FIGURE 2.

Schematic presentation of the association among impaired cardiac function in chronic heart failure, cerebral blood flow, and cognitive decline. Left: The cerebral blood flow (CBF) changes in chronic heart failure (CHF) result from cardiac dysfunction (reduced stroke volume—SV/cardiac output—CO) and activation of the neurohumoral system (NHS). Reduced SV or CO induces local CBF regulatory mechanisms, leading to arteriolar vasodilatation, compromising further vasodilatation potential, and impairing CBF regulation. NHS activation provokes vasoconstriction of cerebral vascular bed, induces structural changes in cerebral resistance vessels, and causes microvascular dysfunction leading to impaired CBF regulation. Atrial fibrillation (AF) as a specific condition may lead to CBF impairment through mechanisms activated in CHF, through microembolic events causing microvascular dysfunction and impairing CBF regulation, or through macroembolic events leading to cerebral ischemia. Right: Cognitive decline (CD) in CHF results from dysfunctional CBF regulation causing hypoperfusion and ischemia of critical brain areas or from microvascular dysfunction due to cardiovascular risk factors associated with neurodegenerative disorders. Stroke volume (SV); cardiac output (cardiac output); neurohumoral System (NHS); atrial fibrillation (AF)