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Association of Left Ventricular Hypertrophy and Atrial Fibrillation with Hemorrhagic Evolution of Small Vessel

Antonio Muscari1, Giovanni Masetti2, Luca Faccioli3

  • 1Stroke Unit-Medical Department of Continuity of Care and Disability, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Italy; Department of Medical and Surgical Sciences, University of Bologna, Italy.

Journal of Stroke and Cerebrovascular Diseases : the Official Journal of National Stroke Association
|July 2, 2021
PubMed

Insights

Hypertension-related cerebral small vessel disease (SVD) can lead to intracerebral hemorrhage (ICH) or lacunar stroke. ICH is linked to cardiac issues like increased left ventricular wall thickness, while lacunar stroke is associated with smoking, diabetes, and white matter lesions.

Area of Science:

  • Neurology
  • Cardiology
  • Vascular Medicine

Background:

  • Cerebral small vessel disease (SVD) is a common complication of hypertension.
  • SVD can progress to either intracerebral hemorrhage (ICH) or lacunar ischemic stroke.
  • The specific factors differentiating the progression pathways of SVD remain unclear.

Purpose of the Study:

  • To investigate the distinct clinical, laboratory, and neuroradiological factors associated with the progression of SVD to ICH versus lacunar lesions.
  • To identify predictors of ICH and lacunar stroke in patients with SVD.

Main Methods:

  • Retrospective analysis of 326 patients with SVD.
  • Patients were categorized into deep ICH (n=143) or lacunar lesions (LL) <2 cm (n=183).
  • Clinical, laboratory, and neuroimaging data were collected; a subgroup had echocardiography.

Main Results:

  • Intracerebral hemorrhage patients exhibited increased left ventricular wall thickness (LVWT) and a higher prevalence of atrial fibrillation.
  • Lacunar stroke patients showed a greater prevalence of white matter lesions, smoking, and diabetes.
  • Hypertension was prevalent in both groups (97% ICH, 89% SAO).

Conclusions:

  • Hypertension is common in SVD, but cardiac organ damage (increased LVWT, atrial fibrillation) characterizes progression to ICH.
  • Cerebral organ damage (white matter lesions) and metabolic factors (smoking, diabetes) are more prevalent in SVD progression to lacunar stroke.
Abstract

Keywords:
Atrial fibrillationEchocardiogramHypertensionIntracerebral hemorrhageLacunar strokeLeft ventricular hypertrophyWhite matter lesions

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