Localized Cerebral Blood Flow Reductions in Patients With Heart Failure: A Study Using<sup>99m</sup>Tc-HMPAO SPECT

Alves, Tania C. T. Ferraz; Rays, Jairo; Fráguas, Renério; Wajngarten, Maurı́cio; Meneghetti, José Cláudio; Prando, Silvana; Busatto, Geraldo F.

doi:10.1111/j.1552-6569.2005.tb00300.x

Cited by 45 publications

(32 citation statements)

References 25 publications

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“…Reduced CBF in HF, as demonstrated by others (Alves et al, 2005; Gruhn et al, 2001) may contribute to the regional tissue damage found earlier in the syndrome (Woo et al, 2003). We can now add that the flow deficits are lateralized; HF patients showed significantly lower right-sided middle cerebral artery CBFV at all but one time point during the ANS challenges relative to control subjects, and left-sided CBFV differed between HF and control subjects at all but two points of ANS testing.…”

Section: Discussionsupporting

confidence: 54%

“…Aberrations of vasomotor reactivity can be induced by trauma, stroke, migraine headache, or reduced CBF (Alves et al, 2005; Baumgartner & Baumgartner, 1998; Franklin, Sandström, Johansson, & Bålfors, 1997; Thie, Fuhlendorf, Spitzer, & Kunze, 1990). No participant had a history of any of these conditions, and the vasomotor reactivity differences should not result from such processes.…”

Section: Discussionmentioning

confidence: 99%

“…The insulae send substantial projections to the hypothalamus, cingulate cortex, and other autonomic regulatory areas, and are instrumental in regulation of blood pressure and heart rate; the insular injury may contribute to the dysfunctional vasomotor reactivity found in this sample. Vasomotor reactivity abnormalities in HF may also develop from decreased CBF (Alves et al, 2005; Franklin et al, 1997; Gruhn et al, 2001). It remains unclear whether decreased CBF contributes to the structural damage, or interacts with the damage to affect vasomotor reactivity status.…”

Section: Discussionmentioning

confidence: 99%

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Cerebral Blood Flow Velocity and Vasomotor Reactivity During Autonomic Challenges in Heart Failure

et al. 2014

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Background Significant alterations in autonomic nervous system (ANS) function, vasomotor reactivity, and cerebral blood flow may develop from damage to brain ANS regulatory areas in heart failure (HF). This preferentially right-sided injury occurs largely in autonomic structures perfused by the middle cerebral artery. Indications of altered, asymmetrical perfusion raise the potential for further neural damage. Objectives To determine whether the extent of middle cerebral artery blood flow velocity and vasomotor reactivity is altered on one side of the brain over the other in HF vs. control subjects, three ANS challenges were administered—each challenge recruited ANS regulatory areas potentially injured in HF. Methods Transcranial Doppler ultrasonography was used to measure cerebral blood flow velocity and vasomotor reactivity in 40 HF (mean age = 52.7 years, SD = 7.5; 27 males; left ventricular ejection fraction 26.8, SD = 8.3) and 42 control subjects (mean age = 48.3 years; SD = 6.0; 22 males) during 5% CO2 and hyperventilation, Valsalva, and orthostatic (upper body tilt) challenges. Results Lower cerebral blood flow velocity and abnormal vasomotor reactivity (p < .01) were noted in HF middle cerebral arteries during all challenges. More right-sided flow velocity reductions appeared in HF, with laterality differences noted during CO2 and orthostatic (p < .05), but not Valsalva challenges. Discussion Diminished cerebral blood flow velocity and altered vasomotor reactivity were associated with HF, changes being preferentially on the right-side; the asymmetry was more pronounced during CO2 and orthostatic challenges. The impaired blood flow regulation may contribute to the lateralized brain pathology in ANS areas, undermining autonomic control in HF.

