Department of Anesthesiology and Perioperative Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA.
Division of Cardiology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA.
J Neurosci Res. 2023 Oct;101(10):1662-1674. doi: 10.1002/jnr.25229. Epub 2023 Jul 17.
Heart failure (HF) leads to brain injury in autonomic, respiratory, mood, and cognitive control sites, revealed as tissue volume loss, altered metabolites, and impaired diffusion tissue properties. The extent of myelin changes in HF and variations within sexes are unclear. Our aim was to examine regional brain subcortical and white matter myelin integrity in HF patients over control subjects, as well as differences between sexes using T1- and T2-weighted clinical images. We acquired T1- and T2-weighted images from 63 HF patients and 129 controls using a 3.0-Tesla MRI scanner. Using T1- and T2-weighted images, ratio maps were computed, normalized to a common space, smoothed, and compared between groups (ANCOVA; covariates: age and sex; SPM12, false discovery rate, p < .010), as well as between male versus female HF (ANCOVA; covariate: age; SPM12, uncorrected p < .005). Multiple brain areas in HF showed decreased myelin integrity, including the amygdala, hippocampus, cingulate, insula, cerebellum, prefrontal cortices, and multiple white matter areas, compared to controls. Female HF patients showed more brain injuries in the parietal, prefrontal and frontal, hippocampus, amygdala, pons, cerebellar, insula, and corpus callosum compared to male HF patients. HF subjects showed compromised subcortical and white matter myelin integrity, especially in sites regulating autonomic, respiratory, mood, and cognition, with more changes in females over males. These findings provide a structural basis for the enhanced symptoms identified in female over male HF patients with similar disease severity.
心力衰竭（HF）导致自主神经、呼吸、情绪和认知控制部位的脑损伤，表现为组织体积损失、代谢物改变和扩散组织特性受损。HF 中髓鞘变化的程度和性别差异尚不清楚。我们的目的是检查 HF 患者与对照组之间的脑皮质下和白质区域的局部脑白质髓鞘完整性，以及性别之间的差异，使用 T1-和 T2-加权临床图像。我们使用 3.0-Tesla MRI 扫描仪从 63 名 HF 患者和 129 名对照者中获取 T1-和 T2-加权图像。使用 T1-和 T2-加权图像，计算出比率图，将其归一化为公共空间，进行平滑处理，并在组间（ANCOVA；协变量：年龄和性别；SPM12，假发现率，p < .010）进行比较，以及在男性与女性 HF 之间进行比较（ANCOVA；协变量：年龄；SPM12，未校正的 p < .005）。与对照组相比，HF 患者的多个大脑区域显示出髓鞘完整性降低，包括杏仁核、海马体、扣带回、脑岛、小脑、前额皮质和多个白质区域。与男性 HF 患者相比，女性 HF 患者的顶叶、前额和额叶、海马体、杏仁核、脑桥、小脑、脑岛和胼胝体的脑损伤更多。HF 患者的皮质下和白质髓鞘完整性受损，特别是在调节自主神经、呼吸、情绪和认知的部位，女性的变化比男性更明显。这些发现为在具有相似疾病严重程度的女性 HF 患者中发现的增强症状提供了结构基础。
