Abstract W P184: Echocardiographic Left Ventricular Hypertrophy is Associated with Severity of Cerebral White Matter Hyperintensities in Acute Ischemic Stroke

Abstract

BACKGROUND & OBJECTIVE: White matter hyperintensities (WMH) indicate an increased risk of cerebrovascular events. Echocardiographic left ventricular hypertrophy (LVH) is an independent predictor of cardiovascular morbidity. We aimed to investigate the association between higher left ventricular mass index (LVMI) and severity of WMH in acute ischemic stroke. METHODS: We evaluated 868 consecutive acute ischemic stroke or transient ischemic attack (TIA) patients who were admitted within 7 days after onset of stroke and underwent magnetic resonance imaging (MRI) and transthoracic echocardiography. LVH was defined as a left ventricular mass index (LVMI) of > 115 g/m2 for men and > 95 g/m2 for women. Periventricular and deep white matter hyperintensities were systematically analyzed and rated according to the modified Fazekas scale (grade 0, 1, 2, and 3) on the baseline MRI. RESULTS: A total of 841 patients were included in this analysis. Numbers of WMH patients are 66 (7%) in grade 0, 546 (65%) in grade 1, 159 (20%) in grade 2, and 70 (8%) in grade 3. Mean LVMIs in each grade of WMH are 86 (SD 18) in grade 0, 95 (SD 22) in grade I, 104 (SD 29) in grade 2, and 100 (SD 28) in grade 3. LVH and 4th quartile of LVMI were associated with grade 2 (OR 2.3, 95% CI 1.1 to 5.0 and OR 3.2, 95% CI 1.4 to 7.2) and grade 3 (OR 2.5, 95% CI 1.1 to 5.9 and OR 2.7, 95% CI 1.1 to 6.6). Binary logistic regression analysis (WMH grade 0-1 versus grade 2-3) showed that age per year (OR 1.09, 95% CI 1.07 to 1.12, p<0.001), hypertension (OR 1.8, 95% CI 1.2 to 2.7, p=0.004), previous stroke or TIA history (OR 2.3, 95% CI 1.5 to 3.4, p<0.001) and increased LVMI per 10 g/m2 (OR 1.15; 95% CI 1.06 to 1.24, p<0.001) were independently associated with grade 2-3 WMH. CONCLUSIONS: Our results demonstrate that higher LVMI or LVH are independently associated with moderate to severe WMH in acute ischemic stroke and TIA patients even after adjusting of established cardiovascular risk factors. Further studies to evaluate whether regression of LVH slows the progression of WMH will be needed.