TY - JOUR
T1 - Associations between atrial cardiopathy and cerebral amyloid
T2 - The aric-pet study
AU - Johansen, Michelle C.
AU - Mosley, Thomas H.
AU - Knopman, David S.
AU - Wong, Dean F.
AU - Ndumele, Chiadi
AU - Shah, Amil M.
AU - Solomon, Scott D.
AU - Gottesman, Rebecca F.
N1 - Funding Information:
Institute (NHLBI) contracts (HHSN268201700001I, HHSN268201700002I, HHSN268201700003I, HHSN268201700005I, and HHSN268201700004I). Neurocognitive data are collected by U01 2U01HL096812, 2U01HL096814, 2U01HL096899, 2U01HL096902, and 2U01HL096917 from the National Institutes of Health (NHLBI, National Institute of Neurological Disorder and Stroke, National Institute on Aging [NIA], and National Institute on Deafness and Other Communication Disorders), and with previous brain magnetic resonance imaging examinations funded by R01-HL70825 from the NHLBI. The ARIC-PET (Positron Emission Tomography) study is funded by the NIA (R01AG040282 to Dr Gottesman). Avid Radiopharmaceuticals provided the florbetapir isotope for the study, but had no role in the study design or interpretation of results. Dr Johansen receives funding from the American Heart Association (No. 19CDA34660295); Dr Gottesman receives funding from the NIA (K24 AG052573).
Funding Information:
The ARIC (Atherosclerosis Risk in Communities) study is performed as a collaborative study supported by National Heart, Lung, and Blood Institute (NHLBI) contracts (HHSN268201700001I, HHSN268201700002I, HHSN268201700003I, HHSN268201700005I, and HHSN268201700004I). Neurocognitive data are collected by U01 2U01HL096812, 2U01HL096814, 2U01HL096899, 2U01HL096902, and 2U01HL096917 from the National Institutes of Health (NHLBI, National Institute of Neurological Disorder and Stroke, National Institute on Aging [NIA], and National Institute on Deafness and Other Communication Disorders), and with previous brain magnetic resonance imaging examinations funded by R01-HL70825 from the NHLBI. The ARIC-PET (Positron Emission Tomography) study is funded by the NIA (R01AG040282 to Dr Gottesman). Avid Radiopharmaceuticals provided the florbetapir isotope for the study, but had no role in the study design or interpretation of results. Dr Johansen receives funding from the American Heart Association (No. 19CDA34660295); Dr Gottesman receives funding from the NIA (K24 AG052573).
Funding Information:
The ARIC (Atherosclerosis Risk in Communities) study is performed as a collaborative study supported by National Heart, Lung, and Blood
Publisher Copyright:
© 2020 The Authors.
PY - 2020/12/15
Y1 - 2020/12/15
N2 - BACKGROUND: Atrial fibrillation (AF) is a risk factor for cognitive decline, possibly from silent brain infarction. Left atrial changes in structure or function (atrial cardiopathy) can lead to AF but may impact cognition independently. It is unknown if AF or atrial cardiopathy also acts on Alzheimer disease–specific mechanisms, such as deposition of β-amyloid. METHODS AND RESULTS: A total of 316 dementia-free participants from the ARIC (Atherosclerosis Risk in Communities) study underwent florbetapir positron emission tomography, electrocardiography, and 2-dimensional echocardiography. Atrial cardiopathy was defined as ≥1: (1) left atrial volume index >34 mL/m2; (2) P-wave terminal force >5000 µV×ms; and (3) serum NT-proBNP (N-terminal pro-B-type natriuretic peptide) >250 pg/mL. Cross-sectional associations between global cortical β-amyloid (>1.2 standardized uptake value ratio) and adjudicated history of AF and atrial cardiopathy, each, were evaluated using multivariable logistic regression. Participants (mean age, 76 years) were 56% women and 42% Black individuals. Odds of elevated florbetapir standardized uptake value ratio were significantly increased among those with atrial cardiopathy (odds ratio, 1.81; 95% CI, 1.02–3.22) and doubled for those with enlarged left atrial volume index after adjustment for demographics/risk factors (95% CI, 1.04–4.61). There was no association between P-wave terminal force or NT-proBNP and elevated florbetapir standardized uptake value ratio, nor between AF and elevated standardized uptake value ratio. CONCLUSIONS: Among healthy, nondemented community-dwelling older individuals, we report an association between atrial cardiopathy, left atrial volume index, and elevated brain amyloid, by positron emission tomography, without a similar association in individuals with AF. Potential limitations include reverse causation and survival bias. Ongoing work will help determine if changes in cardiac structure and function precede or occur simultaneously with amyloid deposition.
AB - BACKGROUND: Atrial fibrillation (AF) is a risk factor for cognitive decline, possibly from silent brain infarction. Left atrial changes in structure or function (atrial cardiopathy) can lead to AF but may impact cognition independently. It is unknown if AF or atrial cardiopathy also acts on Alzheimer disease–specific mechanisms, such as deposition of β-amyloid. METHODS AND RESULTS: A total of 316 dementia-free participants from the ARIC (Atherosclerosis Risk in Communities) study underwent florbetapir positron emission tomography, electrocardiography, and 2-dimensional echocardiography. Atrial cardiopathy was defined as ≥1: (1) left atrial volume index >34 mL/m2; (2) P-wave terminal force >5000 µV×ms; and (3) serum NT-proBNP (N-terminal pro-B-type natriuretic peptide) >250 pg/mL. Cross-sectional associations between global cortical β-amyloid (>1.2 standardized uptake value ratio) and adjudicated history of AF and atrial cardiopathy, each, were evaluated using multivariable logistic regression. Participants (mean age, 76 years) were 56% women and 42% Black individuals. Odds of elevated florbetapir standardized uptake value ratio were significantly increased among those with atrial cardiopathy (odds ratio, 1.81; 95% CI, 1.02–3.22) and doubled for those with enlarged left atrial volume index after adjustment for demographics/risk factors (95% CI, 1.04–4.61). There was no association between P-wave terminal force or NT-proBNP and elevated florbetapir standardized uptake value ratio, nor between AF and elevated standardized uptake value ratio. CONCLUSIONS: Among healthy, nondemented community-dwelling older individuals, we report an association between atrial cardiopathy, left atrial volume index, and elevated brain amyloid, by positron emission tomography, without a similar association in individuals with AF. Potential limitations include reverse causation and survival bias. Ongoing work will help determine if changes in cardiac structure and function precede or occur simultaneously with amyloid deposition.
KW - Atrial cardiopathy
KW - Cognitive decline
KW - Cohort study
KW - Positron emission tomography
UR - http://www.scopus.com/inward/record.url?scp=85098531143&partnerID=8YFLogxK
U2 - 10.1161/JAHA.120.018399
DO - 10.1161/JAHA.120.018399
M3 - Article
C2 - 33289449
AN - SCOPUS:85098531143
SN - 2047-9980
VL - 9
JO - Journal of the American Heart Association
JF - Journal of the American Heart Association
IS - 24
M1 - e018399
ER -