Brain atrophy in heart failure patients following left ventricular assist device implantation or heart transplantation

D.Alan Herbst, MD; Banafsheh Shakibajahromi, MD; Michael V. Genuardi, MD; Amit Iyengar, MD; Dawn Mechanic-Hamilton, PhD; H. Branch Coslett, MD; Pavan Atluri, MD; Christopher G. Favilla, MD

JHLT Open (Feb 2025)

Brain atrophy in heart failure patients following left ventricular assist device implantation or heart transplantation

D.Alan Herbst, MD,
Banafsheh Shakibajahromi, MD,
Michael V. Genuardi, MD,
Amit Iyengar, MD,
Dawn Mechanic-Hamilton, PhD,
H. Branch Coslett, MD,
Pavan Atluri, MD,
Christopher G. Favilla, MD

Affiliations

D.Alan Herbst, MD: Division of Cardiothoracic Surgery, University of Pennsylvania, Philadelphia, PA
Banafsheh Shakibajahromi, MD: Department of Neurology, University of Pennsylvania, Philadelphia, PA
Michael V. Genuardi, MD: Division of Cardiology, University of Pennsylvania, Philadelphia, PA
Amit Iyengar, MD: Division of Cardiothoracic Surgery, University of Pennsylvania, Philadelphia, PA
Dawn Mechanic-Hamilton, PhD: Department of Neurology, University of Pennsylvania, Philadelphia, PA
H. Branch Coslett, MD: Department of Neurology, University of Pennsylvania, Philadelphia, PA
Pavan Atluri, MD: Division of Cardiothoracic Surgery, University of Pennsylvania, Philadelphia, PA
Christopher G. Favilla, MD: Department of Neurology, University of Pennsylvania, Philadelphia, PA; Reprint requests: Christopher G. Favilla, Department of Neurology, University of Pennsylvania, Philadelphia, PA 19104.

Journal volume & issue: Vol. 7
p. 100211

Abstract

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Advanced heart failure is associated with accelerated brain atrophy, largely related to chronic cerebral malperfusion. Both heart transplantation (HT) and left ventricular assist device (LVAD) implantation improve vital organ perfusion, but the comparative effect on brain atrophy remains unclear. Given the MR incompatibility of LVADs, we leveraged serial CT imaging in patients who underwent either HT or LVAD implantation. 58 patients were included in this single-center retrospective cohort (23 LVAD; 35 HT). LVAD patients experienced greater brain atrophy (median: 7.1 mL/year; IQR: 0.9–15.7) than transplant patients (median: 0.4 mL/year; IQR: −6.7–13.9), but this difference was non-significant (p=0.09). Temporal atrophy (expansion of the Sylvian fissure) was greater in LVAD patients (median: 0.91 mm/year; IQR: 0.14–2.27) than HT patients (median: 0.10 mm/year; IQR: 0.02–0.55), p=0.005. These observations reveal a need for future work to prospectively quantify brain atrophy after LVAD implantation and HT, while comparing with that of advanced heart failure.

Published in JHLT Open

ISSN: 2950-1334 (Online)
Publisher: Elsevier
Country of publisher: United States
LCC subjects: Medicine: Surgery; Medicine: Internal medicine: Specialties of internal medicine
Website: https://www.sciencedirect.com/journal/jhlt-open

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