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[Effects of left heart function changes on cerebral small vessel diseases and its cognitive impairment]
1Department of Neurology, the First Affiliated Hospital of Anhui Medical University, Hefei 230022, China.
Insights
Reduced left ventricular ejection fraction (LVEF) is linked to cognitive impairment in cerebral small vessel disease (CSVD). Lower LVEF independently predicts CSVD and its associated vascular cognitive impairment (VCI).
Area of Science:
- Cardiology
- Neurology
- Geriatrics
Background:
- Cerebral small vessel disease (CSVD) is a common cause of cognitive decline in the elderly.
- Left heart dysfunction may contribute to the development and progression of CSVD and cognitive impairment.
- Understanding the relationship between cardiac function and cognitive status in CSVD patients is crucial for effective management.
Purpose of the Study:
- To investigate the association between alterations in left heart function and cognitive impairment in patients diagnosed with CSVD.
- To identify specific echocardiographic parameters reflecting left heart function that correlate with cognitive deficits in CSVD.
- To determine if impaired left heart function serves as an independent risk factor for CSVD and vascular cognitive impairment (VCI).
Main Methods:
- A cohort of 199 CSVD patients and 103 healthy controls underwent neuroimaging (MRI) for CSVD markers and cognitive assessments (MMSE, CAMCOG-C).
- Echocardiography was used to measure left ventricular ejection fraction (LVEF) and left atrial diameter (LAD).
- Statistical analyses, including correlation and logistic regression, were employed to analyze the relationships between cardiac function, cognitive scores, and CSVD status.
Main Results:
- CSVD patients exhibited significantly lower LVEF and higher LAD compared to healthy controls.
- Patients with CSVD and vascular cognitive impairment (CSVD-VCI) showed significantly lower LVEF than those with CSVD but no cognitive impairment (CSVD-NCI).
- LVEF positively correlated with cognitive function scores (MMSE, CAMCOG-C) and emerged as an independent risk factor for CSVD and CSVD-VCI.
Conclusions:
- Changes in left heart function, particularly reduced LVEF, play a significant role in the pathogenesis of CSVD.
- Declined LVEF is independently associated with the presence and severity of cognitive impairment in CSVD patients.
- Left heart function assessment, specifically LVEF, is important for evaluating cognitive impairment risk in CSVD.
Abstract:
Objective: To explore the correlation of left heart function changes with cognitive impairment in patients with cerebral small vessel diseases (CSVD). Methods: From February 2012 to June 2018, 199 CSVD patients admitted to the Department of Neurology of the First Affiliated Hospital of Anhui Medical University were enrolled as CSVD group. A total of 103 healthy elderly persons without cognition disorders were included as normal control group (NC group). According to the diagnostic criteria, CSVD patients were divided into 112 CSVD patients with vascular cognitive impairment (CSVD-VCI group) and 87 CSVD patients without cognitive impairment (CSVD-NCI group). Neuroimaging markers of CSVD (including lacunar infarction and white matter hyperintensity) were assessed through brain MRI. Cognitive function was evaluated by The Mini-Mental State Examination (MMSE), the Cambridge Cognitive Examination-Chinese Version (CAMCOG-C), etc. Routine echocardiography was performed to evaluate left ventricular ejection fraction (LVEF), left atrial diameter (LAD) and other parameters. Results: Compared with NC group, the LVEF level was significantly decreased in CSVD group [(65±5)% and (63±6)%, respectively] (P=0.007), while LAD level was significantly increased in CSVD group (P=0.024). The LVEF level of CSVD-VCI group [(62±6)%] was significantly lower than that of CSVD-NCI group [(64±5)%] (P=0.02). Correlation analysis revealed MMSE and CAMCOG-C scores in CSVD group were positively correlated with LVEF level (r=0.210, P=0.003; r=0.238, P=0.001). Logistic regression analysis revealed that declined LVEF was an independent risk factor associated with CSVD (OR=0.937, 95%CI 0.890-0.986) and CSVD-VCI (OR=0.900, 95%CI 0.829-0.977). Conclusions: Left heart function changes play important roles in the occurrence of CSVD and severity of its cognitive impairment. The declined LVEF may represent an independent risk factor for CSVD and its cognitive impairment.
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