Cardiac Structure Relates to Hemorrhagic Cerebral Small Vessel Disease Phenotype

Area of Science:

• Neurology
• Cardiology
• Radiology

Background:

• Intracerebral hemorrhage (ICH) often results from cerebral small vessel diseases (cSVDs) like arteriolosclerosis and cerebral amyloid angiopathy (CAA).
• Hypertension is a key ICH risk factor, but its specific role in the hemorrhagic manifestations of these arteriopathies requires further clarification.
• Left ventricular mass (LVM), a cardiac structural biomarker for systemic hypertension, was examined in relation to cSVD neuroimaging phenotypes.

Purpose of the Study:

• To investigate the association between left ventricular mass (LVM) and the neuroimaging phenotype of cerebral small vessel diseases (cSVDs) in patients with intracerebral hemorrhage (ICH).
• To explore how cardiac structural changes relate to different types of symptomatic hemorrhagic cSVD.

Main Methods:

• Cross-sectional analysis of brain MRI and echocardiography data from 216 patients with symptomatic hemorrhagic cSVD (ICH, convexity subarachnoid hemorrhage, or cognitive impairment).
• Comparison of LVM across patient groups categorized by cSVD type: possible/probable CAA, mixed pattern cSVD, or arteriolosclerosis.
• Linear regression models were employed to assess associations between LVM, patient characteristics, and cSVD classification.

Main Results:

• Patients with cerebral amyloid angiopathy (CAA) exhibited significantly lower mean LVM (148.8±44.9 g) compared to those with mixed pattern cSVD or arteriolosclerosis (172.8±59.3 g).
• A progressive increase in LVM was observed across SVD classifications: CAA (148.8±44.9 g), mixed pattern cSVD (168.7±55.3 g), and arteriolosclerosis (190.8±72.9 g).
• Multivariable regression, adjusted for age, sex, and hypertension, confirmed LVM was independently associated with cSVD type, with higher LVM in mixed pattern cSVD/arteriolosclerosis compared to CAA (adjusted mean difference 14.6 g, P=0.026).

Conclusions:

• Cardiac structural changes, indicated by LVM, are linked to the neuroimaging phenotype of symptomatic hemorrhagic cSVD, including ICH.
• These findings offer insights into the classification and understanding of hemorrhagic cSVD.
• The relationship between cardiac structure and cSVD phenotype may inform future prevention strategies for hemorrhagic cSVD.