Factors Associated With Decreased Cerebral Blood Flow in Congestive Heart Failure Secondary to Idiopathic Dilated Cardiomyopathy

Choi, Bong Ryong; Kim, Jae Seung; Yang, You; Park, Kyoung-Min; Lee, Cheol Whan; Kim, Yong‐Hak; Hong, Myeong Ki; Song, Jae Kwan; Park, Seong Wook; Kim, Jae Joong

doi:10.1016/j.amjcard.2005.11.059

Cited by 126 publications

(97 citation statements)

References 25 publications

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“…We found in that study that global CBF was approximately 20% less in patients with HF than in control patients (40±4 vs. 49±4 ml · min −1 · 100 g −1 , P<0.01). 22 Little is known of the mechanisms underlying impaired cerebral autoregulation in advanced HF. It is generally assumed that multiple factors are associated with cerebrovascular changes, which lead to increased vascular resistance.…”

Section: Hf and Brain Functionmentioning

confidence: 99%

Heart and Brain Interconnection　– Clinical Implications of Changes in Brain Function During Heart Failure –

Kim

2015

Circ J

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Heart failure (HF) is a highly prevalent disorder worldwide and, consequently, a burden on the healthcare systems of many nations. Although the effects of HF are systemic, many therapeutic targets are focused on cardiac dysfunction. The brain is closely related to the heart, but there are few reports on the relationship between these organs. We describe the effects of the brain on HF progression. Specific brain regions control sympathetic drive and neurohumoral factors, which play an important role in disease exacerbation. In addition, we review some of our previous studies on deranged cerebral metabolism and reduced cerebral blood flow during HF. Although the reasons underlying these effects during HF remain uncertain, we propose plausible mechanisms for these phenomena. In addition, the clinical implications of such conditions in terms of predicting prognosis are discussed. Finally, we investigate cognitive impairment in patients with HF. Cognitive impairment through cerebral infarction or hypoperfusion is associated with adverse outcomes, including death. This brief review of brain function during the development of HF should assist with future strategies to better manage patients with this condition. (Circ J 2015; 79: 942 -947)

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Section: Hf and Brain Functionmentioning

confidence: 99%

Heart and Brain Interconnection　– Clinical Implications of Changes in Brain Function During Heart Failure –

Kim

2015

Circ J

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“…In the resting condition, patients with heart failure have reduced cerebral blood flow compared with normal subjects, and this has been shown to be normalized by cardiac transplantation. 23 On the transition from rest to moderate exercise, global cerebral blood flow increases by 20-30% in both animals and humans. 24 However, during maximal exercise, the recent investigation by González-Alonso et al 24 indicated that blood flow to the brain declines, even in healthy subjects.…”

Section: Mechanisms Determining Cerebral Oxygenation During Exercisementioning

confidence: 99%

Effects of Supplemental O2 Inhalation on Cerebral Oxygenation During Exercise in Patients With Left Ventricular Dysfunction

Koike

Nagayama

Goda

et al. 2007

Circ J

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“…Even in the resting condition, patients with left ventricular dysfunction are known to have reduced cerebral blood flow as compared to normal subjects, which has been shown to be normalized by cardiac transplantation. 17 On the transition from rest to moderate exercise, global cerebral blood flow increases by 20-30% in both animals and humans. 18 During maximal exercise, however, a recent investigation by González-Alonso et al indicated that blood flow to the brain decreases even in healthy subjects.…”

Section: Mechanisms Determining Cerebral Oxygenation During Exercisementioning

confidence: 99%

Clinical Significance of Cerebral Oxygenation During Exercise in Patients With Coronary Artery Disease

