Abstract 2237: Brain White Matter Regulating Autonomic and Cognitive Functions is Damaged in Heart Failure
BACKGROUND: Heart failure (HF) patients have gray matter injury in brain regions regulating autonomic and cognitive functions. The pathophysiology underlying affected gray matter is unknown, but likely involves processes that also damage neural tracts/white matter connecting injured regions. However, the extent and location of any white matter damage in HF is unclear.
METHODS: To determine if HF patients show structural injury in white matter, we examined 17 HF patients (12 male, age 54 ± 8 years, LVEF 0.28±0.07, atrial fibrillation 3 [17%]) and 51 healthy controls (49 male, age 50 ± 7 years) using diffusion tensor imaging during brain MRI. We calculated fractional anisotropy (FA- a measure of white matter change). Whole-brain maps of FA for each subject were aligned, smoothed, and compared using ANCOVA, with age as a covariate. Significance was set at p < 0.05 (correction for multiple comparisons).
RESULTS: Widespread regions showed injury in HF patients as indicated by significantly reduced FA; no areas showed higher FA in HF patients than controls. White matter was especially affected in the bilateral cerebellum, mid corpus callosum, mid and anterior cingulum, extensive regions in medial frontal cortex extending to the internal capsule, and posterior parietal cortex.
CONCLUSIONS: HF patients have extensive white matter damage. Injury to cerebellar processes would be especially important for mediation of blood pressure during orthostatic challenges; cingulate injury would affect sympathetic regulation, as would ventral frontal axonal injury. The callosal injury, together with cerebellar projections to frontal regions, would hinder cognitive processing in the syndrome.