[Skip to Content]
[Skip to Content Landing]
Views 1,153
Citations 0
Original Investigation
May 20, 2019

Association Between Unrecognized Myocardial Infarction and Cerebral Infarction on Magnetic Resonance Imaging

Author Affiliations
  • 1Clinical and Translational Neuroscience Unit, Feil Family Brain and Mind Research Institute, Weill Cornell Medical College, New York, New York
  • 2Department of Neurology, Weill Cornell Medical College, New York, New York
  • 3The Icelandic Heart Association, Kopavogur, Iceland
  • 4Department of Medicine, Weill Cornell Medical College, New York, New York
  • 5Laboratory of Epidemiology and Population Sciences, National Institute on Aging, Bethesda, Maryland
  • 6The University of Iceland, Reykjavik, Iceland
  • 7Cardiovascular and Pulmonary Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
JAMA Neurol. 2019;76(8):956-961. doi:10.1001/jamaneurol.2019.1226
Key Points

Question  Is unrecognized myocardial infarction associated with cerebral infarction?

Findings  In a population-based sample, we found an association between unrecognized myocardial infarction detected by cardiac magnetic resonance imaging and cerebral infarction.

Meaning  Unrecognized myocardial infarction may be a novel risk factor for cerebral infarction.

Abstract

Importance  It is uncertain whether unrecognized myocardial infarction (MI) is a risk factor for cerebral infarction.

Objective  To determine whether unrecognized MI detected by cardiac magnetic resonance imaging (MRI) is associated with cerebral infarction.

Design, Setting, and Participants  This is a cross-sectional study of ICELAND MI, a cohort substudy of the Age, Gene/Environment Susceptibility–Reykjavik Study conducted in Iceland. Enrollment occurred from January 2004 to January 2007 from a community-dwelling cohort of older Icelandic individuals. Participants aged 67 to 93 years who underwent both brain MRI and late gadolinium enhancement cardiac MRI were included. Data analysis was performed from September 2018 to March 2019.

Exposures  Unrecognized MI identified by cardiac MRI.

Main Outcomes and Measures  Unrecognized MI was defined as cardiac MRI evidence of MI without a history of clinically evident MI. Recognized MI was defined as cardiac MRI evidence of MI with a history of clinically evident MI. Cerebral infarctions on brain MRI were included regardless of associated symptoms. Multiple logistic regression was used to evaluate the association between MI status (no MI, unrecognized MI, or recognized MI) and cerebral infarction after adjustment for demographic factors and vascular risk factors. In addition, we evaluated the association between unrecognized MI and embolic infarcts of undetermined source.

Results  Five enrolled participants had nondiagnostic brain MRI studies and were excluded. Among 925 participants, 480 (51.9%) were women; the mean (SD) age was 75.9 (5.3) years. There were 221 participants (23.9%) with cardiac MRI evidence of MI, of whom 68 had recognized MI and 153 unrecognized MI. There were 308 participants (33.3%) with brain MRI evidence of cerebral infarction; 93 (10.0%) had embolic infarcts of undetermined source. After adjustment for demographic factors and vascular risk factors, the likelihood (odds ratio) of having cerebral infarction was 2.0 (95% CI, 1.2-3.4; P = .01) for recognized MI and 1.5 (95% CI, 1.02-2.2; P = .04) for unrecognized MI. After adjustment for demographics and vascular risk factors, unrecognized MI was also associated with embolic infarcts of undetermined source (odds ratio, 2.0 [95% CI, 1.1-3.5]; P = .02).

Conclusions and Relevance  In a population-based sample, we found an association between unrecognized MI and cerebral infarction. These findings suggest that unrecognized MI may be a novel risk factor for cardiac embolism and cerebral infarction.

×