左心室功能、血管功能与脑小血管病测量指标之间的关系：英国生物库的一项横断面磁共振成像研究。

Associations between left ventricular function, vascular function and measures of cerebral small vessel disease: a cross-sectional magnetic resonance imaging study of the UK Biobank.

机构信息

Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands.

Department of Radiology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands.

出版信息

Eur Radiol. 2021 Jul;31(7):5068-5076. doi: 10.1007/s00330-020-07567-1. Epub 2021 Jan 6.

DOI:10.1007/s00330-020-07567-1

PMID:33409793

Abstract

OBJECTIVES

Impaired cardiovascular function has been associated with cognitive deterioration; however, to what extent cardiovascular dysfunction plays a role in structural cerebral changes remains unclear. We studied whether vascular and left ventricular (LV) functions are associated with measures of cerebral small vessel disease (cSVD) in the middle-aged general population.

METHODS

In this cross-sectional analysis of the UK Biobank, 4366 participants (54% female, mean age 61 years) underwent magnetic resonance imaging to assess LV function (ejection fraction [EF] and cardiac index [CI]) and cSVD measures (total brain volume, grey and white matter volumes, hippocampal volume and white matter hyperintensities [WMH]). Augmentation index (AIx) was used as a measure of arterial stiffness. Linear and non-linear associations were evaluated using cardiovascular function measures as determinants and cSVD measures as outcomes.

RESULTS

EF was non-linearly associated with total brain volume and grey matter volume, with the largest brain volume for an EF between 55 and 60% (both p < 0.001). EF showed a negative linear association with WMH (- 0.23% [- 0.44; - 0.02], p = 0.03), yet no associations were found with white matter or hippocampal volume. CI showed a positive linear association with white matter (β 3194 mm [760; 5627], p = 0.01) and hippocampal volume (β 72.5 mm [23.0; 122.0], p = 0.004). No associations were found for CI with total brain volume, grey matter volume or WMH. No significant associations were found between AIx and cSVD measures.

CONCLUSIONS

This study provides novel insights into the complex associations between the heart and the brain, which could potentially guide early interventions aimed at improving cardiovascular function and the prevention of cSVD.

KEY POINTS

• Ejection fraction is non-linearly and cardiac index is linearly associated with MRI-derived measures of cerebral small vessel disease. • No associations were found for arterial stiffness with cSVD measures.

摘要

目的

心血管功能受损与认知功能恶化有关；然而，心血管功能障碍在多大程度上导致脑结构变化尚不清楚。我们研究了中年人群的血管和左心室（LV）功能是否与脑小血管疾病（cSVD）的测量值相关。

方法

在英国生物库的这项横断面分析中，4366 名参与者（54%为女性，平均年龄 61 岁）接受了磁共振成像检查，以评估 LV 功能（射血分数[EF]和心指数[CI]）和 cSVD 测量值（总脑容量、灰质和白质容量、海马体容量和脑白质高信号[WMH]）。增强指数（AIx）被用作动脉僵硬度的测量值。使用心血管功能测量值作为决定因素，cSVD 测量值作为结果，评估线性和非线性关联。

结果

EF 与总脑容量和灰质容量呈非线性相关，EF 在 55%至 60%之间时脑容量最大（均 p < 0.001）。EF 与 WMH 呈负线性关联（-0.23%[-0.44；-0.02]，p=0.03），但与白质或海马体容量无关。CI 与白质呈正线性关联（β 3194mm[760；5627]，p=0.01）和海马体容量（β 72.5mm[23.0；122.0]，p=0.004）。CI 与总脑容量、灰质容量或 WMH 之间无显著关联。AIx 与 cSVD 测量值之间无显著关联。