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Published on: February 16, 2011
Association Between Unrecognized Myocardial Infarction and Cerebral Infarction on Magnetic Resonance Imaging
Alexander E Merkler1,2, Sigurdur Sigurdsson3, Gudny Eiriksdottir3
1Clinical and Translational Neuroscience Unit, Feil Family Brain and Mind Research Institute, Weill Cornell Medical College, New York, New York.
Importance:
It is uncertain whether unrecognized myocardial infarction (MI) is a risk factor for cerebral infarction.
Objective:
To determine whether unrecognized MI detected by cardiac magnetic resonance imaging (MRI) is associated with cerebral infarction.
Design, Setting, And Participants:
This is a cross-sectional study of ICELAND MI, a cohort substudy of the Age, Gene/Environment Susceptibility-Reykjavik Study conducted in Iceland. Enrollment occurred from January 2004 to January 2007 from a community-dwelling cohort of older Icelandic individuals. Participants aged 67 to 93 years who underwent both brain MRI and late gadolinium enhancement cardiac MRI were included. Data analysis was performed from September 2018 to March 2019.
Exposures:
Unrecognized MI identified by cardiac MRI.
Main Outcomes And Measures:
Unrecognized MI was defined as cardiac MRI evidence of MI without a history of clinically evident MI. Recognized MI was defined as cardiac MRI evidence of MI with a history of clinically evident MI. Cerebral infarctions on brain MRI were included regardless of associated symptoms. Multiple logistic regression was used to evaluate the association between MI status (no MI, unrecognized MI, or recognized MI) and cerebral infarction after adjustment for demographic factors and vascular risk factors. In addition, we evaluated the association between unrecognized MI and embolic infarcts of undetermined source.
Results:
Five enrolled participants had nondiagnostic brain MRI studies and were excluded. Among 925 participants, 480 (51.9%) were women; the mean (SD) age was 75.9 (5.3) years. There were 221 participants (23.9%) with cardiac MRI evidence of MI, of whom 68 had recognized MI and 153 unrecognized MI. There were 308 participants (33.3%) with brain MRI evidence of cerebral infarction; 93 (10.0%) had embolic infarcts of undetermined source. After adjustment for demographic factors and vascular risk factors, the likelihood (odds ratio) of having cerebral infarction was 2.0 (95% CI, 1.2-3.4; P = .01) for recognized MI and 1.5 (95% CI, 1.02-2.2; P = .04) for unrecognized MI. After adjustment for demographics and vascular risk factors, unrecognized MI was also associated with embolic infarcts of undetermined source (odds ratio, 2.0 [95% CI, 1.1-3.5]; P = .02).
Conclusions And Relevance:
In a population-based sample, we found an association between unrecognized MI and cerebral infarction. These findings suggest that unrecognized MI may be a novel risk factor for cardiac embolism and cerebral infarction.
Insights
Unrecognized myocardial infarction (MI), detected by cardiac MRI, is associated with an increased risk of cerebral infarction. This finding suggests that silent heart attacks may be a novel risk factor for stroke.
Area of Science:
- Cardiology
- Neurology
- Radiology
Background:
- The association between unrecognized myocardial infarction (MI) and cerebral infarction remains uncertain.
- Cardiac magnetic resonance imaging (MRI) can detect evidence of MI without a prior clinical diagnosis.
Purpose of the Study:
- To investigate the association between unrecognized MI, identified via cardiac MRI, and the presence of cerebral infarction.
- To determine if unrecognized MI is a risk factor for stroke, particularly embolic infarcts of undetermined source.
Main Methods:
- A cross-sectional study was conducted on a community-dwelling cohort of older Icelandic individuals (aged 67-93 years).
- Participants underwent both brain MRI and cardiac MRI with late gadolinium enhancement.
- Unrecognized MI was defined as cardiac MRI evidence of MI without a history of clinically recognized MI. Cerebral infarctions were identified on brain MRI.
Main Results:
- Among 925 participants, 153 (16.5%) had unrecognized MI and 308 (33.3%) had cerebral infarction.
- Unrecognized MI was associated with a 1.5-fold increased likelihood of cerebral infarction (OR, 1.5; 95% CI, 1.02-2.2; P=.04) after adjustment for confounders.
- Unrecognized MI was also linked to embolic infarcts of undetermined source (OR, 2.0; 95% CI, 1.1-3.5; P=.02).
Conclusions:
- Unrecognized myocardial infarction detected by cardiac MRI is associated with cerebral infarction in a population-based sample.
- These findings highlight unrecognized MI as a potential novel risk factor for cardiac embolism and subsequent cerebral infarction.
- Further research may elucidate the mechanisms linking silent MI to stroke risk.
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