Abstract 13410: Severe Brain White Matter Hyperintensity is Associated With Local Brain Atrophy of Parahippocampal Gyrus and Predicts Prognosis in Heart Failure Patients Without Dementia

Abstract

Introduction: Aged heart failure (HF) patients without dementia may have a risk of cognitive impairment (CI) that attenuates the effect of treatment for HF. White Matter Hyperintensity (WMH) is a potential risk of CI through a disconnection of subcortical brain network. On the other hand, patients with CI have severe brain atrophy in parahippocampal gyrus (PHG). However, it is not clear whether WMH is associated with atrophy in PHG and predicts prognosis of HF patients. Hypothesis: In HF patients without dementia, WMH is associated with brain atrophy of PHG, a potential risk of CI, and predicts prognosis. Methods: Sixty-five HF patients (age 76±11 years, NYHA class II, EF47±17 %) were enrolled. We excluded patients with dementia using mini-mental state examination. We took 3D-T1 weighted images and Fluid Attenuated Inversion Recovery (FLAIR) images of whole brain using 1.5T magnetic resonance imaging. Image analysis was performed to evaluate the severity of atrophy of PHG and volume of WMH using 2mm voxel-based morphometry by the statistical parametric mapping software. The Z-score value was calculated to evaluate the severity of atrophy in PHG. A Kaplan-Meier Curve adjusted with age, sex, presence of atrial fibrillation, and blood pressure was constructed using inverse probability weighting method. Results: We determined the cut-off point of the volume of WMH for estimating cardiac death using a receiver operating characteristic curve. Patients were divided into High-WMH group (n=37, volume of WMH 30±13 mL) and Low-WMH group (n=28, volume of WMH 8±5 mL) according to the cut-off value (15mL). As shown in representative cases (Figure1), the Z-score value in PHG (pink circle) was higher in High-WMH group (1.45±0.78, white arrow) compared to Low-WMH group (0.94±0.57, P=0.006). Adjusted Kaplan-Meier curves showed poor prognosis of High-WMH group (Figure 2). Conclusions: In HF patients without dementia, severe WMH is a potential risk of CI and predicts poor prognosis.