Pediatric patients with severe heart failure showed significantly greater cerebrospinal fluid volume (0.30 L vs. 0.25 L, p=0.03) and focal gray matter volume loss in autonomic and limbic regions compared to healthy controls.
Case-Control (n=14)
Single-blind (outcome assessor)
No
Does severe pediatric heart failure result in regional brain volume loss compared to healthy controls?
Pediatric heart failure is associated with significant, focal gray matter volume loss in brain regions regulating autonomic function, mood, and memory, independent of thromboembolic comorbidities.
Absolute Event Rate: 0.3% vs 0.25%
p-value: p=0.03
Autonomic dysfunction, mood disturbances, and memory deficits appear in pediatric and adult heart failure (HF). Brain areas controlling these functions show injury in adult HF patients, many of whom have comorbid cerebrovascular disease. We examined whether similar brain pathology develops in pediatric subjects without such comorbidities. In this study, high-resolution T1 brain magnetic resonance images were collected from seven severe HF subjects age (age 8-18 years mean 13; left ventricular shortening 9 to 19% median 14%) and seven age-matched healthy controls (age 8-18 years mean 13). After segmentation into gray matter (GM), white matter, and cerebrospinal fluid (CSF), regional volume loss between groups was determined by voxel-based morphometry. GM volume loss appeared on all HF scans, but ischemic changes and infarcts were absent. HF subjects showed greater CSF volume than controls (mean ± SD 0.30 ± 0.04 vs. 0.25 ± 0.04 l, P = 0.03), but total intracranial volume was identical (1.39 ± 0.11 vs. 1.39 ± 0.09 l, P = NS). Regional GM volume reduction appeared in the right and left posterior hippocampus, bilateral mid-insulae, and the superior medial frontal gyrus and mid-cingulate cortex of HF subjects (threshold P < 0.001). No volume-loss sites appeared in control brains. We conclude that pediatric HF patients show brain GM loss in areas similar to those of adult HF subjects. Substantial changes emerged in sites that regulate autonomic function as well as mood, personality and short-term memory. In the absence of thromboembolic disease and many comorbid conditions found in adult HF patients, pediatric HF patients show significant, focal GM volume loss, which may coincide with the multiple neurologic and psychological changes observed in patients with HF.
Menteer et al. (Wed,) conducted a case-control in Pediatric heart failure (n=14). Pediatric heart failure vs. Healthy age-matched controls was evaluated on Cerebrospinal fluid volume (L) (p=0.03). Pediatric patients with severe heart failure showed significantly greater cerebrospinal fluid volume (0.30 L vs. 0.25 L, p=0.03) and focal gray matter volume loss in autonomic and limbic regions compared to healthy controls.