Association Between Echocardiographic Parameters and White Matter Hyperintensities in Patients with Ischemic Cerebrovascular Disease

Background: White matter hyperintensities (WMHs) are associated with an increased risk of stroke, cognitive decline, and all-cause mortality.However, the relationship between cardiac function, particularly left ventricular ejection fraction (LVEF) and fractional shortening (FS), and WMH burden has not been fully elucidated.This study aimed to explore the association between left ventricular systolic function and WMHs in patients with ischemic cerebrovascular disease.Methods: This retrospective study included 1,049 patients hospitalized at Huai'an Hospital affiliated with Yangzhou University between January 2023 and December 2024.Cardiac structure and systolic function were assessed using transthoracic echocardiography (TTE), and the severity of WMHs was evaluated by magnetic resonance imaging (MRI) using the Fazekas scale.The associations between echocardiographic parameters and WMH burden were examined using univariate and multivariate logistic regression analyses.Results: Of the 1,049 patients, 723 (68.9%) had none-mild WMHs (Fazekas score 0-2), and 326 (31.1%) had moderate-severe WMHs (Fazekas score 3-6).Patients with a higher WMH burden were more likely to have atrial fibrillation, and smoking history, and showed significantly lower FS and LVEF values.In multivariate logistic regression, atrial fibrillation (OR = 6.48, 95% CI: 3.85-10.88)and decreased LVEF (OR = 0.77, 95% CI: 0.72-0.83)were independently associated with moderatesevere WMHs (both P < 0.001).When FS was analyzed as a continuous variable, each 1% increase was associated with a 16% lower odd of WMHs (OR = 0.84, 95% CI: 0.73-0.89,P < 0.001); however, after categorization into quartiles, the dose-response trend was attenuated and no longer significant (P-trend = 0.245).Subgroup analyses showed significant interactions for LVEF with age, sex (Pinteraction < 0.001, < 0.001 respectively), indicating that the inverse association between LVEF and WMHs was more pronounced in younger patients, females.No significant effect modification was observed for FS.Conclusion: Preserved LVEF was associated with a lower risk of WMHs, whereas the association for FS was attenuated and did not reach statistical significance after full adjustment.These findings highlight the potential contribution of cardiac function to the pathophysiology of WMHs and suggest that echocardiographic assessment may offer clinical insights for early risk stratification.