HEART FAILURE WITH LOW CARDIAC OUTPUT AND RISK OF DEVELOPMENT OF LESIONS IN THE CEREBRAL WHITE MATTER

Aim: Diminished cardiac output can lead to the development of white matter lesions. White matter lesions are related to cognitive impairment, stroke risk and vascular death, yet the precise aetiology is uncertain. Methods: In this study we recruited 130 patients attending our medicine and neurology outpatient department, and divided them into those with a history of heart failure (n:24), atrial fibrillation (n:26), and those with atherosclerotic risk factors (n:80). The patients without low output heart failure and atrial fibrillation were grouped as control. We studied the magnetic resonance imaging (MRI) findings associated with low cardiac output and adjusted for confounding factors. Heart failure with low cardiac output was diagnosed by a cardiologist. Results: The presence of leukoaraiosis (LA) on MRI was assessed in 80 patients with modifiable atherosclerotic risk factors (control group) and 50 patients having heart failure or atrial fibrillation. Hyperintense lesions in T2 and proton weighted and non-hypotense lesions in T1 weighted sequences were considered as white matter abnormalities. MRIs of all cases were evaluated by means of a four grade scoring system -described previously in the literature- by the same neurologist. White matter lesions of patients with heart failure, atrial fibrillation or atherosclerotic risk factors were compared. Patients in the study group were divided into two groups according to the presence of heart failure due to etiologies other than atrial fibrillation (n:24) and atrial fibrillation (n:26). Leukoaraiosis was observed in 18 (75%) cases with heart failure, 18 (69.2%) cases with atrial fibrillation, and 61 (76.3%) patients in the control group. There was no difference between the three groups with respect to the presence of LA (x2:0.51, p: 0.77). Conclusion: This study demonstrated that there was no significant association between heart failure and white matter abnormalities independent of other risk factors despite the fact that cardiac disorders apparently manifested themselves as cases with severe leukoaraiosis.