Some aspects of cardio-cerebral relationship in surgical patients with multifocal atherosclerosis and heart failure

Relevance. The level of cerebral perfusion in patients with multifocal atherosclerosis depends not only on the restriction of blood flow through the carotid arteries, but also on the degree of myocardial changes. Goal of investigation. Determine the presence of a relationship between the indices of regional cerebral blood flow according to SPECT data and echocardiographic parameters of cardiac activity and analyze the mechanism of their relationship.
Material and methods. We examined 22 patients (18 men and 4 women aged 64 ± 6.5 years) with signs of chronic heart failure and multifocal atherosclerosis with the involvement of carotid and coronary arteries, who underwent simultaneous surgery. All patients underwent echocardiographic examination of the heart and SPECT of the brain.
Results. Moderate direct correlations were revealed between the indices of regional cerebral blood flow (CBF) and ejection fraction (p = 0.009307), SV/EDV (p = 0.012431); moderate inverse correlations between the indices of CBF and SV (p = 0.002913), EDV (p = 0.031737), ESV (p = 0.016483), ESV/EDV (p = 0.010645), ESV/SV (p = 0.007255). In the postoperative period, a moderate direct correlation was found between indicators of cognitive status (MMSE) and indicators of cerebral perfusion in the right occipital, parietal and frontal lobes (p = 0.021162, R = 0.511475).
Conclusion. The echocardiographic parameters we studied in patients with chronic heart failure correlate with indicators of regional cerebral blood flow, and this relationship is more pronounced not in the ejection fraction, but is traced between the parameters of the end diastolic volume, end systolic volume and their ratio according to the principle of the golden ratio. The data obtained on the perfusion of the brain by the SPECT method are associated with indicators of cardiac activity and reflect the severity of chronic heart failure.

1. Reznik E.V., Nikitin I.G. Algorithm for the treatment of patients with chronic heart failure with reduced left ventricular ejection fraction. The Russian Archives of Internal Medicine. 2018; 8 (2): 85–99. https://doi.org/10.20514/2226-6704-2018-8-2-85-99 (In Russian)

2. Akimova N.S., Zuev V.V., Martinovich T.V., Sokolov I.M., Shvarts Y.G. Correlations between severity of chronic heart failure and condition of central nervouse system in patients with ischemic heart disease. Fundamental research. 2011; 11–3: 467–471. (In Russian)

3. Furuäng L., Wollmer P., Siennicki-Lantz A., Elmståh S. Cardiac ventricular dimensions predict cognitive decline and cerebral blood flow abnormalities in aging men. BMC Geriatrics. 2013; 13: 45. https://doi.org/10.1186/1471-2318-13-45

4. Semenov S.E., Milinevskiy N.I., Korotkevich A.A., Portnov Yu.M., Semenov A.S. Cerebral perfusion and circulation disturbances. Part III (Non-contrast methods, rationale and safety): A review. Complex Issues of Cardiovascular Diseases. 2018; 7 (4): 101–111. https://doi.org/10.17802/2306-1278-2018-7-4-101-111 (In Russian)

5. Erkelens C.D., Van der Wal H.H., De Jong B.M. et al. Dynamics of cerebral blood flow in patients with mild nonischaemic heart failure. Eur. J. Heart Failure. 2017; 19 (2): 261–268. https://doi.org/10.1002/ejhf.660

6. Usov V.Yu., Sinitsyn V.E., Obradovich V., Dragutinovich G., Efimova I.Yu., Plotnikov M.P., Karpov R.S. Patterns of cerebral blood flow reactivity in adenosine stress-test in patients with carotid stenosis, evaluated with MRI and 99mTc-HMPAO SPECT brain study. Journal of Radiology and Nuclear Medicine. 2000; 6: 4–9. (In Russian)

7. Babiyants A.Ya., Khananashvili Ya.A. Cerebral circulation: physiological aspects and modern research methods. Zhurnal fundamental'noy meditsiny i biologii. 2018; 3: 46–54. (In Russian)

8. Lassen N.A., Andersen A.R., Friberg L., Paulson O.B. The retention of [99mTc]-d,l-HM-PAO in the human brain after intracarotid bolus injection: a kinetic analisis. J. Cerebral Blood Flow Metabol. 1988; 8: 13–22. https://doi.org/10.1038/jcbfm.1988.28

