The scope of the dissertation was to determine the prevalence of cognitive dysfunction in patients with proven coronary heart disease, analysis of factors influencing the development of diastolic dysfunction in patients with coronary heart disease, establishing the role of left ventricle diastolic dysfunction in cognitive impairment in patients with coronary heart disease, and assessment of prognostic role of diastolic dysfunction and cognitive impairment in patients with coronary heart disease.
At the Department of Cardiology of NUH named after PL Shupyk conducted a survey and dynamic observation of 110 patients who were hospitalized in 2014-2016 years due to coronary heart disease.
After establishing compliance with the inclusion/exclusion criteria, depending on the results of echocardiographic examination, according to existing recommendations, patients were divided into 3 groups: the first group consisted of 39 patients with normal LV diastolic function; the second group included 43 patients with DD by type of impaired relaxation; the third group included 28 with DD by type of pseudonormalization or restriction.
All patients were examined using general clinical, instrumental methods and biochemical assays. Determinations of basic anthropometric data and questionnaires were carried out. Additional research methods included: echocardiography, ultrasound examination of the extracranial parts of the brachiocephalic arteries, general blood tests, biochemical parameters - lipid profile, urinary albumin-creatinine ratio. All patients underwent determination of the state of cognitive function, according to standardized questionnaires and scales, as well as scales to determine the presence and severity of depression and anxiety.
When assessing cognitive function on the MMSE scale, it was found that only 17.6% of patients do not have cognitive impairment (score 28 to 30). Mild cognitive impairment was observed in 51.9% of patients (score from 24 to 27). Mild dementia (19-23 points) was detected in 25%, and moderate (11-18 points) - in 5.5%. On the MoCA scale, cognitive impairment (less than 26 points) was observed in 83,6% of patients.
The LVMI was significantly correlated with both the indicator of diastolic function (r = 0.37, p <0.05) and with the indicator E/e ’(r = 0.41, p <0.05). There was an inverse correlation between LV EF and diastolic function (r = -0.25, p <0.05), as well as E/e’ (r = -0.20, p <0.05). According to multivariate regression analysis, it was found that among the following factors – age, sex, hypertension severity, history of AMI, the presence of diabetes mellitus according to glycated hemoglobin levels, LVMI, LV EF - after correction for statistically insignificant, only LVMI (p=0.0003) and the patient's sex (p = 0.02) were associated with E/e'. In a similar analysis of the relationship of the same factors and diastolic function state, the only statistically significant indicator was LVMI (p = 0.001).
The analysis of risk factors for cognitive dysfunction according to the MMSE scale revealed the following: the probability of developing cognitive dysfunction increased with increasing Hb1AC (OR 2.65, 95% CI 1.08 - 6.48, p = 0.033), worsening of diastolic function (OR 3.18, 95% CI 1.18 - 8.59, p = 0.023) and an increase in E/e’ (OR 6.03, 95% CI 2.32 - 15.69, p = 0.0002). It is shown that the probability of developing cognitive dysfunction, assessed on the MoСA scale, increased only with the worsening of diastolic function (OR 2.86, 95% CI 1.18 - 6.94, p = 0.020). Among the numerous risk factors for the development of cognitive impairment after excluding statistically insignificant and uninformative, only the LVFP indicator was reliably associated with the total number of points on the MMSE scale (OR 1.28, 95% CI 1.11-1.47; p = 0.0007). At the same time, the sensitivity and specificity of the E/e’ index, greater than 10.5, in relation to cognitive impairments according to the MMSE scale were 56.2% and 87.2%, respectively.
In the analysis of all endpoints depending on the DD group, a statistically significant (χ² = 9.9, P = 0.007) difference of Kaplan-Meier curves with respect to AF was revealed (P1,2 = 0.55, P1,3 = 0.016, P2, 3 = 0.002, respectively), hospitalization for HF (χ² = 7,8, P = 0,02; P1,2 = 0.55, P1,3 = 0.07, P2,3 = 0.006, respectively), and combined cardiovascular points. Patients with mild to moderate dementia had a significantly worse prognosis in terms of combined cardiovascular endpoints compared to patients without cognitive impairment or MCI (p <0.05).
It was noted, that ethylmethylhydroxypyridine succinate prescription in patients with coronary heart disease, DD and CI is associated with improvement in LV diastolic function, improvement of cognitive function according to the MMSE scale, as well as a decrease of anxiety and depression symptoms.
