Association of Left Ventricular Function With Cerebral Small Vessel Disease in a Community-Based Population
Yingying Yang1, Xueli Cai2, Mengyuan Zhou1,3
1Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
Insights
Left ventricular diastolic dysfunction, measured by mitral E/A ratio, is linked to cerebral small vessel disease (CSVD) burden. This finding suggests echocardiography can help identify individuals at risk for CSVD.
Area of Science:
- Cardiology
- Neurology
- Radiology
Background:
- Cerebral small vessel disease (CSVD) is a common cause of stroke and cognitive impairment.
- The relationship between cardiac function and CSVD is not well understood.
- Investigating this link can improve early detection and management of CSVD.
Purpose of the Study:
- To examine the association between left ventricular (LV) function and CSVD in a community-based population.
- To determine if specific measures of LV systolic and diastolic function correlate with CSVD burden.
- To explore the potential of cardiac function assessment for early CSVD risk stratification.
Main Methods:
- Cross-sectional study of 3063 community-dwelling residents from the PRECISE cohort.
- Transthoracic echocardiogram (TTE) assessed LV systolic function (LVEF, LVFS) and diastolic function (mitral E/A ratio).
- Brain MRI evaluated CSVD markers: white matter hyperintensity (WMH), lacunes, cerebral microbleeds (CMB), and enlarged perivascular spaces (EPVS).
- Logistic regression and restricted cubic spline models analyzed associations between cardiac function and CSVD.
Main Results:
- LV ejection fraction (LVEF) and LV fractional shortening (LVFS) showed no association with CSVD.
- Mitral E/A ratio negatively correlated with total CSVD score (cOR=0.89, p=0.01).
- Lower E/A ratio (<0.8 or ≥2) was associated with higher CSVD burden (cOR=1.20, p=0.046) and correlated with lacunes, EPVS, and WMH.
Conclusions:
- Mitral E/A ratio is associated with non-hemorrhagic CSVD.
- LV diastolic dysfunction, assessed via TTE, may serve as an early warning sign for high CSVD burden.
- Echocardiographic assessment of diastolic function could aid in identifying individuals at risk for CSVD.
Background And Objectives:
The relationship of cardiac function with cerebral small vessel disease (CSVD) remains unknown. The study aimed to investigate the association between left ventricular (LV) function and CSVD in a community-based population.
Methods:
Community-dwelling residents in China from the cross sectional survey of the PRECISE (PolyvasculaR Evaluation for Cognitive Impairment and vaScular Events) cohort were included. LV ejection fraction (LVEF) and LV fractional shortening (LVFS) were measured for LV systolic function, and mitral E/A ratio (the ratio of the peak trans-mitral filling velocity during early diastole and late diastole) was evaluated for LV diastolic function by transthoracic echocardiogram (TTE). Total CSVD score and CSVD imaging makers including white matter hyperintensity (WMH), lacunes, cerebral microbleeds (CMB), and enlarged perivascular spaces (EPVS) were assessed. The associations of cardiac function with CSVD were analyzed using ordinal or binary logistic regression models. Restricted cubic spline models fitted for logistic regression models were used.
Results:
A total of 3063 participants with available TTE and brain MRI data were included in the study. In the multivariable logistic regression analysis, LVEF and LVFS were not associated with total CSVD score or markers of CSVD. E/A ratio showed a negative correlation with total CSVD score (cOR, 0.89, 95% CI: 0.80-0.98, p = 0.01). Participants with E/A ≤ 0.8 or ≥ 2 had a higher total CSVD score than those with 0.8 < E/A < 2 (cOR 1.20, 95% CI: 1.00-1.43, p = 0.046). E/A ratio was also correlated with lacunes, moderate to severe EPVS, and periventricular WMH. Logistic regression analyses with restricted cubic spline further demonstrated that a lower E/A ratio were associated with a higher total CSVD score.
Conclusion:
Our study showed that mitral E/A ratio was associated with nonhemorrhagic CSVD. LV diastolic dysfunction assessed by TTE provides clues for the early warning of high CSVD burden.
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