Cerebral cortical microinfarcts: A novel MRI marker of vascular brain injury in patients with heart failure

Ferro, Doeschka A.; Brink, Hilde van den; Amier, Raquel P.; Buchem, Mark A. van; Bresser, Jeroen de; Bron, Esther E.; Rocca, Hans‐Peter Brunner‐La; Hooghiemstra, Astrid M.; Marcks, Nick; Rossum, Albert C. van; Biessels, Geert Jan

doi:10.1016/j.ijcard.2020.04.032

Cited by 14 publications

(16 citation statements)

References 30 publications

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“…One study reported AF as a risk factor for all cortical CMIs, while another showed that a cardioembolic source was independently associated with CMIs in AIS [12, 15]. A paucity of studies report CMIs to be associated with heart failure and cardiac dysfunction [21, 27]. Thus, we provide further support for an embolic source as the key mechanism for the development of CMIs.…”

Section: Discussionsupporting

confidence: 59%

Acute Cerebral Microinfarcts in Acute Ischemic Stroke: Imaging and Clinical Significance

Tao¹,

Wang²,

Li³

et al. 2022

Cerebrovasc Dis

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Background: Limited data exist on the significance of acute cerebral microinfarcts (A-CMIs) in the context of acute ischemic stroke (AIS). We aimed to determine the profile and prognostic significance of A-CMIs on magnetic resonance imaging (MRI) in patients presenting with AIS. Methods: A prospective single-center series of patients with AIS who had 3T MRIs between March 2013 and December 2019. The presence, number, and location of A-CMIs on diffusion-weighted imaging, and markers of cerebral small vessel disease (CSVD), macroinfarcts features, and etiology were classified as cardioembolism (CE) or large artery atherosclerosis (LAA) or none. Results: Among 273 patients, A-CMIs were detected in 130 patients (47.6%), of whom cortical A-CMIs were found in 95 (73.0%) patients. Patients with A-CMIs were significantly older, less likely to have diabetes mellitus, and more likely to have atrial fibrillation and an embolic source (CE or LAA) compared to other patients. Patients with A-CMI had a higher frequency of macroinfarcts (diameter >20 mm), more often multiple and distributed in single or multiple vessel territories than other patients. An embolic source (LAA or CE) was independently associated with cortical A-CMIs (LAA adjusted odds ratio [aOR] 4.0 95% confidence interval [CI] 1.6–9.5; CE aOR 2.5, 95% CI 1.1–5.6), whereas lacunes were independently related to subcortical A-CMIs (aOR 2.6, 95% CI 1.2–5.8). Conclusions: We have shown A-CMIs occur in cortical and subcortical regions in nearly half of AIS patients, where microembolism and CSVD are, respectively, the key presumed etiological mechanism.

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Section: Discussionsupporting

confidence: 59%

Acute Cerebral Microinfarcts in Acute Ischemic Stroke: Imaging and Clinical Significance

Tao¹,

Wang²,

Li³

et al. 2022

Cerebrovasc Dis

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“…This high predictive value in detection of AF is in line with previous findings. 30,31 To our knowledge, the HAVOC and AS5F scores 32,33 are the only clinical scores developed to stratify patients with cryptogenic stroke/TIA into risk categories of AF detection. Both scores are however solely based on clinical and/or ECG data.…”

Section: Discussionmentioning

confidence: 99%

Association of stroke lesion shape with newly detected atrial fibrillation – Results from the MonDAFIS study

Pimentel

Ingwersen

Hæusler

et al. 2022

European Stroke Journal

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Paroxysmal Atrial fibrillation (AF) is often clinically silent and may be missed by the usual diagnostic workup after ischemic stroke. We aimed to determine whether shape characteristics of ischemic stroke lesions can be used to predict AF in stroke patients without known AF at baseline. Lesion shape quantification on brain MRI was performed in selected patients from the intervention arm of the Impact of standardized MONitoring for Detection of Atrial Fibrillation in Ischemic Stroke (MonDAFIS) study, which included patients with ischemic stroke or TIA without prior AF. Multiple morphologic parameters were calculated based on lesion segmentation in acute brain MRI data. Multivariate logistic models were used to test the association of lesion morphology, clinical parameters, and AF. A stepwise elimination regression was conducted to identify the most important variables. A total of 755 patients were included. Patients with AF detected within 2 years after stroke ( n = 86) had a larger overall oriented bounding box (OBB) volume ( p = 0.003) and a higher number of brain lesion components ( p = 0.008) than patients without AF. In the multivariate model, OBB volume (OR 1.72, 95%CI 1.29–2.35, p < 0.001), age (OR 2.13, 95%CI 1.52–3.06, p < 0.001), and female sex (OR 2.45, 95%CI 1.41–4.31, p = 0.002) were independently associated with detected AF. Ischemic lesions in patients with detected AF after stroke presented with a more dispersed infarct pattern and a higher number of lesion components. Together with clinical characteristics, these lesion shape characteristics may help in guiding prolonged cardiac monitoring after stroke.

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“…A recent study indicated that cerebral cortical microinfarcts, a novel marker of vascular brain injury, were found in 17% of patients with HF and were related to vascular risk factor profile and severity of cardiac dysfunction. 56 …”

Section: Heart and Brainmentioning

confidence: 99%

Reciprocal organ interactions during heart failure: a position paper from the ESC Working Group on Myocardial Function

Ciccarelli

Dawson

Falcão-Pires

et al. 2021

Cardiovascular Research

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Heart failure—either with reduced or preserved ejection fraction (HFrEF/HFpEF)—is a clinical syndrome of multifactorial and gender-dependent aetiology, indicating the insufficiency of the heart to pump blood adequately to maintain blood flow to meet the body's needs. Typical symptoms commonly include shortness of breath, excessive fatigue with impaired exercise capacity, and peripheral oedema, thereby alluding to the fact that heart failure is a syndrome that affects multiple organ systems. Patients suffering from progressed heart failure have a very limited life expectancy, lower than that of numerous cancer types. In this position paper, we provide an overview regarding interactions between the heart and other organ systems, the clinical evidence, underlying mechanisms, potential available or yet-to-establish animal models to study such interactions and finally discuss potential new drug interventions to be developed in the future. Our working group suggests that more experimental research is required to understand the individual molecular mechanisms underlying heart failure and reinforces the urgency for tailored therapeutic interventions that target not only the heart but also other related affected organ systems to effectively treat heart failure as a clinical syndrome that affects and involves multiple organs.

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Cerebral cortical microinfarcts: A novel MRI marker of vascular brain injury in patients with heart failure

Abstract: Biessels a , on behalf of theHeart-Brain Connection Consortium

Cited by 14 publications

References 30 publications

Acute Cerebral Microinfarcts in Acute Ischemic Stroke: Imaging and Clinical Significance

Acute Cerebral Microinfarcts in Acute Ischemic Stroke: Imaging and Clinical Significance

Association of stroke lesion shape with newly detected atrial fibrillation – Results from the MonDAFIS study

Reciprocal organ interactions during heart failure: a position paper from the ESC Working Group on Myocardial Function

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