title: Subclinical left ventricular dysfunction and silent cerebrovascular disease: the Cardiovascular Abnormalities and Brain Lesions (CABL) study.
abstract: BACKGROUND
  Silent brain infarcts (SBIs) and white matter hyperintensities are subclinical cerebrovascular lesions associated with incident stroke and cognitive decline. Left ventricular ejection fraction (LVEF) is a predictor of stroke in patients with heart failure, but its association with subclinical brain disease in the general population is unknown. Left ventricular global longitudinal strain (GLS) can detect subclinical cardiac dysfunction even when LVEF is normal. We investigated the relationship of LVEF and GLS with subclinical brain disease in a community-based cohort.
  
  
  RESULTS
  LVEF and GLS were assessed by 2-dimensional and speckle-tracking echocardiography in 439 participants free of stroke and cardiac disease from the Cardiovascular Abnormalities and Brain Lesions (CABL) study. SBIs and white matter hyperintensities were assessed by brain MRI. Mean age of the study population was 69±10 years, 61% were women, LVEF was 63.8±6.4%, GLS was -17.1±3.0%. SBIs were detected in 53 participants (12%), white matter hyperintensity volume was 0.63±0.86%. GLS was significantly lower in participants with SBI versus those without (-15.7±3.5% versus -17.3±2.9%, P<0.01), whereas no difference in LVEF was observed (63.3±8.6% versus 63.8±6.0%, P=0.60). In multivariate analysis, lower GLS was associated with SBI (odds ratio/unit decrease=1.18; 95% confidence interval, 1.05-1.33; P<0.01), whereas LVEF was not (odds ratio/unit increase=1.00; 95% confidence interval, 0.96-1.05; P=0.98). Lower GLS was associated with greater white matter hyperintensity volume (adjusted β=0.11, P<0.05), unlike LVEF (adjusted β=-0.04, P=0.42).
  
  
  CONCLUSIONS
  Lower GLS was independently associated with subclinical brain disease in a community-based cohort without overt cardiac disease. GLS can provide additional information on cerebrovascular risk burden beyond LVEF assessment.
authors.affiliation: Department of Medicine, Columbia University, New York, NY 10032, USA.
authors.forename: Cesare
authors.initials: C
authors.lastname: Russo
authors.forename: Zhezhen
authors.initials: Z
authors.lastname: Jin
authors.forename: Shunichi
authors.initials: S
authors.lastname: Homma
authors.forename: Mitchell S V
authors.initials: MS
authors.lastname: Elkind
authors.forename: Tatjana
authors.initials: T
authors.lastname: Rundek
authors.forename: Mitsuhiro
authors.initials: M
authors.lastname: Yoshita
authors.forename: Charles
authors.initials: C
authors.lastname: DeCarli
authors.forename: Clinton B
authors.initials: CB
authors.lastname: Wright
authors.forename: Ralph L
authors.initials: RL
authors.lastname: Sacco
authors.forename: Marco R
authors.initials: MR
authors.lastname: Di Tullio
mesh_terms: D000368:Aged; D001921:Brain / Q000473:pathology*; D018376:Cardiovascular Abnormalities / Q000175:diagnosis / Q000453:epidemiology*; D002544:Cerebral Infarction / Q000175:diagnosis / Q000453:epidemiology*; D002561:Cerebrovascular Disorders / Q000175:diagnosis / Q000453:epidemiology; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011159:Population Surveillance / Q000379:methods; D011446:Prospective Studies; D012111:Residence Characteristics; D018487:Ventricular Dysfunction, Left / Q000175:diagnosis / Q000453:epidemiology*
keywords: brain infarction; echocardiography; global longitudinal strain; magnetic resonance imaging; speckle-tracking; ventricular ejection fraction; white matter diseases
references.citation: J Card Fail. 2005 Sep;11(7):485-9
references.pmid: 16198241
references.citation: Stroke. 2004 Aug;35(8):1821-5
references.pmid: 15178824
references.citation: J Am Coll Cardiol. 1997 Apr;29(5):1074-80