9. Shestakova M.V., Vasilenko A.F., GrigorichevaE.A., Karpova M.I., Shamurov Yu.S., Epaneshnikova N.V., Istomina V.V. Cognitive functions in patients with chronic heart failure. S.S. Korsakov Journal of Neurology and Psychiatry. 2014; 114 (6): 70–73. (In Russian)

10. Kazakovtseva T.A., Shostak N.A. Echocardiographic and laboratory markers of chronic heart failure: whether it is possible to use them in rheumatic mitral diseases? Rational Pharmacotherapy in Cardiology. 2009; 5 (1): 33–36. https://doi.org/10.20996/1819-6446-2009-5-1-33-36 (In Russian)

11. Alves T.C., Rays J., Fráguas R. Jr. et al. Localized cerebral blood flow reductions in patients with heart failure: a study using 99mTc-HMPAO SPECT. J. Neuroimaging. 2005; 15 (2): 150–156. https://doi.org/10.1177/1051228404272880

12. Akimova N.S., Sokolov I.M., Martynovich T.V., Shvarts Yu.G. Morphofunctional state of the brain in chronic heart failure. Cardiosomatics. 2017; 8 (2): 59–62. (In Russian)

13. Lu X., Nie B.B., Yun M.K. et al. Association between brain glucose metabolism and cardiac dysfunction in patients with ischemic heart disease undergoing (18) F-FDG PET/CT imaging. Zhonghua Xin Xue Guan Bing Za Zhi. 2020; 48 (3): 211–216. https://doi.org/10.3760/cma.j.cn112148-20190513-00245

14. Ampadu J., Morley J.E. Heart failure and cognitive dysfunction. Int. J. Cardiol. 2015; 178: 12–23. https://doi.org/10.1016/j.ijcard.2014.10.087

15. Kazakovtseva T.A., Shostak N.A. Is there an alternative to ejection fraction in instrumental evaluation of chronic heart failure severity in post-myocardial infarction patients? Rational Pharmacotherapy in Cardiology. 2010; 6 (3): 329–332. https://doi.org/10.20996/1819-6446-2010-6-3-329-332 (In Russian)

16. Bulashova O.V., Abdrakhmanova A.I. Early diagnostics of heart failure in patients with coronary heart disease. Russian Journal of Cardiology. 2003; 8 (4): 24–27. (In Russian)

17. Mazur V.V., Kalinkin A.M., Mazur E.S. Heart remodeling at different stages of chronic heart failure in patients with postinfarction cardiosclerosis and dilated cardiomyopathy. Rational Pharmacotherapy in Cardiology. 2010; 6 (6): 818–822. https://doi.org/10.20996/1819-6446-2010-6-6-818-822 (In Russian)

18. Shvarts Yu.G., Akimova N.S., Martynovich T.V. Analysis of changes in white matter of brain and cognitive disturbances in patients with chronic heart failure and ishemic heart desease. Saratov journal of medical scientific research. 2013; 9 (1): 78–82. (In Russian)

19. Galyautdinov G.S., Lonkin M.A. Gendernyye razlichiya v kachestve zhizni i kognitivnykh narusheniyakh, a takzhe depressiya u patsiyentov, stradayushchikh khronicheskoy serdechnoy nedostatochnost′yu. Eurasian Union of Scientists. 2016; 1–4 (22): 46–49. (In Russian)

20. Gazizova D.Sh. Comparison of ejection fraction and end volumes of the left ventricle as indicators of the severity of heart failure. Kuban Scientific Medical Bulletin. 2019; 26 (3): 33–40. https://doi.org/10.25207/1608-6228-2019-26-3-33-40 (In Russian)

21. Malov Yu.S., Kuchmin A.N., Borisov I.M., Malova A.M. Golden symmetry – an indicator of the norm and pathology of the human heart. Bulletin of the Russian Military Medical Academy. 2020; 2 (70): 189–194. https://doi.org/10.17816/brmma50071 (In Russian)

22. Malov Yu.S., Obrezan A.G., Kosarev M.M. Diagnostics of chronic heart failure using ultrasonic heart examination. Do we apply everything in treatment? Vestnik of Saint Petersburg university. Medicine. 2010; 2: 23–31. (In Russian)