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Published on: April 23, 2021
Brain Imaging Changes and Related Risk Factors of Cognitive Impairment in Patients With Heart Failure
Yangyang Jiang1, Lei Wang1, Ziwen Lu1
1Key Laboratory of Chinese Internal Medicine of Ministry of Education and Beijing, Dongzhimen Hospital Affiliated to Beijing University of Chinese Medicine, Beijing, China.
Insights
Heart failure patients with cognitive impairment show brain imaging changes like medial temporal lobe atrophy and reduced gray matter. Biomarkers such as BNP/NT-proBNP and comorbidities like diabetes are key risk factors.
Area of Science:
- Neurology and Cardiology
- Neuroimaging and Biomarkers
- Systematic Review and Meta-Analysis
Background:
- Cognitive impairment (CI) is a significant concern in heart failure (HF) patients.
- Understanding the neuroimaging correlates and risk factors of CI in HF is crucial for patient management.
Approach:
- A systematic literature search was conducted across major databases (PubMed, Web of Science, Embase, Cochrane Library).
- Data from 66 studies involving 33,579 patients were extracted and analyzed.
- Methodological quality was assessed using standardized scales.
Key Points:
- Medial temporal lobe atrophy (MTA) severity and reduced gray matter (GM) volume correlate with cognitive decline.
- Reduced cerebral blood flow (CBF) may be linked to CI, while white matter (WM) changes might be independent.
- Elevated B-type natriuretic peptide (BNP)/N-terminal pro-B-type natriuretic peptide (NT-proBNP), atrial fibrillation (AF), diabetes mellitus (DM), and anemia are significant risk factors for CI in HF.
- Lower ejection fraction (EF <30%) is associated with cognitive decline, but no significant difference in cognitive scores was found between HFpEF and HFrEF.
Conclusions:
- BNP/NT-proBNP and HF comorbidities (AF, DM, anemia) are independent risk factors for CI in HF patients.
- Imaging markers like MTA and GM volume, along with BMI, depression, sleep disorders, and low EF, show a disposition towards association with CI.
- This review provides a foundation for preventing and treating CI in the context of HF.
Background/Aims:
To explore the imaging changes and related risk factors of heart failure (HF) patients with cognitive impairment (CI).
Methods:
A literature search was systematically carried out in PubMed, Web of Science, Embase, and Cochrane Library. In this systematic review, important relevant information was extracted according to the inclusion and exclusion criteria. The methodological quality was assessed by three scales according to the different study types.
Results:
Finally, 66 studies were included, involving 33,579 patients. In the imaging changes, the severity of medial temporal lobe atrophy (MTA) and the decrease of gray Matter (GM) volume were closely related to the cognitive decline. The reduction of cerebral blood flow (CBF) may be correlated with CI. However, the change of white matter (WM) volume was possibly independent of CI in HF patients. Specific risk factors were analyzed, and the data indicated that the increased levels of B-type natriuretic peptide (BNP)/N-terminal pro-B-type natriuretic peptide (NT-proBNP), and the comorbidities of HF, including atrial fibrillation (AF), diabetes mellitus (DM) and anemia were definitely correlated with CI in patients with HF, respectively. Certain studies had also obtained independent correlation results. Body mass index (BMI), depression and sleep disorder exhibited a tendency to be associated with CI. Low ejection fraction (EF) value (<30%) was inclined to be associated with the decline in cognitive function. However, no significant differences were noted between heart failure with preserved ejection fraction (HFpEF) and heart failure with reduced ejection fraction (HFrEF) in cognitive scores.
Conclusion:
BNP/NT-proBNP and the comorbidities of HF including AF, DM and anemia were inextricably correlated with CI in patients with HF, respectively. These parameters were independent factors. The severity of MTA, GM volume, BMI index, depression, sleep disorder, and low EF value (<30%) have a disposition to associated with CI. The reduction in the CBF volume may be related to CI, whereas the WM volume may not be associated with CI in HF patients. The present systematic review provides an important basis for the prevention and treatment of CI following HF.
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