Affiliations: [a] Department of Pharmacology, National University of Singapore, Singapore
| [b] Memory Aging & Cognition Centre, National University Health System, Singapore
| [c] Clinical Imaging Research Centre, National University of Singapore, Singapore
| [d] Department of Neurology, National Cerebral and Cardiovascular Center, Osaka, Japan
| [e] Department of Biochemistry, National University of Singapore, Singapore
| [f] Department of Radiology and Nuclear Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands | [g] Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore
Correspondence:
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Correspondence to: Saima Hilal, PhD, Saw Swee Hock School of Public Health, National University of Singapore, Tahir Foundation Building, 12 Science Drive 2, level 10, Singapore 117549. Tel.: +65 6516 4988; E-mail: saimahilal@nus.edu.sg.
Abstract: Background: P-wave terminal force in lead V1 (PTFV1) on electrocardiography has been associated with atrial fibrillation and ischemic stroke. Objective: To investigate whether PTFV1 is associated with cerebral small vessel disease (CSVD) markers and etiological subtypes of cognitive impairment and dementia. Methods: Participants were recruited from ongoing memory clinic study between August 2010 to January 2019. All participants underwent physical and medical evaluation along with an electrocardiography and 3 T brain magnetic resonance imaging. Participants were classified as no cognitive impairment, cognitive impairment no dementia, vascular cognitive impairment no dementia, and dementia subtypes (Alzheimer’s disease and vascular dementia). Elevated PTFV1 was defined as > 4,000μV×ms and measured manually on ECG. Results: Of 408 participants, 78 (19.1%) had elevated PTFV1 (37 women [47%]; mean [SD] age, 73.8 [7.2] years). The participants with elevated PTFV1 had higher burden of lacunes, cerebral microbleeds (CMB), and cortical microinfarcts. As for the CMB location, persons with strictly deep CMB and mixed CMB had significantly higher PTFV1 than those with no CMB (p = 0.005, p = 0.007). Regardless of adjustment for cardiovascular risk factors and/or heart diseases, elevated PTFV1 was significantly associated with presence of CMB (odds ratio, 2.26; 95% CI,1.33–3.91). Conclusion: Elevated PTFV1 was associated with CSVD, especially deep CMB. PTFV1 in vascular dementia was also higher compared to Alzheimer’s disease. Thus, PTFV1 might be a potential surrogate marker of brain-heart connection and vascular brain damage.
