异常 p 波参数与脑 MRI 形态学的关系：社区动脉粥样硬化风险认知研究（ARIC-NCS）。
Association of abnormal p-wave parameters with brain MRI morphology: The atherosclerosis risk in communities neurocognitive study (ARIC-NCS).
机构信息
Lillehei Heart Institute and Cardiovascular Division, Department of Medicine, University of Minnesota Medical School, Minneapolis, Minnesota, USA.
Center for Cardiac Arrest Prevention, Department of Cardiology, Cedars-Sinai Smidt Heart Institute, Los Angeles, California, USA.
出版信息
Pacing Clin Electrophysiol. 2023 Aug;46(8):951-959. doi: 10.1111/pace.14687. Epub 2023 Mar 31.
BACKGROUND
Recent evidence indicates that abnormal P-wave parameters (PWPs)-ECG markers of atrial myopathy-are associated with incident dementia, independent of atrial fibrillation (AF) and clinical ischemic stroke. However, the mechanisms remain unclear and may include subclinical vascular brain injury. Hence, we evaluated the association of abnormal PWPs with brain MRI correlates of vascular brain injury in the Atherosclerosis Risk in Communities Neurocognitive Study (ARIC-NCS).
METHODS
ARIC-NCS participants who underwent 3T brain MRI scans in 2011-2013 were included. PWPs were measured from standard 12-lead ECGs. Brain MRI outcomes included cortical infarcts, lacunar infarcts, cerebral microhemorrhages, brain volumes, and white matter disease (WMD) volume. We used weighted multivariable logistic and linear regression to evaluate the associations of abnormal PWPs with brain MRI outcomes.
RESULTS
Among 1715 participants (mean age, 76.1 years; 61% women; 29% Black), 797 (46%) had ≥1 abnormal PWP. After multivariable adjustment, including adjusting for prevalent AF, abnormal P-wave terminal force in lead V1 (aPTFV1) and prolonged P-wave duration (PPWD) were associated with increased odds of both cortical (OR 1.41; 95% CI, 1.14 to 1.74 and OR 1.30; 95% CI, 1.04 to 1.63, respectively) and lacunar infarcts (OR 1.36; 95% CI, 1.15 to 1.63 and OR 1.37; 95% CI, 1.15 to 1.65, respectively). Advanced interatrial block (aIAB) was associated with higher odds of subcortical microhemorrhage (OR 2.04; 95% CI, 1.36 to 3.06). Other than a significant association between aPTFV1 with lower parietal lobe volume, there were no other significant associations with brain or WMD volume.
CONCLUSION
In this exploratory analysis of a US community-based cohort, ECG surrogates of atrial myopathy are associated with a higher prevalence of brain infarcts and microhemorrhage, suggesting subclinical vascular brain injury as a possible mechanism underlying the association of atrial myopathy with dementia.
背景
最近的证据表明，异常 P 波参数（心电图心房肌病的标志物）与痴呆的发生有关，与心房颤动（AF）和临床缺血性中风无关。然而，其机制尚不清楚，可能包括亚临床血管性脑损伤。因此，我们评估了异常 P 波参数与在社区动脉粥样硬化风险神经认知研究（ARIC-NCS）中的血管性脑损伤的脑 MRI 相关性之间的关系。
方法
纳入了 2011 年至 2013 年期间接受 3T 脑 MRI 扫描的 ARIC-NCS 参与者。从标准的 12 导联心电图中测量 P 波参数。脑 MRI 结果包括皮质梗死、腔隙性梗死、脑微出血、脑容量和白质疾病（WMD）体积。我们使用加权多变量逻辑和线性回归来评估异常 P 波参数与脑 MRI 结果之间的关系。
结果
在 1715 名参与者中（平均年龄 76.1 岁，61%为女性，29%为黑人），797 名（46%）至少有 1 个异常 PWP。在多变量调整后，包括调整现患 AF，V1 导联 P 波终末电势（aPTFV1）和 P 波延长（PPWD）与皮质（OR 1.41；95%CI，1.14 至 1.74 和 OR 1.30；95%CI，1.04 至 1.63，分别）和腔隙性梗死（OR 1.36；95%CI，1.15 至 1.63 和 OR 1.37；95%CI，1.15 至 1.65，分别）的发生几率增加有关。高级房间隔阻滞（aIAB）与皮质下微出血的发生几率较高有关（OR 2.04；95%CI，1.36 至 3.06）。除了 aPTFV1 与顶叶体积较低有显著关联外，与脑或 WMD 体积均无其他显著关联。
结论
在这项美国社区为基础的队列的探索性分析中，心电图心房肌病的替代指标与脑梗死和微出血的发生率较高有关，提示亚临床血管性脑损伤可能是心房肌病与痴呆相关的潜在机制。
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