Cerebral blood flow impairment and cognitive decline in heart failure

Ovsenik, Ana; Podbregar, Matej; Fabjan, Andrej

doi:10.1002/brb3.2176

Cited by 51 publications

(43 citation statements)

References 65 publications

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“…Это способствует развитию ремоделирования сердца и сосудов (в том числе мозговых) и дальнейшему формированию и прогрессированию ХСН [9]. Нейрогуморальный дисбаланс, снижение сократительной способности миокарда ЛЖ, уменьшение сердечного выброса, развивающиеся при ХСН, способствуют нарушению церебральной ауторегуляции и мозгового кровотока [10]. В свою очередь, даже небольшие изменения мозгового кровотока могут способствовать возникновению хронической регионарной гипоперфузии мозговой ткани и формированию тонких структурных изменений в уязвимых в связи с особенностями коллатерального кровообращения областях ГМ [11,12], в том числе и в гиппокампе [13], что в дальнейшем может привести к развитию и/или прогрессированию когнитивных расстройств [14].…”

Section: Discussionunclassified

Daily Variability of Blood Pressure and Morphofunctional State of the Central Nervous System in Patients with Chronic Ischemic Heart Failure of Ischemic Origin

Бугаева¹,

Михель²,

Соколов³

et al. 2022

Кардиология В Беларуси

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Цель. Изучить взаимосвязи параметров суточной вариабельности артериального давления с количественными характеристиками гиппокампа и показателями когнитивных тестов у пациентов с хронической сердечной недостаточностью ишемического генеза в сочетании с гипертонической болезнью.Материалы и методы. Обследовано 90 пациентов с гипертонической болезнью и хронической сердечной недостаточностью ишемического генеза. Группу сравнения составили 50 пациентов с гипертонической болезнью без хронической сердечной недостаточности, сопоставимых по полу и возрасту. Всем участникам исследования выполнены стандартная электрокардиография, триплексное сканирование брахиоцефальных артерий, суточное мониторирование артериального давления, трансторакальная допплер-эхокардиография, ядерная магнитно-резонансная томография головного мозга, а также проведена оценка когнитивных способностей. Изучаемые взаимосвязи определялись посредством канонического и парного корреляционного анализов.Результаты. У пациентов с гипертонической болезнью без хронической сердечной недостаточности более высокая вариабельность артериального давления в течение суток достоверно связана с меньшими размерами гиппокампа и не ассоциирована с нарушением когнитивных способностей. У пациентов с хронической сердечной недостаточностью принципиально изменялся характер вышеуказанных взаимосвязей, а именно более высокая вариабельность артериального давления в течение суток ассоциирована с большими размерами гиппокампа, а также с более высокими показателями когнитивных функций.Заключение. Наличие хронической сердечной недостаточности оказывает влияние на характер взаимосвязей между суточной вариабельностью артериального давления и морфофункциональным состоянием центральной нервной системы у пациентов с гипертонической болезнью. Вероятно, снижение вариабельности артериального давления у пациентов с хронической сердечной недостаточностью может косвенно отражать снижение адаптационных способностей организма. Purpose. To study the relationship between the parameters of diurnal variability of blood pressure and the quantitative characteristics of the hippocampus and indicators of cognitive tests in patients with chronic heart failure of ischemic origin in combination with hypertension.Materials and methods. 90 patients with hypertension and chronic heart failure of ischemic origin were examined. The comparison group consisted of 50 patients with hypertension without chronic heart failure, comparable in sex and age. All study participants underwent standard electrocardiography, triplex scanning of the brachiocephalic arteries, 24-hour blood pressure monitoring, transthoracic doppler echocardiography, nuclear magnetic resonance imaging of the brain, and an assessment of cognitive abilities. The studied relationships were determined by canonical and pairwise correlation analyses.Results. In patients with hypertension without chronic heart failure a higher variability in blood pressure during the day was significantly associated with a smaller hippocampus and was not associated with cognitive impairment. In patients with chronic heart failure, the nature of the above relationships fundamentally changed, namely, a higher variability in blood pressure during the day is associated with a larger hippocampus, as well as with higher cognitive functions.Conclusion. The presence of chronic heart failure affects the nature of the relationship between the daily variability of blood pressure and the morphofunctional state of the central nervous system in patients with hypertension. Probably, a decrease in blood pressure variability in patients with chronic heart failure may indirectly reflect a decrease in the body’s adaptive abilities.

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Section: Discussionunclassified

Daily Variability of Blood Pressure and Morphofunctional State of the Central Nervous System in Patients with Chronic Ischemic Heart Failure of Ischemic Origin

Бугаева¹,

Михель²,

Соколов³

et al. 2022

Кардиология В Беларуси

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“…Reduced Cerebral Blood Flow It has well-established that HF usually has unfavorable effect on cerebral perfusion with decreased cerebral blood flow (CBF) (41). According to previous studies, CBF could be reduced by nearly 14-30% in chronic HF depending on the severity and chronicity of HF.…”

Section: Pathophysiology Of CI In Hfmentioning

confidence: 99%

Cognitive Impairment in Heart Failure: Landscape, Challenges, and Future Directions

Yang

Sun

Wang

et al. 2022

Front. Cardiovasc. Med.

