Cardiac Structure Relates to Hemorrhagic Cerebral Small Vessel Disease Phenotype

Most intracerebral hemorrhages (ICH) are caused by 1 of 2 cerebral small vessel diseases (cSVDs): arteriolosclerosis and cerebral amyloid angiopathy (CAA). Hypertension is a major risk factor for ICH, but its contribution to the hemorrhagic manifestations of these arteriopathies remains uncertain. We investigated associations between a cardiac structural biomarker of systemic hypertension (left ventricular mass [LVM]) and cSVD neuroimaging phenotype in patients with ICH.

We assessed brain magnetic resonance imaging and echocardiography cross-sectional data from patients with symptomatic hemorrhagic cSVD, including macroscopic ICH, convexity subarachnoid hemorrhage, or cognitive impairment. We compared LVM in patients with possible or probable CAA, mixed pattern cSVD, or arteriolosclerosis. We used linear regression models to investigate associations between LVM, patient characteristics, and SVD.

We included 216 patients (104 with CAA, 91 with mixed pattern cSVD, and 21 with arteriolosclerosis). Patients with CAA had a significantly lower mean LVM (148.8±44.9 g) compared with those with mixed pattern cSVD or arteriolosclerosis (172.8±59.3 g) (P<0.001). Across all SVD classifications, LVM progressively increased: CAA (148.8±44.9 g), mixed pattern cSVD (168.7±55.3 g), and arteriolosclerosis (190.8±72.9 g). In a multivariable linear regression model adjusted for age, sex, and hypertension, LVM was independently associated with CAA (adjusted mean difference in LVM, 14.6 [95% CI, 1.7-27.4] g higher for mixed pattern cSVD or arteriolosclerosis compared with CAA, P=0.026).

Our findings suggest cardiac structure relates to the neuroimaging phenotype of symptomatic hemorrhagic cSVD, including ICH. This is relevant to the classification, understanding, and prevention of hemorrhagic cSVD.