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Cognitive deficits and microvascular brain alteration in patients with heart failure with preserved ejection fraction (HFpEF). Preliminary data of the HIM-Study

https://doi.org/10.1007/s00392-025-02625-4

Patrick Müller (Magdeburg)1, L. Horndasch (Magdeburg)1, M. Kunz (Magdeburg)1, Y. Lading (Magdeburg)1, H. Mattern (Magdeburg)2, K. Neumann (Magdeburg)3, A. Schmeißer (Magdeburg)1, S. Schreiber (Magdeburg)3, R. Braun-Dullaeus (Magdeburg)1

1Universitätsklinikum Magdeburg A.ö.R. Klinik für Kardiologie, Angiologie und Pneumologie Magdeburg, Deutschland; 2Otto-von-Guericke Universität Magdeburg, Deutschland; 3Universitätsklinik für Neurologie Magdeburg, Deutschland

 

Introduction: Patients with heart failure with preserved ejection fraction (HFpEF) have a high prevalence of cognitive decline and an increased risk for dementia. The underlying mechanisms are poorly understood. We hypothesize that microvascular brain disease (cerebral small vessel disease, CSVD) may be an underlying mechanism.

Methods: In this prospective cohort study, we included 22 HFpEF patients (age: 68.1±9.2) and 25 cognitively normal controls (age: 69.6±6.5) to undergo cardiovascular assessment, cognitive testing, and 3 T brain magnetic resonance imaging (MRI) to quantifiy CSVD prevalence and severity according to the STandards for ReportIng Vascular changes on nEuroimaging criteria (STRIVE).

Results: HFpEF patients have a high prevalence of cognitive impairment (59%mild cognitive impairment, 9% mild dementia), particularly in memory, executive function, and global cognition. CSVD prevalence and severity were more pronounced in HFpEF patients compared to controls (57% vs. 9%, p<.001; mean CSVD score 6,5 ± 2.0 vs. 4.0±1.4, p<.001; Fig. 1), which was driven by larger white matter hyperintensity volumes, greater severity of white matter perivascular spaces, and microbleeds.  Cerebral microvascular dysfunction was associated with cognitive impairment (r=-.695, p<.001). In addition, diastolic function (E/E`, r=.599, p=.013) and arterial stiffness (PWV, r=.613, p<.001]) demonstrated a moderate-to-strong correlation with the CSVD-score.

Discussion: Preliminary data show a high prevalence of cognitive impairment and cerebral microvascular dysfunction in HFpEF patients. Shared cardiovascular risk factors of HFpEF and CSVD and moderate-to-strong correlation between cardiovascular parameters (e.g. diastolic function, arterial stiffness) with the CSVD-score indicate a potential link between HFpEF and CSVD. These data highlight the urgent need for interdisciplinary heart-brain research to investigate potential overlapping pathophysiological mechanisms of HFpEF and CSVD.



Fig. 1: Markers of cerebral small vessel disease in HFpEF patients

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