Atrial fibrillation and the risk of cerebral white matter lesions
Atrial fibrillation and the risk of cerebral white matter lesions
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DOI：
10.1212/wnl.54.9.1795
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发表时间：
2000-05-09
期刊：
影响因子：
9.9
通讯作者：
Breteler, MMB
中科院分区：
文献类型：
--
作者：
de Leeuw, FE;de Groot, JC;Breteler, MMB
背景：在老年非痴呆和痴呆患者的 MRI 扫描中经常观察到脑白质病变。其发病机制尚不完全清楚，但可能与脑灌注不足有关。心房颤动是老年受试者的常见症状，可能导致心输出量减少和脑灌注不足。作者调查了心房颤动与白质病变之间的关联。方法：从 1995 年到 1996 年，作者从两项正在进行的前瞻性人群研究中随机抽取了 1077 名受试者。记录每位参与者的心电图（ECG）；心房颤动和左心室肥厚是通过计算机程序诊断的。对于两组（553 名受试者）中的一组，可以获得较早的心电图（平均随访 4.7 年）。所有受试者均接受1.5-T MRI扫描；脑室周围和皮质下区域的白质病变分别进行评估。结果：75 岁以下受试者中房颤的患病率为 1.9%，75 岁以上受试者中房颤的患病率为 5.5%。患有房颤的受试者总数为 28 人。患有房颤的受试者出现严重的室周白质病变的频率是未患房颤的受试者的两倍多（RR 2.2；95% CI 1.0 - 5.2），但皮质下白质病变的风险没有增加（RR 1.1；95% CI 0.4 - 2.6）。对于 7 名在基线和随访时均患有房颤的受试者，这些相对风险分别为 6.3（95% CI 1.1 至 37.1）和 0.7（95% CT 0.1 至 3.7）。结论：心房颤动与室周白质病变相关，但与皮质下白质病变无关。
Background: Cerebral white matter lesions are often observed on MRI scans of elderly nondemented and demented persons. Their pathogenesis is not fully understood but cerebral hypoperfusion may be involved. Atrial fibrillation is a common finding in elderly subjects and may lead to a reduced cardiac output with cerebral hypoperfusion. The authors investigated the association between atrial fibrillation and the presence of white matter lesions. Methods: From 1995 through 1996, the authors randomly sampled 1077 subjects from two ongoing prospective population-based studies. From each participant, an electrocardiogram (ECG) was recorded; atrial fibrillation and left ventricular hypertrophy were diagnosed with a computer program. For one of the two groups (553 subjects), earlier ECGs were available (mean follow-up 4.7 years). All subjects underwent 1.5-T MRI scanning; white matter lesions were separately rated for the periventricular and subcortical regions. Results: The prevalence of atrial fibrillation was 1.9% among subjects younger than 75 years and 5.5% in subjects older than 75 years. The total number of subjects with atrial fibrillation was 28. Subjects with atrial fibrillation had severe periventricular white matter lesions more than twice as often as subjects who did not (RR 2.2; 95% CI 1.0 to 5.2) but had no increased risk of subcortical white matter lesions (RR 1.1; 95% CI 0.4 to 2.6). For seven subjects with atrial fibrillation both at baseline and at follow up, these relative risks were 6.3 (95% CI 1.1 to 37.1) and 0.7 (95% CT 0.1 to 3.7). Conclusions: Atrial fibrillation is associated with periventricular white matter lesions, but not with subcortical white matter lesions.