Predictive value of baseline cognitive functioning on health-related quality of life in individuals with coronary artery disease: a 5-year longitudinal study.

AIMS: Emerging studies suggest an association exists between coronary artery disease (CAD) and the development of neurodegenerative diseases, with CAD acting as a precursor. Our study aimed to investigate the relationship between baseline measures of cognitive functioning and long-term health-related quality of life (HRQoL) in individuals with CAD with specification to Type D personality traits and sex. METHODS AND RESULTS: This prospective observational cohort study consisted of 864 participants (mean age 58 SD = 9 years, 74.0% men) with CAD after acute coronary syndrome. Baseline characteristics included comprehensive cognitive testing, measures of sociodemographic and clinical factors, and psychological assessment scales, such as Type D personality scale and the Hospital Anxiety and Depression scale. The Minnesota Living with Heart Failure Questionnaire assessed participants' HRQoL, conducted through phone interviews at baseline, every 6 months for up to 2 years, and after 5 years. Cognitive functioning correlated with HRQoL at all time intervals over the 5-year follow-up. Regarding sex and Type D personality, significant differences emerged in associations between impaired cognitive functioning at baseline and HRQoL measured over the period of 5 years. Men participants with characteristics of Type D personality were especially vulnerable to impaired cognitive functioning affecting the 5-year quality of life. CONCLUSION: Men with CAD who obtained scores indicating characteristics of Type D personality were significantly more likely to have lower baseline cognitive functions and long-term HRQoL outcomes. This information could inform healthcare practitioners to screen for personality characteristics and closely follow-up those at a greater risk.

Fatigue Is Associated With Diminished Cardiovascular Response to Anticipatory Stress in Patients With Coronary Artery Disease.

BACKGROUND: Fatigue and psychophysiological reactions to mental stress are known to be problematic in coronary artery disease (CAD) patients. Currently, studies exploring the relationship between fatigue and cardiovascular reactivity to stress are scarce and inconsistent. The current study aimed to investigate the links between cardiovascular response to mental stress and fatigue in CAD patients after acute coronary syndrome (ACS). METHODS: The cross-sectional study investigated 142 CAD patients (85% males, 52 ± 8 years) within 2-3 weeks after recent myocardial infarction or unstable angina pectoris. Fatigue symptoms were measured using Multidimensional Fatigue Inventory 20-items, while cardiovascular reactivity to stress [i.e., systolic (S) and diastolic (D) blood pressure (ΔBP), and heart rate (ΔHR)] was evaluated during Trier Social Stress Test (TSST). In addition, participants completed psychometric measures, including the Hospital Anxiety and Depression scale and the Type D Scale-14. Multivariable linear regression analyses were completed to evaluate associations between fatigue and cardiovascular response to TSST, while controlling for confounders. RESULTS: After controlling for baseline levels of cardiovascular measures, age, gender, education, heart failure severity, arterial hypertension, smoking history, use of nitrates, anxiety and depressive symptoms, Type D Personality, perceived task difficulty, and perceived task efforts, cardiovascular reactivity to anticipatory stress was inversely associated with both global fatigue (ΔHR: ß = -0.238; p = 0.04) and mental fatigue (ΔSBP: ß = -0.244; p = 0.04; ΔHR ß = -0.303; p = 0.01) as well as total fatigue (ΔSBP: ß = -0.331; p = 0.01; ΔHR: ß = -0.324; p = 0.01). CONCLUSION: In CAD patients after ACS, fatigue was linked with diminished cardiovascular function during anticipation of a mental stress challenge, even after inclusion of possible confounders. Further similar studies exploring other psychophysiological stress responses are warranted.

Undiagnosed sleep apnoea in cardiac rehabilitation: Age-dependent effect on diastolic function in coronary artery disease patients with preserved ejection fraction.

