title: Subclinical cardiac dysfunction increases the risk of stroke and dementia: the Rotterdam Study.
abstract: OBJECTIVE
  To investigate the association between cardiac function and the risk of stroke and dementia in elderly free of clinical cardiac disease. Additionally, we investigated the relation between cardiac function and MRI markers of subclinical cerebrovascular disease.
  
  
  METHODS
  This study was conducted within the population-based Rotterdam Study. A total of 3,291 participants (60.8% female, age-range 58-98 years) free of coronary heart disease, heart failure, atrial fibrillation, stroke, and dementia underwent echocardiography in 2002-2005 to measure cardiac function. Follow-up finished in 2012. In 2005-2006, a random subset of 577 stroke-free people without dementia underwent brain MRI on which infarcts and white matter lesion volume were assessed.
  
  
  RESULTS
  During 21,785 person-years of follow-up, 164 people had a stroke and during 19,462 person-years of follow-up, 208 people developed dementia. Measures of better diastolic function, such as higher E/A ratio, were associated with a lower risk of stroke (hazard ratio [HR] 0.82; 95% confidence interval [CI] 0.69; 0.98) and dementia (HR 0.82; 95% CI 0.70; 0.96). Better systolic function, measured as higher fractional shortening, was only associated with a lower risk of stroke (HR 0.84; 95% CI 0.72; 0.98). Better diastolic function was related to a lower prevalence of silent infarcts on MRI, especially lacunar infarcts.
  
