Impairment of Cognitive Function Increases Mortality Risk in Relation to Cardiac Sympathetic Denervation and Renal Dysfunction in Patients With Systolic Heart Failure
Background: In contrast to the well-known prognostic values of the cardiorenal linkage, it remains unclear whether impaired cognitive function affects cardiac prognosis in relation to cardiac sympathetic innervation and renal function in patients with heart failure (HF).Methods and Results: A total...
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| Published in | Circulation Journal Vol. 88; no. 9; pp. 1440 - 1449 |
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| Main Authors | , , , , , , , , , |
| Format | Journal Article |
| Language | English |
| Published |
Japan
The Japanese Circulation Society
23.08.2024
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| Abstract | Background: In contrast to the well-known prognostic values of the cardiorenal linkage, it remains unclear whether impaired cognitive function affects cardiac prognosis in relation to cardiac sympathetic innervation and renal function in patients with heart failure (HF).Methods and Results: A total of 433 consecutive HF patients with left ventricular ejection fraction (LVEF) <50% underwent the Mini-Mental State Examination (MMSE) and a neuropsychological test for screening of cognition impairment or subclinical dementia. Following metaiodobenzylguanidine (MIBG) scintigraphy, patient outcomes with a primary endpoint of lethal cardiac events (CEs) were evaluated for a mean period of 14.8 months. CEs were documented in 84 HF patients during follow-up. MMSE score, estimated glomerular filtration rate (eGFR) and standardized heart-to-mediastinum ratio of MIBG activity (sHMR) were significantly reduced in patients with CEs compared with patients without CEs. Furthermore, overall multivariate analysis revealed that these parameters were significant independent determinants of CEs. The cutoff values of MMSE score (<26), sHMR (<1.80) and eGFR (<47.0 mL/min/1.73 m2) determined by receiver operating characteristic (ROC) analysis successfully differentiated HF patients at more increased risk for CEs from other HF patients.Conclusions: Impairment of cognitive function is not only independently related to but also synergistically increases cardiac mortality risk in association with cardiac sympathetic function and renal function in patients with HF. |
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| AbstractList | In contrast to the well-known prognostic values of the cardiorenal linkage, it remains unclear whether impaired cognitive function affects cardiac prognosis in relation to cardiac sympathetic innervation and renal function in patients with heart failure (HF).Methods and Results: A total of 433 consecutive HF patients with left ventricular ejection fraction (LVEF) <50% underwent the Mini-Mental State Examination (MMSE) and a neuropsychological test for screening of cognition impairment or subclinical dementia. Following metaiodobenzylguanidine (MIBG) scintigraphy, patient outcomes with a primary endpoint of lethal cardiac events (CEs) were evaluated for a mean period of 14.8 months. CEs were documented in 84 HF patients during follow-up. MMSE score, estimated glomerular filtration rate (eGFR) and standardized heart-to-mediastinum ratio of MIBG activity (sHMR) were significantly reduced in patients with CEs compared with patients without CEs. Furthermore, overall multivariate analysis revealed that these parameters were significant independent determinants of CEs. The cutoff values of MMSE score (<26), sHMR (<1.80) and eGFR (<47.0 mL/min/1.73 m
) determined by receiver operating characteristic (ROC) analysis successfully differentiated HF patients at more increased risk for CEs from other HF patients.
