Preventive and therapeutic correction of post-stroke cognitive disorders in patients with atrial fibrillation

Background. Cognitive decline (CD) during the recovery period of ischemic strokes in patients with atrial fibrillation (AF) is associated with left ventricular ejection fraction (LVEF) ≤ 48 %. Objective: to investigate cognitive changes during the recovery period of ischemic strokes in patients with AF and LVEF ≤ 48 % who took sacubitril/valsartan. Materials and methods. Patients with nonvalvular AF and LVEF ≤ 48 % who had an ische­mic non-lacunar stroke within the last 6 months were examined. Thirty-nine people in the control group received protocol treatment, and 14 patients additionally took sacubitril/valsartan 100 mg twice daily for 6 months. Cognitive and echocardiographic para­meters were assessed at the first examination and after 6 months. CD was diagnosed when the cognitive scores decreased by ≥ 1 point. Results. Both groups of patients at the time of inclusion did not differ significantly in cognitive functioning, socio-demographic, clinical, psycho-emotional characteristics, and echocardiographic parameters. Six-month administration of sacubitril/valsartan was associated with a significant reduction in the relative risk of CD on all used cognitive scales compared to the control group: by 3.18 times (95% confidence interval (CI) 1.42–7.16) on the Montreal Cognitive Assessment, by 2.79 times (95% CI 1.29–6.00) on the Clock Drawing Test and by 2.48 times (95% CI 1.19–5.14) on the Mini-Mental State Examination and the Frontal Assessment Battery. In addition, the sacubitril/valsartan intake was associated with a reliable increase in LVEF compared to baseline (40.3 (38.1–42.4) vs. 40.1 (39.4–42.5) %); in contrast, in the control group, no such pattern was observed. Conclusions. In patients with AF and LVEF ≤ 48 %, sacubitril/valsartan administration in the recovery period of ischemic non-lacunar stroke is associated with a significant improvement in cognitive functioning.