Patients with heart failure, particularly post-myocardial infarction with reduced ejection fraction
Care Setting
Cardiovascular and neurological clinical settings focusing on heart failure and cognitive decline management
Key Highlights
Heart failure leads to increased glymphatic influx but impaired clearance of proteins from brain parenchyma.
Cerebral arterial pulsatility is potentiated post-myocardial infarction, influencing glymphatic influx.
Cerebral blood flow correlates with brain clearance, highlighting its regulatory role in glymphatic function.
Guideline-Based Recommendations
Diagnosis
Consider assessment of cerebral blood flow and glymphatic function in patients with heart failure to evaluate risk of cognitive decline.
Management
Target interventions to improve cerebral blood flow may support glymphatic clearance and potentially mitigate neurodegenerative progression in heart failure.
Monitoring & Follow-up
Monitor cognitive function and cerebral blood flow parameters in heart failure patients, especially post-myocardial infarction.
Risks
Impaired glymphatic clearance due to heart failure may increase risk of neurodegeneration and Alzheimer’s disease.
Patient & Prescribing Data
Heart failure patients with reduced ejection fraction post-myocardial infarction
No direct pharmacological treatments targeting glymphatic dysfunction are described; focus is on cardiovascular management to preserve cerebral blood flow and brain clearance mechanisms.
Clinical Best Practices
Recognize the link between heart failure-induced cerebral hypoperfusion and glymphatic dysfunction.
Incorporate cerebral blood flow evaluation in the neurological assessment of heart failure patients.
Support research and clinical monitoring of brain clearance pathways to prevent cognitive decline in cardiovascular disease.
by Marios Kritsilis, Lotte Vanherle, Marko Rosenholm, René in ‘t Zandt, Yuan Yao, Kelley M Swanberg, Pia Weikop, Michael Gottschalk, Nagesh C Shanbhag, Jiebo Luo, Kimberly Boster, Maiken Nedergaard, Anja Meissner, Iben Lundgaard
