Imaging of the brain–heart axis: prognostic value in a European setting-Reference-Cited by-同舟云学术

Imaging of the brain–heart axis: prognostic value in a European setting

Published:2024-04-10 Issue:18 Volume:45 Page:1613-1630
ISSN:0195-668X
Container-title:European Heart Journal
language:en
Short-container-title:

Author:

Mikail Nidaa¹²^ORCID,Sager Dominik F¹²,Gebert Pimrapat¹²³,Haider Ahmed¹²⁴^ORCID,Todorov Atanas¹²^ORCID,Bengs Susan¹²^ORCID,Sablonier Noemi¹²,Glarner Isabelle¹²,Vinzens Adriana¹²,Sang Bastian Nastaran¹²,Epprecht Gioia¹²,Sütsch Claudia¹²,Delcò Alessia¹²,Fiechter Michael¹²⁵^ORCID,Portmann Angela¹²,Treyer Valerie¹^ORCID,Wegener Susanne⁶^ORCID,Gräni Christoph⁷^ORCID,Pazhenkottil Aju¹^ORCID,Gebhard Caroline E⁸^ORCID,Regitz-Zagrosek Vera⁹¹⁰^ORCID,Tanner Felix C¹¹^ORCID,Kaufmann Philipp A¹^ORCID,Buechel Ronny R¹^ORCID,Rossi Alexia¹²,Gebhard Catherine¹²⁷^ORCID

Affiliation:

1. Department of Nuclear Medicine, University Hospital Zurich , Raemistrasse 100, 8091 Zurich , Switzerland

2. Center for Molecular Cardiology, University of Zurich , Wagistrasse 12, 8952, Schlieren , Switzerland

3. Institute of Biometry and Clinical Epidemiology, Charité—Universitätsmedizin Berlin , Berlin , Germany

4. Department of Radiology, Division of Nuclear Medicine and Molecular Imaging, Massachusetts General Hospital and Harvard Medical School , Boston , USA

5. Swiss Paraplegic Center , Nottwil , Switzerland

6. Department of Neurology and Clinical Neuroscience Center, University Hospital Zurich and University of Zurich , Zurich , Switzerland

7. Department of Cardiology, Inselspital, Bern University Hospital, University of Bern , Freiburgstrasse 20, 3010, Bern , Switzerland

8. Intensive Care Unit, Department of Acute Medicine, University Hospital Basel, University of Basel , Basel , Switzerland

9. University of Zurich , Zurich , Switzerland

10. Institute of Gender in Medicine (GiM), Charité—Universitätsmedizin Berlin , Berlin , Germany

11. Department of Cardiology, University Hospital Zurich, University of Zurich , Zurich , Switzerland

Abstract

Abstract Background and Aims Increasing data suggest that stress-related neural activity (SNA) is associated with subsequent major adverse cardiovascular events (MACE) and may represent a therapeutic target. Current evidence is exclusively based on populations from the U.S. and Asia where limited information about cardiovascular disease risk was available. This study sought to investigate whether SNA imaging has clinical value in a well-characterized cohort of cardiovascular patients in Europe. Methods In this single-centre study, a total of 963 patients (mean age 58.4 ± 16.1 years, 40.7% female) with known cardiovascular status, ranging from ‘at-risk’ to manifest disease, and without active cancer underwent 2-[18F]fluoro-2-deoxy-D-glucose positron emission tomography/computed tomography between 1 January 2005 and 31 August 2019. Stress-related neural activity was assessed with validated methods and relations between SNA and MACE (non-fatal stroke, non-fatal myocardial infarction, coronary revascularization, and cardiovascular death) or all-cause mortality by time-to-event analysis. Results Over a maximum follow-up of 17 years, 118 individuals (12.3%) experienced MACE, and 270 (28.0%) died. In univariate analyses, SNA significantly correlated with an increased risk of MACE (sub-distribution hazard ratio 1.52, 95% CI 1.05–2.19; P = .026) or death (hazard ratio 2.49, 95% CI 1.96–3.17; P < .001). In multivariable analyses, the association between SNA imaging and MACE was lost when details of the cardiovascular status were added to the models. Conversely, the relationship between SNA imaging and all-cause mortality persisted after multivariable adjustments. Conclusions In a European patient cohort where cardiovascular status is known, SNA imaging is a robust and independent predictor of all-cause mortality, but its prognostic value for MACE is less evident. Further studies should define specific patient populations that might profit from SNA imaging.

Funder

Swiss National Science Foundation

Olga Mayenfisch Foundation

OPO Foundation

Novartis Foundation

Swissheart Foundation

Helmut Horten Foundation, Switzerland

EMDO Foundation

Iten Kohaut Foundation, Switzerland

University Hospital Zurich Foundation

University of Zurich (UZH) Foundation

Baugarten Foundation