Associations of Echocardiographic Biomarkers with White Matter Hyperintensities: Insights from the British 1946 Birth Cohort

Left atrial volume indexed for body surface area (LAV/BSA) showed the strongest association with global WMH (2.0% increase per unit, 95% CI 0.41-3.66%, p = 0.014), equating to approximately 60 mm³ increase. Figure 1 presents the forest plot summarising these associations across all echocardiographic biomarkers. Regional analyses indicated pronounced frontal lobe effects for both LAV/BSA (2.4% increase, p = 0.005) and E/e' ratio (7.9% increase, p = 0.017); LAV/BSA was associated with WMH across all white matter layers, whereas E/e' ratio was most evident in intermediate layers. Figure 2 provides a heat-map illustrating these spatial patterns. End systolic volume showed a non-linear association with WMH (quadratic term, p = 0.001), suggesting complex interactions CONCLUSION: In this study, echocardiographic parameters, particularly left atrial measures, demonstrated significant associations with subsequent WMH burden over 5-7 years. Although these findings remain observational and do not confirm causality, they support the integration of cardiac assessments into comprehensive risk profiling for age-related brain changes. Future work should clarify whether interventions aiming to optimise cardiac health can mitigate WMH accumulation and related cognitive risks in later life.