Author + information
- Received December 13, 2017
- Revision received March 21, 2018
- Accepted March 21, 2018
- Published online June 25, 2018.
- Anna Frey, MDa,b,∗ (, )
- Roxane Sell, PhDa,c,
- György A. Homola, PhDa,d,
- Carolin Malsch, PhDa,e,
- Peter Kraft, MDa,f,g,
- Ignaz Gunreben, MDa,f,
- Caroline Morbach, MDa,b,
- Bálint Alkonyi, MD, PhDa,d,
- Eric Schmid, MDa,d,
- Isabella Colonna, MDh,
- Edith Hofer, PhDh,
- Wolfgang Müllges, MDa,f,
- Georg Ertl, MDa,b,
- Peter Heuschmann, MDa,e,i,
- László Solymosi, MDa,d,
- Reinhold Schmidt, MDh,
- Stefan Störk, MDa,b and
- Guido Stoll, MDa,f,∗∗ ()
- aComprehensive Heart Failure Center Würzburg, University and University Hospital Würzburg, Germany, Würzburg, Germany
- bDepartment of Medicine I, University Hospital Würzburg, Würzburg, Germany
- cDepartment of Psychiatry, Psychosomatics and Psychotherapy, University Hospital Würzburg, Würzburg, Germany
- dDepartment of Neuroradiology, University Hospital Würzburg, Würzburg, Germany
- eInstitute of Clinical Epidemiology and Biometry, University of Würzburg, Germany
- fDepartment of Neurology, University Hospital Würzburg, Würzburg, Germany
- gDepartment of Neurology, Hospital Main-Spessart, Lohr, Germany
- hDepartment of Neurology, Medical University of Graz, Graz, Austria
- iClinical Trial Center, University Hospital Würzburg, Würzburg, Germany
Objectives This study sought to determine the spectrum of brain lesions seen in heart failure (HF) patients and the extent to which lesion type contributes to cognitive impairment.
Background Cognitive deficits have been reported in patients with HF.
Methods A total of 148 systolic and diastolic HF patients (mean age 64 ± 11 years; 16% female; mean left ventricular ejection fraction 43 ± 8%) were extensively evaluated within 2 days by cardiological, neurological, and neuropsychological testing and brain magnetic resonance imaging (MRI). A total of 288 healthy, sex- and age-matched subjects sampled from the Austrian Stroke Prevention Study served as MRI controls.
Results Deficits in reaction times were apparent in 41% of patients and deficits in verbal memory in 46%. On brain MRI, patients showed more advanced medial temporal lobe atrophy (MTA) (Scheltens score) compared to controls (2.1 ± 0.9 vs. 1.0 ± 0.6; p < 0.001). The degree of MTA was strongly associated with the severity of cognitive impairment, whereas the extent of white matter hyperintensities was similar in patients and controls. Moreover, patients had a 2.7-fold increased risk for presence of clinically silent lacunes.
Conclusions HF patients exhibit cognitive deficits in the domains of attention and memory. MTA but not white matter lesion load seems to be related to cognitive impairment.
This work was supported by grants from the Bundesministerium für Bildung und Forschung (01EO1004 and 01EO1504) through the Comprehensive Heart Failure Center. Dr. Ertl has reported personal fees as consultant, advisory board member, and/or honoraria with Novartis, Bayer, ViFor, and Servier. All other authors have reported that they have conflicts relevant to the contents of this paper to disclose.
- Received December 13, 2017.
- Revision received March 21, 2018.
- Accepted March 21, 2018.
- 2018 American College of Cardiology Foundation