Hypertensive Exposure Markers by MRI in Relation to Cerebral Small Vessel Disease and Cognitive Impairment |
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| Authors: | Raquel P. Amier Nick Marcks Astrid M. Hooghiemstra Robin Nijveldt Mark A. van Buchem Albert de Roos Geert Jan Biessels L. Jaap Kappelle Robert J. van Oostenbrugge Rob J. van der Geest Michiel L. Bots Jacoba P. Greving Wiro J. Niessen Matthias J.P. van Osch Jeroen de Bresser Peter M. van de Ven Wiesje M. van der Flier Hans-Peter Brunner-La Rocca Albert C. van Rossum |
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| Affiliation: | 1. Department of Cardiology, Amsterdam University Medical Center, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Science, Amsterdam, the Netherlands;2. Department of Cardiology, Maastricht University Medical Center, Maastricht, the Netherlands;3. Alzheimer Center and Department of Neurology, Amsterdam University Medical Center, Vrije Universiteit Amsterdam, Amsterdam Neuroscience, Amsterdam, the Netherlands;4. Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands;5. Department of Neurology, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, the Netherlands;6. Department of Neurology, Maastricht University Medical Center, Maastricht, the Netherlands;7. Department of Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands;8. Biomedical Imaging Group Rotterdam and Departments of Medical Informatics and Radiology and Nuclear Medicine, Erasmus MC, Rotterdam, the Netherlands;9. Department of Imaging Physics, Applied Sciences, Delft University of Technology, Delft, the Netherlands;10. C.J. Gorter Center for High-Field Magnetic Resonance Imaging, Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands;11. Department of Epidemiology and Biostatistics, Amsterdam University Medical Center, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands |
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| Abstract: | ObjectivesThis study sought to investigate the extent of hypertensive exposure as assessed by cardiovascular magnetic resonance imaging (MRI) in relation to cerebral small vessel disease (CSVD) and cognitive impairment, with the aim of understanding the role of hypertension in the early stages of deteriorating brain health.BackgroundPreserving brain health into advanced age is one of the great challenges of modern medicine. Hypertension is thought to induce vascular brain injury through exposure of the cerebral microcirculation to increased pressure/pulsatility. Cardiovascular MRI provides markers of (subclinical) hypertensive exposure, such as aortic stiffness by pulse wave velocity (PWV), left ventricular (LV) mass index (LVMi), and concentricity by mass-to-volume ratio.MethodsA total of 559 participants from the Heart-Brain Connection Study (431 patients with manifest cardiovascular disease and 128 control participants), age 67.8 ± 8.8 years, underwent 3.0-T heart-brain MRI and extensive neuropsychological testing. Aortic PWV, LVMi, and LV mass-to-volume ratio were evaluated in relation to presence of CSVD and cognitive impairment. Effect modification by patient group was investigated by interaction terms; results are reported pooled or stratified accordingly.ResultsAortic PWV (odds ratio [OR]: 1.17; 95% confidence interval [CI]: 1.05 to 1.30 in patient groups only), LVMi (in carotid occlusive disease, OR: 5.69; 95% CI: 1.63 to 19.87; in other groups, OR: 1.30; 95% CI: 1.05 to 1.62]) and LV mass-to-volume ratio (OR: 1.81; 95% CI: 1.46 to 2.24) were associated with CSVD. Aortic PWV (OR: 1.07; 95% CI: 1.02 to 1.13) and LV mass-to-volume ratio (OR: 1.27; 95% CI: 1.07 to 1.51) were also associated with cognitive impairment. Relations were independent of sociodemographic and cardiac index and mostly persisted after correction for systolic blood pressure or medical history of hypertension. Causal mediation analysis showed significant mediation by presence of CSVD in the relation between hypertensive exposure markers and cognitive impairment.ConclusionsThe extent of hypertensive exposure is associated with CSVD and cognitive impairment beyond clinical blood pressure or medical history. The mediating role of CSVD suggests that hypertension may lead to cognitive impairment through the occurrence of CSVD. |
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| Keywords: | cognition left ventricular mass left ventricular mass-to-volume ratio pulse wave velocity vascular brain injury BP" },{" #name" :" keyword" ," $" :{" id" :" kwrd0040" }," $$" :[{" #name" :" text" ," _" :" blood pressure CI" },{" #name" :" keyword" ," $" :{" id" :" kwrd0050" }," $$" :[{" #name" :" text" ," _" :" confidence interval COD" },{" #name" :" keyword" ," $" :{" id" :" kwrd0060" }," $$" :[{" #name" :" text" ," _" :" carotid occlusive disease CSVD" },{" #name" :" keyword" ," $" :{" id" :" kwrd0070" }," $$" :[{" #name" :" text" ," _" :" cerebral small vessel disease HF" },{" #name" :" keyword" ," $" :{" id" :" kwrd0080" }," $$" :[{" #name" :" text" ," _" :" heart failure LV" },{" #name" :" keyword" ," $" :{" id" :" kwrd0090" }," $$" :[{" #name" :" text" ," _" :" left ventricle LVMi" },{" #name" :" keyword" ," $" :{" id" :" kwrd0100" }," $$" :[{" #name" :" text" ," _" :" left ventricular mass index MRI" },{" #name" :" keyword" ," $" :{" id" :" kwrd0110" }," $$" :[{" #name" :" text" ," _" :" magnetic resonance imaging OR" },{" #name" :" keyword" ," $" :{" id" :" kwrd0120" }," $$" :[{" #name" :" text" ," _" :" odds ratio PWV" },{" #name" :" keyword" ," $" :{" id" :" kwrd0130" }," $$" :[{" #name" :" text" ," _" :" pulse wave velocity VCI" },{" #name" :" keyword" ," $" :{" id" :" kwrd0140" }," $$" :[{" #name" :" text" ," _" :" vascular cognitive impairment |
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