AUTHOR=Shang Suhang , Liu Ziyu , Gao Jinying , Wang Jin , Lu Wenhui , Fei Yulang , Zhang Binyan , Mi Baibing , Li Pei , Ma Louyan , Jiang Yu , Chen Chen , Dang Liangjun , Liu Jie , Qu Qiumin 

TITLE=The Relationship Between Pre-existing Coronary Heart Disease and Cognitive Impairment Is Partly Explained by Reduced Left Ventricular Ejection Fraction in the Subjects Without Clinical Heart Failure: A Cross-Sectional Study

JOURNAL=Frontiers in Human Neuroscience

VOLUME=Volume 16 - 2022

YEAR=2022

URL=https://www.frontiersin.org/journals/human-neuroscience/articles/10.3389/fnhum.2022.835900

DOI=10.3389/fnhum.2022.835900

ISSN=1662-5161

ABSTRACT=Background
Coronary heart disease (CHD) is closely associated with cognitive impairment, especially in the severe cases of heart failure. However, it is  unclear whether cardiac systolic function plays a role in the relationship between pre-existing CHD and cognitive impairment in the subjects without clinical heart failure.
Methods
208 subjects from the First Affiliated Hospital of Xi'an Jiaotong University were recruited from June 2014 to January 2015, and were divided into CHD (n=118) and non-CHD (n=90) groups according to the inclusion and exclusion criteria. Global cognitive function of all subjects was assessed by Mini-Mental State Examination (MMSE) and cognitive impairment was defined as the score lower than the cutoff value. Left ventricular ejection fraction (LVEF) was measured using transthoracic echocardiograms. The relationship between pre-existing CHD, LVEF, and cognitive impairment was analyzed by multivariate logistic regression. 
Results
34 subjects met criteria of cognitive impairment. Univariate analysis showed that the cognitive impairment prevalence in the CHD group was significantly higher than that in the non-CHD group (22.0% vs 8.9%，P=0.011). Multivariate logistic analysis revealed CHD was significantly associated with higher risk of cognitive impairment (OR=3.284 [95% CI, 1.032-10.450], P=0.044) after adjusting for confounds except LVEF. However, OR of CHD decreased (OR=2.127 [95% CI, 0.624-7.254], P=0.228) when LVEF was further corrected as a continuous variable, and LVEF was negatively associated with risk of cognitive impairment (OR=0.928 [95% CI, 0.882-0.976], P=0.004). 
 Conclusions
Pre-existing CHD is associated with higher risk of cognitive impairment, and such association can be considerably explained by reduced LVEF. Impaired cardiac systolic function may plays a key role in the relationship between CHD and cognitive impairment among patients with pre-heart failure conditions.