Abstract
Introduction: Heart failure (HF) patients exhibit impairments in memory and executive function that contribute to HF mortality. Structural brain changes have been reported in areas which control these functions (mammillary bodies, hippocampi, and frontal cortex) using complex magnetic resonance imaging (MRI) quantitative analysis procedures. However, these quantitative MRI procedures are time-consuming to carry out and are not part of standard clinical assessment. It is unknown whether standard visual examination of MR images can detect changes in brain structures controlling memory and executive function in HF. Hypothesis: Heart failure patients would show more mammillary body, hippocampal, and frontal cortical atrophy versus control subjects. Methods: We visually assessed whole brain regions in 17 HF (mean age ± SD, 54.4 ± 8.1 years; LVEF, 0.28 ± 0.07) and 50 control subjects (age, 50.6 ± 7.0 years) using high-resolution T1-, T2-, and proton density-weighted images acquired from a 3.0 Tesla MRI scanner. Standardized visual scores were assigned to the mammillary bodies and frontal cortex for global atrophy and to the hippocampi for global and regional atrophy and scores were compared between HF and control groups. Results and Conclusions: Significant global changes emerged in the right mammillary body (1.18±1.13 vs. 0.52±0.74; p=0.024), right hippocampus (1.53±0.94 vs. 0.80±0.86; p=0.005), and left frontal cortex (1.76±1.03 vs. 1.24±0.77; p=0.034) in HF compared to controls. Global changes in the left mammillary body, left hippocampus, and right frontal cortex, and regional differences in bilateral hippocampi did not emerge. In conclusion, visual examination of MR images can detect brain damage in areas controlling memory and executive function in HF patients and may allow for increased opportunity to evaluate the progression of injury to these brain structures and to more easily identify and evaluate potential treatments for this damage in HF patients.
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