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Cardiac Structure Relates to Hemorrhagic Cerebral Small Vessel Disease Phenotype

Catriona R Stewart1, James Lyon1, Philip S Nash1

  • 1Department of Translational Neuroscience and Stroke, Stroke Research Centre, UCL Queen Square Institute of Neurology University College London, and National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Foundation Trust London UK.

Journal of the American Heart Association
|February 11, 2026
PubMed

Insights

Cardiac structure, measured by left ventricular mass (LVM), correlates with cerebral small vessel disease (cSVD) neuroimaging phenotypes in intracerebral hemorrhage (ICH) patients. This finding aids in classifying and preventing hemorrhagic cSVD.

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.
Abstract

Keywords:
arteriolosclerosiscerebral amyloid angiopathycerebral small vessel diseaseintracerebral hemorrhageleft ventricular massneuroimaging

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