Cognitive Function in Ambulatory Patients with Systolic Heart Failure: Insights from the Warfarin versus Aspirin in Reduced Cardiac Ejection Fraction (WARCEF) Trial

Graham, Susan; Ye, Siqin; Qian, Min; Sanford, Alexandra; Tullio, Marco R. Di; Sacco, Ralph L.; Mann, Douglas L.; Levin, Bruce; Pullicino, Patrick; Freudenberger, Ronald S; Teerlink, John R.; Mohr, J. P.; Labovitz, Arthur J.; Lip, Gregory Y. H.; Estol, Conrado J.; Lok, Dirk J.; Ponikowski, Piotr; Anker, Stefan D.; Thompson, John L.P.; Homma, Shunichi

doi:10.1371/journal.pone.0113447

Cited by 16 publications

(21 citation statements)

References 29 publications

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“…In aged HF patients, physical activity and the activity of daily living are affected by both ventricular function and frailty. In HF patients, the 6‐min walk test is useful for evaluating the severity of frailty and its link to cognitive function . However, exercise tests including 6‐min walk test cannot be performed for some frail patients with lower extremity pain or arthralgia.…”

Section: Discussionmentioning

confidence: 99%

Atrophy of the parahippocampal gyrus is prominent in heart failure patients without dementia

Meguro

Kunieda

2017

ESC Heart Failure

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AimsThe exacerbation of heart failure (HF) induces brain damage and cognitive impairment (CI), which frequently attenuates the effects of treatment. However, it is not clear whether HF patients without clinical dementia demonstrate increased risk of CI. We examined whether local atrophy in the parahippocampal gyrus, a potential predictor of CI, is prominent in HF patients without clinical dementia.Methods and resultsTwenty stable HF patients with a history of admission due to decompensated HF or presentation of apparent pulmonary congestion following chest X‐ray and 17 controls were enrolled in this observational, analytical, cross‐sectional, case‐control study. Patients with dementia were excluded from this study based on the results of cognitive assessment. Three‐dimensional T1 weighted magnetic resonance image analysis was performed to evaluate the severity of local brain atrophy using software based on statistical parametric mapping. Z‐score values were calculated to evaluate the severity of atrophy in the total brain and parahippocampal gyrus. The severity of total brain atrophy was similar between HF patients (8.0 ± 2.9%) and controls (6.5 ± 3.1%). However, the Z‐score was significantly higher in the HF group (1.12 ± 0.49) in comparison with the control group (0.63 ± 0.36, P = 0.002). The Z‐score value did not correlate with age, ejection fraction, left atrial dimension, left ventricular dimensions, or brain natriuretic peptides in the HF group but did correlate with the Clinical Frailty Scale.ConclusionsLocal atrophy in the parahippocampal gyrus was prominent in HF patients without clinical dementia. This finding showed that HF patients without dementia feature a potential risk for developing CI.

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Section: Discussionmentioning

confidence: 99%

Atrophy of the parahippocampal gyrus is prominent in heart failure patients without dementia

Meguro

Kunieda

2017

ESC Heart Failure

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“…After performing a title and abstract review, 365 studies were excluded resulting in 153 studies that underwent full-text review. Finally, nine studies (five cohort [20][21][22][23][24] , two cross-sectional 14,25 , and two recent cohort 26,27 ) were included in the review (Figure 1). Table 1 summarizes the articles and their findings.…”

Section: Overview Of the Included Studiesmentioning

confidence: 99%

“…Current smoking was an independent determinant of arterial stiffness (β=0.121; p=0.013; n=354). One retrospective cohort study conducted in the US examined the cognitive function depending on the smoking status after HF diagnosis 24 . Both current (β=0.321; p=0.016; n=2043) and former smokers (β=0.204; p=0.041) had higher cognitive function than never smokers.…”

Section: Other Adverse Health Outcomesmentioning

confidence: 99%

Association between persistent smoking after a diagnosis of heart failure and adverse health outcomes: A systematic review and meta-analysis

Son

Lee

2020

Tob. Induc. Dis.