BACKGROUND: Focusing on detection of sleep apnoea early in the cardiac rehabilitation process may improve the recovery process and reduce recurrence of cardiovascular events. Patients who continue to be undiagnosed may experience a significantly worse outcome during their cardiac rehabilitation and recovery. Diastolic dysfunction has both diagnostic and prognostic importance in the management of coronary artery disease. We hypothesise that undiagnosed/untreated sleep apnoea in middle-aged coronary artery disease patients with preserved left ventricular ejection fraction changes the pattern of diastolic filling close to that in elderly patients without sleep apnoea. METHODS AND RESULTS: This cross-sectional study included the 450 coronary artery disease patients with undiagnosed sleep apnoea who had left ventricular ejection fraction ⩾50% and were referred consecutively to the Clinic of Cardiovascular Rehabilitation within two weeks after treatment for acute coronary syndrome. Polysomnographic and echocardiographic measurements were analysed. Mild to severe sleep apnoea was defined as the apnoea-hypopnea index ⩾5. Age was dichotomised into under the age of 60 years and age 60 years or over. Up to 35% of coronary artery disease patients were likely to have undiagnosed sleep apnoea. There was a statistically significant interaction between the effect of sleep apnoea and age group on diastolic function defined as the ratio peak flow velocity in early diastole/peak flow velocity in atrial contraction ratio (p=0.036). This ratio was significantly (p=0.029) lower in the mild-severe sleep apnoea group (0.97, 95% confidence interval 0.88-1.06) than in the non-sleep apnoea group (1.09, 95% confidence interval 1.03-1.15) among middle aged (<60 years) coronary artery disease patients. Therefore, filling patterns in the middle aged (<60 years) patients with sleep apnoea resemble those observed in the elderly (⩾60 years) patients without sleep apnoea. The effect of sleep apnoea on left ventricular filling pattern in elderly was not observed. CONCLUSIONS: Age modifies the effect of sleep apnoea on cardiovascular outcomes. The findings that undiagnosed sleep apnoea impairs diastolic function in a middle-aged coronary artery disease patient underscore the importance of early diagnosis and treatment of sleep apnoea. It is recommended to train and educate cardiac rehabilitation staff on the importance of sleep disorders in this population.

Validation and Psychometric Properties of the Minnesota Living With Heart Failure Questionnaire in Individuals With Coronary Artery Disease in Lithuania.

BACKGROUND: Health-related quality of life (HRQoL) is known to be impaired in individuals with coronary artery disease (CAD), especially in those after a recent acute coronary syndrome (ACS). Heart failure (HF) is a common burden in this population that significantly contributes to worsening HRQoL. To accurately measure the level of HRQoL in individuals with CAD after ACS, disease-specific scales, such as the Minnesota living with heart failure questionnaire (MLHFQ), are recommended. Nevertheless, to date, there has not been a study that would comprehensively evaluate the psychometric properties of the MLHFQ in a large sample of individuals with CAD after ACS. The debate regarding the internal structure of MLHFQ is also still present. Hence, this study aimed to translate the MLHFQ and evaluate its internal structure, reliability/precision, and validity in individuals with CAD following ACS in Lithuania. METHODS: In the cross-sectional study, 1,083 participants (70% men, age M = 58, SD = 9) were evaluated for sociodemographic and clinical characteristics. HRQoL was measured using the MLHFQ and the Short Form-36 health survey (SF-36). In addition, exercise capacity (EC) was also evaluated in the study patients, using a standardized computer-driven bicycle ergometer. RESULTS: The internal consistency of the MLHFQ subscales (0.79-0.88) was found to be good. Confirmatory factor analysis (CFA) provided the support for the three-factor model ("physical domain," "social domain," and "emotional domain") of the MLHFQ and showed acceptable fit [comparative fit indices (CFI) = 0.894; goodness-of-fit (GFI) = 0.898; non-normal fit index (NFI) = 0.879, and root mean square error of approximation (RMSEA) = 0.073]. Regarding convergent evidence, significant associations were found between the MLHFQ domains and the SF-36 domains and EC (r's range 0.11-0.58). CONCLUSION: The current study completed cultural validation and provided further information on the psychometric characteristics of the MLHFQ in Lithuania, suggesting MLHFQ as a valid and reliable instrument to measure HRQoL. The Lithuanian version of MLHFQ is best described by a three-factor solution, measuring physical, social, and emotional dimensions of HRQoL among individuals with CAD following ACS.

Validation of the Multidimensional Fatigue Inventory with Coronary Artery Disease Patients.

