Subclinical Left Ventricular Dysfunction and Silent Cerebrovascular Disease: The Cardiovascular Abnormalities and Brain Lesions (CABL) Study
Background—Silent brain infarcts (SBI) and white matter hyperintensities (WMH) are subclinical cerebrovascular lesions associated with incident stroke and cognitive decline. Left ventricular (LV) 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. LV 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 two-dimensional and speckle-tracking echocardiography in 439 participants free of stroke and cardiac disease from the Cardiovascular Abnormalities and Brain Lesions (CABL) study. SBI and WMH were assessed by brain magnetic resonance imaging. 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%. SBI were detected in 53 participants (12%), WMH volume was 0.63±0.86%. GLS was significantly lower in participants with SBI vs. those without (-15.7±3.5% vs. -17.3±2.9%, p<0.01), whereas no difference in LVEF was observed (63.3±8.6% vs. 63.8±6.0%, p=0.60). In multivariate analysis, lower GLS was associated with SBI (odds ratio/unit decrease=1.18, 95% CI 1.05-1.33, p<0.01), whereas LVEF was not (odds ratio/unit increase=1.00, 95% CI 0.96-1.05, p=0.98). Lower GLS was associated with greater WMH volume (adjusted β=0.11, p<0.05), unlike LVEF (adjusted β=-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.
- Global longitudinal strain
- silent brain infarction
- white matter disease
- left ventricular ejection fraction
- speckle tracking echocardiography
- magnetic resonance imaging
- Received February 13, 2013.
- Revision received June 4, 2013.
- Accepted June 27, 2013.