Koike

Nagayama

Hoshimoto-Iwamoto

et al. 2008

Circ J

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n resting conditions, complex compensatory mechanisms are believed to adequately regulate blood flow to vital organs, especially to the brain. During exercise, however, the O2 demand of exercising muscles surges to levels 10-15 times higher than that in the resting condition. The blood flow to the exercising muscles increases tremendously to meet this sudden surge in O2 demand, thereby leading to a relative hypoperfusion of other organs. Our group recently studied cerebral oxygenation during exercise using near-infrared spectroscopy (NIRS) in patients with left ventricular dysfunction. 1 We found, as a result, that nearly half of the patients exhibited decreases in the cerebral oxyhemoglobin (O2Hb) during exercise, and that the decrease was more prominent in patients with a lower left ventricular ejection fraction (LVEF). 1 In these patients, cerebral O2Hb, a parameter that initially remained constant at lower work rates during incremental exercise, began to decrease at higher work rates. 1,2 The decrease in cerebral O2Hb presumably reflected a cerebral hypoxia during exercise resulting from impaired O2 transport to the brain.While risk stratification of chronic heart disease had been primarily based on resting hemodynamic measurements, cardiopulmonary exercise testing (CPX) has now become indispensable in singling out those patients with a poor prognosis. Among the parameters obtained from CPX, the peak O2 uptake (V • O2) is considered a gold standard for identifying patients with a poor prognosis and selecting candidates for cardiac transplantation. 3 The ratio of the increase in ventilation (V • E) to the increase in CO2 output (V • CO2) during exercise (V • E/V • CO2 slope) and the ratio of the increase in V• O2 to the increase in work rate (ΔV • O2/ΔWR) are also independent prognostic markers in cardiac patients. 4 In 1999, Lee et al reported that cerebral metabolism measured by magnetic resonance spectroscopy is abnormally deranged in patients with heart failure. 5 They also found that this abnormality is an independent predictor of mortality in these patients. 6 The cerebral metabolic abnormality is assumed to be due to overall and/or local disturbances of cerebral blood flow, that is, impaired cerebral oxygenation. 5 The impaired cerebral oxygenation can be detected by the non-invasive measurement of cerebral O2Hb using NIRS, and the detection might be more sensitive during exercise in which the O2 demand by exercising muscles increases tremendously, rather than measurements taken at rest. If the cerebral metabolic abnormality resulting from decreased cerebral O2 transport is related to prognosis, the decrease in cerebral O2Hb during exercise must also influence the prognosis.In the present study, we sought to establish a prognostic value of decreased cerebral O2Hb during exercise in cardiac patients. We selected patients with coronary artery disease, and compared the prognostic power of cerebral O2Hb during exercise with those of established respiratory gas indexes obtained from CPX, as cerebral oxygena...

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Factors Associated With Decreased Cerebral Blood Flow in Congestive Heart Failure Secondary to Idiopathic Dilated Cardiomyopathy

Cited by 126 publications

References 25 publications

Heart and Brain Interconnection　– Clinical Implications of Changes in Brain Function During Heart Failure –

Heart and Brain Interconnection　– Clinical Implications of Changes in Brain Function During Heart Failure –

Effects of Supplemental O2 Inhalation on Cerebral Oxygenation During Exercise in Patients With Left Ventricular Dysfunction

Clinical Significance of Cerebral Oxygenation During Exercise in Patients With Coronary Artery Disease

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Factors Associated With Decreased Cerebral Blood Flow in Congestive Heart Failure Secondary to Idiopathic Dilated Cardiomyopathy

Cited by 126 publications

References 25 publications

Heart and Brain Interconnection – Clinical Implications of Changes in Brain Function During Heart Failure –

Heart and Brain Interconnection – Clinical Implications of Changes in Brain Function During Heart Failure –

Effects of Supplemental O2 Inhalation on Cerebral Oxygenation During Exercise in Patients With Left Ventricular Dysfunction

Clinical Significance of Cerebral Oxygenation During Exercise in Patients With Coronary Artery Disease

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Heart and Brain Interconnection　– Clinical Implications of Changes in Brain Function During Heart Failure –

Heart and Brain Interconnection　– Clinical Implications of Changes in Brain Function During Heart Failure –