1
|
Chen S, Zhang H, Zhang J, Jiang H, Fan W, Zhang X, Jin Y, Yang X, Mao C, Peng H. Association between vascular aging and cognitive function in Chinese adults. BMC Public Health 2024; 24:2149. [PMID: 39113020 PMCID: PMC11308726 DOI: 10.1186/s12889-024-19700-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2024] [Accepted: 08/06/2024] [Indexed: 08/10/2024] Open
Abstract
BACKGROUND Vascular health has been associated with cognition but related evidence is limited in Chinese. The objective of this study was to examine the association of vascular aging assessed by arterial stiffness and blood pressure with cognitive function in an unselected Chinese population. METHODS In the Tianning Cohort (N = 5158), indicators of arterial stiffness and blood pressure including carotid-femoral pulse wave velocity (cfPWV), ankle-brachial index (ABI), pulse pressure (PP), systolic blood pressure (SBP), and diastolic blood pressure (DBP) were measured. Cognitive function was assessed using the Mini Mental State Examination (MMSE) questionnaire. We applied Poisson regression and logistic regression to examine the associations of vascular aging and blood pressure with cognitive function. RESULTS 76 (1.47%) participants had impaired cognitive function diagnosed by a MMSE score of less than 24 points. Participants with a higher level of PP were more likely to have a decreased score of MMSE (β=-0.0121, P < 0.001 for log-transformed pulse pressure) and a higher risk of having impaired cognitive function (OR = 5.95, 95%CI: 2.02-17.79, P < 0.001 for log-transformed PP). Per standard deviation increment in SBP was significantly associated with lower MMSE score (β=-0.0020, P < 0.001) and impaired cognitive function (OR = 1.69, 95%CI: 1.38-2.06, P < 0.001). No significant associations were found regarding other parameters. CONCLUSIONS Blood pressure and hypertension were associated with cognitive function in Chinese adults. PP may be a potential predictor for impaired cognitive function.
Collapse
Affiliation(s)
- Shi Chen
- Department of Nursing, the Second People's Hospital of Kunshan, Suzhou Vocational Health College, Suzhou, China
| | - Hao Zhang
- Department of Epidemiology, School of Public Health, Suzhou Medical College of Soochow University, Suzhou, China
| | - Jianan Zhang
- Department of Chronic Disease, Taicang Center of Disease Prevention and Control, Suzhou, China
| | - Hai Jiang
- Department of Chronic Disease, Taicang Center of Disease Prevention and Control, Suzhou, China
| | - Wenxiu Fan
- Department of Epidemiology, School of Public Health, Suzhou Medical College of Soochow University, Suzhou, China
| | - Xueyang Zhang
- Department of Epidemiology, School of Public Health, Suzhou Medical College of Soochow University, Suzhou, China
| | - Yibing Jin
- Department of Epidemiology, School of Public Health, Suzhou Medical College of Soochow University, Suzhou, China
| | - Xiangdong Yang
- Department of Epidemiology, School of Public Health, Suzhou Medical College of Soochow University, Suzhou, China
| | - Changqing Mao
- Department of Pharmacy, Jinshan Branch of Shanghai Sixth People's Hospital, Shanghai, China.
| | - Hao Peng
- Department of Epidemiology, School of Public Health, Suzhou Medical College of Soochow University, Suzhou, China.
- MOE Key Laboratory of Geriatric Diseases and Immunology, Soochow University, Suzhou, China.
| |
Collapse
|
2
|
Hu H, Hu H, Jiang J, Bi Y, Sun Y, Ou Y, Tan L, Yu J. Echocardiographic measures of the left heart and cerebrospinal fluid biomarkers of Alzheimer's disease pathology in cognitively intact adults: The CABLE study. Alzheimers Dement 2024; 20:3943-3957. [PMID: 38676443 PMCID: PMC11180853 DOI: 10.1002/alz.13837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Revised: 03/01/2024] [Accepted: 03/11/2024] [Indexed: 04/28/2024]
Abstract
INTRODUCTION This study delineated the interrelationships between subclinical alterations in the left heart, cerebrospinal fluid (CSF), Alzheimer's disease (AD) biomarkers, and cognition. METHODS Multiple linear regressions were conducted in 1244 cognitively normal participants (mean age = 65.5; 43% female) who underwent echocardiography (left atrial [LA] and left ventricular [LV] morphologic or functional parameters) and CSF AD biomarkers measurements. Mediating effects of AD pathologies were examined. Differences in cardiac parameters across ATN categories were tested using analysis of variance (ANOVA) and logistic regressions. RESULTS LA or LV enlargement (characterized by increased diameters and volumes) and LV hypertrophy (increased interventricular septal or posterior wall thickness and ventricular mass) were associated with higher CSF phosphorylated (p)-tau and total (t)-tau levels, and poorer cognition. Tau pathologies mediated the heart-cognition relationships. Cardiac parameters were higher in stage 2 and suspected non-Alzheimer's pathology groups than controls. DISCUSSION These findings suggested close associations of subclinical cardiac changes with tau pathologies and cognition. HIGHLIGHTS Various subclinical alterations in the left heart related to poorer cognition. Subclinical cardiac changes related to tau pathologies in cognitively normal adults. Tau pathologies mediated the heart-cognition relationships. Subclinical cardiac changes related to the AD continuum, especially to stage 2. The accumulation of cardiac alterations magnified their damage to the brain.
Collapse
Affiliation(s)
- He‐Ying Hu
- Department of NeurologyQingdao Municipal Hospital, Qingdao UniversityQingdaoShandongChina
| | - Hao Hu
- Department of NeurologyQingdao Municipal Hospital, Qingdao UniversityQingdaoShandongChina
| | - Jing Jiang
- Department of Cardiac UltrasonographyQingdao Municipal Hospital, Qingdao UniversityQingdaoShandongChina
| | - Yan‐Lin Bi
- Department of AnesthesiologyQingdao Municipal Hospital, Qingdao UniversityQingdaoShandongChina
| | - Yan Sun
- Department of NeurologyQingdao Municipal Hospital, Qingdao UniversityQingdaoShandongChina
| | - Ya‐Nan Ou
- Department of NeurologyQingdao Municipal Hospital, Qingdao UniversityQingdaoShandongChina
| | - Lan Tan
- Department of NeurologyQingdao Municipal Hospital, Qingdao UniversityQingdaoShandongChina
| | - Jin‐Tai Yu
- Department of Neurology and National Center for Neurological DisordersHuashan Hospital, State Key Laboratory of Medical Neurobiology and MOE Frontiers Center for Brain Science, Shanghai Medical College, Fudan UniversityShanghaiChina
| |
Collapse
|
3
|
Salem AM, Mateti NR, Adedinsewo D, Demirer M, Youssef H, Anisetti B, Shourav MMI, Middlebrooks EH, Meschia JF, Brott TG, Lin MP. Differential associations between abnormal cardiac left ventricular geometry types and cerebral white matter disease. J Stroke Cerebrovasc Dis 2024; 33:107709. [PMID: 38570059 DOI: 10.1016/j.jstrokecerebrovasdis.2024.107709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 02/19/2024] [Accepted: 04/01/2024] [Indexed: 04/05/2024] Open
Abstract
OBJECTIVES Reduced cardiac outflow due to left ventricular hypertrophy has been suggested as a potential risk factor for development of cerebral white matter disease. Our study aimed to examine the correlation between left ventricular geometry and white matter disease volume to establish a clearer understanding of their relationship, as it is currently not well-established. METHODS Consecutive patients from 2016 to 2021 who were ≥18 years and underwent echocardiography, cardiac MRI, and brain MRI within one year were included. Four categories of left ventricular geometry were defined based on left ventricular mass index and relative wall thickness on echocardiography. White matter disease volume was quantified using an automated algorithm applied to axial T2 FLAIR images and compared across left ventricular geometry categories. RESULTS We identified 112 patients of which 34.8 % had normal left ventricular geometry, 20.5 % had eccentric hypertrophy, 21.4 % had concentric remodeling, and 23.2 % had concentric hypertrophy. White matter disease volume was highest in patients with concentric hypertrophy and concentric remodeling, compared to eccentric hypertrophy and normal morphology with a trend-P value of 0.028. Patients with higher relative wall thickness had higher white matter disease volume (10.73 ± 10.29 cc vs 5.89 ± 6.46 cc, P = 0.003), compared to those with normal relative wall thickness. CONCLUSION Our results showed that abnormal left ventricular geometry is associated with higher white matter disease burden, particularly among those with abnormal relative wall thickness. Future studies are needed to explore causative relationships and potential therapeutic options that may mediate the adverse left ventricular remodeling and its effect in slowing white matter disease progression.
Collapse
Affiliation(s)
- Amr M Salem
- Department of Neurology, Mayo Clinic, Jacksonville, FL, United States
| | - Nihas R Mateti
- Department of Neurology, Mayo Clinic, Jacksonville, FL, United States
| | | | - Mutlu Demirer
- Department of Radiology, Mayo Clinic, Jacksonville, FL, United States
| | - Hossam Youssef
- Department of Neurology, Mayo Clinic, Jacksonville, FL, United States
| | - Bhrugun Anisetti
- Department of Neurology, Mayo Clinic, Jacksonville, FL, United States
| | | | | | - James F Meschia
- Department of Neurology, Mayo Clinic, Jacksonville, FL, United States
| | - Thomas G Brott
- Department of Neurology, Mayo Clinic, Jacksonville, FL, United States
| | - Michelle P Lin
- Department of Neurology, Mayo Clinic, Jacksonville, FL, United States.
| |
Collapse
|
4
|
Avvisato R, Forzano I, Varzideh F, Mone P, Santulli G. A machine learning model identifies a functional connectome signature that predicts blood pressure levels: imaging insights from a large population of 35 882 patients. Cardiovasc Res 2023; 119:1458-1460. [PMID: 37093975 DOI: 10.1093/cvr/cvad065] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Accepted: 04/20/2023] [Indexed: 04/26/2023] Open
Affiliation(s)
- Roberta Avvisato
- Department of Medicine, Division of Cardiology, Wilf Family Cardiovascular Research Institute, Institute for Neuroimmunology and Inflammation (INI), Einstein Institute for Aging Research, Albert Einstein College of Medicine, New York City, 10461, New York, USA
- Department of Advanced Biomedical Sciences, International Translational Research and Medical Education (ITME) Academic Research Unit, 'Federico II' University, 80100, Naples, Italy
- Department of Molecular Pharmacology, Fleischer Institute for Diabetes and Metabolism (FIDAM), Einstein-Mount Sinai Diabetes Research Center (ES-DRC), Albert Einstein College of Medicine, New York City, 10461, New York, USA
| | - Imma Forzano
- Department of Advanced Biomedical Sciences, International Translational Research and Medical Education (ITME) Academic Research Unit, 'Federico II' University, 80100, Naples, Italy
| | - Fahimeh Varzideh
- Department of Molecular Pharmacology, Fleischer Institute for Diabetes and Metabolism (FIDAM), Einstein-Mount Sinai Diabetes Research Center (ES-DRC), Albert Einstein College of Medicine, New York City, 10461, New York, USA
| | - Pasquale Mone
- Department of Medicine, Division of Cardiology, Wilf Family Cardiovascular Research Institute, Institute for Neuroimmunology and Inflammation (INI), Einstein Institute for Aging Research, Albert Einstein College of Medicine, New York City, 10461, New York, USA
| | - Gaetano Santulli
- Department of Medicine, Division of Cardiology, Wilf Family Cardiovascular Research Institute, Institute for Neuroimmunology and Inflammation (INI), Einstein Institute for Aging Research, Albert Einstein College of Medicine, New York City, 10461, New York, USA
- Department of Advanced Biomedical Sciences, International Translational Research and Medical Education (ITME) Academic Research Unit, 'Federico II' University, 80100, Naples, Italy
- Department of Molecular Pharmacology, Fleischer Institute for Diabetes and Metabolism (FIDAM), Einstein-Mount Sinai Diabetes Research Center (ES-DRC), Albert Einstein College of Medicine, New York City, 10461, New York, USA
| |
Collapse
|
5
|
Das AS, Gokcal E, Regenhardt RW, Horn MJ, Schwab K, Daoud N, Viswanathan A, Kimberly WT, Goldstein JN, Biffi A, Rost N, Rosand J, Schwamm LH, Greenberg SM, Gurol ME. Improving detection of cerebral small vessel disease aetiology in patients with isolated lobar intracerebral haemorrhage. Stroke Vasc Neurol 2023; 8:26-33. [PMID: 35981809 PMCID: PMC9985798 DOI: 10.1136/svn-2022-001653] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Accepted: 07/19/2022] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND AND PURPOSE We evaluate whether non-haemorrhagic imaging markers (NHIM) (white matter hyperintensity patterns, lacunes and enlarged perivascular spaces (EPVS)) can discriminate cerebral amyloid angiopathy (CAA) from hypertensive cerebral small vessel disease (HTN-cSVD) among patients with isolated lobar intracerebral haemorrhage (isolated-LICH). METHODS In patients with isolated-LICH, four cSVD aetiologic groups were created by incorporating the presence/distribution of NHIM: HTN-cSVD pattern, CAA pattern, mixed NHIM and no NHIM. CAA pattern consisted of patients with any combination of severe centrum semiovale EPVS, lobar lacunes or multiple subcortical spots pattern. HTN-cSVD pattern consisted of any HTN-cSVD markers: severe basal ganglia PVS, deep lacunes or peribasal ganglia white matter hyperintensity pattern. Mixed NHIM consisted of at least one imaging marker from either pattern. Our hypothesis was that patients with HTN-cSVD pattern/mixed NHIM would have a higher frequency of left ventricular hypertrophy (LVH), which is associated with HTN-cSVD. RESULTS In 261 patients with isolated-LICH, CAA pattern was diagnosed in 93 patients, HTN-cSVD pattern in 53 patients, mixed NHIM in 19 patients and no NHIM in 96 patients. The frequency of LVH was similar among those with HTN-cSVD pattern and mixed NHIM (50% vs 39%, p=0.418) but was more frequent in HTN-cSVD pattern compared with CAA pattern (50% vs 20%, p<0.001). In a regression model, HTN-cSVD pattern (OR: 7.38; 95% CI 2.84 to 19.20) and mixed NHIM (OR: 4.45; 95% CI 1.25 to 15.90) were found to be independently associated with LVH. CONCLUSION Among patients with isolated-LICH, NHIM may help differentiate HTN-cSVD from CAA, using LVH as a marker for HTN-cSVD.
Collapse
Affiliation(s)
- Alvin S Das
- Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Elif Gokcal
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Robert W Regenhardt
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA.,Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Mitchell J Horn
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Kristin Schwab
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Nader Daoud
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Anand Viswanathan
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - W Taylor Kimberly
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Joshua N Goldstein
- Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Alessandro Biffi
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Natalia Rost
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Jonathan Rosand
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Lee H Schwamm
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Steven M Greenberg
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - M Edip Gurol
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| |
Collapse
|
6
|
Rouch L, Hoang T, Xia F, Sidney S, Lima JAC, Yaffe K. Twenty-Five-Year Change in Cardiac Structure and Function and Midlife Cognition: The CARDIA Study. Neurology 2022; 98:e1040-e1049. [PMID: 35082172 PMCID: PMC8967387 DOI: 10.1212/wnl.0000000000013249] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2021] [Accepted: 12/13/2021] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND AND OBJECTIVE The goal of this work was to determine whether midlife cardiac structure and function and their 25-year change from early to middle adulthood are associated with lower midlife cognition. METHODS We studied 2,653 participants from the Coronary Artery Risk Development in Young Adults (CARDIA) study (57% women, 46% Black). Echocardiograms were obtained at year 5, 25, and 30 visits (participant mean age 30, 50, and 55 years) to assess left ventricular (LV) mass (LVM), LV systolic function with LV ejection fraction (LVEF), and LV diastolic function with left atrial volume (LAV) and early peak mitral velocity (E)/early peak mitral annular velocity (e') ratio. LVM and LAV were indexed to body surface area (LVMi and LAVi). At year 30, 5 cognitive domains were measured: global cognition, processing speed, executive function, delayed verbal memory, and verbal fluency. We investigated the association between midlife (year 30) and 25-year change in cardiac structure and function on midlife cognition using linear regressions. RESULTS Over 25 years, LVMi and LAVi increased with mean change (SD) per year of 0.27 (0.28) g/m2 and 0.42 (0.15) mL/m2, while LVEF decreased by 0.11% (0.02%). After adjustment for demographics and education, 25-year increase (≥1 SD) in LVMi was associated with lower cognition on most tests (p ≤ 0.02); 25-year increase in LAVi was associated with lower global cognition (p = 0.04), but 25-year decrease in LVEF was not associated with cognition. Further adjustment for cardiovascular risk factors led to similar results. In addition, unlike year 30 E/e' ratio and LVEF, higher year 30 LVMi and LAVi were significantly associated with worse cognition on most cognitive tests. DISCUSSION Midlife cardiac structure and its change from early to middle adulthood are associated with lower midlife cognition even after accounting for confounders. Unlike systolic function, midlife LV diastolic function and its 25-year change were also linked to cognition. Our results provide information linking early to midlife cardiac structure and function to cognition.