BACKGROUND: Fatigue is a common distressing symptom in patients with coronary artery disease (CAD). The Multidimensional Fatigue Inventory (MFI) is used for measuring fatigue in various clinical settings. Nevertheless, its multidimensional structure has not been consistent across studies. Thus, we aimed to psychometrically evaluate the MFI in patients with CAD. METHODS: In sum, 1162 CAD patients completed questionnaires assessing their subjective fatigue level (MFI-20), mental distress symptoms (HADS, STAI), and health-related quality of life (SF-36). Participants also completed exercise capacity (EC) testing. RESULTS: Confirmatory factor analysis of the four-factor model, showed acceptable fit (CFI = 0.905; GFI = 0.895; NFI = 0.893, RMSEA = 0.077). After eliminating four items, confirmatory factor analysis testing showed improvement in the four-factor model of the MFI-16 (CFI = 0.910; GFI = 0.909; NFI = 0.898, RMSEA = 0.077). Internal consistency values were adequate for the total score and four MFI-16 subscales: General fatigue, physical fatigue, reduced activity, and mental fatigue with Cronbach's α range: 0.60-0.82. The inadequate value (Cronbach's α = 0.43) was received for the subscale of reduced motivation in both MFI-20 and MFI-16. Correlations between the MFI-16 and HADS, STAI, SF-36, and EC measures were statistically significant (all p's < 0.001). CONCLUSIONS: The Lithuanian version of the modified MFI of 16 items showed good factorial structure and satisfactory psychometric characteristics, except for reduced motivation subscale.

Importance of Thyroid Hormone level and Genetic Variations in Deiodinases for Patients after Acute Myocardial Infarction: A Longitudinal Observational Study.

This study aimed to examine the influence of thyroid hormone (TH) levels and genetic polymorphisms of deiodinases on long-term outcomes after acute myocardial infarction (AMI). In total, 290 patients who have experienced AMI were evaluated for demographic, clinical characteristics, risk factors, TH and NT-pro-BNP. Polymorphisms of TH related genes were included deiodinase 1 (DIO1) (rs11206244-C/T, rs12095080-A/G, rs2235544-A/C), deiodinase 2 (DIO2) (rs225015-G/A, rs225014-T/C) and deiodinase 3 (DIO3) (rs945006-T/G). Both all-cause and cardiac mortality was considered key outcomes. Cox regression model showed that NT-pro-BNP (HR = 2.11; 95% CI = 1.18- 3.78; p = 0.012), the first quartile of fT3, and DIO1 gene rs12095080 were independent predictors of cardiac-related mortality (HR = 1.74; 95% CI = 1.04-2.91; p = 0.034). The DIO1 gene rs12095080 AG genotype (OR = 3.97; 95% CI = 1.45-10.89; p = 0.005) increased the risk for cardiac mortality. Lower fT3 levels and the DIO1 gene rs12095080 are both associated with cardiac-related mortality after AMI.

Cardiovascular Reactivity to Acute Mental Stress: THE IMPORTANCE OF TYPE D PERSONALITY, TRAIT ANXIETY, AND DEPRESSION SYMPTOMS IN PATIENTS AFTER ACUTE CORONARY SYNDROMES.

PURPOSE: Links between psychophysiological reactions to stress stimuli and perceived mental distress, including type D personality, anxiety, and depression, are still under debate. The aim of this study was to examine associations between cardiovascular reactivity to social stress and mental distress in patients after acute coronary syndrome. METHODS: Patients (n = 116, 86% males, 52 ± 8 yr) with coronary artery disease 2 wk after acute coronary syndrome were evaluated for sociodemographic, clinical characteristics and coronary artery disease risk factors. The Trier Social Stress Test was employed to measure cardiovascular reactions to social stress (systolic and diastolic blood pressure and heart rate). Mental distress assessment included type D personality (Type D Scale), anxiety and depressive symptoms (Hospital Anxiety and Depression Scale), and state and trait anxiety (State-Trait Anxiety Inventory). RESULTS: Multiple linear regression analysis showed associations between type D personality and lower heart rate during Trier Social Stress Test periods of task instruction (ß = -.196, P < .04), preparation time (ß = -.232, P < .01), and recovery time (ß = -.209, P < .029). Higher trait anxiety was linked with lower heart rate during baseline rest (ß = -.287, P < .01), task instruction (ß = -.286, P < .01), preparation time (ß = -.241, P < .01), and recovery period (ß = -.209, P < .05). Depressive symptoms were associated with higher systolic blood pressure during baseline rest (ß =.187, P < .05), task instruction (ß = .306 P < .01), and free speech (ß = .264, P < .05). CONCLUSIONS: Mental distress was associated with cardiovascular stress reactions independent from possible covariates, suggesting dysregulated psychophysiological reactions to acute stress.

