Left ventricular ejection fraction and right atrial diameter are associated with deep regional CBF in arteriosclerotic cerebral small vessel disease

Background: Systemic cardiac hypoperfusion is a well-acknowledged contributor to ischemic leukoencephalopathy. However, it has remained elusive how atherosclerosis-mediated cardiac remodelling modifies cerebral perfusion homeostasis as well as neuroimaging burden in cerebral small vessel disease (CSVD) development. Methods: This retrospective study identified 103 arteriosclerotic CSVD (aCSVD) patients (CSVD burden(low) 0 similar to 1, n=61 and CSVD burden(high) 2 similar to 4, n=42) from Sep. 2017 to Dec. 2019 who underwent transthoracic echocardiography(n=81), structural magnetic resonance imaging and arterial spin labelling (ASL). Total CSVD burden was graded according to the ordinal small vessel disease rating score (0-4). We investigated the univariate and multivariate linear regression of mean deep regional cerebral blood flow (CBF) as well as logistic regression analysis of CSVD burden(high). Results: Right atrial diameter (B coefficient, -0.289; 95% CI, -0.578 to -0.001; P=0.049) and left ventricular ejection fraction (B coefficient, 32.555; 95% CI, 7.399 to 57.711; P=0.012) were independently associated with deep regional CBF in aCSVD patients. Binary logistic regression analysis demonstrated decreased deep regional CBF (OR 0.894; 95% CI 0.811-0.985; P=0.024) was independently associated with higher CSVD burden after adjusted for clinical confounders. Multivariate receiver operating characteristics curve integrating clinical risk factors, mean deep CBF and echocardiographic parameters showed predictive significance for CSVD burden(high) diagnosis (area under curve=84.25, 95% CI 74.86-93.65%, P<0.0001). Conclusion: The interrelationship of cardiac -deep regional CBF-neuroimaging burden reinforces the importance and prognostic significance of echocardiographic and cerebral hemodynamic assessment in CSVD early-warning.

Automated summary

The study found that the interrelationship of cardiac and cerebral blood flow significantly impacts the neuroimaging burden in CSVD patients, with a strong independent association between deep regional cerebral blood flow and CSVD burden. A multivariate receiver operating characteristics curve integrating clinical risk factors, deep CBF, and echocardiographic parameters showed predictive significance for diagnosing high CSVD burden.