Heart rate fragmentation and brain MRI markers of small vessel disease in MESA

Susan R Heckbert; Paul N Jensen; Guray Erus; Ilya M Nasrallah; Tanweer Rashid; Mohamad Habes; Thomas R Austin; James S Floyd; Christopher L Schaich; Susan Redline; R Nick Bryan; Madalena D Costa

doi:10.1002/alz.13554

Heart rate fragmentation and brain MRI markers of small vessel disease in MESA

Alzheimers Dement. 2024 Feb;20(2):1397-1405. doi: 10.1002/alz.13554. Epub 2023 Nov 27.

Authors

Susan R Heckbert^{1

2}, Paul N Jensen^{1

3}, Guray Erus⁴, Ilya M Nasrallah^{4

5}, Tanweer Rashid⁶, Mohamad Habes^{4

6}, Thomas R Austin^{1

2}, James S Floyd^{1

2

3}, Christopher L Schaich⁷, Susan Redline^{8

9}, R Nick Bryan⁵, Madalena D Costa^{9

10}

Affiliations

¹ Cardiovascular Health Research Unit, University of Washington, Seattle, Washington, USA.
² Department of Epidemiology, University of Washington, Seattle, Washington, USA.
³ Department of Medicine, University of Washington, Seattle, Washington, USA.
⁴ Center for AI and Data Science for Integrated Diagnostics and Center for Biomedical Image Computing and Analytics, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
⁵ Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
⁶ Neuroimage Analytics Laboratory and Biggs Institute Neuroimaging Core, Glenn Biggs Institute for Alzheimer's and Neurodegenerative Diseases, University of Texas Health Science Center San Antonio, San Antonio, Texas, USA.
⁷ Department of Surgery, Hypertension and Vascular Research Center, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA.
⁸ Brigham and Women's Hospital, Boston, Massachusetts, USA.
⁹ Harvard Medical School, Boston, Massachusetts, USA.
¹⁰ Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA.

Abstract

Introduction: Heart rate (HR) fragmentation indices quantify breakdown of HR regulation and are associated with atrial fibrillation and cognitive impairment. Their association with brain magnetic resonance imaging (MRI) markers of small vessel disease is unexplored.

Methods: In 606 stroke-free participants of the Multi-Ethnic Study of Atherosclerosis (mean age 67), HR fragmentation indices including percentage of inflection points (PIP) were derived from sleep study recordings. We examined PIP in relation to white matter hyperintensity (WMH) volume, total white matter fractional anisotropy (FA), and microbleeds from 3-Tesla brain MRI completed 7 years later.

Results: In adjusted analyses, higher PIP was associated with greater WMH volume (14% per standard deviation [SD], 95% confidence interval [CI]: 2, 27%, P = 0.02) and lower WM FA (-0.09 SD per SD, 95% CI: -0.16, -0.01, P = 0.03).

Discussion: HR fragmentation was associated with small vessel disease. HR fragmentation can be measured automatically from ambulatory electrocardiogram devices and may be useful as a biomarker of vascular brain injury.

Keywords: atrial myopathy; brain magnetic resonance imaging; brain microbleeds; brain small vessel disease; heart rate fragmentation; heart rate variability; multi-ethnic study of atherosclerosis; white matter fractional anisotropy; white matter hyperintensity.

Publication types

Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't

MeSH terms

Aged
Brain / diagnostic imaging
Brain / pathology
Cerebral Small Vessel Diseases* / diagnostic imaging
Cerebral Small Vessel Diseases* / pathology
Heart Rate
Humans
Magnetic Resonance Imaging / methods
Stroke* / pathology
White Matter* / diagnostic imaging
White Matter* / pathology

Abstract

Publication types

MeSH terms

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