title: Brain metabolites in autonomic regulatory insular sites in heart failure.
abstract: Autonomic, pain, and neuropsychologic comorbidities appear in heart failure (HF), likely resulting from brain changes, indicated as loss of structural integrity and functional deficits. Among affected brain sites, the anterior insulae are prominent in serving major regulatory roles in many of the disrupted functions commonly seen in HF. Metabolite levels, including N-acetylaspartate (NAA), creatine (Cr), choline (Cho), and myo-inositol (MI), could indicate the nature of anterior insula tissue injury in HF. The study aim was to assess anterior insular metabolites to determine processes mediating autonomic, pain, and neuropsychologic disruptions in HF. We performed magnetic resonance spectroscopy in bilateral anterior insulae in 11 HF and 53 controls, using a 3.0-Tesla magnetic resonance imaging scanner. Peaks for NAA at 2.02 ppm, Cr at 3.02 ppm, Cho at 3.2 ppm, and MI at 3.56 ppm were assigned, peak areas were calculated, and metabolites were expressed as ratios, including NAA/Cr, Cho/Cr, and MI/Cr. HF patients showed significantly increased Cho/Cr ratios, indicative of glial proliferation or injury, on the left anterior insula, and reduced NAA/Cr levels, suggesting neuronal loss/dysfunction, on the right anterior insula over controls. No differences in MI/Cr ratios appeared between groups. Right anterior insular neuronal loss and left glial alterations may contribute to distorted autonomic, pain, and neuropsychologic functions found in HF.
authors.affiliation: UCLA School of Nursing, University of California at Los Angeles, Los Angeles, CA 90095, USA.
authors.forename: Mary A
authors.initials: MA
authors.lastname: Woo
authors.affiliation: Department of Anesthesiology, University of California at Los Angeles, Los Angeles, CA 90095, USA.
authors.forename: Santosh K
authors.initials: SK
authors.lastname: Yadav
authors.affiliation: UCLA School of Nursing, University of California at Los Angeles, Los Angeles, CA 90095, USA; The Brain Research Institute, University of California at Los Angeles, Los Angeles, CA 90095, USA.
authors.forename: Paul M
authors.initials: PM
authors.lastname: Macey
authors.affiliation: Division of Cardiology, University of California at Los Angeles, Los Angeles, CA 90095, USA.
authors.forename: Gregg C
authors.initials: GC
authors.lastname: Fonarow
authors.affiliation: The Brain Research Institute, University of California at Los Angeles, Los Angeles, CA 90095, USA; Department of Neurobiology, University of California at Los Angeles, Los Angeles, CA 90095, USA.
authors.forename: Ronald M
authors.initials: RM
authors.lastname: Harper
authors.affiliation: Department of Anesthesiology, University of California at Los Angeles, Los Angeles, CA 90095, USA; The Brain Research Institute, University of California at Los Angeles, Los Angeles, CA 90095, USA; Department of Radiological Sciences, University of California at Los Angeles, Los Angeles, CA 90095, USA; Department of Bioengineering, University of California at Los Angeles, Los Angeles, CA 90095, USA. Electronic address: rkumar@mednet.ucla.edu.
authors.forename: Rajesh
authors.initials: R
authors.lastname: Kumar
mesh_terms: D000328:Adult; D001341:Autonomic Nervous System / Q000378:metabolism*; D002540:Cerebral Cortex / Q000378:metabolism*; D002794:Choline / Q000378:metabolism; D003401:Creatine / Q000378:metabolism; D005260:Female; D006333:Heart Failure / Q000378:metabolism*; D006801:Humans; D007294:Inositol / Q000378:metabolism; D009682:Magnetic Resonance Spectroscopy; D008297:Male; D008875:Middle Aged
chemical_list: D007294:Inositol; D003401:Creatine; D002794:Choline
keywords: Choline; Depression; Magnetic resonance spectroscopy; Myo-inositol; N-acetylaspartate; Pain