Association of Left Ventricular Function With Cerebral Small Vessel Disease and Cognition

BACKGROUND: Cognitive impairment and dementia are common in patients with heart failure, but the relationships between left ventricular (LV) function, cerebral small vessel disease (CSVD), and cognition remain poorly understood. This cross-sectional study aims to investigate the associations between echocardiographic measures of LV function, magnetic resonance imaging markers of CSVD, and cognition. METHODS: LV systolic and diastolic function were assessed by echocardiography. CSVD markers were graded on 3 Tesla magnetic resonance imaging. Cognition was assessed using neuropsychological assessment and clinical diagnosis of cognitive impairment. Multivariable linear and logistic regression analyses were performed for continuous and binary outcomes, respectively, adjusting for demographics and cardiovascular risk factors. Mediation analysis was conducted to examine the mediating effect of CSVD markers on the association between LV function and cognition. RESULTS: A total of 261 patients (75.3±6.8 years) were recruited from a memory-clinic cohort. LV function measures were associated with CSVD markers, with LV ejection fraction, average mitral inflow early-diastolic velocity/annular early-diastolic velocity, and tricuspid regurgitation velocity related to cortical cerebral microinfarcts, global longitudinal strain and mitral inflow early-diastolic velocity/late-diastolic velocity associated with lacunes, and impaired systolic function associated with white matter hyperintensities. Furthermore, LV systolic dysfunction was associated with lower global cognitive scores (β, -1.05 [95% CI, -1.76 to -0.34]) and increased odds of vascular cognitive impairment (OR, 7.91 [95% CI, 2.26-32.14]). CSVD markers mediated 22.5% of the association between systolic dysfunction and global cognition. CONCLUSIONS: In a memory-clinic population, significant associations were identified between LV function measures, CSVD markers, and cognition. The relationship between LV systolic function and global cognition was mediated by CSVD markers, suggesting the role of vascular pathologies in the heart-cognition connection.