Left Ventricular Mass, Brain Magnetic Resonance Imaging, and Cognitive Performance: Results From the Strong Heart Study.
Left Ventricular Mass, Brain Magnetic Resonance Imaging, and Cognitive Performance: Results From the Strong Heart Study.
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DOI：
10.1161/hypertensionaha.117.09807
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发表时间：
2017-11
期刊：
影响因子：
--
通讯作者：
Devereux RB
中科院分区：
文献类型：
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作者：
Haring B;Omidpanah A;Suchy-Dicey AM;Best LG;Verney SP;Shibata DK;Cole SA;Ali T;Howard BV;Buchwald D;Devereux RB
左心室重量(LVM)已被证明可以作为长期暴露于几种危险因素导致的靶器官损害的衡量标准。关于中年LVM与后来的认知表现之间的关联的数据很少。我们研究了721名成年人(基线平均年龄56岁)，参加了心脏强健研究(SHS，1993-1995)和美国印第安人辅助脑血管疾病及其后果研究(CDCAI，2010-13)，这是一个心血管疾病(CVD)患病率很高的研究人群。用经胸超声心动图评价1993~1995年基线状态的LVm。在2010至2013年间进行了头颅磁共振成像(MRI)和认知测试。广义估计方程被用来建模LVM和后来的成像和认知结果之间的关联。平均随访期17年。高左室压差25gm与较低的海马体积(0.01%；95%可信区间0.02，0.00；p值0.001)和较高的白质分级(0.10；95%可信区间0.02，0.18；p值0.014)相关。在功能方面，左心室成熟度较高的参与者在改良的简易精神状态检查(3MSE)中的得分往往略低(0.58；95%可信区间1.08，0.08；p值0.024)。在对血压水平或血管疾病进行调整后，主要结果仍然存在。总体效应规模小的部分原因是由于我们人群中心血管疾病的高患病率而导致的生存偏差。我们的发现强调了中年心血管健康的作用，作为在晚年预防有害的认知和功能结果的目标。
Left ventricular mass (LVM) has been shown to to serve as measure of target organ damage resulting from chronic exposure to several risk factors. Data on the association of mid-life LVM with later cognitive performance are sparse. We studied 721 adults (mean age 56 years at baseline) enrolled in the Strong Heart Study (SHS, 1993–1995) and the ancillary Cerebrovascular Disease and its Consequences in American Indians Study (CDCAI, 2010–13), a study population with high prevalence of cardiovascular disease (CVD). LVM was assessed with transthoracic echocardiography at baseline in 1993 to 1995. Cranial magnetic resonance imaging (MRI) and cognitive testing were undertaken between 2010 and 2013. Generalized estimating equations were used to model associations between LVM and later imaging and cognition outcomes. The mean follow-up period was 17 years. A difference of 25 gm in higher LVM was associated with marginally lower hippocampal volume (0.01 %; 95% CI 0.02, 0.00; p-value 0.001) and higher white matter grade (0.10; 95% CI 0.02, 0.18; p-value 0.014). Functionally, participants with higher LVM tended to have slightly lower scores on the modified mini-mental state examination (3MSE) (0.58; 95% CI 1.08, 0.08; p-value 0.024). The main results persisted after adjusting for blood pressure levels or vascular disease. The small overall effect sizes are partly explained by survival bias due to the high prevalence of cardiovascular disease in our population. Our findings emphasize the role of cardiovascular health in mid-life as a target for the prevention of deleterious cognitive and functional outcomes in later life.