隐匿性脑血管改变与心脏病患者：系统评价和荟萃分析。
Covert Cerebrovascular Changes in People With Heart Disease: A Systematic Review and Meta-Analysis.
机构信息
From the The George Institute for Global Health (Z.Z., S.Y., Y.S., Y.X., J.Y., Y.W., K.H., C.D., M.W., C.A., C.C.), Faculty of Medicine, University of New South Wales, Sydney, Australia; Department of Neurology and Clinical Research Center of Neurological Disease (S.Y.), The Second Affiliated Hospital of Soochow University, Suzhou, PR China; Department of Neurological Science (Y.S.), Graduate School of Medicine, Nippon Medical School, Tokyo, Japan; Centre for Health Systems and Safety Research (Y.X.), Australian Institute of Health Innovation, Macquarie University, Sydney, Australia; Department of Cardiology (S.D., W.X., J.P.), Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University; Department of Cardiology (W.L., X.D.), Beijing Anzhen Hospital, Capital Medical University; Department of Cardiology (J.Y.), Peking University Third Hospital, Beijing; Department of Neurology (Y.W.), West China Hospital, Sichuan University, Chengdu, PR China; Department of Clinical Medicine (C.D.), Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, Australia; Department of Epidemiology and Biostatistics (M.J.R.), College of Human Medicine, Michigan State University, East Lansing; The George Institute for Global Health and University of Sydney (R.I.L.); South Western Clinical School (M.W.P.), University of New South Wales, Sydney, Australia; The George Institute for Global Health (M.W.), School of Public Health, Imperial College London, United Kingdom; Department of Neurology (C.A., C.C.), Royal Prince Alfred Hospital, Sydney Health Partners, Australia; Edinburgh Imaging and Centre for Clinical Brain Sciences (J.M.W.); and UK Dementia Research Institute (J.M.W.), University of Edinburgh, United Kingdom.
出版信息
Neurology. 2024 Apr 23;102(8):e209204. doi: 10.1212/WNL.0000000000209204. Epub 2024 Mar 26.
BACKGROUND AND OBJECTIVES
To determine the prevalence of silent brain infarction (SBI) and cerebral small vessel disease (CSVD) in adults with atrial fibrillation (AF), coronary artery disease, heart failure or cardiomyopathy, heart valve disease, and patent foramen ovale (PFO), with comparisons between those with and without recent stroke and an exploration of associations between heart disease and SBI/CSVD.
METHODS
Medline, Embase, and Cochrane Library were systematically searched for hospital-based or community-based studies reporting SBI/CSVD in people with heart disease. Data were extracted from eligible studies. Outcomes were SBI (primary) and individual CSVD subtypes. Summary prevalence (95% confidence intervals [CIs]) were obtained using random-effects meta-analysis. Pooled prevalence ratios (PRs) (95% CI) were calculated to compare those with heart disease with available control participants without heart disease from studies.
RESULTS
A total of 221 observational studies were included. In those with AF, the prevalence was 36% (31%-41%) for SBI (70 studies, N = 13,589), 25% (19%-31%) for lacune (26 studies, N = 7,172), 62% (49%-74%) for white matter hyperintensity/hypoattenuation (WMH) (34 studies, N = 7,229), and 27% (24%-30%) for microbleed (44 studies, N = 13,654). Stratification by studies where participants with recent stroke were recruited identified no differences in the prevalence of SBI across subgroups ( = 0.495). Results were comparable across participants with different heart diseases except for those with PFO, in whom there was a lower prevalence of SBI [21% (13%-30%), 11 studies, N = 1,053] and CSVD. Meta-regressions after pooling those with any heart disease identified associations of increased (study level) age and hypertensives with more SBIs and WMH ( <0.05). There was no evidence of a difference in the prevalence of microbleed between those with and without heart disease (PR [95% CI] 1.1 [0.7-1.7]), but a difference was seen in the prevalence of SBI and WMH (PR [95% CI] 2.3 [1.6-3.1] and 1.7 [1.1-2.6], respectively).
DISCUSSION
People with heart disease have a high prevalence of SBI (and CSVD), which is similar in those with vs without recent stroke. More research is required to assess causal links and implications for management.
TRIAL REGISTRATION INFORMATION
PROSPERO CRD42022378272 (crd.york.ac.uk/PROSPERO/).
背景与目的
确定伴有心房颤动（AF）、冠状动脉疾病、心力衰竭或心肌病、心脏瓣膜疾病和卵圆孔未闭（PFO）的成年人中无症状性脑梗死（SBI）和脑小血管疾病（CSVD）的患病率，并比较近期有卒中与无卒中患者之间的差异，同时探讨心脏病与 SBI/CSVD 之间的关联。
方法
系统检索 Medline、Embase 和 Cochrane 图书馆中关于医院或社区人群中 SBI/CSVD 的研究。从合格研究中提取数据。主要结局为 SBI（初级结局）和 CSVD 的各个亚型。采用随机效应荟萃分析获得汇总患病率（95%置信区间[CI]）。计算具有心脏病患者与来自研究的无心脏病对照参与者之间的患病率比值（PR）（95%CI）来进行比较。
结果
共纳入 221 项观察性研究。在 AF 患者中，SBI 的患病率为 36%（31%-41%）（70 项研究，N=13589），腔隙性梗死为 25%（19%-31%）（26 项研究，N=7172），脑白质高信号/低信号为 62%（49%-74%）（34 项研究，N=7229），微出血为 27%（24%-30%）（44 项研究，N=13654）。按纳入近期卒中患者的研究进行分层，各亚组之间 SBI 的患病率无差异（=0.495）。除 PFO 患者外，在不同心脏病患者中，SBI 和 CSVD 的结果相似，在 PFO 患者中，SBI 的患病率较低[21%（13%-30%），11 项研究，N=1053]。对纳入任何心脏病患者的研究进行荟萃回归分析后发现，年龄和高血压与 SBI 和 WMH 增加有关（<0.05）。有或无心脏病患者之间的微出血患病率无差异（PR[95%CI]1.1[0.7-1.7]），但 SBI 和 WMH 的患病率有差异（PR[95%CI]2.3[1.6-3.1]和 1.7[1.1-2.6]）。
讨论
患有心脏病的人群 SBI（和 CSVD）的患病率较高，近期有卒中与无卒中患者之间的患病率相似。需要进一步研究以评估因果关系和对管理的影响。
临床试验注册信息
PROSPERO CRD42022378272（crd.york.ac.uk/PROSPERO/）。
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