Early abnormalities of cerebral blood flow in mild non‐ischaemic heart failure: part of a whole‐body response?

Abstract

This article refers to 'Dynamics of cerebral blood flow in patients with mild non-ischaemic heart failure', by C.D. Erkelens et al., published in this issue on pages 261-268.Chronic heart failure (CHF) is a syndrome consisting of alterations of cardiac function associated with an array of abnormalities of haemodynamic, neuroendocrine, autonomic, and vascular function and frequently co-existing with abnormalities with other major organ systems. 1 It is common in the elderly and its risk factors are frequently the risk factors for other organ pathologies, including the kidneys, liver, lungs, and brain. For both these reasons, and because of the compensatory changes in the body in response to early cardiac dysfunction, clinically evident co-morbidities are common and are frequently clinically important in CHF. 2 -4 Some of the least well studied co-morbidities are those affecting the brain. A wide range of neurological and neuropsychological co-morbidities are associated with CHF, including autonomic, cerebral, cerebrovascular, cognitive, psychiatric, psychological, and neuromuscular. The scale and complexity of the potential interactions at disease and treatment levels are daunting, complicated sadly by the medical profession's tendency to micro-specialize and lose effective communication with other specialities in the management of our mutual patients. Any attempt to understand disease interactions at the patient level and especially if involving different specialities and methodologies is to be welcomed. Thus, the paper by Erkelens and colleagues in this issue 5 is particularly valuable. What does it show? The authors studied 15 relatively young patients with mild CHF of non-ischaemic aetiology matched to 15 healthy controls of a similar age. They found that global cerebral blood flow was normal at rest in their CHF population but with some regional reduction in basilar artery flow. They also showed evidence of altered cerebrovascular autoregulation and vasomotor reactivity in the cerebral vascular bed in the CHF patients. The strengths of the study were that the patients were carefully selected, excludingThe opinions expressed in this article are not necessarily those of the

Dementia and the heart failure patient

“…Therapeutic strategies in this setting, therefore, remain largely empirical. The haemodynamic effects of the HF state on higher cerebral function are still poorly understood, 7 but should not be underestimated 8 , 9 …”