Effects Of Left Heart Function Changes On Cerebral Small Vessel Diseases And Its Cognitive Impairment

Background Cerebral small vessel diseases(CSVD)refer to a range of subclinical pathologies.CSVD is prevalent in middle-aged and elder populations,and it's closely related to their cognitive dysfunction and stroke.Although numerous studies have identified various risk factors for CSVD,the specific pathophysiologic mechanisms are still unclear.Left heart changes are closely associated with cerebrovascular diseases and cognitive dysfunction diseases.Hypoperfusion and cardioembolic have been proposed as primary mechanisms of these disease,which are also suggested as plausible mechanisms of CSVD and its cognitive impairment.The direct relationships between left heart changes and CSVD have been commonly explored in cardiovascular diseases patients,but barely explored in CSVD patients.Additionally,the underlying mechanisms remain to be further investigated.Objective To explore left heart function changes and its correlation with cognitive impairment in CSVD patients.Methods From February 2012 to June 2018,199 CSVD patients admitted to the Department of Neurology of the First Affiliated Hospital of Anhui Medical University were enrolled as CSVD group.103 healthy elderly persons without cognition disorders were selected as normal controls(NC).According to the diagnostic criteria,CSVD patients were divided into 112 CSVD patients with vascular cognitive impairment(CSVD-VCI)and 87 CSVD patients with no cognitive impairment(CSVD-NCI).Neuroimaging markers of CSVD(including lacunar infarction and white matter hyperintensity)were assessed through brain MRI.The Mini Mental State Examination(MMSE),the Montreal Cognitive Assessment(Mo CA)and the Cambridge Cognitive Examination-Chinese Version(CAMCOG-C)were performed to evaluate cognitive function.Routine echocardiography was conducted to collected left ventricular ejection fraction(LVEF),left atrial diameter(LAD)and other parameters.Results The scores of MMSE,Mo CA,CAMCOG-C and its subitems in CSVD group were significantly decreased(all P<0.05).Compared with NC group,CSVD group had significantly lower LVEF level and higher LAD level(P=0.007,P=0.024).The LVEF level of CSVD-VCI group was significantly lower than that of CSVD-NCI group(P=0.02).Correlation analysis revealed that MMSE,Mo CA,CAMCOG-C scores in CSVD group were positively correlated with LVEF level(r=0.210,P=0.003;r=0.155,P=0.029;r=0.238,P=0.001).Logistic regression analysis revealed that LVEF level(OR=0.937,95%CI: 0.890~0.986),body mass index and diastolic blood pressure were independent risk factors associated with CSVD.Meanwhile,its shown that LVEF level(OR=0.900,95%CI: 0.829~0.977),education years,Fazeka scores and lacunar infarction numbers were independent risk factors associated with CSVD-VCI.Conclusions Left heart function changes play important roles in the incidence of CSVD and severity of its cognitive impairment.The declined LVEF may represent an independent risk factor for CSVD and its cognitive impairment.