Impact of Peripheral Microvascular Endothelial Dysfunction on White Matter Hyperintensity.
Impact of Peripheral Microvascular Endothelial Dysfunction on White Matter Hyperintensity.
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DOI：
10.1161/jaha.121.021066
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发表时间：
2021-10-19
影响因子：
5.4
通讯作者：
Lerman A
中科院分区：
文献类型：
--
作者：
Toya T;Sara JD;Scharf EL;Ahmad A;Nardi V;Ozcan I;Lerman LO;Lerman A
白色高信号（WMH）的特征是T2加权液体衰减反转恢复脑磁共振成像上的高信号，与缺血性卒中（IS）风险增加有关。内皮功能障碍是血管功能障碍的指标，可预测IS的风险。本研究旨在探讨内皮功能障碍与局部WMH之间的关系及其对IS未来风险的影响。我们招募了219名患者（平均年龄53.1±14.1岁; 34.7%为男性），他们接受了外周内皮功能评估，使用反应性充血外周动脉张力计和脑磁共振成像，无任何IS病史。使用经验证的自动数字工具自动外推体积WMH分割。总WMH体积和大脑皮质WMH体积/颅内体积（%）随年龄增长而增加，年龄>50岁的患者（n=131）比年龄≤50岁的患者（n=88）更为突出（总WMH ≤50岁，Pearson r=0.24，P=0.03; >50岁，Pearson r =0.62，P<0.0001;>50岁，Pearson r=0.55，P<0.0001）。在校正其他协变量后，年龄>50岁的患者中，反应性充血外周动脉张力指数与总WMH体积和前皮质WMH体积/颅内体积（%）呈负相关（反应性充血外周动脉张力指数，标准化β系数-0.17，P=0.04）。中位随访6.5年期间，皮质旁WMH体积/颅内体积（%）与IS风险增加相关（风险比，1.47; 95% CI，1.05-1.92; P=0.03）。外周内皮功能障碍与年龄>50岁的患者中皮质WMH体积增加相关，这是预测IS未来风险的潜在标志物。
White matter hyperintensity (WMH), characterized by hyperintensities on T2‐weighted fluid‐attenuated inversion recovery brain magnetic resonance imaging, has been linked to an increased risk of ischemic stroke (IS). Endothelial dysfunction is an indicator of vascular dysfunction, predicting the risk of IS. This study aimed to investigate the association between endothelial dysfunction and regional WMH, and its impact on future risk of IS. We enrolled 219 patients (mean age, 53.1±14.1 years; 34.7% men) who underwent peripheral endothelial function assessment using reactive hyperemia peripheral arterial tonometry and brain magnetic resonance imaging without any history of IS. Volumetric WMH segmentation was automatically extrapolated using a validated automated digital tool. Total and juxtacortical WMH volume/intracranial volume (%) increased with aging and became more prominent in patients aged >50 years (n=131) than those aged ≤50 years (n=88) (total WMH: ≤50 years, Pearson r=0.24, P=0.03; >50 years, Pearson r=0.62, P<0.0001; juxtacortical WMH: ≤50 years, Pearson r=0.09, P=0.40; >50 years, Pearson r=0.55, P<0.0001). Reactive hyperemia peripheral arterial tonometry index was negatively associated with total and juxtacortical WMH volume/intracranial volume (%) in patients aged >50 years after adjustment for other covariates (reactive hyperemia peripheral arterial tonometry index, standardized β coefficient −0.17, P=0.04). Juxtacortical WMH volume/intracranial volume (%) was associated with an increased risk of IS during median follow‐up of 6.5 years (hazard ratio, 1.47; 95% CI, 1.05–1.92; P=0.03). Peripheral endothelial dysfunction is associated with an increased volume of juxtacortical WMH in patients aged >50 years, which is a potential marker to predict future risk of IS.