Brain atrophy in heart failure patients following left ventricular assist device implantation or heart transplantation

JHLT Open Pub Date : 2025-02-01 DOI:10.1016/j.jhlto.2025.100211

D.Alan Herbst MD , Banafsheh Shakibajahromi MD , Michael V. Genuardi MD , Amit Iyengar MD , Dawn Mechanic-Hamilton PhD , H. Branch Coslett MD , Pavan Atluri MD , Christopher G. Favilla MD

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Abstract

Advanced heart failure is associated with accelerated brain atrophy, largely related to chronic cerebral malperfusion. Both heart transplantation (HT) and left ventricular assist device (LVAD) implantation improve vital organ perfusion, but the comparative effect on brain atrophy remains unclear. Given the MR incompatibility of LVADs, we leveraged serial CT imaging in patients who underwent either HT or LVAD implantation. 58 patients were included in this single-center retrospective cohort (23 LVAD; 35 HT). LVAD patients experienced greater brain atrophy (median: 7.1 mL/year; IQR: 0.9–15.7) than transplant patients (median: 0.4 mL/year; IQR: −6.7–13.9), but this difference was non-significant (p=0.09). Temporal atrophy (expansion of the Sylvian fissure) was greater in LVAD patients (median: 0.91 mm/year; IQR: 0.14–2.27) than HT patients (median: 0.10 mm/year; IQR: 0.02–0.55), p=0.005. These observations reveal a need for future work to prospectively quantify brain atrophy after LVAD implantation and HT, while comparing with that of advanced heart failure.

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左心室辅助装置植入或心脏移植后心力衰竭患者脑萎缩

晚期心力衰竭与脑萎缩加速相关，主要与慢性脑灌注不良有关。心脏移植（HT）和左心室辅助装置（LVAD）植入均能改善重要器官灌注，但对脑萎缩的比较效果尚不清楚。考虑到LVAD的MR不相容，我们对接受HT或LVAD植入的患者进行了连续CT成像。该单中心回顾性队列纳入了58例患者(23 LVAD；35 HT)。LVAD患者出现更大的脑萎缩(中位数：7.1 mL/年；IQR: 0.9-15.7)高于移植患者(中位数：0.4 mL/年；IQR:−6.7-13.9)，但差异无统计学意义（p=0.09）。颞叶萎缩（颞裂扩张）在LVAD患者中更为严重(中位数：0.91 mm/年；IQR: 0.14-2.27)高于HT患者(中位数：0.10 mm/年；IQR: 0.02 ~ 0.55), p=0.005。这些观察结果表明，未来需要前瞻性地量化LVAD植入和HT后的脑萎缩，并与晚期心力衰竭进行比较。

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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JHLT Open

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