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Profiles of cognitive impairment in chronic heart failure-A cluster analytic approach
Dennis Göpfert1, Jan Traub1,2, Roxane Sell1,3
1Comprehensive Heart Failure Center, University Hospital Würzburg, Würzburg, Germany.
Insights
Cognitive impairment in heart failure (HF) patients presents diverse profiles, including attention deficits and global impairment. Women and those with prior valve surgery face higher risks for global deficits, suggesting tailored interventions are needed.
Area of Science:
- Cardiology
- Neurology
- Psychology
Background:
- Cognitive impairment is a common comorbidity in chronic heart failure (HF).
- HF patients exhibit a wide range of cognitive deficit phenotypes.
- Identifying distinct cognitive profiles is crucial for understanding and managing HF comorbidities.
Purpose of the Study:
- To identify and compare distinct clusters of cognitive deficits in chronic heart failure patients.
- To explore associations between cognitive profiles and clinical, neurological, and neuroradiological factors.
- To inform targeted treatment strategies for cognitive impairment in HF.
Main Methods:
- Prospective cohort study of 147 chronic HF patients.
- Extensive neuropsychological testing assessing attention, memory, and executive function.
- Hierarchical cluster analysis to identify cognitive profiles, with exploratory comparisons to clinical data.
Main Results:
- Three distinct cognitive profiles were identified: no deficits, attention deficits only, and global deficits.
- No significant differences in age or typical HF markers (ejection fraction, 6MWT, NT-proBNP, NYHA class) between clusters.
- Women and patients with prior cardiac valve surgery were more prevalent in the global deficits cluster; lower arterial hypertension prevalence in the no deficits group. Global deficit cluster showed smaller brain volume and elevated glial fibrillary acidic protein.
Conclusions:
- Heart failure patients can exhibit distinct cognitive profiles, including attention-specific deficits.
- Women and patients with prior cardiac valve surgery are at increased risk for global cognitive impairment in HF.
- Multimodal treatment addressing psychosocial factors may benefit HF patients at risk for global cognitive impairment.
Background:
Cognitive impairment is a major comorbidity in patients with chronic heart failure (HF) with a wide range of phenotypes. In this study, we aimed to identify and compare different clusters of cognitive deficits.
Methods:
The prospective cohort study "Cognition.Matters-HF" recruited 147 chronic HF patients (aged 64.5 ± 10.8 years; 16.2% female) of any etiology. All patients underwent extensive neuropsychological testing. We performed a hierarchical cluster analysis of the cognitive domains, such as intensity of attention, visual/verbal memory, and executive function. Generated clusters were compared exploratively with respect to the results of cardiological, neurological, and neuroradiological examinations without correction for multiple testing.
Results:
Dendrogram and the scree plot suggested three distinct cognitive profiles: In the first cluster, 42 patients (28.6%) performed without any deficits in all domains. Exclusively, the intensity of attention deficits was seen in the second cluster, including 55 patients (37.4%). A third cluster with 50 patients (34.0%) was characterized by deficits in all cognitive domains. Age (p = 0.163) and typical clinical markers of chronic HF, such as ejection fraction (p = 0.222), 6-min walking test distance (p = 0.138), NT-proBNP (p = 0.364), and New York Heart Association class (p = 0.868) did not differ between clusters. However, we observed that women (p = 0.012) and patients with previous cardiac valve surgery (p = 0.005) prevailed in the "global deficits" cluster and the "no deficits" group had a lower prevalence of underlying arterial hypertension (p = 0.029). Total brain volume (p = 0.017) was smaller in the global deficit cluster, and serum levels of glial fibrillary acidic protein were increased (p = 0.048).
Conclusion:
Apart from cognitively healthy and globally impaired HF patients, we identified a group with deficits only in the intensity of attention. Women and patients with previous cardiac valve surgery are at risk for global cognitive impairment when suffering HF and could benefit from special multimodal treatment addressing the psychosocial condition.
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