Association of Left Ventricular Function With Cerebral Small Vessel Disease and Cognition

Figures

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  Figure 1. Left ventricular function and cerebral small vessel disease. Odds ratios (95% CIs) were estimated using logistic regression, adjusting for age, sex, education, body mass index, hypertension, hyperlipidemia, diabetes, smoking status, atrial fibrillation, and impaired systolic/diastolic function. Solid squares and lines denote statistical significance. Systolic function measures are shown in blue; diastolic function measures are shown in red. CMB indicates cerebral microbleed; CMI, cerebral microinfarct; E/A, mitral inflow early‐diastolic velocity/late‐diastolic velocity; E/e', mitral inflow early‐diastolic velocity/early‐diastolic velocity; GLS, global longitudinal strain; LAVI, left atrial volume index; LVEF, left ventricular ejection fraction; LVFP, left ventricular filling pressure; TR, tricuspid regurgitation; and WMH, white matter hyperintensity.

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  Figure 2. Left ventricular function and global cognitive function. Coefficients (95% CIs) were estimated using linear regression, adjusting for age, sex, education, body mass index, hypertension, hyperlipidemia, diabetes, smoking status, atrial fibrillation, and impaired systolic/diastolic function. Solid squares and lines denote statistical significance. Systolic function measures are shown in blue; diastolic function measures are shown in red. E/A indicates mitral inflow early‐diastolic velocity/late‐diastolic velocity; E/e', mitral inflow early‐diastolic velocity/early‐diastolic velocity; GLS, global longitudinal strain; LAVI, left atrial volume index; LVEF, left ventricular ejection fraction; LVFP, left ventricular filling pressure; MMSE, Mini‐Mental State Examination; MoCA, Montreal Cognitive Assessment; and TR, tricuspid regurgitation.

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  Figure 3. Left ventricular function and specific cognitive domains. Coefficients (95% CIs) were estimated using linear regression, adjusting for age, sex, education, body mass index, hypertension, hyperlipidemia, diabetes, smoking status, atrial fibrillation, and impaired systolic/diastolic function. Solid squares and lines denote statistical significance (P value<0.05/6 ≈ 0.008 after Bonferroni correction). Systolic function measures are shown in blue; diastolic function measures are shown in red. E/A indicates mitral inflow early‐diastolic velocity/late‐diastolic velocity; E/e', mitral inflow early‐diastolic velocity/early‐diastolic velocity; GLS, global longitudinal strain; LAVI, left atrial volume index; LVEF, left ventricular ejection fraction; LVFP, left ventricular filling pressure; and TR, tricuspid regurgitation.

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  Figure 4. Left ventricular function and nonvascular/vascular cognitive impairment. Odds ratios (95% CIs) were estimated using logistic regression, adjusting for age, sex, education, body mass index, hypertension, hyperlipidemia, diabetes, smoking status, atrial fibrillation, and impaired systolic/diastolic function. Patients with no cognitive impairment were treated as the reference. Solid squares and lines denote statistical significance. Systolic function measures are shown in blue; diastolic function measures are shown in red. E/A indicates mitral inflow early‐diastolic velocity/late‐diastolic velocity; E/e', mitral inflow early‐diastolic velocity/early‐diastolic velocity; GLS, global longitudinal strain; LAVI, left atrial volume index; LVEF, left ventricular ejection fraction; LVFP, left ventricular filling pressure; and TR, tricuspid regurgitation.

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  Figure 5. Mediation analysis. Mediation analysis was conducted to assess whether cortical CMIs, lacunes, and extensive WMHs, treated as a composite variable defined by the presence of any of these markers, mediated the relationship between impaired LV systolic function and MMSE (A), MoCA (B), and global cognitive scores (C), after adjusting for age, sex, education, body mass index, hypertension, hyperlipidemia, diabetes, smoking status, atrial fibrillation, and impaired LV diastolic function. CMI, cerebral microinfarct; LV, left ventricular; MMSE, Mini‐Mental State Examination; MoCA, Montreal Cognitive Assessment; WMH, white matter hyperintensity.