Left Ventricular Hypertrophy and Ischemic Lesions After Intracerebral Hemorrhage.

BACKGROUND

Cerebral ischemia is frequently detected after intracerebral hemorrhage (ICH) on diffusion-weighted imaging (DWI) and is associated with worse outcomes. Although the mechanism is uncertain, cerebral autoregulation impairment due to severe hypertension has been suggested from prior studies. We tested the hypothesis that more severe left ventricular hypertrophy (LVH), a marker of chronic hypertension-mediated organ damage, is associated with DWI lesions after ICH.

METHODS

Using a single-center observational cohort study, we included all patients with spontaneous ICH between 2009 and 2019 with available magnetic resonance imaging (MRI) who underwent transthoracic echocardiography (TTE) during the index hospitalization. LVH was primarily categorized as none/mild or moderate/severe based on the TTE report and was secondarily defined using calculated left ventricular mass index (LVMI) measurement. The primary outcome measure was acute DWI lesion presence on brain MRI. The number of DWI lesions was assessed as a secondary outcome.

RESULTS

A total of 187 patients (mean [SD] age 66.4 [14.5] years, 50.8% female) with a median baseline ICH volume of 12.6 (interquartile range 4.0-32.0) mL had TTE and DWI performed. Moderate/severe LVH was present in 23.5% of patients, and DWI lesions were detected in 30.5% of the cohort. Using multivariable logistic regression, the primary analysis found that moderate/severe LVH was associated with DWI lesion presence with adjustment for ICH severity (adjusted odds ratio [aOR] 2.74, confidence interval [CI] 1.32-5.71; p = 0.01). A similar association was demonstrated between the highest LVMI quartile and DWI lesion presence (aOR 3.60, CI 1.48-8.77; p = 0.01). Linear regression models found moderate/severe LVH was associated with greater DWI lesion count (adjusted B 1.32, CI 0.89-1.76; p < 0.01).

CONCLUSIONS

Greater LVH severity was associated with the presence and burden of DWI lesions after acute ICH. Echocardiography may be a tool to inform secondary ischemia risk stratification and prevention strategies.