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Section: Discussionsupporting

confidence: 54%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Cerebral Blood Flow Velocity and Vasomotor Reactivity During Autonomic Challenges in Heart Failure

et al. 2014

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“…In addition, a reduction in gray matter volume is seen in areas such as the parahippocampal gyrus, cingulate gyrus, and frontal cortex (Woo, Macey, Fonarow, Hamilton, & Harper, 2003). HF patients also exhibit functional brain changes, demonstrating a 19–30% decrease in cerebral perfusion (Choi et al, 2006; Gruhn, et al, 2001), with notable reductions seen in the frontal, temporal, and parietal lobes (Alves, et al, 2005; Burra et al, 2002; Vogels, et al, 2008). In addition, there is evidence to suggest that even transient periods of reduced cerebral blood flow can have a negative effect on cognition.…”

mentioning

confidence: 99%

Cognitive profiles in heart failure: A cluster analytic approach

Miller

Spitznagel

Alosco

et al. 2012

Journal of Clinical and Experimental Neuropsychology

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Cognitive impairment is common among individuals with heart failure (HF), but the exact nature of these impairments remains unclear. The current study examined 140 older adults with heart failure and sought to determine whether there are distinct cognitive profiles using a cluster analytic approach. Results indicated three unique profiles comprising of individuals who were cognitively intact, memory impaired, and globally impaired. Clusters differed on several important demographic and clinical characteristics. These findings suggest cognitive impairment in persons with HF is more heterogeneous than commonly believed and have important implications for treatment recommendations.

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“…Furthermore, vast evidence links cardiac dysfunction—a significant contributor to reduced cerebral perfusion in HF [31]—with reduced cognitive test performance and abnormal neuroimaging [22,25]. HF patients have also been found to exhibit a pattern of cerebral blood flow deficits similar to those observed in patients with AD, including reduced cerebral blood flow of the pre-cuneus and posterior cingulate gyrus [32]. …”

Section: Etiology Of Cognitive Impairment In Hfmentioning

confidence: 99%

Obesity as a risk factor for poor neurocognitive outcomes in older adults with heart failure

2013

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Heart failure (HF) has reached epidemic proportions and is a significant contributor to poor outcomes. HF is an established risk factor for Alzheimer's disease, vascular dementia, and abnormalities on neuroimaging. Moreover, up to 80% of HF patients also exhibit milder impairments on cognitive tests assessing attention, executive function, memory, and language. The mechanisms of cognitive impairment in HF are not entirely clear and involve a combination of physiological processes that negatively impact the brain. Cerebral hypoperfusion and common comorbid conditions in HF are among the most commonly proposed contributors to poor neurocognitive outcomes in this population. Obesity is another likely risk factor for adverse brain changes and cognitive impairment in HF, as it is a known contributor to neurocognitive outcomes in healthy and patient samples. This paper reviews the literature on HF and cognitive function and introduces obesity as a significant risk factor for poor neurocognitive outcomes in this population.

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Localized Cerebral Blood Flow Reductions in Patients With Heart Failure: A Study Using^99mTc-HMPAO SPECT

Cited by 45 publications

References 25 publications

Cerebral Blood Flow Velocity and Vasomotor Reactivity During Autonomic Challenges in Heart Failure

Cerebral Blood Flow Velocity and Vasomotor Reactivity During Autonomic Challenges in Heart Failure

Cognitive profiles in heart failure: A cluster analytic approach

Obesity as a risk factor for poor neurocognitive outcomes in older adults with heart failure

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Localized Cerebral Blood Flow Reductions in Patients With Heart Failure: A Study Using99mTc-HMPAO SPECT

Cited by 45 publications

References 25 publications

Cerebral Blood Flow Velocity and Vasomotor Reactivity During Autonomic Challenges in Heart Failure

Cerebral Blood Flow Velocity and Vasomotor Reactivity During Autonomic Challenges in Heart Failure

Cognitive profiles in heart failure: A cluster analytic approach

Obesity as a risk factor for poor neurocognitive outcomes in older adults with heart failure

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Product

Resources

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Localized Cerebral Blood Flow Reductions in Patients With Heart Failure: A Study Using^99mTc-HMPAO SPECT