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INTRODUCTION Heart failure (HF) is associated with increased mortality worldwide. Adverse health outcomes in HF are commonly attributed to poor adherence to self-care, including smoking cessation. Smoking is the major modifiable risk factor for HF. Patients have been observed to continue smoking even after diagnosis with HF. Despite the possible association between persistent smoking and adverse health outcomes among HF populations, no consensus has been reached. We aimed to review the literature to determine the association between smoking status after HF diagnosis and adverse health outcomes. METHODS A systematic literature search was performed in PubMed, PsycINFO, Web of Science, and Embase. Hand searching was also performed. In total, 9 articles (n=70461) were included in the review for meta-analysis, including seven cohort studies and two cross-sectional studies. Quality was assessed using the modified version of the Newcastle-Ottawa Scale. RESULTS Approximately 16% of HF patients continued smoking after HF diagnosis. Persistent smoking increased the hazard ratio (HR) of mortality by 38.4% (HR=1.384; 95% CI: 1.139-1.681) and readmission by 44.8% (HR=1.448; 95% CI: 1.086-1.930). Our review also found that persistent smoking was associated with poor health status, ventricular tachycardia, and arterial stiffness. CONCLUSIONS This review highlights the importance of assessment for any history of smoking before and after HF diagnosis. There is a need for smoking cessation programs to be established as crucial components of care for patients with HF. More studies are needed to investigate the possible mechanisms underlying relations among smoking patterns and health consequences.

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“…Severe cardiac dysfunction, as measured by left ventricular ejection fraction (LVEF), is associated with cognitive impairment 1, 2. However, reduced LVEF represents a mid to late feature of impaired myocardial contractility3 and is normal in 50% of individuals with clinical heart failure 4.…”

mentioning

confidence: 99%

“…S evere cardiac dysfunction, as measured by left ventricular ejection fraction (LVEF), is associated with cognitive impairment. 1,2 However, reduced LVEF represents a mid to late feature of impaired myocardial contractility 3 and is normal in 50% of individuals with clinical heart failure. 4 Emerging evidence suggests an association between subclinical heart dysfunction and worse brain health in older adults, 5 but LVEF may not detect subclinical dysfunction 6 or relate to cognitive changes in the absence of severe cardiac dysfunction.…”

mentioning

confidence: 99%

Subclinical Compromise in Cardiac Strain Relates to Lower Cognitive Performances in Older Adults

Kresge

Khan

Wagener

et al. 2018

JAHA

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BackgroundGlobal longitudinal strain (GLS), reflecting total shortening of the myocardium during the cardiac cycle, has emerged as a more precise myocardial function measure than left ventricular ejection fraction (LVEF). Longitudinal strain may be selectively affected in subclinical heart disease, even in the presence of normal LVEF. This study examines subclinical cardiac dysfunction, assessed by GLS and LVEF, and cognition among older adults.Methods and ResultsVanderbilt Memory and Aging Project participants who were free of clinical dementia, stroke, and heart failure (n=318, 73±7 years, 58% male) completed neuropsychological assessment and cardiac magnetic resonance to quantify GLS and LVEF. Linear regression models related GLS and LVEF to neuropsychological performances, adjusting for age, sex, race/ethnicity, education, Framingham Stroke Risk Profile, cognitive diagnosis, and APOE*ε4 status. Models were repeated with a cardiac×cognitive diagnosis interaction term. Compromised GLS (reflected by higher values) related to worse naming (β=−0.07, P=0.04), visuospatial immediate recall (β=−0.83, P=0.03), visuospatial delayed recall (β=−0.22, P=0.03), and verbal delayed recall (β=−0.11, P=0.007). LVEF did not relate to worse performance on any measure (P>0.18). No diagnostic interactions were observed.ConclusionsOur study results are among the first to suggest that compromised GLS relates to worse episodic memory and language performance among older adults who are free of clinical dementia, stroke, and heart failure. Subclinical cardiac dysfunction may correlate with cognitive health in late life, even when LVEF remains normal. The results add to growing evidence that GLS may be a more sensitive and preferred method for quantifying subclinical changes in cardiac function.

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Cognitive Function in Ambulatory Patients with Systolic Heart Failure: Insights from the Warfarin versus Aspirin in Reduced Cardiac Ejection Fraction (WARCEF) Trial

Cited by 16 publications

References 29 publications

Atrophy of the parahippocampal gyrus is prominent in heart failure patients without dementia

Atrophy of the parahippocampal gyrus is prominent in heart failure patients without dementia

Association between persistent smoking after a diagnosis of heart failure and adverse health outcomes: A systematic review and meta-analysis

Subclinical Compromise in Cardiac Strain Relates to Lower Cognitive Performances in Older Adults

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