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

Abstract

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 burdenlow 0 ~ 1, n = 61 and CSVD burdenhigh 2 ~ 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 burdenhigh. 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 burdenhigh 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.

Perfusion heterogeneity of cerebral small vessel disease revealed via arterial spin labeling MRI and machine learning

“…Traditional studies of CSVD have been conducted before determining subtypes on the basis of perfusion patterns, these studies commonly revealed overlapping relationships between CSVD clinical symptoms and CBF ( Chen et al, 2021 , Jann et al, 2021 , Yu et al, 2020 ). In the current study, associations between clinical symptoms and CSVD were assessed after determining the CSVD subtypes, and several common risk factors between healthy controls and CSVD patients were found, including age, proportion of subjects drinking alcohol.…”

Echocardiographic correlates of MRI imaging markers of cerebral small-vessel disease in patients with atrial-fibrillation-related ischemic stroke

“…According to one study (22) of chronic valvular heart disease patients, right atrial pressure is independently associated with higher WMH volume. RAD has also been reported (23) to be negatively correlated with mean deep regional CBF. Collectively, there is therefore a need to continuously pay attention to pathogenesis involving RAD in CSVD in future research.…”

Contrast‐agent‐free state‐of‐the‐art MRI on cerebral small vessel disease—part 1. ASL, IVIM, and CVR

“…This suggests that periventricular CBF could be an early biomarker of cSVD. In another study, echocardiographic and deep regional CBF in arteriosclerotic cSVD showed association with total burden, suggesting a prognostic potential 29 . Also, a correlation was found between thalamic blood flow measured with ASL and gait in an elderly group with at least one vascular risk factor, suggesting that subcortical vascularity must be considered when studying the functional decline in the elderly population 30 …”

“…In another study, echocardiographic and deep regional CBF in arteriosclerotic cSVD showed association with total burden, suggesting a prognostic potential. 29 Also, a correlation was found between thalamic blood flow measured with ASL and gait in an elderly group with at least one vascular risk factor, suggesting that subcortical vascularity must be considered when studying the functional decline in the elderly population. 30 Finally, an ASL pulse sequence combined with diffusion gradients before the readout module (DP-pCASL, diffusion-prepared pCASL) appears to be a promising approach to noninvasively map the water exchange across the BBB.…”