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Left ventricular ejection fraction and right atrial diameter are associated with deep regional CBF in
Xiaodong Chen1, Danli Lu1, Ning Guo2
1Department of Neurology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510630, China.
Insights
Cardiac remodeling impacts cerebral blood flow and neuroimaging burden in arteriosclerotic cerebral small vessel disease (aCSVD). Echocardiography and cerebral hemodynamic assessments are crucial for early CSVD detection and prognosis.
Area of Science:
- Cardiovascular Medicine
- Neurology
- Radiology
Background:
- Systemic cardiac hypoperfusion contributes to ischemic leukoencephalopathy.
- The role of atherosclerosis-mediated cardiac remodeling in cerebral perfusion and neuroimaging burden in cerebral small vessel disease (CSVD) remains unclear.
Purpose of the Study:
- To investigate the relationship between cardiac remodeling, cerebral hemodynamics, and neuroimaging burden in arteriosclerotic CSVD (aCSVD).
- To identify predictors of high CSVD burden in aCSVD patients.
Main Methods:
- Retrospective study of 103 aCSVD patients.
- Utilized transthoracic echocardiography, structural MRI, and arterial spin labeling (ASL) to assess cardiac function and cerebral blood flow (CBF).
- Graded total CSVD burden using a 0-4 rating score and analyzed associations with CBF and clinical factors.
Main Results:
- Right atrial diameter and left ventricular ejection fraction were independently associated with deep regional CBF.
- Decreased deep regional CBF was independently associated with higher CSVD burden.
- A model integrating clinical factors, CBF, and echocardiographic parameters predicted high CSVD burden with high accuracy (AUC 84.25%).
Conclusions:
- The interplay between cardiac status, cerebral blood flow, and neuroimaging burden highlights the prognostic significance of cardiac and hemodynamic assessments in early CSVD detection.
- Echocardiographic and cerebral hemodynamic evaluations are vital for managing and predicting outcomes in aCSVD.
Background:
Systemic cardiac hypoperfusion is a well-acknowledged contributor to ischemic leukoencephalopathy. However, it has remained elusive how atherosclerosis-mediated cardiac remodelling modifies cerebral perfusion homeostasis as well as neuroimaging burden in cerebral small vessel disease (CSVD) development.
Methods:
This retrospective study identified 103 arteriosclerotic CSVD (aCSVD) patients (CSVD burdenlow 0 ~ 1, n = 61 and CSVD burdenhigh 2 ~ 4, n = 42) from Sep. 2017 to Dec. 2019 who underwent transthoracic echocardiography(n = 81), structural magnetic resonance imaging and arterial spin labelling (ASL). Total CSVD burden was graded according to the ordinal "small vessel disease" rating score (0-4). We investigated the univariate and multivariate linear regression of mean deep regional cerebral blood flow (CBF) as well as logistic regression analysis of CSVD burdenhigh.
Results:
Right atrial diameter (B coefficient, - 0.289; 95% CI, - 0.578 to - 0.001; P = 0.049) and left ventricular ejection fraction (B coefficient, 32.555; 95% CI, 7.399 to 57.711; P = 0.012) were independently associated with deep regional CBF in aCSVD patients. Binary logistic regression analysis demonstrated decreased deep regional CBF (OR 0.894; 95% CI 0.811-0.985; P = 0.024) was independently associated with higher CSVD burden after adjusted for clinical confounders. Multivariate receiver operating characteristics curve integrating clinical risk factors, mean deep CBF and echocardiographic parameters showed predictive significance for CSVD burdenhigh diagnosis (area under curve = 84.25, 95% CI 74.86-93.65%, P < 0.0001).
Conclusion:
The interrelationship of "cardiac -deep regional CBF-neuroimaging burden" reinforces the importance and prognostic significance of echocardiographic and cerebral hemodynamic assessment in CSVD early-warning.
