1Universitätsklinikum Würzburg Medizinische Klinik und Poliklinik I, ZIM Kardiologie Würzburg, Deutschland; 2Universitätsklinikum Würzburg Neuroradiologie Würzburg, Deutschland; 3Universitätsklinikum Würzburg Medizinische Klinik I, Kardiologie Würzburg, Deutschland; 4Universitätsklinik Würzburg Psychiatrie Würzburg, Deutschland; 5Universitätsklinikum Würzburg Deutsches Zentrum für Herzinsuffizienz Würzburg, Deutschland; 6Universitätsklinikum Würzburg Medizinische Klinik und Poliklinik I Würzburg, Deutschland
Background and Aims: Cognitive impairment (CI) is a frequent, yet unrecognized comorbidity in chronic heart failure (cHF), affecting broadly every second patient. As longitudinal data on this aspect of cHF is rare, we aimed to quantify individual trajectories of cognitive performance, brain morphology and related clinical outcome over almost six years.
Methods: The Cognition.Matters-HF cohort study recruited patients with cHF of any etiology and severity. Beyond cardiological assessment, the extensive workup included domain-specific cognitive testing and brain magnetic resonance imaging (MRI). Brain volumes were quantified using a longitudinal image-processing framework.
Results: One hundred forty-eight cHF patients were recruited at baseline with a median age of 65 (quartiles 56, 72) years, left ventricular ejection fraction of 44 (38, 48) %, and NT-proBNP levels of 672 (237, 1677) pg/ml. Within 69 (68, 70) months of follow-up, twenty-nine patients (20%) died and twenty-six patients (18%) were at least once hospitalized due to worsening of cHF. The presence of CI at baseline had no effect on overall (p=0.290) or hospitalization-free (p=0.450) survival. Sixty-seven patients (45%) completed all scheduled visits without deterioration of cHF parameters. Their age of 62 (53, 70) years and left ventricular ejection fraction (LVEF) of 45 (39, 49) % did not differ from the full sample at baseline. Cognitive performance remained stable, except for further impairment of intensity of attention (decrease of age-adjusted T-scores from 42 (38, 46) to 38 (34, 44); p<0.001). Lower baseline LVEF independently related to deterioration of intensity of attention (ρ=0.37, p=0.004). Complete MRI datasets at all study visits were available from 47 patients (32% of total sample). Total brain volume shrunk from 1103 (1060, 1143) cm³ to 1078 (1027, 1117) cm³ with an age-appropriate annual change of -0.4%. Only age at baseline, but not cHF parameters related to greater brain parenchyma loss (ρ=-0.47; p<0.001).
Conclusions: In clinically stable cHF patients upon guideline-based medical treatment and regular doctoral visits, the presence of CI does not affect overall and hospitalization-free survival, and the loss of brain parenchyma in cHF does not exceed normal ageing. However, accumulating attentional deficits call for multimodal treatment approaches and cognitive testing.