1
|
Zheng C, Cui Y, Gu S, Yan S, Cui B, Song T, Li J, Si J, Xiao K, Ge Q, Yang Y, Zhou Y, Li J, Li X, Lu J. Cerebral hypometabolism mediates the effect of stroke volume on cognitive impairment in heart failure patients. ESC Heart Fail 2024; 11:444-455. [PMID: 38037178 PMCID: PMC10804188 DOI: 10.1002/ehf2.14599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 11/07/2023] [Indexed: 12/02/2023] Open
Abstract
AIMS The present study aimed to phenotype the cerebral structural and glucose metabolic alterations in patients with heart failure (HF) using simultaneous positron emission tomography (PET)/magnetic resonance (MR) and to investigate their relationship to cardiac biomarkers and cognitive performance. METHODS AND RESULTS Forty-two HF patients caused by ischaemic heart disease (mean age 67.2 ± 10.4, 32 males) and 32 age- and sex-matched healthy volunteers (mean age 61.3 ± 4.8, 18 males) were included in this study. Participants underwent simultaneous cerebral fluorine-18 (18 F) fluorodeoxyglucose PET/MR followed by cardiac MR scan, and neuropsychological scores were obtained to assess cognitive performance. The grey matter volume (GMV) and standardized uptake value ratio (SUVR) were calculated to examine cerebral structural and metabolic alterations. Cardiac biomarkers included cardiac MR parameters and cardiac serum laboratory tests. Mediation analysis was performed to explore the associations among cerebral alterations, cardiac biomarkers, and cognitive performance. HF patients demonstrated notable cognitive impairment compared with normal controls (P < 0.001). Furthermore, HF patients exhibited regional brain hypometabolism in the bilateral calcarine cortex, caudate nucleus, thalamus, hippocampus, precuneus, posterior cingulate cortex, lingual and olfactory cortex, and GMV reduction in bilateral thalamus and hippocampus (cluster level at P < 0.05, Gaussian random field correction). The SUVR of the hypometabolic brain regions was correlated with the Montreal Cognitive Assessment (MoCA) scores (r = 0.55, P = 0.038) and cardiac stroke volume (r = 0.49, P = 0.002). Cerebral hypometabolism played a key role in the relationship between the decreased stroke volume and MoCA scores, with a mediation effect of 33.2%. CONCLUSIONS HF patients suffered cerebral metabolic and structural alterations in regions associated with cognition. The observed correlation between cardiac stroke volume and cognitive impairment underscored the potential influence of cerebral hypometabolism, suggesting that cerebral hypometabolism due to chronic systemic hypoperfusion may significantly contribute to cognitive impairment in HF patients.
Collapse
Affiliation(s)
- Chong Zheng
- Department of Radiology and Nuclear MedicineXuanwu Hospital, Capital Medical UniversityNo. 45 Changchun Street, Xicheng DistrictBeijingChina
- Beijing Key Laboratory of Magnetic Resonance Imaging and Brain InformaticsBeijingChina
| | - Yadong Cui
- Department of Radiology and Nuclear MedicineXuanwu Hospital, Capital Medical UniversityNo. 45 Changchun Street, Xicheng DistrictBeijingChina
- Beijing Key Laboratory of Magnetic Resonance Imaging and Brain InformaticsBeijingChina
| | - Shanshan Gu
- Department of Radiology and Nuclear MedicineXuanwu Hospital, Capital Medical UniversityNo. 45 Changchun Street, Xicheng DistrictBeijingChina
- Beijing Key Laboratory of Magnetic Resonance Imaging and Brain InformaticsBeijingChina
| | - Shaozhen Yan
- Department of Radiology and Nuclear MedicineXuanwu Hospital, Capital Medical UniversityNo. 45 Changchun Street, Xicheng DistrictBeijingChina