The association of cardiovascular reactivity during the Trier Social Stress Test with quality of life in coronary artery disease patients.

OBJECTIVE: Knowledge of objective psychophysiological stress parameters and its relationship to health-related quality of life (HRQoL) is limited in patients with coronary artery disease (CAD). The aim was to investigate the association of cardiovascular reaction to psychosocial stress with HRQoL in patients with CAD. METHODS: One-hundred and thirty-six patients (84.6% men, age 52 ±â€¯8) within 2-3 weeks after acute coronary syndromes (ACS) during cardiac rehabilitation were recruited in this cross-sectional study. Patients were evaluated for HRQoL (SF-36 questionnaire), symptoms of anxiety and depression (Hospital Anxiety and Depression scale) and Type D personality (DS14 scale). Trier Social Stress Test (TSST) was employed to evaluate cardiovascular reactivity (systolic and diastolic blood pressure [BP], and heart rate [HR]) to psychosocial stress. Multiple linear regression analyses were performed to test for the associations between cardiovascular reactivity and HRQoL, while controlling for possible confounders. RESULTS: After controlling for baseline levels of HR, gender, age, NYHA functional class, AH, Type D personality, symptoms of anxiety and depression, use of beta-blockers, and history of smoking, the SF-36 Social functioning scale (ß = -0.182; p = .03) and SF-36 Vitality scale (ß = -0.203; p = .03) was associated with prolonged HR recovery following stress evoking tasks. No associations were found between HRQoL and BP measures during the TSST. CONCLUSION: In CAD patients who have experienced ACS, HRQoL was associated with prolonged HR recovery after mental stress, even after controlling for potential confounder. Future studies should investigate the possible role of mediating factors involved in the mechanisms relating cardiovascular stress response and HRQoL.

Stressful Life Events Are Associated With Health-Related Quality of Life During Cardiac Rehabilitation and at 2-yr Follow-up in Patients With Heart Failure.

PURPOSE: According to recent literature, stressful life events might represent an important risk factor of health-related quality of life (HRQoL) in patients with heart failure. The aim of this study was to evaluate the association between stressful life events and HRQoL in patients with heart failure after acute coronary syndrome, both during cardiac rehabilitation and during 2 yr of follow-up. METHODS: Patients with heart failure (n = 481; 75% male; mean age: 58 ± 9 yr) were evaluated for sociodemographic, clinical, and mental distress factors including stressful life events, anxiety and depression symptoms, perceived social support, and type D personality. Health-related quality of life was evaluated at baseline and at follow-up by telephone interview. Patients were also tested for exercise capacity at baseline. RESULTS: Stressful life events were associated with impaired HRQoL independently of sociodemographic characteristics, clinical factors, mental distress, social support, and type D personality. CONCLUSION: Stress level due to experiencing stressful life events should be specifically assessed during cardiac rehabilitation, as it is associated with patients HRQoL.

Deiodinases, Organic Anion Transporter Polypeptide Polymorphisms, and Thyroid Hormones in Patients with Myocardial Infarction.

AIM: To investigate the association among deiodinases (DIO), organic anion-transporting polypeptide 1C1 (OATP1C1) gene polymorphisms, and thyroid hormones (THs) in patients with acute myocardial infarction (AMI). METHODS: In summary, 290 patients with AMI were evaluated for sociodemographic and clinical characteristics, coronary artery disease (CAD) risk factors, and comorbidities, as well as circulating thyroid-stimulating hormone and TH (triiodothyronine [T3], thyroxine [T4], free T3, free T4, and reverse T3) levels. Ten single nucleotide polymorphisms for thyroid axis related genes: DIO1 (rs11206244-C/T, rs12095080-A/G, rs2235544-A/C), DIO2 (rs225014-T/C, rs225015-G/A), DIO3 (rs945006-T/G), and OATP1C1 (rs10444412-T/C, rs10770704-C/T, rs1515777-A/G, rs974453-G/A) were genotyped. RESULTS: Marginal associations were observed between the DIO1, DIO2, and OATP1C1 gene polymorphisms and almost all analyzed THs (p's < 0.05). After controlling for potential confounders, the OATP1C1 rs1515777-A/G minor allele homozygous genotype (G/G) was associated with a decrease in circulating free T3 and free T3/free T4. In the AMI cohort, associations between: DIO1 rs12095080 and hypertension; DIO2 rs225015 and diabetes mellitus; and the OATP1C1 rs974453 genotype, and AMI type were established. CONCLUSIONS: DIO1 and DIO2 gene polymorphisms are mainly associated with T3, free T4, free T3/free T4, and [natural-log transformed (ln)] reverse T3 levels, while the OATP1C1 minor allele homozygous genotype is associated with free T3 and free T3/free T4 in CAD patients after AMI.

