Клініко-гемодинамічні предиктори когнітивної дисфункції в пацієнтів з ішемічною хворобою серця
Authors: Nudchenko O. O. , Dolzhenko M. M. 
Published: February 2020

The aim – to determine the clinical and hemodynamic risk factors for the development of cognitive dysfunction in patients with coronary heart disease.Materials and methods. 110 patients with a history of acute myocardial infarction, unstable angina pectoris, or coronary artery revascularization were included in the study. Depending on the diastolic function, the patients were divided into three groups: I group – normal diastolic function, II group – impaired relaxation, III group – pseudonormalization or restriction. Cognitive function was assessed on the MMSE, MoCA scales, Frontal Assessment Battery (FAB), Trial Making Test and Rey audio-verbal test.Results and discussion. The average number of points on the MMSE scale with an increase in the severity of diastolic dysfunction (DD) decreased and amounted to 25.40±2.58 in the I group, 24.95±2.69 in the II group, and 22.30±3.17 in the III group (p1,3<0.0001, p2,3=0.001); on the MoCA scale it equaled to 23.47±3.41 in the I group, 22.09±3.48 in the II group and 19.85±5.19 in the III group (p1,2=0.039, p1,3=0.004, p2,3>0.05). A negative correlation of average degree (r=–0.35, p<0.05) between MMSE score and the type of DD was revealed, and a negative correlation of the strong degree (r=–0.50, p<0.00001) – between MMSE score and left ventricular filling pressure (LVFP). The MoCA scale showed a moderate degree negative correlation (r=–0.30, p=0.0018) with DD and a strong degree negative correlation (r=–0.41, p<0.05) with LVFP. A negative correlation of a weak degree was also revealed between the score on the FAB and LVFP (r=–0.24, p<0.05). It was found that the number of points on the MMSE scale reliably correlates with smoking status, left atrium indexed volume and left ventricular myocardial mass index (r=0.23, r=–0.25, r=–0.25, respectively). The values of the left atrium volume index and left ventricular myocardial mass index correlated with the score on the MoCA scale (r=–0.25, r=–0.18, respectively). The likelihood of development of cognitive dysfunction increased with an increase in glycated hemoglobin (OR 2.65, 95 % CI 1.08–6.48, p=0.033), diastolic function worsening (OR 3.18, 95 % CI 1.18–8.59, p=0.023) and an increase in LVFP (OR 6.03, 95 % CI 2.32–15.69, p=0.0002) on the MMSE scale, and with a worsening of diastolic function (OR 2.86, 95 % CI 1.18–6.94, p=0.020) on the MoCA scale. According to the results of direct multiple logistic regression, it was revealed that among all the indicators, only LVFP significantly affected the total number of points on the MMSE scale (OR 1.28, 95 % CI 1.11–1.47, p=0.0007).Conclusions. It was revealed that the diastolic function has a significant influence on the state of cognitive function. A negative correlation was noted between the type of DD, LVFP, and the scores on the scales of cognitive functions. The likelihood of cognitive dysfunction on the MMSE scale increased with an increase in glycated hemoglobin, diastolic function worsening, increase in LVFP, diastolic function worsening (on the MoСA scale). According to the results of multiple regression, only LVFP significantly affected the total number of points on the MMSE scale.