Visual Assessment of Brain Magnetic Resonance Imaging Detects Injury to Cognitive Regulatory Sites in Patients With Heart Failure

Abstract

Background Heart failure (HF) patients exhibit depressive and executive function impairments that contribute to HF mortality. Using specialized magnetic resonance imaging (MRI) analysis procedures, brain changes appear in areas regulating these functions (mammillary bodies, hippocampi, and frontal cortex). However, specialized MRI procedures are not part of standard clinical assessment for HF (which is usually a visual evaluation), and it is unclear whether visual examination can detect changes in these structures. Methods and Results Using brain MRI, we visually examined the mammillary bodies and frontal cortex for global and hippocampi for global and regional tissue changes in 17 HF and 50 control subjects. Significant global changes emerged in the right mammillary body (HF vs. control scores; 1.18±1.13 vs. 0.52±0.74; P=.024), right hippocampus (1.53±0.94 vs. 0.80±0.86; P=0.005), and left frontal cortex (1.76±1.03 vs. 1.24±0.77; P=0.034) between groups. Comparison of the visual method with specialized MRI techniques corroborates right hippocampal and left frontal cortical, but not mammillary body, atrophy. Conclusions Visual examination of brain MRI can detect damage in HF in areas regulating depression and executive function, including the right hippocampus and left frontal cortex. Visual MRI assessment may facilitate evaluation of injury to these structures and the assessment of the impact of potential treatments for this damage.

Left Ventricular Ejection Fraction Predicts Severity of Posttraumatic Stress Disorder in Patients With Implantable Cardioverter‐Defibrillators

“…Because impaired cardiac function was reported to relate to the circulatory system (including cerebral perfusion), we consider that the ICD patients with impaired cardiac function also have CNS hypoperfusion, which is one of the causes of cerebral atrophy . In addition, previous magnetic resonance imaging studies have reported that the hippocampus, frontal cortex, and insular cortex were injured in patients with severe cardiac dysfunction . These reports concluded that brain hypoperfusion caused by impaired cardiac function was a critical factor resulting in temporal lobe and cerebral dysfunction.…”

Hippocampal and diencephalic pathology in developmental amnesia

“…Although reports of hypoxia-ischaemia causing severe, and selective damage to the mammillary bodies are rare, extensive atrophy of this structure has been described in adults after prolonged heart failure (Kumar et al., 2009, Pan et al., 2013). Volume reduction in the medial nucleus of the mammillary bodies has also been reported following adult-onset damage to the hippocampus and fornix (Loftus et al., 2000, Schubert and Friede, 1979).…”

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

“…Possible pathophysiological mechanisms are associated with chronic cerebral hypoperfusion, microemboli from LV thrombi, disruptions of blood–brain barrier, vascular remodelling, systemic inflammation and endothelial dysfunction. Accordingly, injury and tissue loss of brain areas involved in cognition have been described such as in the frontal cortex, hippocampus, mammillary bodies, and the putamen . Clinical factors associated with cognitive decline and dementia in HF include a history of hypertension, stroke, AF, metabolic abnormalities, reduced ejection fraction and low cardiac output, impaired LV diastolic filling, high plasma brain natriuretic peptide, reduced physical activity, depression, anaemia, liver failure, increased homocysteine, and low testosterone levels in males …”