with end-stage disease. The NOTCH3-SVD staging system is a simple but effective tool for uniform disease staging in the clinic and in research.