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Left Ventricular Hypertrophy and Ischemic Lesions After Intracerebral Hemorrhage
Mohamed Ridha1,2, Marialaura Simonetto2, Fernanda Carvalho Poyraz2,3
1Department of Neurology, Ohio State University, Columbus, OH, USA.
Insights
Severe left ventricular hypertrophy (LVH) is linked to more diffusion-weighted imaging (DWI) lesions after intracerebral hemorrhage (ICH). Echocardiography can help identify patients at risk for secondary ischemia.
Area of Science:
- Neurology
- Cardiology
- Radiology
Background:
- Cerebral ischemia is common after intracerebral hemorrhage (ICH) and linked to poor outcomes.
- Impaired cerebral autoregulation due to hypertension is a suspected cause.
- Left ventricular hypertrophy (LVH), a marker of chronic hypertension, was investigated for its association with DWI lesions.
Purpose of the Study:
- To test the hypothesis that greater LVH severity is associated with diffusion-weighted imaging (DWI) lesions post-ICH.
- To explore LVH as a predictor of secondary ischemia after ICH.
Main Methods:
- A single-center observational cohort study included 187 patients with spontaneous ICH.
- Transthoracic echocardiography (TTE) assessed LVH (categorized as none/mild vs. moderate/severe) and left ventricular mass index (LVMI).
- Brain MRI identified acute DWI lesions, with lesion count as a secondary outcome.
Main Results:
- Moderate/severe LVH was present in 23.5% of patients; DWI lesions were detected in 30.5%.
- Moderate/severe LVH was significantly associated with DWI lesion presence (aOR 2.74, p=0.01) and count (aB 1.32, p<0.01).
- Higher LVMI quartiles also correlated with increased DWI lesion presence (aOR 3.60, p=0.01).
Conclusions:
- Increased LVH severity is associated with the presence and burden of DWI lesions following acute ICH.
- Echocardiography can aid in risk stratification for secondary ischemia and prevention strategies in ICH patients.
Background:
Cerebral ischemia is frequently detected after intracerebral hemorrhage (ICH) on diffusion-weighted imaging (DWI) and is associated with worse outcomes. Although the mechanism is uncertain, cerebral autoregulation impairment due to severe hypertension has been suggested from prior studies. We tested the hypothesis that more severe left ventricular hypertrophy (LVH), a marker of chronic hypertension-mediated organ damage, is associated with DWI lesions after ICH.
Methods:
Using a single-center observational cohort study, we included all patients with spontaneous ICH between 2009 and 2019 with available magnetic resonance imaging (MRI) who underwent transthoracic echocardiography (TTE) during the index hospitalization. LVH was primarily categorized as none/mild or moderate/severe based on the TTE report and was secondarily defined using calculated left ventricular mass index (LVMI) measurement. The primary outcome measure was acute DWI lesion presence on brain MRI. The number of DWI lesions was assessed as a secondary outcome.
Results:
A total of 187 patients (mean [SD] age 66.4 [14.5] years, 50.8% female) with a median baseline ICH volume of 12.6 (interquartile range 4.0-32.0) mL had TTE and DWI performed. Moderate/severe LVH was present in 23.5% of patients, and DWI lesions were detected in 30.5% of the cohort. Using multivariable logistic regression, the primary analysis found that moderate/severe LVH was associated with DWI lesion presence with adjustment for ICH severity (adjusted odds ratio [aOR] 2.74, confidence interval [CI] 1.32-5.71; p = 0.01). A similar association was demonstrated between the highest LVMI quartile and DWI lesion presence (aOR 3.60, CI 1.48-8.77; p = 0.01). Linear regression models found moderate/severe LVH was associated with greater DWI lesion count (adjusted B 1.32, CI 0.89-1.76; p < 0.01).
Conclusions:
Greater LVH severity was associated with the presence and burden of DWI lesions after acute ICH. Echocardiography may be a tool to inform secondary ischemia risk stratification and prevention strategies.
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