Left Ventricular Hypertrophy and Cerebral Small Vessel Disease: A Systematic Review and Meta-Analysis

Abstract

Background and purpose: Left ventricular hypertrophy (LVH) is associated with the risk of stroke and dementia independently of other vascular risk factors, but its association with cerebral small vessel disease (CSVD) remains unknown. Here, we employed a systematic review and meta-analysis to address this gap.

Methods: Following the MOOSE guidelines (PROSPERO protocol: CRD42018110305), we systematically searched the literature for studies exploring the association between LVH or left ventricular (LV) mass, with neuroimaging markers of CSVD (lacunes, white matter hyperintensities [WMHs], cerebral microbleeds [CMBs]). We evaluated risk of bias and pooled association estimates with random-effects meta-analyses.

Results: We identified 31 studies (n=25,562) meeting our eligibility criteria. In meta-analysis, LVH was associated with lacunes and extensive WMHs in studies of the general population (odds ratio [OR]lacunes, 1.49; 95% confidence interval [CI], 1.12 to 2.00) (ORWMH, 1.73; 95% CI, 1.38 to 2.17) and studies in highrisk populations (ORlacunes: 2.39; 95% CI, 1.32 to 4.32) (ORWMH, 2.01; 95% CI, 1.45 to 2.80). The.

Results: remained stable in general population studies adjusting for hypertension and other vascular risk factors, as well as in sub-analyses by LVH assessment method (echocardiography/electrocardiogram), study design (cross-sectional/cohort), and study quality. Across LV morphology patterns, we found gradually increasing ORs for concentric remodelling, eccentric hypertrophy, and concentric hypertrophy, as compared to normal LV geometry. LVH was further associated with CMBs in high-risk population studies.

Conclusion: s LVH is associated with neuroimaging markers of CSVD independently of hypertension and other vascular risk factors. Our findings suggest LVH as a novel risk factor for CSVD and highlight the link between subclinical heart and brain damage.

Keywords: Cerebral hemorrhage; Cerebral small vessel diseases; Hypertrophy, left ventricular; Leukoaraiosis; Meta-analysis; Stroke, lacunar.

Figure 1.

Flowchart of the study selection process. The included articles for each of the outcomes do not sum up to the total number of included articles because several studies provided data for more than one outcome.

Figure 2.

Associations of left ventricular hypertrophy with (A) lacunes, and (B) extensive white matter hyperintensities in general and high-risk population studies. Odds ratios (ORs) of each study are depicted as data markers; shaded boxes around the data markers indicate the statistical weight of the respective study; 95% confidence intervals (CIs) are indicated by the error bars; pooled-effect estimates for general and high-risk populations along with their 95% CI are reflected as a diamond.

Figure 3.

Associations of left ventricular hypertrophy with lacunes and extensive white matter hyperintensities in general population studies adjusting for age, sex, hypertension, and other vascular risk factors. Odds ratios (ORs) of each study are depicted as data markers; shaded boxes around the data markers indicate the statistical weight of the respective study; 95% confidence intervals (CIs) are indicated by the error bars; pooled-effect estimates for general populations along with their 95% CI are reflected as a diamond.

Figure 4.

Associations of left ventricular morphology patterns (normal geometry, concentric remodeling, eccentric and concentric hypertrophy) with (A) lacunes and (B) extensive white matter hyperintensities (WMHs) in general (red lines) and high-risk (black lines) population studies. Odds ratios (ORs) are depicted as data markers and 95% confidence intervals (CIs) are indicated by the error bars. All comparisons use “normal geometry” as the reference group (total number: lacunes general population, 665; lacunes high-risk population, 345; extensive WMHs general population, 665; extensive WMHs high-risk population, 419).