LA volumes and reservoir function are associated with subclinical cerebrovascular disease: the CABL (Cardiovascular Abnormalities and Brain Lesions) study.
LA volumes and reservoir function are associated with subclinical cerebrovascular disease: the CABL (Cardiovascular Abnormalities and Brain Lesions) study.
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LA体积和储层功能与亚临床脑血管疾病有关：CABL（心血管异常和脑病变）研究。
DOI：
10.1016/j.jcmg.2012.10.019
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发表时间：
2013-03
影响因子：
14
通讯作者：
Di Tullio, Marco R.
中科院分区：
文献类型：
--
作者：
Russo, Cesare;Jin, Zhezhen;Liu, Rui;Iwata, Shinichi;Tugcu, Aylin;Yoshita, Mitsuhiro;Homma, Shunichi;Elkind, Mitchell S. V.;Rundek, Tatjana;DeCarli, Charles;Wright, Clinton B.;Sacco, Ralph L.;Di Tullio, Marco R.
关键词：
在无卒中社区队列中评估左心房（LA）相位容积和左心房储血功能与亚临床脑血管病的关系。LA大小的增加与心血管事件（包括卒中）相关。然而，目前尚不清楚左心房相位容积和储血功能是否与亚临床脑血管病相关。通过实时三维超声心动图评估了来自社区心血管痉挛和脑病变（CABL）研究的455名无卒中受试者的左心房最小（LAVmin）和最大（LAVmax）容积以及左心房储血功能（测量为总排空容积（LAEV）和总排空分数（LAEF））。亚临床脑血管病通过脑磁共振成像（MRI）评估为无症状脑梗死（SBI）和白色高信号体积（WMHV）。SBI患病率为15.4%;平均WMHV为0.66± 0.92%。与无SBI的受试者相比，SBI受试者的LAVmin（17.1±9.3 vs. 12.5±5.6 ml/m2，p<0.01）和LAVmax（26.6±8.8 vs. 23.3±7.0 ml/m2，p<0.01）更大。SBI患者的LAEV（9.5±3.4 vs. 10.8±3.9 ml/m2，p<0.01）和LAEF（38.7±14.7% vs. 47.0± 11.9%，p<0.01）也降低。在单变量分析中，较大的左心房容量和较小的储血功能与较大的WMHV显著相关。在多变量分析中，LAVmin仍与SBI [每SD增加的校正比值比（OR）：1.37，95%置信区间（CI）1.04-1.80，p<0.05]和WMHV（β=0.12，p<0.01）显著相关，而LAVmax与两者均无独立相关性。较小的LAEF与SBI（校正OR=0.67，95% CI 0.50-0.90，p<0.01）和WMHV（β=-0.09，p<0.05）独立相关。在无卒中史的受试者中，左心房容积增大和左心房储血功能降低与脑MRI检测到的亚临床脑血管疾病相关。特别是LAVmin和LAEF与SBI和WMHV的相关性比更常见的LAVmax更强，它们与亚临床脑病变的关系独立于其他心血管危险因素。
To assess the relationship of left atrial (LA) phasic volumes and LA reservoir function with subclinical cerebrovascular disease in a stroke-free community-based cohort. An increase in LA size is associated with cardiovascular events including stroke. However, it is not known whether LA phasic volumes and reservoir function are associated with subclinical cerebrovascular disease. LA minimum (LAVmin) and maximum (LAVmax) volumes, and LA reservoir function, measured as total emptying volume (LAEV) and total emptying fraction (LAEF), were assessed by real-time three-dimensional echocardiography in 455 stroke-free participants from the community-based Cardiovascular Abnormalities and Brain Lesions (CABL) study. Subclinical cerebrovascular disease was assessed as silent brain infarcts (SBI) and white matter hyperintensity volume (WMHV) by brain magnetic resonance imaging (MRI). SBI prevalence was 15.4%; mean WMHV was 0.66±0.92%. Participants with SBI showed greater LAVmin (17.1±9.3 vs. 12.5±5.6 ml/m2, p<0.01) and LAVmax (26.6±8.8 vs. 23.3±7.0 ml/m2, p<0.01) compared to those without SBI. LAEV (9.5±3.4 vs. 10.8±3.9 ml/m2, p<0.01) and LAEF (38.7±14.7% vs. 47.0±11.9%, p<0.01) were also reduced in participants with SBI. In univariate analyses, greater LA volumes and smaller reservoir function were significantly associated with greater WMHV. In multivariate analyses, LAVmin remained significantly associated with SBI [adjusted odds ratio (OR) per SD increase: 1.37, 95% confidence intervals (CI) 1.04–1.80, p<0.05] and with WMHV (β=0.12, p<0.01), whereas LAVmax was not independently associated with either. Smaller LAEF was independently associated with SBI (adjusted OR=0.67, 95% CI 0.50–0.90, p<0.01) and WMHV (β=−0.09, p<0.05). Greater LA volumes and reduced LA reservoir function are associated with subclinical cerebrovascular disease detected by brain MRI in subjects without history of stroke. LAVmin and LAEF, in particular, are more strongly associated with SBI and WMHV than the more commonly measured LAVmax, and their relationship with subclinical brain lesions is independent of other cardiovascular risk factors.
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