From the Departments of Epidemiology (R.F.A.G.d.B., M.L.P.P., M.J.G.L., M.J.B., A.H., M.W.V., O.H.F., M.A.I.), Neurology (R.F.A.G.d.B., M.L.P.P., P.J.K., M.A.I.), Cardiology (M.J.G.L.), Radiology (A.v.d.L., W.J.N., M.W.V., M.A.I.), and Medical Informatics (W.J.N.), Erasmus Medical Center, Rotterdam; and Imaging Science and Technology (W.J.N.), Faculty of Applied Sciences, Delft University of Technology, the Netherlands.
Neurology. 2015 Feb 24;84(8):833-40. doi: 10.1212/WNL.0000000000001289. Epub 2015 Jan 28.
To investigate the association between cardiac function and the risk of stroke and dementia in elderly free of clinical cardiac disease. Additionally, we investigated the relation between cardiac function and MRI markers of subclinical cerebrovascular disease.
This study was conducted within the population-based Rotterdam Study. A total of 3,291 participants (60.8% female, age-range 58-98 years) free of coronary heart disease, heart failure, atrial fibrillation, stroke, and dementia underwent echocardiography in 2002-2005 to measure cardiac function. Follow-up finished in 2012. In 2005-2006, a random subset of 577 stroke-free people without dementia underwent brain MRI on which infarcts and white matter lesion volume were assessed.
During 21,785 person-years of follow-up, 164 people had a stroke and during 19,462 person-years of follow-up, 208 people developed dementia. Measures of better diastolic function, such as higher E/A ratio, were associated with a lower risk of stroke (hazard ratio [HR] 0.82; 95% confidence interval [CI] 0.69; 0.98) and dementia (HR 0.82; 95% CI 0.70; 0.96). Better systolic function, measured as higher fractional shortening, was only associated with a lower risk of stroke (HR 0.84; 95% CI 0.72; 0.98). Better diastolic function was related to a lower prevalence of silent infarcts on MRI, especially lacunar infarcts.
In elderly free of clinical cardiac disease, worse diastolic function is associated with clinical stroke, dementia, and silent infarcts on MRI, whereas worse systolic function is related only to clinical stroke. These findings can form the basis for future research on the utility of cardiac function as potential intervention target for prevention of neurologic diseases.
探究心功能与无临床心脏疾病的老年人群中风和痴呆风险之间的关联。此外，我们还研究了心功能与亚临床脑血管疾病的 MRI 标志物之间的关系。
本研究在基于人群的鹿特丹研究中进行。共有 3291 名参与者（60.8%为女性，年龄范围为 58-98 岁）在 2002-2005 年期间接受了超声心动图检查，以测量心功能。随访于 2012 年结束。在 2005-2006 年期间，一组随机的、无痴呆且无中风的 577 名患者接受了脑部 MRI 检查，评估了脑梗死和脑白质病变体积。
在 21785 人年的随访期间，有 164 人发生了中风，在 19462 人年的随访期间，有 208 人发生了痴呆。更好的舒张功能指标，如更高的 E/A 比值，与较低的中风风险（风险比 [HR] 0.82；95%置信区间 [CI] 0.69；0.98）和痴呆风险（HR 0.82；95% CI 0.70；0.96）相关。更好的收缩功能，表现为更高的分数缩短，仅与较低的中风风险相关（HR 0.84；95% CI 0.72；0.98）。更好的舒张功能与 MRI 上无症状性脑梗死（尤其是腔隙性梗死）的患病率较低有关。
在无临床心脏疾病的老年人群中，较差的舒张功能与临床中风、痴呆和 MRI 上的无症状性脑梗死有关，而较差的收缩功能仅与临床中风有关。这些发现可以为未来研究心功能作为预防神经疾病的潜在干预靶点的效用提供基础。
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