Exploring potential biomarkers associated with health-related quality of life in patients with coronary artery disease and heart failure.

OBJECTIVE: There has been a lack of research examining associations between biomarkers and health-related quality of life (HRQoL) in patients with coronary artery disease and heart failure. In patients with coronary artery disease and heart failure, we aimed to explore potential associations between biomarkers of health such as serum levels of thyroid hormones, N-terminal pro-B-type natriuretic peptide (NT-pro-BNP), inflammatory biomarkers and HRQoL. METHODS: In sum, 482 patients (75% male; mean age 58±10 years) with coronary artery disease and heart failure were evaluated for socio-demographic and clinical coronary artery disease risk factors. Blood samples were drawn to evaluate thyroid hormones, NT-pro-BNP, high-sensitivity C-reactive protein and interleukin-6 (IL-6). Additional data was collected on HRQoL (the Minnesota Living with Heart Failure Questionnaire), anxiety and depressive symptoms (Hospital Anxiety and Depression Scale), Type D personality (DS14 scale). RESULTS: In multivariable models, lower levels of high-sensitivity C-reactive protein and interleukin-6 were associated with worse results on the Minnesota Living with Heart Failure Questionnaire emotional subscale (ß = -0.107, p = 0.003; ß = -0.106, p = 0.004). Lower levels of interleukin-6 were associated with worse perceived global health (ß = -0.101, p = 0.011). CONCLUSION: Even after controlling for socio-demographic and clinical risk factors including mental distress symptoms, lower levels of inflammatory biomarkers were associated with worse HRQoL.

Mental Distress Factors and Exercise Capacity in Patients with Coronary Artery Disease Attending Cardiac Rehabilitation Program.

PURPOSE: There is still insufficient data on mental distress factors contributing to exercise capacity (EC) improvement before and after cardiac rehabilitation (CR) in patients with coronary artery disease (CAD). The aim of our study was to evaluate the associations between various mental distress factors and EC before and after exercise-based CR (EBCR). METHODS: Over 12 months, 223 CAD patients (70% men, mean age 58 ± 9 years) were evaluated for socio-demographic, clinical, and mental distress symptoms as measured by the Hospital Anxiety and Depression scale (HADS), Beck Depression Inventory-II (BDI-II), and Spielberger State-Trait Anxiety Inventory (STAI). Patients were tested for EC at baseline and after EBCR. RESULTS: In a multivariate linear regression model, EC before EBCR was associated with HADS anxiety subscale (ß = -.186, p = .002) and BDI-II somatic/affective subscale (ß = -.249, p < .001). EC after EBCR was associated with HADS anxiety and depression subscales (ß = -.198, p < .001; ß = -.170, p = .002, respectively) and BDI-II (ß = -.258, p < .001). The BDI-II somatic/affective subscale was the best predictor of reduced EC before and after EBCR. CONCLUSIONS: Mental distress and somatic/affective symptoms of depression are strongly associated with EC both at the beginning and after EBCR. Analysis of possible mediating or moderating factors was beyond the scope of our study. Future studies should focus on comprehensive evaluation of EC risk factors including other mental distress characteristics, subjectively experienced fatigue, and post-operative CAD symptoms.

The association of sleep disordered breathing with left ventricular remodeling in CAD patients: a cross-sectional study.

