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Their association with brain magnetic resonance imaging (MRI) markers of small vessel disease is unexplored.<\/jats:p><\/jats:sec><jats:sec><jats:title>METHODS<\/jats:title><jats:p>In 606 stroke\u2010free participants of the Multi\u2010Ethnic 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\u2010Tesla brain MRI completed 7 years later.<\/jats:p><\/jats:sec><jats:sec><jats:title>RESULTS<\/jats:title><jats:p>In adjusted analyses, higher PIP was associated with greater WMH volume (14% per standard deviation [SD], 95% confidence interval [CI]: 2, 27%, <jats:italic>P<\/jats:italic>\u00a0=\u00a00.02) and lower WM FA (\u20130.09 SD per SD, 95% CI: \u20130.16, \u20130.01, <jats:italic>P<\/jats:italic>\u00a0=\u00a00.03).<\/jats:p><\/jats:sec><jats:sec><jats:title>DISCUSSION<\/jats:title><jats:p>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.<\/jats:p><\/jats:sec>","DOI":"10.1002\/alz.13554","type":"journal-article","created":{"date-parts":[[2023,11,27]],"date-time":"2023-11-27T17:57:37Z","timestamp":1701107857000},"page":"1397-1405","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Heart rate fragmentation and brain MRI markers of small vessel disease in MESA"],"prefix":"10.1002","volume":"20","author":[{"given":"Susan R.","family":"Heckbert","sequence":"first","affiliation":[{"name":"Cardiovascular Health Research Unit University of Washington  Seattle Washington USA"},{"name":"Department of Epidemiology University of Washington  Seattle Washington USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paul N.","family":"Jensen","sequence":"additional","affiliation":[{"name":"Cardiovascular Health Research Unit University of Washington  Seattle Washington USA"},{"name":"Department of Medicine University of Washington  Seattle Washington USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Guray","family":"Erus","sequence":"additional","affiliation":[{"name":"Center for AI and Data Science for Integrated Diagnostics and Center for Biomedical Image Computing and Analytics University of Pennsylvania  Philadelphia Pennsylvania USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ilya M.","family":"Nasrallah","sequence":"additional","affiliation":[{"name":"Center for AI and Data Science for Integrated Diagnostics and Center for Biomedical Image Computing and Analytics University of Pennsylvania  Philadelphia Pennsylvania USA"},{"name":"Department of Radiology Perelman School of Medicine University of Pennsylvania  Philadelphia Pennsylvania USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tanweer","family":"Rashid","sequence":"additional","affiliation":[{"name":"Neuroimage Analytics Laboratory and Biggs Institute Neuroimaging Core Glenn Biggs Institute for Alzheimer's and Neurodegenerative Diseases University of Texas Health Science Center San Antonio  San Antonio Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohamad","family":"Habes","sequence":"additional","affiliation":[{"name":"Center for AI and Data Science for Integrated Diagnostics and Center for Biomedical Image Computing and Analytics University of Pennsylvania  Philadelphia Pennsylvania USA"},{"name":"Neuroimage Analytics Laboratory and Biggs Institute Neuroimaging Core Glenn Biggs Institute for Alzheimer's and Neurodegenerative Diseases University of Texas Health Science Center San Antonio  San Antonio Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas R.","family":"Austin","sequence":"additional","affiliation":[{"name":"Cardiovascular Health Research Unit University of Washington  Seattle Washington USA"},{"name":"Department of Epidemiology University of Washington  Seattle Washington USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"James S.","family":"Floyd","sequence":"additional","affiliation":[{"name":"Cardiovascular Health Research Unit University of Washington  Seattle Washington USA"},{"name":"Department of Epidemiology University of Washington  Seattle Washington USA"},{"name":"Department of Medicine University of Washington  Seattle Washington USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christopher L.","family":"Schaich","sequence":"additional","affiliation":[{"name":"Department of Surgery Hypertension and Vascular Research Center Wake Forest University School of Medicine  Winston\u2010Salem North Carolina USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Susan","family":"Redline","sequence":"additional","affiliation":[{"name":"Brigham and Women's Hospital  Boston Massachusetts USA"},{"name":"Harvard Medical School  Boston Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"R. 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