Impairment of cognitive function is not only independently related to but also synergistically increases cardiac mortality risk in association with cardiac sympathetic function and renal function in patients with HF. Background: In contrast to the well-known prognostic values of the cardiorenal linkage, it remains unclear whether impaired cognitive function affects cardiac prognosis in relation to cardiac sympathetic innervation and renal function in patients with heart failure (HF).Methods and Results: A total of 433 consecutive HF patients with left ventricular ejection fraction (LVEF) <50% underwent the Mini-Mental State Examination (MMSE) and a neuropsychological test for screening of cognition impairment or subclinical dementia. Following metaiodobenzylguanidine (MIBG) scintigraphy, patient outcomes with a primary endpoint of lethal cardiac events (CEs) were evaluated for a mean period of 14.8 months. CEs were documented in 84 HF patients during follow-up. MMSE score, estimated glomerular filtration rate (eGFR) and standardized heart-to-mediastinum ratio of MIBG activity (sHMR) were significantly reduced in patients with CEs compared with patients without CEs. Furthermore, overall multivariate analysis revealed that these parameters were significant independent determinants of CEs. The cutoff values of MMSE score (<26), sHMR (<1.80) and eGFR (<47.0 mL/min/1.73 m2) determined by receiver operating characteristic (ROC) analysis successfully differentiated HF patients at more increased risk for CEs from other HF patients.Conclusions: Impairment of cognitive function is not only independently related to but also synergistically increases cardiac mortality risk in association with cardiac sympathetic function and renal function in patients with HF. In contrast to the well-known prognostic values of the cardiorenal linkage, it remains unclear whether impaired cognitive function affects cardiac prognosis in relation to cardiac sympathetic innervation and renal function in patients with heart failure (HF).BACKGROUNDIn contrast to the well-known prognostic values of the cardiorenal linkage, it remains unclear whether impaired cognitive function affects cardiac prognosis in relation to cardiac sympathetic innervation and renal function in patients with heart failure (HF).A total of 433 consecutive HF patients with left ventricular ejection fraction (LVEF) <50% underwent the Mini-Mental State Examination (MMSE) and a neuropsychological test for screening of cognition impairment or subclinical dementia. Following metaiodobenzylguanidine (MIBG) scintigraphy, patient outcomes with a primary endpoint of lethal cardiac events (CEs) were evaluated for a mean period of 14.8 months. CEs were documented in 84 HF patients during follow-up. MMSE score, estimated glomerular filtration rate (eGFR) and standardized heart-to-mediastinum ratio of MIBG activity (sHMR) were significantly reduced in patients with CEs compared with patients without CEs. Furthermore, overall multivariate analysis revealed that these parameters were significant independent determinants of CEs. The cutoff values of MMSE score (<26), sHMR (<1.80) and eGFR (<47.0 mL/min/1.73 m2) determined by receiver operating characteristic (ROC) analysis successfully differentiated HF patients at more increased risk for CEs from other HF patients.METHODS AND RESULTSA total of 433 consecutive HF patients with left ventricular ejection fraction (LVEF) <50% underwent the Mini-Mental State Examination (MMSE) and a neuropsychological test for screening of cognition impairment or subclinical dementia. Following metaiodobenzylguanidine (MIBG) scintigraphy, patient outcomes with a primary endpoint of lethal cardiac events (CEs) were evaluated for a mean period of 14.8 months. CEs were documented in 84 HF patients during follow-up. MMSE score, estimated glomerular filtration rate (eGFR) and standardized heart-to-mediastinum ratio of MIBG activity (sHMR) were significantly reduced in patients with CEs compared with patients without CEs. Furthermore, overall multivariate analysis revealed that these parameters were significant independent determinants of CEs. The cutoff values of MMSE score (<26), sHMR (<1.80) and eGFR (<47.0 mL/min/1.73 m2) determined by receiver operating characteristic (ROC) analysis successfully differentiated HF patients at more increased risk for CEs from other HF patients.Impairment of cognitive function is not only independently related to but also synergistically increases cardiac mortality risk in association with cardiac sympathetic function and renal function in patients with HF.CONCLUSIONSImpairment of cognitive function is not only independently related to but also synergistically increases cardiac mortality risk in association with cardiac sympathetic function and renal function in patients with HF. |
| ArticleNumber | CJ-24-0124 |
| Author | Nabuchi, Mirei Hatano, Ryosuke Nakata, Tomoaki Nagahara, Daigo Iwano, Hiroyuki Yuda, Satoshi Hashimoto, Akiyoshi Komuro, Kaoru Tsuzuki, Taro Doi, Takahiro |
