Background: Heart failure (HF) is a disease that impacts many organs, but the effect on the brain remains poorly understood. To explore associations with subclinical disease, in the Atherosclerosis Risk in Communities (ARIC) study, we evaluated the relationship between cardiac dysfunction on echocardiography and vascular lesions on brain MRI.
Methods: A cross-sectional analysis between subclinical cardiac and brain markers was performed using echo and brain MRI data from the 5th visit of the ARIC study (n=1974), a community-based biracial cohort study. LV structure was assessed using wall thickness (mm) and mass index (g/m2), while diastolic function was assessed as LA volume index (g/m2). MRI was evaluated for presence/size/location/number of infarcts and white matter hyperintensities (WMH). Demographic and vascular risk factors (including hypertension) were considered as covariates in statistical models.
Results: In adjusted models, worse LV structure was significantly associated with the presence of WMH as well as infarction. WMH was 0.66 cm3 greater (95%CI [0.11, 1.21]) for every 1 mm increase in wall thickness, and 0.65 cm3 greater (95%CI [0.27, 1.03]) for every 10g/m2 increase in LV mass index. Odds of infarction increased (OR 1.11, 95%CI [1.02, 1.21]), per 1 mm thicker LV wall increase as well as with larger LV mass (per 10 g/m2) (OR 1.08, 95%CI [1.02, 1.14]). The rate of accumulating additional cortical infarcts was increased by 2.4% (95%CI 1.01, 1.04) per ml/m2 increase in LA volume index, a marker of LV diastolic function. The rate of accumulation of lacunar infarcts was increased by 1.5% per ml/m2 increase in LA volume index (95% CI [1.00, 1.03]). No significant interactions were detected by race.
Conclusions: Among participants in a large cohort study, subclinical changes in markers of LV structure were associated with increased odds of infarction and volume of WMH even when controlling for hypertension. Our findings could suggest that the brain represents another end-organ at risk among patients with even early stages of heart failure.