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
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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.
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