Abstract
The hemodynamic consequences of a persistent reduced ejection fraction and unknown cardiac output on the brain have not been thoroughly studied. We sought to explore the status of the mechanisms of cerebrovascular regulation in patients with heart failure with reduced (HFrEF) and recovered (HFrecEF) ejection fraction. We monitored cerebral blood flow velocity (CBFV) with transcranial Doppler and blood pressure. Cerebral autoregulation, assessed by transfer function from the spontaneous oscillations of blood pressure to CBFV and neurovascular coupling (NVC) with visual stimulation were compared between groups of HFrEF, HFrecEF and healthy controls. NVC was significantly impaired in HFrEF patients with reduced augmentation of CBFV during stimulation (overshoot systolic CBFV 19.11 ± 6.92 vs. 22.61 ± 7.78 vs. 27.92 ± 6.84, p = 0.04), slower upright of CBFV (rate time to overshoot: 1.19 ± 3.0 vs. 3.06 (4.30) vs. 2.90 ± 3.84, p = 0.02); p = 0.023) and reduced arterial oscillatory properties (natural frequency 0.17 ± 0.06 vs. 0.20 ± 0.09 vs. 0.24 ± 0.07, p = 0.03; attenuation 0.34 ± 0.24 vs. 0.48 ± 0.35 vs. 0.50 ± 0.23, p = 0.05). Cerebral autoregulation was preserved. The neurovascular unit of subjects with chronically reduced heart pumping capability is severely dysfunctional. Dynamic testing with transcranial Doppler could be useful in these patients, but whether it helps in predicting cognitive impairment must be addressed in future prospective studies.
Highlights
Increased rates of cognitive decline and dementia have been documented in patients with heart failure (HF) [1]
Vascular risk factors were distributed in HF with reduced ejection fraction (HFrEF) patients and HF with recovered ejection fraction (HFrecEF) controls
Mean Montreal Cognitive Assessment (MoCA) scores were similar in both groups of HF subjects, 3 out of 20 patients with HFrEF had a MoCA score compatible with cognitive deficit, with 2 SD below appropriate norms, adjusted to age and education level, but without criteria for dementia [11]
Summary
Increased rates of cognitive decline and dementia have been documented in patients with heart failure (HF) [1]. Some previous studies adopted EF, the percentage of blood volume ejected in one cardiac cycle, to infer the severity of the disease while others focused on CO, the volume of blood pumped by the heart in every minute, since it considers both systolic and diastolic functions. These parameters are commonly related but not always in accordance when cardiac function is studied. Of how heart performance was estimated, while stroke and cerebrovascular disease has been investigated, the hemodynamic consequences of a persistent reduced
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