- Beijing Key Laboratory of Magnetic Resonance Imaging and Brain InformaticsBeijingChina
| | - Bixiao Cui
- Department of Radiology and Nuclear MedicineXuanwu Hospital, Capital Medical UniversityNo. 45 Changchun Street, Xicheng DistrictBeijingChina
- Beijing Key Laboratory of Magnetic Resonance Imaging and Brain InformaticsBeijingChina
| | - Tianbin Song
- Department of Radiology and Nuclear MedicineXuanwu Hospital, Capital Medical UniversityNo. 45 Changchun Street, Xicheng DistrictBeijingChina
- Beijing Key Laboratory of Magnetic Resonance Imaging and Brain InformaticsBeijingChina
| | - Jing Li
- Department of Radiology and Nuclear MedicineXuanwu Hospital, Capital Medical UniversityNo. 45 Changchun Street, Xicheng DistrictBeijingChina
- Beijing Key Laboratory of Magnetic Resonance Imaging and Brain InformaticsBeijingChina
| | - Jin Si
- Department of GeriatricsXuanwu Hospital, Capital Medical University, National Clinical Research Center for Geriatric DiseasesBeijingChina
| | - Keling Xiao
- Department of GeriatricsXuanwu Hospital, Capital Medical University, National Clinical Research Center for Geriatric DiseasesBeijingChina
| | - Qi Ge
- Central Research InstituteUnited Imaging HealthcareShanghaiChina
| | - Yang Yang
- Beijing United Imaging Research Institute of Intelligent ImagingBeijingChina
| | - Yun Zhou
- Central Research InstituteUnited Imaging HealthcareShanghaiChina
- School of Biomedical EngineeringShanghaiTech UniversityShanghaiChina
| | - Jing Li
- Department of GeriatricsXuanwu Hospital, Capital Medical University, National Clinical Research Center for Geriatric DiseasesBeijingChina
| | - Xiang Li
- Division of Nuclear Medicine, Department of Biomedical Imaging and Image‐guided TherapyVienna General Hospital, Medical University of ViennaWaehringer Guertel 18‐20ViennaAustria
| | - Jie Lu
- Department of Radiology and Nuclear MedicineXuanwu Hospital, Capital Medical UniversityNo. 45 Changchun Street, Xicheng DistrictBeijingChina
- Beijing Key Laboratory of Magnetic Resonance Imaging and Brain InformaticsBeijingChina
| |
Collapse
|
2
|
van Weperen VYH, Vaseghi M. Cardiac vagal afferent neurotransmission in health and disease: review and knowledge gaps. Front Neurosci 2023; 17:1192188. [PMID: 37351426 PMCID: PMC10282187 DOI: 10.3389/fnins.2023.1192188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Accepted: 05/23/2023] [Indexed: 06/24/2023] Open
Abstract
The meticulous control of cardiac sympathetic and parasympathetic tone regulates all facets of cardiac function. This precise calibration of cardiac efferent innervation is dependent on sensory information that is relayed from the heart to the central nervous system. The vagus nerve, which contains vagal cardiac afferent fibers, carries sensory information to the brainstem. Vagal afferent signaling has been predominantly shown to increase parasympathetic efferent response and vagal tone. However, cardiac vagal afferent signaling appears to change after cardiac injury, though much remains unknown. Even though subsequent cardiac autonomic imbalance is characterized by sympathoexcitation and parasympathetic dysfunction, it remains unclear if, and to what extent, vagal afferent dysfunction is involved in the development of vagal withdrawal. This review aims to summarize the current understanding of cardiac vagal afferent signaling under in health and in the setting of cardiovascular disease, especially after myocardial infarction, and to highlight the knowledge gaps that remain to be addressed.
