Cognitive impairment and its association with circulating biomarkers in patients with acute decompensated heart failure

Ying-Chang Tung; Fu-Chih Hsiao; Chia-Pin Lin; Wen-Chuin Hsu; Pao-Hsien Chu

摘要：BACKGROUND Cognitive impairment (CI) is common in patients with heart failure (HF), but the association between CI and biomarkers related to HF or cognitive decline in patients with HF remains unclear. METHODS This prospective observational study investigated the incidence of CI, subsequent cognitive changes, and the asso-ciation between CI and novel biomarkers in patients with left ventricular ejection fraction < 40％ who were hospitalized for acute decompensated HF. Patients were evaluated for CI, depressive symptoms, and quality of life with the Mini-Mental State Examin-ation (MMSE) and the Mini-Cog, Beck Depression Inventory (BDI)-II, and Kansas City Cardiomyopathy Questionnaire (KCCQ), respectively. The primary endpoint was a composite of all-cause mortality or hospitalization for HF at one year. RESULTS Among the 145 patients enrolled in this study, 54 had CI (37.2％) at baseline. The mean MMSE increased signific-antly at the 3-month and 1-year follow-up, accompanied by decreased BDI-Ⅱ and increased KCCQ scores. The improvement in the MMSE scores mainly occurred in patients with CI. Among the biomarkers assayed, only growth/differentiation factor (GDF)-15 > 1621.1 pg/mL was significantly associated with CI (area under the curve = 0.64; P = 0.003). An increase in GDF-15 per 1000 units was associated with an increased risk of the primary endpoint (hazard ratio = 1.42; 95％ confidence interval: 1.17–1.73; P <0.001). CONCLUSIONS In patients with HF with CI, cognitive function, depression, and quality of life measures improved at the 3-month and 1-year follow-up. GDF-15 predicted CI with moderate discrimination capacity and was associated with worse HF out-comes.