Visual assessment of brain magnetic resonance imaging detects injury to cognitive regulatory sites in patients with heart failure

Abstract

Background: Heart failure (HF) patients exhibit depression and executive function impairments that contribute to HF mortality. Using specialized magnetic resonance imaging (MRI) analysis procedures, brain changes appear in areas regulating these functions (mammillary bodies, hippocampi, and frontal cortex). However, specialized MRI procedures are not part of standard clinical assessment for HF (which is usually a visual evaluation), and it is unclear whether visual MRI examination can detect changes in these structures.

Methods and results: Using brain MRI, we visually examined the mammillary bodies and frontal cortex for global and hippocampi for global and regional tissue changes in 17 HF and 50 control subjects. Significantly global changes emerged in the right mammillary body (HF 1.18 ± 1.13 vs control 0.52 ± 0.74; P = .024), right hippocampus (HF 1.53 ± 0.94 vs control 0.80 ± 0.86; P = .005), and left frontal cortex (HF 1.76 ± 1.03 vs control 1.24 ± 0.77; P = .034). Comparison of the visual method with specialized MRI techniques corroborates right hippocampal and left frontal cortical, but not mammillary body, tissue changes.

Conclusions: Visual examination of brain MRI can detect damage in HF in areas regulating depression and executive function, including the right hippocampus and left frontal cortex. Visual MRI assessment in HF may facilitate evaluation of injury to these structures and the assessment of the impact of potential treatments for this damage.

Figure 1. Examples of mammillary body atrophy grading

Panels A-D display increasingly smaller bodies.

Figure 2. Illustrations of global and regional hippocampal atrophy grading

Panels A-D show increasingly severe hippocampal atrophy.

Figure 3. Diagram of frontal cortical atrophy grading

Panels A-D exhibit progressively more hyperintensity in the frontal cortex, corresponding to increased frontal cortical atrophy

Figure 4. Brain images showing right hippocampal atrophy detected from (A) T2 relaxometry and (B) visual assessment

(A) The highlighted areas correspond to damage in HF over control subjects. (B) A typical HF patient displays global hippocampal atrophy. The arrows point to the hippocampus.

Figure 5. Brain images displaying frontal cortical atrophy detected from (A) T2 relaxometry and (B) visual assessment

(A) The highlighted areas correspond to tissue injury in HF over control subjects. (B) A typical HF patient exhibits frontal cortical atrophy. The arrows point to the atrophy in the frontal cortex.