LAUSR

Background Systemic cardiac hypoperfusion is a well-acknowledged contributor to ischemic leukoencephalopathy. However, it has remained elusive how atherosclerosis-mediated cardiac remodelling modifies cerebral perfusion homeostasis as well as neuroimaging burden in cerebral small vessel disease (CSVD) development. Methods This retrospective study identified 103 arteriosclerotic CSVD (aCSVD) patients (CSVD burden low 0 ~ 1, n  = 61 and CSVD burden high 2 ~ 4, n  = 42) from Sep. 2017 to Dec. 2019 who underwent transthoracic echocardiography( n  = 81), structural magnetic resonance imaging and arterial spin labelling (ASL). Total CSVD burden was graded according to the ordinal “small vessel disease” rating score (0–4). We investigated the univariate and multivariate linear regression of mean deep regional cerebral blood flow (CBF) as well as logistic regression analysis of CSVD burden high . Results Right atrial diameter ( B coefficient , − 0.289; 95% CI , − 0.578 to − 0.001; P  = 0.049) and left ventricular ejection fraction ( B coefficient , 32.555; 95% CI , 7.399 to 57.711; P  = 0.012) were independently associated with deep regional CBF in aCSVD patients. Binary logistic regression analysis demonstrated decreased deep regional CBF ( OR 0.894; 95% CI 0.811–0.985; P  = 0.024) was independently associated with higher CSVD burden after adjusted for clinical confounders. Multivariate receiver operating characteristics curve integrating clinical risk factors, mean deep CBF and echocardiographic parameters showed predictive significance for CSVD burden high diagnosis (area under curve = 84.25, 95% CI 74.86–93.65%, P  < 0.0001). Conclusion The interrelationship of “cardiac -deep regional CBF-neuroimaging burden” reinforces the importance and prognostic significance of echocardiographic and cerebral hemodynamic assessment in CSVD early-warning.