The state of cognitive function in patients with chronic heart failure and reduced left ventricular ejection fraction depending on the main clinical, demographic and hemodynamic parameters

Main Article Content

L. G. Voronkov
A. S. Solonovych
A. V. Lyashenko

Abstract

The aim – to investigate clinical and other factors associated with cognitive dysfunction in patients with chronic heart failure (CHF) and reduced left ventricular ejection fraction.
Material and methods. 124 patients with stable CHF and reduced left ventricular ejection fraction (< 40 %), NYHA II–IV not older than 75 years were examined. Vital signs, routine laboratory tests, glomerular filtration rate by CKD-EPI, electrocardiography and ehocardiography parameters were studied. Cognitive function was evaluated by standard neuropsychological tests – MMSE (Mini Mental State Examination), Shulte and HADS. Cognitive dysfunction was defined as MMSE ≤ 26 points. Apart from routine examination, quality of life evaluation by The Minnesota Living with Heart Failure Questionnaire (The MLHFQ); evaluation of functional capacity by Duke Activity Status Index, endothelium-dependent vasodilation test were performed.
Results. Cognitive dysfunction (abnormal MMSE) was observed in 85 (68.6 %) patients. There was no significant differences of MMSE and Schulte test results in men and women, groups of patients with atrial fibrillation (AF) and sinus rhythm. Instead, a significantly worse MMSE and Schulte tests were observed in groups of patients with higher NYHA class (Р<0.001 for both tests), arterial hypertension (P=0.04 and P=0.012, respectively), coronary heart disease (Р<0.001 for both tests) and after myocardial infarction (Р<0.001 and P=0.002, respectively). The group of elderly patients had significantly worse MMSE and Schulte scores (Р<0.001 for both tests). Levels of systolic blood pressure, heart rate and left ventricular ejection fraction did not significantly affect cognitive function, while lower glomerular filtration rate was associated with presence of the cognitive dysfunction.
There was a significantly higher prevalence of cognitive dysfunction in patients with diabetes (P=0.049). At the same time, MMSE and Schulte tests were significantly worse in patients with anemia (P=0.02 and Р<0.001, respectively) and renal dysfunction (GFR < 60 ml/(min • 1,73 m2)) (P=0.003 and Р<0.001, respectively).
Conclusion. Cognitive dysfunction was observed in 68.6 % of stable CHF patients. There was no significant influence of heart rate, systolic blood pressure, left ventricular ejection fraction, atrial fibrillation and COPD on cognitive tests. Cognitive dysfunction in patients with CHF is associated with older age, coronary heart disease, history of hypertension and myocardial infarction, anemia and renal dysfunction.

Article Details

Keywords:

Хронічна серцева недостатність, когнітивна дисфункція, коморбідні стани

References

Voronkov LG, Parashenyk LP. Sertceva nedostatnist – Heart failure 2010;2:12–16 (in Russ).

Gilyarevskiy SR, Orlov VA, Bendeliani NG. Rossiyskiy kardiologicheskiy jurnal – Russian cardiology journal 2001;3:58–72 (in Russ).

Gurievich MA. Rossiyskiy kardiologicheskiy jurnal – Russian cardiology journal 2005;3:5–10 (in Russ).

Zaharov VV. Consilium medicum – Medical concilium 2011;13(2):82–90 (in Russ).

Mironova EE.ENVILA,2006.146 p (in Russ).

Bennett SJ, Sauve MJ. Cognitive deficits in patients with heart failure: A review of the literature. Journal of Cardiovascular Nursing 2003;18(3):219–242.

Celermajer DS, Sorensen KE, Bull C, Robinson J, Deanfield JE. Endothelium-dependent dilation in the systemic arteries of asymptomatic subjects relates to coronary risk factors and their interaction. J Am Coll Cardiol. 1994;24(6):1468–1474.

Chen LY, Agarwal SK, Norby FL, Gottesman RF, Loehr RL, Soliman EZ, Mosley TH, Folsom AR, Coresh J, Alonso A. Persistent but not paroxysmal atrial fibrillation is independently associated with lower cognitive function: the Atherosclerosis Risk in Communities (ARIC) Study. J Am Coll Cardiol. 2016 Mar 22;67(11):1379–1380. doi: 10.1016/j.jacc.2015.11.064.

