Structural brain injury on magnetic resonance imaging in heart failure and identifying patients at high-risk

Background Structural brain injury characteristics in heart failure (HF) and risk factors for such injury are poorly defined. Methods 143 consecutive patients with HF who underwent brain magnetic resonance imaging after a HF diagnosis were enrolled. Brain imaging assessments included cerebral infarcts, white matter hyperintensities (WMH), and cerebral atrophy. Logistic regression was used to identify predictors of brain lesions. Cluster analysis was applied to investigate potential phenotypes. Results Among HF patients, 20.3% had large brain infarcts and 51.0% had lacunes. In those without large infarcts, most showed WMHs (93.9%) and cerebral atrophy (72.8%). Smoking (OR: 5.069, P=0.004), diabetes (OR: 3.140, P=0.028), and serum N-terminal pro-brain natriuretic peptide (NT-proBNP) ≥900 pg/mL (OR: 3.472, P=0.023) were associated with large brain infarcts. Age (OR: 1.075, P=0.002), hypertension (OR: 3.075, P=0.019), higher plasma fibrinogen level (OR: 2.039, P=0.012), and increased serum high-density lipoprotein cholesterol (HDL-C; OR: 7.100, P=0.041) predicted higher WMH Scheltens score. Age (OR: 1.132, P<0.001) and an increased systemic immune-inflammation index (SII; OR: 1.001, P=0.029) were associated with pronounced cerebral atrophy. Cluster analysis revealed that a subtype characterized by higher systemic inflammation, poorer nutrition, and worse cardiac, renal, and hepatic function was associated with a greater risk of lacunar infarcts and atrophy. Conclusions Structural brain abnormalities are common in HF. Smoking, diabetes, and elevated NT-proBNP predict large brain infarcts; age, hypertension, elevated fibrinogen, and higher HDL-C are associated with WMH severity; and age and SII are linked to cerebral atrophy. A clinical subtype with heightened inflammation and poorer nutrition may face increased risk of brain injury.