Association of early left ventricular dysfunction with advanced magnetic resonance white matter and gray matter brain measures: The CARDIA study

Abstract

Introduction Relations between heart failure and clinically manifested stroke are well known, but the associations between heart and brain early abnormalities are not totally clear. Aims We explore relations of subclinical brain abnormalities with early cardiac dysfunction in a large healthy middle-aged biracial cohort. Methods The CARDIA study enrolled 5,115 young adults aged 18–30 years at baseline (1985–1986). We assessed 719 Caucasian and African-American participants of the CARDIA study, with echocardiograms and brain MRI at follow-up year-25 (2010–2011). Echocardiography assessed aortic root diameter; LVEF; circumferential, longitudinal, and radial deformation. Cerebral MRI DTI, and, on a subset, ASL perfusion sequences were used to assess white matter fractional anisotropy and grey matter cerebral blood flow (CBF). Linear regression explored relations between cardiac parameters and cerebral measures, adjusting for anthropometrics, risk factors, and brain constitutional variation. Results Mean age 50±4 years, SBP 118±15mmHg; 60% white, and 48% men. Mean CBF was 46±9mL/100g/min and white matter fractional anisotropy was 0.31±0.02. Worse circumferential deformation and larger aortic root related to worse white matter fractional anisotropy. Worse radial systolic deformation was related to worse CBF in multivariable models. LVEF did not relate to early brain abnormalities. Conclusions In spite of no apparent effect of LV ejection fraction, early subclinical cardiac dysfunction and brain abnormalities are present and associated in middle-aged generally healthy individuals.

Strain Longitudinal e Acidente Vascular Encefálico Isquêmico na Ausência de Cardiopatia Conhecida

“…19 demonstraram que anormalidades cerebrais e cardíacas subclínicas estavam simultaneamente presentes nos participantes do estudo descrito acima -NOMAS -e Armstrong e cols. demonstraram no estudo CARDIA, com duração de 25 anos 25 , que o SLG reduzido estava associada a alterações microscópicas, macroestruturais e subclínicas da perfusão cerebral. Esses achados reforçam a hipótese de que alterações cerebrais e cardíacas subclínicas estão presentes ao mesmo tempo, antes da doença cardiovascular manifestada clinicamente.…”

Reduced Ejection Fraction and Augmented Right Atrium are Independent Risk Factors of Deep Regional CBF in Cerebral Small Vessel Disease

“…However, no considerable effect of LVEF on white matter microstructure damage and deterioration of CBF are observed in healthy middle-aged cohort (13). Actually, WMH is predisposed to lower CBF perfusion in patients with reduced cardiac output but not in patients with normal cardiac output (14).…”

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

“…Thereinto, left ventricular ejection fraction (LVEF), a well-established cardiac perfusion indicator, reduces considerably in CSVD patients with dementia [ 12 ]. However, no considerable effect of LVEF on white matter microstructure damage and deterioration of CBF are observed in healthy middle-aged cohort [ 13 ]. Actually, WMH is predisposed to lower CBF perfusion in patients with heart failure but not in patients with normal cardiac function [ 14 ].…”