Background and Purpose: Pathogenesis of cerebral white matter hyperintensity (WMH) is unclear, though it has been known to be the major pathology. Diffuse cerebral hypoperfusion related to low cardiac output from left ventricular systolic dysfunction may be a possible contributor, which has not been validated yet in patients with ischemic stroke.
Methods: We recruited consecutive patients with first-ever stroke patients within 7 days of symptom onset. Left ventricular systolic function was evaluated with ejection fraction from echocardiography. WMH volume was measured quantitatively with semi-automated methods. Sensitivity analysis was performed with the Fazekas scale in both periventricular and subcortical areas.
Results: A total of 862 patients (mean age 66 years, male 61%) were included, and the median volume of WMH was 3.70 [1.44-11.21] mL. The WMH volumes were negatively correlated with ejection fraction (Pearson correlation efficient = -0.182, P < 0.001). In multivariate analysis, lower ejection fraction [β = -0.045, standard error (SE) = 0.008, P < 0.001], older age (β = 0.056, SE = 0.005, P < 0.001), and frequent diabetes (β = 0.308, SE = 0.133, P = 0.021) were significantly associated with WMH volumes. Sensitivity analysis revealed that low ejection fraction remained significant in the periventricular WMH volumes (P = 0.039), but not in the subcortical WMH volumes (P = 0.565).
Conclusions: Left ventricular systolic dysfunction is associated with the extent of WMH, especially in periventricular area. These results indicate that cardiac dysfunction may have potential role in the pathogenesis of cerebral WMH