PDF(Pubmed)
Abstract：
Neurocognitive dysfunction is common in heart failure (HF), with 30% to 80% of patients experiencing some degree of deficits in one or more cognitive domains, including memory, attention, learning ability, executive function, and psychomotor speed. Although the mechanism is not fully understood, reduced cardiac output, comorbidities, chronic cerebral hypoperfusion, and cardioembolic brain injury leading to cerebral hypoxia and brain damage seem to trigger the neurocognitive dysfunction in HF. Cognitive impairment is independently associated with worse outcomes including mortality, rehospitalization, and reduced quality of life. Patients with poorer cognitive function are at an increased risk of severe disease as they tend to have greater difficulty complying with treatment requirements. Coronary revascularization in patients with ischemic HF has the potential to improve cardiovascular outcomes but risks worsening neurocognitive dysfunction even further. Revascularization by coronary artery bypass grafting carries inherent risks for delirium, cognitive impairment, neurologic injury, and stroke, which are known to exacerbate the risk of neurocognitive dysfunction. Alternatively, percutaneous coronary intervention, as a less-invasive approach, has the potential to minimize the risk of cognitive impairment but has not yet been evaluated as an alternative to coronary artery bypass grafting in patients with ischemic HF. Therefore, it is paramount to raise awareness of the neurocognitive consequences in ischemic HF and devise strategies for recognition and prevention as an important target of patient management and personalized decision making that contributes to patient outcomes.
摘要：
神经认知功能障碍在心力衰竭（HF）中很常见，30%到80%的患者在一个或多个认知领域出现一定程度的缺陷，包括记忆，注意,学习能力,执行功能，和精神运动速度。尽管机制尚未完全了解，心输出量减少,合并症,慢性脑低灌注,心脏栓塞性脑损伤导致脑缺氧和脑损伤似乎会引发HF的神经认知功能障碍。认知障碍与包括死亡率在内的较差预后独立相关，再住院,降低了生活质量。认知功能较差的患者患严重疾病的风险增加，因为他们往往很难满足治疗要求。缺血性HF患者的冠状动脉血运重建有可能改善心血管预后，但有进一步恶化神经认知功能障碍的风险。冠状动脉旁路移植术的血运重建具有谵妄的固有风险，认知障碍，神经损伤，和中风，已知会加剧神经认知功能障碍的风险。或者，经皮冠状动脉介入治疗,作为一种侵入性较小的方法，有可能将认知障碍的风险降至最低，但尚未评估为缺血性HF患者冠状动脉旁路移植术的替代方法。因此,最重要的是提高对缺血性HF的神经认知后果的认识,并制定识别和预防策略,作为患者管理和个性化决策的重要目标,有助于患者预后.
