Brain structural and functional changes in patients with chronic heart failure

Heart failure (HF) frequently suffers from brain abnormalities and cognitive impairments. This study aims to investigate brain structure and function alteration in patients with chronic HF. This retrospective study included 49 chronic HF and 49 health controls (HCs). Voxel-based morphometry was conducted on structural MRI to quantify gray matter volume (GMV), and functional connectivity (FC) was assessed with seed-based analysis using resting-state fMRI. White matter microstructure integrity was also evaluated through tract-based spatial statistics employing DTI. Correlations between multimodal MRI features and cognitive performance were further investigated in patients with chronic HF. Patients with chronic HF exhibited significantly reduced regional GMV, white matter microstructure injury (Family wise error correction, p＜0.05), and decreased FC in multiple brain regions involved in cognition, sensorimotor, visual function (Gaussian random field correction, voxel level p＜0.0001 and cluster-level p＜0.01). There was no observed increases in GMV or FC compared with HCs. Decreased GMV showed positive correlations with cognitive performance (r = 0.025-0.577, p = 0.025-0.001), while decreased fractional anisotropy was negatively correlated with anxiety scores (r = -0.339, p = 0.040) in patients with chronic HF. This study revealed that patients with chronic HF exhibited brain structure injury affecting gray matter and white matter, as well as FC abnormalities of brain regions responsible for cognition, sensorimotor and visual function. These findings suggest GMV could serve as a neuroimaging biomarker for cognitive impairments and a potential target for neuroprotective therapies in patients with chronic HF.