| Author_xml | – sequence: 1 fullname: Nabuchi, Mirei organization: Department of Cardiology, Teine Keijinkai Hospita – sequence: 2 fullname: Doi, Takahiro organization: Department of Cardiology, Teine Keijinkai Hospita – sequence: 3 fullname: Hatano, Ryosuke organization: Department of Cardiology, Teine Keijinkai Hospita – sequence: 4 fullname: Tsuzuki, Taro organization: Department of Cardiology, Teine Keijinkai Hospita – sequence: 5 fullname: Komuro, Kaoru organization: Department of Cardiology, Teine Keijinkai Hospita – sequence: 6 fullname: Iwano, Hiroyuki organization: Department of Cardiology, Teine Keijinkai Hospita – sequence: 7 fullname: Nagahara, Daigo organization: Department of Cardiology, Teine Keijinkai Hospita – sequence: 8 fullname: Yuda, Satoshi organization: Department of Cardiology, Teine Keijinkai Hospita – sequence: 9 fullname: Hashimoto, Akiyoshi organization: Department of Cardiovascular, Renal and Metabolic Medicine, Sapporo Medical University Hospital – sequence: 10 fullname: Nakata, Tomoaki organization: Department of Cardiology, Hakodate Goryokaku Hospital |
| BackLink | https://www.ncbi.nlm.nih.gov/pubmed/38972736$$D View this record in MEDLINE/PubMed |
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| References_xml | – reference: 8. Ashton NJ, Moseby-Knappe M, Benedet AL, Grötschel L, Lantero-Rodriguez J, Karikari TK, et al. Alzheimer disease blood biomarkers in patients with out-of-hospital cardiac arrest. JAMA Neurol 2023; 80: 388–396. – reference: 14. Stocker H, Beyer L, Trares K, Perna L, Rujescu D, Holleczek B, et al. Association of kidney function with development of Alzheimer disease and other dementias and dementia-related blood biomarkers. JAMA Netw Open 2023; 6: e2252387. – reference: 15. Tanaka S, Okusa MD. Crosstalk between the nervous system and the kidney. Kidney Int 2020; 97: 466–476. – reference: 27. Ozono I, Ikawa F, Hidaka T, Yoshiyama M, Kuwabara M, Matsuda S, et al. Hypertension and advanced age increase the risk of cognitive impairment after mild traumatic brain injury: A registry-based study. World Neurosurg 2022; 162: e273–e280. – reference: 30. Chen Y, Cui P, Pan Y, Li Y. Use of the dementia assessment sheet for community-based integrated care system 21 items among Chinese community-dwelling older adults. Geriatr Gerontol Int 2021; 21: 705–711. – reference: 17. Villringer A, Laufs U. Heart failure, cognition, and brain damage. Eur Heart J 2021; 42: 1579–1581. – reference: 7. Stakos DA, Stamatelopoulos K, Bampatsias D, Sachse M, Zormpas E, Vlachogiannis NI, et al. The Alzheimer’s disease amyloid-beta hypothesis in cardiovascular aging and disease: JACC Focus Seminar. J Am Coll Cardiol 2020; 75: 952–967. – reference: 18. Tsoi KK, Chan JY, Hirai HW, Wong SY, Kwok TC. Cognitive tests to detect dementia: A systematic review and meta-analysis. JAMA Intern Med 2015; 175: 1450–1458. – reference: 6. Jefferson AL, Poppas A, Paul RH, Cohen RA. Systemic hypoperfusion is associated with executive dysfunction in geriatric cardiac patients. Neurobiol Aging 2007; 28: 477–483. – reference: 29. Fujiwara Y, Suzuki H, Yasunaga M, Sugiyama M, Ijuin M, Sakuma N, et al. Brief screening tool for mild cognitive impairment in older Japanese: Validation of the Japanese version of the Montreal Cognitive Assessment. Geriatr Gerontol Int 2010; 10: 225–232. – reference: 1. Kuller LH, Lopez OL, Mackey RH, Rosano C, Edmundowicz D, Becker JT, et al. Subclinical cardiovascular disease and death, dementia, and coronary heart disease in patients 80+ years. J Am Coll Cardiol 2016; 67: 1013–1022. – reference: 21. Jacobson AF, Senior R, Cerqueira MD, Wong ND, Thomas GS, Lopez VA, et al; ADMIRE-HF Investigators. Myocardial iodine-123 meta-iodobenzylguanidine imaging and cardiac events in heart failure: Results of the prospective ADMIRE-HF (AdreView Myocardial Imaging for Risk Evaluation in Heart Failure) study. J Am Coll Cardiol 2010; 55: 2212–2221. – reference: 12. Pulignano G, Del Sindaco D, Di Lenarda A, Tinti MD, Tarantini L, Cioffi G, et al. Chronic renal dysfunction and anaemia are associated with cognitive impairment in older patients with heart failure. 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| Snippet | Background: In contrast to the well-known prognostic values of the cardiorenal linkage, it remains unclear whether impaired cognitive function affects cardiac... In contrast to the well-known prognostic values of the cardiorenal linkage, it remains unclear whether impaired cognitive function affects cardiac prognosis in... |
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| SubjectTerms | Cardiac sympathetic denervation Cognitive function Renal dysfunction |
| Title | Impairment of Cognitive Function Increases Mortality Risk in Relation to Cardiac Sympathetic Denervation and Renal Dysfunction in Patients With Systolic Heart Failure |
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