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导管消融对心房颤动患者脑微结构和血流改变的影响及其对认知改善的作用:一项纵向初步研究

Impact of Catheter Ablation on Brain Microstructure and Blood Flow Alterations for Cognitive Improvements in Patients with Atrial Fibrillation: A Pilot Longitudinal Study.

作者信息

Tatewaki Yasuko, Mutoh Tatsushi, Sato Hirokazu, Kobayashi Akiko, Totsune Tomoko, Thyreau Benjamin, Sekiguchi Atsushi, Nakase Taizen, Yagi Tetsuo, Taki Yasuyuki

机构信息

Department of Aging Research and Geriatric Medicine, Institute of Development, Aging and Cancer, Tohoku University, Sendai 980-8575, Japan.

Department of Geriatric Medicine and Neuroimaging, Tohoku University Hospital, Sendai 980-8575, Japan.

出版信息

J Clin Med. 2022 Jul 26;11(15):4346. doi: 10.3390/jcm11154346.

Abstract

Atrial fibrillation (AF) predisposes patients to develop cognitive decline and dementia. Clinical and epidemiological data propose that catheter ablation may provide further benefit to improve neurocognitive function in patients with AF, but the underlying mechanism is poorly available. Here, we conducted a pilot prospective study to investigate whether AF ablation can alter regional cerebral blood flow (rCBF) and brain microstructures, using multimodal magnetic resonance imaging (MRI) technique. Eight patients (63 ± 7 years) with persistent AF underwent arterial-spin labeling (ASL) perfusion, 3D T1-structural images and cognitive test batteries before and 6 months after intervention. ASL and structural MR images were spatially normalized, and the rCBF and cortical thickness of different brain areas were compared between pre- and 6-month post-treatment. Cognitive-psychological function was improved, and rCBF was significantly increased in the left posterior cingulate cortex (PCC) ( = 0.013), whereas decreased cortical thickness was found in the left posterior insular cortex ( = 0.023). Given that the PCC is a strategic site in the limbic system, while the insular cortex is known to play an important part in the central autonomic nervous system, our findings extend the hypothesis that autonomic system alterations are an important mechanism explaining the positive effect of AF ablation on cognitive function.

摘要

心房颤动(AF)使患者易发生认知功能下降和痴呆。临床和流行病学数据表明,导管消融术可能为改善AF患者的神经认知功能带来更多益处,但其潜在机制尚不清楚。在此,我们进行了一项前瞻性初步研究,采用多模态磁共振成像(MRI)技术,调查AF消融术是否能改变局部脑血流量(rCBF)和脑微结构。8例持续性AF患者(63±7岁)在干预前和干预后6个月接受了动脉自旋标记(ASL)灌注、三维T1结构成像和认知测试。对ASL和结构磁共振图像进行空间标准化处理,比较治疗前和治疗后6个月不同脑区的rCBF和皮质厚度。认知心理功能得到改善,左侧后扣带回皮质(PCC)的rCBF显著增加(P = 0.013),而左侧岛叶皮质的皮质厚度减少(P = 0.023)。鉴于PCC是边缘系统的一个关键部位,而岛叶皮质在中枢自主神经系统中发挥重要作用,我们的研究结果扩展了自主神经系统改变是解释AF消融术对认知功能产生积极影响的重要机制这一假说。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/c3a8/9332426/07c59b28857e/jcm-11-04346-g001.jpg

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