Collapse
Affiliation(s)
- Valerie Y. H. van Weperen
- Division of Cardiology, Department of Medicine, UCLA Cardiac Arrhythmia Center, Los Angeles, CA, United States
| | - Marmar Vaseghi
- Division of Cardiology, Department of Medicine, UCLA Cardiac Arrhythmia Center, Los Angeles, CA, United States
- Molecular, Cellular, and Integrative Physiology Interdepartmental Program, University of California, Los Angeles, Los Angeles, CA, United States
| |
Collapse
|
3
|
Yun M, Nie B, Wen W, Zhu Z, Liu H, Nie S, Lanzenberger R, Wei Y, Hacker M, Shan B, Schelbert HR, Li X, Zhang X. Assessment of cerebral glucose metabolism in patients with heart failure by 18F-FDG PET/CT imaging. J Nucl Cardiol 2022; 29:476-488. [PMID: 32691347 DOI: 10.1007/s12350-020-02258-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Accepted: 06/10/2020] [Indexed: 12/23/2022]
Abstract
BACKGROUND To evaluate the cerebral metabolism in patients with heart failure (HF). METHODS One hundred and two HF patients were prospectively enrolled, who underwent gated 99mTc-sestamibi single photon emission computed tomography (SPECT)/CT, cardiac and cerebral 18F-fluorodeoxyglucose (FDG) positron emission tomography (PET)/CT. Fifteen healthy volunteers served as controls. Patients were stratified by extent of hibernating myocardium (HM) and left ventricular ejection fraction (LVEF) into 4 groups where Group1: HM < 10% (n = 33); Group2: HM ≥ 10%, LVEF < 25% (n = 34); Group3: HM ≥ 10%, 25% ≤ LVEF ≤ 40% (n = 16) and Group 4: LVEF > 40% (n = 19). The standardized uptake value (SUV) in the whole brain (SUVwhole-brain) and the SUV ratios (SUVR) in 24 cognition-related brain regions were determined. SUVwhole-brain and SUVRs were compared between the 4 patient groups and the healthy controls. RESULTS SUVwhole-brain (r = 0.245, P = 0.013) and SUVRs in frontal areas, hippocampus, and para-hippocampus (r: 0.213 to 0.308, all P < 0.05) were correlated with HM. SUVwhole-brain differed between four patient groups and the healthy volunteers (P = 0.016) and SUVwhole-brain in Group 1 was lower than that in healthy volunteers (P < 0.05). SUVRs of Group 3 in frontal areas were the highest among four patient subgroups (P < 0.05). CONCLUSIONS Cerebral metabolism in the whole brain was reduced but maintained in cognition-related frontal areas in HF patients with HM and moderately impaired global left ventricular function.
Collapse
Affiliation(s)
- Mingkai Yun
- Department of Nuclear Medicine, Laboratory for Molecular Imaging, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
- Beijing Key Laboratory of Upper Airway Dysfunction and Related Cardiovascular Diseases, Beijing, China
| | - Binbin Nie
- Division of Nuclear Technology and Applications, Institute of High Energy Physics, Chinese Academy of Sciences, Beijing, China
| | - Wanwan Wen
- Department of Nuclear Medicine, Laboratory for Molecular Imaging, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
- Beijing Key Laboratory of Upper Airway Dysfunction and Related Cardiovascular Diseases, Beijing, China
| | - Ziwei Zhu
- Department of Nuclear Medicine, Laboratory for Molecular Imaging, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
- Beijing Key Laboratory of Upper Airway Dysfunction and Related Cardiovascular Diseases, Beijing, China
| | - Hua Liu
- Division of Nuclear Technology and Applications, Institute of High Energy Physics, Chinese Academy of Sciences, Beijing, China
| | - Shaoping Nie
- Beijing Key Laboratory of Upper Airway Dysfunction and Related Cardiovascular Diseases, Beijing, China
- Division of Emergency & Critical Care Centre, Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Rupert Lanzenberger
- Neuroimaging Labs (NIL), Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria
| | - Yongxiang Wei
- Department of Nuclear Medicine, Laboratory for Molecular Imaging, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
- Beijing Key Laboratory of Upper Airway Dysfunction and Related Cardiovascular Diseases, Beijing, China
| | - Marcus Hacker
- Division of Nuclear Medicine, Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Baoci Shan
- Division of Nuclear Technology and Applications, Institute of High Energy Physics, Chinese Academy of Sciences, Beijing, China
| | - Heinrich R Schelbert
- Department of Molecular and Medical Pharmacology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Xiang Li
- Department of Nuclear Medicine, Laboratory for Molecular Imaging, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
- Division of Nuclear Medicine, Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Xiaoli Zhang
- Department of Nuclear Medicine, Laboratory for Molecular Imaging, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.
- Beijing Key Laboratory of Upper Airway Dysfunction and Related Cardiovascular Diseases, Beijing, China.
