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Patients with heart failure (HF) are at risk for vascular brain injury. Cerebral cortical microinfarcts (CMIs) are a novel MRI marker of vascular brain injury. This study aims to determine the occurrence of CMIs in patient with HF and their clinical correlates, including haemodynamic status. From the Heart-Brain Study, a multicenter prospective cohort study, 154 patients with clinically stable HF without concurrent atrial fibrillation (mean age 69.5 ± 10.1, 32% female) and 124 reference participants without HF (mean age 65.6 ± 7.4, 47% females) were evaluated for CMIs on 3 T MRI. CMI presence in HF was tested for associations with vascular risk profile, cardiac function and history, MRI markers of vascular brain injury and cognitive profile. CMI occurrence was higher in patient with HF (17%) than reference participants (7%); after correction for age and sex OR 2.5 [95% CI 1.1–6.0] p =.032; after additional correction for vascular risk factors OR 2.7 [1.0–7.1] p =.052. In patients with HF, CMI presence was associated with office hypertension (OR 2.7 [1.2–6.5] p =.021) and a lower cardiac index (B = -0.29 [−0.55−−0.04] p =.023 independent of vascular risk factors), but not with cause or duration of HF. Presence of CMIs was not associated with cognitive performance in patients with HF. CMIs are a common occurrence in patients with HF and related to an adverse vascular risk factor profile and severity of cardiac dysfunction. CMIs thus represent a novel marker of vascular brain injury in these patients. • Heart failure is associated with an increased risk for vascular brain injury and cognitive impairment. • Cerebral cortical microinfarcts (CMIs) are a novel MRI-marker of vascular brain injury that is associated with reduced cerebral blood flow and predicts cognitive decline. • In this cohort study we demonstrate that CMIs are very common in patients with heart failure and related to severity of cardiac pump-dysfunction. • Future research must indicate whether CMIs predict cognitive decline over time in patients with heart failure. [ABSTRACT FROM AUTHOR]