Introduction: Patients with heart failure with preserved ejection fraction (HFpEF) show high prevalence of cognitive decline and are at high risk for all cause dementia development. The underlying mechanisms are currently incompletely understood. We hypothesize that microvascular brain disease (cerebral small vessel disease, CSVD) could play a pivotal role.
Methods: In this prospective cohort study we included 14 HFpEF patients (age: 66.6 ± 10.0 years) and 11 cognitively normal controls (age: 69.4 ± 9.4) who underwent cognitive testing and 3 T brain magnetic resonance imaging (MRI) where CSVD prevalence and severity were quantified in accordance with the STandards for ReportIng Vascular changes on nEuroimaging criteria (STRIVE).
Results: Around 75% of all HFpEF patients had some degree of cognitive decline (58% mild cognitive impairment, 17% mild dementia), particularly in memory, visual spatial function, and global cognitive impairment. CSVD prevalence and severity was more pronounced in HFpEF patients compared to controls (43% vs. 9%, p=.033; mean CSVD score 6.6 vs. 3.7, p<.001; Fig. 1), which was driven by larger white matter hyperintensity volumes and greater severity of white matter perivascular spaces. Greater CSVD burden was related to worse global cognition (r=-.720, p<.001). Moreover, echo markers of HFpEF (left atrial volume index, LAVI [r=.549, p=.028], diastolic function, E/E` [r=.562, p=.024) and vascular aging (pulse wave velocity [r=.661, p<.001]) demonstrated moderate-to-large correlation with the CSVD-score.
Discussion: Both, HFpEF and CSVD are major causes for morbidity and mortality. Our results demonstrate a high rate of cognitive impairment and CSVD burden in HFpEF patients. The moderate-to-large correlation between marker of HFpEF and cardiovascular aging with the CSVD-Score and the shared cardiovascular risk factors indicate a likely link between HFpEF and CSVD. This data point out the urgent need for interdisciplinary heart-brain research investigating potential overlapping pathophysiological mechanisms of HFpEF and CSVD.
Fig. 1: Markers of cerebral small vessel disease in HFpEF patients
