Comprehensive Heart Failure Center Würzburg, University and University Hospital Würzburg, Am Schwarzenberg 15, 97078 Würzburg, Germany.
Department of Medicine I, University Hospital Würzburg, Josef-Schneider-Straße 11, Würzburg 97080, Germany.
Eur Heart J. 2021 Apr 21;42(16):1569-1578. doi: 10.1093/eurheartj/ehab003.
We quantified the concurring dynamics affecting total and hippocampal brain volume and cognitive function in patients with chronic heart failure (HF) over a period of three years.
A total of 148 patients with mild stable HF entered this monocentric prospective cohort study: mean age 64.5 (10.8) years; 16.2% female; 77% in New York Heart Association functional classes I-II; 128 and 105 patients attended follow-up visits after 1 and 3 years, respectively. The assessment included cardiological, neurological, psychological work-up, and brain magnetic resonance imaging. Total and regional brain volumes were quantified using an operator-independent fully automated approach and reported normalized to the mean estimated intracranial volume. At baseline, the mean hippocampal volume was ∼13% lower than expected. However, the 3-year progressive hippocampal volume loss was small: -62 mm3 [95% confidence interval (CI) -81 to -42, P < 0.0001). This corresponded to a relative change of -1.8% (95% CI -2.3 to -1.2), which was similar in magnitude as observed with physiological aging. Moreover, the load of white matter hypointensities increased within the limits of normal aging. Cognitive function during the 3-year observation period remained stable, with 'intensity of attention' as the only domain declining (LSmean -1.82 points, 95% CI -3.05 to -0.58, P = 0.004). After 3 years, performance in all domains of cognition remained associated with hippocampal volume (r ≥ 0.29).
In patients with predominantly mild HF, the markedly reduced hippocampal volume observed at baseline was associated with impaired cognitive function, but no accelerated deterioration in cognition and brain atrophy became evident over a mid-term period of three years.
我们定量分析了在三年内影响慢性心力衰竭（HF）患者总脑容量和海马脑容量及认知功能的并发因素。
这项单中心前瞻性队列研究共纳入 148 例轻度稳定型 HF 患者：平均年龄 64.5（10.8）岁；16.2%为女性；77%处于纽约心脏协会心功能 I-II 级；128 例和 105 例患者分别在 1 年和 3 年后进行了随访。评估包括心脏、神经、心理检查和脑磁共振成像。采用一种独立于操作者的全自动方法对总脑和区域脑容量进行定量，并报告为标准化平均预期颅内体积。基线时，平均海马体体积比预期低约 13%。然而，3 年内海马体体积的渐进性损失较小：-62 mm3[95%置信区间（CI）-81 至-42，P < 0.0001]。这相当于相对变化-1.8%（95% CI -2.3 至-1.2），与生理性衰老观察到的变化程度相似。此外，在正常衰老范围内，白质低信号的负荷增加。在 3 年的观察期内，认知功能保持稳定，只有“注意力强度”这一领域下降（LSmean -1.82 分，95% CI -3.05 至-0.58，P = 0.004）。3 年后，认知功能的所有领域的表现仍与海马体体积相关（r ≥ 0.29）。
在以轻度 HF 为主的患者中，基线时观察到的明显减少的海马体体积与认知功能受损有关，但在 3 年的中期内，认知功能和脑萎缩均无加速恶化的迹象。
