Left ventricular ejection fraction is associated with small vessel disease in ischaemic stroke patients

Background and purpose The purpose was to evaluate the association between the left ventricular ejection fraction ( LVEF ) and cerebral small vessel disease ( cSVD ) in ischaemic stroke patients. Methods Consecutive first‐ever ischaemic stroke patients between 2010 and 2013 were included. White matter hyperintensity ( WMH ) volumes were rated using both the Fazekas score and quantitative methods on fluid‐attenuated inversion recovery images. As spectra of cSVD , lacunes, cerebral microbleeds ( CMB s) and enlarged perivascular spaces ( EPVS s) were also evaluated. To assess the dose–response relationship between LVEF and cSVD , the burdens of each radiological marker and the total cSVD score were rated. Results A total of 841 patients were included [median WMH volume 2.98 (1.22–10.50) ml; the frequencies of lacunes, CMB s and moderate to severe EPVS s were 38%, 31% and 35%, respectively]. In the multivariate analysis about predictors of WMH volumes, the LVEF ( B = −0.052, P < 0.001) remained significant after adjusting for confounders. LVEF was also a predictor of lacunes [adjusted odds ratio ( aOR ) 0.978, P = 0.012], CMB s ( aOR = 0.96, P < 0.001) and moderate to severe EPVS s ( aOR = 0.94, P < 0.001) after adjusting for their confounders. The LVEF values were negatively correlated with the burdens of lacunes ( P = 0.026), CMB s ( P < 0.001) and EPVS s ( P = 0.002). The total cSVD score also showed a negative association with LVEF in a dose–response manner ( P < 0.001). Conclusions The burden of cSVD is negatively correlated with the LVEF in a dose–response manner. Our results suggest clues for further studies about determining the pathophysiology of cSVD .