Frontiers in medicine · 2026
Brain perivascular diffusion and cognitive impairment in heart failure with preserved ejection fraction.
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Yu Tianyi, Duan Chongzhen, Sun Minwen, Liu Yixin, Yuan Yuchun
Аннотация
OBJECTIVE: Heart failure with preserved ejection fraction (HFpEF) is increasingly recognized as a systemic cardiovascular disorder that may involve extra-cardiac organs, including the brain. This study aimed to investigate whether brain perivascular diffusivity, assessed using diffusion tensor image analysis along the perivascular space (DTI-ALPS), is associated with cognitive performance, assessed with the Montreal Cognitive Assessment (MoCA) and the Mini-Mental State Examination (MMSE), in patients with HFpEF.
MATERIALS AND METHODS: Thirty-five patients with HFpEF and 20 healthy controls underwent brain diffusion kurtosis imaging and neuropsychological assessment. Left, right, and mean DTI-ALPS indices were calculated for each participant. Group differences were evaluated using independent-samples t tests, Mann-Whitney U tests, or chi-square tests as appropriate. Associations between DTI-ALPS indices and cognitive outcomes were examined using Spearman correlation analyses and multivariable linear regression models adjusted for age, sex, and educational level.
RESULTS: Compared with healthy controls, patients with HFpEF had lower MoCA (22.34 ± 3.38 vs. 28.70 ± 1.69; t = 9.29, p < 0.01) and MMSE scores (median 24.00 vs. 28.50; Z = -5.03, p < 0.01), together with poorer visuospatial/executive function, attention, language, abstraction, and delayed recall (all p < 0.01), whereas naming and orientation did not differ between groups (both p > 0.05). The left DTI-ALPS index was lower in patients than in controls (1.64 ± 0.24 vs. 1.77 ± 0.21, t = 2.08, p = 0.04), whereas the right and mean indices showed no significant group difference (p = 0.54 and p = 0.16, respectively). After adjustment for age, sex, and educational level, a lower left DTI-ALPS index was independently associated with worse MMSE (β = 0.031, p = 0.001), MoCA (β = 0.021, p = 0.007), and delayed recall scores (β = 0.050, p = 0.009).
CONCLUSION: HFpEF was associated with cognitive impairment and a left-predominant reduction in perivascular diffusivity as reflected by DTI-ALPS. These findings suggest that DTI-ALPS may be a candidate neuroimaging marker of brain involvement in HFpEF. Given the cross-sectional design, causal and predictive interpretations should be avoided until confirmed by longitudinal multimodal studies.
MATERIALS AND METHODS: Thirty-five patients with HFpEF and 20 healthy controls underwent brain diffusion kurtosis imaging and neuropsychological assessment. Left, right, and mean DTI-ALPS indices were calculated for each participant. Group differences were evaluated using independent-samples t tests, Mann-Whitney U tests, or chi-square tests as appropriate. Associations between DTI-ALPS indices and cognitive outcomes were examined using Spearman correlation analyses and multivariable linear regression models adjusted for age, sex, and educational level.
RESULTS: Compared with healthy controls, patients with HFpEF had lower MoCA (22.34 ± 3.38 vs. 28.70 ± 1.69; t = 9.29, p < 0.01) and MMSE scores (median 24.00 vs. 28.50; Z = -5.03, p < 0.01), together with poorer visuospatial/executive function, attention, language, abstraction, and delayed recall (all p < 0.01), whereas naming and orientation did not differ between groups (both p > 0.05). The left DTI-ALPS index was lower in patients than in controls (1.64 ± 0.24 vs. 1.77 ± 0.21, t = 2.08, p = 0.04), whereas the right and mean indices showed no significant group difference (p = 0.54 and p = 0.16, respectively). After adjustment for age, sex, and educational level, a lower left DTI-ALPS index was independently associated with worse MMSE (β = 0.031, p = 0.001), MoCA (β = 0.021, p = 0.007), and delayed recall scores (β = 0.050, p = 0.009).
CONCLUSION: HFpEF was associated with cognitive impairment and a left-predominant reduction in perivascular diffusivity as reflected by DTI-ALPS. These findings suggest that DTI-ALPS may be a candidate neuroimaging marker of brain involvement in HFpEF. Given the cross-sectional design, causal and predictive interpretations should be avoided until confirmed by longitudinal multimodal studies.