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Updated: Nov 6, 2025
Ultrasonic Assessment of Myocardial Microstructure
Published on: January 14, 2014
The association between transthoracic echocardiogram parameters and white matter hyperintensities
Kayla S Navarro1, Ka-Ho Wong1, Majd M Ibrahim2
1Department of Neurology, University of Utah, Salt Lake City, UT 84132, USA.
Insights
Normal cardiac chamber sizes, specifically left atrial area (LAA) and right ventricular internal diameter (RVID), may predict white matter hyperintensities (WMH) on brain MRI. This suggests potential early identification of cerebral small vessel disease (CSVD) before cardiac changes are evident.
Area of Science:
- Cardiology
- Neurology
- Radiology
Background:
- Cerebral small vessel disease (CSVD) is a significant cause of stroke and cognitive impairment.
- Transthoracic echocardiogram (TTE) assesses cardiac structure and function, which may be linked to neurological conditions.
- White matter hyperintensities (WMH) on brain MRI are a key indicator of CSVD.
Purpose of the Study:
- To determine if cardiac chamber size and hemodynamic parameters on TTE can predict the progression of CSVD, indicated by WMH on brain MRI.
- To investigate the association between specific TTE measurements and the severity of WMH.
Main Methods:
- A retrospective review of adult patients with both brain MRI and TTE data was conducted.
- The Fazekas score, measuring white matter hyperintensities (WMH), was the primary outcome.
- Multivariate ordinal logistic regression models were used to analyze the association between TTE parameters and WMH, adjusting for confounders.
Main Results:
- While cardiac functional markers were not significant predictors, cardiac structural markers showed associations.
- Normal values for right ventricular internal diameter (RVID) and left atrial area (LAA) were associated with increased WMH (p=0.020 and p=0.041, respectively).
- No association was found between cardiac structure/function and isolated deep or periventricular white matter hyperintensities.
Conclusions:
- Normal left atrial area (LAA) and right ventricular internal diameter (RVID) on TTE may be associated with a higher degree of white matter hyperintensities (WMH) on brain MRI.
- This finding could indicate an earlier stage of WMH detection prior to observable cardiac changes.
- Further prospective studies are needed to validate these associations and explore quantitative comparisons.
Objective:
Identify abnormal cardiac chamber size and hemodynamic parameters on transthoracic echocardiogram (TTE) as predictors of advancing cerebral small vessel disease (CSVD) on brain magnetic resonance imaging (MRI).
Materials And Methods:
A retrospective chart review of adults with a brain MRI and a 2-dimensional TTE was performed. WMH measured by the Fazekas score served as the primary outcome. We fit multivariate ordinal logistic regression models to the Fazekas score with the individual predictors of the TTE measurements and adjusted for potential confounders.
Results:
132 individuals were included. Cardiac functional markers were not significant, including tricuspid annular plane systolic excursion (p = 0.818), right ventricular ejection fraction (p = 0.818) and left ventricular ejection fraction (p = 0.673). Cardiac structural markers included right atrial area (p = 0.247), right ventricular internal diameter (RVID, p = 0.020) and left atrial area (LAA, p = 0.041). RVID and LAA were identified as being predictors, although the direction of the association suggested that normal values resulted in more WMH. Analysis of isolated DWM or PVWM Fazekas scores were not associated with cardiac structure or function.
Conclusions:
In our study, we found that normal LAA and RVID values were associated with an increased degree of WMH on MRI. This finding may represent earlier identification of WMH prior to TTE cardiac changes. Future studies are needed for more robust quantitative comparison as well as evaluation prospectively of the association between cardiac chamber sizes and development of WMH.
