Resumen
Objetivo: El estudio busca analizar críticamente la evidencia científica sobre las repercusiones neurológicas de la insuficiencia cardíaca (IC), centrándose en las alteraciones estructurales y funcionales detectadas por la neuroimagen, y su relación con las disfunciones cognitivas. Métodos: Se trata de una revisión integradora de la literatura, realizada con rigor metodológico. Se seleccionaron artículos publicados entre 2019 y 2024 en bases de datos científicas, incluyendo MEDLINE y LILACS, utilizando los descriptores DECS/MESH: "Insuficiencia cardíaca", "Cerebro" y "Neuroimagen", incluidos sus sinónimos. Se aplicaron estrictos criterios de inclusión y exclusión, lo que dio como resultado ocho artículos analizados en detalle. Resultados: Los estudios revisados indican que los pacientes con IC presentan reducción de la perfusión cerebral, atrofia cortical, hiperintensidad de la sustancia blanca y alteraciones en la conectividad funcional, particularmente en la corteza prefrontal y en regiones del sistema límbico. Estos cambios estructurales se asocian con el deterioro cognitivo, la disfunción autonómica y un mayor riesgo de trastornos neuropsiquiátricos. Consideraciones finales: La neuroimagen revela impactos significativos de la IC en el cerebro, reforzando la necesidad de estrategias terapéuticas que integren enfoques cardiológicos y neurológicos. Los estudios futuros deben profundizar en los mecanismos subyacentes e investigar las intervenciones para mitigar el deterioro cognitivo.
Referencias
ALOSCO ML e HAYES SM. Structural brain alterations in heart failure: a review of the literature and implications for risk of Alzheimer’s disease. Heart Failure Reviews, 2015; 20(5): 561–571.
ALTHAMMER F, et al. Angiotensin-II drives changes in microglia–vascular interactions in rats with heart failure. Communications Biology, 2024; 7(1): 1365–1378.
BENNETT J, et al. Assessment of microvascular disease in heart and brain by MRI: application in heart failure with preserved ejection fraction and cerebral small vessel disease. Medicina, 2023; 59(9): 1596.
BERMUDEZ C, et al. Volumetric brain MRI signatures of heart failure with preserved ejection fraction in the setting of dementia. Magnetic Resonance Imaging, 2024; 109: 49–55.
CARVALHO RF e MOREIRA AL. Insuficiência cardíaca com fração de ejeção preservada: combater equívocos para uma nova abordagem. Arquivos Brasileiros de Cardiologia, 2011; 96(6): 504–514.
CHOI S, et al. Heart Failure Self-care Associated with brain injury in executive control regions. The Journal of Cardiovascular Nursing, 2019; 34(6): 433–439.
DARDIOTIS E, et al. Cognitive impairment in heart failure. Cardiology Research and Practice, 2012; 1–9.
DESTE G, et al. Neuroimaging Links between heart failure and depression—a narrative review. BrainSciences, 2024; 14(12): 1283–1283.
DRIDI H, et al. Heart failure-induced cognitive dysfunction is mediated by intracellular Ca2+ leak through ryanodine receptor type 2. NatureNeuroscience, 2023; 26(8): 1365–1378.
HANAUER M, et al. Associação entre classes funcionais da insuficiência cardíaca com fração de ejeção preservada e comprometimento cognitivo. RevistaBrasileira de Neurologia, 2021; 57(3): 1–8.
HAO G, et al. Prevalence of heart failure and left ventricular dysfunction in China: the China Hypertension Survey, 2012–2015. European Journal of Heart Failure, 2019; 21(11): 1329–1337.
ICHIJO Y, et al. Impaired frontal brain activity in patients with heart failure assessed by near‐infrared spectroscopy. Journal of the American Heart Association, 2020; 9(3): 1–8.
JIANG L, et al. Aberrant static and dynamic functional network connectivity in heart failure with preserved ejection fraction. ESC Heart Failure, 2022; 9(4): 2558–2566.
LI T, et al. Heart failure and cognitive impairment: A narrative review of neuroimaging mechanism from the perspective of brain MRI. Frontiers in Neuroscience, 2023; 17: 1–8.
LIU Y, et al. Arterial spin labeling MRI study of age and gender effects on brain perfusion hemodynamics. Magnetic Resonance in Medicine, 2012; 68(3): 912–922.
MAKWANA B, et al. Cerebrovascular Perfusion among older adults with and without cardiovascular disease. Journal of Neuroimaging, 2020; 30(6): 851–856.
MASSARO AR. Complicações neurológicas da insuficiência cardíaca. Manual de Neurologia Clínica, 2021; 177(8): 77–89.
SCHAICH CL, et al. Neurocognitive impairments and their improvement following exercise and dietary interventions in older patients with heart failure with preserved ejection fraction. Circulation Heart Failure, 2024; 17(1): 1–8.
SCHROETER ML, et al. Heart failure decouples the precuneus in interaction with social cognition and executive functions. Scientific Reports, 2023; 13(1): 1236.
SERBER SL, et al. cerebral blood flow velocity and vasomotor reactivity during autonomic challenges in heart failure. Nursing Research, 2014; 63(3): 194–202.
SHI Z, et al. Impact of cognitive impairment on heart failure prognosis: insights into central nervous system mechanism. EJNMMI Research, 2024; 14(1): 1–8.
SONG X, et al. Aberrant brain functional connectivity dynamic responses to the valsalva maneuver in heart failure. Journal of Cardiac Failure, 2019; 25(9): 757–766.
SOUZA MT, et al. Integrative review: what is it? how to do it? Einstein (São Paulo), 2010; 8(1): 102–106.
VALE RMC, et al. Intervenções por exercício físico e funções cognitivas de idosos: revisão sistemática da literatura. RevistaBrasileira de Atividade Física&Saúde, 2022; 27: 1–12.
VERÍSSIMO AOL, et al. Alterações cognitivas e de autocuidado em pacientes com insuficiência cardíaca na Amazônia. Pesquisa, Sociedade e Desenvolvimento, 2020; 6: 98963321.
VOGELS RLC, et al. Brain magnetic resonance imaging abnormalities in patients with heart failure. 2007; 9(10): 1003–1009.