Collapse
Affiliation(s)
- Laure Rouch
- From the Departments of Psychiatry (L.R., K.Y.), Neurology (K.Y.), and Epidemiology (K.Y.), University of California, San Francisco; Northern California Institute for Research and Education (T.H., F.X.), San Francisco; Kaiser Permanente Northern California (S.S.), Division of Research, Oakland; Johns Hopkins University School of Medicine (J.A.C.L.), Baltimore, MD; and San Francisco VA Medical Center (K.Y.), CA.
| | - Tina Hoang
- From the Departments of Psychiatry (L.R., K.Y.), Neurology (K.Y.), and Epidemiology (K.Y.), University of California, San Francisco; Northern California Institute for Research and Education (T.H., F.X.), San Francisco; Kaiser Permanente Northern California (S.S.), Division of Research, Oakland; Johns Hopkins University School of Medicine (J.A.C.L.), Baltimore, MD; and San Francisco VA Medical Center (K.Y.), CA
| | - Feng Xia
- From the Departments of Psychiatry (L.R., K.Y.), Neurology (K.Y.), and Epidemiology (K.Y.), University of California, San Francisco; Northern California Institute for Research and Education (T.H., F.X.), San Francisco; Kaiser Permanente Northern California (S.S.), Division of Research, Oakland; Johns Hopkins University School of Medicine (J.A.C.L.), Baltimore, MD; and San Francisco VA Medical Center (K.Y.), CA
| | - Stephen Sidney
- From the Departments of Psychiatry (L.R., K.Y.), Neurology (K.Y.), and Epidemiology (K.Y.), University of California, San Francisco; Northern California Institute for Research and Education (T.H., F.X.), San Francisco; Kaiser Permanente Northern California (S.S.), Division of Research, Oakland; Johns Hopkins University School of Medicine (J.A.C.L.), Baltimore, MD; and San Francisco VA Medical Center (K.Y.), CA
| | - Joao A C Lima
- From the Departments of Psychiatry (L.R., K.Y.), Neurology (K.Y.), and Epidemiology (K.Y.), University of California, San Francisco; Northern California Institute for Research and Education (T.H., F.X.), San Francisco; Kaiser Permanente Northern California (S.S.), Division of Research, Oakland; Johns Hopkins University School of Medicine (J.A.C.L.), Baltimore, MD; and San Francisco VA Medical Center (K.Y.), CA
| | - Kristine Yaffe
- From the Departments of Psychiatry (L.R., K.Y.), Neurology (K.Y.), and Epidemiology (K.Y.), University of California, San Francisco; Northern California Institute for Research and Education (T.H., F.X.), San Francisco; Kaiser Permanente Northern California (S.S.), Division of Research, Oakland; Johns Hopkins University School of Medicine (J.A.C.L.), Baltimore, MD; and San Francisco VA Medical Center (K.Y.), CA
| |
Collapse
|
7
|
Moore EE, Khan OA, Shashikumar N, Pechman KR, Liu D, Bell SP, Nair S, Terry JG, Gifford KA, Anderson AW, Landman BA, Blennow K, Zetterberg H, Hohman TJ, Carr JJ, Jefferson AL. Axonal Injury Partially Mediates Associations Between Increased Left Ventricular Mass Index and White Matter Damage. Stroke 2022; 53:808-816. [PMID: 34702069 PMCID: PMC8885768 DOI: 10.1161/strokeaha.121.034349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND AND PURPOSE Left ventricular (LV) mass index is a marker of subclinical LV remodeling that relates to white matter damage in aging, but molecular pathways underlying this association are unknown. This study assessed if LV mass index related to cerebrospinal fluid (CSF) biomarkers of microglial activation (sTREM2 [soluble triggering receptor expressed on myeloid cells 2]), axonal injury (NFL [neurofilament light]), neurodegeneration (total-tau), and amyloid-β, and whether these biomarkers partially accounted for associations between increased LV mass index and white matter damage. We hypothesized higher LV mass index would relate to greater CSF biomarker levels, and these pathologies would partially mediate associations with cerebral white matter microstructure. METHODS Vanderbilt Memory and Aging Project participants who underwent cardiac magnetic resonance, lumbar puncture, and diffusion tensor imaging (n=142, 72±6 years, 37% mild cognitive impairment [MCI], 32% APOE-ε4 positive, LV mass index 51.4±8.1 g/m2, NFL 1070±588 pg/mL) were included. Linear regressions and voxel-wise analyses related LV mass index to each biomarker and diffusion tensor imaging metrics, respectively. Follow-up models assessed interactions with MCI and APOE-ε4. In models where LV mass index significantly related to a biomarker and white matter microstructure, we assessed if the biomarker mediated white matter associations. RESULTS Among all participants, LV mass index was unrelated to CSF biomarkers (P>0.33). LV mass index interacted with MCI (P=0.01), such that higher LV mass index related to increased NFL among MCI participants. Associations were also present among APOE-ε4 carriers (P=0.02). NFL partially mediated up to 13% of the effect of increased LV mass index on white matter damage. CONCLUSIONS Subclinical cardiovascular remodeling, measured as an increase in LV mass index, is associated with neuroaxonal degeneration among individuals with MCI and APOE-ε4. Neuroaxonal degeneration partially reflects associations between higher LV mass index and white matter damage. Findings highlight neuroaxonal degeneration, rather than amyloidosis or microglia, may be more relevant in pathways between structural cardiovascular remodeling and white matter damage.
Collapse
Affiliation(s)
- Elizabeth E. Moore
- Vanderbilt Memory & Alzheimer’s Center, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Omair A. Khan
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Niranjana Shashikumar
- Vanderbilt Memory & Alzheimer’s Center, Vanderbilt University Medical Center, Nashville, TN, USA,Department of Neurology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Kimberly R. Pechman
- Vanderbilt Memory & Alzheimer’s Center, Vanderbilt University Medical Center, Nashville, TN, USA,Department of Neurology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Dandan Liu
- Vanderbilt Memory & Alzheimer’s Center, Vanderbilt University Medical Center, Nashville, TN, USA,Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Susan P. Bell
- Division of Cardiovascular Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Sangeeta Nair
- Department of Radiology & Radiological Sciences, Vanderbilt University Medical Center, Nashville, TN, USA
| | - James G. Terry
- Department of Radiology & Radiological Sciences, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Katherine A. Gifford
- Vanderbilt Memory & Alzheimer’s Center, Vanderbilt University Medical Center, Nashville, TN, USA,Department of Neurology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Adam W. Anderson
- Department of Biomedical Engineering, Vanderbilt University, Nashville, TN, USA
| | - Bennett A. Landman
- Department of Radiology & Radiological Sciences, Vanderbilt University Medical Center, Nashville, TN, USA,Department of Biomedical Engineering, Vanderbilt University, Nashville, TN, USA,Department of Electrical Engineering and Computer Science, Vanderbilt University, Nashville, TN, USA
| | - Kaj Blennow
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, The Sahlgrenska Academy at University of Gothenburg, Mölndal, Sweden,Clinical Neurochemistry Lab, Sahlgrenska University Hospital, Mölndal, Sweden
| | - Henrik Zetterberg
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, The Sahlgrenska Academy at University of Gothenburg, Mölndal, Sweden,Clinical Neurochemistry Lab, Sahlgrenska University Hospital, Mölndal, Sweden,Department of Neurodegenerative Disease, University of College London Institute of Neurology, Queen Square, London, UK,United Kingdom Dementia Research Institute at University College London, London, UK
| | - Timothy J. Hohman
- Vanderbilt Memory & Alzheimer’s Center, Vanderbilt University Medical Center, Nashville, TN, USA,Department of Neurology, Vanderbilt University Medical Center, Nashville, TN, USA,Vanderbilt Genetics Institute, Vanderbilt University Medical Center, Nashville, TN, USA
| | - John Jeffrey Carr
- Department of Radiology & Radiological Sciences, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Angela L. Jefferson
- Vanderbilt Memory & Alzheimer’s Center, Vanderbilt University Medical Center, Nashville, TN, USA,Department of Neurology, Vanderbilt University Medical Center, Nashville, TN, USA,Division of Cardiovascular Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| |
Collapse
|
8
|
Moncion K, Rodrigues L, MacKay-Lyons M, Eng JJ, Billinger SA, Ploughman M, Bailey DM, Trivino M, Bayley M, Thiel A, Roig M, Tang A. Exercise-Based Stroke Rehabilitation: Clinical Considerations Following the COVID-19 Pandemic. Neurorehabil Neural Repair 2022; 36:3-16. [PMID: 34711094 PMCID: PMC8721549 DOI: 10.1177/15459683211054175] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Background. The COVID-19 pandemic attributable to the severe acute respiratory syndrome virus (SARS-CoV-2) has had a significant and continuing impact across all areas of healthcare including stroke. Individuals post-stroke are at high risk for infection, disease severity, and mortality after COVID-19 infection. Exercise stroke rehabilitation programs remain critical for individuals recovering from stroke to mitigate risk factors and morbidity associated with the potential long-term consequences of COVID-19. There is currently no exercise rehabilitation guidance for people post-stroke with a history of COVID-19 infection. Purpose. To (1) review the multi-system pathophysiology of COVID-19 related to stroke and exercise; (2) discuss the multi-system benefits of exercise for individuals post-stroke with suspected or confirmed COVID-19 infection; and (3) provide clinical considerations related to COVID-19 for exercise during stroke rehabilitation. This article is intended for healthcare professionals involved in the implementation of exercise rehabilitation for individuals post-stroke who have suspected or confirmed COVID-19 infection and non-infected individuals who want to receive safe exercise rehabilitation. Results. Our clinical considerations integrate pre-COVID-19 stroke (n = 2) and COVID-19 exercise guidelines for non-stroke populations (athletic [n = 6], pulmonary [n = 1], cardiac [n = 2]), COVID-19 pathophysiology literature, considerations of stroke rehabilitation practices, and exercise physiology principles. A clinical decision-making tool for COVID-19 screening and eligibility for stroke exercise rehabilitation is provided, along with key subjective and physiological measures to guide exercise prescription. Conclusion. We propose that this framework promotes safe exercise programming within stroke rehabilitation for COVID-19 and future infectious disease outbreaks.
Collapse
Affiliation(s)
- Kevin Moncion
- School of Rehabilitation Science, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Lynden Rodrigues
- Memory and Motor Rehabilitation Laboratory, Feil and Oberfeld Research Centre, Jewish Rehabilitation Hospital, Montreal Centre for Interdisciplinary Research in Rehabilitation, Laval, QC, Canada
- School of Physical and Occupational Therapy, Faculty of Medicine, McGill University, Montreal, QC, Canada
| | - Marilyn MacKay-Lyons
- School of Physiotherapy, Faculty of Health, Dalhousie University, Halifax, NS, Canada
| | - Janice J. Eng
- Department of Physical Therapy, University of British Columba and Rehabilitation Research Program, GF Strong Rehab Centre, Vancouver, BC, Canada
- Department of Physical Therapy and Rehabilitation Science, University of Kansas Medical Center, Kansas City, KS, USA
| | - Sandra A. Billinger
- Department of Physical Therapy and Rehabilitation Science, University of Kansas Medical Center, Kansas City, KS, USA
- University of Kansas Alzheimer’s Disease Center, Fairway, KS, USA
- Department of Neurology, University of Kansas Medical Center, Kansas City, KS, USA
| | - Michelle Ploughman
- Recovery and Performance Laboratory, BioMedical Sciences, Faculty of Medicine, Memorial University of Newfoundland, St. John’s, NL, Canada
| | - Damian M. Bailey
- Neurovascular Research Laboratory, University of South Wales Faculty of Life Sciences and Education, Pontypridd, UK
| | - Michael Trivino
- Jewish Rehabilitation Hospital, Montreal Centre for Interdisciplinary Research in Rehabilitation, Laval, QC, Canada
| | - Mark Bayley
- Division of Physical Medicine and Rehabilitation, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- KITE Research Institute, Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
| | - Alexander Thiel
- Jewish General Hospital Lady Davis Institute for Medical Research, Montreal, QC, Canada
- Department of Neurology and Neurosurgery, McGill University, Montreal, QC, Canada
| | - Marc Roig
- Memory and Motor Rehabilitation Laboratory, Feil and Oberfeld Research Centre, Jewish Rehabilitation Hospital, Montreal Centre for Interdisciplinary Research in Rehabilitation, Laval, QC, Canada
- School of Physical and Occupational Therapy, Faculty of Medicine, McGill University, Montreal, QC, Canada
| | - Ada Tang
- School of Rehabilitation Science, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| |
Collapse
|
9
|
Barbieri A, Albini A, Maisano A, De Mitri G, Camaioni G, Bonini N, Mantovani F, Boriani G. Clinical Value of Complex Echocardiographic Left Ventricular Hypertrophy Classification Based on Concentricity, Mass, and Volume Quantification. Front Cardiovasc Med 2021; 8:667984. [PMID: 33987213 PMCID: PMC8110723 DOI: 10.3389/fcvm.2021.667984] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Accepted: 03/24/2021] [Indexed: 12/28/2022] Open
Abstract
Echocardiography is the most validated, non-invasive and used approach to assess left ventricular hypertrophy (LVH). Alternative methods, specifically magnetic resonance imaging, provide high cost and practical challenges in large scale clinical application. To include a wide range of physiological and pathological conditions, LVH should be considered in conjunction with the LV remodeling assessment. The universally known 2-group classification of LVH only considers the estimation of LV mass and relative wall thickness (RWT) to be classifying variables. However, knowledge of the 2-group patterns provides particularly limited incremental prognostic information beyond LVH. Conversely, LV enlargement conveys independent prognostic utility beyond LV mass for incident heart failure. Therefore, a 4-group LVH subdivision based on LV mass, LV volume, and RWT has been recently suggested. This novel LVH classification is characterized by distinct differences in cardiac function, allowing clinicians to distinguish between different LV hemodynamic stress adaptations in various cardiovascular diseases. The new 4-group LVH classification has the advantage of optimizing the LVH diagnostic approach and the potential to improve the identification of maladaptive responses that warrant targeted therapy. In this review, we summarize the current knowledge on clinical value of this refinement of the LVH classification, emphasizing the role of echocardiography in applying contemporary proposed indexation methods and partition values.
Collapse
Affiliation(s)
- Andrea Barbieri
- Division of Cardiology, Department of Diagnostics, Clinical and Public Health Medicine, Policlinico University Hospital of Modena, University of Modena and Reggio Emilia, Modena, Italy
| | - Alessandro Albini
- Division of Cardiology, Department of Diagnostics, Clinical and Public Health Medicine, Policlinico University Hospital of Modena, University of Modena and Reggio Emilia, Modena, Italy
| | - Anna Maisano
- Division of Cardiology, Department of Diagnostics, Clinical and Public Health Medicine, Policlinico University Hospital of Modena, University of Modena and Reggio Emilia, Modena, Italy
| | - Gerardo De Mitri
- Division of Cardiology, Department of Diagnostics, Clinical and Public Health Medicine, Policlinico University Hospital of Modena, University of Modena and Reggio Emilia, Modena, Italy
| | - Giovanni Camaioni
- Division of Cardiology, Department of Diagnostics, Clinical and Public Health Medicine, Policlinico University Hospital of Modena, University of Modena and Reggio Emilia, Modena, Italy
| | - Niccolò Bonini
- Division of Cardiology, Department of Diagnostics, Clinical and Public Health Medicine, Policlinico University Hospital of Modena, University of Modena and Reggio Emilia, Modena, Italy
| | | | - Giuseppe Boriani
- Division of Cardiology, Department of Diagnostics, Clinical and Public Health Medicine, Policlinico University Hospital of Modena, University of Modena and Reggio Emilia, Modena, Italy
| |
Collapse
|
10
|
Jiang X, Guo Y, Zhao Y, Gao X, Peng D, Zhang H, Deng W, Fu W, Qin N, Chang R, Manor B, Lipsitz LA, Zhou J. Multiscale Dynamics of Blood Pressure Fluctuation Is Associated With White Matter Lesion Burden in Older Adults With and Without Hypertension: Observations From a Pilot Study. Front Cardiovasc Med 2021; 8:636702. [PMID: 33718456 PMCID: PMC7952298 DOI: 10.3389/fcvm.2021.636702] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Accepted: 01/25/2021] [Indexed: 01/17/2023] Open
Abstract
Background: White matter lesions (WMLs) are highly prevalent in older adults, and hypertension is one of the main contributors to WMLs. The blood pressure (BP) is regulated by complex underlying mechanisms over multiple time scales, thus the continuous beat-to-beat BP fluctuation is complex. The association between WMLs and hypertension may be manifested as diminished complexity of BP fluctuations. The aim of this pilot study is to explore the relationships between hypertension, BP complexity, and WMLs in older adults. Method: Fifty-three older adults with clinically diagnosed hypertension and 47 age-matched older adults without hypertension completed one MRI scan and one BP recording of 10-15 min when sitting quietly. Their cerebral WMLs were assessed by two neurologists using the Fazekas scale based on brain structural MRI of each of their own. Greater score reflected higher WML grade. The complexity of continuous systolic (SBP) and diastolic (DBP) BP series was quantified using multiscale entropy (MSE). Lower MSE reflected lower complexity. Results: Compared to the non-hypertensive group, hypertensives had significantly greater Fazekas scores (F > 5.3, p < 0.02) and lower SBP and DBP complexity (F > 8.6, p < 0.004). Both within each group (β < -0.42, p < 0.01) and across groups (β < -0.47, p < 0.003), those with lower BP complexity had higher Fazekas score. Moreover, complexity of both SBP and DBP mediated the influence of hypertension on WMLs (indirect effects > 0.25, 95% confidence intervals = 0.06 - 0.50). Conclusion: These results suggest that diminished BP complexity is associated with WMLs and may mediate the influence of hypertension on WMLs. Future longitudinal studies are needed to examine the causal relationship between BP complexity and WMLs.
