Cerebral cortical microinfarcts: A novel MRI marker of vascular brain injury in patients with heart failure

Doeschka Ferro,Hilde Van Den Brink,Raquel Amier,Mark Van Buchem,Jeroen De Bresser,Esther Bron,Hans-Peter Brunner-La Rocca,Astrid Hooghiemstra,Nick Marcks,Albert Van Rossum,Geert Jan Biessels

doi:10.1016/j.ijcard.2020.04.032

Abstract

BackgroundPatients with heart failure (HF) are at risk for vascular brain injury. Cerebral cortical microinfarcts (CMIs) are a novel MRI marker of vascular brain injury. This study aims to determine the occurrence of CMIs in patient with HF and their clinical correlates, including haemodynamic status. MethodsFrom the Heart-Brain Study, a multicenter prospective cohort study, 154 patients with clinically stable HF without concurrent atrial fibrillation (mean age 69.5 ± 10.1, 32% female) and 124 reference participants without HF (mean age 65.6 ± 7.4, 47% females) were evaluated for CMIs on 3 T MRI. CMI presence in HF was tested for associations with vascular risk profile, cardiac function and history, MRI markers of vascular brain injury and cognitive profile. ResultsCMI occurrence was higher in patient with HF (17%) than reference participants (7%); after correction for age and sex OR 2.5 [95% CI 1.1–6.0] p = .032; after additional correction for vascular risk factors OR 2.7 [1.0–7.1] p = .052. In patients with HF, CMI presence was associated with office hypertension (OR 2.7 [1.2–6.5] p = .021) and a lower cardiac index (B = -0.29 [−0.55−−0.04] p = .023 independent of vascular risk factors), but not with cause or duration of HF. Presence of CMIs was not associated with cognitive performance in patients with HF. ConclusionsCMIs are a common occurrence in patients with HF and related to an adverse vascular risk factor profile and severity of cardiac dysfunction. CMIs thus represent a novel marker of vascular brain injury in these patients.

Highlights

Heart failure (HF) is associated with an increased risk for vascular brain injury [1]
Among patients with heart failure (HF), we explored the relation between cortical microinfarcts (CMIs) presence and vascular risk profile, measures of cardiac functions and cardiac history, MRI markers of vascular brain injury and cognitive performance
CMI occurrence was higher in patients with HF than reference participants after correction for age and sex

Summary

Introduction

Heart failure (HF) is associated with an increased risk for vascular brain injury [1]. Cerebral cortical microinfarcts (CMIs) have attracted attention as a novel marker of vascular brain injury. Cerebral cortical microinfarcts (CMIs) are a novel MRI marker of vascular brain injury. CMI presence in HF was tested for associations with vascular risk profile, cardiac function and history, MRI markers of vascular brain injury and cognitive profile. In patients with HF, CMI presence was associated with office hypertension (OR 2.7 [1.2–6.5] p = .021) and a lower cardiac index (B = -0.29 [−0.55−−0.04] p = .023 independent of vascular risk factors), but not with cause or duration of HF. Conclusions: CMIs are a common occurrence in patients with HF and related to an adverse vascular risk factor profile and severity of cardiac dysfunction. CMIs represent a novel marker of vascular brain injury in these patients

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