Expression levels of serum microRNA-1-3p and activating transcription factor 4 in elderly patients with chronic heart failure and their relationships with cognitive impairment

Objective To explore the expression levels of serum microRNA-1-3p (miR-1-3p) and activating transcription factor 4 (ATF4) in elderly patients with chronic heart failure (CHF) and their relationships with cognitive impairment.

Methods A total of 150 elderly patients with CHF were selected as the study subjects. Based on the Montreal Cognitive Assessment (MoCA) score, the patients were divided into cognitive impairment group (n=75) and normal cognitive function group (n=75). Real-time fluorescent quantitative polymerase chain reaction (RT-qPCR) was used to detect the serum miR-1-3p levels in both groups. Enzyme-linked immunosorbent assay (ELISA) was employed to measure the serum ATF4 levels in the two groups. Pearson correlation analysis was applied to analyze the correlation between serum miR-1-3p and ATF4 level in elderly CHF patients with cognitive impairment. Logistic regression analysis was conducted to identify the influencing factors of cognitive impairment in elderly CHF patients. The predictive value of serum miR-1-3p and ATF4 levels for cognitive impairment in CHF patients was evaluated using receiver operating characteristic (ROC) curves.

Results The left ventricular ejection fraction (LVEF), MoCA score and serum miR-1-3p level were significantly lower in the cognitive impairment group, while the N-terminal pro-brain natriuretic peptide (NT-proBNP) level and serum ATF4 level were significantly higher than those in the normal cognitive function group (P < 0.05). There was a negative correlation between serum miR-1-3p level and serum ATF4 level in elderly CHF patients with cognitive impairment (r=-0.523, P < 0.001). Both miR-1-3p and ATF4 were identified as influencing factors for cognitive impairment in elderly CHF patients (P < 0.05). The area under the curve (AUC) for predicting cognitive impairment in elderly CHF patients using a combination of serum miR-1-3p and ATF4 was significantly greater than the AUCs for prediction of serum miR-1-3p or ATF4 alone (P < 0.05 or P < 0.001).

Conclusion The expression level of serum miR-1-3p is positively correlated while the expression of serum ATF4 is negatively correlated with cognitive function in elderly CHF patients. The serum miR-1-3p and ATF4 may serve as potential markers for evaluating cognitive impairment in elderly CHF patients.