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Brain Damage With Heart Failure: Cardiac Biomarker Alterations and Gray Matter Decline
Karsten Mueller1, Friederike Thiel1, Frank Beutner2,3
1From the Max Planck Institute for Human Cognitive and Brain Sciences, Germany (K.M., F.T., S.F., T.B., H.E.M., K.I., A.V., M.L.S.).
Insights
Heart failure (HF) is linked to brain structure changes. Reduced heart function correlates with decreased gray matter density (GMD) in key brain areas, suggesting potential cognitive implications.
Area of Science:
- Cardiology
- Neurology
- Neuroimaging
Background:
- Heart failure (HF) impairs cardiac function, reducing blood flow and potentially affecting brain oxygen supply.
- Neurological symptoms are common in HF, but the underlying structural brain changes and their mechanisms are not fully understood.
- Existing research suggests regional gray matter reduction in HF patients, necessitating further investigation into the heart-brain axis.
Purpose of the Study:
- To investigate the relationship between cardiac function markers and structural brain changes in patients with heart failure.
- To explore correlations between heart failure biomarkers and gray matter density (GMD) using magnetic resonance imaging (MRI).
- To determine if impaired heart function is associated with specific alterations in brain structure.
Main Methods:
- A case-control study was conducted with 80 patients from the Leipzig Heart Center.
- Magnetic resonance imaging (MRI) was used to assess gray matter density (GMD) in the brain.
- Key heart failure biomarkers, including ejection fraction and NT-proBNP (N-terminal prohormone of brain natriuretic peptide), were measured and correlated with GMD.
Main Results:
- A significant positive correlation was observed between cardiac ejection fraction and GMD in the frontal and parietal medial cortex.
- A significant negative correlation was found between NT-proBNP levels and GMD in the medial and posterior cingulate cortex, precuneus, and hippocampus.
- Diminished GMD was associated with decreased ejection fraction and increased NT-proBNP, affecting widespread brain regions including the frontomedian cortex, hippocampus, and precuneus.
Conclusions:
- Significant correlations exist between brain structure (GMD) and heart failure markers (ejection fraction, NT-proBNP).
- Reduced heart function in HF is associated with diminished GMD in brain regions crucial for cognition, such as the hippocampus and precuneus.
- These structural brain changes may underlie cognitive alterations in HF, warranting further longitudinal research to confirm causality.
Rationale:
Heart failure (HF) following heart damage leads to a decreased blood flow due to a reduced pump efficiency of the heart muscle. A consequence can be insufficient oxygen supply to the organism including the brain. While HF clearly shows neurological symptoms, such as fatigue, nausea, and dizziness, the implications for brain structure are not well understood. Few studies show regional gray matter decrease related to HF; however, the underlying mechanisms leading to the observed brain changes remain unclear.
Objective:
To study the relationship between impaired heart function, hampered blood circulation, and structural brain change in a case-control study.
Methods And Results:
Within a group of 80 patients of the Leipzig Heart Center, we investigated a potential correlation between HF biomarkers and the brain's gray matter density (GMD) obtained by magnetic resonance imaging. We observed a significant positive correlation between cardiac ejection fraction and GMD across the whole frontal and parietal medial cortex reflecting the consequence of HF onto the brain's gray matter. Moreover, we also obtained a relationship between GMD and the NT-proBNP (N-terminal prohormone of brain natriuretic peptide)-a biomarker that is used for screening, diagnosis, and prognosis of HF. Here, we found a significant negative correlation between NT-proBNP and GMD in the medial and posterior cingulate cortex but also in precuneus and hippocampus, which are key regions implicated in structural brain changes in dementia.
Conclusions:
We obtained significant correlations between brain structure and markers of heart failure including ejection fraction and NT-proBNP. A diminished GMD was found with decreased ejection fraction and increased NT-proBNP in wide brain regions including the whole frontomedian cortex as well as hippocampus and precuneus. Our observations might reflect structural brain damage in areas that are related to cognition; however, whether these structural changes facilitate the development of cognitive alterations has to be proven by further longitudinal studies.
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