Left ventricular myocardial strain impairment correlates with cerebral small vessel disease burden in patients with normal ejection fraction.

BACKGROUND

The relationship between subclinical alterations in heart and brain structure and function remains poorly understood. Emerging evidence indicates that subclinical myocardial dysfunction may be associated with neuroimaging markers of cerebral microvascular injury.

PURPOSE: To evaluate the association between subclinical left ventricular dysfunction and cerebral small vessel disease (CSVD) burden in individuals with preserved left ventricular ejection fraction using cardiac and brain magnetic resonance imaging (MRI).

METHODS

This cross-sectional study enrolled 139 participants who underwent concurrent cardiac and brain MRI between March 2022 and December 2024. CSVD burden was assessed using a composite score incorporating white matter hyperintensities, enlarged perivascular spaces, and lacunar infarcts. Left ventricular function was assessed via feature-tracking cardiac MRI parameters, including global longitudinal strain (GLS), global circumferential strain (GCS), and global radial strain. Participants were classified into high (score ≥ 1) and low (score = 0) CSVD burden groups.

RESULTS

High CSVD burden was identified in 83 participants (60%). Both GLS and GCS demonstrated significant correlations with CSVD severity. In adjusted multivariable analysis, impaired GLS remained an independent predictor of an elevated CSVD burden (OR = 1.170, 95% CI: 1.007-1.359, P = 0.040).

CONCLUSIONS

Reduced GLS, a sensitive marker of subclinical left ventricular dysfunction, was independently associated with increased CSVD burden. These findings suggest that GLS may provide incremental value for identifying individuals at increased cerebrovascular risk despite preserved left ventricular ejection fraction.