Neurovascular Coupling Impairment in Heart Failure with Reduction Ejection Fraction
Abstract
:1. Introduction
2. Materials and Methods
2.1. Study Design
2.2. Medical Evaluation
2.3. Cerebral Hemodynamic Procedure
2.3.1. Cerebral Autoregulation
2.3.2. Neurovascular Coupling
2.4. Statistics
3. Results
4. Discussion
4.1. Neurovascular Unit Dysfunction
4.2. Cerebral Autoregulation
4.3. Limitations
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Acknowledgments
Conflicts of Interest
References
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Baseline Characteristic | HFrEF (n = 23) | HFrecEF (n = 8) | Healthy Controls (n = 13) | p Value *,† | |
Age—years, mean (SD) | 60 (8) | 58 (15) | 60 (20) | 0.98 | |
Male—n (%) | 20 (87) | 6 (75) | 9 (69) | 0.42 | |
BMI—kg/m2, mean (SD) | 29 (5) | 27 (4) | 26 (2) | 0.02 | |
Systolic BP—mmHg, mean (SD) | 125 (23) | 133 (19) | 122 (13) | 0.45 | |
Diastolic BP—mmHg, mean (SD) | 71 (15) | 74 (6) | 70 (9) | 0.76 | |
PxxMAP, mean (SD) | 63 (184) | 16 (22) | 8 (4) | 0.45 | |
HR—bpm, mean (SD) | 64 (12) | 64 (8) | 71 (11) | 0.13 | |
Ejection Fraction—%, mean (SD) | 27 (8) | 49 (12) | - | 0.00 | |
Disease duration—years, mean (SD) | 3.70 (3.78) | 2.75 (1.75) | - | 0.35 | |
Hypertension—n (%) | 9 (31) | 2 (25) | - | 0.47 | |
Diabetes Mellitus—n (%) | 9 (31) | 1 (13) | - | 0.17 | |
Dyslipidemia—n (%) | 11 (48) | 1 (13) | - | 0.08 | |
Chronic Kidney Disease—n (%) | 5 (22) | 1 (13) | - | 0.57 | |
Excessive alcohol intake§—n (%) | 5 (22) | 3 (38) | - | 0.38 | |
Tobacco—n (%) | 4 (17) | 3 (38) | - | 0.24 | |
Obstructive sleep apnea—n (%) | 4 (17) | 0 | - | 0.21 | |
Previous Myocardial Infarction—n (%) | 5 (22) | 0 | - | 0.15 | |
Medication—n (%) | p Value † | ||||
Beta-blockers | Starting dose | 14 (60.9) | 4 (50.0) | - | 0.86 |
Target dose | 9 (39.1) | 3 (37.5) | - | ||
ACEI | Starting dose | 8 (34.8) | 1 (12.5) | - | 0.05 |
Target dose | 4 (17.4) | 5 (62.5) | - | ||
ARB | Starting dose | - | - | - | - |
Target dose | 2 (8.7) | - | - | ||
MRA | Starting dose | 7 (30.4) | 2 (25) | - | 0.96 |
Target dose | 8 (34.8) | 3 (37.5) | - | ||
Sacubitril/valsartan | Starting dose | 3 (13) | 1 (12.5) | - | 0.44 |
Target dose | 4 (17.4) | - | - | ||
Ivabradin | Starting dose | 5 (21.7) | 1 (12.5) | - | 0.55 |
Target dose | 2 (8.7) | - | - | ||
NYHA Class—n (%) | p Value † | ||||
I | 14 (60.9) | 5 (62.5) | - | 0.94 | |
II | 9 (39.1) | 3 (37.5) | - | ||
HF Etiology—n (%) | p Value † | ||||
Idiopathic DCM | 10 (44) | 1 (13) | - | 0.10 | |
Ischemic | 7 (30) | 1 (13) | - | ||
