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Eur J Neurol. 2019 Apr 19. doi: 10.1111/ene.13970. [Epub ahead of print]

Association between excessive supraventricular ectopy and subclinical cerebrovascular disease: a population-based study.

Author information

1
Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
2
Department of Environmental Medicine and Public Health, Faculty of Medicine, Shimane University, Izumo, Japan.
3
Department of Public Health, Shiga University of Medical Science, Otsu, Japan.
4
Center for Epidemiologic Research in Asia, Shiga University of Medical Science, Otsu, Japan.
5
Molecular Neuroscience Research Center, Shiga University of Medical Science, Otsu, Japan.
6
Department of Neurosurgery, Shiga University of Medical Science, Otsu, Japan.
7
Department of Preventive Medicine and Public Health, Faculty of Medicine, Fukuoka University, Fukuoka, Japan.
8
Department of Hygiene and Public Health, Teikyo University School of Medicine, Tokyo, Japan.

Abstract

BACKGROUND AND PURPOSE:

The association between an increased supraventricular ectopic beat (SVEB) and subclinical cerebrovascular disease remains unclear. Given the emerging concept that an increased SVEB is a marker of atrial cardiomyopathy or atherosclerosis burden, we sought to determine whether excessive supraventricular ectopic activity (ESVEA) is associated with a higher burden of subclinical cerebrovascular disease in the middle-aged to older cohort with neither apparent stroke nor atrial fibrillation.

METHODS:

We conducted a cross-sectional population-based study of 462 men (mean age, 68.1 years) who underwent 24-h Holter electrocardiography and brain magnetic resonance imaging. ESVEA was defined as the presence of >10 SVEBs/h. Subclinical cerebrovascular diseases were defined as silent brain infarct (SBI), white matter hyperintensity (WMH) and intracranial atherosclerotic stenosis (ICAS). The association of ESVEA with the presence of subclinical cerebrovascular diseases was adjusted for potential confounding covariates.

RESULTS:

A total of 88 (19.0%) participants had ESVEA and 81 (17.5%), 91 (19.7%) and 109 (23.6%) had SBI, WMH and ICAS, respectively. In multivariable-adjusted Poisson regression with robust error variance, ESVEA was associated with the presence of WMH (relative risk, 1.58; 95% confidence interval, 1.06-2.36) and ICAS (relative risk, 1.49; 95% confidence interval, 1.02-2.18), but not with that of SBI (relative risk, 1.32; 95% confidence interval, 0.86-2.01). These associations were consistent when the graded distributions of subclinical cerebrovascular diseases were applied as outcomes in ordinal logistic regression.

CONCLUSIONS:

The ESVEA was independently associated with higher burdens of WMH and ICAS. This suggests that increased SVEBs might improve risk stratification of individuals at high risk of subclinical cerebrovascular disease and consequently apparent ischaemic stroke.

KEYWORDS:

atrial cardiomyopathy; electrocardiography; epidemiology; magnetic resonance imaging; premature atrial contraction; subclinical cerebrovascular disease/stroke

PMID:
31002446
DOI:
10.1111/ene.13970

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