Heart failure (HF) patients show inability to regulate heart rate and blood pressure in response to autonomic challenge. Using BOLD-fMRI and DTI-MD procedures, we found that functional MRI responses during the Valsalva maneuver in cerebellum and insular are delayed or reduced in amplitude, and comparable areas showed structural injury in HF subjects. These findings show that impaired functional responses during the Valsalva maneuver have brain structural basis in HF condition.
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