Central nervous system changes in pediatric heart failure: a volumetric study

Area of Science:

• Neuroscience
• Cardiology
• Pediatrics

Background:

• Pediatric and adult heart failure (HF) are associated with autonomic dysfunction, mood disturbances, and memory deficits.
• Brain pathology is observed in adult HF patients, often with comorbid cerebrovascular disease.
• The impact of HF on the pediatric brain, particularly without comorbidities, requires investigation.

Purpose of the Study:

• To investigate whether pediatric heart failure (HF) subjects exhibit similar brain pathology, specifically gray matter (GM) volume loss, as observed in adult HF patients.
• To identify specific brain regions affected by GM volume loss in pediatric HF patients without significant comorbidities.

Main Methods:

• High-resolution T1 brain magnetic resonance imaging (MRI) was used to scan seven severe pediatric HF subjects (age 8-18) and seven age-matched healthy controls.
• Voxel-based morphometry was employed to segment brain images into gray matter (GM), white matter, and cerebrospinal fluid (CSF), and to determine regional volume differences between groups.
• Statistical analysis identified significant GM volume reduction in specific brain areas in HF subjects compared to controls.

Main Results:

• Pediatric HF subjects demonstrated GM volume loss across all scans, with no evidence of ischemic changes or infarcts.
• HF subjects had significantly greater CSF volume compared to controls, while total intracranial volume remained identical.
• Significant regional GM volume reduction was observed in the hippocampus, insulae, superior medial frontal gyrus, and mid-cingulate cortex of HF subjects.

Conclusions:

• Pediatric heart failure (HF) patients exhibit gray matter (GM) brain volume loss in regions analogous to those affected in adult HF patients.
• This GM loss occurs in brain areas critical for autonomic function, mood, personality, and short-term memory.
• The findings suggest that pediatric HF directly contributes to focal GM volume loss and associated neurological and psychological changes, independent of common comorbidities.