Sabayan Behnam, van Buchem Mark A, Sigurdsson Sigurdur, Zhang Qian, Harris Tamara B, Gudnason Vilmundur, Arai Andrew E, Launer Lenore J
Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands (B.S., M.A.B.).
Icelandic Heart Association, Reykjavik, Iceland (S.S., V.G.).
J Am Heart Assoc. 2015 Jan 27;4(1):e001294. doi: 10.1161/JAHA.114.001294.
Advanced heart failure is linked with structural and functional alterations in the brain. It is unclear whether a graded decrease in cardiac function puts older subjects at risk for brain aging. We investigated the association between cardiac hemodynamics and features of brain aging in community-dwelling older subjects.
With data from a sub-study (n=931 subjects, mean age 75.9 years, 47.7% male) of the Age, Gene/Environment Susceptibility (AGES)-Reykjavik Study, we investigated the association of MRI measures of cardiac hemodynamics, including left ventricular stroke volume (LVSV) and cardiac output (CO) to brain characteristics. In multivariable analyses, each 10 mL lower LVSV was associated with 4.4 mL (95% CI 1.9 to 6.9) lower total parenchymal brain volume (TBV) and 3.7 mL (95% CI 1.8 to 5.7) lower gray matter volume (GMV). Likewise, each unit (L/min) lower CO was associated with 3.9 mL (95% CI 0.4 to 7.4) lower TBV and 3.9 mL (95% CI 0.4 to 7.4) lower GMV. Lower LVSV was associated with worse performance in processing speed (P=0.043) and executive function (P<0.001). Lower CO was associated with worse performance in processing speed (P=0.015) and executive function (P=0.003). Each 10 mL lower LVSV and each unit lower CO associated with a higher risk of mild cognitive impairment or dementia (odds ratio: 1.24, 95% CI 0.99 to 1.57 and odds ratio: 1.40, 95% CI 0.99 to 2.00, respectively).
A graded decrease in cardiac functioning is associated with features of brain aging. Older persons with cardiac or cognitive signs and symptoms may have both cardiac and cerebral diseases and should be evaluated accordingly.
晚期心力衰竭与大脑的结构和功能改变有关。尚不清楚心脏功能的分级下降是否会使老年受试者面临脑老化风险。我们调查了社区居住的老年受试者心脏血流动力学与脑老化特征之间的关联。
利用年龄、基因/环境易感性（AGES）-雷克雅未克研究的一项子研究（n = 931名受试者，平均年龄75.9岁，47.7%为男性）的数据，我们研究了心脏血流动力学的MRI测量指标，包括左心室每搏输出量（LVSV）和心输出量（CO）与脑特征的关联。在多变量分析中，LVSV每降低10 mL，与全脑实质体积（TBV）降低4.4 mL（95%CI 1.9至6.9）和灰质体积（GMV）降低3.7 mL（95%CI 1.8至5.7）相关。同样地，CO每降低1个单位（L/min），与TBV降低3.9 mL（95%CI 0.4至7.4）和GMV降低3.9 mL（95%CI 0.4至7.4）相关。较低的LVSV与处理速度（P = 0.043）和执行功能（P < 0.001）较差有关。较低的CO与处理速度（P = 0.015）和执行功能（P = 0.003）较差有关。LVSV每降低10 mL和CO每降低1个单位均与轻度认知障碍或痴呆的较高风险相关（优势比分别为：1.24，95%CI 0.99至1.57和优势比：1.40，95%CI 0.99至2.00）。
心脏功能的分级下降与脑老化特征相关。有心脏或认知体征和症状的老年人可能同时患有心脏和脑部疾病，应进行相应评估。
