Impact of cognitive impairment on heart failure prognosis: insights into central nervous system mechanism.

IF 3.1 3区医学 Q1 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING

EJNMMI Research Pub Date : 2024-11-28 DOI:10.1186/s13550-024-01183-6

Zhiyong Shi, Mingkai Yun, Binbin Nie, Enjun Zhu, Wei Fu, Baoci Shan, Sijin Li, Xiaoli Zhang, Xiang Li

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引用次数: 0

Abstract

Background: Epidemiological studies have indicated that patients with heart failure (HF) who experience cognitive impairment (CI) have a poor prognosis. While poor self-management and compliance are suggested as contributing factors, they do not fully explain the underlying mechanisms of high risk of cardiac events in HF patients with CI. Given the interconnectedness of CI and the autonomic nervous system (ANS), both regulated by the central nervous system, this study investigated the relationship among cognitive function, metabolism in ANS-related brain regions, and major arrhythmic events (MAEs) in patients with HF with reduced ejection fraction (HFrEF).

Results: We retrospectively enrolled 72 patients with HFrEF who underwent gated myocardial perfusion imaging, heart and brain ¹⁸F-FDG positron emission tomography/computed tomography imaging, and cognitive testing. Cognitive function was evaluated using the Mini-Mental State Examination. During the follow-up period, 13 patients (17.8%) experienced MAEs. Patients with MAEs exhibited decreased cognitive function across various domains, including orientation, registration, and language and praxis (all p < 0.05). Patients with CI displayed a prolonged heart rate-corrected QT (QTc) interval and hypometabolism in the left hippocampus and bilateral caudate nuclei (all p < 0.05). Significant correlations were observed between cognitive function, QTc interval, and metabolism in ANS-related brain regions (all p < 0.05). Cox regression model analysis showed that the predictive value of cognitive function is not independent of the QTc interval and there is a significant interaction. The mediation analyses suggested that a prolonged QTc interval resulting from ANS disorder increased risk of MAEs in HFrEF patients with CI. Patients with CI exhibited reduced central autonomic network (CAN) connectivity.

Conclusion: ANS dysfunction, exacerbated by reduced metabolism in ANS-related brain regions and CAN connectivity, contributed to an increased risk of MAEs in HFrEF patients with CI.

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认知障碍对心力衰竭预后的影响：中枢神经系统机制的见解。

背景：流行病学研究表明，心力衰竭（HF）患者认知功能障碍（CI）预后较差。虽然不良的自我管理和依从性被认为是促成因素，但它们并不能完全解释心力衰竭合并CI患者心脏事件高风险的潜在机制。鉴于CI和自主神经系统（ANS）均受中枢神经系统的调控，本研究探讨了心力衰竭伴射血分数降低（HFrEF）患者的认知功能、自主神经相关脑区代谢和主要心律失常事件（MAEs）之间的关系。结果：我们回顾性地纳入了72例HFrEF患者，他们接受了门控心肌灌注成像、心脑18F-FDG正电子发射断层扫描/计算机断层扫描成像和认知测试。使用简易精神状态检查评估认知功能。随访期间13例（17.8%）发生MAEs。患有MAEs的患者表现出不同领域的认知功能下降，包括定向、定位、语言和实践(所有p结论：ANS功能障碍，由ANS相关脑区代谢减少和CAN连接加剧，导致HFrEF合并CI患者发生MAEs的风险增加。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

EJNMMI Research RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING&nb-

CiteScore

5.90

自引率

3.10%

发文量

审稿时长

13 weeks

期刊介绍： EJNMMI Research publishes new basic, translational and clinical research in the field of nuclear medicine and molecular imaging. Regular features include original research articles, rapid communication of preliminary data on innovative research, interesting case reports, editorials, and letters to the editor. Educational articles on basic sciences, fundamental aspects and controversy related to pre-clinical and clinical research or ethical aspects of research are also welcome. Timely reviews provide updates on current applications, issues in imaging research and translational aspects of nuclear medicine and molecular imaging technologies. The main emphasis is placed on the development of targeted imaging with radiopharmaceuticals within the broader context of molecular probes to enhance understanding and characterisation of the complex biological processes underlying disease and to develop, test and guide new treatment modalities, including radionuclide therapy.