Table 3 -.

Summary of Findings (GRADE)—Association between biomarkers and cognitive impairment in CHF

Outcome	Anticipated absolute effects (95% CI)	Mean difference (95% CI)	Participants (studies)	Certainty of evidence (GRADE)	Comments / Interpretation
hs-cTnT levels (ng/L): cognitive impairment vs. no impairment	Not applicable (continuous variable)	MD 3.36 ng/L (0.42 to 6.31)	209 (2 studies)	⊕○○○ Very low	Patients with cognitive impairment showed higher hs-cTnT concentrations. The evidence is of very low certainty due to the observational design, potential residual confounding, and imprecision (small sample size and predominance of a single study).
NT-proBNP levels (pg/mL): cognitive impairment vs. no impairment	Not applicable (continuous variable)	MD 410.16 pg/mL (−276.22 to 1096.53)	310 (3 studies)	⊕○○○ Very low	The results are uncertain; the confidence interval includes no effect. Moderate heterogeneity was observed (I²=51%) with no explained cause. The evidence was downgraded due to risk of bias, inconsistency, and imprecision.
Extracardiac biomarkers (GDF-15, S100B, pTau, NfL, BDNF, sICAM-1/sVCAM-1)	Not pooled (different measurements)	Narrative synthesis	368 (4 studies)	⊕○○○ Very low	Qualitative evidence suggests an association with inflammation, endothelial dysfunction, and neurodegeneration. Certainty downgraded due to indirectness, heterogeneity, and imprecision.