BACKGROUND: There is still insufficient knowledge on the potential effect of mild to moderate sleep-disordered breathing (SDB) that is widely prevalent, often asymptomatic, and largely undiagnosed in patients with stable coronary artery disease (CAD). SDB affects 34% of men and 17% of women aged between 30 and 70. The objective of this study was to evaluate the association between SDB and left ventricular (LV) hypertrophy as well as structural remodeling in stable CAD patients. METHODS: The study was based on a cross-sectional design. Echocardiography and polysomnography was performed in 772 patients with CAD and with untreated sleep apnea. All study participants underwent testing by Epworth Sleepiness Scale questionnaire. Their mean age, NYHA and left ventricular ejection fraction were, respectively: 57 ± 9 years, 2.1 ± 0.5 and 51 ± 8%, and 76% were men. Sleep apnea (SA) was defined as an apnea-hypopnea-index (AHI) ≥5 events/h, and, non-SA, as an AHI <5. RESULTS: Sleep apnea was present in 39% of patients, and a large fraction of those patients had no complaints on excessive daytime sleepiness. The patients with SA were older, with higher body mass and higher prevalence of hypertension. LV hypertrophy (LVH), defined by allometrically corrected (LV mass/height2.7) gender-independent criteria, was more common among the patients with SA than those without (86% vs. 74%, p < 0.001). The frequency of LVH by wall thickness criteria (interventricular septal thickness or posterior wall thickness ≥ 12 mm: 49% vs. 33%, p < 0.001) and concentric LVH (61% vs. 47%, p = 0.001) was higher in CAD patients with SA. The patients with SA had significantly higher values of both interventricular septal thickness and posterior wall thickness. Multiple logistic regression analysis showed that even mild sleep apnea was an independent predictor for LVH by wall thickness criteria and concentric LVH (OR = 1.5; 95% CI 1.04-2.2 and OR = 1.9; 1.3-2.9 respectively). CONCLUSIONS: We concluded that unrecognized sleep apnea was highly prevalent among patients with stable CAD, and the majority of those patients did not report daytime sleepiness. Mild to moderate sleep apnea was associated with increased LV wall thickness, LV mass, and with higher prevalence of concentric LV hypertrophy independently of coexisting obesity, hypertension, diabetes mellitus or advancing age.

Prevalence and predictors of sleep apnea in patients with stable coronary artery disease: a cross-sectional study.

BACKGROUND: Sleep apnea (SA) is increasingly recognized as being important in the prognosis of patients with coronary artery disease (CAD); however, symptoms of SA are not easily identified, and as many as 80% of sufferers remain undiagnosed. AIM: This cross-sectional study investigated the prevalence and predictors of SA that may help to increase the awareness and diagnosis of SA in stable CAD patients. MATERIALS AND METHODS: Polysomnography was performed in 772 medically stable CAD patients with untreated SA recruited from the Clinic of Cardiovascular Rehabilitation. Patients were predominantly male (76%), median age was 58 years (32-81). All subjects completed the Epworth sleepiness scale (ESS). The frequency of all apneas and hypopneas associated with 3% oxygen desaturation is referred to as the apnea-hypopnea index (AHI). Mild-to-severe SA was defined as AHI ≥5/h, moderate-to-severe SA as AHI ≥15/h. RESULTS: AHI was within a range of values that was considered normal or only mildly elevated. The median AHI was 3.4 (interquartile range [IQR 1-9]), and 39% of patients had unrecognized mild-to-severe SA (moderate-to-severe in 14%), which was not higher than other known risk indicators for CAD such as hypertension and obesity (83% and 47%, respectively). These patients did not show sleepiness and the risk-related cut-off score for excessive daily sleepiness was lower than the official for ESS. CONCLUSION: Hypertension, age, male gender, obesity, ESS ≥6, and left ventricular ejection fraction ≤45% were the best predictors of mild-to-severe SA. While, male gender, age 50-70 years and, mainly, the presence of obesity but not hypertension were clinical predictors for moderate-to-severe SA. In addition, association between mild-to-severe SA and obesity was not evident in women. SA is prevalent comorbidity in the stable CAD patients, especially in its asymptomatic mild form. We suggest that SA should be considered in the secondary prevention protocols for CAD.

Cognitive Functioning in Coronary Artery Disease Patients: Associations with Thyroid Hormones, N-Terminal Pro-B-Type Natriuretic Peptide and High-Sensitivity C-Reactive Protein.

