Brain Cortex Thinning in Cardiac Allograft Vasculopathy ― Associations With Myocardial Fibrosis and Cognitive Impairment ―

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BACKGROUND: The aim of this study was to investigate changes in cortical thickness in patients with cardiac allograft vasculopathy (CAV) using magnetic resonance imaging (MRI), and links to myocardial fibrosis and cognitive function. METHODS AND RESULTS: In all, 77 patients after heart transplantation (35 with CAV, 42 without CAV), as well as 45 healthy controls (HC), underwent brain MRI and cardiac MRI (CMR). Analysis of covariance (ANCOVA), partial correlation and mediation analyses were performed. The CAV group exhibited significant cortical thinning in several brain regions, including the bilateral superior frontal gyrus, left angular gyrus, and left supramarginal gyrus (false discovery rate [FDR] P<0.05). Cortical thickness in the left cingulate gyrus (r=-0.377, P=0.015) and right cuneus (r=-0.297, P=0.009) was negatively correlated with extracellular volume (FDR P<0.05). Montreal Cognitive Assessment (MoCA) and Mini-Mental State Examination scores were lower in the CAV than non-CAV and HC groups. Cortical thickness in the bilateral inferior frontal gyrus, left cingulate gyrus, right angular gyrus, and right postcentral sulcus was positively correlated with MoCA scores (FDR P<0.05). The cortical thickness of the left cingulate gyrus partially mediated the association between extracellular volume and MoCA scores (β=-0.135; 95% confidence interval -0.323, -0.025). CONCLUSIONS: Our findings reveal a cardiocerebral interaction, highlighting cortical thinning as a neuroimaging marker for CAV-related myocardial fibrosis and cognitive decline.

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