Предиктори когнітивної дисфункції у пацієнтів з хронічною серцевою недостатністю та зниженою фракцією викиду лівого шлуночка

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.