Abstract 12308: Stress-Related Neural Activity Predicts Subsequent Heart Failure

Abstract

Introduction: Higher stress-related neural activity (SNA) associates with subsequent risk of cardiovascular disease. We investigated whether heightened SNA predicts subsequent heart failure (HF). Methods: Individuals (N=2,112; median age 69 years; 48% female) enrolled in the Mass General Brigham Biobank without baseline HF who underwent clinically indicated 18 F-fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT) imaging were retrospectively identified. SNA was measured using validated methods, as amygdalar metabolic activity corrected for regulatory brain (i.e., medial prefrontal cortical) activity. Subsequent development of HF was determined via medical record review using International Classification of Diseases 10 (ICD-10) codes. Survival analyses using Cox and Kaplan-Meier models were performed. Results: Over a median follow-up period of 3.9 years after imaging, 210 individuals developed HF (57 systolic, 93 diastolic). Individuals with subsequent HF (versus no HF) had higher baseline SNA (mean Z-score 0.19 ± 1.07 versus -0.08 ± 0.99; p=0.005, adjusted for age and sex). SNA associated with subsequent HF when divided into tertiles (Figure) and as a continuous measure (standardized HR [95% CI]: 1.38 [1.11-1.70], p=0.003, adjusted for age, sex, hypertension, hyperlipidemia, diabetes and smoking). The association between SNA and HF subtype was stronger for diastolic HF (1.37 [1.00-1.88], p=0.047) than for systolic HF (1.14 [0.87-1.49], p=0.348) in models additionally adjusting for history of myocardial infarction. Conclusion: In this retrospective study of individuals with clinical FDG-PET/CT imaging, higher SNA predicted subsequent HF with a somewhat stronger association for diastolic HF. Understanding the link between heightened stress-associated neural activity and subsequent HF may provide important insights into better HF prevention and management strategies.