Abnormal Left Ventricular Geometry is Associated with Cerebral White Matter Disease
Amr Salem1, Nihas Mateti1, Mutlu Demirer3, Bhrugun Anisetti1, Hossam Youssef1, Ahamed Elkhair1, Demilade Adedinsewo2, James Meschia4, Michelle Lin1
1Neurology, 2Cardiology, Mayo Clinic Florida, 3Mayo Clinic Florida, 4Neurology, Mayo Clinic
Objective:
To evaluate the association between left ventricular (LV) geometry and cerebral white matter disease (WMD).
Background:
WMD is a type of cerebral small vessel disease shown to increase risk of stroke and dementia. Reduced cardiac outflow due to left ventricular hypertrophy has been suggested as a potential risk factor for the development of WMD. The relationship between the LV geometry and the WMD volume has not been well established.
Design/Methods:
Consecutive patients from 2016-2022 who are ≥18 years who underwent an echocardiogram, Cardiac MRI, NT-proBNP test, and a brain MRI within one year were included. Four categories of LV geometry were defined: normal, eccentric hypertrophy, concentric remodeling, and concentric hypertrophy. WMD volume was quantified using an automated algorithm applied to axial T2 FLAIR images. Multivariable regression analyses were performed to evaluate the relationship between LV geometry and WMD volume.
Results:
A total of 112 patients were identified. Mean age was 63 ± 16 years, 48.2% were females, 68.8% had hypertension and 67.9% had coronary heart disease. WMD volume was highest in patients with concentric remodeling (11.34 ± 10.12cc) and concentric hypertrophy (10.08 ± 10.66cc) compared to eccentric hypertrophy (6.39 ± 6.06cc) and normal morphology (5.66 ± 6.74cc) with a trend-P value of 0.028. Patients with relative wall thickness (RWT) >42% had higher WMD volume (10.73 ± 10.29cc vs 5.89 ± 6.46cc, P=0.003), compared to those with RWT≤42%. Patients with fibrosis on cardiac MRI appeared to have higher WMD volume but did not achieve statistical significance (10.30 ± 10.59cc vs 7.41 ± 8.02cc, P=0.144).
Conclusions:
Our results showed that abnormal LV geometry is associated with higher WMD burden. Future studies are needed to explore whether the control of hypertension with specific class of antihypertensive medication may mediate the adverse left ventricular remodeling in slowing WMD progression.