Arangalage Dimitri, Ederhy Stéphane, Dufour Laurie, Joffre Jérémie, Van der Vynckt Clélie, Lang Sylvie, Tzourio Christophe, Cohen Ariel
Service de Cardiologie, Hôpital Saint Antoine, Assistance Publique - Hôpitaux de Paris, Paris, France; University Paris 6, Faculté de Médecine Pierre et Marie Curie, Paris, France.
Service de Cardiologie, Hôpital Saint Antoine, Assistance Publique - Hôpitaux de Paris, Paris, France.
J Am Soc Echocardiogr. 2015 Mar;28(3):264-74. doi: 10.1016/j.echo.2014.11.009. Epub 2014 Dec 20.
With >24 million people affected worldwide, dementia is one of the main public health challenges modern medicine has to face. The path leading to dementia is often long, with a wide spectrum of clinical presentations, and preceded by a long preclinical phase. Previous studies have demonstrated that clinical strokes and covert vascular lesions of the brain contribute to the risk for developing dementia. Although it is not yet known whether preventing such lesions reduces the risk for dementia, it is likely that starting preventive measures early in the course of the disease may be beneficial. Echocardiography is a widely available, relatively inexpensive, noninvasive imaging modality whereby morphologically or hemodynamically derived parameters may be integrated easily into a risk assessment model for dementia. The aim of this review is to analyze the information that has accumulated over the past two decades on the prognostic value of echocardiographic factors in cognitive impairment. The associations between cognitive impairment and echocardiographic parameters, including left ventricular systolic and diastolic indices, left atrial morphologic parameters, cardiac output, left ventricular mass, and aortic root diameter, have previously been reported. In the light of these studies, it appears that echocardiography may help further improve currently used risk assessment models by allowing detection of subclinical cardiac abnormalities associated with future cognitive impairment. However, many limitations, including methodologic heterogeneity and the observational designs of these studies, restrict the scope of these results. Further prospective studies are required before integrating echocardiography into a preventive strategy.
全球有超过2400万人受到痴呆症影响，痴呆症是现代医学必须面对的主要公共卫生挑战之一。通往痴呆症的病程往往很长，临床表现多种多样，且在漫长的临床前期之前就已出现。先前的研究表明，临床中风和大脑隐匿性血管病变会增加患痴呆症的风险。虽然尚不清楚预防此类病变是否能降低患痴呆症的风险，但在疾病进程早期就开始采取预防措施可能是有益的。超声心动图是一种广泛应用、相对廉价的非侵入性成像方式，通过它可以轻松地将形态学或血流动力学得出的参数整合到痴呆症风险评估模型中。这篇综述的目的是分析过去二十年来积累的关于超声心动图因素在认知障碍中的预后价值的信息。认知障碍与超声心动图参数之间的关联，包括左心室收缩和舒张指标、左心房形态学参数、心输出量、左心室质量和主动脉根部直径，此前已有报道。根据这些研究，超声心动图似乎可以通过检测与未来认知障碍相关的亚临床心脏异常，帮助进一步改进目前使用的风险评估模型。然而，包括方法学异质性和这些研究的观察性设计在内的许多局限性，限制了这些结果的适用范围。在将超声心动图纳入预防策略之前，还需要进一步的前瞻性研究。
