| Part1 Incremental value of low-frequency amplitude in prognostic prediction of chronic heart failure based on resting state functional magnetic resonance imagingBackgroundChronic heart failure(CHF)is often accompanied by cognitive and emotional abnormalities,which are regulated by the central nervous system.The purpose of this study was to explore the changes of brain structure and function in patients with CHF and its association with clinical outcomes in CHF patients.MethodsThe study retrospectively enrolled 49 hospitalized CHF patients in the department of cardiology of Jinling hospital,and 49 age-,sex-and education level-matched healthy controls(HCs)were recruited.Neuropsychological assessment and multimodal MRI were performed,and follow-up was performed in CHF patients.The patients’ clinical outcomes after discharge were followed up.The brain volume,CBF and the amplitude of low-frequency fluctuation(ALFF)were analyzed.Logistic regression as used to explore the value of brain imaging indicators in predicting the clinical outcomes of patients with chronic heart failure.Odds ratio(OR)and 95%Confidence interval(CI)results of performance prediction models.At the same time,receiver operating characteristic(ROC)curve was used to represent the performance of the prediction model.ResultsCompared with control group,the total volume of white matter and gray matter in patients with chronic heart failure significantly decreased(white matter volume:568.66±57.95cm3 vs 597.67±63.50cm3,P=0.020;Gray matter volume:470.13±57.95 cm3 vs.502.26±53.5 cm3,P=0.005).Moreover,cerebral blood flow in the left inferior parietal lobe and left posterior central gyrus was lower in chronic heart failure patients than that in the control group(GRF corrected,P<0.001).The analysis of resting ALFF showed that ALFF in parietal lobe,frontal lobe,temporal lobe and occipital lobe decreased in patients with chronic heart failure.While the ALFF values were increased in the right hippocampus and right inferior temporal gyrus than in the control group(P<0.001 voxel level,GRF corrected).Logistic regression analysis showed that cerebral parenchymal volume and cerebral blood flow in each brain region were not included in the prognosis prediction model,and only the left posterior central gyrus(OR:0.7[95%CI:0.005-0.939],P=0.045)and the ALFF values of right hippocampus(OR:48.4[95%CI:2.2-1081.3],P=0.014)were associated with poor outcomes in patients with chronic heart failure.The outcome prediction model combined with the ALFF values of the left posterior central gyrus and right hippocampus and the New York Heart Association(NYHA)classification was superior to the prediction model established by NYHA classification alone(AUC:0.944 vs 0.804,P=0.032).ConclusionsReduced brain volume,CBF and abnormally functional activity were showed in patients with chronic heart failure.The ALFF values of the right hippocampus and the left postcentral gyrus are independent risk factors for poor prognosis in patients with chronic failure.Part 2 The changes of hippocampal functional connectivity in patients with chronic heart failure based on resting state functional magnetic resonance imagingBackgroundThe previous study showed that increased ALFF in right hippocampus was associated with adverse clinical outcomes in patients with chronic heart failure.However,the change pattern of hippocampus functional connectivity(FC)is not clear,and it is difficult to clarify or speculate its underlying mechanism.The purpose of this study is to explore the changes of global brain functional connections in the hippocampus of patients with chronic heart failure and to provide imaging basis for further study of its predictive value..MethodsIn this section,49 hospitalized CHF patients and 49 HCs in the department of cardiology of Jinling hospital were retrospectively included.All subjects had complete baseline data,neuropsychological assessment,and rs-fMRI scan.Finally,47 patients were followed up.Thevoxel-levels FC between bilateral hippocampus,hippocampus subregion(hippocampus head,hippocampus body,hippocampus tail)and whole brain voxel were calculated.Firstly,the differences of FC between CHF and HCs were compared.ResultsCompared with HCs,CHF patients had significantly lower FC between bilateral hippocampus and bilateral middle cingulate gyrus and right supplementary motor area(GRF correlation,P<0.001).In the subregion analysis,FC between right hippocampus and bilateral middle cingulate gyrus were decreased.No significant abnormality was observed in FC of left hippocampus,right hippocampus head,right hippocampus tail and whole brain.ConclusionThe functional connection between hippocampus and bilateral middle cingulate gyrus is decreased in patients with chronic heart failure,especially in the right hippocampal body,which suggests that hippocampus may play an important role in central nervous system injury in patients with chronic heart failure. |
