Abstract 4140001: Impact of White Matter Hyperintensity in the Corpus Callosum on Parahippocampal Atrophy and Prognosis in Heart Failure Patients Without Dementia

Background: Aged heart failure (HF) patients without dementia have a risk of cognitive impairment (CI) that attenuates the effect of treatment for HF. White Matter Hyperintensity (WMH) and gray matter atrophy in parahippocampal gyrus (PHG) are a potential risk of CI. However, it is not clear whether location and volume of local WMH is associated with atrophy in PHG and predicts prognosis of HF patients. Hypothesis: In HF patients without dementia, local WMH volume is associated with brain atrophy of PHG and predicts prognosis. Methods: We enrolled sixty-one HF patients (age 76±11 years, NYHA class II, EF47±17 %) in the study. We excluded patients with dementia using mini-mental state examination. We took 3D-T1 weighted images and Fluid Attenuated Inversion Recovery (FLAIR) images of whole brain using 1.5T magnetic resonance imaging (MRI). We performed image analysis using 2mm voxel-based morphometry with Statistical Parametric Mapping to evaluate the local WMH volume in the frontal, temporal, parietal, and occipital lobes, as well as the corpus callosum ( CC ), and to assess the severity of PHG atrophy. We quantified the severity of PHG atrophy using Z-scores. We constructed receiver operating characteristic (ROC) curves to determine the cut-off point of the each local WMH volume for estimating cardiac death and admission due to HF. We constructed Kaplan-Meier Curves adjusted with age, sex, presence of atrial fibrillation, diabetes, dyslipidemia, and blood pressure using inverse probability weighting method. Results: Local WMH volume of CC demonstrated the highest prognostic accuracy (area under the ROC curve 0.73). We divided patients into High-WMH group (n=36, volume of WMH in CC 0.65±37 mL) and Low-WMH group (n=25, volume of WMH in CC 0.14±0.07 mL) according to the cut-off value (0.24 mL) of local WMH volume in CC. As shown in representative cases in Figure1, the Z-score value in PHG (pink circle) was higher in High-WMH group (1.43±0.77) compared to Low-WMH group (0.93±0.63, P=0.01). Adjusted Kaplan-Meier curves showed poor prognosis of High-WMH group (Figure 2). Conclusions: In HF patients without dementia, local WMH in corpus callosum is a potential risk of CI and predicts poor prognosis.