Association of Left Ventricular Function With Cerebral Small Vessel Disease in a Community-Based Population

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.