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Relation of left ventricular ejection fraction to cognitive aging (from the Framingham Heart Study).

ABSTRACT: Heart failure is a risk factor for Alzheimer's disease and cerebrovascular disease. In the absence of heart failure, it was hypothesized that left ventricular ejection fraction (LVEF), an indicator of cardiac dysfunction, would be associated with preclinical brain magnetic resonance imaging (MRI) and neuropsychological markers of ischemia and Alzheimer disease in the community. Brain MRI, cardiac MRI, neuropsychological, and laboratory data were collected from 1,114 Framingham Heart Study Offspring Cohort participants free from clinical stroke or dementia (aged 40 to 89 years, mean age 67 ± 9 years, 54% women). Neuropsychological and neuroimaging markers of brain aging were related to cardiac MRI-assessed LVEF. In multivariable-adjusted linear regressions, LVEF was not associated with any brain aging variable (p values >0.15). However, LVEF quintile analyses yielded several U-shaped associations. Compared to the referent (quintile 2 to 4), the lowest quintile (quintile 1) LVEF was associated with lower mean cognitive performance, including Visual Reproduction Delayed Recall (? = -0.27, p <0.001) and Hooper Visual Organization Test (? = -0.27, p <0.001). Compared to the referent, the highest quintile (quintile 5) LVEF values also were associated with lower mean cognitive performance, including Logical Memory Delayed Recall (? = -0.18, p = 0.03), Visual Reproduction Delayed Recall (? = -0.17, p = 0.03), Trail Making Test Part B - Part A (? = -0.22, p = 0.02), and Hooper Visual Organization Test (? = -0.20, p = 0.02). Findings were similar when analyses were repeated excluding prevalent cardiovascular disease. In conclusion, although these observational cross-sectional data cannot establish causality, they suggest a nonlinear association between LVEF and measures of accelerated cognitive aging.

SUBMITTER: Jefferson AL

PROVIDER: S-EPMC3204899 | biostudies-literature | 2011 Nov

REPOSITORIES: biostudies-literature

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Relation of left ventricular ejection fraction to cognitive aging (from the Framingham Heart Study).

Jefferson Angela L AL Himali Jayandra J JJ Au Rhoda R Seshadri Sudha S Decarli Charles C O'Donnell Christopher J CJ Wolf Philip A PA Manning Warren J WJ Beiser Alexa S AS Benjamin Emelia J EJ

The American journal of cardiology 20110830 9

Heart failure is a risk factor for Alzheimer's disease and cerebrovascular disease. In the absence of heart failure, it was hypothesized that left ventricular ejection fraction (LVEF), an indicator of cardiac dysfunction, would be associated with preclinical brain magnetic resonance imaging (MRI) and neuropsychological markers of ischemia and Alzheimer disease in the community. Brain MRI, cardiac MRI, neuropsychological, and laboratory data were collected from 1,114 Framingham Heart Study Offspr ...[more]

PMID: 21880293

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Project description:Aims: Evidence-based guidelines for heart failure management depend mainly on current left ventricular ejection fraction (LVEF). However, fewer studies have examined the impact of prior LVEF. Patients may enter the heart failure with midrange ejection fraction (HFmrEF) category when heart failure with preserved ejection fraction (HFpEF) deteriorates or heart failure with reduced ejection fraction (HFrEF) improves. In this study, we examined the association between change in LVEF and adverse outcomes. Methods: HFmrEF patients with at least two or more echocardiograms 3 months apart at the First Affiliated Hospital of Dalian Medical University between September 1, 2015 and November 30, 2019 were identified. According to the prior LVEF, the subjects were divided into improved group (prior LVEF < 40%), stable group (prior LVEF between 40 and 50%), and deteriorated group (prior LVEF ≥ 50%). The primary outcomes were cardiovascular death, all-cause mortality, hospitalization for worsening heart failure, and composite event of all-cause mortality or all-cause hospitalization. Results: A total of 1,168 HFmrEF patients (67.04% male, mean age 63.60 ± 12.18 years) were included. The percentages of improved, stable, and deteriorated group were 310 (26.54%), 334 (28.60%), and 524 (44.86%), respectively. After a period of follow-up, 208 patients (17.81%) died and 500 patients met the composite endpoint. The rates of all-cause mortality were 35 (11.29%), 55 (16.47%), and 118 (22.52%), and the composite outcome was 102 (32.90%), 145 (43.41%), and 253 (48.28%) for the improved, stable, and deteriorated groups, respectively. Cox regression analysis showed that the deterioration group had higher risk of cardiovascular death (HR: 1.707, 95% CI: 1.064-2.739, P = 0.027), all-cause death (HR 1.948, 95% CI 1.335-2.840, P = 0.001), and composite outcome (HR 1.379, 95% CI 1.096-1.736, P = 0.006) compared to the improvement group. The association still remained significant after fully adjusted for both all-cause mortality (HR = 1.899, 95% CI 1.247-2.893, P = 0.003) and composite outcome (HR: 1.324, 95% CI: 1.020-1.718, P = 0.035). Conclusion: HFmrEF patients are heterogeneous with three different subsets identified, each with different outcomes. Strategies for managing HFmrEF should include previously measured LVEF to allow stratification based on direction changes in LVEF to better optimize treatment.

