Brain volumes and risk of cardiovascular events and mortality. The SMART-MR study
Pieternella H van der Veen1, Majon Muller2, Koen L Vincken3
1Department of Radiology, University Medical Center Utrecht, Utrecht, the Netherlands; Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands.
Insights
Smaller brain volumes in patients with arterial disease predict higher risks of death and stroke, regardless of traditional cardiovascular factors. This highlights brain health as a key indicator for poor outcomes in high-risk individuals.
Area of Science:
- Neurology
- Cardiology
- Radiology
Background:
- Brain atrophy is a known predictor of cognitive decline, dementia, and increased mortality.
- Patients with cardiovascular disease exhibit greater brain atrophy and higher morbidity/mortality rates.
Purpose of the Study:
- To investigate the association between brain volumes, assessed via magnetic resonance imaging, and the risk of cardiovascular events and mortality.
- To determine if brain volumes predict outcomes in patients with manifest arterial disease.
Main Methods:
- Utilized automated brain segmentation to quantify intracranial volume, total brain volume, sulcal cerebrospinal fluid, and ventricles.
- Analyzed data from 1215 patients with manifest arterial disease (mean age 58 years) over a median follow-up of 8.3 years.
Main Results:
- Smaller relative brain volumes were significantly associated with an increased risk of all-cause death (HR 1.58), vascular death (HR 1.69), and ischemic stroke (HR 1.96) per standard deviation decrease.
- These associations remained independent of established cardiovascular risk factors.
- Outcomes included 184 deaths, 49 ischemic strokes, and 100 ischemic cardiac complications during follow-up.
Conclusions:
- Brain volumes are a significant determinant of adverse outcomes in patients with high cardiovascular risk.
- Reduced brain volume independently predicts mortality and ischemic stroke in individuals with arterial disease.
- Findings suggest brain health assessment could be crucial for risk stratification in cardiovascular patients.
Abstract:
Brain atrophy is a strong predictor for cognitive decline and dementia, and these are, in turn, associated with increased mortality in the general population. Patients with cardiovascular disease have more brain atrophy and a higher morbidity and mortality. We investigated if brain volumes on magnetic resonance imaging were associated with the risk of cardiovascular events and mortality in patients with manifest arterial disease (n = 1215; mean age 58 years). Automated brain segmentation was used to quantify intracranial volume, and volumes of total brain, sulcal cerebrospinal fluid, and ventricles. After a median follow-up of 8.3 years, 184 patients died, 49 patients had an ischemic stroke, and 100 patients had an ischemic cardiac complication. Smaller relative brain volumes increased the risk of all-cause death (hazard ratio [HR] per standard deviation decrease in total brain volume: 1.58, 95% confidence interval [95% CI]: 1.33-1.88), vascular death (HR 1.69, 95% CI: 1.35-2.13), and ischemic stroke (HR 1.96, 95% CI: 1.43-2.69), independent of cardiovascular risk factors. These results suggest that brain volumes are an important determinant of poor outcome in patients with high cardiovascular risk.
Related Concept Videos
01:21Imaging Studies for Cardiovascular System IV: CMRI
01:27Regulation of Stroke Volume
Preload refers to the degree of stretch on the heart before it contracts. It's analogous to the stretching of a rubber band; the more it's stretched, the more forcefully it snaps back. This concept is encapsulated in the Frank-Starling law of the...
01:24Magnetic Resonance Imaging
01:28Imaging Studies for Cardiovascular System V: CT
01:11Cardiac Output and Stroke Volume
In an average resting adult male, the typical cardiac...
01:22Cardiac Output II: Effect of Stroke Volume on Cardiac Output
Preload
Preload refers to the initial elongation of the cardiac myocytes before contraction and is related to the volume of blood filling the heart at the end of diastole, or end-diastolic volume. The...