Association between excessive supraventricular ectopy and subclinical cerebrovascular disease: a population-based study
Association between excessive supraventricular ectopy and subclinical cerebrovascular disease: a population-based study
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DOI：
10.1111/ene.13970
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发表时间：
2019-09-01
影响因子：
5.1
通讯作者：
Ueshima, H.
中科院分区：
文献类型：
--
作者：
Hisamatsu, T.;Miura, K.;Ueshima, H.
背景与目的室上性异位搏动（SVEB）增加与亚临床脑血管病之间的关系尚不清楚。考虑到SVEB增加是心房心肌病或动脉粥样硬化负荷的标志物这一新兴概念，我们试图确定过度室上性异位活动（ESVEA）是否与中年至老年队列中亚临床脑血管疾病的较高负荷相关，这些队列既无明显卒中也无房颤。方法我们对462名男性（平均年龄68.1岁）进行了一项横断面人群研究，这些男性接受了24小时动态霍尔特心电图和脑磁共振成像。ESVEA定义为存在>10 SVEB/h。亚临床脑血管病定义为无症状性脑梗死（SBI）、白色高信号（WMH）和颅内动脉粥样硬化性狭窄（ICAS）。ESVEA与亚临床脑血管疾病的相关性被调整为潜在的混杂协变量。结果ESVEA患者88例（19.0%），SBI患者81例（17.5%），WMH患者91例（19.7%），ICAS患者109例（23.6%）。在具有稳健误差方差的多变量调整泊松回归中，ESVEA与WMH的存在相关（相对风险，1.58; 95%置信区间，1.06-2.36）和ICAS（相对危险度，1.49; 95%可信区间，1.02-2.18），但与SBI（相对危险度，1.32; 95%可信区间，0.86-2.01）不相关。当亚临床脑血管病的分级分布作为有序Logistic回归的结果时，这些关联是一致的。结论ESVEA与WMH和ICAS的高负担独立相关。这表明，增加SVEB可能会改善亚临床脑血管疾病和明显缺血性卒中高风险个体的风险分层。
Background and purpose The association between an increased supraventricular ectopic beat (SVEB) and subclinical cerebrovascular disease remains unclear. Given the emerging concept that an increased SVEB is a marker of atrial cardiomyopathy or atherosclerosis burden, we sought to determine whether excessive supraventricular ectopic activity (ESVEA) is associated with a higher burden of subclinical cerebrovascular disease in the middle-aged to older cohort with neither apparent stroke nor atrial fibrillation. Methods We conducted a cross-sectional population-based study of 462 men (mean age, 68.1 years) who underwent 24-h Holter electrocardiography and brain magnetic resonance imaging. ESVEA was defined as the presence of >10 SVEBs/h. Subclinical cerebrovascular diseases were defined as silent brain infarct (SBI), white matter hyperintensity (WMH) and intracranial atherosclerotic stenosis (ICAS). The association of ESVEA with the presence of subclinical cerebrovascular diseases was adjusted for potential confounding covariates. Results A total of 88 (19.0%) participants had ESVEA and 81 (17.5%), 91 (19.7%) and 109 (23.6%) had SBI, WMH and ICAS, respectively. In multivariable-adjusted Poisson regression with robust error variance, ESVEA was associated with the presence of WMH (relative risk, 1.58; 95% confidence interval, 1.06-2.36) and ICAS (relative risk, 1.49; 95% confidence interval, 1.02-2.18), but not with that of SBI (relative risk, 1.32; 95% confidence interval, 0.86-2.01). These associations were consistent when the graded distributions of subclinical cerebrovascular diseases were applied as outcomes in ordinal logistic regression. Conclusions The ESVEA was independently associated with higher burdens of WMH and ICAS. This suggests that increased SVEBs might improve risk stratification of individuals at high risk of subclinical cerebrovascular disease and consequently apparent ischaemic stroke.