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Updated: Mar 7, 2026
Assessing Cortical Cerebral Microinfarcts on High Resolution MR Images
Published on: November 20, 2015
Association Between Subclinical Cardiac Biomarkers and Clinically Manifest Cardiac Diseases With Cortical Cerebral
Saima Hilal1, Yuek Ling Chai2, Susanne van Veluw3
1Department of Pharmacology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore2Memory Aging and Cognition Center, National University Health System, Singapore3Department of Radiology and Epidemiology, Erasmus Medical Center, Rotterdam, the Netherlands.
Insights
Cardiac disease, including subclinical and clinical conditions, is linked to cortical cerebral microinfarcts (CMIs) on MRI. Biomarkers like NT-proBNP and hs-cTnT indicate this association, suggesting cardiac dysfunction as a target for preventing brain injury.
Area of Science:
- Neurology
- Cardiology
- Radiology
Background:
- Cardiac diseases are associated with cerebrovascular disease markers like lacunes and white matter hyperintensities.
- Cortical cerebral microinfarcts (CMIs) are a novel MRI marker of cerebral vascular disease.
- The relationship between cardiac diseases and CMIs has not been previously studied.
Purpose of the Study:
- To investigate the association between blood biomarkers of subclinical cardiac disease and clinically manifest cardiac diseases with CMIs.
- To analyze CMIs using 3-T MRI in a memory clinic population.
Main Methods:
- Cross-sectional analysis of 464 memory clinic participants.
- Collection of blood samples for NT-proBNP and hs-cTnT measurement.
- 3-T MRI for CMI grading and neuropsychological assessment.
Main Results:
- Seventy participants (28.8%) had CMIs.
- CMIs were associated with higher prevalence of atrial fibrillation, ischemic heart disease, and congestive heart failure.
- Elevated NT-proBNP and hs-cTnT levels were significantly associated with CMIs, even after adjusting for confounders and excluding patients with manifest cardiac disease.
Conclusions:
- Subclinical and clinical cardiac diseases are associated with CMIs on 3-T MRI.
- Cardiac dysfunction may contribute to CMI development.
- Targeting cardiac dysfunction could be a strategy to prevent CMI-related brain injury.
Importance:
Subclinical and clinical cardiac diseases have been previously linked to magnetic resonance imaging (MRI) manifestations of cerebrovascular disease, such as lacunes and white matter hyperintensities, as well as dementia. Cortical cerebral microinfarcts (CMIs), a novel MRI marker of cerebral vascular disease, have not been studied, to date, in relation to subclinical and clinical cardiac diseases.
Objective:
To examine the association of blood biomarkers of subclinical cardiac disease and clinically manifest cardiac diseases with CMIs graded on 3-T MRI in a memory clinic population.
Design, Setting, And Participants:
This baseline cross-sectional analysis of a cohort study performed from August 12, 2010, to July 28, 2015, included 464 memory clinic participants. All participants underwent collection of blood samples, neuropsychological assessment, and 3-T MRI.
Exposures:
N-terminal pro-brain natriuretic peptide (NT-proBNP) and high-sensitivity cardiac troponin T (hs-cTnT) concentrations were measured by electrochemiluminescence immunoassays. Cardiac disease was defined as a history of atrial fibrillation, ischemic heart diseases, or congestive heart failure.
Main Outcomes And Measures:
The CMIs were graded according to a previously validated protocol.
Results:
Of 464 participants, 124 had insufficient blood plasma samples and 97 had no CMI grading (none, incomplete, or ungradable MRI), leaving a sample size of 243 for final analysis (mean [SD] age, 72.8 [9.1] years; 116 men [42.9%]). Seventy participants (28.8%) had cortical CMIs (median, 1; range, 0-43). Compared with participants with no CMIs, those with CMIs had a significantly higher prevalence of atrial fibrillation (rate ratio [RR], 1.62; 95% CI, 1.20-21.8), ischemic heart disease (RR, 4.31; 95% CI, 3.38-5.49), and congestive heart failure (RR, 2.05; 95% CI, 1.29-3.25). Significantly higher levels of NT-proBNP (RR, 3.16; 95% CI, 2.33-4.27) and hs-cTnT (RR, 2.17; 95% CI, 1.00-4.74) were found in participants with CMIs. In multivariate models adjusted for demographics and vascular risk factors, higher levels of NT-proBNP (RR, 3.19; 95% CI, 2.62-3.90) and hs-cTnT (RR, 4.86; 95% CI, 3.03-7.08) were associated with CMIs. These associations persisted even after excluding patients with clinically manifest cardiac disease.
Conclusions And Relevance:
This study found that biomarkers of subclinical cardiac disease and clinically manifest cardiac diseases were associated with CMIs on 3-T MRI in patients attending a memory clinic, suggesting that cardiac disease may contribute to the development of CMIs. Hence, cardiac dysfunction should be targeted as a potentially modifiable factor to prevent CMI-related brain injury.
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