| |
Collapse
|
4
|
Fiechter M, Roggo A, Haider A, Bengs S, Burger IA, Marędziak M, Portmann A, Treyer V, Becker AS, Messerli M, Mühlematter UJ, Kudura K, von Felten E, Benz DC, Fuchs TA, Gräni C, Pazhenkottil AP, Buechel RR, Kaufmann PA, Gebhard C. Metabolic Activity in Central Neural Structures of Patients With Myocardial Injury. J Am Heart Assoc 2019; 8:e013070. [PMID: 31566462 PMCID: PMC6806042 DOI: 10.1161/jaha.119.013070] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Background Increasing evidence suggests a psychosomatic link between neural systems and the heart. In light of the growing burden of ischemic cardiovascular disease across the globe, a better understanding of heart‐brain interactions and their implications for cardiovascular treatment strategies is needed. Thus, we sought to investigate the interaction between myocardial injury and metabolic alterations in central neural areas in patients with suspected or known coronary artery disease. Methods and Results The association between resting metabolic activity in distinct neural structures and cardiac function was analyzed in 302 patients (aged 66.8±10.2 years; 70.9% men) undergoing fluor‐18‐deoxyglucose positron emission tomography and 99mTc‐tetrofosmin single‐photon emission computed tomography myocardial perfusion imaging. There was evidence for reduction of callosal, caudate, and brainstem fluor‐18‐deoxyglucose uptake in patients with impaired left ventricular ejection fraction (<55% versus ≥55%: P=0.047, P=0.022, and P=0.013, respectively) and/or in the presence of myocardial ischemia (versus normal perfusion: P=0.010, P=0.013, and P=0.016, respectively). In a sex‐stratified analysis, these differences were observed in men, but not in women. A first‐order interaction term consisting of sex and impaired left ventricular ejection fraction or myocardial ischemia was identified as predictor of metabolic activity in these neural regions (left ventricular ejection fraction: P=0.015 for brainstem; myocardial ischemia: P=0.004, P=0.018, and P=0.003 for callosal, caudate, or brainstem metabolism, respectively). Conclusions Myocardial dysfunction and injury are associated with reduced resting metabolic activity of central neural structures, including the corpus callosum, the caudate nucleus, and the brainstem. These associations differ in women and men, suggesting sex differences in the pathophysiological interplay of the nervous and cardiovascular systems.
Collapse
Affiliation(s)
- Michael Fiechter
- Department of Nuclear Medicine University Hospital Zurich Zurich Switzerland.,Center for Molecular Cardiology University of Zurich Switzerland.,Swiss Paraplegic Center Nottwil Switzerland
| | - Andrea Roggo
- Department of Nuclear Medicine University Hospital Zurich Zurich Switzerland
| | - Ahmed Haider
- Department of Nuclear Medicine University Hospital Zurich Zurich Switzerland.,Center for Molecular Cardiology University of Zurich Switzerland
| | - Susan Bengs
- Department of Nuclear Medicine University Hospital Zurich Zurich Switzerland.,Center for Molecular Cardiology University of Zurich Switzerland
| | - Irene A Burger
- Department of Nuclear Medicine University Hospital Zurich Zurich Switzerland
| | - Monika Marędziak
- Department of Nuclear Medicine University Hospital Zurich Zurich Switzerland.,Center for Molecular Cardiology University of Zurich Switzerland
| | - Angela Portmann
- Department of Nuclear Medicine University Hospital Zurich Zurich Switzerland
| | - Valerie Treyer
- Department of Nuclear Medicine University Hospital Zurich Zurich Switzerland
| | - Anton S Becker
- Department of Diagnostic and Interventional Radiology University Hospital Zurich Zurich Switzerland
| | - Michael Messerli
- Department of Nuclear Medicine University Hospital Zurich Zurich Switzerland
| | - Urs J Mühlematter
- Department of Diagnostic and Interventional Radiology University Hospital Zurich Zurich Switzerland
| | - Ken Kudura
- Department of Nuclear Medicine University Hospital Zurich Zurich Switzerland
| | - Elia von Felten
- Department of Nuclear Medicine University Hospital Zurich Zurich Switzerland
| | - Dominik C Benz
- Department of Nuclear Medicine University Hospital Zurich Zurich Switzerland
| | - Tobias A Fuchs
- Department of Nuclear Medicine University Hospital Zurich Zurich Switzerland
| | - Christoph Gräni
- Department of Nuclear Medicine University Hospital Zurich Zurich Switzerland
| | - Aju P Pazhenkottil
- Department of Nuclear Medicine University Hospital Zurich Zurich Switzerland
| | - Ronny R Buechel
- Department of Nuclear Medicine University Hospital Zurich Zurich Switzerland
| | - Philipp A Kaufmann
- Department of Nuclear Medicine University Hospital Zurich Zurich Switzerland
| | - Catherine Gebhard
- Department of Nuclear Medicine University Hospital Zurich Zurich Switzerland.,Center for Molecular Cardiology University of Zurich Switzerland
| |
Collapse
|