Collapse
Affiliation(s)
- Xin Jiang
- Department of Geriatrics, Shenzhen People's Hospital, Shenzhen, China.,The Second Clinical Medical College, Jinan University, Shenzhen, China.,The First Affiliated Hospital, Southern University of Science and Technology, Shenzhen, China
| | - Yi Guo
- The Second Clinical Medical College, Jinan University, Shenzhen, China.,The First Affiliated Hospital, Southern University of Science and Technology, Shenzhen, China.,Department of Neurology, Shenzhen People's Hospital, Shenzhen, China.,Shenzhen Bay Laboratory, Shenzhen, China
| | - Yue Zhao
- Department of Electrical and Computer Engineering, University of Rochester, Rochester, NY, United States
| | - Xia Gao
- Department of Geriatrics, Shenzhen People's Hospital, Shenzhen, China.,The Second Clinical Medical College, Jinan University, Shenzhen, China.,The First Affiliated Hospital, Southern University of Science and Technology, Shenzhen, China
| | - Dan Peng
- Department of Geriatrics, Shenzhen People's Hospital, Shenzhen, China.,The Second Clinical Medical College, Jinan University, Shenzhen, China.,The First Affiliated Hospital, Southern University of Science and Technology, Shenzhen, China
| | - Hui Zhang
- The Second Clinical Medical College, Jinan University, Shenzhen, China.,The First Affiliated Hospital, Southern University of Science and Technology, Shenzhen, China.,Department of Neurology, Shenzhen People's Hospital, Shenzhen, China
| | - Wuhong Deng
- Department of Geriatrics, Shenzhen People's Hospital, Shenzhen, China.,The Second Clinical Medical College, Jinan University, Shenzhen, China.,The First Affiliated Hospital, Southern University of Science and Technology, Shenzhen, China
| | - Wen Fu
- Department of Geriatrics, Shenzhen People's Hospital, Shenzhen, China.,The Second Clinical Medical College, Jinan University, Shenzhen, China.,The First Affiliated Hospital, Southern University of Science and Technology, Shenzhen, China
| | - Na Qin
- Department of Geriatrics, Shenzhen People's Hospital, Shenzhen, China.,The Second Clinical Medical College, Jinan University, Shenzhen, China.,The First Affiliated Hospital, Southern University of Science and Technology, Shenzhen, China
| | - Ruizhen Chang
- Department of Geriatrics, Shenzhen People's Hospital, Shenzhen, China.,The Second Clinical Medical College, Jinan University, Shenzhen, China.,The First Affiliated Hospital, Southern University of Science and Technology, Shenzhen, China
| | - Brad Manor
- Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, MA, United States.,Division of Gerontology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, United States
| | - Lewis A Lipsitz
- Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, MA, United States.,Division of Gerontology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, United States
| | - Junhong Zhou
- Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, MA, United States.,Division of Gerontology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, United States
| |
Collapse
|
11
|
Bella JN. Mediation Effect of Left Ventricular Geometric Adaptation to Lifetime Blood Pressure on Cognitive Function in Middle-Age: The Heart-Brain Connection (Partially) Explained. Circ Cardiovasc Imaging 2020; 13:e011325. [PMID: 32772574 DOI: 10.1161/circimaging.120.011325] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Jonathan N Bella
- BronxCare Health System and Icahn School of Medicine of Mount Sinai, Bronx, NY
| |
Collapse
|
12
|
Papadopoulos A, Palaiopanos K, Protogerou AP, Paraskevas GP, Tsivgoulis G, Georgakis MK. Left Ventricular Hypertrophy and Cerebral Small Vessel Disease: A Systematic Review and Meta-Analysis. J Stroke 2020; 22:206-224. [PMID: 32635685 PMCID: PMC7341009 DOI: 10.5853/jos.2019.03335] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Accepted: 03/06/2020] [Indexed: 12/30/2022] Open
Abstract
Background and Purpose Left ventricular hypertrophy (LVH) is associated with the risk of stroke and dementia independently of other vascular risk factors, but its association with cerebral small vessel disease (CSVD) remains unknown. Here, we employed a systematic review and meta-analysis to address this gap. Methods Following the MOOSE guidelines (PROSPERO protocol: CRD42018110305), we systematically searched the literature for studies exploring the association between LVH or left ventricular (LV) mass, with neuroimaging markers of CSVD (lacunes, white matter hyperintensities [WMHs], cerebral microbleeds [CMBs]). We evaluated risk of bias and pooled association estimates with random-effects meta-analyses. Results We identified 31 studies (n=25,562) meeting our eligibility criteria. In meta-analysis, LVH was associated with lacunes and extensive WMHs in studies of the general population (odds ratio [OR]lacunes, 1.49; 95% confidence interval [CI], 1.12 to 2.00) (ORWMH, 1.73; 95% CI, 1.38 to 2.17) and studies in high-risk populations (ORlacunes: 2.39; 95% CI, 1.32 to 4.32) (ORWMH, 2.01; 95% CI, 1.45 to 2.80). The results remained stable in general population studies adjusting for hypertension and other vascular risk factors, as well as in sub-analyses by LVH assessment method (echocardiography/electrocardiogram), study design (cross-sectional/cohort), and study quality. Across LV morphology patterns, we found gradually increasing ORs for concentric remodelling, eccentric hypertrophy, and concentric hypertrophy, as compared to normal LV geometry. LVH was further associated with CMBs in high-risk population studies. Conclusions LVH is associated with neuroimaging markers of CSVD independently of hypertension and other vascular risk factors. Our findings suggest LVH as a novel risk factor for CSVD and highlight the link between subclinical heart and brain damage.
Collapse
Affiliation(s)
| | | | - Athanasios P Protogerou
- Cardiovascular Prevention and Research Unit, Department of Pathophysiology, National and Kapodistrian University of Athens, Athens, Greece
| | - George P Paraskevas
- Cognitive and Movement Disorders Unit and Unit of Neurochemistry and Biological Markers, First Department of Neurology, Eginition University Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Georgios Tsivgoulis
- Second Department of Neurology, Attikon Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece.,Department of Neurology, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Marios K Georgakis
- Institute for Stroke and Dementia Research, LMU University Hospital, Ludwig-Maximilians-University (LMU), Munich, Germany
| |
Collapse
|
13
|
Jung E, Lee SY, Park JH, Ro YS, Hong KJ, Song KJ, Ryu HH, Shin SD. Interaction Effects Between Targeted Temperature Management and Hypertension on Survival Outcomes After Out-of-Hospital Cardiac Arrest: A National Observational Study from 2009 to 2016. Ther Hypothermia Temp Manag 2019; 10:141-147. [PMID: 31414970 DOI: 10.1089/ther.2019.0015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Targeted temperature management (TTM) has been used to improve neurological recovery in comatose patients after out-of-hospital cardiac arrest (OHCA). Hypertension (HTN) existing before a cardiac arrest represents a risk of OHCA, but it is not known whether it affects neurological prognosis. This study aimed at investigating the effect of TTM on neurological recovery in OHCA patients with or without underlying HTN. This study was conducted by using the national cardiac arrest registry of OHCA patients with presumed cardiac etiology between 2009 and 2016. The endpoint was cerebral performance category (CPC) 1 and 2 at discharge. We compared outcomes between the TTM and non-TTM groups by using multivariable logistic regression with an interaction term between TTM and HTN for calculating adjusted odd ratios (AORs) and 95% confidence intervals (CIs) after adjusting for potential confounders. Among the 25,985 patients with OHCA who survived till hospital admission, TTM was performed on 12.2%. The TTM group showed better outcomes than the non-TTM group: 28.1% versus 15.5% for good neurologic recovery (p < 0.01). The AOR of TTM for good neurological recovery for all study groups was 1.65 (1.47-1.85). In the interaction model, the AOR of TTM for good neurological recovery was 1.87 (1.26-2.76) in patients without HTN and 0.87 (0.75-1.02) in patients with HTN. The underlying HTN modified the effect of TTM on neurological outcomes for OHCA patients. TTM is associated with good neurological recovery in patients without HTN, but not in patients with HTN.
Collapse
Affiliation(s)
- Eujene Jung
- Department of Emergency Medicine, Chonnam National University Hospital, Gwangju, Republic of Korea
| | - Sun Young Lee
- Department of Emergency Medicine, Seoul National University College of Medicine, Jongno-gu, Republic of Korea
| | - Jeong Ho Park
- Department of Emergency Medicine, Seoul National University College of Medicine, Jongno-gu, Republic of Korea
| | - Young Sun Ro
- Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, Republic of Korea
| | - Ki Jeong Hong
- Department of Emergency Medicine, Seoul National University College of Medicine, Jongno-gu, Republic of Korea
| | - Kyoung Jun Song
- Department of Emergency Medicine, Seoul National University College of Medicine, Jongno-gu, Republic of Korea
| | - Hyun Ho Ryu
- Department of Emergency Medicine, Chonnam National University Hospital, Gwangju, Republic of Korea
| | - Sang Do Shin
- Department of Emergency Medicine, Seoul National University College of Medicine, Jongno-gu, Republic of Korea
| |
Collapse
|
14
|
Li Y, Yu G, Liu L, Long J, Su S, Zhao T, Liu W, Shen S, Niu X. Rosiglitazone attenuates cell apoptosis through antioxidative and anti-apoptotic pathways in the hippocampi of spontaneously hypertensive rats. Int J Mol Med 2018; 43:693-700. [PMID: 30483729 DOI: 10.3892/ijmm.2018.3991] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2018] [Accepted: 09/27/2018] [Indexed: 12/13/2022] Open
Abstract
Oxidative stress serves an important role in hypertensive brain damage. Peroxisome proliferator‑activated receptor γ (PPAR‑γ) agonists possess antioxidative and anti‑apoptotic effects. The present study verified the possibility that rosiglitazone serves a neuroprotective role by alleviating oxidative stress and cell apoptosis in the hippocampi of spontaneously hypertensive rats (SHRs). SHRs and age‑matched Wistar‑Kyoto (WKY; both 56 weeks old) rats received gavage administration of vehicle or rosiglitazone (5 mg/kg/day) for eight weeks. Systolic blood pressure (SBP) was measured by the indirect tail‑cuff method. The expression ratio of activated astrocytes was analyzed by glial fibrillary acidic protein immunohistochemistry. PPAR‑γ, inducible nitric oxide synthase (iNOS), gp47phox, B‑cell lymphoma 2 (Bcl‑2), Bcl‑2‑associated X protein (Bax) and caspase‑3 expression were investigated by quantitative polymerase chain reaction and western blot analysis. The number of apoptotic cells in the hippocampus of four groups was detected using the terminal deoxynucleotidyl transferase‑mediated dUTP end‑labeling (TUNEL) method. Compared with the WKY group, the SHR group exhibited decreased Bcl‑2 and PPAR‑γ expression, increased SBP, increased ratio of activated astrocytes and TUNEL‑positive cells, increased expression of iNOS, gp47phox, caspase‑3 and Bax. Rosiglitazone administration increased Bcl‑2 and PPAR‑γ expression, decreased the ratio of activated astrocytes and TUNEL‑positive cells, decreased iNOS, gp47phox, caspase‑3 and Bax expression in the hippocampi of SHRs. However, rosiglitazone did not significantly decreased SBP in the SHR group. Therefore, rosiglitazone exerts neuroprotective effect through antioxidative and anti‑apoptotic pathways, which was independent of blood pressure control.
Collapse
Affiliation(s)
- Yali Li
- Department of Rehabilitation, Weihai Municipal Hospital, Weihai, Shandong 264200, P.R. China
| | - Guanghu Yu
- Department of Rehabilitation, Weihai Municipal Hospital, Weihai, Shandong 264200, P.R. China
| | - Lijuan Liu
- Department of Rehabilitation, Weihai Municipal Hospital, Weihai, Shandong 264200, P.R. China
| | - Jun Long
- Department of Rehabilitation, Weihai Municipal Hospital, Weihai, Shandong 264200, P.R. China
| | - Shujie Su
- Department of Rehabilitation, Weihai Municipal Hospital, Weihai, Shandong 264200, P.R. China
| | - Ting Zhao
- Department of Rehabilitation, Weihai Municipal Hospital, Weihai, Shandong 264200, P.R. China
| | - Wenjin Liu
- Department of Rehabilitation, Weihai Municipal Hospital, Weihai, Shandong 264200, P.R. China
| | - Shunji Shen
- Department of Rehabilitation, Weihai Municipal Hospital, Weihai, Shandong 264200, P.R. China
| | - Xiaolin Niu
- Department of Cardiology, The Second Affiliated Hospital, School of Medicine, Xi'an Jiaotong University, Xi'an, Shanxi 710004, P.R. China
| |
Collapse
|
15
|
Wang Z, Zhang C, Bao H, Huang X, Fan F, Zhao Y, Li J, Chen J, Hong K, Li P, Wu Y, Wu Q, Wang B, Xu X, Li Y, Huo Y, Cheng X. Value of electrocardiographic left ventricular hypertrophy as a predictor of poor blood pressure control: Evidence from the China stroke primary prevention trial. Medicine (Baltimore) 2018; 97:e12966. [PMID: 30383646 PMCID: PMC6221643 DOI: 10.1097/md.0000000000012966] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Recent studies have shown that hypertension is poorly controlled in many populations worldwide. Electrocardiographic left ventricular hypertrophy is a common manifestation of preclinical cardiovascular disease that strongly predicts cardiovascular disease morbidity and mortality. However, little information is available regarding the role of left ventricular hypertrophy in blood pressure (BP) control. We aimed to assess the relationship between electrocardiographic left ventricular hypertrophy and BP control in the China Stroke Primary Prevention Trial. The study population included 17,312 hypertensive patients who were selected from a group of 20,702 adults who had participated in the China Stroke Primary Prevention Trial and had undergone electrocardiography at baseline visit. Multivariate analysis identified left ventricular hypertrophy as a predictor of unsatisfactory BP control. The results revealed that 8.1% of hypertensive adults exhibit left ventricular hypertrophy and that the disease is more prevalent in males (12.8%) than in females. Multivariate regression analysis showed that the electrocardiographic left ventricular hypertrophy group had a significantly higher rate of unsatisfactory BP control [odds ratio (OR) 1.42, 95% confidence interval (95% CI) 1.26-1.61, P < .001) than the nonleft ventricular hypertrophy group.Notable differences in BP control were also observed among males (OR 1.37, 95% CI 1.17-1.60, P < .001) and females (OR 1.45, 95% CI 1.18-1.77, P < .001) and especially among patients with comorbid diabetes (OR 2.32, 95% CI 1.31-4.12, P = .004). In conclusion, the results of this study indicate that electrocardiographic left ventricular hypertrophy appears to be an independent predictive factor for poor BP control, especially in females and patients with comorbid diabetes.
Collapse
Affiliation(s)
- Zhenzhen Wang
- Department of Cardiovascular Medicine, the Second Affiliated Hospital of Nanchang University, Nanchang
| | - Chunyan Zhang
- Department of Neurology, the Second Hospital, Shanxi Medical University, Shanxi
| | - Huihui Bao
- Department of Cardiovascular Medicine, the Second Affiliated Hospital of Nanchang University, Nanchang
| | - Xiao Huang
- Department of Cardiovascular Medicine, the Second Affiliated Hospital of Nanchang University, Nanchang
| | - Fangfang Fan
- Department of Cardiology, Peking University First Hospital, Beijing
| | - Yan Zhao
- Department of Cardiovascular Medicine, XinHua Hospital Affiliated with Shanghai Jiao Tong University School of Medicine, Shanghai
| | - Juxiang Li
- Department of Cardiovascular Medicine, the Second Affiliated Hospital of Nanchang University, Nanchang
| | - Jing Chen
- Department of Cardiovascular Medicine, the Second Affiliated Hospital of Nanchang University, Nanchang
| | - Kui Hong
- Department of Cardiovascular Medicine, the Second Affiliated Hospital of Nanchang University, Nanchang
| | - Ping Li
- Department of Cardiovascular Medicine, the Second Affiliated Hospital of Nanchang University, Nanchang
| | - Yanqing Wu
- Department of Cardiovascular Medicine, the Second Affiliated Hospital of Nanchang University, Nanchang
| | - Qinghua Wu
- Department of Cardiovascular Medicine, the Second Affiliated Hospital of Nanchang University, Nanchang
| | - Binyan Wang
- National Clinical Research Study Center for Kidney Disease; State Key Laboratory for Organ Failure Research; Renal Division, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Xiping Xu
- National Clinical Research Study Center for Kidney Disease; State Key Laboratory for Organ Failure Research; Renal Division, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Yigang Li
- Department of Cardiovascular Medicine, XinHua Hospital Affiliated with Shanghai Jiao Tong University School of Medicine, Shanghai
| | - Yong Huo
- Department of Cardiology, Peking University First Hospital, Beijing
| | - Xiaoshu Cheng
- Department of Cardiovascular Medicine, the Second Affiliated Hospital of Nanchang University, Nanchang
| |
Collapse
|
16
|
Wang H, Wang S, Yi X, Tao Y, Qian H, Jia P, Chen Y, Sun Y. Estimate of ischemic stroke prevalence according to a novel 4-tiered classification of left ventricular hypertrophy: insights from the general Chinese population. Ann Med 2018; 50:519-528. [PMID: 30001637 DOI: 10.1080/07853890.2018.1500702] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Recently, a novel 4-tiered classification of left ventricular hypertrophy (LVH) based on ventricular dilatation (indexed LV end-diastolic volume [EDV]) and concentricity (mass/EDV0.67) has improved all-cause and cardiovascular mortality risk stratification. However, their possible association with ischemic stroke has not been extensively evaluated in the general population. METHODS We evaluated a cross-sectional study of 11,037 subjects from the general population of China in whom echocardiographic and ischemic stroke data were available to subdivide patients with LVH into four geometric patterns: indeterminate, dilated, thick and both thick and dilated hypertrophy. RESULTS Compared with normal LV geometry, indeterminate and thick hypertrophy showed a higher prevalence of ischemic stroke (p < .05). Ischemic stroke was significantly greater in participants with indeterminate (adjusted odd ratio [OR]:1.635, 95% confidence interval [CI]: 1.115-2.398) and thick (2.143 [1.329-3.456]) hypertrophy but not significantly in those with dilated (1.251 [0.803-1.950]) and both thick and dilated hypertrophy (0.926 [0.435-1.971]) compared with normal geometry in multivariable analysis. CONCLUSIONS Indeterminate and thick hypertrophy were significantly associated with the presence of ischemic stroke in the general Chinese population. The new 4-tiered categorization of LVH can permit a better understanding of which subjects are at high enough risk for ischemic stroke to warrant early targeted therapy. Key messages This was the first study to investigate whether a 4-tiered classification of LVH defines subgroups in the general population that are at variable risks of ischemic stroke. We identified that thick hypertrophy carried the greatest odd for ischemic stroke, independently of traditional risk factors, followed by indeterminate hypertrophy. The new 4-tiered categorization of LVH emerged as a valuable operational approach, a potential alternative to LVM, to refine ischemic stroke stratification in general population.
