Abstract
Patients with ischemic heart failure (iHF) have a high risk of neurological complications such as cognitive impairment and stroke. We hypothesized that iHF patients have a higher incidence of impaired dynamic cerebral autoregulation (dCA). Adult patients with iHF and healthy volunteers were included. Cerebral blood flow velocity (CBFV, transcranial Doppler, middle cerebral artery), end-tidal CO2 (capnography), and arterial blood pressure (Finometer) were continuously recorded supine for 5 min at rest. Autoregulation index (ARI) was estimated from the CBFV step response derived by transfer function analysis using standard template curves. Fifty-two iHF patients and 54 age-, gender-, and BP-matched healthy volunteers were studied. Echocardiogram ejection fraction was 40 (20-45) % in iHF group. iHF patients compared with control subjects had reduced end-tidal CO2 (34.1 ± 3.7 vs. 38.3 ± 4.0 mmHg, P < 0.001) and lower ARI values (5.1 ± 1.6 vs. 5.9 ± 1.0, P = 0.012). ARI <4, suggestive of impaired CA, was more common in iHF patients (28.8 vs. 7.4%, P = 0.004). These results confirm that iHF patients are more likely to have impaired dCA compared with age-matched controls. The relationship between impaired dCA and neurological complications in iHF patients deserves further investigation.
Highlights
ISCHEMIC HEART FAILURE is the most common type of cardiomyopathy worldwide
Dynamic Cerebral autoregulation (CA) reflects the transient response of cerebral blood flow (CBF), often recorded as CBF velocity (CBFV) with transcranial Doppler ultrasound (TCD), to rapid changes in blood pressure (BP) [32]
Patients were considered eligible to participate in the study if they fulfilled the following criteria: heart failure due to ischemic, clinically diagnosed chronic heart failure; functional class II or III, according to the New York Heart Association classification [2]; left ventricular ejection fraction (LVEF) Յ45% on transthoracic echocardiography
Summary
ISCHEMIC HEART FAILURE (iHF) is the most common type of cardiomyopathy worldwide. It mainly affects middle-aged and elderly people, leading to high mortality rates, high health care costs, and worsening quality of life [8]. Recent advances in the pathophysiology of heart failure in patients have shown the compromise of neural pathways [38], as well as cerebral structural abnormalities [39]. The pathogenesis of neurological complications in these patients is not well known, they are probably due to low cardiac output and concomitant reduced flow to brain tissue, and/or embolism [6, 10]. Given the potential association between disturbances in CBF regulation and neurological complications, we tested the hypothesis that CA is impaired in patients with iHF
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