  
  CONCLUSIONS
  In elderly free of clinical cardiac disease, worse diastolic function is associated with clinical stroke, dementia, and silent infarcts on MRI, whereas worse systolic function is related only to clinical stroke. These findings can form the basis for future research on the utility of cardiac function as potential intervention target for prevention of neurologic diseases.
authors: From the Departments of Epidemiology (R.F.A.G.d.B., M.L.P.P., M.J.G.L., M.J.B., A.H., M.W.V., O.H.F., M.A.I.), Neurology (R.F.A.G.d.B., M.L.P.P., P.J.K., M.A.I.), Cardiology (M.J.G.L.), Radiology (A.v.d.L., W.J.N., M.W.V., M.A.I.), and Medical Informatics (W.J.N.), Erasmus Medical Center, Rotterdam; and Imaging Science and Technology (W.J.N.), Faculty of Applied Sciences, Delft University of Technology, the Netherlands.
authors: Renée F A G
authors: RF
authors: de Bruijn
authors: From the Departments of Epidemiology (R.F.A.G.d.B., M.L.P.P., M.J.G.L., M.J.B., A.H., M.W.V., O.H.F., M.A.I.), Neurology (R.F.A.G.d.B., M.L.P.P., P.J.K., M.A.I.), Cardiology (M.J.G.L.), Radiology (A.v.d.L., W.J.N., M.W.V., M.A.I.), and Medical Informatics (W.J.N.), Erasmus Medical Center, Rotterdam; and Imaging Science and Technology (W.J.N.), Faculty of Applied Sciences, Delft University of Technology, the Netherlands.
authors: Marileen L P
authors: ML
authors: Portegies
authors: From the Departments of Epidemiology (R.F.A.G.d.B., M.L.P.P., M.J.G.L., M.J.B., A.H., M.W.V., O.H.F., M.A.I.), Neurology (R.F.A.G.d.B., M.L.P.P., P.J.K., M.A.I.), Cardiology (M.J.G.L.), Radiology (A.v.d.L., W.J.N., M.W.V., M.A.I.), and Medical Informatics (W.J.N.), Erasmus Medical Center, Rotterdam; and Imaging Science and Technology (W.J.N.), Faculty of Applied Sciences, Delft University of Technology, the Netherlands.
authors: Maarten J G
authors: MJ
authors: Leening
authors: From the Departments of Epidemiology (R.F.A.G.d.B., M.L.P.P., M.J.G.L., M.J.B., A.H., M.W.V., O.H.F., M.A.I.), Neurology (R.F.A.G.d.B., M.L.P.P., P.J.K., M.A.I.), Cardiology (M.J.G.L.), Radiology (A.v.d.L., W.J.N., M.W.V., M.A.I.), and Medical Informatics (W.J.N.), Erasmus Medical Center, Rotterdam; and Imaging Science and Technology (W.J.N.), Faculty of Applied Sciences, Delft University of Technology, the Netherlands.
authors: Michiel J
authors: MJ
authors: Bos
authors: From the Departments of Epidemiology (R.F.A.G.d.B., M.L.P.P., M.J.G.L., M.J.B., A.H., M.W.V., O.H.F., M.A.I.), Neurology (R.F.A.G.d.B., M.L.P.P., P.J.K., M.A.I.), Cardiology (M.J.G.L.), Radiology (A.v.d.L., W.J.N., M.W.V., M.A.I.), and Medical Informatics (W.J.N.), Erasmus Medical Center, Rotterdam; and Imaging Science and Technology (W.J.N.), Faculty of Applied Sciences, Delft University of Technology, the Netherlands.
authors: Albert
authors: A
authors: Hofman
authors: From the Departments of Epidemiology (R.F.A.G.d.B., M.L.P.P., M.J.G.L., M.J.B., A.H., M.W.V., O.H.F., M.A.I.), Neurology (R.F.A.G.d.B., M.L.P.P., P.J.K., M.A.I.), Cardiology (M.J.G.L.), Radiology (A.v.d.L., W.J.N., M.W.V., M.A.I.), and Medical Informatics (W.J.N.), Erasmus Medical Center, Rotterdam; and Imaging Science and Technology (W.J.N.), Faculty of Applied Sciences, Delft University of Technology, the Netherlands.
authors: Aad
authors: A
authors: van der Lugt
authors: From the Departments of Epidemiology (R.F.A.G.d.B., M.L.P.P., M.J.G.L., M.J.B., A.H., M.W.V., O.H.F., M.A.I.), Neurology (R.F.A.G.d.B., M.L.P.P., P.J.K., M.A.I.), Cardiology (M.J.G.L.), Radiology (A.v.d.L., W.J.N., M.W.V., M.A.I.), and Medical Informatics (W.J.N.), Erasmus Medical Center, Rotterdam; and Imaging Science and Technology (W.J.N.), Faculty of Applied Sciences, Delft University of Technology, the Netherlands.
authors: Wiro J
authors: WJ
authors: Niessen
authors: From the Departments of Epidemiology (R.F.A.G.d.B., M.L.P.P., M.J.G.L., M.J.B., A.H., M.W.V., O.H.F., M.A.I.), Neurology (R.F.A.G.d.B., M.L.P.P., P.J.K., M.A.I.), Cardiology (M.J.G.L.), Radiology (A.v.d.L., W.J.N., M.W.V., M.A.I.), and Medical Informatics (W.J.N.), Erasmus Medical Center, Rotterdam; and Imaging Science and Technology (W.J.N.), Faculty of Applied Sciences, Delft University of Technology, the Netherlands.
authors: Meike W
authors: MW
authors: Vernooij
authors: From the Departments of Epidemiology (R.F.A.G.d.B., M.L.P.P., M.J.G.L., M.J.B., A.H., M.W.V., O.H.F., M.A.I.), Neurology (R.F.A.G.d.B., M.L.P.P., P.J.K., M.A.I.), Cardiology (M.J.G.L.), Radiology (A.v.d.L., W.J.N., M.W.V., M.A.I.), and Medical Informatics (W.J.N.), Erasmus Medical Center, Rotterdam; and Imaging Science and Technology (W.J.N.), Faculty of Applied Sciences, Delft University of Technology, the Netherlands.
authors: Oscar H
authors: OH
authors: Franco
authors: From the Departments of Epidemiology (R.F.A.G.d.B., M.L.P.P., M.J.G.L., M.J.B., A.H., M.W.V., O.H.F., M.A.I.), Neurology (R.F.A.G.d.B., M.L.P.P., P.J.K., M.A.I.), Cardiology (M.J.G.L.), Radiology (A.v.d.L., W.J.N., M.W.V., M.A.I.), and Medical Informatics (W.J.N.), Erasmus Medical Center, Rotterdam; and Imaging Science and Technology (W.J.N.), Faculty of Applied Sciences, Delft University of Technology, the Netherlands.
authors: Peter J
authors: PJ
authors: Koudstaal
authors: From the Departments of Epidemiology (R.F.A.G.d.B., M.L.P.P., M.J.G.L., M.J.B., A.H., M.W.V., O.H.F., M.A.I.), Neurology (R.F.A.G.d.B., M.L.P.P., P.J.K., M.A.I.), Cardiology (M.J.G.L.), Radiology (A.v.d.L., W.J.N., M.W.V., M.A.I.), and Medical Informatics (W.J.N.), Erasmus Medical Center, Rotterdam; and Imaging Science and Technology (W.J.N.), Faculty of Applied Sciences, Delft University of Technology, the Netherlands. m.a.ikram@erasmusmc.nl.
authors: M Arfan
authors: MA
authors: Ikram
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002318:Cardiovascular Diseases / Q000175:diagnosis* / Q000453:epidemiology*; D015331:Cohort Studies; D003704:Dementia / Q000175:diagnosis* / Q000453:epidemiology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009426:Netherlands / Q000453:epidemiology; D011159:Population Surveillance / Q000379:methods; D011446:Prospective Studies; D012307:Risk Factors; D020521:Stroke / Q000175:diagnosis* / Q000453:epidemiology*