Collapse
Affiliation(s)
- Haoyu Wang
- a Department of Cardiology , The First Hospital of China Medical University , Shenyang , Liaoning , China
| | - Shuze Wang
- b Department of Computational Medicine and Bioinformatics , University of Michigan , Ann Arbor , MI , USA
| | - Xin Yi
- c Department of Cardiovascular Medicine , Beijing Moslem Hospital , Beijing , China
| | - Yining Tao
- d Department of Radiology , Shanghai Jiao Tong University Affiliated Sixth People's Hospital , Shanghai , China
| | - Hao Qian
- a Department of Cardiology , The First Hospital of China Medical University , Shenyang , Liaoning , China
| | - Pengyu Jia
- a Department of Cardiology , The First Hospital of China Medical University , Shenyang , Liaoning , China
| | - Yintao Chen
- e Department of Cardiovascular Medicine , The First Affiliated Hospital of Chongqing Medical University , Chongqing , China
| | - Yingxian Sun
- a Department of Cardiology , The First Hospital of China Medical University , Shenyang , Liaoning , China
| |
Collapse
|
17
|
Dobkowska-Chudon W, Wrobel M, Karlowicz P, Dabrowski A, Krupienicz A, Targowski T, Nowicki A, Olszewski R. Detecting cerebrovascular changes in the brain caused by hypertension in atrial fibrillation group using acoustocerebrography. PLoS One 2018; 13:e0199999. [PMID: 29979716 PMCID: PMC6034798 DOI: 10.1371/journal.pone.0199999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2017] [Accepted: 06/18/2018] [Indexed: 11/23/2022] Open
Abstract
Acoustocerebrography is a novel, non-invasive, transcranial ultrasonic diagnostic method based on the transmission of multispectral ultrasound signals propagating through the brain tissue. Dedicated signal processing enables the estimation of absorption coefficient, frequency-dependent attenuation, speed of sound and tissue elasticity. Hypertension and atrial fibrillation are well known factors correlated with white matter lesions, intracerebral hemorrhage and cryptogenic stroke numbers. The aim of this study was to compare the acoustocerebrography signal in the brains of asymptomatic atrial fibrillation patients with and without hypertension. The study included 97 asymptomatic patients (40 female and 57 male, age 66.26 ± 6.54 years) who were clinically monitored for atrial fibrillation. The patients were divided into two groups: group I (patients with hypertension) n = 75, and group II (patients without hypertension) n = 22. Phase and amplitude of all spectral components for the received signals from the brain path were extracted and compared to the phase and amplitude of the transmitted pulse. Next, the time of flight and the attenuation of each frequency component were calculated. Additionally, a fast Fourier transformation was performed and its features were extracted. After introducing a machine learning technique, the ROC plot of differentiations between group I and group II with an AUC of 0.958 (sensitivity 0.99 and specificity 0.968) was obtained. It can be assumed that the significant difference in the acoustocerebrography signals in patients with hypertension is due to changes in the brain tissue, and it allows for the differentiating of high-risk patients with asymptomatic atrial fibrillation and hypertension.
Collapse
Affiliation(s)
| | | | | | | | | | - Tomasz Targowski
- Department of Geriatrics, National Institute of Geriatrics, Rheumatology and Rehabilitation, Warsaw, Poland
| | - Andrzej Nowicki
- IPPT, Polish Academy of Science, Department of Ultrasound, Warsaw, Poland
| | - Robert Olszewski
- Department of Geriatrics, National Institute of Geriatrics, Rheumatology and Rehabilitation, Warsaw, Poland
- IPPT, Polish Academy of Science, Department of Ultrasound, Warsaw, Poland
| |
Collapse
|
18
|
Orgah JO, Yu J, Zhao T, Wang L, Yang M, Zhang Y, Fan G, Zhu Y. Danhong Injection Reversed Cardiac Abnormality in Brain-Heart Syndrome via Local and Remote β-Adrenergic Receptor Signaling. Front Pharmacol 2018; 9:692. [PMID: 30018549 PMCID: PMC6037833 DOI: 10.3389/fphar.2018.00692] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Accepted: 06/07/2018] [Indexed: 12/18/2022] Open
Abstract
Ischemic brain injury impacts cardiac dysfunction depending on the part of the brain affected, with a manifestation of irregular blood pressure, arrhythmia, and heart failure. Generally called brain–heart syndrome in traditional Chinese medicine, few mechanistic understanding and treatment options are available at present. We hypothesize that considering the established efficacy for both ischemic stroke and myocardial infarction (MI), Danhong injection (DHI), a multicomponent Chinese patent medicine, may have a dual pharmacological potential for treating the brain–heart syndrome caused by cerebral ischemic stroke through its multi-targeted mechanisms. We investigated the role of DHI in the setting of brain–heart syndrome and determined the mechanism by which it regulates this process. We induced Ischemia/Reperfusion in Wistar rats and administered intravenous dose of DHI twice daily for 14 days. We assessed the neurological state, infarct volume, CT scan, arterial blood pressure, heart rhythm, and the hemodynamics. We harvested the brain and heart tissues for immunohistochemistry and western blot analyses. Our data show that DHI exerts potent anti-stroke effects (infarct volume reduction: ∗∗p < 0.01 and ∗∗∗p < 0.001 vs. vehicle. Neurological deficit correction: ∗p < 0.05 and ∗∗∗p < 0.001 vs. vehicle), and effectively reversed the abnormal arterial pressure (∗p < 0.05 vs. vehicle) and heart rhythm (∗∗p < 0.01 vs. vehicle). The phenotype of this brain–heart syndrome is strikingly similar to those of MI model. Quantitative assessment of hemodynamic in cardiac functionality revealed a positive uniformity in the PV-loop after administration with DHI and valsartan in the latter. Immunohistochemistry and western blot results showed the inhibitory effect of DHI on the β-adrenergic pathway as well as protein kinase C epsilon (PKCε) (∗∗p < 0.01 vs. model). Our data showed the underlying mechanisms of the brain–heart interaction and offer the first evidence that DHI targets the adrenergic pathway to modulate cardiac function in the setting of brain–heart syndrome. This study has made a novel discovery for proper application of the multi-target DHI and could serve as a therapeutic option in the setting of brain–heart syndrome.
Collapse
Affiliation(s)
- John O Orgah
- Tianjin State Key Laboratory of Modern Chinese Medicine, Tianjin University of Traditional Chinese Medicine, Tianjin, China.,Research and Development Center of TCM, Tianjin International Joint Academy of Biotechnology and Medicine, Tianjin, China
| | - Jiahui Yu
- Tianjin State Key Laboratory of Modern Chinese Medicine, Tianjin University of Traditional Chinese Medicine, Tianjin, China.,Research and Development Center of TCM, Tianjin International Joint Academy of Biotechnology and Medicine, Tianjin, China
| | - Tiechan Zhao
- Tianjin State Key Laboratory of Modern Chinese Medicine, Tianjin University of Traditional Chinese Medicine, Tianjin, China.,Research and Development Center of TCM, Tianjin International Joint Academy of Biotechnology and Medicine, Tianjin, China
| | - Lingyan Wang
- Tianjin State Key Laboratory of Modern Chinese Medicine, Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Mingzhu Yang
- Tianjin State Key Laboratory of Modern Chinese Medicine, Tianjin University of Traditional Chinese Medicine, Tianjin, China.,Research and Development Center of TCM, Tianjin International Joint Academy of Biotechnology and Medicine, Tianjin, China
| | - Yan Zhang
- Tianjin State Key Laboratory of Modern Chinese Medicine, Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Guanwei Fan
- Tianjin State Key Laboratory of Modern Chinese Medicine, Tianjin University of Traditional Chinese Medicine, Tianjin, China.,First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Yan Zhu
- Tianjin State Key Laboratory of Modern Chinese Medicine, Tianjin University of Traditional Chinese Medicine, Tianjin, China.,Research and Development Center of TCM, Tianjin International Joint Academy of Biotechnology and Medicine, Tianjin, China
| |
Collapse
|
19
|
Tziomalos K, Sofogianni A, Angelopoulou SM, Christou K, Kostaki S, Papagianni M, Satsoglou S, Spanou M, Savopoulos C, Hatzitolios AI. Left ventricular hypertrophy assessed by electrocardiogram is associated with more severe stroke and with higher in-hospital mortality in patients with acute ischemic stroke. Atherosclerosis 2018; 274:206-211. [DOI: 10.1016/j.atherosclerosis.2018.05.030] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2017] [Revised: 04/28/2018] [Accepted: 05/16/2018] [Indexed: 10/16/2022]
|
20
|
Moore EE, Liu D, Pechman KR, Terry JG, Nair S, Cambronero FE, Bell SP, Gifford KA, Anderson AW, Hohman TJ, Carr JJ, Jefferson AL. Increased Left Ventricular Mass Index Is Associated With Compromised White Matter Microstructure Among Older Adults. J Am Heart Assoc 2018; 7:e009041. [PMID: 29945917 PMCID: PMC6064880 DOI: 10.1161/jaha.118.009041] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Accepted: 05/21/2018] [Indexed: 02/03/2023]
Abstract
BACKGROUND Left ventricular (LV) hypertrophy is associated with cerebrovascular disease and cognitive decline. Increased LV mass index is a subclinical imaging marker that precedes overt LV hypertrophy. This study relates LV mass index to white matter microstructure and cognition among older adults with normal cognition and mild cognitive impairment. METHODS AND RESULTS Vanderbilt Memory & Aging Project participants free of clinical stroke, dementia, and heart failure (n=318, 73±7 years, 58% male, 39% mild cognitive impairment) underwent brain magnetic resonance imaging, cardiac magnetic resonance, and neuropsychological assessment. Voxelwise analyses related LV mass index (g/m2) to diffusion tensor imaging metrics. Models adjusted for age, sex, education, race/ethnicity, Framingham Stroke Risk Profile, cognitive diagnosis, and apolipoprotein E-ε4 status. Secondary analyses included a LV mass index×diagnosis interaction term with follow-up models stratified by diagnosis. With identical covariates, linear regression models related LV mass index to neuropsychological performances. Increased LV mass index related to altered white matter microstructure (P<0.05). In models stratified by diagnosis, associations between LV mass index and diffusion tensor imaging were present among mild cognitive impairment participants only (P<0.05). LV mass index was related only to worse visuospatial memory performance (β=-0.003, P=0.036), an observation that would not withstand correction for multiple testing. CONCLUSIONS In the absence of prevalent heart failure and clinical stroke, increased LV mass index corresponds to altered white matter microstructure, particularly among older adults with clinical symptoms of prodromal dementia. Findings highlight the potential link between subclinical LV remodeling and cerebral white matter microstructure vulnerability.
Collapse
Affiliation(s)
- Elizabeth E Moore
- Department of Neurology, Vanderbilt Memory & Alzheimer's Center, Vanderbilt University Medical Center, Nashville, TN
| | - Dandan Liu
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN
| | - Kimberly R Pechman
- Department of Neurology, Vanderbilt Memory & Alzheimer's Center, Vanderbilt University Medical Center, Nashville, TN
| | - James G Terry
- Department of Radiology & Radiological Sciences, Vanderbilt University Medical Center, Nashville, TN
| | - Sangeeta Nair
- Department of Radiology & Radiological Sciences, Vanderbilt University Medical Center, Nashville, TN
| | - Francis E Cambronero
- Department of Neurology, Vanderbilt Memory & Alzheimer's Center, Vanderbilt University Medical Center, Nashville, TN
| | - Susan P Bell
- Department of Neurology, Vanderbilt Memory & Alzheimer's Center, Vanderbilt University Medical Center, Nashville, TN
- Division of Cardiovascular Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN
| | - Katherine A Gifford
- Department of Neurology, Vanderbilt Memory & Alzheimer's Center, Vanderbilt University Medical Center, Nashville, TN
| | - Adam W Anderson
- Department of Biomedical Engineering, Vanderbilt University, Nashville, TN
| | - Timothy J Hohman
- Department of Neurology, Vanderbilt Memory & Alzheimer's Center, Vanderbilt University Medical Center, Nashville, TN
| | - John Jeffrey Carr
- Department of Radiology & Radiological Sciences, Vanderbilt University Medical Center, Nashville, TN
| | - Angela L Jefferson
- Department of Neurology, Vanderbilt Memory & Alzheimer's Center, Vanderbilt University Medical Center, Nashville, TN
- Division of Cardiovascular Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN
| |
Collapse
|
21
|
Carnevale L, D’Angelosante V, Landolfi A, Grillea G, Selvetella G, Storto M, Lembo G, Carnevale D. Brain MRI fiber-tracking reveals white matter alterations in hypertensive patients without damage at conventional neuroimaging. Cardiovasc Res 2018; 114:1536-1546. [DOI: 10.1093/cvr/cvy104] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Accepted: 04/27/2018] [Indexed: 12/14/2022] Open
Affiliation(s)
- Lorenzo Carnevale
- Department of Angiocardioneurology and Translational Medicine, IRCCS Neuromed, Via dell'elettronica, Pozzilli (IS), Italy
| | - Valentina D’Angelosante
- Department of Angiocardioneurology and Translational Medicine, IRCCS Neuromed, Via dell'elettronica, Pozzilli (IS), Italy
| | - Alessandro Landolfi
- Department of Angiocardioneurology and Translational Medicine, IRCCS Neuromed, Via dell'elettronica, Pozzilli (IS), Italy
| | - Giovanni Grillea
- Department of Neuroradiology, IRCCS Neuromed, Via dell'elettronica, Pozzilli (IS), Italy
| | - Giulio Selvetella
- Department of Angiocardioneurology and Translational Medicine, IRCCS Neuromed, Via dell'elettronica, Pozzilli (IS), Italy
| | - Marianna Storto
- Department of Analysis Lab Diagnostics, IRCCS Neuromed, Via dell'elettronica, Pozzilli (IS), Italy
| | - Giuseppe Lembo
- Department of Angiocardioneurology and Translational Medicine, IRCCS Neuromed, Via dell'elettronica, Pozzilli (IS), Italy
- Department of Molecular Medicine, ‘Sapienza’ University of Rome, Viale Regina Elena 324, Rome, Italy
| | - Daniela Carnevale
- Department of Angiocardioneurology and Translational Medicine, IRCCS Neuromed, Via dell'elettronica, Pozzilli (IS), Italy
- Department of Molecular Medicine, ‘Sapienza’ University of Rome, Viale Regina Elena 324, Rome, Italy
| |
Collapse
|
22
|
Liu D, Hu K, Schmidt M, Müntze J, Maniuc O, Gensler D, Oder D, Salinger T, Weidemann F, Ertl G, Frantz S, Wanner C, Nordbeck P. Value of the CHA 2DS 2-VASc score and Fabry-specific score for predicting new-onset or recurrent stroke/TIA in Fabry disease patients without atrial fibrillation. Clin Res Cardiol 2018; 107:1111-1121. [PMID: 29797054 PMCID: PMC6244978 DOI: 10.1007/s00392-018-1285-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2018] [Accepted: 05/22/2018] [Indexed: 12/03/2022]
Abstract
Objectives To evaluate potential risk factors for stroke or transient ischemic attacks (TIA) and to test the feasibility and efficacy of a Fabry-specific stroke risk score in Fabry disease (FD) patients without atrial fibrillation (AF). Background FD patients often experience cerebrovascular events (stroke/TIA) at young age. Methods 159 genetically confirmed FD patients without AF (aged 40 ± 14 years, 42.1% male) were included, and risk factors for stroke/TIA events were determined. All patients were followed up over a median period of 60 (quartiles 35–90) months. The pre-defined primary outcomes included new-onset or recurrent stroke/TIA and all-cause death. Results Prior stroke/TIA (HR 19.97, P < .001), angiokeratoma (HR 4.06, P = .010), elevated creatinine (HR 3.74, P = .011), significant left ventricular hypertrophy (HR 4.07, P = .017), and reduced global systolic strain (GLS, HR 5.19, P = .002) remained as independent risk predictors of new-onset or recurrent stroke/TIA in FD patients without AF. A Fabry-specific score was established based on above defined risk factors, proving somehow superior to the CHA2DS2-VASc score in predicting new-onset or recurrent stroke/TIA in this cohort (AUC 0.87 vs. 0.75, P = .199). Conclusions Prior stroke/TIA, angiokeratoma, renal dysfunction, left ventricular hypertrophy, and global systolic dysfunction are independent risk factors for new-onset or recurrent stroke/TIA in FD patients without AF. It is feasible to predict new or recurrent cerebral events with the Fabry-specific score based on the above defined risk factors. Future studies are warranted to test if FD patients with high risk for new-onset or recurrent stroke/TIA, as defined by the Fabry-specific score (≥ 2 points), might benefit from antithrombotic therapy. Clinical trial registration HEAL-FABRY (evaluation of HEArt invoLvement in patients with FABRY disease, NCT03362164). Electronic supplementary material The online version of this article (10.1007/s00392-018-1285-4) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Dan Liu
- Department of Internal Medicine I, University Hospital Würzburg, Oberdürrbacher Str. 6, 97080, Würzburg, Germany.,Comprehensive Heart Failure Center (CHFC), University of Würzburg, Würzburg, Germany
| | - Kai Hu
- Department of Internal Medicine I, University Hospital Würzburg, Oberdürrbacher Str. 6, 97080, Würzburg, Germany.,Comprehensive Heart Failure Center (CHFC), University of Würzburg, Würzburg, Germany
| | - Marie Schmidt
- Department of Internal Medicine I, University Hospital Würzburg, Oberdürrbacher Str. 6, 97080, Würzburg, Germany.,Comprehensive Heart Failure Center (CHFC), University of Würzburg, Würzburg, Germany
| | - Jonas Müntze
- Department of Internal Medicine I, University Hospital Würzburg, Oberdürrbacher Str. 6, 97080, Würzburg, Germany.,Comprehensive Heart Failure Center (CHFC), University of Würzburg, Würzburg, Germany
| | - Octavian Maniuc
- Department of Internal Medicine I, University Hospital Würzburg, Oberdürrbacher Str. 6, 97080, Würzburg, Germany.,Comprehensive Heart Failure Center (CHFC), University of Würzburg, Würzburg, Germany
| | - Daniel Gensler
- Department of Internal Medicine I, University Hospital Würzburg, Oberdürrbacher Str. 6, 97080, Würzburg, Germany.,Comprehensive Heart Failure Center (CHFC), University of Würzburg, Würzburg, Germany
| | - Daniel Oder
- Department of Internal Medicine I, University Hospital Würzburg, Oberdürrbacher Str. 6, 97080, Würzburg, Germany.,Comprehensive Heart Failure Center (CHFC), University of Würzburg, Würzburg, Germany
| | - Tim Salinger
- Department of Internal Medicine I, University Hospital Würzburg, Oberdürrbacher Str. 6, 97080, Würzburg, Germany.,Comprehensive Heart Failure Center (CHFC), University of Würzburg, Würzburg, Germany
| | - Frank Weidemann
- Medizinische Klinik I, Klinikum Vest, Recklinghausen, Germany
| | - Georg Ertl
- Department of Internal Medicine I, University Hospital Würzburg, Oberdürrbacher Str. 6, 97080, Würzburg, Germany.,Comprehensive Heart Failure Center (CHFC), University of Würzburg, Würzburg, Germany
| | - Stefan Frantz
- Department of Internal Medicine I, University Hospital Würzburg, Oberdürrbacher Str. 6, 97080, Würzburg, Germany.,Comprehensive Heart Failure Center (CHFC), University of Würzburg, Würzburg, Germany
| | - Christoph Wanner
- Department of Internal Medicine I, University Hospital Würzburg, Oberdürrbacher Str. 6, 97080, Würzburg, Germany.,Comprehensive Heart Failure Center (CHFC), University of Würzburg, Würzburg, Germany
| | - Peter Nordbeck
- Department of Internal Medicine I, University Hospital Würzburg, Oberdürrbacher Str. 6, 97080, Würzburg, Germany. .,Comprehensive Heart Failure Center (CHFC), University of Würzburg, Würzburg, Germany.
