Imaging-based pregenetic screening for NOTCH3 p.R544C mutation in ischemic stroke in Taiwan
Journal
Annals of Clinical and Translational Neurology
Journal Volume
7
Journal Issue
10
Pages
1951-1961
Date Issued
2020-10-01
Author(s)
Abstract
Objective: To develop an easily applicable screening score to guide NOTCH3 p.R544C genetic testing for patients who presented with acute ischemic cerebrovascular events in Taiwan. Methods: 1734 patients who presented with ischemic cerebrovascular events were enrolled from the Formosa Stroke Genetic Consortium stroke registry and were screened for the NOTCH3 p.R544C mutation. Clinical and MRI characteristics of NOTCH3 p.R544C mutation carriers (n?=?36) and a subset of noncarriers (n?=?673) were tested in a logistic regression model to identify key features associated with the NOTCH3 p.R544C carrier status. Variables and their odds ratios in the regression model were used to develop the R544C screening score to predict positive NOTCH3 p.R544C test results. Results: We constructed the R544C screening score using five clinical and imaging characteristics, including stroke onset before 50?years of age, the small vessel occlusion subtype, a family history of stroke/TIA in siblings, external capsule involvement, and advanced deep white matter hyperintensity. The area under the ROC curve of the screening score was 0.867 (95% CI?=?0.810-0.924). The sensitivity, specificity, positive predictive value, negative predictive value and accuracy were 0.75, 0.88, 0.13, 0.99, and 0.88, respectively, for a cutoff score of 5 points. In addition, the R544C screening score was validated in another cohort composed of 235 stroke patients with comparable performance (area under the ROC curve?=?0.957, 95% CI?=?0.916-0.997). Interpretations: For Taiwanese patients presenting with acute ischemic cerebrovascular events, the R544C screening score is easily applicable and can efficiently select high-risk patients for NOTCH3 p.R544C mutation test. ? 2020 The Authors. Annals of Clinical and Translational Neurology published by Wiley Periodicals LLC on behalf of American Neurological Association
SDGs
Other Subjects
Notch3 receptor; Notch receptor; NOTCH3 protein, human; Notch3 receptor; adult; aged; Article; brain infarction size; brain ischemia; cerebrovascular accident; cohort analysis; controlled study; diagnostic test accuracy study; family history; female; gene mutation; genetic association; genetic screening; human; image analysis; major clinical study; male; National Institutes of Health Stroke Scale; nuclear magnetic resonance imaging; phenotype; predictive value; prevalence; priority journal; questionnaire; receiver operating characteristic; risk factor; scoring system; sensitivity and specificity; Taiwan; transient ischemic attack; Asian continental ancestry group; brain ischemia; CADASIL; diagnostic imaging; genetic predisposition; genetics; metabolism; middle aged; mutation; pathology; procedures; very elderly; Aged, 80 and over; Asian Continental Ancestry Group; Brain Ischemia; CADASIL; Female; Genetic Predisposition to Disease; Humans; Ischemic Stroke; Magnetic Resonance Imaging; Male; Middle Aged; Mutation; Receptor, Notch3; Receptors, Notch; Taiwan
Publisher
Wiley-Blackwell
Type
journal article