Reduced regional cerebral blood flow in patients with heart failure

Abstract

Aim Heart failure (HF) patients show significant lateralized neural injury, accompanied by autonomic, mood, and cognitive deficits. Both gray and white matter damage appears, and likely develops from altered cerebral blood flow (CBF), a consequence of impaired cardiac output. However, the distribution of regional CBF changes in HF patients is unknown, but is an issue in determining mechanisms of neural injury. Our aim was to examine regional CBF changes in HF over control subjects using non-invasive pseudo-continuous arterial spin labeling (pCASL) procedures. Methods and results We collected pCASL data from 19 HF (age, 55.5±9.1 years; body-mass-index, 27.7±5.3 kg/m2; 13 male) and 29 control subjects (51.4±5.3 years; 25.7±3.6 kg/m2; 18 male), using a 3.0-Tesla-MRI scanner. Whole-brain CBF maps were calculated, normalized to a common space, smoothed, and compared between groups using ANCOVA (covariates; age, gender, and gray matter volume). Reduced CBF appeared in multiple sites in HF over controls, with principally-lateralized lower flow in temporal, parietal, and occipital regions. Areas with decreased CBF included the bilateral pre-frontal, frontal, temporal and occipital cortex, thalamus, cerebellum, corona radiate, corpus callosum, hippocampus, and amygdala. Conclusion HF subjects showed lower, and largely lateralized, CBF in multiple autonomic, mood, and cognitive regulatory sites. The reduced CBF likely contributes to the lateralized brain injury, leading to autonomic and neuropsychological deficits found in the condition.

Brain abnormalities in cognition, anxiety, and depression regulatory regions in adolescents with single ventricle heart disease

“…Also, this study utilized a 3.0‐Tesla compared to a 1.5‐Tesla MRI machine, which produces higher‐resolution images with greater anatomic details. Lateralization of brain tissue abnormalities was noteworthy, however lateralized brain injury in autonomic, anxiety, depression, and cognition regulatory sites are often observed in other conditions (Kumar et al, ; Roy et al, ; Tummala et al, ). The aberrations here might result from low cardiac output, endothelial dysfunction, ischemic changes, and underlying perfusion deficits in the condition.…”

Heart and brain interaction in patients with heart failure: overview and proposal for a taxonomy. A position paper from the Study Group on Heart and Brain Interaction of the Heart Failure Association

“…Regional vascular recruitment is modulated by functional activity and local oxygen demands and is locally controlled by a range of factors addressed as ‘neuro‐vascular unit’, a heterogeneous structure composed of different cell types including astrocytes, pericytes, endothelial cells of the blood brain barrier, microglia, and neurons . Regional hypoperfusion has been observed in HF in multiple brain areas being largely lateralized towards the right side in the occipital, temporal, frontal, and parietal regions . Bilateral areas of reduced blood flow were observed in the prefrontal cortex, frontal white matter, anterior corpus callosum, thalamus, hippocampus, amygdala, and occipital cortex.…”

“…The decreased regional perfusion may contribute to the autonomic, mood and cognitive regulatory deficits observed in HF. Further, impaired perfusion of multiple brain areas involved in control of vision, language and speech has been observed that could explain the respective deficits in HF patients …”

“…Structural alterations leading to mood disorders in HF have been investigated in several clinical studies with cranial magnetic resonance imaging (MRI). Roy et al demonstrated that cerebral blood flow in HF patients was decreased in all sites of brain compared to controls. Brain mood regulating sites, e.g.…”

February 2018 at a glance: heart and brain interaction, prognostic variables, and acute heart failure and post‐discharge outcomes

“…A position paper from the Heart Failure Association (HFA) reviews the heart and brain interactions in patients with heart failure (HF) . These include cerebral hypoperfusion, causing either ischaemic stroke, symptomatic or not, or a progressive decline in brain function, abnormalities in cortical functions, with cognitive decline, dementia, depression and anxiety, abnormalities in the autonomic nervous system and cardiac reflexes, changes related to HF treatment. A final section of this fascinating review covers the existing gaps in knowledge and unresolved issues …”