缺血性心脏病心脏康复前后脑白质微观结构破坏的探测证据：一项弥散张量磁共振成像研究。

Probing Evidence of Cerebral White Matter Microstructural Disruptions in Ischemic Heart Disease Before and Following Cardiac Rehabilitation: A Diffusion Tensor MR Imaging Study.

机构信息

Lawson Imaging, Lawson Health Research Institute, London, Ontario, Canada.

Department of Medical Biophysics, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada.

出版信息

J Magn Reson Imaging. 2024 Jun;59(6):2137-2149. doi: 10.1002/jmri.28964. Epub 2023 Aug 17.

DOI:10.1002/jmri.28964

PMID:37589418

Abstract

BACKGROUND

Ischemic heart disease (IHD) is linked to brain white matter (WM) breakdown but how age or disease effects WM integrity, and whether it is reversible using cardiac rehabilitation (CR), remains unclear.

PURPOSE

To assess the effects of brain aging, cardiovascular disease, and CR on WM microstructure in brains of IHD patients following a cardiac event.

STUDY TYPE

Retrospective.

POPULATION

Thirty-five IHD patients (9 females; mean age = 59 ± 8 years), 21 age-matched healthy controls (10 females; mean age = 59 ± 8 years), and 25 younger controls (14 females; mean age = 26 ± 4 years).

FIELD STRENGTH/SEQUENCE: 3 T diffusion-weighted imaging with single-shot echo planar imaging acquired at 3 months and 9 months post-cardiac event.

ASSESSMENT

Tract-based spatial statistics (TBSS) and tractometry were used to compare fractional anisotropy (FA), mean diffusivity (MD), axial diffusivity (AD), and radial diffusivity (RD) in cerebral WM between: 1) older and younger controls to distinguish age-related from disease-related WM changes; 2) IHD patients at baseline (pre-CR) and age-matched controls to investigate if cardiovascular disease exacerbates age-related WM changes; and 3) IHD patients pre-CR and post-CR to investigate the neuroplastic effect of CR on WM microstructure.

STATISTICAL TESTS

Two-sample unpaired t-test (age: older vs. younger controls; IHD: IHD pre-CR vs. age-matched controls). One-sample paired t-test (CR: IHD pre- vs. post-CR). Statistical threshold: P < 0.05 (FWE-corrected).

RESULTS

TBSS and tractometry revealed widespread WM changes in older controls compared to younger controls while WM clusters of decreased FA in the fornix and increased MD in body of corpus callosum were observed in IHD patients pre-CR compared to age-matched controls. Robust WM improvements (increased FA, increased AD) were observed in IHD patients post-CR.

DATA CONCLUSION

In IHD, both brain aging and cardiovascular disease may contribute to WM disruptions. IHD-related WM disruptions may be favorably modified by CR.

LEVEL OF EVIDENCE

3 TECHNICAL EFFICACY: Stage 2.

摘要

背景

缺血性心脏病（IHD）与脑白质（WM）损伤有关，但年龄或疾病如何影响 WM 完整性，以及心脏康复（CR）是否可以逆转这种情况尚不清楚。

目的

评估脑老化、心血管疾病和 CR 对心脏病发作后 IHD 患者脑 WM 微观结构的影响。

研究类型

回顾性。

人群

35 名 IHD 患者（9 名女性；平均年龄 59±8 岁），21 名年龄匹配的健康对照者（10 名女性；平均年龄 59±8 岁）和 25 名年轻对照者（14 名女性；平均年龄 26±4 岁）。

场强/序列：3T 弥散加权成像，采用单次回波平面成像，在心脏病发作后 3 个月和 9 个月采集。

评估

采用基于束的空间统计学（TBSS）和束路径测量法比较脑 WM 中的各向异性分数（FA）、平均弥散度（MD）、轴向弥散度（AD）和径向弥散度（RD）：1）比较老年和年轻对照组，以区分与年龄相关和与疾病相关的 WM 变化；2）比较 IHD 患者的基线（CR 前）和年龄匹配的对照组，以研究心血管疾病是否会加重与年龄相关的 WM 变化；3）比较 IHD 患者的 CR 前和 CR 后，以研究 CR 对 WM 微观结构的神经可塑性影响。