title: Dynamics of cerebral blood flow in patients with mild non-ischaemic heart failure.
abstract: Heart failure (HF) is associated with tissue hypoperfusion and congestion leading to organ dysfunction. Although cerebral blood flow (CBF) is preserved over a wide range of perfusion pressures in healthy subjects, it is impaired in end-stage HF. We aimed to compare CBF, autoregulation, and cognitive function in patients with mild non-ischaemic HF with healthy controls.
  
  
  
  Fifteen patients with mild idiopathic dilated cardiomyopathy and 15 matched healthy controls were studied. Co-existing cerebrovascular disease was excluded. All subjects, except five patients with an implantable cardioverter defibrillator, underwent magnetic resonance imaging for measurements of both CBF by arterial spin labelling and quantitative volume flow entering the brain. Cardiocerebral vascular function was assessed with Doppler techniques testing cerebral dynamic autoregulation and vasomotor reactivity. Cognitive analysis was performed by neuropsychological testing. Global and regional CBF did not differ between HF patients (44.3 mL/100 g.min) and controls (42.1 mL/100 g.min). Basilar but not carotid artery inflow was reduced in patients (1.95 mL/s vs. 2.51 mL/s, P = 0.009). Testing autoregulation revealed fewer dampened blood flow fluctuations in HF patients vs. controls (0.96% vs. 0.67%, P < 0.001). Vasomotor reactivity in HF patients showed a reduced CBF velocity (48.4% vs. 61.0%, P = 0.05) and regional cerebral oxygen saturation (18.3% vs. 23.8%, P = 0.02). Cognitive function overall was not affected.
  
  
  
  Although global CBF was unaffected in patients with mild HF, significant changes in basilar inflow volume, cerebral autoregulation and vasomotor reactivity were observed. We describe a model of dynamic cerebral mechanisms required to compensate for the impaired haemodynamics in early-stage HF.
authors.affiliation: Department of Neurology, University Medical Centre Groningen, Hanzeplein 1, PO Box 30.001, 9700RB, Groningen, the Netherlands.
authors.forename: Christian D
authors.initials: CD
authors.lastname: Erkelens
authors.affiliation: Department of Cardiology, University Medical Centre Groningen, Hanzeplein 1, PO Box 30.001, 9700RB, Groningen, the Netherlands.
authors.forename: Haye H
authors.initials: HH
authors.lastname: van der Wal
authors.affiliation: Department of Neurology, University Medical Centre Groningen, Hanzeplein 1, PO Box 30.001, 9700RB, Groningen, the Netherlands.
authors.forename: Bauke M
authors.initials: BM
authors.lastname: de Jong
authors.affiliation: Department of Clinical Neurophysiology, University Medical Centre Groningen, Hanzeplein 1, PO Box 30.001, 9700RB, Groningen, the Netherlands.
authors.forename: Jan-Willem
authors.initials: JW
authors.lastname: Elting
authors.affiliation: Department of Radiology and Neuro-Imaging Centre, University Medical Centre Groningen, Hanzeplein 1, PO Box 30.001, 9700RB, Groningen, the Netherlands.
authors.forename: Remco
authors.initials: R
authors.lastname: Renken
authors.affiliation: Department of Neuropsychology, University Medical Centre Groningen, Hanzeplein 1, PO Box 30.001, 9700RB, Groningen, the Netherlands.
authors.forename: Marleen
authors.initials: M
authors.lastname: Gerritsen
authors.affiliation: Department of Radiology and Neuro-Imaging Centre, University Medical Centre Groningen, Hanzeplein 1, PO Box 30.001, 9700RB, Groningen, the Netherlands.
authors.forename: Peter Jan
authors.initials: PJ
authors.lastname: van Laar
authors.affiliation: Department of Cardiology, University Medical Centre Groningen, Hanzeplein 1, PO Box 30.001, 9700RB, Groningen, the Netherlands.
authors.forename: Vincent M
authors.initials: VM
authors.lastname: van Deursen
authors.affiliation: Department of Cardiology, University Medical Centre Groningen, Hanzeplein 1, PO Box 30.001, 9700RB, Groningen, the Netherlands.
authors.forename: Peter
authors.initials: P
authors.lastname: van der Meer
authors.affiliation: Department of Cardiology, University Medical Centre Groningen, Hanzeplein 1, PO Box 30.001, 9700RB, Groningen, the Netherlands.
authors.forename: Dirk J
authors.initials: DJ
authors.lastname: van Veldhuisen
authors.affiliation: Department of Cardiology, University Medical Centre Groningen, Hanzeplein 1, PO Box 30.001, 9700RB, Groningen, the Netherlands.
authors.forename: Adriaan A
authors.initials: AA
authors.lastname: Voors
authors.affiliation: Department of Neurology, University Medical Centre Groningen, Hanzeplein 1, PO Box 30.001, 9700RB, Groningen, the Netherlands.
authors.forename: Gert-Jan
authors.initials: GJ
authors.lastname: Luijckx
mesh_terms: D000328:Adult; D001488:Basilar Artery / Q000000981:diagnostic imaging / Q000503:physiopathology; D001783:Blood Flow Velocity; D002311:Cardiomyopathy, Dilated / Q000000981:diagnostic imaging / Q000503:physiopathology* / Q000523:psychology; D002339:Carotid Arteries / Q000000981:diagnostic imaging / Q000503:physiopathology; D016022:Case-Control Studies; D002560:Cerebrovascular Circulation / Q000502:physiology*; D003071:Cognition; D015150:Echocardiography, Doppler; D005260:Female; D006333:Heart Failure / Q000000981:diagnostic imaging / Q000503:physiopathology* / Q000523:psychology; D006706:Homeostasis; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009483:Neuropsychological Tests; D010092:Oximetry; D013318:Stroke Volume; D018608:Ultrasonography, Doppler; D014666:Vasomotor System / Q000503:physiopathology
keywords: Cerebral blood flow; Cerebral haemodynamics; Cerebrovascular circulation; Heart failure; Magnetic resonance imaging