Impaired microvascular function in HF is related to cognitive impairment.


08 October 2023

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Source/Disclosure


Disclosures: Hillier and another author are listed as patent holders for a method and apparatus for determining biomarkers of vascular function using BOLD cardiac MRI. Please see the study for relevant financial disclosures of all other authors.


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key takeaways:

  • Heart failure may be a precursor to microvascular dysfunction in the heart and brain.
  • Both cardiac output and myocardial oxygenation reserve were correlated with impaired cognitive function.

The researchers reported that HF ​​was independently predictive of impaired cognitive function, both cardiac and cerebral microvascular dysfunction.

data was published Circulation: Heart Failure,



heart brain 2019 adobe
Heart failure may be a precursor to microvascular dysfunction in the heart and brain.
Image: Adobe Stock

“Although the underlying pathophysiology of HF is heterogeneous and remains incompletely understood, several overlapping pathophysiological mechanisms have been proposed for the development of HF-associated cognitive impairment, including chronic cerebral hypoperfusion or endothelial dysfunction through arterial hypertension and systemic inflammation. “Includes a reduction in cerebrovascular reactivity.” , Elizabeth Hillier, PhD, A research scientist in the Division of Experimental Medicine, Faculty of Medicine and Health Sciences at McGill University in Montreal, and colleagues wrote. “The purpose of this study is to assess myocardial and cerebral oxygenation status in patients with HF and to correlate these findings with cardiovascular and cognitive functional status.”

hillier elizabeth 2019

Elizabeth Hillier

To assess microvascular function, Hillier and colleagues used a standardized breathing exercise to determine cerebral and myocardial oxygenation reserve in 20 patients with HF (mean age, 64 years; 50% women) compared with 21 healthy controls (mean age, 64 years; 50% women). Used oxygenation-sensitive MRI during the maneuver. 55 years; 62% women). Cognitive function was assessed using the Montreal Cognitive Assessment Test.

The researchers observed lower cerebral and myocardial oxygenation reserve in patients with HF compared with healthy controls (mean myocardial oxygenation reserve, 0.1 versus 5; mean cerebral oxygenation reserve, 0.43 versus 1.21). The mean Montreal Cognitive Assessment score results were also lower within the HF group (23.9 vs. 27.8; P = .002) and both correlated with cardiac output (R = 0.55; P = .011) and myocardial oxygenation reserve (R = 0.46; P = .04).

“To our knowledge, this is the first study to semi-simultaneously evaluate brain and myocardial oxygenation changes during vasoactive intervention. “In the present study, we observed reduced oxygenation reserve in both the myocardial and cerebral vascular beds of patients with HF, which was not related to left ventricular ejection fraction, but rather to cardiac output,” the researchers wrote. “A reduction in oxygenation reserve was also observed in the brain, where it was associated with reduced cognitive function.

“The positive correlation observed between cerebral and myocardial oxygenation reserve indicates a possible parallel pathophysiology of microvascular dysfunction in both vascular beds,” the researchers wrote. “This may be explained by systemic factors, such as hypertension and related treatments as confounders, or chronic hypoperfusion due to decreased overall ventricular function.”

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