Subclinical left ventricular dysfunction and silent cerebrovascular disease: The cardiovascular abnormalities and brain lesions (CABL) study

Cesare Russo, Zhezhen Jin, Shunichi Homma, Mitchell S V Elkind, Tatjana Rundek, Mitsuhiro Yoshita, Charles DeCarli, Clinton B. Wright, Ralph L. Sacco, Marco R. Di Tullio

Research output: Contribution to journalArticle

36 Citations (Scopus)

Abstract

BACKGROUND-: Silent brain infarcts (SBIs) and white matter hyperintensities are subclinical cerebrovascular lesions associated with incident stroke and cognitive decline. Left ventricular 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. Left ventricular 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 2-dimensional and speckle-tracking echocardiography in 439 participants free of stroke and cardiac disease from the Cardiovascular Abnormalities and Brain Lesions (CABL) study. SBIs and white matter hyperintensities were assessed by brain MRI. 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%. SBIs were detected in 53 participants (12%), white matter hyperintensity volume was 0.63±0.86%. GLS was significantly lower in participants with SBI versus those without (-15.7±3.5% versus-17.3±2.9%, P<0.01), whereas no difference in LVEF was observed (63.3±8.6% versus 63.8±6.0%, P=0.60). In multivariate analysis, lower GLS was associated with SBI (odds ratio/unit decrease=1.18; 95% confidence interval, 1.05-1.33; P<0.01), whereas LVEF was not (odds ratio/unit increase=1.00; 95% confidence interval, 0.96-1.05; P=0.98). Lower GLS was associated with greater white matter hyperintensity 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.

Original languageEnglish (US)
Pages (from-to)1105-1111
Number of pages7
JournalCirculation
Volume128
Issue number10
DOIs
StatePublished - Sep 3 2013

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Cardiovascular Abnormalities
Cerebrovascular Disorders
Left Ventricular Dysfunction
Stroke Volume
Brain
Brain Diseases
Stroke
Heart Diseases
Odds Ratio
Confidence Intervals
Population
Echocardiography
Multivariate Analysis
Heart Failure

Keywords

  • brain infarction
  • echocardiography
  • global longitudinal strain
  • magnetic resonance imaging
  • speckle-tracking
  • ventricular ejection fraction
  • white matter diseases

ASJC Scopus subject areas

  • Physiology (medical)
  • Cardiology and Cardiovascular Medicine

Cite this

Subclinical left ventricular dysfunction and silent cerebrovascular disease : The cardiovascular abnormalities and brain lesions (CABL) study. / Russo, Cesare; Jin, Zhezhen; Homma, Shunichi; Elkind, Mitchell S V; Rundek, Tatjana; Yoshita, Mitsuhiro; DeCarli, Charles; Wright, Clinton B.; Sacco, Ralph L.; Di Tullio, Marco R.

In: Circulation, Vol. 128, No. 10, 03.09.2013, p. 1105-1111.

Research output: Contribution to journalArticle

Russo, C, Jin, Z, Homma, S, Elkind, MSV, Rundek, T, Yoshita, M, DeCarli, C, Wright, CB, Sacco, RL & Di Tullio, MR 2013, 'Subclinical left ventricular dysfunction and silent cerebrovascular disease: The cardiovascular abnormalities and brain lesions (CABL) study', Circulation, vol. 128, no. 10, pp. 1105-1111. https://doi.org/10.1161/CIRCULATIONAHA.113.001984
Russo, Cesare ; Jin, Zhezhen ; Homma, Shunichi ; Elkind, Mitchell S V ; Rundek, Tatjana ; Yoshita, Mitsuhiro ; DeCarli, Charles ; Wright, Clinton B. ; Sacco, Ralph L. ; Di Tullio, Marco R. / Subclinical left ventricular dysfunction and silent cerebrovascular disease : The cardiovascular abnormalities and brain lesions (CABL) study. In: Circulation. 2013 ; Vol. 128, No. 10. pp. 1105-1111.
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T1 - Subclinical left ventricular dysfunction and silent cerebrovascular disease

T2 - The cardiovascular abnormalities and brain lesions (CABL) study

AU - Russo, Cesare

AU - Jin, Zhezhen

AU - Homma, Shunichi

AU - Elkind, Mitchell S V

AU - Rundek, Tatjana

AU - Yoshita, Mitsuhiro

AU - DeCarli, Charles

AU - Wright, Clinton B.

AU - Sacco, Ralph L.

AU - Di Tullio, Marco R.

PY - 2013/9/3

Y1 - 2013/9/3

N2 - BACKGROUND-: Silent brain infarcts (SBIs) and white matter hyperintensities are subclinical cerebrovascular lesions associated with incident stroke and cognitive decline. Left ventricular 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. Left ventricular 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 2-dimensional and speckle-tracking echocardiography in 439 participants free of stroke and cardiac disease from the Cardiovascular Abnormalities and Brain Lesions (CABL) study. SBIs and white matter hyperintensities were assessed by brain MRI. 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%. SBIs were detected in 53 participants (12%), white matter hyperintensity volume was 0.63±0.86%. GLS was significantly lower in participants with SBI versus those without (-15.7±3.5% versus-17.3±2.9%, P<0.01), whereas no difference in LVEF was observed (63.3±8.6% versus 63.8±6.0%, P=0.60). In multivariate analysis, lower GLS was associated with SBI (odds ratio/unit decrease=1.18; 95% confidence interval, 1.05-1.33; P<0.01), whereas LVEF was not (odds ratio/unit increase=1.00; 95% confidence interval, 0.96-1.05; P=0.98). Lower GLS was associated with greater white matter hyperintensity 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.

AB - BACKGROUND-: Silent brain infarcts (SBIs) and white matter hyperintensities are subclinical cerebrovascular lesions associated with incident stroke and cognitive decline. Left ventricular 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. Left ventricular 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 2-dimensional and speckle-tracking echocardiography in 439 participants free of stroke and cardiac disease from the Cardiovascular Abnormalities and Brain Lesions (CABL) study. SBIs and white matter hyperintensities were assessed by brain MRI. 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%. SBIs were detected in 53 participants (12%), white matter hyperintensity volume was 0.63±0.86%. GLS was significantly lower in participants with SBI versus those without (-15.7±3.5% versus-17.3±2.9%, P<0.01), whereas no difference in LVEF was observed (63.3±8.6% versus 63.8±6.0%, P=0.60). In multivariate analysis, lower GLS was associated with SBI (odds ratio/unit decrease=1.18; 95% confidence interval, 1.05-1.33; P<0.01), whereas LVEF was not (odds ratio/unit increase=1.00; 95% confidence interval, 0.96-1.05; P=0.98). Lower GLS was associated with greater white matter hyperintensity 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.

KW - brain infarction

KW - echocardiography

KW - global longitudinal strain

KW - magnetic resonance imaging

KW - speckle-tracking

KW - ventricular ejection fraction

KW - white matter diseases

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