Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
Department of Environmental Medicine and Public Health, Faculty of Medicine, Shimane University, Izumo, Japan.
Eur J Neurol. 2019 Sep;26(9):1219-1225. doi: 10.1111/ene.13970. Epub 2019 May 9.
The association between an increased supraventricular ectopic beat (SVEB) and subclinical cerebrovascular disease remains unclear. Given the emerging concept that an increased SVEB is a marker of atrial cardiomyopathy or atherosclerosis burden, we sought to determine whether excessive supraventricular ectopic activity (ESVEA) is associated with a higher burden of subclinical cerebrovascular disease in the middle-aged to older cohort with neither apparent stroke nor atrial fibrillation.
We conducted a cross-sectional population-based study of 462 men (mean age, 68.1 years) who underwent 24-h Holter electrocardiography and brain magnetic resonance imaging. ESVEA was defined as the presence of >10 SVEBs/h. Subclinical cerebrovascular diseases were defined as silent brain infarct (SBI), white matter hyperintensity (WMH) and intracranial atherosclerotic stenosis (ICAS). The association of ESVEA with the presence of subclinical cerebrovascular diseases was adjusted for potential confounding covariates.
A total of 88 (19.0%) participants had ESVEA and 81 (17.5%), 91 (19.7%) and 109 (23.6%) had SBI, WMH and ICAS, respectively. In multivariable-adjusted Poisson regression with robust error variance, ESVEA was associated with the presence of WMH (relative risk, 1.58; 95% confidence interval, 1.06-2.36) and ICAS (relative risk, 1.49; 95% confidence interval, 1.02-2.18), but not with that of SBI (relative risk, 1.32; 95% confidence interval, 0.86-2.01). These associations were consistent when the graded distributions of subclinical cerebrovascular diseases were applied as outcomes in ordinal logistic regression.
The ESVEA was independently associated with higher burdens of WMH and ICAS. This suggests that increased SVEBs might improve risk stratification of individuals at high risk of subclinical cerebrovascular disease and consequently apparent ischaemic stroke.
频发房性期前收缩（SVEB）与亚临床脑血管病之间的关系尚不清楚。鉴于频发房性期前收缩增加是心房心肌病或动脉粥样硬化负担的标志这一新兴概念，我们试图确定在无明显中风或心房颤动的中年至老年人群中，是否过度的室上性异位活动（ESVEA）与亚临床脑血管病负担增加有关。
我们进行了一项基于人群的横断面研究，纳入了 462 名男性（平均年龄 68.1 岁），这些患者接受了 24 小时动态心电图和脑磁共振成像检查。ESVEA 定义为每小时存在 >10 次房性期前收缩。亚临床脑血管疾病定义为无症状性脑梗死（SBI）、脑白质高信号（WMH）和颅内动脉粥样硬化性狭窄（ICAS）。在调整潜在混杂协变量后，ESVEA 与亚临床脑血管疾病的发生之间的关联。
共有 88 名（19.0%）参与者存在 ESVEA，81 名（17.5%）、91 名（19.7%）和 109 名（23.6%）分别存在 SBI、WMH 和 ICAS。在具有稳健误差方差的多变量调整泊松回归中，ESVEA 与 WMH 的发生相关（相对风险，1.58；95%置信区间，1.06-2.36）和 ICAS（相对风险，1.49；95%置信区间，1.02-2.18），但与 SBI 无关（相对风险，1.32；95%置信区间，0.86-2.01）。当亚临床脑血管疾病的分级分布作为有序逻辑回归的结果时，这些关联仍然一致。
ESVEA 与较高的 WMH 和 ICAS 负担独立相关。这表明增加的房性期前收缩可能改善亚临床脑血管病和随后明显缺血性中风高危个体的风险分层。
