Clinical markers of cognitive impairment in patients with chronic heart failure of ischemic origin during out-patient regular follow-up: a cross-sectional study

Almanac of Clinical Medicine Pub Date : 2024-04-01 DOI:10.18786/2072-0505-2024-52-003

O. Efremova, O. V. Dudchenko, L. A. Kamyshnikova, T. N. Proskokova, O. A. Bolkhovitina, Ekaterina V. Lysenko

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Abstract

Background: Cognitive impairment (CI) is present in 25–50% of chronic heart failure (CHF) patients. Doctors who monitor patients with cardiovascular disorders do not have clearly set criteria for their referral to a neurologist in case of suspected CI. Therefore, CHF patients do not receive treatment for CI on time. Aim: To identify significant clinical markers of CI in patients with CHF of ischemic origin. Materials and methods: This cross-sectional cohort study included 134 patients with CHF of ischemic origin (mean age 63.36 ± 10.63 years; men, 76.12%), who were regularly monitored in a municipal polyclinic. All patients were tested for CI with the Montreal Cognitive Assessment Scale (MoCA); basic hemodynamic parameters, lipid profile, brain natriuretic peptide (NT-proBNP) were assessed, and triglyceride-glucose index (TyG) and body mass index (BMI) were calculated. Cardio-ankle vascular index (CAVI) was measured, echocardiography and a 6-minute walk test (SMWТ) were performed and past history of CHF, arterial hypertension (AH) and diabetes mellitus (DM) was collected. Results: CI (MoCA score ≤ 25) was detected in 85 (63.43%) outpatients with CHF of ischemic origin; the group without CI (MoCA score 26) included 49 (36.67%) patients. There were significant correlations between MoCA and CAVI scores (partial correlation coefficient, r = -0.802, p 0.001; adjusted squared multiple correlation coefficient (adj. R2) = 0.881, p 0.001), MoCA and TyG (r = -0.357, p = 0.029; adj. R2 = 0.363, p 0.001), MoCA and SMWТ (r = -0.211, p = 0.037; adj. R2 = 0.696, p 0.001). The multivariate test for significance of planned comparisons between CAVI and MoCA scores (Wilks' lambda) was 0.005 (F = 4.74; p 0.001). Conclusion: CAVI, TyG and SMWТ values are the clinical markers of CI in patients with CHF of ischemic origin. There is a direct association between increased CAVI and the presence of CI, regardless of age, lipid metabolism parameters, structural and functional heart parameters, CHF duration, AH and DM. Identification of these markers could be an indication for an in-depth assessment of CHF patients by a neurologist.

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缺血性慢性心力衰竭患者在门诊定期随访期间认知障碍的临床指标：一项横断面研究

背景：25%-50%的慢性心力衰竭（CHF）患者存在认知障碍（CI）。监测心血管疾病患者的医生并没有明确的标准，要求他们在怀疑出现 CI 时将患者转介给神经科医生。因此，CHF 患者无法及时接受 CI 治疗。目的：确定缺血性 CHF 患者 CI 的重要临床指标。材料和方法：这项横断面队列研究纳入了 134 名缺血性慢性心力衰竭患者（平均年龄为 63.36 ± 10.63 岁；男性占 76.12%），他们在一家市级综合医院接受定期监测。所有患者都接受了蒙特利尔认知评估量表（MoCA）的 CI 测试；评估了基本血液动力学参数、血脂状况、脑钠肽（NT-proBNP），并计算了甘油三酯-葡萄糖指数（TyG）和体重指数（BMI）。测量了心踝关节血管指数（CAVI），进行了超声心动图检查和 6 分钟步行测试（SMWТ），并收集了慢性心力衰竭、动脉高血压（AH）和糖尿病（DM）的既往史。结果显示85例（63.43%）缺血性CHF门诊患者检测到CI（MoCA评分≤25分）；无CI（MoCA评分26分）组包括49例（36.67%）患者。MoCA 评分与 CAVI 评分之间存在明显的相关性（部分相关系数 r = -0.802，P 0.001；调整后的平方多重相关系数 (adj. R2) = 0.881）。R2）= 0.881，p 0.001）、MoCA 和 TyG（r = -0.357，p = 0.029；adj. R2 = 0.363，p 0.001）、MoCA 和 SMWТ（r = -0.211，p = 0.037；adj. R2 = 0.696，p 0.001）。CAVI 和 MoCA 评分之间计划比较的多变量显著性检验（Wilks' lambda）为 0.005 (F = 4.74; p 0.001)。结论CAVI、TyG和SMWТ值是缺血性CHF患者CI的临床标志。无论年龄、脂代谢参数、心脏结构和功能参数、CHF 持续时间、AH 和 DM 如何，CAVI 升高与 CI 存在直接关联。这些标志物的识别可作为神经科医生对 CHF 患者进行深入评估的指征。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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Almanac of Clinical Medicine

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