Covert Cerebrovascular Changes in People With Heart Disease: A Systematic Review and Meta-Analysis

Zien Zhou; Shoujiang You; Yuki Sakamoto; Ying Xu; Song Ding; Wenyi Xu; Wenjie Li; Jie Yu; Yanan Wang; Katie Harris; Candice Delcourt; Mathew J Reeves; Richard I Lindley; Mark W Parsons; Mark Woodward; Craig Anderson; Xin Du; Jun Pu; Joanna M Wardlaw; Cheryl Carcel

doi:10.1212/WNL.0000000000209204

Covert Cerebrovascular Changes in People With Heart Disease: A Systematic Review and Meta-Analysis

Neurology. 2024 Apr 23;102(8):e209204. doi: 10.1212/WNL.0000000000209204. Epub 2024 Mar 26.

Authors

Zien Zhou¹, Shoujiang You¹, Yuki Sakamoto¹, Ying Xu¹, Song Ding¹, Wenyi Xu¹, Wenjie Li¹, Jie Yu¹, Yanan Wang¹, Katie Harris¹, Candice Delcourt¹, Mathew J Reeves¹, Richard I Lindley¹, Mark W Parsons¹, Mark Woodward¹, Craig Anderson¹, Xin Du¹, Jun Pu¹, Joanna M Wardlaw¹, Cheryl Carcel¹

Affiliation

¹ From the The George Institute for Global Health (Z.Z., S.Y., Y.S., Y.X., J.Y., Y.W., K.H., C.D., M.W., C.A., C.C.), Faculty of Medicine, University of New South Wales, Sydney, Australia; Department of Neurology and Clinical Research Center of Neurological Disease (S.Y.), The Second Affiliated Hospital of Soochow University, Suzhou, PR China; Department of Neurological Science (Y.S.), Graduate School of Medicine, Nippon Medical School, Tokyo, Japan; Centre for Health Systems and Safety Research (Y.X.), Australian Institute of Health Innovation, Macquarie University, Sydney, Australia; Department of Cardiology (S.D., W.X., J.P.), Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University; Department of Cardiology (W.L., X.D.), Beijing Anzhen Hospital, Capital Medical University; Department of Cardiology (J.Y.), Peking University Third Hospital, Beijing; Department of Neurology (Y.W.), West China Hospital, Sichuan University, Chengdu, PR China; Department of Clinical Medicine (C.D.), Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, Australia; Department of Epidemiology and Biostatistics (M.J.R.), College of Human Medicine, Michigan State University, East Lansing; The George Institute for Global Health and University of Sydney (R.I.L.); South Western Clinical School (M.W.P.), University of New South Wales, Sydney, Australia; The George Institute for Global Health (M.W.), School of Public Health, Imperial College London, United Kingdom; Department of Neurology (C.A., C.C.), Royal Prince Alfred Hospital, Sydney Health Partners, Australia; Edinburgh Imaging and Centre for Clinical Brain Sciences (J.M.W.); and UK Dementia Research Institute (J.M.W.), University of Edinburgh, United Kingdom.

PMID: 38531010
DOI: 10.1212/WNL.0000000000209204

Abstract

Background and objectives: To determine the prevalence of silent brain infarction (SBI) and cerebral small vessel disease (CSVD) in adults with atrial fibrillation (AF), coronary artery disease, heart failure or cardiomyopathy, heart valve disease, and patent foramen ovale (PFO), with comparisons between those with and without recent stroke and an exploration of associations between heart disease and SBI/CSVD.

Methods: Medline, Embase, and Cochrane Library were systematically searched for hospital-based or community-based studies reporting SBI/CSVD in people with heart disease. Data were extracted from eligible studies. Outcomes were SBI (primary) and individual CSVD subtypes. Summary prevalence (95% confidence intervals [CIs]) were obtained using random-effects meta-analysis. Pooled prevalence ratios (PRs) (95% CI) were calculated to compare those with heart disease with available control participants without heart disease from studies.

Results: A total of 221 observational studies were included. In those with AF, the prevalence was 36% (31%-41%) for SBI (70 studies, N = 13,589), 25% (19%-31%) for lacune (26 studies, N = 7,172), 62% (49%-74%) for white matter hyperintensity/hypoattenuation (WMH) (34 studies, N = 7,229), and 27% (24%-30%) for microbleed (44 studies, N = 13,654). Stratification by studies where participants with recent stroke were recruited identified no differences in the prevalence of SBI across subgroups (p_homogeneity = 0.495). Results were comparable across participants with different heart diseases except for those with PFO, in whom there was a lower prevalence of SBI [21% (13%-30%), 11 studies, N = 1,053] and CSVD. Meta-regressions after pooling those with any heart disease identified associations of increased (study level) age and hypertensives with more SBIs and WMH (p_regression <0.05). There was no evidence of a difference in the prevalence of microbleed between those with and without heart disease (PR [95% CI] 1.1 [0.7-1.7]), but a difference was seen in the prevalence of SBI and WMH (PR [95% CI] 2.3 [1.6-3.1] and 1.7 [1.1-2.6], respectively).

Discussion: People with heart disease have a high prevalence of SBI (and CSVD), which is similar in those with vs without recent stroke. More research is required to assess causal links and implications for management.

Trial registration information: PROSPERO CRD42022378272 (crd.york.ac.uk/PROSPERO/).

Publication types

Meta-Analysis
Systematic Review

MeSH terms

Adult
Brain Infarction / etiology
Cerebral Hemorrhage / complications
Cerebral Small Vessel Diseases* / complications
Heart Diseases* / complications
Humans
Risk Factors
Stroke* / epidemiology