Silent cerebral infarction in chronic heart failure: Ischemic and nonischemic dilated cardiomyopathy

Abstract

Objectives: Patients with dilated cardiomyopathy (DCM) may have a high incidence of clinically asymptomatic silent cerebral infarction (SCI). Prevalence of SCI and its risk factors may differ between ischemic and nonischemic DCM. The purpose of this study was to evaluate prevalence and related parameters of silent cerebral infarction in patients with ischemic and nonischemic DCM. Methods: Patients with ischemic and nonischemic DCM (53 male, 19 female, aged 62 ± 12 years) were included in the study. Etiology of DCM was ischemic in 46 and nonischemic in 26 patients. Fifty-six age-and gender-matched healthy volunteers served as a control group for comparison of SCI prevalence. Results: Prevalence of SCI was 39%, 27%, and 3.6% in ischemic, nonischemic DCM, and control group, respectively (ischemic DCM vs control group, p Ͻ 0.001, nonischemic DCM vs control group, p = 002). In patients with nonischemic DCM, the mean age of the subjects with SCI was signifi cantly higher than that of subjects without lesions (67 ± 5 years vs 53 ± 13, p Ͻ 0.001), whereas in ischemic DCM NHYA Functional Class was statistically higher in patients with SCI than without SCI (p = 0.03). In both groups, patients with SCI had lower systolic functions than patients with normal MRI fi ndings. In multivariable logistic regression analysis, restrictive type of diastolic fi lling pattern was found as an independent factor for SCI occurrence on the whole patient population (OR: 16.5, 95% CI: 4.4-61.8, p Ͻ 0.001). Conclusion: SCI is common in patients with both ischemic and nonischemic DCM. In univariate analysis, both groups have similar systolic and diastolic characteristics in the occurrence of SCI. Logistic regression analysis revealed that restrictive diastolic fi lling pattern is an independent risk factor in the occurrence of SCI for the whole patient population.

Heart and brain interaction in patients with heart failure: overview and proposal for a taxonomy. A position paper from the Study Group on Heart and Brain Interaction of the Heart Failure Association

“…A cerebral lesion may manifest as ischaemic stroke but also may remain clinically undetected as a so-called 'silent infarction'. The prevalence of silent cerebral infarctions is comparably high in HF cohorts ranging between 20-40%, 10 which is two to four-fold higher than in age-matched subjects without HF. 'Silent strokes', however, are not truly 'silent', but have been linked to cognitive function and dementia.…”

Silent brain infarction in the presence of systemic vascular disease

“…A community based study in Umbria, Italy2097138.3Vermeer et al (2002) 11 Prevalence and risk factors of silent brain infarcts in the population-based Rotterdam Scan Study10777524Vermeer et al (2003) 2 Silent brain infarcts and white matter lesions increase stroke risks in the general population: the Rotterdam Scan Study66871 ± 714CADGeerlings et al (2010) 28 Brain volumes and cerebrovascular lesions on MRI in patients with atherosclerotic disease. The SMART study104458 ± 10 years10Giele et al (2004) 9 Silent brain infarcts in patients with manifest vascular disease30818–7917Hara et al (1994) 7 Silent cerebral infarction associated with coronary artery disease50–80Hoshide et al (2001) 29 Different patterns of silent cerebral infarct in patients with coronary artery disease or hypertension1076246Kozdag et al (2008) 30 Silent cerebral infarction in chronic heart failure: ischemic and nonischemic dilated cardiomyopathy7250–7439Nadareishvili et al (1999) 31 Cerebral microembolism in acute myocardial Infarction11268 ± 11 years15Ozeren et al (1998) 32 Silent cerebral lesions on MRI in subjects with CAD7243Pardo et al (1998) 33 <...>…”

Ischemic stroke and heart failure: facts and numbers

“…Indeed, the best predictors of functional dependency 1 year after stroke were HF, stroke severity, and old age . Moreover, ischemic brain lesions with seemingly no apparent consequence, termed as ‘silent strokes’, are more prevalent in HF patients (20–42%) compared with non‐HF (0–12%) . The debate is ongoing that these brain lesions are not truly ‘silent’, but rather indicate a subtle and with time progressing deterioration of cognitive and other cerebral functions.…”

“…5 Moreover, ischemic brain lesions with seemingly no apparent consequence, termed as 'silent strokes', are more prevalent in HF patients (20-42%) compared with non-HF (0-12%). [10][11][12][13] The debate is ongoing that these brain lesions are not truly 'silent', but rather indicate a subtle and with time progressing deterioration of cognitive and other cerebral functions. Of note, the risk of recurrent stroke is roughly doubled in stroke patients with HF compared with those without HF.…”