Project description:Heart failure is a group of syndromes caused by various cardiac structural or functional disorders leading to impaired ventricular filling and (or) ejection capacity. Because of decreased ventricular systolic function and impaired ejection function, the amount of cardiac output cannot meet the body's metabolic needs; organ and tissue blood perfusion is insufficient; at the same time, pulmonary circulation and (or) systemic circulation congestion; the clinical manifestations are mainly dyspnea and weakness but restricted physical activity and edema. Treatment of the disease should include preventing and delaying the onset of wails, relieving symptoms of clinical wails, improving its long-term prognosis, and reducing mortality. The aim of the study is to observe the efficacy and safety of Entresto in the treatment of left ventricular ejection fraction heart failure (HFpEF). Seventy-eight patients with HFpEF treated in our hospital from October 2017 to April 2018 were randomized into a treatment group (Entresto 50 mg + basic treatment, n = 39) and a control group (basic treatment, n = 39). The course of treatment was ten weeks. The levels of brain natriuretic peptide (BNP) and echocardiographic indicators (LVMI, LVEF, LVEDD, LVESD, E/E' Ratio, E/A ratio, DT), 6-minute walking test (6MWD), and Minnesota Quality of Life Scale (MLHFQ) were analyzed before and after treatment. LVMI, LVEF, LVEDD, LVESD, E/E' ratio, E/A ratio, DT, and BNP were all significantly improved in the Entresto group after treatment. In the control group, except for LVEDD, LVESD, the E/A ratio, and BNP, other indicators were significantly improved after treatment (P < 0.05). Posttreatment, both groups had significantly improved 6MWD and MLHFQ scores (P < 0.05). Differences in these parameters between the two groups were statistically significant (P < 0.05). After treatment, the levels of NE, AngII, ALD, and MMP-9 in the two groups were decreased (P < 0.05), with the lower lever in the treatment group (P < 0.05). The effective rate was 76.92% in the control group and 94.87% in the Entresto group, and this rate difference was statistically significant (P < 0.05). The number of patients re-hospitalized due to cardiovascular events was 2 (the Entresto group) vs. 7 (the control group) cases; worsening of heart failure was observed in 1 patient (the Entresto group) vs. 6 (the control group), and the difference between the two groups was statistically significant (P < 0.05). However, the incidence of adverse reactions between the two groups was not statistically significant. Entresto can significantly improve left ventricular diastolic function in heart failure patients with preserved left ventricular ejection fraction and improve quality of life. This treatment is safe and effective and worthy of clinical application. This trail is registered with ChiCTR2000031486. This trial was approved by the Chinese Clinical Trial Registry (clinical trial number: ChiCTR2000031486). The registration number of this study is 2022-R008.

Project description:ObjectivesTo determine clinical and prognostic differences between preserved and deteriorated systolic function (defined as left ventricular (LV) ejection fractions > or = 50% and < 50%, respectively) in patients with heart failure satisfying modified Framingham criteria.Patients and methodsRecords were studied of 1252 patients with congestive heart failure (CHF) (mean (SD) age 69.4 (11.7) years; 485 women, 767 men) who had been admitted to a cardiology service for CHF in the period 1991-2002 and whose LV systolic function had been echocardiographically evaluated within two weeks of admission. Data were collected on the main clinical findings, supplementary examinations, treatment, and duration of hospitalisation. Whether the patient was alive in the spring of 2003 was evaluated by searching the general archives of the hospital and by telephone survey.ResultsLV systolic function was preserved in 39.8% of patients. Age, female to male sex ratio, and prevalence of atrial fibrillation, valve disease, and other non-ischaemic, non-dilated cardiopathies were all significantly greater in the group with preserved systolic function. New York Heart Association functional class IV, third heart sound, jugular vein congestion, cardiomegaly, radiological signs of lung oedema, pathological Q waves, left bundle branch block, sinus rhythm, ischaemic cardiopathy, and dilated cardiomyopathy were all significantly more prevalent in the group with deteriorated systolic function, as was treatment with angiotensin converting enzyme inhibitors and most other antihypertensive drugs on discharge from hospital. There was no significant difference in survival between the groups with preserved and deteriorated systolic function (either survival regardless of age at admission or in subgroups aged < 75 and > or = 75 years at admission). In the whole group, survival rates after one, three, and five years were 84.0%, 66.7%, and 50.9%, respectively.ConclusionIn view of the poor prognosis of patients with CHF with preserved LV systolic function, who are currently treated empirically, it is to be hoped that relevant controlled clinical trials under way will afford information allowing optimisation of their treatment.

Dataset Information

Relation of left ventricular ejection fraction to cognitive aging (from the Framingham Heart Study).

Publications

Relation of left ventricular ejection fraction to cognitive aging (from the Framingham Heart Study).

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