Dardiotis E, Giamouzis G, Mastrogiannis D, Vogiatzi C, Skoularigis G, Triposkiadis F, Georgeos MH. Cognitive impairment in heart failure. Cardiology Research and Practice. 2012; ID 595821: 9 pages doi:10.1155/2012/595821.

Dassanayaka S, Jones SP. Recent developments in heart failure. Circulation. 2015;117:58–63. doi: 10.1161/CIRCRESAHA.115.305765.

Davis TP, Alexander J, Lesch M. Electrocardiographic changes associated with acute cerebrovascular disease: a clinical review. Prog. Cardiovasc. Dis. 1993;36(3):245–260.

Dlugaj M, Winkler A, Weimar C, Dürig J, Broecker-Preuss M, Dragano N, Moebus S, Jöckel KH, Erbel R, Eisele L; Heinz. Anemia and mild cognitive impairment in the German General Population. Journal of Alzheimer’s Disease. 2015;49(4):1031–1042.DOI: 10.3233/JAD-150434.

Doehner W, Ural D, Čelutkienė J. Heart–brain interactions in patients with heart failure, including takotsubo syndrome: a need to monitor autonomic sympathetic activity: reply. Europ. J. of Heart Failure. 2018; https://doi.org/10.1002/ejhf.1177.

Khalid A, Bhatti SK, Al Amoodi M. Clinical factors associated with left ventricular ejection fraction disparity in patients with left ventricular dysfunction undergoing multimodality imaging. Missouri Medicine.2012;109 (6):489–492.

Marzona I, O’Donnell M, Teo K, Gao P, Anderson C, Bosch J, Yusuf S. Increased risk of cognitive and functional decline in patients with atrial fibrillation: results of the ONTARGET and TRANSCEND studies. CMAJ. 2012;184(6):329–336.

Mikolich JR, Jacobs WC, Fletcher GF. Cardiac arrhythmias in patients with acute cerebrovascular accidents. JAMA.1981;246:1314–1317.

Ruitenberg A, Skoog I, Ott A, Aevarsson O, Witteman JC, Lernfelt B, van Harskamp F, Hofman A, Breteler MM. Blood pressure and risk of dementia: results from the Rotterdam study and the Gothenburg H-70 Study. Dementia Geriatr Cogn Disorders.2001;12(1):33–39.

Skoog I, Lernfelt B, Landahl S, Nilsson L, Persson G, Palmertz B, Andreasson A, Odén A, Svanborg A. 15-year longitudinal study of blood pressure and dementia. Lancet.1996;347:1141–1145.

Stevens LA, Coresh J, Greene T, Levey AS. Assessing kidney function—measured and estimated glomerular filtration rate. N Engl J Med. 2006;354: 2473–2483.

Thacker EL, McKnight B, Psaty BM, Longstreth WT Jr, Sitlani CM, Dublin S, Arnold AM, Fitzpatrick AL, Gottesman RF, Heckbert SR. Atrial fibrillation and cognitive decline: a longitudinal cohort study. Neurology. 2013;81:119–125.

Vogels RLC, Scheltens P, Schroeder-Tanka JM, Weinstein HC. Cognitive impairment in heart failure: a systematic review of the literature. European Journal of Heart Failure. 2007;9(5):440–449.

Vogels RLC, Oosterman JM, Van Harten B, Flier WM, Schroeder-Tanka JM. Profile of cognitive impairment in chronic heart failure. Journal of the American Geriatrics Society. 2007;55(11):1764–1770.

Vogels RL, Oosterman JM, van Harten B, Gouw AA, Schroeder-Tanka JM, Scheltens P, van der Flier WM, Weinstein HC. Neuroimaging and correlates of cognitive function among patients with heart failure. Dement Geriatr Cogn Disord. 2007;24:418–423.

Zuccala G, Cattel C, Manes-Gravina, Di Niro MG, Cocchi A, Bernabei R. Left ventricular dysfunction: a clue to cognitive impairment in older patients with heart failure. J. Neurol. Neurosurg. Psychiatry. 1997;63:509–512.

Most read articles by the same author(s)

1 2 3 > >>