Association of total cerebral small vessel disease burden with left ventricular hypertrophy and geometry in patients with ischemic stroke.

PURPOSE: Cerebral small vessel disease (CSVD) is a key driver of motor dysfunction, cognitive impairment, and physical frailty. Cardiac structural alterations, particularly left ventricular hypertrophy (LVH), are important prognostic markers for adverse cardiovascular outcomes. Both conditions share common risk factors, yet their clinical and pathological association remains incompletely understood. METHODS: This cross-sectional study enrolled a total of 491 ischemic stroke patients. Data on the four main magnetic resonance imaging (MRI) markers of CSVD [lacune, cerebral microbleed (CMB), white matter hyperintensity (WMH), and basal ganglia perivascular space (PVS)] were collected. Based on the total CSVD MRI burden score, subjects were divided into the CSVD score 0 group (n = 99) and the CSVD score ≥ 1 group (n = 392), among whom 149 had LVH. Subjects were categorized into four left ventricular (LV) geometric patterns according to echocardiography: concentric hypertrophy, eccentric hypertrophy, concentric remodeling, and normal geometry. Binary and ordinal logistic regression analyses were performed to determine the impact of cardiac structural parameters on CSVD. Differences in CSVD markers were compared between the LVH and non-LVH groups, as well as across the four LV geometric patterns. RESULTS: Logistic regression analysis revealed that LVH was associated with a total CSVD score of 1 or higher, and left ventricular mass index (LVMI) was positively correlated with the overall severity of CSVD. Compared with the non-LVH group, the LVH group had more CMBs, a higher total WMH score, and a higher basal ganglia PVS score, whereas no significant difference was observed in the lacune counts. Significant differences were found in the total CSVD score, total WMH score, and CMB counts across the four LV geometric patterns. The total CSVD score in the concentric hypertrophy group was higher than that in the normal geometry and concentric remodeling groups. CONCLUSION: LVH and elevated LVMI are associated with increased severity of CSVD in ischemic stroke patients. WMH and CMB may be influenced by LV structural alterations, and concentric hypertrophy may be closely related to CSVD. Further large-scale prospective studies are warranted to clarify the causal relationships and pathological mechanisms between CSVD and cardiac structural alterations.