Identify abnormal cardiac chamber size and hemodynamic parameters on transthoracic echocardiogram (TTE) as predictors of advancing cerebral small vessel disease (CSVD) on brain magnetic resonance imaging (MRI).

White matter hyperintensities (WMH) are a radiographic marker of CSVD. Alterations in cardiac structure and function have been hypothesized to be involved in the pathogenesis of WMH, although prior results have been inconsistent. We performed a cross sectional analysis of the association between cardiac measurements on TTE and WMH on MRI.

A retrospective chart review of adults with a brain MRI and a 2-dimensional TTE was performed. WMH measured by the Fazekas score served as the primary outcome. We fit multivariate ordinal logistic regression models to the Fazekas score with the individual predictors of the TTE measurements and adjusted for potential confounders.

132 individuals were included. Cardiac functional markers, such as tricuspid annular plane systolic excursion were not significant. Cardiac structural markers included apical 4-chamber end-systole right atrial area, diastolic right ventricular base internal diameter (RVID) and apical 4-chamber end-systole left atrial area (LAA). RVID (OR 0.46, 95% CI 0.24 to 0.89, p = 0.020) and LAA (OR 0.94, 95% CI 0.88 to 1.00, p = 0.041) were identified as being predictors, although the direction of the association suggested that normal values resulted in more WMH. Analysis of isolated DWM or PVWM Fazekas scores were not significant predictors of cardiac structure or function.

In our study, we found that normal LAA and RVID values were associated with an increased degree of WMH on MRI. This finding may be possible due to increased central venous pressure prior to cardiac remodeling or due to differences in imaging modalities. Several limitations are noted including subjectivity in interpreting TTE data. Future studies are needed for more robust objective comparison between cardiac chamber sizes and development of WMH.