{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,15]],"date-time":"2026-09-15T05:02:50Z","timestamp":1789448570608,"version":"build-2803163510"},"reference-count":21,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,9,15]],"date-time":"2026-09-15T00:00:00Z","timestamp":1789430400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Materials and methods<\/jats:title>\n                    <jats:p>\n                      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\n                      <jats:italic>t<\/jats:italic>\n                      tests, Mann\u2013Whitney U tests, or chi-square tests as appropriate. Associations between DTI-ALPS indices and cognitive outcomes were examined using Spearman correlation analyses and multivariable linear regression models adjusted for age, sex, and educational level.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Compared with healthy controls, patients with HFpEF had lower MoCA (22.34\u202f\u00b1\u202f3.38 vs. 28.70\u202f\u00b1\u202f1.69;\n                      <jats:italic>t<\/jats:italic>\n                      \u202f=\u202f9.29,\n                      <jats:italic>p<\/jats:italic>\n                      \u202f&amp;lt;\u202f0.01) and MMSE scores (median 24.00 vs. 28.50;\n                      <jats:italic>Z<\/jats:italic>\n                      \u202f=\u202f\u22125.03,\n                      <jats:italic>p<\/jats:italic>\n                      \u202f&amp;lt;\u202f0.01), together with poorer visuospatial\/executive function, attention, language, abstraction, and delayed recall (all\n                      <jats:italic>p<\/jats:italic>\n                      \u202f&amp;lt;\u202f0.01), whereas naming and orientation did not differ between groups (both\n                      <jats:italic>p<\/jats:italic>\n                      \u202f&amp;gt;\u202f0.05). The left DTI-ALPS index was lower in patients than in controls (1.64\u202f\u00b1\u202f0.24 vs. 1.77\u202f\u00b1\u202f0.21,\n                      <jats:italic>t<\/jats:italic>\n                      \u202f=\u202f2.08,\n                      <jats:italic>p<\/jats:italic>\n                      \u202f=\u202f0.04), whereas the right and mean indices showed no significant group difference (\n                      <jats:italic>p<\/jats:italic>\n                      \u202f=\u202f0.54 and\n                      <jats:italic>p<\/jats:italic>\n                      \u202f=\u202f0.16, respectively). After adjustment for age, sex, and educational level, a lower left DTI-ALPS index was independently associated with worse MMSE (\n                      <jats:italic>\u03b2<\/jats:italic>\n                      \u202f=\u202f0.031,\n                      <jats:italic>p<\/jats:italic>\n                      \u202f=\u202f0.001), MoCA (\n                      <jats:italic>\u03b2<\/jats:italic>\n                      \u202f=\u202f0.021,\n                      <jats:italic>p<\/jats:italic>\n                      \u202f=\u202f0.007), and delayed recall scores (\n                      <jats:italic>\u03b2<\/jats:italic>\n                      \u202f=\u202f0.050,\n                      <jats:italic>p<\/jats:italic>\n                      \u202f=\u202f0.009).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fmed.2026.1811109","type":"journal-article","created":{"date-parts":[[2026,9,15]],"date-time":"2026-09-15T04:26:12Z","timestamp":1789446372000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Brain perivascular diffusion and cognitive impairment in heart failure with preserved ejection fraction"],"prefix":"10.3389","volume":"13","author":[{"given":"Tianyi","family":"Yu","sequence":"first","affiliation":[{"name":"Department of Radiology, Shandong Provincial Hospital Affiliated to Shandong First Medical University","place":["Jinan, China"]},{"name":"Shandong Key Laboratory of Multimodal Imaging Artificial Intelligence and Genetics","place":["Jinan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chongzhen","family":"Duan","sequence":"additional","affiliation":[{"name":"Department of Radiology, Shandong Provincial Hospital Affiliated to Shandong First Medical University","place":["Jinan, China"]},{"name":"Shandong Key Laboratory of Multimodal Imaging Artificial Intelligence and Genetics","place":["Jinan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Minwen","family":"Sun","sequence":"additional","affiliation":[{"name":"Department of Radiology, The Second Affiliated Hospital of Shandong University of Traditional Chinese Medicine","place":["Jinan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yixin","family":"Liu","sequence":"additional","affiliation":[{"name":"School of Clinical and Basic Medical Sciences, Shandong First Medical University & Shandong Academy of Medical Sciences","place":["Jinan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuchun","family":"Yuan","sequence":"additional","affiliation":[{"name":"Department of Radiology, The Second Affiliated Hospital of Shandong University of Traditional Chinese Medicine","place":["Jinan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,9,15]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"412","DOI":"10.1007\/s11897-022-00578-7","article-title":"Biomarkers in HFpEF for diagnosis, prognosis, and biological phenotyping","volume":"19","author":"Eltelbany","year":"2022","journal-title":"Curr Heart Fail Rep"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"1205","DOI":"10.1016\/j.amjcard.2013.12.032","article-title":"Prevalence of memory disorders in ambulatory patients aged \u226570 years with chronic heart failure (from the EFICARE study)","volume":"113","author":"Hanon","year":"2014","journal-title":"Am J Cardiol"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"583","DOI":"10.1016\/j.jchf.2018.03.010","article-title":"Cognitive deficits and related brain lesions in patients with chronic heart failure","volume":"6","author":"Frey","year":"2018","journal-title":"JACC Heart Fail"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"2894","DOI":"10.1002\/ehf2.12899","article-title":"Trends in cause-specific readmissions in heart failure with preserved vs. reduced and mid-range ejection fraction. 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