Heart and brain interaction in patients with heart failure: Overview and proposal for a taxonomy. A position paper from the Study Group on Heart and Brain Interaction of the Heart Failure Association

Wolfram Doehner, Dilek Ural, Karl Georg Haeusler, Jelena Čelutkiene, Reinaldo Bestetti, Yuksel Cavusoglu, Marco A. Peña-Duque, Duska Glavas, Massimo Iacoviello, Ulrich Laufs, Ricardo Marmol Alvear, Amam Mbakwem, Massimo F. Piepoli, Stuart D. Rosen, Georgios Tsivgoulis, Cristiana Vitale, M. Birhan Yilmaz, Stefan D. Anker, Gerasimos Filippatos, Petar SeferovicAndrew J.S. Coats, Frank Ruschitzka

Research output: Contribution to journalArticle

Abstract

Heart failure (HF) is a complex clinical syndrome with multiple interactions between the failing myocardium and cerebral (dys-)functions. Bi-directional feedback interactions between the heart and the brain are inherent in the pathophysiology of HF: (i) the impaired cardiac function affects cerebral structure and functional capacity, and (ii) neuronal signals impact on the cardiovascular continuum. These interactions contribute to the symptomatic presentation of HF patients and affect many co-morbidities of HF. Moreover, neuro-cardiac feedback signals significantly promote aggravation and further progression of HF and are causal in the poor prognosis of HF. The diversity and complexity of heart and brain interactions make it difficult to develop a comprehensive overview. In this paper a systematic approach is proposed to develop a comprehensive atlas of related conditions, signals and disease mechanisms of the interactions between the heart and the brain in HF. The proposed taxonomy is based on pathophysiological principles. Impaired perfusion of the brain may represent one major category, with acute (cardio-embolic) or chronic (haemodynamic failure) low perfusion being sub-categories with mostly different consequences (i.e. ischaemic stroke or cognitive impairment, respectively). Further categories include impairment of higher cortical function (mood, cognition), of brain stem function (sympathetic over-activation, neuro-cardiac reflexes). Treatment-related interactions could be categorized as medical, interventional and device-related interactions. Also interactions due to specific diseases are categorized. A methodical approach to categorize the interdependency of heart and brain may help to integrate individual research areas into an overall picture.

Original languageEnglish
JournalEuropean Journal of Heart Failure
DOIs
Publication statusAccepted/In press - Jan 1 2017

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Keywords

  • Cardiac reflex
  • Chagas disease
  • Cognition
  • Heart failure
  • Mood
  • Muscle
  • Stroke
  • Takotsubo

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Doehner, W., Ural, D., Haeusler, K. G., Čelutkiene, J., Bestetti, R., Cavusoglu, Y., Peña-Duque, M. A., Glavas, D., Iacoviello, M., Laufs, U., Alvear, R. M., Mbakwem, A., Piepoli, M. F., Rosen, S. D., Tsivgoulis, G., Vitale, C., Yilmaz, M. B., Anker, S. D., Filippatos, G., ... Ruschitzka, F. (Accepted/In press). Heart and brain interaction in patients with heart failure: Overview and proposal for a taxonomy. A position paper from the Study Group on Heart and Brain Interaction of the Heart Failure Association. European Journal of Heart Failure. https://doi.org/10.1002/ejhf.1100