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Published on: October 5, 2020
Heart Failure Self-care Associated With Brain Injury in Executive Control Regions
Sarah Choi1, Bhaswati Roy, Rajesh Kumar
1Sarah Choi, PhD, RN, FNP Associate Professor, School of Nursing, University of California Los Angeles. Bhaswati Roy, PhD Postdoctoral Scholar, Department of Anesthesiology, David Geffen School of Medicine, University of California Los Angeles. Rajesh Kumar, PhD Professor, Departments of Anesthesiology, Radiology, and Bioengineering, David Geffen School of Medicine, University of California Los Angeles. Gregg C. Fonarow, MD Professor and Director, David Geffen School of Medicine, University of California Los Angeles, and Ahmanson-UCLA Cardiomyopathy Center. Mary A. Woo, PhD, RN Professor, School of Nursing, University of California Los Angeles.
Background:
Inadequate self-care is linked to poor health outcomes in heart failure (HF). Self-care depends on decision-making abilities, but links between self-care and brain injury to executive decision-making regulatory areas (prefrontal cortices) are unclear.
Objective:
We investigated the relationships between HF self-care and status of prefrontal cortices.
Methods:
Magnetic resonance imaging-based diffusion tensor imaging was performed in 21 patients with HF (age, 53.8 ± 7.9 years; 15 men; left ventricular ejection fraction, 25.1% ± 6.1%), and self-care and executive function were measured with the Self-care of Heart Failure Index (SCHFI) and Trail Making Test B. Using diffusion tensor imaging data, mean diffusivity (MD) maps were calculated and region-of-interest analyses were performed on the left and right prefrontal brain areas. Statistical analyses consisted of partial correlations (covariates, age, and gender).
Results:
The mean ± SD SCHFI scores were 70.78 ± 11.37 for maintenance, 70 ± 17.32 for management, and 74.91 ± 15.76 for confidence. The mean ± SD Trail Making Test B score was 90.2 ± 73.3 seconds. The mean ± SD MD values (higher values indicate tissue injury) of the left and right prefrontal cortices were 1.46 ± 0.16 (×10 mm/s) and 1.44 ± 0.14 (×10 mm/s), respectively. Significant negative correlations emerged between prefrontal MD values and SCHFI maintenance (left/right, r = -0.64/-0.70; P < .003) and SCHFI management (r = -0.93/-0.86; P < .003). Significant positive correlations were observed between prefrontal MD values and Trail Making Test B (r = 0.71/0.74; P < .001). A nonsignificant correlation emerged between prefrontal MD values and SCHFI confidence scores.
Conclusions:
Brain tissue integrity in executive function regulatory regions is associated with HF self-care for maintenance and management. The findings indicate that protection and brain injury repair in executive control areas may improve HF self-care.
