Comparison of clinical characteristics of patients with chronic heart failure and reduced left ventricular ejection fraction in regard of state of cognitive function

Abstract

The aim — to establish clinical factors associated with cognitive dysfunction (CD) in patients with chronic heart failure (CHF) and reduced left ventricular ejection fraction (LV EF). Materials and methods. We examined 124 patients aged 18 to 75 years with CHF II — IV functional class according to the criteria of the New York Heart Association (NYHA). The cognitive function was assessed using a mini­mental state examination (MMSE), the Schulte test, the HADS scale. The number of points on the MMSE scale £ 26 indicated the presence of CD. In addition to the standard general clinical examination, the quality of life was assessed by the MLHFQ (The Minnesota Living with Heart Failure Questionnaire), the physical activity index was calculated using the Duke Activity Status index (DASI), a 6­minute walk test, an immunoassay study (levels of interleukin­6, N­terminal fragment of the brain natriuretic peptide and insulin were determined), ultrasound diagnosis of the vasodilating function of the endothelium of the brachial artery (flux­dependent vasodilation (FDVD)) using a sample with a reactive hyperemia. Results and discussion. CD was observed in 85 (68.6 %) patients. There was no statistically significant effect of sex, LVEF value, the influence of atrial fibrillation on the state of cognitive function. CD in patients with CHF and decreased LVEF was associated with the worst functional class by NYHA (p = 0.001), the presence of hypertension, coronary heart disease and renal dysfunction (p = 0.037, p = 0.021 and p = 0.032, respectively). Patients with CD were statistically significantly older (p = 0.002), had worse quality of life by MLHFQ (p = 0.04) and low DASI (p = 0.037), a high level of depression on the HADS scale (p = 0.032), lower glomerular filtration rate (p = 0.012), greater thickness of the posterior wall of the left ventricle (p = 0.011), inferior FDVD (p = 0.049) compared to patients without CD. The number of points on the MMSE scale directly correlated with the distance of a 6­minute walk (r = 0.264, p = 0.003), the DASI value (r = 0.275, p = 0.002), the glomerular filtration rate (r = 0.275, p = 0.002), FDVD (r = 0.207, p = 0.021) and the activity of superoxide dismutase (r = 0.205, p = 0.028) and inversely proportional to the degree of deterioration of the quality of life in MLHFQ (r = –0.179, p = 0.049), age (r = –0.429, p = 0.0001), the score on the HADS­D scale (r = –0.257, p = 0.004) and the level of ceruloplasmin (r = –0.308, p = 0.004). Conclusions. CD in patients with CHF and decreased LVEF was detected in 85 (68.6 %) cases. CD was associated with the severity of heart failure and the presence of hypertensive disease, coronary heart disease and renal dysfunction. Patients with CHF and CD are statistically significantly older in age, have a worse quality of life and physical activity, a high level of depressive manifestations, a higher concentration of ceruloplasmin in the blood plasma, a lower glomerular filtration rate and a worse flux­dependent vasodilator response compared to patients without CD.