Factors Associated With Decreased Cerebral Blood Flow in Congestive Heart Failure Secondary to Idiopathic Dilated Cardiomyopathy

Cerebral blood flow (CBF) is decreased and cognitive dysfunction develops in the advanced stages of heart failure. However, few data are available regarding the factors associated with decreased CBF. Fifty-two patients with advanced congestive heart failure (CHF) secondary to idiopathic dilated cardiomyopathy (ejection fraction ≤35%) and 10 healthy volunteers were included in this study. Echocardiography and symptom-limited bicycle exercise testing were performed. Global CBF was measured by radionuclide angiography. Global CBF was 19% less in patients with CHF than in controls (p <0.01). Such reduced CBF became normalized in 4 patients with CHF who underwent cardiac transplantation. In a univariate linear regression analysis, global CBF was significantly associated with New York Heart Association functional class, disease duration, atrial fibrillation, serum B-type natriuretic peptide level, the early mitral velocity/early diastolic annular velocity ratio, and pulmonary artery systolic pressure. Global CBF was not found to be associated with the ejection fraction, peak oxygen consumption, or anaerobic threshold. In a stepwise multivariate linear regression analysis, serum B-type natriuretic peptide level (p = 0.047) and New York Heart Association functional class (p = 0.003) were significantly related to global CBF (global CBF = 48.373 - 0.05 × serum B-type natriuretic peptide level - 3.283 × New York Heart Association functional class; r² = 0.401). In conclusion, CBF is decreased in patients with CHF, which may be used to predict disease severity and chronicity.