| |
Collapse
|
23
|
Association of Cardiac Structure and Function With Neurocognition in Hispanics/Latinos: The Echocardiographic Study of Latinos. Mayo Clin Proc Innov Qual Outcomes 2018; 2:165-175. [PMID: 30225446 PMCID: PMC6124325 DOI: 10.1016/j.mayocpiqo.2018.02.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Objective To study the associations of comprehensive measures of cardiac structure and function with multidimensional neurocognitive measures. Patients and Methods The Echocardiographic Study of Latinos is a population-based cohort of Hispanic/Latino adults older than 45 years enrolled from October 1, 2011, through June 30, 2014. Neurocognitive measures included Word Fluency (WF), Brief-Spanish English Verbal Learning Test (B-SEVLT), and Digit Symbol Substitution Test. The B-SEVLT included B-SEVLT-recall and B-SEVLT-sum. Echocardiographic measures included cardiac structure, systolic and diastolic function, and myocardial strain. Multivariable regression models were fit using survey statistics and sampling probabilities. Results A total of 1794 participants (mean age, 56±0.5 years; 56% women) were included in the analysis. In the adjusted model, higher left ventricular mass index was associated with lower B-SEVLT-sum and Digit Symbol Substitution Test scores. Left ventricular systolic dysfunction was associated with lower WF scores. Abnormal left ventricular geometry was associated with lower B-SEVLT-sum scores. Higher relative wall thickness was associated with B-SEVLT-recall and B-SEVLT-sum scores. Mitral annular relaxation velocities were associated with lower B-SEVLT-recall, B-SEVLT-sum, and WF scores. Higher mitral inflow to annular early diastolic velocity ratio was associated with lower B-SEVLT-recall and B-SEVLT-sum scores. Diastolic dysfunction was associated with lower B-SEVLT-sum scores. Finally, lower global longitudinal strain was associated with lower WF scores. Conclusion Alterations in cardiac structure, systolic and diastolic function, and myocardial strain were associated with worse neurocognitive function. Further study is needed to determine the mechanisms (ie, impairment of cerebral flow and silent brain infarctions) mediating these heart-brain associations.
Collapse
Key Words
- B-SEVLT, Brief-Spanish English Verbal Learning Test
- BMI, body mass index
- CVH, cardiovascular health
- DSST, Digit Symbol Substitution Test
- E/e′ ratio, ratio of the early mitral inflow velocity to the mitral annular early diastolic velocity
- ECHO-SOL, Echocardiographic Study of Latinos
- EF, ejection fraction
- GLS, global longitudinal strain
- HCHS/SOL, Hispanic Community Health Study/Study of Latinos
- LA, left atrial
- LAVI, left atrial volume index
- LV, left ventricular
- LVESV, left ventricular end-systolic volume
- LVMI, left ventricular mass index
- RWT, relative wall thickness
- SIS, Six-Item Screener
- S′, peak systolic annular velocity
- WF, Word Fluency
- e′, mitral annular early diastolic velocity
Collapse
|
24
|
Iribarren C, Round AD, Lu M, Okin PM, McNulty EJ. Cohort Study of ECG Left Ventricular Hypertrophy Trajectories: Ethnic Disparities, Associations With Cardiovascular Outcomes, and Clinical Utility. J Am Heart Assoc 2017; 6:e004954. [PMID: 28982671 PMCID: PMC5721817 DOI: 10.1161/jaha.116.004954] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2016] [Accepted: 05/09/2017] [Indexed: 12/31/2022]
Abstract
BACKGROUND ECG left ventricular hypertrophy (LVH) is a well-known predictor of cardiovascular disease. However, no prior study has characterized patterns of presence/absence of ECG LVH ("ECG LVH trajectories") across the adult lifespan in both sexes and across ethnicities. We examined: (1) correlates of ECG LVH trajectories; (2) the association of ECG LVH trajectories with incident coronary heart disease, transient ischemic attack, ischemic stroke, hemorrhagic stroke, and heart failure; and (3) reclassification of cardiovascular disease risk using ECG LVH trajectories. METHODS AND RESULTS We performed a cohort study among 75 412 men and 107 954 women in the Northern California Kaiser Permanente Medical Care Program who had available longitudinal exposures of ECG LVH and covariates, followed for a median of 4.8 (range <1-9.3) years. ECG LVH was measured by Cornell voltage-duration product. Adverse trajectories of ECG LVH (persistent, new development, or variable pattern) were more common among blacks and Native American men and were independently related to incident cardiovascular disease with hazard ratios ranging from 1.2 for ECG LVH variable pattern and transient ischemic attack in women to 2.8 for persistent ECG LVH and heart failure in men. ECG LVH trajectories reclassified 4% and 7% of men and women with intermediate coronary heart disease risk, respectively. CONCLUSIONS ECG LVH trajectories were significant indicators of coronary heart disease, stroke, and heart failure risk, independently of level and change in cardiovascular disease risk factors, and may have clinical utility.
Collapse
Affiliation(s)
| | | | - Meng Lu
- Division of Research, Kaiser Permanente, Oakland, CA
| | - Peter M Okin
- Division of Cardiology, Department of Medicine, Weill Cornell Medical College, New York, NY
| | - Edward J McNulty
- Cardiology Department, Kaiser Permanente San Francisco Medical Center, San Francisco, CA
| |
Collapse
|
25
|
Abstract
Neurocardiology is an emerging specialty that addresses the interaction between the brain and the heart, that is, the effects of cardiac injury on the brain and the effects of brain injury on the heart. This review article focuses on cardiac dysfunction in the setting of stroke such as ischemic stroke, brain hemorrhage, and subarachnoid hemorrhage. The majority of post-stroke deaths are attributed to neurological damage, and cardiovascular complications are the second leading cause of post-stroke mortality. Accumulating clinical and experimental evidence suggests a causal relationship between brain damage and heart dysfunction. Thus, it is important to determine whether cardiac dysfunction is triggered by stroke, is an unrelated complication, or is the underlying cause of stroke. Stroke-induced cardiac damage may lead to fatality or potentially lifelong cardiac problems (such as heart failure), or to mild and recoverable damage such as neurogenic stress cardiomyopathy and Takotsubo cardiomyopathy. The role of location and lateralization of brain lesions after stroke in brain-heart interaction; clinical biomarkers and manifestations of cardiac complications; and underlying mechanisms of brain-heart interaction after stroke, such as the hypothalamic-pituitary-adrenal axis; catecholamine surge; sympathetic and parasympathetic regulation; microvesicles; microRNAs; gut microbiome, immunoresponse, and systemic inflammation, are discussed.
Collapse
Affiliation(s)
- Zhili Chen
- From the Gerontology and Neurological Institute, Tianjin Medical University General Hospital, China (Z.C., T.Y., J.C.); Department of Neurology, Henry Ford Hospital, Detroit, MI (P.V., D.S., M.C., J.C.); and Department of Physics, Oakland University, Rochester, MI (M.C.)
| | - Poornima Venkat
- From the Gerontology and Neurological Institute, Tianjin Medical University General Hospital, China (Z.C., T.Y., J.C.); Department of Neurology, Henry Ford Hospital, Detroit, MI (P.V., D.S., M.C., J.C.); and Department of Physics, Oakland University, Rochester, MI (M.C.)
| | - Don Seyfried
- From the Gerontology and Neurological Institute, Tianjin Medical University General Hospital, China (Z.C., T.Y., J.C.); Department of Neurology, Henry Ford Hospital, Detroit, MI (P.V., D.S., M.C., J.C.); and Department of Physics, Oakland University, Rochester, MI (M.C.)
| | - Michael Chopp
- From the Gerontology and Neurological Institute, Tianjin Medical University General Hospital, China (Z.C., T.Y., J.C.); Department of Neurology, Henry Ford Hospital, Detroit, MI (P.V., D.S., M.C., J.C.); and Department of Physics, Oakland University, Rochester, MI (M.C.)
| | - Tao Yan
- From the Gerontology and Neurological Institute, Tianjin Medical University General Hospital, China (Z.C., T.Y., J.C.); Department of Neurology, Henry Ford Hospital, Detroit, MI (P.V., D.S., M.C., J.C.); and Department of Physics, Oakland University, Rochester, MI (M.C.)
| | - Jieli Chen
- From the Gerontology and Neurological Institute, Tianjin Medical University General Hospital, China (Z.C., T.Y., J.C.); Department of Neurology, Henry Ford Hospital, Detroit, MI (P.V., D.S., M.C., J.C.); and Department of Physics, Oakland University, Rochester, MI (M.C.).
| |
Collapse
|
26
|
Mahinrad S, Vriend AE, Jukema JW, van Heemst D, Sattar N, Blauw GJ, Macfarlane PW, Clark EN, de Craen AJ, Sabayan B. Left Ventricular Hypertrophy and Cognitive Decline in Old Age. J Alzheimers Dis 2017; 58:275-283. [DOI: 10.3233/jad-161150] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Simin Mahinrad
- Department of Gerontology and Geriatrics, Leiden University Medical Center, Leiden, The Netherlands
| | - Annelotte E. Vriend
- Department of Gerontology and Geriatrics, Leiden University Medical Center, Leiden, The Netherlands
| | - J. Wouter Jukema
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Diana van Heemst
- Department of Gerontology and Geriatrics, Leiden University Medical Center, Leiden, The Netherlands
| | - Naveed Sattar
- BHF Glasgow Cardiovascular Research Center, University of Glasgow, Glasgow, UK
| | - Gerard Jan Blauw
- Department of Gerontology and Geriatrics, Leiden University Medical Center, Leiden, The Netherlands
| | - Peter W. Macfarlane
- Institute of Cardiovascular and Medical Science, University of Glasgow, Glasgow, UK
| | - Elaine N. Clark
- Institute of Cardiovascular and Medical Science, University of Glasgow, Glasgow, UK
| | - Anton J.M. de Craen
- Department of Gerontology and Geriatrics, Leiden University Medical Center, Leiden, The Netherlands
| | - Behnam Sabayan
- Department of Gerontology and Geriatrics, Leiden University Medical Center, Leiden, The Netherlands
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
- Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| |
Collapse
|
27
|
Ferreira JP, Kearney Schwartz A, Watfa G, Zohra L, Felblinger J, Boivin JM, Bracard S, Hossu G, Verger A, Joly L, Zannad F, Rossignol P, Benetos A. Memory Alterations and White Matter Hyperintensities in Elderly Patients With Hypertension: The ADELAHYDE-2 Study. J Am Med Dir Assoc 2017; 18:451.e13-451.e25. [PMID: 28279605 DOI: 10.1016/j.jamda.2017.01.008] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2017] [Accepted: 01/18/2017] [Indexed: 01/18/2023]
Abstract
OBJECTIVES The longitudinal ADELAHYDE-2 study aims to identify the factors associated with cognitive impairment/decline and white matter hyperintensities burden. METHODS Longitudinal single-center study comprising two visits separated by approximately 7 years. A total of 131 patients completed the two visits. The primary outcome was global memory composite scale, while the secondary outcome was white matter hyperintensities (WMH/Fazekas scale) load. RESULTS Global memory at visit 2 (V2) was largely influenced by age, smoking status, glycated hemoglobin, and history of stroke already present at visit 1 (V1). These variables accounted for ∼51% of the memory alterations at V2. WMH at V2 was likely influenced by age, left ventricular hypertrophy, diabetes mellitus, carotid intima-media thickness, and body mass index at V1. These findings accounted for ∼37% of the WMH changes at V2. Increase in pulse wave velocity from V1 to V2 showed a trend for association with memory deterioration (adjusted estimates = 0.06; P = .067), whereas smoking and increase in systolic blood pressure (trend) were associated with an increment in WMH (adjusted estimates = 0.49; P = .047 and adjusted estimates = 0.01; P = .08, respectively). On the other hand, angiotensin-converting enzyme inhibitor/angiotensin receptor blockers and statins (trend) were likely to be protective (adjusted estimates for angiotensin-converting enzyme inhibitor/angiotensin receptor blockers = -0.49; P = .049, and adjusted estimates for statins = -0.46; P = .055). CONCLUSIONS Several readily identifiable factors are associated with memory deterioration and WMH, many of which are potentially modifiable. Interventions aimed to control these risk factors need to be tested prospectively in order to assess their cognitive protective value.
Collapse
Affiliation(s)
- João Pedro Ferreira
- INSERM, Centre d'Investigations Cliniques Plurithématique 1433, INSERM U1116, Université de Lorraine, CHRU de Nancy, F-CRIN INI-CRCT, Nancy, France; Department of Physiology and Cardiothoracic Surgery, Cardiovascular Research and Development Unit, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Anna Kearney Schwartz
- INSERM, Centre d'Investigations Cliniques Plurithématique 1433, INSERM U1116, Université de Lorraine, CHRU de Nancy, F-CRIN INI-CRCT, Nancy, France; Service de Gériatrie, CHRU de Nancy, Nancy, France
| | | | - Lamiral Zohra
- INSERM, Centre d'Investigations Cliniques Plurithématique 1433, INSERM U1116, Université de Lorraine, CHRU de Nancy, F-CRIN INI-CRCT, Nancy, France
| | - Jacques Felblinger
- INSERM, Centre d'Investigations Cliniques Plurithématique 1433, INSERM U1116, Université de Lorraine, CHRU de Nancy, F-CRIN INI-CRCT, Nancy, France; INSERM, U947, IADI, Nancy, F-54000, France, Département de Neuroradiologie Diagnostique et Interventionnelle, Pôle Imagerie, Centre Hospitalier Universitaire de Nancy, Nancy, France
| | - Jean-Marc Boivin
- INSERM, Centre d'Investigations Cliniques Plurithématique 1433, INSERM U1116, Université de Lorraine, CHRU de Nancy, F-CRIN INI-CRCT, Nancy, France
| | - Serge Bracard
- INSERM, Centre d'Investigations Cliniques Plurithématique 1433, INSERM U1116, Université de Lorraine, CHRU de Nancy, F-CRIN INI-CRCT, Nancy, France; Département de Neuroradiologie Diagnostique et Interventionnelle, Centre Hospitalier Universitaire de Nancy, Nancy, France
| | - Gabriella Hossu
- INSERM, Centre d'Investigations Cliniques Plurithématique 1433, INSERM U1116, Université de Lorraine, CHRU de Nancy, F-CRIN INI-CRCT, Nancy, France; INSERM U1116, Université de Lorraine, Nancy, France; U947, INSERM, Nancy, France
| | - Antoine Verger
- CHRU Nancy, Nuclear Medicine & Nancyclotep Experimental Imaging Platform, Nancy, France
| | - Laure Joly
- Service de Gériatrie, CHRU de Nancy, Nancy, France; INSERM U1116, Université de Lorraine, Nancy, France
| | - Faiez Zannad
- INSERM, Centre d'Investigations Cliniques Plurithématique 1433, INSERM U1116, Université de Lorraine, CHRU de Nancy, F-CRIN INI-CRCT, Nancy, France; INSERM U1116, Université de Lorraine, Nancy, France
| | - Patrick Rossignol
- INSERM, Centre d'Investigations Cliniques Plurithématique 1433, INSERM U1116, Université de Lorraine, CHRU de Nancy, F-CRIN INI-CRCT, Nancy, France; INSERM U1116, Université de Lorraine, Nancy, France
| | - Athanase Benetos
- INSERM, Centre d'Investigations Cliniques Plurithématique 1433, INSERM U1116, Université de Lorraine, CHRU de Nancy, F-CRIN INI-CRCT, Nancy, France; Service de Gériatrie, CHRU de Nancy, Nancy, France; INSERM U1116, Université de Lorraine, Nancy, France.
| |
Collapse
|
28
|
Nakanishi K, Jin Z, Homma S, Elkind MSV, Rundek T, Tugcu A, Yoshita M, DeCarli C, Wright CB, Sacco RL, Di Tullio MR. Left ventricular mass-geometry and silent cerebrovascular disease: The Cardiovascular Abnormalities and Brain Lesions (CABL) study. Am Heart J 2017; 185:85-92. [PMID: 28267479 PMCID: PMC5341701 DOI: 10.1016/j.ahj.2016.11.010] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2016] [Accepted: 11/15/2016] [Indexed: 01/19/2023]
Abstract
BACKGROUND Although abnormal left ventricular geometric patterns have prognostic value for morbidity and mortality, their possible association with silent cerebrovascular disease has not been extensively evaluated. METHODS We examined 665 participants in the CABL study who underwent transthoracic echocardiography and brain magnetic resonance imaging. Participants were divided into 4 geometric patterns: normal geometry (n=397), concentric remodeling (n=89), eccentric hypertrophy (n=126), and concentric hypertrophy (n=53). Subclinical cerebrovascular disease was defined as silent brain infarcts (SBIs) and white matter hyperintensity volume (WMHV; expressed as log-transformed percentage of the total cranial volume). RESULTS Silent brain infarcts were observed in 94 participants (14%). Mean log-WMHV was -0.97±0.93. Concentric hypertrophy carried the greatest risk for both SBI (adjusted odds ratio [OR] 3.39, P<.001) and upper quartile of log-WMHV (adjusted OR 3.35, P<.001), followed by eccentric hypertrophy (adjusted ORs 2.52 [P=.001 for SBI] and 1.96 [P=.004] for log-WMHV). Concentric remodeling was not associated with subclinical brain disease. In subgroup analyses, concentric and eccentric hypertrophies were significantly associated with SBI and WMHV in both genders and nonobese participants, but differed for SBI by age (all ages for eccentric hypertrophy, only patients ≥70years for concentric hypertrophy) and by race-ethnicity (Hispanics for eccentric hypertrophy, blacks for concentric hypertrophy; no association in whites). CONCLUSIONS Left ventricular hypertrophy, with both eccentric and concentric patterns, was significantly associated with subclinical cerebrovascular disease in a multiethnic stroke-free general population. Left ventricular geometric patterns may carry different risks for silent cerebrovascular disease in different sex, age, race-ethnic, and body size subgroups.
