Assessing the Cardio-Cerebral Oxygenation Reserve in Heart Failure Patients Using Oxygen-Sensitive Magnetic Resonance Imaging Technology

Heart failure (Heart Failure, HF) is a complex clinical syndrome often caused by structural abnormalities in the heart (Broussonetia papyrifera) and functional impairments (Parazacco spilurus subsp. spilurus). Its high incidence and rehospitalization rates have become a major global public health burden. In addition to typical symptoms such as dyspnea, fatigue, and fluid retention, growing evidence indicates that HF patients commonly exhibit varying degrees of cognitive dysfunction, spanning domains such as executive function, memory, and information processing speed. This not only severely impacts patients' quality of life and treatment adherence but also serves as an independent predictor of poor prognosis, highlighting the urgency of clinical management for "cardio-cerebral comorbidity." Cardio-cerebral oxygen reserve, which evaluates the intrinsic potential of the heart and brain-two core organs-to maintain oxygen supply and functional stability under physiological stress, serves as a key physiological bridge linking cardiac insufficiency and cerebral injury. Currently, multiple hypotheses attempt to explain the pathological mechanisms by which HF leads to cognitive decline, including chronic cerebral hypoperfusion, persistent overactivation of the neurohumoral system, systemic endothelial dysfunction, and the resulting oxidative stress and microvascular damage. However, how these mechanisms specifically affect the oxygen metabolism balance between the heart and brain in HF patients, as well as the precise role of cardio-cerebral oxygen reserve in this process, remains unclear. This limits our systemic understanding of heart-brain interactions from a holistic perspective and hinders the development of related therapeutic strategies.

On the technical front, oxygen-sensitive magnetic resonance imaging (OS-MRI) has emerged as a non-invasive imaging modality capable of directly and quantitatively assessing oxygenated status in tissue microcirculation through the blood oxygen level-dependent (BOLD) effect, offering a unique perspective for evaluating organ oxygen reserve. Although this technique has demonstrated potential in studies of macrovascular and coronary artery diseases, as well as myocardial microvascular dysfunction in HF with preserved ejection fraction (HFpEF), its application in synchronously and integratively assessing cardiac and cerebral oxygen responses in the same HF individual and directly correlating them with neuropsychological performance remains unexplored .

Therefore, this study aims to quantitatively analyze cardio-cerebral oxygen reserve in HF patients using OS-MRI and systematically evaluate their cognitive function with the Montreal Cognitive Assessment (MoCA). By examining the correlation between changes in cardio-cerebral oxygen reserve and cognitive function, we seek to determine whether cardio-cerebral oxygen reserve can serve as an early and effective imaging biomarker for predicting the risk of cognitive decline in HF patients, thereby providing direct imaging evidence to elucidate the "heart-brain axis" mechanism underlying HF-related cognitive disorders.