Abstract 18696: Regional Distribution of Cerebral White Matter Hyperintensities in HFrEF and HFpEF

Abstract

Introduction: Patients with heart failure (HF) commonly suffer from cognitive impairment. White matter hyperintensities (WMHs) are associated with cognitive decline, cardiovascular risk in healthy aging and CNS disorders. Studies have shown that patients with heart failure with reduced ejection fraction (HFrEF) have greater volume of WMHs compared to controls. However, little is known about the distribution and size of WMHs in patients with heart failure with preserved ejection fraction (HFpEF). This study utilizes quantitative neuroimaging analysis to examine volume and regional distribution of WMHs between patients with HFrEF, HFpEF, and controls. Methods: Thirty-nine HF patients (mean age=68.2) and 28 controls (mean age=67.4) underwent high-resolution T-2 weighted fluid attenuated inversion recovery imaging. Volume of WMHs was calculated using the Lesion Segmentation Tool in Statistical Parametric Mapping 8 (SPM8). Total volume of WMHs was divided by intracranial volume to calculate WMH ratio (WMHr). Regional analysis of WMHs was performed using a multiple regression analysis of lesion probability maps in SPM8. Imaging results were family wise error corrected for multiple comparisons. Results: One-way ANCOVA revealed that individuals with HF had greater WMHr compared to controls, controlling for age, sex, and comorbid burden (p=0.001). Further analysis revealed that there was no significant difference in WMHr between HFrEF and HFpEF, although both groups had significantly greater WMHr compared to controls (p=0.005). Individuals with HF were more likely to have WMHs in the right cingulum (p<0.001) and right genu (p=0.001) of the corpus callosum. There were no differences in distribution of WMHs between patients with HRrEF or HFpEF. Conclusion: Patients with HFrEF or HFpEF have greater WMHr compared to controls and WMHs are likely to be located in the right cingulum and genu. The cingulum and genu are white matter tracts that are essential for memory and cognitive control. In patients with HF, the damage to these areas caused by WMHs may be associated changes in cognition. Future studies are needed to further examine the relationship between cognition and WMHs in HF patients and the mechanistic relationship between HF and WMHs.