Collapse
Affiliation(s)
- Koki Nakanishi
- Department of Medicine, Columbia University, New York, NY
| | - Zhezhen Jin
- Department of Biostatistics, Columbia University, New York, NY
| | - Shunichi Homma
- Department of Medicine, Columbia University, New York, NY
| | - Mitchell S V Elkind
- Departments of Neurology and Epidemiology, Columbia University, New York, NY
| | - Tatjana Rundek
- Department of Neurology, Miller School of Medicine, University of Miami, Miami, FL; Department of Public Health Sciences, Miller School of Medicine, University of Miami, Miami, FL
| | - Aylin Tugcu
- Department of Medicine, Columbia University, New York, NY
| | | | - Charles DeCarli
- Department of Neurology, University of California at Davis, Davis, CA
| | - Clinton B Wright
- Department of Neurology, Miller School of Medicine, University of Miami, Miami, FL; Department of Public Health Sciences, Miller School of Medicine, University of Miami, Miami, FL
| | - Ralph L Sacco
- Department of Neurology, Miller School of Medicine, University of Miami, Miami, FL; Department of Public Health Sciences, Miller School of Medicine, University of Miami, Miami, FL; Department of Human Genetics, Miller School of Medicine, University of Miami, Miami, FL
| | | |
Collapse
|
29
|
Georgakis MK, Synetos A, Mihas C, Karalexi MA, Tousoulis D, Seshadri S, Petridou ET. Left ventricular hypertrophy in association with cognitive impairment: a systematic review and meta-analysis. Hypertens Res 2017; 40:696-709. [DOI: 10.1038/hr.2017.11] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2016] [Revised: 12/03/2016] [Accepted: 12/21/2016] [Indexed: 02/06/2023]
|
30
|
Hemorrhagic transformation of acute ischemic stroke is limited in hypertensive patients with cardiac hypertrophy. Int J Cardiol 2016; 219:362-6. [DOI: 10.1016/j.ijcard.2016.06.060] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2016] [Accepted: 06/18/2016] [Indexed: 12/18/2022]
|
31
|
Butenaerts D, Chrzanowska-Wasko J, Slowik A, Dziedzic T. Left ventricular geometry and white matter lesions in ischemic stroke patients. Blood Press 2015; 25:149-54. [PMID: 26581453 DOI: 10.3109/08037051.2015.1110927] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Abnormal left ventricular (LV) geometry is associated with extracardiac organ damage in patients with hypertension. The aim of this study was to determine the relationship between LV geometry and white matter lesions (WMLs) in ischemic stroke patients. We retrospectively analyzed data from 155 patients (median age 62; 49.8% male) with mild ischemic stroke (median National Institutes of Health Stroke Scale score 4) who underwent brain magnetic resonance imaging and echocardiography. Patients were categorized into four groups: normal LV geometry, concentric remodeling, eccentric left ventricular hypertrophy (LVH) and concentric LVH. WMLs were graded using the Fazekas scale on fluid-attenuated inversion recovery images. Extensive WMLs were defined as a Fazekas score > 2. Extensive WMLs were more prevalent in patients with concentric LVH, eccentric LVH and concentric remodeling than in those with normal LV geometry. After adjusting for hypertension, age, diabetes mellitus, hypercholesterolemia, glomerular filtration rate and ischemic heart disease, patients with concentric remodeling [odds ratio (OR) 3.94, 95% confidence interval (CI) 1.26-12.31, p = 0.02] and those with concentric LVH (OR 3.69, 95% CI 1.24-10.95, p = 0.02), but not patients with eccentric LVH (OR 2.44, 95% CI 0.72-8.29, p = 0.15), had higher risk of extensive WMLs than patients with normal LV geometry.
Collapse
Affiliation(s)
- Demian Butenaerts
- a Department of Neurology , Jagiellonian University Medical College , Krakow , Poland
| | | | - Agnieszka Slowik
- a Department of Neurology , Jagiellonian University Medical College , Krakow , Poland
| | - Tomasz Dziedzic
- a Department of Neurology , Jagiellonian University Medical College , Krakow , Poland
| |
Collapse
|
32
|
Fellgiebel A, Gartenschläger M, Wildberger K, Scheurich A, Desnick RJ, Sims K. Enzyme replacement therapy stabilized white matter lesion progression in Fabry disease. Cerebrovasc Dis 2015; 38:448-56. [PMID: 25502511 DOI: 10.1159/000369293] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2014] [Accepted: 10/21/2014] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND The central nervous system manifestations in Fabry disease (FD) include progressive white matter lesions (WMLs) and stroke. Due to progressive microvascular involvement, men and women with FD over 35 years of age develop WMLs. Moreover, the prevalence of stroke has been estimated to be 12 times higher in FD compared with the general population. Enzyme replacement therapy (ERT) is available and has shown beneficial effects on renal, cardiac, and peripheral nerve function in FD, but the ERT effect on the progression of WMLs, or the reduction in cerebrovascular events, remains unknown. METHODS The WML burden and the effect of agalsidase beta 1 mg/kg biweekly on WML progression were assessed longitudinally in a Phase 4 agalsidase-beta placebo-controlled analysis of untreated and treated FD patients with mild-to-moderate renal involvement (serum creatinine measurements of ≥1.2 mg/dl and <3.0 mg/dl). The primary end point was the difference in the number of patients with increased WML burden between the agalsidase beta and placebo groups at the end of treatment. The diameters of the WMLs were determined manually using axial flow-attenuated-inversion-recovery-weighted magnetic resonance imaging (MRI) scans taken at baseline and follow-up. RESULTS MRI scans from 41 FD patients (mean age 43.9, age range 20-68, 3 females; n=25 on ERT, n=16 on placebo) were analyzed. WML burden was present in 63% of patients at baseline, increased over a mean of 27 months (range 12-33 months) follow-up, and correlated with left ventricular hypertrophy (LVPW). Patients with previous or recent strokes (n=11, 39-68 years) showed an increase in the number of WMLs (p=0.005). A greater proportion of younger patients (≤50 years) on ERT (n=18) had stable WML burden compared with younger patients in the placebo group (n=13): 44% (8 of 18) versus 31% (4 of 13), p=0.014. The number needed to treat was 8. CONCLUSIONS This FD patient cohort, with mild-to-moderate renal involvement, had a significant WML burden and high inter-individual variability associated with the degree of LVPW but not the degree of kidney dysfunction. These advanced patients with increased LVPW and stroke evidence may have had a higher cerebrovascular risk. The WML burden in patients on ERT was more likely to remain stable, compared with patients on placebo. Thus, ERT may reduce the progression of vascular disease, even in advanced FD patients, suggesting that early treatment may stabilize WML progression and stroke risk.
Collapse
Affiliation(s)
- Andreas Fellgiebel
- Department of Psychiatry and Psychotherapy, University Medical Center Mainz, Mainz, Germany
| | | | | | | | | | | |
Collapse
|
33
|
Arangalage D, Ederhy S, Dufour L, Joffre J, Van der Vynckt C, Lang S, Tzourio C, Cohen A. Relationship between cognitive impairment and echocardiographic parameters: a review. J Am Soc Echocardiogr 2014; 28:264-74. [PMID: 25532969 DOI: 10.1016/j.echo.2014.11.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2014] [Indexed: 01/03/2023]
Abstract
With >24 million people affected worldwide, dementia is one of the main public health challenges modern medicine has to face. The path leading to dementia is often long, with a wide spectrum of clinical presentations, and preceded by a long preclinical phase. Previous studies have demonstrated that clinical strokes and covert vascular lesions of the brain contribute to the risk for developing dementia. Although it is not yet known whether preventing such lesions reduces the risk for dementia, it is likely that starting preventive measures early in the course of the disease may be beneficial. Echocardiography is a widely available, relatively inexpensive, noninvasive imaging modality whereby morphologically or hemodynamically derived parameters may be integrated easily into a risk assessment model for dementia. The aim of this review is to analyze the information that has accumulated over the past two decades on the prognostic value of echocardiographic factors in cognitive impairment. The associations between cognitive impairment and echocardiographic parameters, including left ventricular systolic and diastolic indices, left atrial morphologic parameters, cardiac output, left ventricular mass, and aortic root diameter, have previously been reported. In the light of these studies, it appears that echocardiography may help further improve currently used risk assessment models by allowing detection of subclinical cardiac abnormalities associated with future cognitive impairment. However, many limitations, including methodologic heterogeneity and the observational designs of these studies, restrict the scope of these results. Further prospective studies are required before integrating echocardiography into a preventive strategy.
Collapse
Affiliation(s)
- Dimitri Arangalage
- Service de Cardiologie, Hôpital Saint Antoine, Assistance Publique - Hôpitaux de Paris, Paris, France; University Paris 6, Faculté de Médecine Pierre et Marie Curie, Paris, France
| | - Stéphane Ederhy
- Service de Cardiologie, Hôpital Saint Antoine, Assistance Publique - Hôpitaux de Paris, Paris, France
| | - Laurie Dufour
- Service de Cardiologie, Hôpital Saint Antoine, Assistance Publique - Hôpitaux de Paris, Paris, France; University Paris 6, Faculté de Médecine Pierre et Marie Curie, Paris, France
| | - Jérémie Joffre
- Service de Cardiologie, Hôpital Saint Antoine, Assistance Publique - Hôpitaux de Paris, Paris, France
| | - Clélie Van der Vynckt
- Service de Cardiologie, Hôpital Saint Antoine, Assistance Publique - Hôpitaux de Paris, Paris, France; University Paris 6, Faculté de Médecine Pierre et Marie Curie, Paris, France
| | - Sylvie Lang
- Service de Cardiologie, Hôpital Saint Antoine, Assistance Publique - Hôpitaux de Paris, Paris, France
| | - Christophe Tzourio
- INSERM Research Center for Epidemiology and Biostatistics (U897), Team Neuroepidemiology, and University of Bordeaux, Bordeaux, France
| | - Ariel Cohen
- Service de Cardiologie, Hôpital Saint Antoine, Assistance Publique - Hôpitaux de Paris, Paris, France; University Paris 6, Faculté de Médecine Pierre et Marie Curie, Paris, France.
| |
Collapse
|
34
|
Delgado P, Riba-Llena I, Tovar JL, Jarca CI, Mundet X, López-Rueda A, Orfila F, Llussà J, Manresa JM, Alvarez-Sabín J, Nafría C, Fernández JL, Maisterra O, Montaner J. Prevalence and associated factors of silent brain infarcts in a Mediterranean cohort of hypertensives. Hypertension 2014; 64:658-63. [PMID: 24958500 DOI: 10.1161/hypertensionaha.114.03563] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Silent brain infarcts (SBIs) are detected by neuroimaging in approximately 20% of elderly patients in population-based studies. Limited evidence is available for hypertensives at low cardiovascular risk countries. Investigating Silent Strokes in Hypertensives: a Magnetic Resonance Imaging Study (ISSYS) is aimed to assess the prevalence and risk factors of SBIs in a hypertensive Mediterranean population. This is a cohort study in randomly selected hypertensives, aged 50 to 70 years old, and free of clinical stroke and dementia. On baseline, all participants underwent a brain magnetic resonance imaging to assess prevalence and location of silent infarcts, and data on vascular risk factors, comorbidities, and the presence of subclinical cardiorenal damage (left ventricular hypertrophy and microalbuminuria) were collected. Multivariate analyses were performed to determine SBIs associated factors. A total of 976 patients (49.4% men, mean age 64 years) were enrolled, and 163 SBIs were detected in 99 participants (prevalence 10.1%; 95% CI, 8.4%-12.2%), most of them (64.4%) located in the basal ganglia and subcortical white matter. After adjustment, besides age and sex, microalbuminuria and increasing total cardiovascular risk (assessed by the Framingham-calibrated for Spanish population risk function) were independently associated with SBIs. Male sex increased the odds of having SBIs in 2.5 as compared with females. Our results highlight the importance of considering both global risk assessment and sex differences in hypertension and may be useful to design future preventive interventions of stroke and dementia.
Collapse
Affiliation(s)
- Pilar Delgado
- From the Neurovascular Research Laboratory, Vall Hebron Research Institute (P.D., I.R.-L., A.L.-R., C.N., J.M.), Barcelona City Research Support Unit-IDIAP Jordi Gol (X.M., F.O.), Departament de Medicina (J.L.), and Departament d'Infermeria (J.M.M.), Universitat Autònoma de Barcelona, Bellaterra, Spain; Nephrology Service (J.L.T.) and Department of Neurology, Neurovascular Section (J.Á.-S, O.M., J.M.), Vall Hebron's University Hospital, Barcelona, Spain; Emergency Department, CUAP Horta, Barcelona, Spain (C.I.J.); Equip d'Atenció Primària Sant Roc, Institut Català de la Salut, Badalona, Spain (J.L.); Unitat de Suport a la Recerca Metropolitana Nord, IDIAP Jordi Gol, Sabadell, Spain (J.M.M.); and Neurorradiology, Clínica Dr Manchón, Barcelona, Spain (J.L.F.).
| | - Iolanda Riba-Llena
- From the Neurovascular Research Laboratory, Vall Hebron Research Institute (P.D., I.R.-L., A.L.-R., C.N., J.M.), Barcelona City Research Support Unit-IDIAP Jordi Gol (X.M., F.O.), Departament de Medicina (J.L.), and Departament d'Infermeria (J.M.M.), Universitat Autònoma de Barcelona, Bellaterra, Spain; Nephrology Service (J.L.T.) and Department of Neurology, Neurovascular Section (J.Á.-S, O.M., J.M.), Vall Hebron's University Hospital, Barcelona, Spain; Emergency Department, CUAP Horta, Barcelona, Spain (C.I.J.); Equip d'Atenció Primària Sant Roc, Institut Català de la Salut, Badalona, Spain (J.L.); Unitat de Suport a la Recerca Metropolitana Nord, IDIAP Jordi Gol, Sabadell, Spain (J.M.M.); and Neurorradiology, Clínica Dr Manchón, Barcelona, Spain (J.L.F.)
| | - José L Tovar
- From the Neurovascular Research Laboratory, Vall Hebron Research Institute (P.D., I.R.-L., A.L.-R., C.N., J.M.), Barcelona City Research Support Unit-IDIAP Jordi Gol (X.M., F.O.), Departament de Medicina (J.L.), and Departament d'Infermeria (J.M.M.), Universitat Autònoma de Barcelona, Bellaterra, Spain; Nephrology Service (J.L.T.) and Department of Neurology, Neurovascular Section (J.Á.-S, O.M., J.M.), Vall Hebron's University Hospital, Barcelona, Spain; Emergency Department, CUAP Horta, Barcelona, Spain (C.I.J.); Equip d'Atenció Primària Sant Roc, Institut Català de la Salut, Badalona, Spain (J.L.); Unitat de Suport a la Recerca Metropolitana Nord, IDIAP Jordi Gol, Sabadell, Spain (J.M.M.); and Neurorradiology, Clínica Dr Manchón, Barcelona, Spain (J.L.F.)
| | - Carmen I Jarca
- From the Neurovascular Research Laboratory, Vall Hebron Research Institute (P.D., I.R.-L., A.L.-R., C.N., J.M.), Barcelona City Research Support Unit-IDIAP Jordi Gol (X.M., F.O.), Departament de Medicina (J.L.), and Departament d'Infermeria (J.M.M.), Universitat Autònoma de Barcelona, Bellaterra, Spain; Nephrology Service (J.L.T.) and Department of Neurology, Neurovascular Section (J.Á.-S, O.M., J.M.), Vall Hebron's University Hospital, Barcelona, Spain; Emergency Department, CUAP Horta, Barcelona, Spain (C.I.J.); Equip d'Atenció Primària Sant Roc, Institut Català de la Salut, Badalona, Spain (J.L.); Unitat de Suport a la Recerca Metropolitana Nord, IDIAP Jordi Gol, Sabadell, Spain (J.M.M.); and Neurorradiology, Clínica Dr Manchón, Barcelona, Spain (J.L.F.)
| | - Xavier Mundet
- From the Neurovascular Research Laboratory, Vall Hebron Research Institute (P.D., I.R.-L., A.L.-R., C.N., J.M.), Barcelona City Research Support Unit-IDIAP Jordi Gol (X.M., F.O.), Departament de Medicina (J.L.), and Departament d'Infermeria (J.M.M.), Universitat Autònoma de Barcelona, Bellaterra, Spain; Nephrology Service (J.L.T.) and Department of Neurology, Neurovascular Section (J.Á.-S, O.M., J.M.), Vall Hebron's University Hospital, Barcelona, Spain; Emergency Department, CUAP Horta, Barcelona, Spain (C.I.J.); Equip d'Atenció Primària Sant Roc, Institut Català de la Salut, Badalona, Spain (J.L.); Unitat de Suport a la Recerca Metropolitana Nord, IDIAP Jordi Gol, Sabadell, Spain (J.M.M.); and Neurorradiology, Clínica Dr Manchón, Barcelona, Spain (J.L.F.)
| | - Antonio López-Rueda
- From the Neurovascular Research Laboratory, Vall Hebron Research Institute (P.D., I.R.-L., A.L.-R., C.N., J.M.), Barcelona City Research Support Unit-IDIAP Jordi Gol (X.M., F.O.), Departament de Medicina (J.L.), and Departament d'Infermeria (J.M.M.), Universitat Autònoma de Barcelona, Bellaterra, Spain; Nephrology Service (J.L.T.) and Department of Neurology, Neurovascular Section (J.Á.-S, O.M., J.M.), Vall Hebron's University Hospital, Barcelona, Spain; Emergency Department, CUAP Horta, Barcelona, Spain (C.I.J.); Equip d'Atenció Primària Sant Roc, Institut Català de la Salut, Badalona, Spain (J.L.); Unitat de Suport a la Recerca Metropolitana Nord, IDIAP Jordi Gol, Sabadell, Spain (J.M.M.); and Neurorradiology, Clínica Dr Manchón, Barcelona, Spain (J.L.F.)
