Heart failure is independently associated with white matter lesions: insights from the population‐based LIFE‐Adult Study

Stegmann, T; Chu, Mai L.; Witte, Veronica; Villringer, Arno; Kumral, Deniz; Riedel‐Heller, Steffi G.; Röhr, Susanne; Hagendorff, Andreas; Laufs, Ulrich; Loeffler, Markus; Wachter, Rolf; Zeynalova, Samira

doi:10.1002/ehf2.13166

Cited by 21 publications

(11 citation statements)

References 48 publications

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“…In HF patients, loss of GM may occur to a higher extent in the bilateral parahippocampal gyrus, bilateral cingulate gyrus, left superior temporal gyrus, and middle gyrus ( 98 ). Total WM injury is increased with the duration of HF ( 99 ). These may have negative impacts on cognitive function in HF patients.…”

Section: Discussionmentioning

confidence: 99%

Brain Imaging Changes and Related Risk Factors of Cognitive Impairment in Patients With Heart Failure

Jiang

Wang

et al. 2022

Front. Cardiovasc. Med.

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Background/AimsTo explore the imaging changes and related risk factors of heart failure (HF) patients with cognitive impairment (CI).MethodsA literature search was systematically carried out in PubMed, Web of Science, Embase, and Cochrane Library. In this systematic review, important relevant information was extracted according to the inclusion and exclusion criteria. The methodological quality was assessed by three scales according to the different study types.ResultsFinally, 66 studies were included, involving 33,579 patients. In the imaging changes, the severity of medial temporal lobe atrophy (MTA) and the decrease of gray Matter (GM) volume were closely related to the cognitive decline. The reduction of cerebral blood flow (CBF) may be correlated with CI. However, the change of white matter (WM) volume was possibly independent of CI in HF patients. Specific risk factors were analyzed, and the data indicated that the increased levels of B-type natriuretic peptide (BNP)/N-terminal pro-B-type natriuretic peptide (NT-proBNP), and the comorbidities of HF, including atrial fibrillation (AF), diabetes mellitus (DM) and anemia were definitely correlated with CI in patients with HF, respectively. Certain studies had also obtained independent correlation results. Body mass index (BMI), depression and sleep disorder exhibited a tendency to be associated with CI. Low ejection fraction (EF) value (<30%) was inclined to be associated with the decline in cognitive function. However, no significant differences were noted between heart failure with preserved ejection fraction (HFpEF) and heart failure with reduced ejection fraction (HFrEF) in cognitive scores.ConclusionBNP/NT-proBNP and the comorbidities of HF including AF, DM and anemia were inextricably correlated with CI in patients with HF, respectively. These parameters were independent factors. The severity of MTA, GM volume, BMI index, depression, sleep disorder, and low EF value (<30%) have a disposition to associated with CI. The reduction in the CBF volume may be related to CI, whereas the WM volume may not be associated with CI in HF patients. The present systematic review provides an important basis for the prevention and treatment of CI following HF.

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Section: Discussionmentioning

confidence: 99%

Brain Imaging Changes and Related Risk Factors of Cognitive Impairment in Patients With Heart Failure

Jiang

Wang

et al. 2022

Front. Cardiovasc. Med.

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“…In the univariable analysis, the risk for advanced WMHs was 4.4-fold in participants with HF ( Table 2 ). After adjustment for age and sex, stroke (OR 2.90, 95% CI 1.52–5.56, p = 0.001), hypertension (OR 2.06, 95% CI 1.57–2.70, p<0.001), HF (OR 2.88, 95% CI 1.27–6.55, p = 0.012), and PR interval ≥160ms (OR 1.40, 95% CI 1.05–1.86, p = 0.022) were associated with increased risk of advanced WMHs [ 28 ].…”

Section: Resultsmentioning

confidence: 99%

“…Adverse effects of AF on cerebral small vessel disease may be one mechanism by which AF contributes to cognitive impairment. However, several studies failed to demonstrate an association between AF and WMHs [ 28 , 47 , 48 ]. Of note, a cross-sectional analysis of the community-based Framingham Heart Study did not report any associations between AF and lower total brain volume [ 7 ].…”

