The value of the parameters of the severity of chronic heart failure in the assessment of cognitive dysfunction in patients with coronary heart disease


DOI: https://dx.doi.org/10.18565/therapy.2021.3.20-27

Akimova N.S., Bugaeva O.V., Sokolov I.M., Schwartz E.Yu., Kiselev A.R.

1) V.I. Razumovsky Saratov State Medical University of the Ministry of Healthcare of Russia; 2) V.A. Almazov National Medical Research Centre of the Ministry of Healthcare of Russia, Saint Petersburg; 3) National Medical Research Center for Therapy and Preventive Medicine of the Ministry of Healthcare of Russia, Moscow
Abstract. Purpose of the study: to assess the value of the left ventricular ejection fraction (LV EF) and the functional class (FC) of chronic heart failure (CHF) as potential markers and predictors of the development of morphofunctional disorders of the central nervous system (CNS) in patients with heart failure of ischemic origin.
Material and methods. A total of 54 patients with ischemic heart disease and CHF of II–IV FC were examined. The exclusion criteria were possible diseases and conditions that could independently lead to the appearance of cognitive impairments. Doppler echocardiography, nuclear magnetic resonance imaging of the brain with the calculation of the volume and length of the right and left hippocampus, dimensions of the cerebral ventricles as well as the thickness of the gray and white matter of the cerebral cortex were performed. Cognitive functions were assessed using Wechsler’s verbal and non-verbal subtests (variants 5 and 7), Bourdon’s proof test.
Results. A significant decrease in the results of the Wechsler cognitive subtests 5 and 7, a lesser thickness of the gray matter of the parietal lobes and a smaller volume of the right hippocampus in patients with III–IV FC of CHF compared with patients with II FC of CHF were found. Lower diffusion coefficients of water molecules in the white matter of the parietal and occipital lobes and a smaller thickness of the middle pedicles of the cerebellum were also found in the group of patients with III–IV FC of CHF. Comparative analysis of changes in indicators of the state of the CNS in patients with CHF with relatively intact systolic function (EF ≥45%) and in patients with CHF with reduced systolic function did not show significant differences. Also, no significant differences were found in the study of indicators of cognitive tests and parameters of nuclear magnetic resonance imaging of the brain in patients with heart failure with EF ≤35% and EF >35%.
Conclusion. The FC of CHF, obviously, characterizes not only the severity of heart failure, but can also be considered as a marker of cognitive dysfunction, while the EF of the LV is less significant in this regard.
Keywords: chronic heart failure, cognitive dysfunction, central nervous system, ejection fraction, functional class
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About the Autors

Natalia S. Akimova, MD, professor of Department of faculty therapy, faculty of general medicine of V.I. Razumovsky Saratov State Medical University of the Ministry of Healthcare of Russia. Address: 410012, Saratov, 112 Bol`shaya Kazach`ya Str. Tel.: +7 (927) 058-20-74. E-mail: astraveritas@yandex.ru. ORCID: 0000-0002-5935-2655
Oksana V. Bugaeva, assistant of Department of faculty therapy, faculty of general medicine of V.I. Razumovsky Saratov State Medical University of the Ministry of Healthcare of Russia. Address: 410012, Saratov, 112 Bol`shaya Kazach`ya Str. Tel.: +7 (927) 221-52-33. E-mail: link7fun@rambler.ru. ORCID: 0000-0003-1559-2830
Ivan M. Sokolov, MD, professor of Department of faculty therapy, faculty of general medicine of V.I. Razumovsky Saratov State Medical University of the Ministry of Healthcare of Russia. Address: 410012, Saratov, 112 Bol`shaya Kazach`ya Str. Tel.: +7 (927) 221-52-33. E-mail: docsim@bk.ru. ORCID: 0000-0002-9547-705Х
Elena Yu. Schwartz, 2-year resident of the Department of cardiovascular surgery of the Institute of medical education, V.A. Almazov National Medical Research Centre of the Ministry of Healthcare of Russia. Address: 197341, Saint Petersburg, 2 Akkuratova Str. E-mail: shwartz58@yandex.ru
Anton R. Kiselev, MD, associate professor, head of the Center for coordination of fundamental scientific activity, National Medical Research Center for Therapy and Preventive Medicine of the Ministry of Healthcare of Russia. Address: 101990, Moscow, 10/3 Petroverigskiy Lane. E-mail: antonkis@list.ru. ORCID: 0000-0003-3967-3950

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