Stage C chronic heart failure was associated with greater longitudinal reductions in cerebral blood flow compared to Stage B (-1.96 vs 0.78 mL/100g/min, P<0.001), correlating with delayed memory.
Cohort (n=55)
Does progression to Stage C chronic heart failure reduce cerebral blood flow and correlate with cognitive impairment compared to Stage B?
Stage C chronic heart failure is associated with longitudinal reductions in cerebral blood flow in cognitive processing regions, which correlates with worsening delayed memory.
Absolute Event Rate: -1.96% vs 0.78%
p-value: p=<0.001
Abstract Background Chronic heart failure (CHF) encompasses a spectrum of cardiac dysfunctions, including heart failure with preserved and reduced ejection fractions. Irrespective of ejection fraction status, CHF is associated with systemic hypoperfusion, leading to reduced cerebral blood flow (CBF). However, longitudinal assessments of CBF changes in this population remain limited. Purpose This study aimed to compare the longitudinal changes in CBF between patients with (Stage C) and those without CHF (Stage B), with investigations of their associations with changes in cognitive impairments and depressive symptoms. Methods Longitudinal data of CBF images, delayed memory and depressive symptoms were acquired from 32 Stage B (age 63.3±10.5 years, 21.5% women) and 23 Stage C CHF patients (age 67.3±7.1 years, 30.4% women) over a mean follow-up of 3.1 years. CBF was quantified using pseudo-continuous arterial spin labeling (pCASL) with 3D fast spin-echo acquisition on a 1.5-T MRI system and an 8-channel head coil. CBF images were analysed using SPM12 in MATLAB. Voxel-wise analysis, adjusted for age and sex, identified brain regions with CBF changes between Stage B and Stage C patients. Delayed memory and depressive symptoms were assessed using the logical memory subtest of the Wechsler Memory Scale-Revised and the 15-item Geriatric Depression Scale. Multivariable regression analyses were tested to assess associations of CBF changes with delayed memory or depressive symptoms, adjusted for age, sex and Stage B or C. Statistical significance was set at P0.05, with voxel-wise analysis corrected for multiple comparisons using family-wise error at a cluster threshold of P0.05 (voxel-level P0.005). Results Baseline characteristics was not different between Stage B and C CHF patients, including global CBF (B vs. C: 41.0±8.8 vs. 43.7±9.2 mL/100g/min), delayed memory (B vs. C: 15.8±1.4 vs. 14.6±1.4) or depressive symptoms (2.97±0.42 vs. 4.13±0.51) (either P0.05). The voxel-wise analysis showed that CBF was reduced in the four (left-anterior, right-anterior, left posterior and right-posterior) clusters, including the regions involved in cognitive processing (Figure), in Stage C relative to Stage B patients (B vs. C: 0.78±2.01 vs. –1.96±2.45 mL/100g/min, P0.001). There were not significant changes in delayed memory (B vs. C: –4.4±1.1 vs. –5.1±1.3) or depressive symptoms (B vs. C: 0.16±0.45 vs. 0.39±0.80) between Stage B and C patients (either P0.05). However, changes in CBF were associated with those in delayed memory (Estimate 0.12 95% confidence interval 0.2–0.22 mL/100g/min), while no association was found between changes in CBF and depressive symptoms (P0.05). Conclusions Stage C CHF patients exhibited longitudinal CBF reductions in brain regions involved in cognitive processing. Changes in CBF were positively correlated with those in delayed memory. The reduction in CBF may contribute to the progression of cognitive impairment in CHF.Figure
Sugano et al. (2025) conducted a cohort in chronic heart failure (n=55). Stage C CHF vs. Stage B CHF was evaluated on longitudinal changes in cerebral blood flow (CBF) (p=<0.001). Stage C chronic heart failure was associated with greater longitudinal reductions in cerebral blood flow compared to Stage B (-1.96 vs 0.78 mL/100g/min, P<0.001), correlating with delayed memory.