Predictors of cognitive impairment in patients with chronic heart failure and reduced left ventricular ejection fraction
Journal Title: Український терапевтичний журнал - Year 2018, Vol 0, Issue 2
Abstract
Objective — to investigate the predictors of cognitive impairment (CI) in patients with CHF and reduced left ventricular ejection fraction of (rLVEF). Materials and methods. The examinations involved 124 patients with CHF aged 18 to 75 years, NYHA II—IV. Cognitive function was evaluated with the use of Mini-Mental State Examination (MMSE), Schulte рrobe, HADS scale. CI counted as MMSE ≤ 26 points. In addition to the standard general clinical examination, the quality of life was assessed with the use of The Minnesota Living with Heart Failure Questionnaire (MLHFQ); physical activity of patients was evaluated by Duke Activity Status Index (DASI) and the 6-minute walking test; immunoenzymometric (determination of interleukin 6, NT-proBNP, insulin), ultrasound diagnostic of endothelium-mediated vasodilatory response of the brachial artery. Statistical methods: descriptive statistics (median, upper and lower quartile), univariant logistic regression, multivariate logistic regression. Results and discussion. CI was observed in 68.5 % of patients and was associated with age (OR 1.07, 95 % CI: 1.03—1.11), duration of CHF symptoms (OR 1.02, 95 % CI: 1.001—1.03), and with the presence and duration of such co-morbidities as AH and IHD (OR 3.46, 95 % CI: 1.44—8.30 and OR 2.60, 95 % CI: 1.14—5.90 respectively). According to the univariate regression analysis, high risk of CI was defined in patients NYHA III—IV (OR 2.68, 95 % CI: 1.22—5.87) with worse quality of life assessed by MLHFQ (OR 1.02, 95 % CI: 1.002—1.04) and with the high ceruloplasmin levels (OR 1.02, 95 % CI: 1.01—1.03). At the same time, lower risk of CD was associated with better functional status (the 6-minute walking test, DASI (OR 0.996, 95 % CI: 0.99—0.999 and OR 0.96, 95 % CI: 0.94—0.99 respectively) and adherence to therapy (OR 0.77, 95 % CI: 0.60—0.98), and also with better endothelium-mediated vasodilatory response (OR 0.9, 95 % CI: 0.83—0.98). According to multivariate analysis, the independent CI predictors in patients with CHF and rLVEF were age, duration of AH, low adherence to therapy and high ceruloplasmin level of blood plasma. Conclusions. Cognitive dysfunction was observed in the majority of patients with CHF and associated with age, duration of CHF symptoms, presence and duration of AH and IHD. High risk of CI have patients with NYHA III—IV functional class, worse quality of life and high ceruloplasmin level. At the same time, the risk of CI developing was lower in the individuals with better functional status (6-minute walking test, DASI), better adherence to the treatment, and better endothelium-mediated vasodilatory response. According to the results of multivariate analysis, independent predictors of CI in patients with CHF were age, duration of AH, poor adherence to treatment and high serum ceruloplasmin level.
Authors and Affiliations
A. S. Solonovych, A. V. Liashenko, L. S. Mkhitaryan, T. I. Gavrilenko, I. L. Revyenko, L. G. Voronkov
Influence of the tobacco smoking factor in the comorbid course of chronic obstructive pulmonary disease and ischemic heart disease
Objective — to assess the clinical state, external respiration, structural and functional state of the heart and blood vessels, blood levels of NT-proBNP and factors of the systemic inflammatory response in patients with...
Age-related aspects of bone tissue condition at chronic pancreatitis
The fact that chronic pancreatitis (СP) affects mostly patients of employable age is one of the important factors of its social significance. Objective — to study the state of bone tissue of patients with СP of various a...
Assessment of the pulmonary ventilation function in the development of pulmonary hypertension in patients with bronchial asthma in conjunction with impaired endothelium-dependent vasodilation
Objective — to assess the state of pulmonary ventilation function in the development of pulmonary hypertension (PH) in patients with bronchial asthma (BA) in conjunction with the impaired endothelium-dependent vasodilat...
The improvement of the efficiency of treatment of hypertension and obesity by individual correction of the eating behavior
Objective — to improve the efficiency of treatment and secondary prevention of hypertension (H) and obesity by individual correction of the eating behavior (EB) against the background of standard therapy. Materials and m...
The polymorphism of a gene β1-adrenorecepters and a long-term forecast of patients with heart failure
Objective — to investigate of the effect of polymorphism β1-adrenorecepters (β1-AR) gene on the long-term prognosis of patients with heart failure (HF). Materials and methods. The investigation involved 195 patients with...