Heart Failure-Induced Brain Injury

• Published in: Journal of the American College of Cardiology Vol. 69; no. 12; pp. 1609 - 1616
• Main Authors: Havakuk, Ofer, MD, King, Kevin S., MD, Grazette, Luanda, MD, Yoon, Andrew J., MD, Fong, Michael, MD, Bregman, Noa, MD, Elkayam, Uri, MD, Kloner, Robert A., MD, PhD
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 28.03.2017; Elsevier Limited
• Subjects: Adhesion; Aging (artificial); Angiotensin; Angiotensin-converting enzyme inhibitors; Animal models; Arteries; Attention; Attenuation; Augmentation; Autopsies; Blood circulation; Blood flow; Blood pressure; Blood vessels; Brain; Brain - pathology; Brain Injuries - etiology; Brain Injuries - pathology; Brain Injuries - psychology; Brain injury; Carbon dioxide; Cardiology; Cardiovascular; Central nervous system; cerebral blood flow; Cerebrospinal fluid; Cerebrovascular Circulation; Cognition; Cognitive ability; Cognitive Dysfunction - etiology; cognitive impairment; depression; Diagnosis; Health risks; Heart; Heart failure; Heart Failure - complications; Hippocampus; Humans; Hypertension; Internal Medicine; Magnetic resonance imaging; Maneuvers; Mathematical models; Mental depression; Mental disorders; Mortality; Nervous system; Neuroimaging; NMR; Nuclear magnetic resonance; Organs; Patients; Peptidyl-dipeptidase A; Pharmacology; Psychomotor performance; Pumps; Quality of life; Risk; Rodents; Sympathetic nervous system; Transplantation; Transplants & implants; Traumatic brain injury; Ultrasound; Vasoactive agents; Vasodilation; Veins; Ventricle; magnetic resonance imaging; IHD; CF-LVAD; MRI; CBF; ischemic heart disease; CNS; sigma-1 receptor; HFpEF; LVAD; cardiac output; white matter; heart failure with preserved ejection fraction; S1R; WM; interleukin; continuous-flow left ventricular assist device; total plasma homocysteine; heart failure; IL; CI; GM; CO; central nervous system; gray matter; cerebral blood flow; cognitive impairment; depression; left ventricular assist device; HF; tHcy
• ISSN: 0735-1097; 1558-3597
• DOI: 10.1016/j.jacc.2017.01.022

Abstract Heart failure (HF) is a systemic illness with grave implications for bodily functions. The brain, among other vital organs, often suffers insults as a result of HF, and both anatomic and functional brain abnormalities were found in the HF population. This injury was demonstrated across a wide range of clinical conditions and cardiac functions and was shown to affect patients’ outcomes. Although reduced cardiac output and high burden of cardiovascular risk factors are the prevailing explanations for these findings, there are data showing the involvement of neurohormonal, nutritional, and inflammatory mechanisms in this complex process. Here, the authors review the suggested pathophysiology behind brain injury in HF, describe its effect on patients’ outcomes, offer a diagnostic approach, and discuss possible therapeutic options.