references.pmid: 9120162
references.citation: Stroke. 2003 May;34(5):1126-9
references.pmid: 12690219
references.citation: Heart. 2012 May;98(10):813-20
references.pmid: 22543839
references.citation: Neurobiol Aging. 2005 Apr;26(4):491-510
references.pmid: 15653178
references.citation: J Am Soc Echocardiogr. 2005 Dec;18(12):1440-63
references.pmid: 16376782
references.citation: Neurology. 2001 Oct 9;57(7):1222-9
references.pmid: 11591840
references.citation: Stroke. 1998 May;29(5):913-7
references.pmid: 9596234
references.citation: Stroke. 1997 Jun;28(6):1158-64
references.pmid: 9183343
references.citation: Circulation. 1977 Nov;56(5):786-94
references.pmid: 912839
references.citation: Stroke. 2005 Jun;36(6):1207-11
references.pmid: 15879345
references.citation: JACC Cardiovasc Imaging. 2013 Mar;6(3):313-23
references.pmid: 23473112
references.citation: Am Heart J. 2006 Feb;151(2):419-25
references.pmid: 16442909
references.citation: Echocardiography. 2013 Aug;30(7):794-802
references.pmid: 23360509
references.citation: Neurology. 2008 Feb 5;70(6):425-30
references.pmid: 17898325
references.citation: Am J Cardiol. 2008 Jun 1;101(11):1626-9
references.pmid: 18489941
references.citation: J Am Coll Cardiol. 2012 Nov 13;60(20):2074-81
references.pmid: 23083779
references.citation: Stroke. 2003 Feb;34(2):392-6
references.pmid: 12574548
references.citation: Stroke. 2004 Nov;35(11):2598-603
references.pmid: 15472111
references.citation: J Hypertens. 2011 Mar;29(3):574-82
references.pmid: 21169863
references.citation: Arterioscler Thromb Vasc Biol. 1999 Feb;19(2):356-65
references.pmid: 9974419
references.citation: J Am Soc Echocardiogr. 2008 Aug;21(8):907-11
references.pmid: 18325736
references.citation: Circulation. 2012 Jan 3;125(1):e2-e220
references.pmid: 22179539
references.citation: Neurology. 2005 Jun 28;64(12):2056-62
references.pmid: 15985571
references.citation: Eur J Echocardiogr. 2011 Feb;12(2):148-55
references.pmid: 21106580
references.citation: J Am Coll Cardiol. 2003 Aug 20;42(4):736-42
references.pmid: 12932612
references.citation: Am J Cardiol. 2009 Jan 15;103(2):232-7
references.pmid: 19121442
references.citation: J Am Coll Cardiol. 2009 Dec 8;54(24):2303-11
references.pmid: 19958966
references.citation: Stroke. 1997 Oct;28(10):1932-9
references.pmid: 9341698
references.citation: Circulation. 1994 Jan;89(1):122-31
references.pmid: 8281637
references.citation: Am J Cardiol. 2011 Nov 1;108(9):1346-51
references.pmid: 21880293
references.citation: Circ Cardiovasc Imaging. 2009 Sep;2(5):356-64
references.pmid: 19808623
references.citation: Neurology. 2011 Jun 14;76(24):2112-8
references.pmid: 21653889
references.citation: Stroke. 2006 Jul;37(7):1715-9
references.pmid: 16741172
references.citation: Int J Cardiol. 2006 Mar 8;107(3):376-81
references.pmid: 15913815
references.citation: Hypertension. 2012 Aug;60(2):362-8
references.pmid: 22753223
references.citation: Exp Neurol. 2008 Apr;210(2):585-91
references.pmid: 18222425
references.citation: Arch Intern Med. 2006 May 8;166(9):1003-8
references.pmid: 16682574
references.citation: N Engl J Med. 2003 Mar 27;348(13):1215-22
references.pmid: 12660385
references.citation: Stroke. 2002 Jan;33(1):21-5
references.pmid: 11779883
references.citation: J Am Coll Cardiol. 1995 Jul;26(1):195-202
references.pmid: 7797752
references.citation: Stroke. 1995 Jul;26(7):1171-7
references.pmid: 7604409
references.citation: Am J Cardiol. 2009 Nov 15;104(10):1398-401
references.pmid: 19892057
references.citation: Eur J Echocardiogr. 2009 Jul;10(5):695-701
references.pmid: 19401300
references.citation: Circulation. 1977 Apr;55(4):613-8
references.pmid: 138494
references.citation: N Engl J Med. 2007 Nov 1;357(18):1821-8
references.pmid: 17978290