Section: Discussionmentioning

confidence: 99%

PR interval duration is associated with the presence of white matter hyperintensities: Insights from the epidemiologic LIFE-Adult Study

et al. 2022

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Background PR interval prolongation is a preliminary stage of atrial cardiomyopathy which is considered as an intermediate phenotype for atrial fibrillation (AF). AF is a known risk factor for cerebrovascular adverse outcomes including stroke. Cerebral ischemia is one cause of white matter hyperintensities (WMHs), and cognitive dysfunction. Aim To analyze the relationship between PR interval and WMHs. Materials and methods We performed a cross-sectional analysis with individuals from the LIFE-Adult-Study (a population-based cohort study of randomly selected individuals from Leipzig, Germany) with available brain MRI and ECG. The Fazekas stages were used to quantify WMHs (0 = none; 1 = punctate foci; 2 = beginning confluence; 3 = large confluent areas). Stages 2–3 were defined as advanced WMHs. The PR interval was measured from resting 12-lead ECG. PR duration >200ms was defined as PR interval prolongation. We used a binary logistic regression for statistical analysis. We examined the relationship between MRI and ECG measures and adjusted them for clinical risk factors. Results We included 2464 individuals (age 59±15 years, 47% women) into analyses. The median PR interval was 160ms (interquartile range 143–179), and 319 (13%) individuals with advanced WMHs, were significantly older, had more cardiovascular comorbidities and risk factors compared to individuals without WMHs (all p<0.005). On univariable analysis, PR interval duration (OR 1.01, 95%CI 1.01–1.02, p≤0.001) and PR interval ≥160 ms (OR 2.1, 95%CI 1.6–2.7, p≤0.001) were associated with advanced WMHs. In multivariable analysis, while PR interval duration was not associated with WMHs in the whole cohort, individuals with PR ≥160ms had higher risk for WMHs. Conclusion PR interval duration is associated with advanced WMHs beside advanced age, hypertension, and history of stroke. Further research is needed to determine whether changes in PR interval indices are clinically relevant for changes in WMHs.

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“…Vogels et al found that patients with HF had more WMLs and lacunar infarcts compared to both healthy participants and patients with other cardiovascular diseases [ 55 ]. In addition, a recent study by Stegmann et al demonstrated an increase in WMLs with a longer HF disease duration [ 57 ]. Frey et al, however, found that the extent of WMLs in patients with HF was not increased at baseline and progressed within the limits of physiological ageing [ 19 , 50 ].…”

Section: Anatomical Brain Changesmentioning

confidence: 99%

Cognitive Impairment in Heart Failure—A Review

Goh

Kong

Wong

et al. 2022

Biology

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Cognitive impairment (CI) is common in heart failure (HF). Patients with HF demonstrate reduced global cognition as well as deficits in multiple cognitive domains compared to controls. Degree of CI may be related to HF severity. HF has also been associated with an increased risk of dementia. Anatomical brain changes have been observed in patients with HF, including grey matter atrophy and increased white matter lesions. Patients with HF and CI have poorer functional independence and self-care, more frequent rehospitalisations as well as increased mortality. Pathophysiological pathways linking HF and CI have been proposed, including cerebral hypoperfusion and impaired cerebrovascular autoregulation, systemic inflammation, proteotoxicity and thromboembolic disease. However, these mechanisms are poorly understood. We conducted a search on MEDLINE, Embase and Scopus for original research exploring the connection between HF and CI. We then reviewed the relevant literature and discuss the associations between HF and CI, the patterns of brain injury in HF and their potential mechanisms, as well as the recognition and management of CI in patients with HF.

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Heart failure is independently associated with white matter lesions: insights from the population‐based LIFE‐Adult Study

Cited by 21 publications

References 48 publications

Brain Imaging Changes and Related Risk Factors of Cognitive Impairment in Patients With Heart Failure

Brain Imaging Changes and Related Risk Factors of Cognitive Impairment in Patients With Heart Failure

PR interval duration is associated with the presence of white matter hyperintensities: Insights from the epidemiologic LIFE-Adult Study

Cognitive Impairment in Heart Failure—A Review

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