Ferro Doeschka, van den Brink Hilde, Amier Raquel, van Buchem Mark, de Bresser Jeroen, Bron Esther, Brunner-La Rocca Hans-Peter, Hooghiemstra Astrid, Marcks Nick, van Rossum Albert, Biessels Geert Jan
Department of Neurology, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht, the Netherlands.
Department of Neurology, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht, the Netherlands.
Int J Cardiol. 2020 Jul 1;310:96-102. doi: 10.1016/j.ijcard.2020.04.032. Epub 2020 Apr 13.
Patients with heart failure (HF) are at risk for vascular brain injury. Cerebral cortical microinfarcts (CMIs) are a novel MRI marker of vascular brain injury. This study aims to determine the occurrence of CMIs in patient with HF and their clinical correlates, including haemodynamic status.
From the Heart-Brain Study, a multicenter prospective cohort study, 154 patients with clinically stable HF without concurrent atrial fibrillation (mean age 69.5 ± 10.1, 32% female) and 124 reference participants without HF (mean age 65.6 ± 7.4, 47% females) were evaluated for CMIs on 3 T MRI. CMI presence in HF was tested for associations with vascular risk profile, cardiac function and history, MRI markers of vascular brain injury and cognitive profile.
CMI occurrence was higher in patient with HF (17%) than reference participants (7%); after correction for age and sex OR 2.5 [95% CI 1.1-6.0] p = .032; after additional correction for vascular risk factors OR 2.7 [1.0-7.1] p = .052. In patients with HF, CMI presence was associated with office hypertension (OR 2.7 [1.2-6.5] p = .021) and a lower cardiac index (B = -0.29 [-0.55--0.04] p = .023 independent of vascular risk factors), but not with cause or duration of HF. Presence of CMIs was not associated with cognitive performance in patients with HF.
CMIs are a common occurrence in patients with HF and related to an adverse vascular risk factor profile and severity of cardiac dysfunction. CMIs thus represent a novel marker of vascular brain injury in these patients.
心力衰竭（HF）患者存在血管性脑损伤风险。脑皮质微梗死（CMIs）是血管性脑损伤的一种新型MRI标志物。本研究旨在确定HF患者中CMIs的发生率及其临床相关性，包括血流动力学状态。
从心脏-脑研究（一项多中心前瞻性队列研究）中，选取154例临床稳定且无并发房颤的HF患者（平均年龄69.5±10.1岁，女性占32%）和124例无HF的对照参与者（平均年龄65.6±7.4岁，女性占47%），在3T MRI上评估CMIs。检测HF患者中CMIs的存在情况与血管风险概况、心脏功能和病史、血管性脑损伤的MRI标志物以及认知概况之间的关联。
HF患者中CMIs的发生率（17%）高于对照参与者（7%）；校正年龄和性别后，比值比（OR）为2.5[95%可信区间（CI）1.1 - 6.0]，P = 0.032；进一步校正血管危险因素后，OR为2.7[1.0 - 7.1]，P = 0.052。在HF患者中，CMIs的存在与门诊高血压（OR 2.7[1.2 - 6.5]，P = 0.021）和较低的心脏指数（B = -0.29[-0.55 - -0.04]，P = 0.023，独立于血管危险因素）相关，但与HF的病因或病程无关。HF患者中CMIs的存在与认知功能无关。
CMIs在HF患者中很常见，且与不良血管危险因素概况和心脏功能障碍的严重程度相关。因此，CMIs是这些患者血管性脑损伤的一种新型标志物。
