Multimodal MRI reveals cortical triple-hit and subcortical compensation in cognitively normal chronic heart failure patients
C Pan, Y Pan, Y Zhou, Q Xie, W Tang, T Jia, F Hu, L Lu, M Shao, A Wang, J ChenAbstract
Background
Chronic heart failure (HF) is an independent risk factor for cognitive impairment, with cerebral hypoperfusion serving as the core pathological pathway mediating HF-related brain dysfunction. Previous studies have largely relied on a single imaging modality and focused on HF patients with overt cognitive symptoms. However, systematic multi-modality imaging evidence integrating cerebral blood flow, brain structure, and function remains lacking in HF patients with normal cognitive function.
Objective
To investigate aberrant multi-modality brain imaging patterns in cognitively normal HF patients by combining arterial spin labeling (ASL), voxel-based morphometry (VBM), and regional homogeneity (ReHo), thereby providing evidence for the early identification of HF-related subclinical brain alterations.
Methods
Forty-seven patients with chronic HF diagnosed according to guideline criteria and 34 non-HF controls rigorously matched for age, sex, years of education, and underlying cardiovascular diseases were enrolled. All participants underwent cognitive assessments and 3.0T multi-modality MRI scanning to obtain cerebral blood flow (CBF), gray matter volume, and ReHo parameters. Between-group comparisons were performed using two-sample t-tests controlling for key covariates, followed by rigorous correction for multiple comparisons. The spatial overlap patterns of multi-modality abnormalities and their correlations with left ventricular ejection fraction (LVEF) were analyzed.
Results
No significant differences in cognitive scale scores were observed between the two groups (P > 0.05). Extensive brain imaging abnormalities were already present in HF patients: the left occipital cortex exhibited triple negative alterations characterized by decreased CBF, gray matter atrophy, and reduced ReHo (FDR correction, P < 0.001); the bilateral basal ganglia and cerebellum showed compensatory dual alterations with increased CBF and elevated ReHo (FDR correction, P < 0.001). Imaging metrics in the left occipital region were significantly positively correlated with LVEF (P < 0.01).
Conclusions
Characteristic multi-modality brain imaging alterations exist in cognitively normal HF patients, featuring a distinct pattern of "cortical negative alterations—subcortical compensation". Multi-modality MRI may provide sensitive biomarkers for the early identification of HF-related subclinical brain abnormalities.Figure2Figure1