Atherosclerotic Plaques in the Aortic Arch and Subclinical Cerebrovascular Disease.
Atherosclerotic Plaques in the Aortic Arch and Subclinical Cerebrovascular Disease.
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DOI：
10.1161/strokeaha.116.015002
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发表时间：
2016-11
期刊：
影响因子：
8.3
通讯作者：
Di Tullio MR
中科院分区：
文献类型：
--
作者：
Tugcu A;Jin Z;Homma S;Elkind MS;Rundek T;Yoshita M;DeCarli C;Nakanishi K;Shames S;Wright CB;Sacco RL;Di Tullio MR
主动脉弓斑块（AAP）是缺血性中风的危险因素，但其与亚临床脑血管疾病的关联尚未确定。我们在老年无中风社区队列中研究了 AAP 与亚临床脑血管疾病之间的关联。心血管异常和脑损伤（CABL）研究旨在调查老年人无症状脑血管疾病的心血管预测因素。通过胸骨上经胸超声心动图 (TTE) 对 954 名参与者进行了 AAP 评估。通过脑 MRI 评估 SBI 和白质高信号体积 (WMHV)。通过逻辑回归分析评估 AAP 厚度与 SBI 和 WMHV 的关联。平均年龄为 71.6 ± 9.3 岁，其中 63% 为女性。 658 名 (69%) 受试者中存在 AAP。 138 名参与者 (14.5%) 检测到无症状脑梗塞 (SBI)。在针对潜在混杂因素进行调整的多变量分析中，AAP厚度和大AAP（厚度≥4mm）与WMHV（WMHV-Q4）的上四分位数显着相关（OR=1.17；95% CI，1.04–1.32；P=0.009和OR=1.79；95% CI，1.40–3.09；P=0.036），但不是与 SBI（分别为 OR=1.08；95% CI，0.94–1.23；P=0.265 和 OR=1.46；95% CI，0.77–2.77；P=0.251）。在无卒中社区老年队列中，主动脉弓动脉粥样硬化与 WMHV 相关。这种关联在斑块较大且与心血管危险因素无关的受试者中更为明显。 TTE 的主动脉弓评估可能有助于识别亚临床脑血管疾病风险较高的受试者，这些受试者可能受益于积极的中风危险因素治疗。
Aortic arch plaque (AAP) is a risk factor for ischemic stroke, but its association with subclinical cerebrovascular disease is not established. We investigated the association between AAP and subclinical cerebrovascular disease in an elderly stroke-free community-based cohort. The Cardiovascular Abnormalities and Brain Lesions (CABL) study was designed to investigate cardiovascular predictors of silent cerebrovascular disease in the elderly. AAPs were assessed by suprasternal transthoracic echocardiography (TTE) in 954 participants. SBI and white matter hyperintensity volume (WMHV) were assessed by brain MRI. The association of AAP thickness with SBI and WMHV was evaluated by logistic regression analysis. Mean age was 71.6 ± 9.3 years, 63% were women. AAP was present in 658 (69%) subjects. Silent brain infarcts (SBI) were detected in 138 participants (14.5%). In multivariate analysis adjusted for potential confounders, AAP thickness and large AAP (≥4mm in thickness) were significantly associated with the upper quartile of WMHV (WMHV-Q4) (OR=1.17; 95% CI, 1.04–1.32; P=0.009 and OR=1.79; 95% CI, 1.40–3.09; P=0.036, respectively), but not with SBI (OR=1.08; 95% CI, 0.94–1.23; P=0.265 and OR=1.46; 95% CI, 0.77–2.77; P=0.251, respectively). Aortic arch atherosclerosis was associated with WMHV in a stroke-free community-based elderly cohort. This association was stronger in subjects with large plaques and independent of cardiovascular risk factors. Aortic arch assessment by TTE may help identify subjects at higher risk of subclinical cerebrovascular disease, who may benefit from aggressive stroke risk factors treatment.