Herbst D Alan, Shakibajahromi Banafsheh, Genuardi Michael V, Iyengar Amit, Mechanic-Hamilton Dawn, Branch Coslett H, Atluri Pavan, Favilla Christopher G
Division of Cardiothoracic Surgery, University of Pennsylvania, Philadelphia, PA.
Department of Neurology, University of Pennsylvania, Philadelphia, PA.
JHLT Open. 2025 Jan 15;7:100211. doi: 10.1016/j.jhlto.2025.100211. eCollection 2025 Feb.
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 (=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), =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.
晚期心力衰竭与脑萎缩加速有关，这在很大程度上与慢性脑灌注不足有关。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仍不明确。鉴于LVAD与磁共振成像不兼容，我们对接受HT或LVAD植入的患者进行了系列CT成像检查。本单中心回顾性队列研究纳入了58例患者（23例LVAD；35例HT）。LVAD患者的脑萎缩程度（中位数：7.1 mL/年；四分位间距：0.9 - 15.7）高于移植患者（中位数：0.4 mL/年；四分位间距：-6.7 - 13.9），但这种差异无统计学意义（P = 0.09）。LVAD患者的颞叶萎缩（大脑外侧裂增宽）程度（中位数：0.91 mm/年；四分位间距：0.14 - 2.27）高于HT患者（中位数：0.10 mm/年；四分位间距：0.02 - 0.55），P = 0.005。这些观察结果表明，未来有必要开展前瞻性研究，对LVAD植入和HT后的脑萎缩进行量化，并与晚期心力衰竭患者的脑萎缩情况进行比较。