| | - Francesc Orfila
- From the Neurovascular Research Laboratory, Vall Hebron Research Institute (P.D., I.R.-L., A.L.-R., C.N., J.M.), Barcelona City Research Support Unit-IDIAP Jordi Gol (X.M., F.O.), Departament de Medicina (J.L.), and Departament d'Infermeria (J.M.M.), Universitat Autònoma de Barcelona, Bellaterra, Spain; Nephrology Service (J.L.T.) and Department of Neurology, Neurovascular Section (J.Á.-S, O.M., J.M.), Vall Hebron's University Hospital, Barcelona, Spain; Emergency Department, CUAP Horta, Barcelona, Spain (C.I.J.); Equip d'Atenció Primària Sant Roc, Institut Català de la Salut, Badalona, Spain (J.L.); Unitat de Suport a la Recerca Metropolitana Nord, IDIAP Jordi Gol, Sabadell, Spain (J.M.M.); and Neurorradiology, Clínica Dr Manchón, Barcelona, Spain (J.L.F.)
| | - Judit Llussà
- From the Neurovascular Research Laboratory, Vall Hebron Research Institute (P.D., I.R.-L., A.L.-R., C.N., J.M.), Barcelona City Research Support Unit-IDIAP Jordi Gol (X.M., F.O.), Departament de Medicina (J.L.), and Departament d'Infermeria (J.M.M.), Universitat Autònoma de Barcelona, Bellaterra, Spain; Nephrology Service (J.L.T.) and Department of Neurology, Neurovascular Section (J.Á.-S, O.M., J.M.), Vall Hebron's University Hospital, Barcelona, Spain; Emergency Department, CUAP Horta, Barcelona, Spain (C.I.J.); Equip d'Atenció Primària Sant Roc, Institut Català de la Salut, Badalona, Spain (J.L.); Unitat de Suport a la Recerca Metropolitana Nord, IDIAP Jordi Gol, Sabadell, Spain (J.M.M.); and Neurorradiology, Clínica Dr Manchón, Barcelona, Spain (J.L.F.)
| | - Josep M Manresa
- From the Neurovascular Research Laboratory, Vall Hebron Research Institute (P.D., I.R.-L., A.L.-R., C.N., J.M.), Barcelona City Research Support Unit-IDIAP Jordi Gol (X.M., F.O.), Departament de Medicina (J.L.), and Departament d'Infermeria (J.M.M.), Universitat Autònoma de Barcelona, Bellaterra, Spain; Nephrology Service (J.L.T.) and Department of Neurology, Neurovascular Section (J.Á.-S, O.M., J.M.), Vall Hebron's University Hospital, Barcelona, Spain; Emergency Department, CUAP Horta, Barcelona, Spain (C.I.J.); Equip d'Atenció Primària Sant Roc, Institut Català de la Salut, Badalona, Spain (J.L.); Unitat de Suport a la Recerca Metropolitana Nord, IDIAP Jordi Gol, Sabadell, Spain (J.M.M.); and Neurorradiology, Clínica Dr Manchón, Barcelona, Spain (J.L.F.)
| | - José Alvarez-Sabín
- From the Neurovascular Research Laboratory, Vall Hebron Research Institute (P.D., I.R.-L., A.L.-R., C.N., J.M.), Barcelona City Research Support Unit-IDIAP Jordi Gol (X.M., F.O.), Departament de Medicina (J.L.), and Departament d'Infermeria (J.M.M.), Universitat Autònoma de Barcelona, Bellaterra, Spain; Nephrology Service (J.L.T.) and Department of Neurology, Neurovascular Section (J.Á.-S, O.M., J.M.), Vall Hebron's University Hospital, Barcelona, Spain; Emergency Department, CUAP Horta, Barcelona, Spain (C.I.J.); Equip d'Atenció Primària Sant Roc, Institut Català de la Salut, Badalona, Spain (J.L.); Unitat de Suport a la Recerca Metropolitana Nord, IDIAP Jordi Gol, Sabadell, Spain (J.M.M.); and Neurorradiology, Clínica Dr Manchón, Barcelona, Spain (J.L.F.)
| | - Cristina Nafría
- From the Neurovascular Research Laboratory, Vall Hebron Research Institute (P.D., I.R.-L., A.L.-R., C.N., J.M.), Barcelona City Research Support Unit-IDIAP Jordi Gol (X.M., F.O.), Departament de Medicina (J.L.), and Departament d'Infermeria (J.M.M.), Universitat Autònoma de Barcelona, Bellaterra, Spain; Nephrology Service (J.L.T.) and Department of Neurology, Neurovascular Section (J.Á.-S, O.M., J.M.), Vall Hebron's University Hospital, Barcelona, Spain; Emergency Department, CUAP Horta, Barcelona, Spain (C.I.J.); Equip d'Atenció Primària Sant Roc, Institut Català de la Salut, Badalona, Spain (J.L.); Unitat de Suport a la Recerca Metropolitana Nord, IDIAP Jordi Gol, Sabadell, Spain (J.M.M.); and Neurorradiology, Clínica Dr Manchón, Barcelona, Spain (J.L.F.)
| | - José L Fernández
- From the Neurovascular Research Laboratory, Vall Hebron Research Institute (P.D., I.R.-L., A.L.-R., C.N., J.M.), Barcelona City Research Support Unit-IDIAP Jordi Gol (X.M., F.O.), Departament de Medicina (J.L.), and Departament d'Infermeria (J.M.M.), Universitat Autònoma de Barcelona, Bellaterra, Spain; Nephrology Service (J.L.T.) and Department of Neurology, Neurovascular Section (J.Á.-S, O.M., J.M.), Vall Hebron's University Hospital, Barcelona, Spain; Emergency Department, CUAP Horta, Barcelona, Spain (C.I.J.); Equip d'Atenció Primària Sant Roc, Institut Català de la Salut, Badalona, Spain (J.L.); Unitat de Suport a la Recerca Metropolitana Nord, IDIAP Jordi Gol, Sabadell, Spain (J.M.M.); and Neurorradiology, Clínica Dr Manchón, Barcelona, Spain (J.L.F.)
| | - Olga Maisterra
- From the Neurovascular Research Laboratory, Vall Hebron Research Institute (P.D., I.R.-L., A.L.-R., C.N., J.M.), Barcelona City Research Support Unit-IDIAP Jordi Gol (X.M., F.O.), Departament de Medicina (J.L.), and Departament d'Infermeria (J.M.M.), Universitat Autònoma de Barcelona, Bellaterra, Spain; Nephrology Service (J.L.T.) and Department of Neurology, Neurovascular Section (J.Á.-S, O.M., J.M.), Vall Hebron's University Hospital, Barcelona, Spain; Emergency Department, CUAP Horta, Barcelona, Spain (C.I.J.); Equip d'Atenció Primària Sant Roc, Institut Català de la Salut, Badalona, Spain (J.L.); Unitat de Suport a la Recerca Metropolitana Nord, IDIAP Jordi Gol, Sabadell, Spain (J.M.M.); and Neurorradiology, Clínica Dr Manchón, Barcelona, Spain (J.L.F.)
| | - Joan Montaner
- From the Neurovascular Research Laboratory, Vall Hebron Research Institute (P.D., I.R.-L., A.L.-R., C.N., J.M.), Barcelona City Research Support Unit-IDIAP Jordi Gol (X.M., F.O.), Departament de Medicina (J.L.), and Departament d'Infermeria (J.M.M.), Universitat Autònoma de Barcelona, Bellaterra, Spain; Nephrology Service (J.L.T.) and Department of Neurology, Neurovascular Section (J.Á.-S, O.M., J.M.), Vall Hebron's University Hospital, Barcelona, Spain; Emergency Department, CUAP Horta, Barcelona, Spain (C.I.J.); Equip d'Atenció Primària Sant Roc, Institut Català de la Salut, Badalona, Spain (J.L.); Unitat de Suport a la Recerca Metropolitana Nord, IDIAP Jordi Gol, Sabadell, Spain (J.M.M.); and Neurorradiology, Clínica Dr Manchón, Barcelona, Spain (J.L.F.)
| | | |
Collapse
|
35
|
Subramaniam V, Lip GYH. Hypertension to heart failure: a pathophysiological spectrum relating blood pressure, drug treatments and stroke. Expert Rev Cardiovasc Ther 2014; 7:703-13. [DOI: 10.1586/erc.09.43] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
|
36
|
Muscari A, Puddu GM, Fabbri E, Napoli C, Vizioli L, Zoli M. Factors predisposing to small lacunar versus large non-lacunar cerebral infarcts: is left ventricular mass involved? Neurol Res 2013; 35:1015-21. [DOI: 10.1179/1743132813y.0000000240] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Affiliation(s)
- Antonio Muscari
- Stroke Unit – Department of Medical and Surgical SciencesUniversity of Bologna and S. Orsola-Malpighi Hospital, Bologna, Italy
| | - Giovanni M Puddu
- Stroke Unit – Department of Medical and Surgical SciencesUniversity of Bologna and S. Orsola-Malpighi Hospital, Bologna, Italy
| | - Elisa Fabbri
- Stroke Unit – Department of Medical and Surgical SciencesUniversity of Bologna and S. Orsola-Malpighi Hospital, Bologna, Italy
| | - Chiara Napoli
- Stroke Unit – Department of Medical and Surgical SciencesUniversity of Bologna and S. Orsola-Malpighi Hospital, Bologna, Italy
| | - Luca Vizioli
- Stroke Unit – Department of Medical and Surgical SciencesUniversity of Bologna and S. Orsola-Malpighi Hospital, Bologna, Italy
| | - Marco Zoli
- Stroke Unit – Department of Medical and Surgical SciencesUniversity of Bologna and S. Orsola-Malpighi Hospital, Bologna, Italy
| |
Collapse
|
37
|
Alosco ML, Gunstad J, Jerskey BA, Clark US, Hassenstab JJ, Xu X, Poppas A, Cohen RA, Sweet LH. Left atrial size is independently associated with cognitive function. Int J Neurosci 2013; 123:544-52. [PMID: 23394115 PMCID: PMC4166650 DOI: 10.3109/00207454.2013.774396] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Left atrial (LA) diameter is easily attainable from echocardiograph and sensitive to underlying cardiovascular disease severity, although its association with neurocognitive outcomes is not well understood. Fifty older adults (64.50 ± 9.41 years), recruited from outpatient cardiology clinics and local papers who underwent magnetic resonance imaging, were administered the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS), and completed psychosocial self-report measures. LA diameter was quantified using echocardiogram. Hierarchical regression analyses revealed that greater LA size was independently associated with reduced performance on the following RBANS composites: language, delayed memory, and total index (p < 0.05 for all). Hierarchical regression analysis demonstrated no significant association between LA diameter and whole brain volume (p > 0.05). The current study suggests that greater LA size is associated with cognitive dysfunction in older adults and prospective studies are needed to validate these findings and elucidate underlying mechanisms.
Collapse
Affiliation(s)
- Michael L Alosco
- Department of Psychology, Kent State University, Kent, OH 44242, USA.
| | | | | | | | | | | | | | | | | |
Collapse
|
38
|
Kim HK, Park WS, Warda M, Park SY, Ko EA, Kim MH, Jeong SH, Heo HJ, Choi TH, Hwang YW, Lee SI, Ko KS, Rhee BD, Kim N, Han J. Beta adrenergic overstimulation impaired vascular contractility via actin-cytoskeleton disorganization in rabbit cerebral artery. PLoS One 2012; 7:e43884. [PMID: 22916309 PMCID: PMC3423383 DOI: 10.1371/journal.pone.0043884] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2012] [Accepted: 07/26/2012] [Indexed: 11/22/2022] Open
Abstract
Background and Purpose Beta adrenergic overstimulation may increase the vascular damage and stroke. However, the underlying mechanisms of beta adrenergic overstimulation in cerebrovascular dysfunctions are not well known. We investigated the possible cerebrovascular dysfunction response to isoproterenol induced beta-adrenergic overstimulation (ISO) in rabbit cerebral arteries (CAs). Methods ISO was induced in six weeks aged male New Zealand white rabbit (0.8–1.0 kg) by 7-days isoproterenol injection (300 μg/kg/day). We investigated the alteration of protein expression in ISO treated CAs using 2DE proteomics and western blot analysis. Systemic properties of 2DE proteomics result were analyzed using bioinformatics software. ROS generation and following DNA damage were assessed to evaluate deteriorative effect of ISO on CAs. Intracellular Ca2+ level change and vascular contractile response to vasoactive drug, angiotensin II (Ang II), were assessed to evaluate functional alteration of ISO treated CAs. Ang II-induced ROS generation was assessed to evaluated involvement of ROS generation in CA contractility. Results Proteomic analysis revealed remarkably decreased expression of cytoskeleton organizing proteins (e.g. actin related protein 1A and 2, α-actin, capping protein Z beta, and vimentin) and anti-oxidative stress proteins (e.g. heat shock protein 9A and stress-induced-phosphoprotein 1) in ISO-CAs. As a cause of dysregulation of actin-cytoskeleton organization, we found decreased level of RhoA and ROCK1, which are major regulators of actin-cytoskeleton organization. As functional consequences of proteomic alteration, we found the decreased transient Ca2+ efflux and constriction response to angiotensin II and high K+ in ISO-CAs. ISO also increased basal ROS generation and induced oxidative damage in CA; however, it decreased the Ang II-induced ROS generation rate. These results indicate that ISO disrupted actin cytoskeleton proteome network through down-regulation of RhoA/ROCK1 proteins and increased oxidative damage, which consequently led to contractile dysfunction in CA.
Collapse
Affiliation(s)
- Hyoung Kyu Kim
- National Research Laboratory for Mitochondrial Signaling, Department of Physiology, College of Medicine, Cardiovascular and Metabolic Disease Center, Inje University, Busan, Korea
| | - Won Sun Park
- Department of Physiology, Kangwon National University School of Medicine, Chuncheon, Korea
| | - Mohamad Warda
- Department of Biochemistry, Faculty of Veterinary Medicine, Cairo University, Cairo, Egypt
| | - So Youn Park
- Department of Pharmacology, College of Medicine and Medical Research Center for Ischemic Tissue Regeneration, Pusan National University, Busan, Korea
| | - Eun A. Ko
- Department of Medicine, Section of Pulmonary, Critical Care and Sleep Medicine, University of Illinois at Chicago, Chicago, Illinois, United States of America
| | - Min Hee Kim
- National Research Laboratory for Mitochondrial Signaling, Department of Physiology, College of Medicine, Cardiovascular and Metabolic Disease Center, Inje University, Busan, Korea
| | - Seung Hun Jeong
- National Research Laboratory for Mitochondrial Signaling, Department of Physiology, College of Medicine, Cardiovascular and Metabolic Disease Center, Inje University, Busan, Korea
| | - Hye-Jin Heo
- National Research Laboratory for Mitochondrial Signaling, Department of Physiology, College of Medicine, Cardiovascular and Metabolic Disease Center, Inje University, Busan, Korea
| | - Tae-Hoon Choi
- Department of Physical Education, Andong Science College, Andong, Korea
| | - Young-Won Hwang
- Department of Neurosurgery, College of Medicine, Inje University, Busan Paik Hospital, Busan, Korea
| | - Sun-Il Lee
- Department of Neurosurgery, College of Medicine, Inje University, Busan Paik Hospital, Busan, Korea
| | - Kyung Soo Ko
- National Research Laboratory for Mitochondrial Signaling, Department of Physiology, College of Medicine, Cardiovascular and Metabolic Disease Center, Inje University, Busan, Korea
| | - Byoung Doo Rhee
- National Research Laboratory for Mitochondrial Signaling, Department of Physiology, College of Medicine, Cardiovascular and Metabolic Disease Center, Inje University, Busan, Korea
| | - Nari Kim
- National Research Laboratory for Mitochondrial Signaling, Department of Physiology, College of Medicine, Cardiovascular and Metabolic Disease Center, Inje University, Busan, Korea
| | - Jin Han
- National Research Laboratory for Mitochondrial Signaling, Department of Physiology, College of Medicine, Cardiovascular and Metabolic Disease Center, Inje University, Busan, Korea
- * E-mail:
| |
Collapse
|
39
|
Hayakawa M, Yano Y, Kuroki K, Inoue R, Nakanishi C, Sagara S, Koga M, Kubo H, Imakiire S, Aoyagi Z, Kitani M, Kanemaru K, Hidehito S, Shimada K, Kario K. Independent association of cognitive dysfunction with cardiac hypertrophy irrespective of 24-h or sleep blood pressure in older hypertensives. Am J Hypertens 2012; 25:657-63. [PMID: 22421907 DOI: 10.1038/ajh.2012.27] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Our aim was to assess whether cardiac hypertrophy is associated with cognitive function independently of office, 24-h, or sleep blood pressure (BP) levels in older hypertensive patients treated with antihypertensive medications. METHODS In this cross-sectional study, we recruited 443 hypertensive patients aged over 60 years (mean age: 73.0 years; 41% men) who were ambulatory, lived independently, and were without clinically overt dementia. They underwent measurements of 24-h BP monitoring, echocardiographic left ventricular mass index (LVMI), and cognitive function (mini-mental state examination, MMSE). RESULTS MMSE score was inversely associated with office, 24-h, awake, and sleep systolic BP (SBP) (each, P < 0.05). There was a close association between MMSE score and LVMI (ρ = -0.32; P < 0.001). Using multiple logistic regression analysis including numerous covariates (i.e., age, sex, obesity, current smoking, educational level, duration of antihypertensive medications, renal dysfunction, statin use, and previous history of cardiovascular disease), the odds ratio (OR) for the presence of cognitive dysfunction, defined as the lowest quartile of MMSE score (median MMSE score: 23 points; n = 115), was estimated; the presence of cardiac hypertrophy (LVMI ≥125 kg/m(2) in men and ≥110 kg/m(2) in women) as well as uncontrolled 24-h BP (mean 24-h SBP/diastolic BP (DBP) ≥130/80 mm Hg) or sleep BP (mean sleep SBP/DBP ≥120/70 mm Hg), but not uncontrolled office BP (mean office SBP/DBP ≥140/90 mm Hg), were independently associated with cognitive dysfunction (all P < 0.05). CONCLUSIONS Among older hypertensive patients with antihypertensive medications, those who had echocardiographically determined cardiac hypertrophy may be at high risk for cognitive dysfunction, irrespective of their office BP and 24-h BP levels.
