Sarah Choi, PhD, RN, FNP Associate Professor, School of Nursing, University of California Los Angeles. Bhaswati Roy, PhD Postdoctoral Scholar, Department of Anesthesiology, David Geffen School of Medicine, University of California Los Angeles. Rajesh Kumar, PhD Professor, Departments of Anesthesiology, Radiology, and Bioengineering, David Geffen School of Medicine, University of California Los Angeles. Gregg C. Fonarow, MD Professor and Director, David Geffen School of Medicine, University of California Los Angeles, and Ahmanson-UCLA Cardiomyopathy Center. Mary A. Woo, PhD, RN Professor, School of Nursing, University of California Los Angeles.
J Cardiovasc Nurs. 2019 Nov/Dec;34(6):433-439. doi: 10.1097/JCN.0000000000000611.
Inadequate self-care is linked to poor health outcomes in heart failure (HF). Self-care depends on decision-making abilities, but links between self-care and brain injury to executive decision-making regulatory areas (prefrontal cortices) are unclear.
We investigated the relationships between HF self-care and status of prefrontal cortices.
Magnetic resonance imaging-based diffusion tensor imaging was performed in 21 patients with HF (age, 53.8 ± 7.9 years; 15 men; left ventricular ejection fraction, 25.1% ± 6.1%), and self-care and executive function were measured with the Self-care of Heart Failure Index (SCHFI) and Trail Making Test B. Using diffusion tensor imaging data, mean diffusivity (MD) maps were calculated and region-of-interest analyses were performed on the left and right prefrontal brain areas. Statistical analyses consisted of partial correlations (covariates, age, and gender).
The mean ± SD SCHFI scores were 70.78 ± 11.37 for maintenance, 70 ± 17.32 for management, and 74.91 ± 15.76 for confidence. The mean ± SD Trail Making Test B score was 90.2 ± 73.3 seconds. The mean ± SD MD values (higher values indicate tissue injury) of the left and right prefrontal cortices were 1.46 ± 0.16 (×10 mm/s) and 1.44 ± 0.14 (×10 mm/s), respectively. Significant negative correlations emerged between prefrontal MD values and SCHFI maintenance (left/right, r = -0.64/-0.70; P < .003) and SCHFI management (r = -0.93/-0.86; P < .003). Significant positive correlations were observed between prefrontal MD values and Trail Making Test B (r = 0.71/0.74; P < .001). A nonsignificant correlation emerged between prefrontal MD values and SCHFI confidence scores.
Brain tissue integrity in executive function regulatory regions is associated with HF self-care for maintenance and management. The findings indicate that protection and brain injury repair in executive control areas may improve HF self-care.
心力衰竭（HF）患者自我护理不足与健康状况不佳有关。自我护理取决于决策能力，但自我护理与大脑损伤执行决策调节区域（前额叶皮质）之间的联系尚不清楚。
我们研究了 HF 自我护理与前额叶皮质状态之间的关系。
对 21 例 HF 患者（年龄 53.8±7.9 岁；男性 15 例；左心室射血分数 25.1%±6.1%）进行基于磁共振成像的弥散张量成像，使用心力衰竭自我护理量表（SCHFI）和连线测试 B 测量自我护理和执行功能。使用弥散张量成像数据计算平均弥散度（MD）图，并对左、右前额叶脑区进行感兴趣区分析。统计分析包括偏相关（协变量为年龄和性别）。
SCHFI 中维持、管理和信心的平均得分分别为 70.78±11.37、70±17.32 和 74.91±15.76。连线测试 B 的平均得分（秒）为 90.2±73.3。左、右前额皮质的 MD 值（平均值±标准差，更高的值表示组织损伤）分别为 1.46±0.16（×10mm/s）和 1.44±0.14（×10mm/s）。前额皮质 MD 值与 SCHFI 维持（左/右，r=-0.64/-0.70；P<0.003）和 SCHFI 管理（r=-0.93/-0.86；P<0.003）呈显著负相关。前额皮质 MD 值与连线测试 B 呈显著正相关（r=0.71/0.74；P<0.001）。前额皮质 MD 值与 SCHFI 信心评分呈正相关。
执行功能调节区域的脑组织完整性与 HF 患者的自我护理维持和管理有关。这些发现表明，在执行控制区域保护和脑损伤修复可能会改善 HF 患者的自我护理。
