Merkler Alexander E, Alakbarli Javid, Barbar Tarek, Baradaran Hediyeh, Adejumo Oluwayemisi, Navi Babak B, Kamel Hooman, Kim Jiwon, Okin Peter M, Gupta Ajay, Weinsaft Jonathan W
Department of Neurology, Weill Cornell Medical College, New York, NY, USA; Clinical and Translational Neuroscience Unit, Weill Cornell Medical College, New York, NY, USA.
Department of Medicine, Weill Cornell Medical College, New York, NY, USA.
J Neurol Sci. 2020 Dec 15;419:117182. doi: 10.1016/j.jns.2020.117182. Epub 2020 Oct 13.
Myocardial infarction (MI) is a known cause of cerebral infarction. We assessed whether the size and location of MI is associated with the risk of cerebral infarction.
We performed a cross-sectional study of adults who underwent both brain MRI and delayed-enhancement cardiac MRI (DE-CMR) within 365 days of each other at Weill Cornell Medicine between 2014 and 2017 and had evidence of MI on DE-CMR. We used multiple logistic regression to evaluate associations between MI size and any cerebral infarction, apical MI location and any cerebral infarction, and MI size/location and cortical versus subcortical cerebral infarction. Models were adjusted for demographics, and the total number of vascular risk factors. Among 234 patients who underwent both DE-CMR and brain MRI within 365 days, 76 had evidence for MI on DE-CMR. Among these 76 patients, 51 (67.1%) had evidence of cerebral infarction. The size of MI (global MI burden) was not associated with any cerebral infarction (OR per 5% increase in MI size, 1.12; 95% CI, 0.85-1.47), but was associated with cortical cerebral infarction (OR per 5% increase in MI size, 1.30; 95% CI, 1.00.-1.68). Similarly, apical MI location was not associated with any cerebral infarction (OR 2.63, 95% CI, 0.78-8.87), but was associated with cortical cerebral infarction (OR, 3.67; 95% CI, 1.19-11.33).
Among patients with MI on cardiac MRI, both size and apical location of MI were associated with cortical cerebral infarction. Our results may help stratify cardioembolic risk and inform antithrombotic treatment algorithms among patients with MI.
心肌梗死（MI）是脑梗死的已知病因。我们评估了MI的大小和位置是否与脑梗死风险相关。
我们对2014年至2017年间在威尔康奈尔医学院彼此间隔365天内接受脑部MRI和延迟强化心脏MRI（DE-CMR）检查且DE-CMR显示有MI证据的成年人进行了一项横断面研究。我们使用多因素逻辑回归来评估MI大小与任何脑梗死之间的关联、心尖部MI位置与任何脑梗死之间的关联，以及MI大小/位置与皮质性脑梗死和皮质下脑梗死之间的关联。模型对人口统计学因素和血管危险因素总数进行了校正。在365天内同时接受DE-CMR和脑部MRI检查的234例患者中，76例在DE-CMR上有MI证据。在这76例患者中，51例（67.1%）有脑梗死证据。MI大小（整体MI负荷）与任何脑梗死均无关联（MI大小每增加5%的比值比为1.12；95%可信区间为0.85-1.47），但与皮质性脑梗死相关（MI大小每增加5%的比值比为1.30；95%可信区间为1.00-1.68）。同样，心尖部MI位置与任何脑梗死均无关联（比值比为2.63，95%可信区间为0.78-8.87），但与皮质性脑梗死相关（比值比为3.67；95%可信区间为1.19-11.33）。
在心脏MRI显示有MI的患者中，MI的大小和心尖部位置均与皮质性脑梗死相关。我们的结果可能有助于对心源性栓塞风险进行分层，并为MI患者的抗栓治疗方案提供参考。
