Brain perivascular diffusion and cognitive impairment in heart failure with preserved ejection fraction.

Objective: Heart failure with preserved ejection fraction (HFpEF) is increasingly recognized as a systemic cardiovascular disorder that may involve extra-cardiac organs, including the brain. This study aimed to investigate whether brain perivascular diffusivity, assessed using diffusion tensor image analysis along the perivascular space (DTI-ALPS), is associated with cognitive performance, assessed with the Montreal Cognitive Assessment (MoCA) and the Mini-Mental State Examination (MMSE), in patients with HFpEF. Materials and methods: Thirty-five patients with HFpEF and 20 healthy controls underwent brain diffusion kurtosis imaging and neuropsychological assessment. Left, right, and mean DTI-ALPS indices were calculated for each participant. Group differences were evaluated using independent-samples Results: Compared with healthy controls, patients with HFpEF had lower MoCA (22.34 ± 3.38 vs. 28.70 ± 1.69; Conclusion: HFpEF was associated with cognitive impairment and a left-predominant reduction in perivascular diffusivity as reflected by DTI-ALPS. These findings suggest that DTI-ALPS may be a candidate neuroimaging marker of brain involvement in HFpEF. Given the cross-sectional design, causal and predictive interpretations should be avoided until confirmed by longitudinal multimodal studies.