From the Department of Cardiovascular Sciences, University of Leicester, United Kingdom (N.P., J.J., M.A.H., L.C., E.M.L.C.).
NIHR Leicester Biomedical Research Centre-Cardiovascular Theme, Glenfield Hospital, United Kingdom (N.P., E.M.L.C.).
Stroke. 2019 Feb;50(2):336-343. doi: 10.1161/STROKEAHA.118.023355.
Background and Purpose- Cerebral microbleeds (CMBs) have been observed using magnetic resonance imaging in patients with cardiovascular risk factors, cognitive deterioration, small vessel disease, and dementia. They are a well-known consequence of cerebral amyloid angiopathy, chronic hypertension, and diffuse axonal injury, among other causes. However, the frequency and location of new CMBs postadult cardiac surgery, in association with cognition and perioperative risk factors, have yet to be studied. Methods- Pre- and postsurgery magnetic resonance susceptibility-weighted images and neuropsychological tests were analyzed from a total of 75 patients undergoing cardiac surgery (70 men; mean age, 63±10 years). CMBs were identified by a neuroradiologist blinded to clinical details who independently assessed the presence and location of CMBs using standardized criteria. Results- New CMBs were identified in 76% of patients after cardiac surgery. The majority of new CMBs were located in the frontal lobe (46%) followed by the parietal lobe (15%), cerebellum (13%), occipital lobe (12%), and temporal lobe (8%). Patients with new CMBs typically began with a higher prevalence of preexisting CMBs ( P=0.02). New CMBs were associated with longer cardiopulmonary bypass times ( P=0.003), and there was a borderline association with lower percentage hematocrit ( P=0.04). Logistic regression analysis suggested a ≈2% increase in the odds of acquiring new CMBs during cardiac surgery for every minute of bypass time (odds ratio, 1.02; 95% CI, 1.00-1.05; P=0.04). Postoperative neuropsychological decline was observed in 44% of patients and seemed to be unrelated to new CMBs. Conclusions- New CMBs identified using susceptibility-weighted images were found in 76% of patients who underwent cardiac surgery. CMBs were globally distributed with the highest numbers in the frontal and parietal lobes. Our regression analysis indicated that length of cardiopulmonary bypass time and lowered hematocrit may be significant predictors for new CMBs after cardiac surgery. Clinical Trial Registration- URL: http://www.isrctn.com . Unique identifier: 66022965.
背景与目的- 在存在心血管危险因素、认知能力下降、小血管疾病和痴呆的患者中，磁共振成像已观察到脑微出血（CMB）。CMB 是脑淀粉样血管病、慢性高血压和弥漫性轴索损伤等多种原因导致的一种众所周知的后果。然而，与认知和围手术期危险因素相关的成人心脏手术后新 CMB 的频率和位置尚未得到研究。方法- 共分析了 75 例行心脏手术的患者（70 名男性；平均年龄 63±10 岁）的术前和术后磁共振磁敏感加权图像和神经心理学测试。由一名对临床细节一无所知的神经放射科医生使用标准化标准独立评估 CMB 的存在和位置，从而识别 CMB。结果- 心脏手术后，76%的患者发现了新的 CMB。新 CMB 主要位于额叶（46%），其次是顶叶（15%）、小脑（13%）、枕叶（12%）和颞叶（8%）。出现新 CMB 的患者通常具有更高的先前存在的 CMB 发生率（P=0.02）。新 CMB 与心肺旁路时间延长有关（P=0.003），与较低的红细胞压积呈边缘相关（P=0.04）。逻辑回归分析表明，心脏手术期间旁路时间每延长一分钟，获得新 CMB 的几率增加约 2%（优势比，1.02；95%置信区间，1.00-1.05；P=0.04）。44%的患者出现术后神经心理下降，似乎与新 CMB 无关。结论- 接受心脏手术的患者中有 76%发现了使用磁敏感加权图像识别的新 CMB。CMB 呈全球性分布，额叶和顶叶数量最多。我们的回归分析表明，心肺旁路时间和红细胞压积降低可能是心脏手术后新 CMB 的重要预测因素。临床试验注册- 网址：http://www.isrctn.com 。独特标识符：66022965。
