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Published on: June 10, 2025
Cognitive impairment and its association with circulating biomarkers in patients with acute decompensated heart
Ying-Chang Tung1, Fu-Chih Hsiao1, Chia-Pin Lin1
1Division of Cardiology, Department of Internal Medicine, Taipei, Taiwan, China.
Insights
Cognitive impairment (CI) in heart failure (HF) patients improved over one year. Growth/differentiation factor-15 (GDF-15) predicted CI and worse HF outcomes, highlighting its role in managing HF patients with cognitive decline.
Area of Science:
- Cardiology
- Neurology
- Biomarker Research
Background:
- Cognitive impairment (CI) is prevalent in heart failure (HF) patients.
- The relationship between CI and HF biomarkers is not well understood.
Purpose of the Study:
- To investigate CI incidence and changes in HF patients with reduced ejection fraction.
- To explore associations between CI, HF biomarkers, and clinical outcomes.
Main Methods:
- Prospective observational study of 145 hospitalized acute decompensated HF patients (LVEF < 40%).
- Evaluated CI using Mini-Mental State Examination (MMSE) and Mini-Cog.
- Assessed depressive symptoms (BDI-II) and quality of life (KCCQ).
- Primary endpoint: all-cause mortality or HF hospitalization at 1 year.
Main Results:
- 54% of patients had CI at baseline.
- Cognitive function (MMSE), depression (BDI-II), and quality of life (KCCQ) improved at 3 months and 1 year, particularly in CI patients.
- Growth/differentiation factor-15 (GDF-15) > 1621.1 pg/mL was the only biomarker significantly associated with CI (AUC=0.64, P=0.003).
- Elevated GDF-15 predicted increased risk of mortality or HF hospitalization (HR=1.42, P<0.001).
Conclusions:
- HF patients with CI showed improvements in cognitive function, mood, and quality of life.
- GDF-15 demonstrated moderate predictive capacity for CI and was linked to adverse HF outcomes.
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 association 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 Examination (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 significantly 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 outcomes.
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