From the Julius Center for Health Sciences and Primary Care (I.R., M.I.G.), Department of Radiology (C.L., R.G., J.H.), and Department of Neurology (L.J.K.), University Medical Center Utrecht and Utrecht University, the Netherlands.
Neurology. 2021 Sep 14;97(11):e1063-e1074. doi: 10.1212/WNL.0000000000012539. Epub 2021 Jul 21.
To investigate the association of silent vascular lesions, imaging negative ischemia, and symptomatic cerebrovascular disease with long-term progression of brain atrophy and cerebrovascular lesions in patients with arterial disease.
Within the Second Manifestations of Arterial Disease-Magnetic Resonance (SMART-MR) study, stroke status of participants at baseline was classified as no cerebrovascular disease (reference group, n = 829), symptomatic cerebrovascular disease (n = 206), silent vascular lesion (n = 157), and imaging-negative ischemia (n = 90) according to clinical and MRI findings. With the use of linear mixed models, changes in brain and white matter hyperintensity (WMH) volumes at baseline and during 12 years of follow-up were studied in stroke classifications. Relative risks were estimated for new infarcts during follow-up associated with stroke classifications. Analyses were adjusted for age, sex, cardiovascular risk factors, and medications.
Symptomatic cerebrovascular disease associated with 0.35 SD (95% confidence interval [CI] 0.24-0.47) smaller brain volume and 0.61 SD (95% CI 0.48-0.74) larger WMH volume at baseline and increased risk for new infarcts during follow-up (risk ratio [RR] 2.89, 95% CI 2.00-4.16). Silent vascular lesions were associated with 0.15 SD (95% CI 0.01-0.88) smaller brain volume, 0.02 SD (95% CI 0.01-0.03) steeper brain atrophy slope, and 0.48 SD (95% CI 0.32-0.64) larger WMH volume at baseline, in addition to increased risk for lacunes (RR 2.08, 95% CI 1.48-2.94). Individuals with imaging-negative ischemia had increased risk for cortical infarcts (RR 2.88, 95% CI 2.17-3.82).
Patients with symptomatic cerebrovascular disease, silent vascular lesions, or imaging-negative ischemia have a different course of brain volume loss and cerebrovascular lesion development. These findings may have implications for future stroke risk and dementia and need further investigation.
本研究旨在探讨无症状性血管病变、影像学阴性缺血和症状性脑血管疾病与动脉疾病患者脑萎缩和脑血管病变长期进展的相关性。
在动脉疾病的第二次表现-MRI（SMART-MR）研究中，根据临床和 MRI 结果，将基线时参与者的卒中情况分为无脑血管疾病（参照组，n=829）、症状性脑血管疾病（n=206）、无症状性血管病变（n=157）和影像学阴性缺血（n=90）。使用线性混合模型，研究卒中分类在基线和 12 年随访期间脑和脑白质高信号（WMH）体积的变化。分析了随访期间与卒中分类相关的新发梗死的相对风险。分析调整了年龄、性别、心血管危险因素和药物治疗。
症状性脑血管疾病与基线时脑体积缩小 0.35 SD（95%置信区间[CI] 0.24-0.47）和 WMH 体积增大 0.61 SD（95% CI 0.48-0.74）相关，随访期间新发梗死的风险增加（风险比[RR] 2.89，95% CI 2.00-4.16）。无症状性血管病变与脑体积缩小 0.15 SD（95% CI 0.01-0.88）、脑萎缩斜率更陡峭 0.02 SD（95% CI 0.01-0.03）和 WMH 体积增大 0.48 SD（95% CI 0.32-0.64）相关，此外，腔隙性梗死的风险增加（RR 2.08，95% CI 1.48-2.94）。影像学阴性缺血的患者皮质梗死的风险增加（RR 2.88，95% CI 2.17-3.82）。
症状性脑血管疾病、无症状性血管病变或影像学阴性缺血患者的脑容量损失和脑血管病变发展过程不同。这些发现可能对未来的卒中风险和痴呆具有重要意义，需要进一步研究。
