Heart failure, Self-care, Brain, Magnetic Resonance Imaging



  1. Choi, Sarah PhD, RN, FNP
  2. Roy, Bhaswati PhD
  3. Kumar, Rajesh PhD
  4. Fonarow, Gregg C. MD
  5. Woo, Mary A. PhD, RN


Background: Inadequate self-care is linked to poor health outcomes in heart failure (HF). Self-care depends on decision-making abilities, but links between self-care and brain injury to executive decision-making regulatory areas (prefrontal cortices) are unclear.


Objective: We investigated the relationships between HF self-care and status of prefrontal cortices.


Methods: Magnetic resonance imaging-based diffusion tensor imaging was performed in 21 patients with HF (age, 53.8 +/- 7.9 years; 15 men; left ventricular ejection fraction, 25.1% +/- 6.1%), and self-care and executive function were measured with the Self-care of Heart Failure Index (SCHFI) and Trail Making Test B. Using diffusion tensor imaging data, mean diffusivity (MD) maps were calculated and region-of-interest analyses were performed on the left and right prefrontal brain areas. Statistical analyses consisted of partial correlations (covariates, age, and gender).


Results: The mean +/- SD SCHFI scores were 70.78 +/- 11.37 for maintenance, 70 +/- 17.32 for management, and 74.91 +/- 15.76 for confidence. The mean +/- SD Trail Making Test B score was 90.2 +/- 73.3 seconds. The mean +/- SD MD values (higher values indicate tissue injury) of the left and right prefrontal cortices were 1.46 +/- 0.16 (x10-3 mm2/s) and 1.44 +/- 0.14 (x10-3 mm2/s), respectively. Significant negative correlations emerged between prefrontal MD values and SCHFI maintenance (left/right, r = -0.64/-0.70; P < .003) and SCHFI management (r = -0.93/-0.86; P < .003). Significant positive correlations were observed between prefrontal MD values and Trail Making Test B (r = 0.71/0.74; P < .001). A nonsignificant correlation emerged between prefrontal MD values and SCHFI confidence scores.


Conclusions: Brain tissue integrity in executive function regulatory regions is associated with HF self-care for maintenance and management. The findings indicate that protection and brain injury repair in executive control areas may improve HF self-care.