Microvascular function affected by HF correlated to cognitive impairment
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Key takeaways:
- Heart failure may be a predictor of microvascular dysfunction in the heart and brain.
- Both cardiac output and myocardial oxygenation reserve were correlated with impaired cognitive function.
Researchers reported that HF was independently prognostic of both cardiac and cerebral microvascular dysfunction predictive of impaired cognitive function.
The data were published in Circulation: Heart Failure.
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“Although the underlying pathophysiology of HF is heterogenous and remains incompletely understood, many overlapping pathophysiologic mechanisms have been proposed for the HF-associated development of cognitive impairment, including chronic cerebral hypoperfusion or decreased cerebrovascular reactivity through endothelial dysfunction, arterial hypertension, and systemic inflammation,” Elizabeth Hillier, PhD, a research scientist in the faculty of medicine and health sciences, division of experimental medicine, at McGill University in Montreal, and colleagues wrote. “This study aims to assess the myocardial and cerebral oxygenation status in patients with HF and to correlate these findings to the cardiac and cognitive functional status.”
To assess microvascular function, Hillier and colleagues used oxygenation-sensitive MRI during a standardized breathing maneuver to determine cerebral and myocardial oxygenation reserve in 20 patients with HF (mean age, 64 years; 50% women) compared with 21 healthy controls (mean age, 55 years; 62% women). Cognitive function was evaluated using the Montreal Cognitive Assessment test.
Researchers observed lower cerebral and myocardial oxygenation reserve among patients with HF compared with healthy controls (mean myocardial oxygenation reserve, 0.1 vs. 5; mean cerebral oxygenation reserve, 0.43 vs. 1.21). Average Montreal Cognitive Assessment score results were also lower within the HF group (23.9 vs. 27.8; P = .002) and correlated with both cardiac output (r = 0.55; P = .011) and myocardial oxygenation reserve (r = 0.46; P = .04).
“To our knowledge, this is the first study to perform a quasi-simultaneous assessment of cerebral and myocardial oxygenation changes during vasoactive interventions. In the present study, we observed a reduced oxygenation reserve in both myocardial and cerebral vascular beds of patients with HF, that was not related to left ventricular ejection fraction but to cardiac output,” the researchers wrote. “A reduced oxygenation reserve was also observed in the brain, where it was associated with a reduced cognitive function.
“The observed positive correlation between cerebral and myocardial oxygenation reserve indicates a possible parallel pathophysiology of microvascular dysfunction in both vascular beds,” the researchers wrote. “This may be explained by systemic factors, such as hypertension and associated therapies as confounders, or chronic hypoperfusion caused by reduced overall ventricular function.”
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