Abstract：
OBJECTIVE: Cognitive impairment (CI) is a common, yet frequently unrecognized co-morbidity in chronic heart failure (HF). We quantified trajectories of cognitive performance, brain volume, and related clinical outcome over a time course of 6 years.
RESULTS: The Cognition.Matters-HF cohort study recruited patients with stable HF of any aetiology and severity. Beyond cardiological assessment, the workup included cognitive testing and brain magnetic resonance imaging (MRI). Of 148 recruited patients, 70% exhibited CI at baseline. During the median follow-up time of 69 months (quartiles: 68, 70), indicators of HF severity remained essentially unaltered. CI was also stable, with the exception of intensity of attention, where age-adjusted t-scores decreased from 42 (38, 46) to 38 (34, 44; P < 0.001). Complete sets of four serial brain MRI scans were available in 47 patients (32% of total sample). Total brain volume shrank by 0.4% per year, from 1103 (1060, 1143) cm3 to 1078 (1027, 1117) cm3, which was within limits observed in non-diseased ageing individuals. During follow-up, 29 study participants (20%) died, and 26 (18%) were at least once hospitalized due to worsening HF. The presence of CI was not associated with overall (P = 0.290) or hospitalization-free (P = 0.450) survival.
CONCLUSIONS: In patients with stable HF patients receiving guideline-directed pharmacologic treatment and regular medical care, the presence of CI did not affect overall and hospitalization-free 6-year survival. The loss of brain parenchyma observed in patients with stable HF did not exceed that of normal ageing.
RESULTS: The Cognition.Matters-HF cohort study recruited patients with stable HF of any aetiology and severity. Beyond cardiological assessment, the workup included cognitive testing and brain magnetic resonance imaging (MRI). Of 148 recruited patients, 70% exhibited CI at baseline. During the median follow-up time of 69 months (quartiles: 68, 70), indicators of HF severity remained essentially unaltered. CI was also stable, with the exception of intensity of attention, where age-adjusted t-scores decreased from 42 (38, 46) to 38 (34, 44; P < 0.001). Complete sets of four serial brain MRI scans were available in 47 patients (32% of total sample). Total brain volume shrank by 0.4% per year, from 1103 (1060, 1143) cm3 to 1078 (1027, 1117) cm3, which was within limits observed in non-diseased ageing individuals. During follow-up, 29 study participants (20%) died, and 26 (18%) were at least once hospitalized due to worsening HF. The presence of CI was not associated with overall (P = 0.290) or hospitalization-free (P = 0.450) survival.
CONCLUSIONS: In patients with stable HF patients receiving guideline-directed pharmacologic treatment and regular medical care, the presence of CI did not affect overall and hospitalization-free 6-year survival. The loss of brain parenchyma observed in patients with stable HF did not exceed that of normal ageing.
摘要：
目的：认知障碍（CI）是一种常见的，然而，在慢性心力衰竭（HF）中经常未被识别的合并症。我们量化了认知表现的轨迹，脑容量,和相关的临床结果在6年的时间进程。
结果：认知。Matters-HF队列研究招募了任何病因和严重程度的稳定HF患者。除了心脏病评估，检查包括认知测试和脑磁共振成像(MRI).在148名招募的患者中，基线时显示70%的CI。在69个月的中位随访时间（四分位数：68，70），HF严重程度的指标基本保持不变。CI也很稳定，除了注意力的强度，其中年龄调整后的t评分从42（38，46）降至38（34，44；P<0.001）。47名患者（占总样本的32％）可获得完整的四次连续脑部MRI扫描。大脑总容量每年减少0.4%,从1103（1060，1143）cm3到1078（1027，1117）cm3，这在非患病衰老个体中观察到的范围内。随访期间,29名研究参与者（20%）死亡，26例(18%)因HF恶化至少住院一次.CI的存在与总体生存（P=0.290）或无住院生存（P=0.450）无关。
结论：在接受指导药物治疗和定期医疗护理的稳定期HF患者中，CI的存在并不影响6年总生存率和无住院生存率.在稳定的HF患者中观察到的脑实质损失不超过正常衰老。
结果：认知。Matters-HF队列研究招募了任何病因和严重程度的稳定HF患者。除了心脏病评估，检查包括认知测试和脑磁共振成像(MRI).在148名招募的患者中，基线时显示70%的CI。在69个月的中位随访时间（四分位数：68，70），HF严重程度的指标基本保持不变。CI也很稳定，除了注意力的强度，其中年龄调整后的t评分从42（38，46）降至38（34，44；P<0.001）。47名患者（占总样本的32％）可获得完整的四次连续脑部MRI扫描。大脑总容量每年减少0.4%,从1103（1060，1143）cm3到1078（1027，1117）cm3，这在非患病衰老个体中观察到的范围内。随访期间,29名研究参与者（20%）死亡，26例(18%)因HF恶化至少住院一次.CI的存在与总体生存（P=0.290）或无住院生存（P=0.450）无关。
结论：在接受指导药物治疗和定期医疗护理的稳定期HF患者中，CI的存在并不影响6年总生存率和无住院生存率.在稳定的HF患者中观察到的脑实质损失不超过正常衰老。
