Correlations between chronic heart failure with preserved ejection fraction, subclinical atherosclerosis, daily activity and cognitive decline
A Militaru, D Lighezan, R Ibanescu, M MilitaruAbstract
Background and aims
Recent studies show that chronic heart-failure(HF) and cardiovascular-risk-factors (CVRFs) contribute to cognitive-decline (CD). The aim of the study was to evaluate the CD, daily-activity screening, signs of depression, subclinical-atherosclerosis(intima-media-thickness(IMT), ankle−brachial-index(ABI)) and hemodynamic-changes in CVRFs patients with chronic HF with preserved-ejection-fraction (HFpEF) versus CVRFs patients without HF.
Methods
We included in the study 165 CVRFs patients with/without chronic HF, without peripheral-atherosclerotic-disease or stroke. We compared the results of the 83(50.30%) CVRFs patients with HFpEF versus 82 (49.70%) CVRFs patients without HF. They underwent clinical-examinations, blood-pressure(BP), heart-rate(HR), Mini-Mental-State-Examination(MMSE), Activities-of-Daily-Living-Score(ADL), Geriatric-Depression-Scale(GDS-15). We measured left-ventricular-ejection-fraction(LVEF)(%) by echocardiography, IMT(mm) using a carotid-duplex-scan and ABI in both groups of patients.
Results
From 83(50.30%) patients with HFpEF, with mean-age 72.04±10.30 (44-89 years)(31(37.30%)male/52(62.70%)female), there were 79(95.20%) hypertension patients, 32(38.60%) diabetes-mellitus patients, 57(68.70%) with dyslipidemia and 21(25.30%) smokers. MMSE, ADL, ABI-left, and LVEF were significantly-decreased and SBP/DBP, IMT-left/right and GDS-15 were significantly-increased in CVRFs -patients with HFpEF compared with CVRFs patients without HFpEF(p<0.05). Patients with HFpEF/age>65 have significantly lower rates of daily-activity(ADL) and CD(MMSE)(p<0.05) and significantly higher rates of depression (GDS-15)(p<0.05) and higher rates of IMT, versus HFpEF/age<65 patients. In patients with HFpEF we found a statistically significant weak-negative correlation between age with MMSE (p=0.001), moderate-negative correlation with ADL (p<0.001), moderate-positive correlation with GDS-15 (p<0.001) and weak-positive correlation with SBP/DBP (p˂0.05).We determined a statistically significant strong-negative correlation between MMSE with SBP/DBP (p<0.001) and GDS-15 (p<0.001) and a weak-negative correlation with HR (p<0.05) and IMT-left/right (p<0.05) and a moderate-positive correlation between MMSE and ADL (p<0.001). We found a statistically significant weak/moderate-negative correlation between IMT-left/right with MMSE (p<0.05) and ADL (p˂0.05) and a weak/moderate-positive correlation with SBP/DBP (p<0.001) and GDS-15(p<0.001)
Conclusion
In patients with HFpEF and CVRFs, impairments in activities of daily-living, depression symptoms and CD are more frequently observed. In this context, we consider systematic assessment of early CD, depression symptoms and daily functioning to be essential, as well as the identification of subclinical-atherosclerosis(IMT/ABI) and hemodynamic-changes(LVEF), correlated with age, blood-pressure values, heart-rate and cognitive parameters, in order to prevent further deterioration of cognitive function.