OBJECTIVE: To determine whether biomarkers of health such as serum levels of free triiodothyronine (fT3), total triiodothyronine (TT3), N-terminal pro-B-type natriuretic peptide (NT-proBNP), and high-sensitivity C-reactive protein (hsCRP) impact the cognitive functioning of coronary artery disease (CAD) patients. METHOD: About 278 patients were evaluated for socio-demographic and clinical risk factors as well as fT3, TT3, NT-proBNP, and hsCRP serum levels. Cognitive functioning measures included the Mini-Mental State Examination, Digit Span Test, Digit Symbol Substitution Test (DSST), and Trail Making Test A (TMTA). Depressive symptoms were assessed with the Hospital Anxiety and Depression Scale. RESULTS: Lower fT3 concentrations were associated with longer completion time of the DSST and TMTA. Elevated levels of NT-proBNP were also associated with inferior performance on TMTA independently of socio-demographic characteristics, clinical risk factors, and depression symptoms. CONCLUSIONS: Lower fT3 concentrations and higher levels of NT-proBNP were associated with worse cognitive functioning in CAD patients.

Exploring Cognitive Concomitants of Mental Fatigue in Patients with Coronary Artery Disease.

OBJECTIVE: Fatigue and reduced exercise capacity are common concomitants of coronary artery disease (CAD). They are known to be associated with the deterioration in mental health, including emotional and cognitive status. However, the precise nature of the inter-relationship is poorly understood. The aim of this study was to investigate the relationship between fatigue and exercise capacity on the one hand and changes in cognitive functioning on the other, to generate new heuristics for clinical management and outcome prediction of CAD. METHODS: A cross-sectional study included 827 in-patients (58 ± 9 years, 75% men) with CAD. Patients were evaluated for demographic, cardiac characteristics, and exercise capacity. The Multidimensional Fatigue Inventory-20 was used to assess fatigue, the Mini Mental State Examination for global cognitive function, the Digit Span Test, Digit Symbol Test, and Trail Making Test for executive aspects of cognitive functioning, and the Hospital Anxiety and Depression Scale for anxiety and depression symptom severity. RESULTS: Using multiple regression analysis, after adjusting for possible confounders such as anxiety and depression, mental fatigue was associated with several executive aspects of cognitive function including short-term memory (Digit Symbol Test pairs recalled correctly [ß = -0.127, p < 0.005]), psychomotor performance (time to complete the Digit Symbol Test [ß = 0.089, p < 0.03]), and cognitive processing speed (Trail Making Test A [ß = 0.081, p < 0.05]). CONCLUSION: In rehabilitating CAD patients, certain aspects of executive functioning were independently associated with mental fatigue. These findings suggest that the subjective experience of mental fatigue, rather than reduced exercise capacity, is significantly associated with cognitive function.

Association of Depression, Anxiety, and Type D Personality with Cognitive Function in Patients with Coronary Artery Disease.

BACKGROUND AND OBJECTIVE: Cognitive impairment predicts poor outcomes in patients with coronary artery disease (CAD), but much remains to be learned about these patients' cognitive function. We investigated how depression, anxiety, and Type D personality relate to cognitive function in patients with CAD, adjusting for sociodemographic factors and clinical markers of CAD severity. METHODS: We evaluated 510 consecutive patients with CAD (364 men, 146 women; mean age 58±9 years) but no history of coronary artery bypass graft surgery or cognitive impairment who were attending a cardiac rehabilitation program. We assessed the patients' cognitive function (Mini-Mental State Examination, Digit Span Test, Digit Symbol Test, and Trail Making Test Part A), depressive symptoms (Beck Depression Inventory-II), anxiety (State-Trait Anxiety Inventory), Type D personality (14-item Type D Scale), and clinical markers of CAD severity. RESULTS: After adjusting for sex, age, education, New York Heart Association functional class, and left ventricular ejection fraction, we found that higher depression symptom scores correlated with longer Digit Symbol Test completion time (ß=0.158, P<0.004). Higher state anxiety scores correlated with worse Digit Span Test backward recall (ß=-0.117, P<0.008) and Trail Making Test Part A scores (ß=0.182, P<0.004). Type D personality correlated with lower Mini-Mental State Examination scores (ß=-0.148, P=0.001). CONCLUSIONS: For patients with CAD undergoing a cardiac rehabilitation program, depression, anxiety, and Type D personality were associated with worse cognitive performance independent of clinical CAD severity and sociodemographic characteristics.

Relationship and prognostic importance of thyroid hormone and N-terminal pro-B-Type natriuretic peptide for patients after acute coronary syndromes: a longitudinal observational study.

