Heart rate fragmentation and brain MRI markers of small vessel disease in MESA

Susan R. Heckbert, Paul N. Jensen, Guray Erus, Ilya M. Nasrallah, Tanweer Rashid, Mohamad Habes, Thomas R. Austin, James S. Floyd, Christopher L. Schaich, Susan Redline, R. Nick Bryan, Madalena D. Costa

Research output: Contribution to journalArticlepeer-review


INTRODUCTION: Heart rate (HR) fragmentation indices quantify breakdown of HR regulation and are associated with atrial fibrillation and cognitive impairment. Their association with brain magnetic resonance imaging (MRI) markers of small vessel disease is unexplored. METHODS: In 606 stroke-free participants of the Multi-Ethnic Study of Atherosclerosis (mean age 67), HR fragmentation indices including percentage of inflection points (PIP) were derived from sleep study recordings. We examined PIP in relation to white matter hyperintensity (WMH) volume, total white matter fractional anisotropy (FA), and microbleeds from 3-Tesla brain MRI completed 7 years later. RESULTS: In adjusted analyses, higher PIP was associated with greater WMH volume (14% per standard deviation [SD], 95% confidence interval [CI]: 2, 27%, P = 0.02) and lower WM FA (–0.09 SD per SD, 95% CI: –0.16, –0.01, P = 0.03). DISCUSSION: HR fragmentation was associated with small vessel disease. HR fragmentation can be measured automatically from ambulatory electrocardiogram devices and may be useful as a biomarker of vascular brain injury.

Original languageEnglish (US)
Pages (from-to)1397-1405
Number of pages9
JournalAlzheimer's and Dementia
Issue number2
StatePublished - Feb 2024


  • atrial myopathy
  • brain magnetic resonance imaging
  • brain microbleeds
  • brain small vessel disease
  • heart rate fragmentation
  • heart rate variability
  • multi-ethnic study of atherosclerosis
  • white matter fractional anisotropy
  • white matter hyperintensity

ASJC Scopus subject areas

  • Clinical Neurology
  • Geriatrics and Gerontology
  • Psychiatry and Mental health
  • Cellular and Molecular Neuroscience
  • Health Policy
  • Developmental Neuroscience
  • Epidemiology


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