Subclinical Left Ventricular Dysfunction and Silent Cerebrovascular Disease: The Cardiovascular Abnormalities and Brain Lesions (CABL) Study

Background Silent brain infarcts (SBIs) and white matter hyperintensities are subclinical cerebrovascular lesions associated with incident stroke and cognitive decline. Left ventricular ejection fraction (LVEF) is a predictor of stroke in patients with heart failure, but its association with subclinical brain disease in the general population is unknown. Left ventricular global longitudinal strain (GLS) can detect subclinical cardiac dysfunction even when LVEF is normal. We investigated the relationship of LVEF and GLS with subclinical brain disease in a community-based cohort. Methods and Results LVEF and GLS were assessed by 2-dimensional and speckle-tracking echocardiography in 439 participants free of stroke and cardiac disease from the Cardiovascular Abnormalities and Brain Lesions (CABL) study. SBIs and white matter hyperintensities were assessed by brain MRI. Mean age of the study population was 69 +/- 10 years, 61% were women, LVEF was 63.8 +/- 6.4%, GLS was -17.1 +/- 3.0%. SBIs were detected in 53 participants (12%), white matter hyperintensity volume was 0.63 +/- 0.86%. GLS was significantly lower in participants with SBI versus those without (-15.7 +/- 3.5% versus -17.3 +/- 2.9%, P<0.01), whereas no difference in LVEF was observed (63.3 +/- 8.6% versus 63.8 +/- 6.0%, P=0.60). In multivariate analysis, lower GLS was associated with SBI (odds ratio/unit decrease=1.18; 95% confidence interval, 1.05-1.33; P<0.01), whereas LVEF was not (odds ratio/unit increase=1.00; 95% confidence interval, 0.96-1.05; P=0.98). Lower GLS was associated with greater white matter hyperintensity volume (adjusted =0.11, P<0.05), unlike LVEF (adjusted =-0.04, P=0.42). Conclusions Lower GLS was independently associated with subclinical brain disease in a community-based cohort without overt cardiac disease. GLS can provide additional information on cerebrovascular risk burden beyond LVEF assessment.