Blood-Brain Barrier Dysfunction in Adults With Heart Failure

Area of Science:

• Neuroscience
• Cardiology
• Radiology

Background:

• Heart failure (HF) is associated with brain tissue injury affecting autonomic, cognitive, and mood functions, increasing patient morbidity and mortality.
• The precise pathological mechanisms of brain injury in HF remain unclear, with blood-brain barrier (BBB) dysfunction being a potential contributor.

Purpose of the Study:

• To investigate blood-brain barrier (BBB) integrity and function in patients with heart failure (HF) compared to healthy controls.
• To explore the relationship between BBB dysfunction, large artery integrity, and cognitive and mood impairments in HF.

Main Methods:

• Diffusion-weighted pseudo-continuous arterial spin labeling (DW-pCASL) MRI was employed on 27 HF patients and 59 controls.
• Arterial transit time (ATT) and water exchange rate across the BBB (Kw) were quantified to assess large artery integrity and BBB function, respectively.
• Cognitive function, anxiety, and depressive symptoms were evaluated and correlated with MRI findings.

Main Results:

• HF patients demonstrated significantly poorer cognition and increased mood deficits compared to controls.
• Altered Kw and ATT values were observed in multiple brain regions involved in cognition and mood regulation in HF patients.
• Specifically, increased Kw was noted in the insula, hippocampus, and cerebellum, while ATT changes varied across different brain areas.

Conclusions:

• Heart failure is associated with impaired blood-brain barrier (BBB) function and altered large artery integrity.
• These BBB alterations may contribute to neural damage in brain regions regulating autonomic, mood, and cognitive functions.
• Therapeutic strategies targeting BBB repair are warranted to mitigate neurological damage and improve brain function in HF patients.