Cognitive impairment in patients with chronic heart failure and reduced left ventricular ejection fraction on the background of hypertension

А.S. Solonovych, L.G. Voronkov


Background. Arterial hypertension (AH) is a risk factor for both chronic heart failure (CHF) and cerebrovascular diseases that cause cognitive decline. Cognitive impairment (CI) is common among this category of patients. However, the factors and mechanisms associated with CI in persons with hypertension complicated by CHF are underinvestigated. The purpose was to establish clinical and other factors associated with CI in persons with AH and CHF with reduced left ventricular ejection fraction. Materials and methods. General clinical examination, routine laboratory tests, 12-lead electrocardiogram, echocardiography according to the standard procedure; standard psychological testing methods: Mini-Mental State Examination (MMSE); Schulte test; Hospital Anxiety and Depression Scale. CI was considered with MMSE score ≤ 26 points; quality of life evaluation by the Minnesota Living with Heart Failure Questionnaire (MLHFQ); self-esteem by patients of domestic physical activity using the Duke University questionnaire; enzyme-linked immunosorbent assay (determination of the level of interleukin-6, NT-proBNP, insulin) results were taken into account; ultrasound diagnosis of vasodilating function of the brachial artery endothelium was performed using a test with reactive hyperemia; statistical methods of information processing (descriptive statistics, dispersion analysis, Spearman correlation, logistic regression) were applied. Results. One hundred twenty-four patients with AH and CHF were examined. The presence of CI in CHF depends on the age, severity of CHF, coronary heart disease and renal dysfunction. Patients with AH, CHF and CI have worse quality of life (p = 0.04), worse physical activity (p = 0.037), higher depression level (p = 0.032), worse adherence to treatment (p = 0.002), higher blood ceruloplasmin level (p = 0.006), worse endothelium-mediated vasodilatory response (p = 0.049) compared with persons without CI. In multivariate analysis, the independent predictors of CI in patients with AH and CHF were duration of hypertension, left ventricular posterior wall thickness and the MLHFQ score. The MMSE was highly informative regarding the prediction of long-term survival and the onset of a combined critical event even after adjustment to age and New York Heart Association class. Using the heart failure disease-specific questionnaire had a high informativity for prediction long-term survival and the onset of a combined critical event in patients with CHF. Prescription for four weeks of fixed combination of meldonium with gamma-butyrobetaine in addition to the standard basic treatment was associated with significant improvement of cognitive tests, quality of life, and endothelium-mediated vasodilatory response in patients with CHF.


chronic heart failure; hypertension; left ventricular posterior wall thickness; cognitive impairment; predictors


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