Reduced Ejection Fraction and Augmented Right Atrium are Independent Risk Factors of Deep Regional CBF in 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 CSVD 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. 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: Augmented right atrial diameter (B coefficient, -0.289; 95% CI, -0.578 to -0.001; P=0.049) and decreased left ventricular ejection fraction (B coefficient, 32.555; 95% CI, 7.399 to 57.711; P=0.012) were echocardiographic parameters linked with declined deep regional CBF in CSVD patients. Binary logistic regression analysis demonstrated decreased mean deep 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 combing 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.