Association between Left Ventricular Hypertrophy and Neuroimaging Markers of Cerebral Small Vessel Disease in Patients with ischemic stroke: CNRS-III study
Authors: Yue Fangfang , Yan Hongyi , Pan Yuesong , Jing Jing , Meng Xia , Jiang Yong , Li Zixiao , Li Hao , Wang Yongjun , Wang Yilong 
Published: February 2023

Data from the CNSR III Study (The Third China National Stroke Registry), a total of 9600 participants were included in this study who underwent transthoracic echocardiography and brain magnetic resonance imaging. Our study demonstrated a strong association between left ventricular hypertrophy(LVH) and different neuroimaging markers of cerebral small vascular disease in patient with ischemic stroke. Concentric hypertrophy was associated with DWMH(deep white matter hyperintensity),EPVS (enlarged perivascular space),Lacune, brain atrophy, and CMBs(cerebral microbleeds), but not PVWMH(periventricular white matter hyperintensity). Eccentric hypertrophy was associated with DWMH,EPVS-CS(enlarged perivascular space in centrum semioval), Lacune, CMBs, but not PVWMH, EPVS-BG(enlarged perivascular space in basal ganglia), or brain atrophy.The results remained stable after adjustment for conventional covariates. There were some variance in two subtypes of LVH, especially in people with DWMH or EPVS-CS, eccentric LVH seems to have a higher risk than concentric LVH.

Background

Some clinical special cardiovascular diseases have a certain associationwith the occurrence and development of cerebral small vessel disease(CSVD). Left ventricular hypertrophy (LVH) as a subclinical heart damage preceded heart failure is considered to be a risk factor for CSVD[2.3]. However, the precise relationship of LVH and CSVD is unclear.

Methods

Patients with acute ischaemic stroke or transient ischaemic attack in China from the registric survey of the CNSR-III (The Third China National Stroke Registry) from August 2015 to March 2018 were included in present study.The markers of CSVD on magnetic resonance imaging, including white matter hypertintensity, perivascular space, lacunes, cerebral microbleeds, and brain atrophy, were assessed at baseline survey.Participants were divided into 4 groups according to relative wall thickness and left ventricular mass index assesed by transthoracic echocardiography. The association of left ventricular geomatric patterns with CSVD imaging markers was analyzed using ordinary or binary logistic regression models.

Results

A total of 9600 participants were included in this study. The mean age of the participants was 61.9+11.2 years, and 6558(68.3%) were men.Compared with normal heart geometry, concentric hypertrophy had higher risk of deep white matter hyperintensity(DWMH)(odds ratio [OR]:1.54;95% confidence interval [CI]:1.16-2.04), enlarged perivascular space in basal gangalia(EPVS-BG) (OR:1.26; 95%CI:1.08-1.46), enlarged perivascular space in centrum semiovale(EPVS-CS) (OR:1.16; 95%CI:1.01-1.33), lacune (OR:1.45; 95%CI:1.26-1.67), brain atrophy (OR:1.42; 95%CI:1.20-1.69), but not periventricular white matter hyperintensity(PVWMH) after adjustment for covariates. Further, we did not found the association between eccentric heart hypertrophy and PVWMH, EPVS-BG and brain atrophy.

Conclusions

In this ischemic stroke registry,we found a possible association between LVH and CSVD imaging markers at different sites, neither concentric nor eccentric heart hypertrophy was associated with PVWMH, that was independent of hypertension and other traditional vascular risk factors.

Graphical Abstract

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