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Associations Between Atrial Cardiopathy and Cerebral Amyloid: The ARIC-PET Study
Michelle C Johansen1, Thomas H Mosley2, David S Knopman3
1The Johns Hopkins University School of Medicine Baltimore MD.
Insights
Atrial cardiopathy, a heart condition, is linked to increased brain amyloid levels, a hallmark of Alzheimer's disease. This association was observed in older adults without dementia, suggesting a potential cardiac impact on Alzheimer's pathology.
Area of Science:
- Cardiology
- Neurology
- Gerontology
Background:
- Atrial fibrillation (AF) is a known risk factor for cognitive decline, potentially linked to silent brain infarction.
- Left atrial structural or functional changes (atrial cardiopathy) may independently affect cognition and are associated with AF.
- The relationship between atrial cardiopathy and Alzheimer disease-specific mechanisms, like beta-amyloid deposition, remains unclear.
Purpose of the Study:
- To investigate the association between atrial cardiopathy and Alzheimer disease-related brain amyloid deposition.
- To determine if specific markers of atrial cardiopathy are linked to elevated brain amyloid.
- To explore the independent associations of atrial cardiopathy and AF with brain amyloid.
Main Methods:
- Utilized florbetapir positron emission tomography, electrocardiography, and echocardiography in 316 dementia-free ARIC study participants.
- Defined atrial cardiopathy by left atrial volume index, P-wave terminal force, or serum NT-proBNP levels.
- Employed multivariable logistic regression to assess cross-sectional associations between atrial cardiopathy/AF and global cortical beta-amyloid.
Main Results:
- A significant association was found between atrial cardiopathy and elevated brain amyloid (florbetapir standardized uptake value ratio >1.2).
- Specifically, an enlarged left atrial volume index was associated with doubled odds of elevated brain amyloid.
- No significant association was observed between atrial fibrillation (AF) itself and elevated brain amyloid.
Conclusions:
- Atrial cardiopathy, particularly enlarged left atrial volume, is associated with elevated brain amyloid in cognitively normal older adults.
- This finding suggests a potential link between cardiac structural changes and Alzheimer's pathology, independent of AF.
- Further research is needed to clarify the temporal relationship and underlying mechanisms, considering potential limitations like reverse causation and survival bias.
Abstract:
Background Atrial fibrillation (AF) is a risk factor for cognitive decline, possibly from silent brain infarction. Left atrial changes in structure or function (atrial cardiopathy) can lead to AF but may impact cognition independently. It is unknown if AF or atrial cardiopathy also acts on Alzheimer disease-specific mechanisms, such as deposition of β-amyloid. Methods and Results A total of 316 dementia-free participants from the ARIC (Atherosclerosis Risk in Communities) study underwent florbetapir positron emission tomography, electrocardiography, and 2-dimensional echocardiography. Atrial cardiopathy was defined as ≥1: (1) left atrial volume index >34 mL/m2; (2) P-wave terminal force >5000 µV×ms; and (3) serum NT-proBNP (N-terminal pro-B-type natriuretic peptide) >250 pg/mL. Cross-sectional associations between global cortical β-amyloid (>1.2 standardized uptake value ratio) and adjudicated history of AF and atrial cardiopathy, each, were evaluated using multivariable logistic regression. Participants (mean age, 76 years) were 56% women and 42% Black individuals. Odds of elevated florbetapir standardized uptake value ratio were significantly increased among those with atrial cardiopathy (odds ratio, 1.81; 95% CI, 1.02-3.22) and doubled for those with enlarged left atrial volume index after adjustment for demographics/risk factors (95% CI, 1.04-4.61). There was no association between P-wave terminal force or NT-proBNP and elevated florbetapir standardized uptake value ratio, nor between AF and elevated standardized uptake value ratio. Conclusions Among healthy, nondemented community-dwelling older individuals, we report an association between atrial cardiopathy, left atrial volume index, and elevated brain amyloid, by positron emission tomography, without a similar association in individuals with AF. Potential limitations include reverse causation and survival bias. Ongoing work will help determine if changes in cardiac structure and function precede or occur simultaneously with amyloid deposition.
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