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Heart failure (HF) is a major global healthcare problem accounting for substantial deterioration of prognosis. As a complex clinical syndrome, HF often coexists with multi-comorbidities of which cognitive impairment (CI) is particularly important. CI is increasing in prevalence among patients with HF and is present in around 40%, even up to 60%, of elderly patients with HF. As a potent and independent prognostic factor, CI significantly increases the hospitalization and mortality and decreases quality of life in patients with HF. There has been a growing awareness of the complex bidirectional interaction between HF and CI as it shares a number of common pathophysiological pathways including reduced cerebral blood flow, inflammation, and neurohumoral activations. Research that focus on the precise mechanism for CI in HF is still ever insufficient. As the tremendous adverse consequences of CI in HF, effective early diagnosis of CI in HF and interventions for these patients may halt disease progression and improve prognosis. The current clinical guidelines in HF have begun to emphasize the importance of CI. However, nearly half of CI in HF is underdiagnosed, and few recommendations are available to guide clinicians about how to approach CI in patients with HF. This review aims to synthesize knowledge about the link between HF and cognitive dysfunction, issues pertaining to screening, diagnosis and management of CI in patients with HF, and emerging therapies for prevention. Based on data from current studies, critical gaps in knowledge of CI in HF are identified, and future research directions to guide the field forward are proposed.

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“…Smoking appears to worsen the effects of hypertension in the cerebral microvasculature (Hara et al, 2019), and there is impaired neurovascular coupling in the PCA of young chronic smokers (Olah et al, 2008). Chronic heart failure can affect cerebral autoregulation, reduce cerebral blood flow (CBF) and has been shown to affect NVC in the PCA (Aires et al, 2020;Ovsenik et al, 2021). The prevalence of CSVD is higher in patients with coronary artery disease (Berry et al, 2019), and it has been identified as an independent risk factor for vascular dementia (Gorelick et al, 2011).…”

Section: Limitationsmentioning

confidence: 99%

Neurovascular Coupling Is Impaired in Hypertensive and Diabetic Subjects Without Symptomatic Cerebrovascular Disease

Monteiro

Castro

Pereira

et al. 2021

Front. Aging Neurosci.

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The mechanistic link between hypertension, diabetes and cerebral small vessel disease (CSVD) is still poorly understood. We hypothesized that hypertension and diabetes could impair cerebrovascular regulation prior to irreversibly established cerebrovascular disease. In this study, 52 hypertensive patients [54% males; age 64 ± 11 years; 58% with comorbid diabetes mellitus (DM)] without symptomatic cerebrovascular disease underwent transcranial Doppler (TCD) monitoring in the middle (MCA) and posterior (PCA) cerebral arteries, to assess vasoreactivity to carbon dioxide (VRCO2) and neurovascular coupling (NVC). 1.5T magnetic resonance imaging was also performed and white matter hyperintensity volume was automatically segmented from FLAIR sequences. TCD data from 17 healthy controls were obtained for comparison (47% males; age 60 ± 16 years). Hypertensive patients showed significant impairment of NVC in the PCA, with reduced increment in cerebral blood flow velocity during visual stimulation (22.4 ± 9.2 vs. 31.6 ± 5.7, p < 0.001), as well as disturbed NVC time-varying properties, with slower response (lower rate time: 0.00 ± 0.02 vs. 0.03 ± 6.81, p = 0.001), and reduced system oscillation (reduced natural frequency: 0.18 ± 0.08 vs. 0.22 ± 0.06, p < 0.001), when compared to controls. VRCO2 remained relatively preserved in MCA and PCA. These results were worse in hypertensive diabetic patients, with lower natural frequency (p = 0.043) than non-diabetic patients. White matter disease burden did not predict worse NVC. These findings suggest that hypertensive diabetic patients may have a precocious impairment of NVC, already occurring without symptomatic CSVD. Future research is warranted to evaluate whether NVC assessment could be useful as an early, non-invasive, surrogate marker for CSVD.

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Cerebral blood flow impairment and cognitive decline in heart failure

Cited by 51 publications

References 65 publications

Daily Variability of Blood Pressure and Morphofunctional State of the Central Nervous System in Patients with Chronic Ischemic Heart Failure of Ischemic Origin

Daily Variability of Blood Pressure and Morphofunctional State of the Central Nervous System in Patients with Chronic Ischemic Heart Failure of Ischemic Origin

Cognitive Impairment in Heart Failure: Landscape, Challenges, and Future Directions

Neurovascular Coupling Is Impaired in Hypertensive and Diabetic Subjects Without Symptomatic Cerebrovascular Disease

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