This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Lee, C. W. Articles by Kim, J.-J. Search for Related Content PubMed PubMed Citation Articles by Lee, C. W. Articles by Kim, J.-J. Related Collections Congestive Brain Circulation and Metabolism

(Circulation. 2001;103:2784.)
© 2001 American Heart Association, Inc.

Brief Rapid Communications

Prognostic Significance of Cerebral Metabolic Abnormalities in Patients With Congestive Heart Failure

Cheol Whan Lee, MD; Jung Hee Lee, PhD; Tae-Hwan Lim, MD, PhD; Hyun Suk Yang, MD; Myeong-Ki Hong, MD; Jae-Kwan Song, MD, PhD; Seong-Wook Park, MD, PhD; Seung-Jung Park, MD, PhD; Jae-Joong Kim, MD, PhD

From the Departments of Medicine (C.W.L., H.S.Y., M.-K.H., J.-K.S., S.-W.P., S.-J.P., J.-J.K.) and Radiology (T.-H.L.) and the Asan Institute for Life Science (J.H.L.), Asan Medical Center, University of Ulsan, Seoul, Korea.

Correspondence to Jae-Joong Kim, MD, PhD, Department of Medicine, University of Ulsan, Asan Medical Center, 388-1 Poongnap-dong, Songpa-gu, Seoul, 138-736,Korea. E-mail jjkim{at}www.amc.seoul.kr

Background—Cerebral metabolic abnormalities were proposed as a potential marker of disease severity in congestive heart failure (CHF), but their prognostic significance remains uncertain.

Methods and Results—We investigated the prognostic value of cerebral metabolic abnormalities in 130 consecutive patients with advanced CHF (100 men aged 42.6±11.9 years; left ventricular ejection fraction, 22.2±6.2%). Proton magnetic resonance spectroscopy data were obtained from localized regions (8 mL) of the occipital gray matter and the parietal white matter. The primary end point was the occurrence of death after the proton magnetic resonance spectroscopy. During follow-up (18.5±14.4 months), 21 patients died and 15 underwent urgent heart transplantation. In the Cox proportional model, occipital metabolites (N-acetylaspartate, creatine, choline, and myoinositol), parietal N-acetylaspartate level, and the duration of CHF symptoms (>12 months) were validated as univariate predictors of death. In multivariate Cox analyses, however, the occipital N-acetylaspartate level was an independent predictor of death (hazard ratio, 0.52; 95% CI, 0.41 to 0.67; P<0.001). An analysis with respect to the combined end point of death or urgent transplantation showed similar results. The best cutoff value (9.0 mmol/kg) for occipital N-acetylaspartate level had 75% sensitivity and 67% specificity to predict mortality.

Conclusions—The occipital N-acetylaspartate level is a powerful and independent predictor of CHF mortality, suggesting that cerebral metabolic abnormalities may be used as a new prognostic marker in the assessment of patients with CHF.

Key Words: brain • heart failure • magnetic resonance imaging • prognosis • spectroscopy

This article has been cited by other articles:

				A. Xie, J. B. Skatrud, B. Morgan, B. Chenuel, R. Khayat, K. Reichmuth, J. Lin, and J. A. Dempsey Influence of cerebrovascular function on the hypercapnic ventilatory response in healthy humans J. Physiol., November 15, 2006; 577(1): 319 - 329. [Abstract] [Full Text] [PDF]

				A. Xie, J. B. Skatrud, R. Khayat, J. A. Dempsey, B. Morgan, and D. Russell Cerebrovascular Response to Carbon Dioxide in Patients with Congestive Heart Failure Am. J. Respir. Crit. Care Med., August 1, 2005; 172(3): 371 - 378. [Abstract] [Full Text] [PDF]

				K. Kario, J. Ishikawa, S. Hoshide, Y. Matsui, M. Morinari, K. Eguchi, S. Ishikawa, and K. Shimada Diabetic Brain Damage in Hypertension: Role of Renin-Angiotensin System Hypertension, May 1, 2005; 45(5): 887 - 893. [Abstract] [Full Text] [PDF]

				G. Zuccala, G. Onder, E. Marzetti, M. R. L. Monaco, M. Cesari, A. Cocchi, P. Carbonin, R. Bernabei, and for the GIFA Study Group Use of angiotensin-converting enzyme inhibitors and variations in cognitive performance among patients with heart failure Eur. Heart J., February 1, 2005; 26(3): 226 - 233. [Abstract] [Full Text] [PDF]

				T. Sabatini, P. Barbisoni, R. Rozzini, M. Trabucchi, and G. Zuccala Hypotension and cognitive impairment: Selective association in patients with heart failure Neurology, August 27, 2002; 59(4): 651 - 651. [Full Text] [PDF]

				P. M. Pullicino and J. Hart Cognitive impairment in congestive heart failure?: Embolism vs hypoperfusion Neurology, December 11, 2001; 57(11): 1945 - 1946. [Full Text] [PDF]

				C. R. Malloy Correlation of Cerebral Metabolites With Clinical Outcome Among Patients With Severe Congestive Heart Failure Circulation, June 12, 2001; 103(23): 2771 - 2772. [Full Text] [PDF]