Collapse
|
40
|
Scuteri A, Lakatta EG. Bringing prevention in geriatrics: evidences from cardiovascular medicine supporting the new challenge. Exp Gerontol 2012; 48:64-8. [PMID: 22406133 DOI: 10.1016/j.exger.2012.02.009] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2011] [Revised: 02/10/2012] [Accepted: 02/22/2012] [Indexed: 02/06/2023]
Abstract
Aging is a dynamic and systemic process, with high inter-individual heterogeneity, likely partially adaptive. Cardiovascular disease and hypertension are among the leading conditions causing disabilities in older subjects. If, in accordance with most recent definition, prevention is any intervention before the patient receives a diagnosis, prevention is possible at any age. Additionally, disability and CV disease in the elderly may be prevented by targeting factors underlying and modulating the arterial aging process. Cross-talk between arterial and brain aging will be discussed in this context as a paradigmatic clinical model fostering prevention in older subjects.
Collapse
Affiliation(s)
- Angelo Scuteri
- Laboratory Cardiovascular Sciences, National Institute on Aging Intramural Research Program - NIH, Baltimore, USA.
| | | |
Collapse
|
41
|
Microvascular brain damage with aging and hypertension: pathophysiological consideration and clinical implications. J Hypertens 2012; 29:1469-77. [PMID: 21577138 DOI: 10.1097/hjh.0b013e328347cc17] [Citation(s) in RCA: 101] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Loss of cognitive function and hypertension are two common conditions in the elderly and both significantly contribute to loss of personal independency. Microvascular brain damage - the result of age-associated alteration in large arteries and the progressive mismatch of their cross-talk with small cerebral arteries - represents a potent risk factor for cognitive decline and for the onset of dementia in older individuals. The present review discusses the complexity of factors linking large artery to microvascular brain disease and to cognitive decline and the evidence for possible clinical markers useful for prevention of this phenomenon. The possibility of dementia prevention by cardiovascular risk factors control has not been demonstrated. In the absence of research clinical trials specifically and primarily designed to demonstrate the antihypertensive treatment efficacy for reducing the risk of dementia, further evidence demonstrating that it is possible to limit the progression of microvascular brain damage is needed.
Collapse
|
42
|
Different pattern of carotid and myocardial changes according to left ventricular geometry in hypertensive patients. J Hum Hypertens 2012; 27:7-12. [PMID: 22237632 DOI: 10.1038/jhh.2011.115] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The relation between left ventricular (LV) hypertrophy and LV function is well known. However, less is known about the vascular changes influenced by LV geometry. We sought to investigate the relationship of LV geometry to carotid arterial and LV function. A total of 476 hypertensive patients were prospectively recruited. All subjects underwent echocardiography and carotid ultrasound. LV geometry is categorized into four groups according to relative wall thickness (RWT) and LV mass index (LVMI). Concentric LV geometry was associated with increased carotid intima-media thickness (IMT), β-stiffness, and lower strain. All of the carotid parameters showed a stepwise change according to RWT of LV, whereas LV function was worse in hypertrophic geometry, as reflected by significantly lower systolic mitral annular velocity, higher left atrial volume index and E/E' ratio (P<0.001). By multivariate analysis after adjustment for clinical and laboratory parameters, IMT was independently associated with RWT, whereas myocardial function was independently associated with LVMI. Carotid arterial function and IMT showed worse values in concentric geometry, whereas LV systolic and diastolic function were worse in hypertrophic geometry, suggesting a discrepancy between carotid arterial and LV function in hypertensive patients.
Collapse
|
43
|
Slark J, Bentley P, Sharma P. Silent brain infarction in the presence of systemic vascular disease. JRSM Cardiovasc Dis 2012; 1:10.1258_cvd.2012.012002. [PMID: 24175060 PMCID: PMC3738320 DOI: 10.1258/cvd.2012.012002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Objective To determine the prevalence of asymptomatic brain ischaemic in the presence of vascular disease in other arterial territories. Design Studies up to January 2011 were identified through comprehensive search strategies. Arcsine transformation for meta-analysis was used to calculate the standardized mean difference (SMD) and 95% confidence intervals (CI). Setting A systematic review and meta-analysis were performed. Participants For each study, the proportion of patients positive for SBI in the presence of other systemic vascular disease was extracted and analyzed. Main outcome measures Using a random-effects model, a pooled effect estimate interpreted as a percentage prevalence of disease was calculated. Results SBI in the presence of acute ischaemic stroke was found in 23% (SMD 0.99; P < 0.001; 95% CI 0.88–1.10); a 35% prevalence was found in patients with coronary artery disease (SMD 1.26; P < 0.001; 95% CI 0.95–1.58); and a 14% prevalence in patients with peripheral artery disease (SMD 0.48; P < 0.002; 95% CI 0.42–0.54), although the data-set in the latter is smaller. Conclusions Patients with systemic vascular disease are at an increased risk of silent brain infarction.
Collapse
Affiliation(s)
- Julia Slark
- Imperial College Cerebrovascular Research Unit (ICCRU), Department of Clinical Neurology, Imperial College London , London W6 8RF , UK
| | | | | |
Collapse
|
44
|
Gorelick PB, Scuteri A, Black SE, Decarli C, Greenberg SM, Iadecola C, Launer LJ, Laurent S, Lopez OL, Nyenhuis D, Petersen RC, Schneider JA, Tzourio C, Arnett DK, Bennett DA, Chui HC, Higashida RT, Lindquist R, Nilsson PM, Roman GC, Sellke FW, Seshadri S. Vascular contributions to cognitive impairment and dementia: a statement for healthcare professionals from the american heart association/american stroke association. Stroke 2011; 42:2672-713. [PMID: 21778438 PMCID: PMC3778669 DOI: 10.1161/str.0b013e3182299496] [Citation(s) in RCA: 2558] [Impact Index Per Article: 196.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND AND PURPOSE This scientific statement provides an overview of the evidence on vascular contributions to cognitive impairment and dementia. Vascular contributions to cognitive impairment and dementia of later life are common. Definitions of vascular cognitive impairment (VCI), neuropathology, basic science and pathophysiological aspects, role of neuroimaging and vascular and other associated risk factors, and potential opportunities for prevention and treatment are reviewed. This statement serves as an overall guide for practitioners to gain a better understanding of VCI and dementia, prevention, and treatment. METHODS Writing group members were nominated by the writing group co-chairs on the basis of their previous work in relevant topic areas and were approved by the American Heart Association Stroke Council Scientific Statement Oversight Committee, the Council on Epidemiology and Prevention, and the Manuscript Oversight Committee. The writing group used systematic literature reviews (primarily covering publications from 1990 to May 1, 2010), previously published guidelines, personal files, and expert opinion to summarize existing evidence, indicate gaps in current knowledge, and, when appropriate, formulate recommendations using standard American Heart Association criteria. All members of the writing group had the opportunity to comment on the recommendations and approved the final version of this document. After peer review by the American Heart Association, as well as review by the Stroke Council leadership, Council on Epidemiology and Prevention Council, and Scientific Statements Oversight Committee, the statement was approved by the American Heart Association Science Advisory and Coordinating Committee. RESULTS The construct of VCI has been introduced to capture the entire spectrum of cognitive disorders associated with all forms of cerebral vascular brain injury-not solely stroke-ranging from mild cognitive impairment through fully developed dementia. Dysfunction of the neurovascular unit and mechanisms regulating cerebral blood flow are likely to be important components of the pathophysiological processes underlying VCI. Cerebral amyloid angiopathy is emerging as an important marker of risk for Alzheimer disease, microinfarction, microhemorrhage and macrohemorrhage of the brain, and VCI. The neuropathology of cognitive impairment in later life is often a mixture of Alzheimer disease and microvascular brain damage, which may overlap and synergize to heighten the risk of cognitive impairment. In this regard, magnetic resonance imaging and other neuroimaging techniques play an important role in the definition and detection of VCI and provide evidence that subcortical forms of VCI with white matter hyperintensities and small deep infarcts are common. In many cases, risk markers for VCI are the same as traditional risk factors for stroke. These risks may include but are not limited to atrial fibrillation, hypertension, diabetes mellitus, and hypercholesterolemia. Furthermore, these same vascular risk factors may be risk markers for Alzheimer disease. Carotid intimal-medial thickness and arterial stiffness are emerging as markers of arterial aging and may serve as risk markers for VCI. Currently, no specific treatments for VCI have been approved by the US Food and Drug Administration. However, detection and control of the traditional risk factors for stroke and cardiovascular disease may be effective in the prevention of VCI, even in older people. CONCLUSIONS Vascular contributions to cognitive impairment and dementia are important. Understanding of VCI has evolved substantially in recent years, based on preclinical, neuropathologic, neuroimaging, physiological, and epidemiological studies. Transdisciplinary, translational, and transactional approaches are recommended to further our understanding of this entity and to better characterize its neuropsychological profile. There is a need for prospective, quantitative, clinical-pathological-neuroimaging studies to improve knowledge of the pathological basis of neuroimaging change and the complex interplay between vascular and Alzheimer disease pathologies in the evolution of clinical VCI and Alzheimer disease. Long-term vascular risk marker interventional studies beginning as early as midlife may be required to prevent or postpone the onset of VCI and Alzheimer disease. Studies of intensive reduction of vascular risk factors in high-risk groups are another important avenue of research.
Collapse
|
45
|
Rumana N, Turin TC, Miura K, Nakamura Y, Kita Y, Hayakawa T, Choudhury SR, Kadota A, Nagasawa SY, Fujioshi A, Takashima N, Okamura T, Okayama A, Ueshima H. Prognostic value of ST-T abnormalities and left high R waves with cardiovascular mortality in Japanese (24-year follow-up of NIPPON DATA80). Am J Cardiol 2011; 107:1718-24. [PMID: 21497783 DOI: 10.1016/j.amjcard.2011.02.335] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2010] [Revised: 02/12/2011] [Accepted: 02/12/2011] [Indexed: 10/18/2022]
Abstract
Little is known about the prognostic value of ST-segment depression and/or T wave (ST-T abnormalities) with or without left high R waves on electrocardiogram recorded at rest for death from cardiovascular disease (CVD) in Asian populations. Japanese participants without a history of CVD and free of major electrocardiographic (ECG) abnormalities were followed for 24 years. Subjects were divided into 4 groups based on baseline ECG findings: isolated left high R waves, isolated ST-T abnormalities, ST-T abnormalities with left high R waves, and normal electrocardiogram. Cox proportional hazard model was used to estimate risk of CVD mortality in groups with ECG abnormalities compared to the normal group. Of 8,572 participants (44.4% men, mean age 49.5 years; 55.6% women, mean age 49.4 years), 1,142 had isolated left high R waves, 292 had isolated ST-T abnormalities, and 128 had ST-T abnormalities with left high R waves at baseline. Multivariable-adjusted hazard ratios of ST-T abnormalities with left high R waves for CVD mortality were 1.95 (95% confidence interval 1.25 to 3.04) in men and 2.68 (95% confidence interval 1.81 to 3.97) in women. Isolated ST-T abnormalities increased the risk for CVD death by 1.66 times (95% confidence interval 1.01 to 2.71) in men and 1.62 times (95% confidence interval 1.18 to 2.24) in women. Association of ECG abnormalities with CVD mortality was independent of age, body mass index, systolic blood pressure, serum cholesterol, blood glucose, smoking and drinking, and antihypertensive medication. In conclusion, ST-T abnormalities with or without left high R waves on electrocardiogram recorded at rest constitute an independent predictor of CVD mortality in Japanese men and women.
Collapse
|
46
|
Correlations between left ventricular mass index and cerebrovascular lesion. Open Med (Wars) 2011. [DOI: 10.2478/s11536-011-0019-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
AbstractLeft ventricular (LV) mass and LV geometry are well-established measures of hypertension chronicity and severity, have a prognostic value on cardiovascular morbidity and mortality, and are related to asymptomatic cerebral small-artery disease (SAD) and largeartery disease (LAD). The aim of the present study was to clarify the different effects of LV mass and LV geometry on underlying SAD compared with its effects on underlying LAD in ischemic stroke patients. Four hundred three ischemic stroke patients underwent echocardiography to determine LV mass index and relative wall thickness. Brain magnetic resonance imaging, angiography, and carotid magnetic resonance angiography were preformed to detect LAD (≥50% stenosis) and SAD (leukoaraiosis, microbleeds, and old lacunar infarction) in the brain. Multivariate analyses showed that the LV mass index was highly associated with underlying SAD but not with underlying LAD. Among the various subtypes of SAD, only cerebral microbleeds were closely related to the LV mass index. Concentric LV hypertrophy was not related to the presence of either SAD or LAD. Subgroup analyses revealed that, among the various subtypes of SAD, only cerebral microbleeds were associated with concentric LV hypertrophy. In conclusion, cerebral microbleeds may imply more advanced target organ damage than underlying LAD and ischemic subtypes of SAD.
Collapse
|
47
|
Left ventricular hypertrophy versus chronic kidney disease as predictors of cardiovascular events in hypertension: a Greek 6-year-follow-up study. J Hypertens 2009; 27:744-52. [PMID: 19516174 DOI: 10.1097/hjh.0b013e32832401ff] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
OBJECTIVES We assessed the comparative prognostic role of left ventricular hypertrophy (LVH) and chronic kidney disease (CKD) for major cardiovascular events in a prospective observational study in Greek essential hypertensive patients. METHODS We followed up 1652 hypertensive patients (mean age 54.3 years, 696 male patients, office blood pressure 147/93 mmHg) free of cardiovascular disease for a mean period of 6 years. CKD and echocardiographically detected LVH were evaluated at baseline along with five major traditional risk factors [age > 65 years, sex, current smoking, diabetes mellitus and dyslipidemia (low density lipoprotein > 160 mg/dl)]. End points of interest were the incidence of coronary artery disease, stroke, all-cause mortality and their composite. RESULTS At the end of follow-up, coronary artery disease was the most prevalent (5.2%), followed by stroke (5%) and total mortality (3.1%). The presence of both LVH and CKD is associated with a 2.5-fold increase in coronary artery disease (P = 0.034), four-fold in stroke (P = 0.002) and 3.2-fold in the composite (P < 0.001), whereas the presence of LVH alone was associated with a 2.5-fold higher risk for stroke (P = 0.009) and 1.7-fold for the composite (P = 0.018). By multivariate Cox regression analysis, LVH (hazard ratio = 1.53, P = 0.036) and CKD (hazard ratio = 1.66, P = 0.039) turned out to be independent prognosticators of the composite end point, whereas age more than 65 years (hazard ratio = 4.59, P < 0.001) and the presence of LVH (hazard ratio = 2.01, P = 0.043) were the only predictors of stroke. CONCLUSIONS In hypertensive patients free of cardiovascular disease, CKD and LVH are both independent prognosticators of the composite end point of all-cause death and cardiovascular morbidity, whereas LVH but not CKD is a major predictor for stroke.
Collapse
|
48
|
Scuteri A, Coluccia R, Castello L, Nevola E, Brancati AM, Volpe M. Left ventricular mass increase is associated with cognitive decline and dementia in the elderly independently of blood pressure. Eur Heart J 2009; 30:1525-1529. [DOI: 10.1093/eurheartj/ehp133] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/30/2023] Open
|
49
|
Detection of silent cerebrovascular disease refines risk stratification of hypertensive patients. J Hypertens 2009; 27:846-53. [DOI: 10.1097/hjh.0b013e3283232c96] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
50
|
Fox ER, Alnabhan N, Penman AD, Butler KR, Taylor HA, Skelton TN, Mosley TH. Echocardiographic left ventricular mass index predicts incident stroke in African Americans: Atherosclerosis Risk in Communities (ARIC) Study. Stroke 2007; 38:2686-91. [PMID: 17761924 PMCID: PMC3292849 DOI: 10.1161/strokeaha.107.485425] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2007] [Accepted: 04/16/2007] [Indexed: 01/19/2023]
Abstract
BACKGROUND AND PURPOSE Despite theories that link stroke to left ventricular mass, few large, population-based studies have examined the predictive value of echocardiographically derived left ventricular mass index (LVMI) to incident stroke in African Americans. METHODS Participants in the Jackson cohort of the Atherosclerotic Risk in Communities study have had extensive baseline evaluations, have undergone echocardiography during the third examination (1993-1995), and have been followed up for incident cardiovascular disease including ischemic stroke. RESULTS The study population consisted of 1792 participants, of whom 639 (35.7%) were men and the mean+/-SD age was 58.8+/-5.7 years. Compared with those without ischemic stroke, those with ischemic stroke had a higher frequency of hypertension (85.6% vs 58.7%) and diabetes (46.9% vs 21.0%). Left ventricular hypertrophy was more prevalent in those with stroke (62.2% vs 38.6%). During a median follow-up of 8.8 years, 98 incident strokes occurred (6.5 per 1000 person-years). LVMI was independently associated with stroke after adjusting for age, sex, hypertension, systolic blood pressure, smoking, diabetes, total to HDL cholesterol ratio, body mass index, and low left ventricular ejection fraction (adjusted hazard ratio per 10 g/m(2.7) increment of LVMI=1.15; 95% CI, 1.02 to 1.28). The relation remained statistically significant after adding left atrial size and mitral annular calcification to the multivariable model. CONCLUSIONS In this large, population-based African American cohort, we found that echocardiographic LVMI was an independent predictor of incident ischemic stroke even after taking into account traditional clinical risk factors.
Collapse
Affiliation(s)
- Ervin R Fox
- Jackson Heart Study, Department of Medicine, University of Mississippi Medical Center, 2500, N State St, Jackson, MS 39216, USA.
| | | | | | | | | | | | | |
Collapse
|