The Role of Biomarkers in Predicting Cognitive Impairment in Elderly Patients with Heart Failure

Turk Kardiyol Dern Ars. 2024 Jun;52(4):244-252. doi: 10.5543/tkda.2024.97143.


Objective: This study explores the impact of sST2, Growth Differentiation Factor 15 (GDF-15), and clinical factors on cognitive dysfunction in elderly patients with heart failure with reduced ejection fraction (HFrEF).

Methods: A cohort of 101 chronic stable HFrEF patients aged over 65 years old participated in the study. Cognitive functions were assessed using the Montreal Cognitive Assessment (MoCA) test and the Mini Mental State Examination (MMSE). Levels of sST2, GDF-15, and N-terminal pro b-type natriuretic peptide (NT-proBNP) were also measured.

Results: Notably higher levels of NT-proBNP and GDF-15 were observed in the group with cognitive dysfunction, whereas sST2 levels were similar between the groups. The cognitive dysfunction group consisted of older patients. A higher proportion of patients with normal cognitive function had received influenza vaccinations. Furthermore, GDF-15 levels inversely correlated with MMSE score. Right ventricular diameter was negatively correlated, while hemoglobin levels were positively correlated with both MoCA and MMSE scores. Logistic regression analysis identified increased GDF-15 levels, older age, and advanced New York Heart Association (NYHA) classes as predictors of higher cognitive dysfunction risk, whereas influenza vaccination was linked to a reduced risk of cognitive dysfunction.

Conclusion: Cognitive dysfunction in elderly patients with heart failure may be influenced by factors such as age, right ventricular enlargement, anemia, NYHA functional class, and levels of GDF-15 and NT-proBNP.

MeSH terms

  • Aged
  • Aged, 80 and over
  • Biomarkers* / blood
  • Cognitive Dysfunction* / blood
  • Cohort Studies
  • Female
  • Growth Differentiation Factor 15* / blood
  • Heart Failure* / blood
  • Heart Failure* / complications
  • Humans
  • Interleukin-1 Receptor-Like 1 Protein / blood
  • Male
  • Mental Status and Dementia Tests
  • Natriuretic Peptide, Brain* / blood
  • Peptide Fragments* / blood
  • Stroke Volume / physiology


  • Biomarkers
  • Growth Differentiation Factor 15
  • Peptide Fragments
  • pro-brain natriuretic peptide (1-76)
  • Natriuretic Peptide, Brain
  • Interleukin-1 Receptor-Like 1 Protein
  • GDF15 protein, human
  • IL1RL1 protein, human