BACKGROUND: Altered thyroid function and increased rates of N-terminal pro-B-Type natriuretic peptide (NT-pro-BNP) are highly prevalent in coronary artery disease (CAD) patients with heart failure, and are associated with unfavorable prognosis. This study was undertaken to examine the relationship and prognostic impact of thyroid hormones, inflammatory biomarkers, and NT-pro-BNP on long-term outcomes in patients after acute coronary syndrome (ACS). METHODS: The study comprised of 642 patients (age 58 ± 10 years, 77% male) attending an in-patient cardiac rehabilitation program after experiencing ACS. Patients were evaluated for demographic, clinical and CAD risk factors as well as thyroid hormones (e.g., fT3, fT4 level, fT3/fT4 ratio), inflammatory biomarkers (hs-CRP, IL-6) and NT-pro-BNP levels. Data on fT3/fT4 ratio and NT-pro-BNP levels were not normally distributed and were natural-log transformed (ln). Both all-cause (cumulative) and cardiac-related mortality were considered the primary outcomes of interest. RESULTS: According to the Cox model, age, NYHA class, (ln)NT-pro-BNP levels (HR 1.53, 95% CI 1.13-2.07), fT4 level (HR 1.15, 95% CI 1.04-1.27), and (ln)fT3/fT4 ratio (HR 0.08, 95% CI 0.02-0.32) were the most important predictors of all-cause mortality among CAD patients after ACS. Similarly, age, NYHA class, (ln)NT-pro-BNP levels (HR 1.62, 95% CI 1.11-2.36), fT4 (HR 1.15, 95% CI 1.02-1.29) and (ln)fT3/fT4 ratio (HR 0.10, 95% CI 0.02-0.55) independently predicted cardiac-related mortality. Kaplan-Meier analyses provided significant prognostic information with the highest risk for all-cause mortality in the low cut off measures of fT3/fT4 ratio <0.206 and NT-pro-BNP ≥ 290.4 ng/L (HR 2.03, 95% CI 1.39-2.96) and fT4 level >12.54 pg/ml (HR = 2.34, 95% CI 1.05-5.18). There was no association between hs-CRP, IL-6 and mortality in CAD patients after ACS. CONCLUSIONS: Thyroid hormones (i.e., fT4 level and fT3/fT4 ratio) together with NT-pro-BNP level may be valuable and simple predictors of long-term outcomes of CAD patients after experiencing ACS.

Relationship between left ventricular mechanics and low free triiodothyronine levels after myocardial infarction: a prospective study.

Low free triiodothyronine (fT3) levels following acute myocardial infarction (AMI) are associated with greater impairment in cardiac mechanics compared with patients with AMI who have normal values of thyroid hormones. The objectives are to investigate left ventricular (LV) function and mechanics during a 6-month follow-up after myocardial infarction and to evaluate their prognostic implication using two-dimensional (2D) echocardiography and 2D speckle-tracking echocardiography in patients with low fT3 levels. The study design is prospective cohort study. One hundred forty patients with first-onset AMI were grouped according to serum fT3 levels: low fT3 group (fT3 <3.2 pmol/L; n = 44) and control group (fT3 >3.2 pmol/L; n = 96). Low levels of fT3 were associated with greater LV diameters and LV end-diastolic volume, and decreased systolic LV function. Systolic apical and basal rotation, peak systolic global longitudinal strain and strain rate, and LV twist and torsion were significantly decreased in the low fT3 group. The prognostic implication for predicting low fT3 levels was evaluated using ROC analysis. LV end-diastolic diameter index is the most sensitive (94.12 %), but has low specificity (37.93 %; area = 0.659, p = 0.01). By contrast, LV end-systolic volume is the most specific (94.03 %), but has low sensitivity (26.32 %; area = 0.594, p = 0.04). Low fT3 levels are significantly associated with worse LV mechanics. Low fT3 levels are important for prediction of LV structure, function, rotation, and deformation parameters during the late post-myocardial infarction period.

Beta-1-Selective Beta-Blockers and Cognitive Functions in Patients With Coronary Artery Disease: A Cross-Sectional Study.

The association between current beta-1-selective beta-blocker use and cognitive function was evaluated in 722 patients with coronary artery disease without dementia. Beta-1-selective beta-blocker use was associated with worse incidental learning independently of sociodemographic characteristics, clinical coronary artery disease severity, and depression/anxiety.