Abstract Background Cerebral small vessel disease (CSVD) significantly contributes to adverse brain health outcomes including vascular dementia and stroke. The global CSVD score integrates neuroimaging markers including white matter hyperintensities (WMH), enlarged perivascular spaces (EPVS), lacunes, and cerebral microbleeds (CMB). While patients with acute myocardial infarction (AMI) may experience accelerated cerebrovascular pathology, CSVD progression in this population remains unexplored. Purpose This study evaluated longitudinal changes in CSVD burden among AMI patients by comparing brain magnetic resonance imaging (MRI) findings at two timepoints: within one month post-AMI (baseline) and at one-year follow-up. Methods We assessed the global CSVD score (0–6 points) and its individual components using established criteria, with independent adjudication by two neuroradiologists. Progression analysis included paired t-tests for mean differences and multiple visualization techniques to characterize changes between timepoints. Results In our predominantly male (92.9%) cohort (mean age 54.1±9.9 years), the mean of the baseline global CSVD score was 1.26 (SD: 0.98). Figure 1 demonstrates the distribution of global CSVD scores in this cohort. Among individual CSVD neuroimaging markers, 43% of AMI patients had moderate to severe WMH burden (Fazekas scale 3-6), 54% had ≥1 lacune, 12% had ≥1 CMB and 19% had ≥20 EPVS. At the one-year follow-up, the mean global CSVD score increased significantly to 1.78 (SD: 1.03, p0.001). Notably, the prevalence of ≥20 EPVS nearly tripled (19% to 54%, p0.001), and lacunes increased from 54% to 62% (p0.001). In contrast, WMH burden remained stable (43% to 46% with moderate to severe WMH burden, p = 0.28), as did the presence of CMB (12% to 16% had ≥1 CMB, p = 0.32). Distribution analysis revealed a clear shift toward higher global CSVD score categories over time. Conclusion AMI patients demonstrated progressive CSVD over the one-year follow-up period, marked primarily by an increase in EPVS and lacunes. These findings highlight ongoing cerebrovascular pathology following an AMI event, which may have significant implications for long-term brain health. Future studies should explore the predictors of CSVD progression in this high-risk population.Figure 1:Histogram of Global CSVD Score Figure 2:MRI CSVD Baseline vs. 1-Year
Yun et al. (Sat,) studied this question.