Abstract
BackgroundStudies of the relevance of cardiac functional markers to cognitive performance in heart failure (HF) have primarily focused on systolic markers. In this study, we examine whether concomitant diastolic dysfunction further interferes with cognitive performance in memory, attention, and executive function in patients with HF.Methods and resultsIn this cross-sectional correlational study, 82 patients completed face-to-face interviews for neuropsychological testing for cognitive evaluation. Echocardiographic data were obtained from a review of medical records. Mild to moderate (ejection fraction [EF] ≥ 30%) and severe (EF < 30%) systolic dysfunction were present in 55 (67.1%) and 27 (32.9%) patients, respectively, while 21 (26.3%) had diastolic dysfunction (E/e′ > 15). Those patients who had severe systolic dysfunction had significantly lower attention scores (Digit Span Test [DST] backward, t = 2.62, p = 0.011), while those with concomitant severe diastolic dysfunction had significantly lower verbal fluency (t = 2.84, p = 0.006) and executive function (Korean-Trail Making Test Part B) (t = -2.14, p = 0.036) scores than those without severe diastolic dysfunction. After controlling for age and education, systolic patients with HF with concomitant severe diastolic dysfunction had worse cognitive performance in verbal fluency than those without severe diastolic dysfunction (F = 4.33, p = 0.041, partial eta = 0.057). Concomitant moderate to severe systolic and severe diastolic dysfunction further reduced verbal fluency (F = 8.42, p = 0.005, partial eta = 0.106).ConclusionsCognitive performance, particularly executive function, was worse in patients with HF with systolic dysfunction when diastolic dysfunction was concomitantly present. Routine monitoring of and surveillance for diastolic dysfunction and cognitive screening are warranted in the management of patients with HF.
Highlights
Poor cognitive function is a common comorbid condition in heart failure (HF) that often involves multiple domains, including memory, attention, psychomotor speed, and executive function [1, 2]
We examine whether concomitant diastolic dysfunction further interferes with cognitive performance in memory, attention, and executive function in patients with HF
Studies that reported the association between echocardiography data and cognitive function have primarily been performed in patients with cardiovascular disease and in Framingham offspring; among the examined indices, ejection fraction (EF) and/or cardiac output were evaluated in healthy controls or patients with HF with preserved EF (HFpEF) [4]
Summary
Poor cognitive function is a common comorbid condition in heart failure (HF) that often involves multiple domains, including memory, attention, psychomotor speed, and executive function [1, 2]. Among cardiac functional indices in HF, poor cognitive performance occurs more often in patients with systolic dysfunction, with reduced ejection fraction (EF) or cardiac output [2, 4, 14, 15]. Concurrent systolic and diastolic dysfunction in HF was more likely to increase susceptibility to cognitive impairment, that affecting attention and executive function [4, 17]. Studies that reported the association between echocardiography data and cognitive function have primarily been performed in patients with cardiovascular disease and in Framingham offspring; among the examined indices, EF and/or cardiac output were evaluated in healthy controls or patients with HF with preserved EF (HFpEF) [4]. We examine whether concomitant diastolic dysfunction further interferes with cognitive performance in memory, attention, and executive function in patients with HF
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