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Subclinical cardiac dysfunction increases the risk of stroke and dementia: the Rotterdam Study
Renée F A G de Bruijn1, Marileen L P Portegies1, Maarten J G Leening1
1From the Departments of Epidemiology (R.F.A.G.d.B., M.L.P.P., M.J.G.L., M.J.B., A.H., M.W.V., O.H.F., M.A.I.), Neurology (R.F.A.G.d.B., M.L.P.P., P.J.K., M.A.I.), Cardiology (M.J.G.L.), Radiology (A.v.d.L., W.J.N., M.W.V., M.A.I.), and Medical Informatics (W.J.N.), Erasmus Medical Center, Rotterdam; and Imaging Science and Technology (W.J.N.), Faculty of Applied Sciences, Delft University of Technology, the Netherlands.
Insights
In older adults without heart disease, impaired diastolic function is linked to higher risks of stroke, dementia, and silent brain infarcts. Better diastolic function may help prevent neurological diseases.
Area of Science:
- Cardiology
- Neurology
- Geriatrics
Background:
- Cardiac function plays a crucial role in overall health, but its specific impact on cerebrovascular health in elderly individuals without pre-existing cardiac conditions is not fully understood.
- Subclinical cerebrovascular disease, detectable via MRI, may precede clinical events like stroke and dementia.
Purpose of the Study:
- To examine the association between cardiac function (both diastolic and systolic) and the risk of stroke and dementia in an elderly population free of clinical heart disease.
- To investigate the relationship between cardiac function and MRI-detected markers of subclinical cerebrovascular disease.
Main Methods:
- The study utilized data from the population-based Rotterdam Study, including 3,291 participants aged 58-98 years, initially free of major cardiovascular and neurological diseases.
- Echocardiography was performed to assess cardiac function, with a subset undergoing brain MRI to evaluate infarcts and white matter lesions.
Main Results:
- During follow-up, 164 strokes and 208 dementia cases occurred.
- Improved diastolic function (higher E/A ratio) correlated with reduced risk of stroke and dementia.
- Enhanced systolic function (higher fractional shortening) was associated with a lower stroke risk.
- Better diastolic function was linked to fewer silent infarcts, particularly lacunar infarcts, on brain MRI.
Conclusions:
- Worse diastolic cardiac function is associated with increased risk of clinical stroke, dementia, and subclinical cerebrovascular disease in older adults without diagnosed heart disease.
- Worse systolic cardiac function is primarily linked to an increased risk of clinical stroke.
- These findings suggest cardiac function, particularly diastolic function, as a potential target for interventions aimed at preventing neurological diseases.
Objective:
To investigate the association between cardiac function and the risk of stroke and dementia in elderly free of clinical cardiac disease. Additionally, we investigated the relation between cardiac function and MRI markers of subclinical cerebrovascular disease.
Methods:
This study was conducted within the population-based Rotterdam Study. A total of 3,291 participants (60.8% female, age-range 58-98 years) free of coronary heart disease, heart failure, atrial fibrillation, stroke, and dementia underwent echocardiography in 2002-2005 to measure cardiac function. Follow-up finished in 2012. In 2005-2006, a random subset of 577 stroke-free people without dementia underwent brain MRI on which infarcts and white matter lesion volume were assessed.
Results:
During 21,785 person-years of follow-up, 164 people had a stroke and during 19,462 person-years of follow-up, 208 people developed dementia. Measures of better diastolic function, such as higher E/A ratio, were associated with a lower risk of stroke (hazard ratio [HR] 0.82; 95% confidence interval [CI] 0.69; 0.98) and dementia (HR 0.82; 95% CI 0.70; 0.96). Better systolic function, measured as higher fractional shortening, was only associated with a lower risk of stroke (HR 0.84; 95% CI 0.72; 0.98). Better diastolic function was related to a lower prevalence of silent infarcts on MRI, especially lacunar infarcts.
Conclusions:
In elderly free of clinical cardiac disease, worse diastolic function is associated with clinical stroke, dementia, and silent infarcts on MRI, whereas worse systolic function is related only to clinical stroke. These findings can form the basis for future research on the utility of cardiac function as potential intervention target for prevention of neurologic diseases.
