Futami Shutaro, Ishikawa Joji, Jubishi Chihiro, Shimizu Ruri, Murata Teppei, Aoyama Rie, Harada Kazumasa
Tokyo Metropolitan Geriatric Hospital and Institute of Gerontology, Department of Cardiology Tokyo Japan.
Circ Rep. 2020 Mar 26;2(5):265-270. doi: 10.1253/circrep.CR-19-0115.
Elderly patients admitted to hospital with heart failure (HF) often have cognitive impairment, but the association between these conditions is unclear. We enrolled 43 patients admitted to a geriatric hospital with HF. We evaluated echocardiography, Mini Mental State Examination (MMSE), and extracellular water/total body water (ECW/TBW) ratio (Inbody S10). Mean age was 85.1±8.0 years (range, 60-99 years) and 44.2% of the patients were men. Mean MMSE score was 20.5±5.4, with 66.7% of the patients showing cognitive impairment (MMSE ≤23). There was a significant negative correlation of MMSE score with age (r=-0.344, P=0.032), regular alcohol drinking (r=0.437, P=0.007), uric acid level (r=0.413, P=0.010), and ECW/TBW ratio (r=-0.437, P=0.007). On stepwise regression analysis including these covariates, MMSE score was significantly associated with the ECW/TBW ratio (β=0.443, P=0.009). When several echocardiography parameters (i.e., end-diastolic left ventricular volume, r=0.327, P=0.048; left atrial volume index, r=-0.411, P=0.012; and transmitral inflow A wave velocity, r=-0.625, P=0.001) were added to the model, MMSE score was found to be related to the A wave (P=0.001) and to atrial volume index (P=0.015), which are measures of diastolic function. In elderly patients with HF, cognitive function might be influenced by body water distribution and diastolic heart function.
因心力衰竭（HF）入院的老年患者常伴有认知障碍，但二者之间的关联尚不清楚。我们纳入了43名入住老年医院的HF患者。我们评估了超声心动图、简易精神状态检查表（MMSE）以及细胞外液/总体液（ECW/TBW）比值（Inbody S10）。平均年龄为85.1±8.0岁（范围60 - 99岁），44.2%的患者为男性。MMSE平均得分为20.5±5.4，66.7%的患者存在认知障碍（MMSE≤23）。MMSE得分与年龄（r = -0.344，P = 0.032）、经常饮酒（r = 0.437，P = 0.007）、尿酸水平（r = 0.413，P = 0.010）以及ECW/TBW比值（r = -0.437，P = 0.007）之间存在显著负相关。在纳入这些协变量的逐步回归分析中，MMSE得分与ECW/TBW比值显著相关（β = 0.443，P = 0.009）。当将几个超声心动图参数（即舒张末期左心室容积，r = 0.327，P = 0.048；左心房容积指数，r = -0.411，P = 0.012；以及二尖瓣流入A波速度，r = -0.625，P = 0.001）添加到模型中时，发现MMSE得分与A波（P = 0.001）和心房容积指数（P = 0.015）相关，这二者均为舒张功能的指标。在老年HF患者中，认知功能可能受身体水分分布和舒张期心脏功能的影响。
