Ye Kaili, Tao Wendan, Wang Zhetao, Li Dayan, Xu Mangmang, Liu Junfeng, Liu Ming
Department of Neurology, West China Hospital of Sichuan University, Chengdu, Sichuan, China.
Department of Radiology, West China Hospital, Sichuan University, Chengdu, China.
Front Neurol. 2023 Mar 23;14:1137488. doi: 10.3389/fneur.2023.1137488. eCollection 2023.
Atrial fibrillation (AF) has been linked to dementia risk, partly explained by cerebral small vessel disease (CSVD). Since AF and cardiovascular comorbidities were associated with cardiac dysfunction, we aimed to determine the association between echocardiographic parameters and neuroimaging markers of CSVD in patients with AF-related ischemic stroke.
This cross-sectional study enrolled patients with AF-related ischemic stroke from March 2013 to December 2019 who underwent transthoracic echocardiography and brain 3T MRI, including T1, T2, Flair, and SWI imaging sequences. We assessed the presence of lacunes and cerebellar microbleeds (CMBs), the severity of white matter hyperintensity (WMH) scored by the Fazekas scale (0-6), and the severity of enlarged perivascular spaces (EPVS) in basal ganglia (BG) and centrum semiovale (CSO) classified into three categories (0-10, 10-25, and >25). CSVD burden was rated on a 0-to-4 ordinal scale. Generalized linear regression analysis and post hoc comparisons with Bonferroni correction were performed to assess the association between various echocardiographic parameters and these lesions, adjusted for demographics and potential confounders.
119 patients (68.38 ± 12.692 years; male 45.4 %) were included for analysis, of whom 55 (46.2%) had lacunes, 40 (33.6%) had CMBs, and median severity for WMH, BG-EPVS, CSO-EPVS, and CSVD burden were 2 (IQR: 1-3), 1 (IQR: 1-2), 1 (IQR: 0-1), and 1 (IQR: 1-2) respectively. In multivariable, fully adjusted models, left ventricular posterior wall thickness (LVPW) was associated with a higher risk of lacunes (RR 1.899, 95% CI: 1.342-2.686) and CSVD burden (RR = 2.081, 95%CI: 1.562-2.070). Right atrial diameter (RAD) was associated with greater CSO-EPVS (RR = 2.243, 95%CI: 1.234-4.075). No echocardiographic parameters were revealed to be associated with CMBs and WMH.
In patients with AF-related ischemic stroke, LVPW is associated with a higher risk of lacunes and CSVD burden, while RAD was associated with greater CSO-EPVS. Larger studies are required to determine these associations and to elucidate if these associations can help facilitate cognitive evaluation and brain MRI screening.
房颤（AF）与痴呆风险相关，部分原因可由脑小血管疾病（CSVD）解释。由于房颤和心血管合并症与心脏功能障碍有关，我们旨在确定房颤相关性缺血性卒中患者的超声心动图参数与CSVD神经影像学标志物之间的关联。
这项横断面研究纳入了2013年3月至2019年12月期间患有房颤相关性缺血性卒中且接受了经胸超声心动图检查和脑部3T磁共振成像（包括T1、T2、Flair和SWI成像序列）的患者。我们评估了腔隙性脑梗死和小脑微出血（CMB）的存在情况、采用Fazekas量表（0 - 6分）对白质高信号（WMH）严重程度进行评分，以及对基底节（BG）和半卵圆中心（CSO）的血管周围间隙扩大（EPVS）严重程度分为三类（0 - 10、10 - 25和>25）。CSVD负担按0至4的有序量表进行评级。进行广义线性回归分析以及采用Bonferroni校正的事后比较，以评估各种超声心动图参数与这些病变之间的关联，并对人口统计学和潜在混杂因素进行了校正。
纳入119例患者（年龄68.38±12.692岁；男性占45.4%）进行分析，其中55例（46.2%）有腔隙性脑梗死，40例（33.6%）有CMB，WMH、BG - EPVS、CSO - EPVS和CSVD负担的中位数分别为2（四分位间距：1 - 3）、1（四分位间距：1 - 2）、1（四分位间距：0 - 1）和1（四分位间距：1 - 2）。在多变量、完全校正模型中，左心室后壁厚度（LVPW）与腔隙性脑梗死风险较高（风险比1.899, 95%置信区间：1.342 - 2.686）和CSVD负担（风险比 = 2.081, 95%置信区间：1.562 - 2.070）相关。右心房直径（RAD）与更大的CSO - EPVS相关（风险比 = 2.243, 95%置信区间：1.234 - 4.075）。未发现超声心动图参数与CMB和WMH相关。
在房颤相关性缺血性卒中患者中，LVPW与腔隙性脑梗死和CSVD负担风险较高相关，而RAD与更大的CSO - EPVS相关。需要更大规模的研究来确定这些关联，并阐明这些关联是否有助于促进认知评估和脑部MRI筛查。
