Abstract 13948: Deep Learning Identification of Brain Structural Atrophy Associated With Heart Failure With Preserved Ejection Fraction Among Patients With Preexisting Dementia Using Clinical Imaging

Abstract

Background: Heart failure with preserved ejection fraction (HFpEF) and dementia share several cardiovascular risk factors and have been independently associated with brain atrophy. However, it is unclear how HFpEF affects brain morphology in patients with preexisting dementia. Advances in bioinformatics data extraction pipelines, quantitative neuroimaging, and deep learning, have made possible the analysis of the effects of cardiovascular disease on clinical neuroimaging in large datasets. Hypothesis: We hypothesized that HFpEF in the setting of dementia would be associated with distinct brain morphology imaging changes compared to dementia in the absence of HFpEF. Methods: We used the bioinformatics tools at Vanderbilt University Medical Center to extract and analyze deidentified clinical neuroimaging from patients with a diagnosis of dementia with and without coexisting HFpEF from the electronic health record. We identified a total of 30 patients with HFpEF and dementia who had high-resolution, clinical neuroimaging as well as 301 age- and sex-matched controls. We used an automated pipeline to segment the brain into 132 distinct brain regions and estimate their volume to find structural differences associated with HFpEF. Results: We found six regions with significant atrophy associated with HFpEF: accumbens area, amygdala, posterior insula, anterior orbital gyrus, angular gyrus, and cerebellar white matter. There were no regions with atrophy inversely associated with HFpEF (Figure 1). Conclusions: Here, we show that patients with HFpEF have a distinct neuroimaging signature on patients with preexisting dementia. A possible mechanism of injury for this region and the subsequent atrophy has been linked to high aortic stiffening secondary to chronic cardiovascular disease and its risk factors, resulting in end-organ damage due to barotrauma and shear forces.