Alcoholic | 5 (22) | 3 (38) | - | ||
Tachyarrhythmia | 1 (4) | 1 (13) | - | ||
Other | - | 2 (25) | - | ||
MoCA Scores—n (%) | p Value *, † | ||||
Mean ± SD | 24 ± 4 | 25 ± 6 | 0.83 | ||
Normal | 14 (70) | 7 (87.5) | - | 0.69 | |
−1SD | 1 (5) | - | |||
−1.5 SD | 2 (10) | - | |||
−2 SD | 3 (15) | 1 (12.5) | - |
HFrEF (n = 23) | HFrecEF (n = 8) | Healthy Controls (n = 13) | p Values * | ||
Mean FV (cm/s) | MCA | 53.64 (14.22) | 52.94 (9.11) | 44.85 (11.25) | 0.35 |
PCA | 33.19 (8.48) | 37.10 (4.79) | 26.91 (6.49) | ||
Mean Pfv (cm/s) | MCA | 8.26 (7.86) | 5.25 (3.23) | 4.40 (3.12) | 0.62 |
PCA | 6.10 (5.28) | 4.72 (2.78) | 3.07 (2.47) | ||
Cerebral Autoregulation | |||||
HFrEF (n = 23) | HFrecEF (n = 8) | Healthy Controls (n = 13) | p Values * | ||
VLF Gain (%/mm Hg) | MCA | 1.08 (0.53) | 0.93 (0.44) | 0.97 (0.37) | 0.71 |
PCA | 1.49 (1.06) | 1.19 (0.58) | 1.15 (0.51) | ||
LF Gain (%/mm Hg) | MCA | 1.12 (0.64) | 0.94 (0.58) | 1.48 (0.46) | 0.67 |
PCA | 1.49 (0.83) | 1.14 (0.56) | 1.76 (0.42) | ||
VLF Phase (radians) | MCA | 0.99 (0.47) | 1.04 (0.22) | 1.15 (0.50) | 0.30 |
PCA | 1.06 (0.52) | 1.32 (0.33) | 1.17 (0.38) | ||
LF Phase (radians) | MCA | 0.86 (0.50) | 0.86 (0.36) | 0.73 (0.26) | 0.67 |
PCA | 0.80 (0.55) | 0.97 (0.31) | 0.79 (0.31) | ||
Neurovascular Coupling (PCA) | |||||
HFrEF (n = 23) | HFrecEF (n = 8) | Healthy Controls (n = 13) | p Values * | ||
Overshoot systolic CBFV (%) | 19.11 (6.92) | 22.61 (7.78) | 27.92 (6.84) | 0.04 | |
Gain (%) | 13.12 (6.31) | 16.70 (8.56) | 19.65 (4.73) | 0.02 | |
Natural frequency (Hz) | 0.17 (0.06) | 0.20 (0.09) | 0.24 (0.07) | 0.03 | |
Attenuation (a.u) | 0.34 (0.24) | 0.48 (0.35) | 0.50 (0.23) | 0.05 | |
Rate time (s) | 1.19 (3.0) | 3.06 (4.30) | 2.90 (3.84) | 0.02 |
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Aires, A.; Andrade, A.; Azevedo, E.; Gomes, F.; Araújo, J.P.; Castro, P. Neurovascular Coupling Impairment in Heart Failure with Reduction Ejection Fraction. Brain Sci. 2020, 10, 714. https://doi.org/10.3390/brainsci10100714
Aires A, Andrade A, Azevedo E, Gomes F, Araújo JP, Castro P. Neurovascular Coupling Impairment in Heart Failure with Reduction Ejection Fraction. Brain Sciences. 2020; 10(10):714. https://doi.org/10.3390/brainsci10100714
Chicago/Turabian StyleAires, Ana, António Andrade, Elsa Azevedo, Filipa Gomes, José Paulo Araújo, and Pedro Castro. 2020. "Neurovascular Coupling Impairment in Heart Failure with Reduction Ejection Fraction" Brain Sciences 10, no. 10: 714. https://doi.org/10.3390/brainsci10100714