Relationship of cardiac biomarkers with white matter hyperintensities in cardioembolic stroke due to atrial fibrillation and/or rheumatic heart disease.
Relationship of cardiac biomarkers with white matter hyperintensities in cardioembolic stroke due to atrial fibrillation and/or rheumatic heart disease.
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心房颤动和/或风湿性心脏病引起的心源性卒中中心脏生物标志物与白质高信号的关系
DOI：
10.1097/md.0000000000011892
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发表时间：
2018-08
期刊：
影响因子：
1.6
通讯作者：
Liu M
中科院分区：
文献类型：
--
作者：
Wei C;Zhang S;Liu J;Yuan R;Liu M
摘要白质高信号(WMH)是老年人常见的致残因素，可与心脏损伤并存。目前尚不清楚心脏生物标记物是否与WMH相关。为了研究这个问题，我们前瞻性地招募了因心房颤动(AF)和/或风湿性心脏病(RHD)而发生心栓性中风的患者。检测四种心脏生物标志物：肌红蛋白、高敏心肌肌钙蛋白T(hs-cTnT)、肌酸激酶-MB和末端脑利钠肽原。分别测定脑室周围白质和深部白质的WMHs。在171例患者中，120例(70.2%)表现为WMH，其中18例(10.5%)表现为中至重度深部白质高信号(DWMH)，55例(32.2%)表现为中至重度脑室周围高信号(PVH)。在调整混杂因素后，高肌红蛋白水平的患者发生中重度PVH的风险是低水平患者的2.460倍，hs-cTnT水平高的患者发生中重度PVH的风险是低水平患者的2.608倍。4种心脏生物标志物中的任何一种与中度至重度DWMH均无显著关联。这项前瞻性观察研究为房颤和/或风湿性心脏病所致心栓性卒中患者心脏生物标志物与WMH的潜在关系提供了新的证据。我们发现，肌红蛋白水平升高和hs-TnT水平升高与中度至重度PVH的存在独立相关。需要进一步的研究来检验我们的发现，并探索心脏生物标记物是否直接与WMHs的发病有关。
Abstract White matter hyperintensities (WMHs), which are common in elderly people and contribute to age-related disability, can coexist with cardiac injury. It remains unclear whether cardiac biomarkers are associated with WMHs. To investigate this question, we prospectively recruited patients with cardioembolic stroke due to atrial fibrillation (AF) and/or rheumatic heart disease (RHD). Four cardiac biomarkers were measured: myoglobin, high-sensitivity cardiac troponin T (hs-cTnT), creatine kinase-MB, and terminal pro-brain natriuretic peptide. WMHs in periventricular and deep white matter were assessed separately. In the entire sample of 171 patients, 120 (70.2%) presented with WMHs, of whom 18 (10.5%) presented with moderate to severe deep white matter hyperintensities (DWMH) and 55 (32.2%) presented with moderate to severe periventricular hyperintensities (PVH). Risk of moderate to severe PVH, after adjusting for confounders, was 2.460-fold higher in patients with high myoglobin levels than in those with low levels, and the risk was 2.608-fold higher in patients with high hs-cTnT levels than in those with low levels. There were no significant associations between any of the 4 cardiac biomarkers and moderate to severe DWMH. This prospective observational study provides new evidence of the potential relationship of cardiac biomarkers with WMHs in patients with cardioembolic stroke due to AF and/or RHD. We found that elevated myoglobin levels and high hs-TnT levels were independently associated with the presence of moderate to severe PVH. Further studies are required to test our findings and explore whether cardiac biomarkers contribute directly to WMHs pathogenesis.